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Savant Journals
2052-1480
Savant Journal of Medicine and Medical Sciences
Vol 1(1) pp. 014-021 June, 2015.
http://www.savantjournals.org/sjmms
Copyright © 2015 Savant Journals
Original Research Paper
Pattern of Malocclusion in a Sample of Orthodontic Patients from a
Hospital in the Kingdom of Saudi Arabia
Azzam Al-Jundi1*, and Hicham Riba2
1
Assistant Professor, Department of Orthodontics, College of Dentistry, King Saud bin Abdulaziz University for Health
Sciences, Riyadh, Saudi Arabia.
2
Assistant Professor, Department of Pedodontics, College of Dentistry, King Saud bin Abdulaziz University for Health
Sciences, Riyadh, Saudi Arabia.
th
Accepted 15 June, 2015.
Background: Malocclusion can present itself in numerous ways. It is present in every society, but the norms and pattern
vary. In order to correct occlusal disharmony, it is imperative to identify its pattern in the population so that proper
resources can be directed toward its diagnosis and treatment planning. The aim of this study was to determine of
skeletal and dental malocclusion in a sample of Saudi orthodontic patients. Material and Methods: To achieve this,
dentofacial characteristics of 510 patients from September 2013 to May 2015 were analyzed and tabulated. Both male
and female were included in this study. Different cephalometric values were used to evaluate the type of malocclusion.
Casts were analyzed to record the patient’s dental classification. Results: Molar Class II malocclusion was the most
frequent, whereas class III subdivision the least frequent. Statistically significant difference was observed in normal
overjet, overbite, crossbite, slight midline deviation, ANB, NL/ML, NSL/ML, according to gender and between the
hypodivergent and hyperdivergent groups, and between ANB, AOBO in the skeletal class I and class II group. Conclusion:
the results give a detailed pattern of malocclusion in orthodontic patients and may provide a baseline data for planning
orthodontic service. Class II Saudi patients have a higher motivation for orthodontic therapy. Statistically significant
difference was found between vertical and sagittal angles.
Keywords: Malocclusion, Dentofacial characteristics, Orthodontic patients.
INTRODUCTION
Malocclusion, defined as an improper relationship between
teeth in the opposite jaws, has been a prevalent disorder in
1
recent decades . The prevalence of malocclusion varies in
different parts of the world among different populations.
Knowledge about the distribution of different malocclusions
may help orthodontic practitioners in a better understanding of
the extent of malocclusion problem in a geographic location
and help them in the proper orientation and management of
2
treatment possibilities .
There have been several studies investigating the
prevalence of various dento-facial characteristics, but only a
3-6
few have been conducted on an orthodontic population . In
Saudi Arabia, a few studies have evaluated the prevalence and
7,8
distribution of skeletal and dental malocclusion
. Only a
limited number of these studies have reported the distribution
of the different malocclusion features in Saudi patients
attending orthodontic treatment. The subject of distinguishing
clearly between skeletal and dental malocclusions was hardly
9
studied .
The literature review concerning the prevalence of
malocclusion had shown that several factors could be
considered to have roles in the patterns of malocclusion in
different populations. These contributing factors include: the
time of the study, geographic and topographic areas, and the
10
age and gender of the population studied .
Methods of recording and measuring malocclusion could
be broadly divided into two types: qualitative (Angle
classification), and quantitative (overjet and overbite). Among
the qualitative methods of recording malocclusion, Angle’s
method of classifying malocclusion, with or without
3, 4
modifications, was probably the most widely used . ANB
11
angle described by Downs , and Wits analysis described by
12
Jacobson have been proposed in the assessment of an
antero-posterior jaw base relationship.
*Corresponding Author: Azzam Al-Jundi: Assistant Professor of Orthodontics, King Saud Bin Abdul Aziz University for Health
Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail: [email protected] Tel : +966549933916
Al-Jundi et al
Savant. J. Med. Med. Sci.
However, each of the methods described exhibits its own
inherent weakness based on the variability of factors other
13
than the jaw relationship itself .
AIMS OF THE STUDY
This study was done to describe malocclusion Pattern among
patients who presented for treatment at orthodontic clinics at
King Abdul Aziz Medical City, National Guard Health Affairs,
Riyadh, Kingdom of Saudi Arabia. This study attempted to
achieve the following aims:
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Incisor relationship: (Measured by metal ruler)
Overjet, the distance between the edge of upper central incisor
and the labial surface of the lower central incisor, was
measured in millimeters. The over jet between 0 and 4 mm
were considered normal. Greater than 4 mm was considered
increased. Over 8 mm was considered exaggerated. Anterior
cross bite “negative over jet” < 0 mm was recorded when one
or more upper incisor teeth were palatal to the lower incisor
14, 15
teeth
Cephalometric variables
-
-
To determine the pattern of skeletal and dental
malocclusions using ANB angle, Wits analysis, and
angle classification in a sample of Saudi orthodontic
patients.
To compare the results of this study with that of other
data reported in different populations
The radiographic lateral cephalograms used were taken
according to the conventional norm.
All cephalograms were taken by the same radiographic
apparatus:
MATERIAL AND METHODS
Planmeca panorax 3Ds/3D
Planmeca OY/A Sentajankatu 6/00800 Helsinki/Finland
Pre-treatment dental casts and lateral cephalometric
radiographs were obtained randomly after searching through
2400 files from the archive of orthodontic clinic at King Abdul
Aziz Medical City, National Guard Health Affairs, Riyadh,
Kingdom of Saudi Arabia. The selection criteria were based on
the followings:
Cephalometric landmarks were marked and digitized by one
examiner to avoid inter-observer variability. Angular and linear
variables were established and measured using Dolphin imaging
10.0 software (Dolphin imaging and management solutions,
Chats worth, California) by one examiner, and the following
measurements were obtained:



All subjects shall be of Saudi descent in permanent
dentition
Available pre-treatment dental casts (neatly trimmed
with no broken teeth) and lateral cephalometric
radiographs.
Patients with syndromes, severe medical histories,
and developmental anomalies such as ectodermal
dysplasia, cleft lip and palate, Down syndrome,
extractions of any permanent teeth, history of
previous
orthodontic
treatment,
prosthodontic
treatment, or trauma to any tooth before the
commencement of orthodontic treatment were
excluded.
Five hundred and ten (510) Saudi patients who fulfilled the
inclusion criteria formed the sample of the present study. Data
was obtained from study models and cephalometric analysis
during the period of September 2013 to May 2015.
Criteria of examination
Antero-posterior dimension
Angle classification: (study cast evaluation)
One examiner assessed the molar relationship (anteroposterior dental arch relationship) on the basis of Angle’s
definition. Molar class I was defined as occurring where the
mesio-buccal cusp of the upper first molar occluded with the
mesio-buccal groove of the lower first molar. Class I, class II
Div. 1, class II Div. 2, class II subdivision, class III and class III
subdivision were also evaluated. Asymmetry was designated
by the subdivision: class I on one side and class II on the other
side, or class I on one side and class III on the other side.
Patients with class II on one side and class III on the other side
were excluded
ANB angle
A cephalometric angular measurement of the antero-Posterior
relationship of the maxilla with the mandible. The skeletal pattern
was often determined cephalometrically by comparing the
relationship of the maxilla and mandible with the cranial base by
means of angles SNA and SNB. The difference between those two
measurements was the ANB angle.
Subjects were classified into different skeletal malocclusion
groups based on the following criteria:
ANB angle
16-17
- Skeletal class I: 0° to 4°
- Skeletal class II: > 4°
- Skeletal class III: < 0°
Wits appraisal: AoBo
A cephalometric linear measurement compares the
relationship of the maxilla and mandible with the occlusal
12
plan . Since that all the cephalometric radiographs were taken
from the same source, correction for the magnification factor
was not considered during measurement of Wits appraisal.
12
The following ranges of the skeletal classes were defined :
- Skeletal class I: -3 to +7 mm
-Skeletal class II: > +7 mm
-Skeletal class III: < -3 mm.
Vertical dimension
Incisor relationship (overbite)
Overbite is the perpendicular distance from the edge of the
central lower incisor to the upper central incisor edge. Normal
overbite 50% height: half or less than the lower central incisor
is covered by the upper central incisor.
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Al-Jundi et al
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Overbite > 50% height: more than half of the lower central is
covered by the upper central incisor but less than the total
crown. Total overbite of incisors 100% height; mandibular
incisors are in contact with palatal mucosa. Overbite was
measured in millimeters and considered as normal between 0
and 4 mm. Greater than 4 mm was considered as deep bite.
18
Less than 0 mm was considered as an open bite .
Cephalometric variable
-FMA (22°-28°): angle between FH plan and mandibular plan.
-NL/ML (25°-31°): angle between palatal plan and mandibular
plan
-NSL/ML (29°-35°): angle between SN plan and mandibular
19
plan .
Transverse dimension
Posterior crossbite
Included teeth in an edge-to-edge position unilateral cross-bite
when one or more lower posterior teeth distal to the lateral
incisor were placed buccal to the upper posterior teeth at
maximum inter-cuspation in one side, while bilateral cross-bite
20
in both sides .
Non occlusion bite: (Scissor bite)
One or more lower posterior teeth in any quadrant distal to the
lateral incisor were lingually placed with respect to upper
posterior teeth at maximum inter-cuspation.
Midline deviation
Shifting of the midline of the upper or lower teeth from the
facial
Midline at centric occlusion
-Slight: 0-2 mm
-Medium: >2 - 5 mm
-High: >5 mm.
Statistical Analysis
Data were evaluated using statistical package. Software
system, version 13 (SPSS 13.0) and the following tests were
used:
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Method error (Intra-examiner reliability test results)
The error of the method was determined by repeating the
evaluations and measurements of 20 lateral cephalometric
radiographs and their 20 pairs of study casts that were
randomly selected from the sample within two-week interval to
ensure acceptable intra-examiner reliability. All investigations
were made by the same examiner.
Paired t-test was used to determine intra-examiner
measurement error between the first and second
measurements of ANB and Wits appraisal. No statistical
significance differences were observed between the first and
second reading of ANB and Wits using paired t-test (P> 0.05),
Table (1). Table (2) shows the coefficient of reliability (0.970)
and the coefficient of correlation (0.942) for both ANB and Wits
was significant. Kappa statistics were calculated to determine
the reliability of molar relation. Kappa score of 1 indicates
perfect agreement between the first and second evaluations,
was observed.
RESULTS
Two thousand and four hundred case records at the
orthodontic clinic at King Abdul Aziz Medical City, National
Guard Health Affairs, Riyadh were searched, and five hundred
and ten 510 were selected according to the inclusion criteria
previously specified. Of these, 312 were female and 198 were
male.
Malocclusion types (Table 3)
Class I malocclusion was found in 119 patients, which
represented 23.3% of the total sample. Class II malocclusion
(division 1 and 2) was diagnosed in 244 which represented
47.84% of the total sample. Class III malocclusion group
consisted of 38 individuals, which represented 7.45% of the
total sample. Class II subdivision was found in 98 patients,
which represented 19.22%, and class III subdivision was found
in 11 patients, which represented 2.16%.
No significant difference in the distribution of malocclusion
according to Angle classification between genders was found.
Association of the molar classes across gender was studied
using Chi-Square test, the results showed that there was no
statistically significant association (P = 0.554) between the
different classes of molar relationships and gender.
Occlusal relationship in the antero-posterior dimension
Distribution of overjet. (Table 4)
-
-
-
Descriptive statistics for the distribution of occlusal
traits of the total sample were presented using
frequencies and percentages.
Chi-Square test was used to evaluate an association
between some variables (Angle classification, over jet,
overbite, cross bite, midline deviation) and gender.
Cephalometric variables in each sagittal (ANB and
AoBo) and vertical dimension (FMA, NL/ML and
NSL/ML) separately, were evaluated and assessed
using Chi-Square test.
Independent student t-test was used for comparing
the distribution of cephalometric variables (SNA, SNB,
ANB, AoBo, FMA, NL/ML and NSL/ML) between
males and females.
The alpha level was set at 0.05.
46.47% of the total sample had an over jet between 0 to 4 mm,
which could be regarded as normal antero-posterior incisor
relationship, and was the most prevalent. 5.69% had 0 mm
over jet, 5.49 had reversed anterior over jet, 29.80% had a
greater over jet between 5 and 8 mm, and 12.55% had an over
jet greater than 8 mm. A significant difference in the over jet
distribution between male and female was found in the normal
group (0 -4 mm); the female group was the most prevalent
(29.41%).
Distribution of skeletal malocclusion using ANB angle and
AoBo measurement. (Table 5)
Table 5 shows the distribution of skeletal classes using ANB
angle among the sample.
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Table (1): Error of the mode for the first and second reading of ANB and Wits by paired t-test
Variables
ANB and Wits
t-value
0.817
p-value
0.419
Table (2): The intra examiner error of 20 repeated measurements for angular and linear variables evaluated by coefficient of reliability
and Pearson’s correlation
Variables
ANB and Wits
coefficient of reliability
0.970
coefficient of correlation
0.942
Table (3): Distribution of malocclusion types according to Angle and gender
Angle classification
Male
Female
Class I
48
9.41%
71
13.92%
Class II
96
18.82%
148
29.02%
Class II sub
33
6.47%
65
12.75%
Class III
18
3.53%
20
3.92%
Class III sub
3
0.59%
8
1.57%
Total
198
38.82%
312
61.18%
Statistical comparison could not be done because of the small size of the sample
N.S. Non-significant group differences.
Total
119
244
98
38
11
510
23.33%
47.84%
19.22%
7.45%
2.16%
100%
0.90 NS
0.06 NS
066 NS
Table (4): Distribution of overjet according to gender
Over jet (mm)
Male
Female
<0 mm
15
2.94%
13
2.55%
0 mm
10
1.96%
19
3.73%
0-4 mm
87
17.06%
150
29.41%
>4 - 8 mm
60
11.76%
92
18.04%
>8 mm
26
5.10%
38
7.45%
Total
198
38.82%
312
61.18%
Statistical comparison could not be done because of the small size of the sample
*Significant group differences P < o.o5.
N.S. Non-significant group differences.
Total
28
29
237
152
64
510
5.49%
5.69%
46.47%
29.80%
12.55%
100%
P Value
+
+
0.05*
0.22 NS
0.92 NS
Table (5): Distribution of ANB and AoBo
ANB
N
%
Skeletal
Malocclusion
Class III
<0
45
8.82
Class I
0-4
256
50.20
Class II
>4
209
40.98
Total
510
100
N.S. Non-significant group differences.
*Significant group differences P < 0.05
AoBo
Class III
Class I
Class II
Total
The majority 50.20% had class I skeletal class. 40.98% had
class II skeletal class relation, and 8.82% had class III
relationship.
Table 5 shows that 82.94% had class I skeletal relation using
AoBo measurement, (Wits appraisal), 11.96% had skeletal
class III and 5.10% had class II skeletal relationship. A
significant difference was noted between the two
cephalometric measurements, angle ANB and AoBo
measurement representing the sagittal relation between upper
and lower jaws among the normal class I, ANB (0-4 degree),
AoBo (-3 to +7 mm) and skeletal class II distal group ANB> 4°,
Ao Bo> +7 mm.
N
61
423
26
510
%
11.96
82.94
5.10
100
Chi-Square
P
0.79 NS
<0.005****
0.002***
Occlusal relation in the vertical dimension
Distribution of overbite (Table 6)
Normal overbite (50% crown height) was displayed by 48.03%
of patients followed by 37.84% representing the overbite group
(>50% crown height). Overbite (0-0.5 mm) accounted for
5.30%, deep over-bite (100% crown height) represented for
4.32%. Open bite < 0 mm represented 4.51%. A significant
difference in overbite distribution between male and female
was found in the normal group. (50% crown height), female
group had the higher percentage (31.96).
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Table (6): Overbite distribution according to gender
Overbite
Male
Female
<0 mm
11
2.16%
12
2.35%
0 mm
11
2.16%
16
3.14%
50% h
82
16.07%
163
31.96%
>50% h
79
15.49%
114
22.35%
100% h
15
2.94%
7
1.38%
Total
198
38.82%
312
61.18%
+ Statistical comparison could not be done because of the small size of the sample.
*Significant group differences P < 0.05
N.S. Non-significant group differences.
Total
23
27
245
193
22
510
P Value
+
+
0.0063 ****
0.18 NS
4.51%
5.30%
48.03%
37.84%
4.32%
100%
Table (7): Distribution of vertical angle FMA, NL/ML/NSL/ML
Vertical Analysis
Hypo divergent
Normal divergent
Hyper divergent
N
158
234
118
FMA
%
30.98
45.88
23.14
N
219
203
88
NL/ML
%
42.94
39.80
17.26
N
87
202
221
NSL/ML
%
17.06
39.61
43.33
Total
510
100
510
100
510
100
Chi-Square P
0.0003 ****
0.38 NS
0.00005*****
*Significant group differences P < 0.05 .
N.S. Non-significant group differences.
Table (8): Cross bite distribution according to gender
Crossbite
Male
Female
No crossbite
150
29.41%
254
49.81%
Unilateral Crossbite
36
7.06%
48
9.41%
Bilateral Crossbite
12
2.35%
10
1.96%
Total
198
38.82%
312
61.18%
Statistical comparison could not be done because of the small size of the sample.
*Significant group differences P < 0.05.
N.S. Non-significant group differences.
Total
404
84
22
510
79.22%
16.47%
4.31%
100%
P Value
0.00014 ****
0.86 NS
Table (9): Distribution of midline deviation according to gender
Midline Deviation
Male
Female
0-2 mm
136
26.67%
234
45.89%
>2-5 mm
55
10.78%
70
13.72%
>5 mm
7
1.37%
8
1.57%
Total
198
38.82%
312
61.18%
Statistical comparison could not be done because of the small size of the sample.
*Significant group differences P < 0.05.
N. S. Non-significant group differences.
Total
370
125
15
510
72.56%
24.50%
2.94%
100%
P Value
0.00043 ****
0.52 NS
+
Table (10): Distribution of cephalometric variables according to gender
Angles
Male
Average
SNA
SNB
ANB
AOBO
FMA
NL/ ML
NSL/ ML
80.5
76.73
3.36
1.7
24.02
25.22
33.82
S.D.
3.67
5.56
3.83
4.52
6.08
6.37
6.63
Female
Average
80.45
76.96
3.83
1.33
24.5
25.81
34.97
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S.D.
3.58
3.66
2.75
3.77
5.86
6.71
6.71
Gender
P value
O.8 NS
0.85 NS
0.0068 ***
0.08 NS
0.054*
0.025 *
0.000017*****
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Distribution and comparison of angles of the vertical
dimension: FMA, NL/ML (Table 7)
The vertical dimension divided into three groups (hypo
divergent, normo divergent and hyper divergent) was
described by three main angles: FMA, NL/ML, and NSL/ML.
FMA revealed the highest prevalence 45.88% for the normodivergent group, NL/ML (42.94%) for the hypo divergent group,
and NSL/ML (43.33%) for the hyper divergent group. A
significant difference was found between these angles in the
hypo and hyperdivergent groups, and no significant difference
in the normo-divergent group.
Occlusal relationship in transverse dimension
Distribution of crossbite (Table 8)
Unilateral crossbite in 16.47% and bilateral crossbite in 4.31%
were found in the total sample. The frequency of the normal
group with no crossbite was the highest (79.22%). No
statistically significant difference between male and female for
the unilateral and bilateral crossbite group was noted except
for the normal group, where female had the highest frequency
49.81%.
Distribution of midline deviation (Table 9)
The frequency of midline deviation was higher in the slight
midline deviation (0-2 mm) group (72.56%), followed by
(24.50%) for the (>2 - 5 mm) group, and (2.94%) for the great
(>5 mm) group. A statistical difference was found in the slight
midline deviation (0-2 mm) group between male (26.67%) and
female (45.89%).
Distribution of cephalometric variables according to
gender (Table 10)
Among the angles of sagittal dimension (SNA, SNB, ANB,
AoBo) only ANB angle revealed a statistical difference
between male and female, (P = 0.0068), while the angles of
vertical dimension as FMA is tangentially statistically significant
(P = 0.054), NL/ML (P = 0.025) and NSL/ML (P = 0.000017)
are highly statistically significant.
DISCUSSION
The results of the study will supplement existing orthodontic
literature since it reports data about the prevalence of dental
and skeletal malocclusion. It provides clinicians with an
understanding of the most common types of malocclusion
among Saudi orthodontic patients. Although many studies
have been published and described the prevalence and type of
malocclusion, there were some variability between their
findings and ours due to the varying methods and indices used
to assess and record occlusal relationships, age differences of
the study populations, examiner subjectivity, specific objectives
3,9,10,21,22
and different sample sizes
,.
Our results showed that the most common type of
malocclusion was Angle class II which represents (47.84%) of
the sample. The frequency of class I was (23.33%), class III
malocclusion was observed in (7.45%), class II subdivision
(19.22%) and class III subdivision (2.16%).
The population of this study is similar to that found in other
surveys of orthodontic patients in terms of gender distribution
14,23,24,25
and prevalence of molar relationship
,. However, in
| 019
view of the biased nature of the sample, the data of this
orthodontic population cannot be extrapolated to the whole of
the Saudi population. This might be because our sample was
selected from patients seeking orthodontic treatment and those
individuals tend to present with class II and class III molar
relation more than the general population.
Angle’s class II was the most frequent pattern of
malocclusion found in our sample. Similar findings were
observed by Geglor et al, Gul-e-Erumand Fida.,
14,23,24,25,
Ijaz A, Hameed et al.
On the contrary, the study of Aldress, Al-Balkhi and
9,10,22,.
AlZahrani, AlKawari found different findings
International literature reported class II malocclusion as
more frequent than class I and III malocclusions in Asian
26
men .
The type of malocclusion is an important factor that reflects
patient’s motivation to seek orthodontic treatment. Wilmont et
al reported that patients with severe sagittal class II
malocclusion had a higher motivation for orthodontic treatment
27
than class III patients .
Jones investigated malocclusion and facial type in 132
Saudi Arabian patients referred for orthodontic treatment, and
reported that 55.8% had class I, 28.8% had class II division 1,
4.5% had class II division 2, and 12.9% had class III
malocclusion. However, these results don’t represent the
prevalence of malocclusion in a referred Saudi Arabian
28
population because of the insufficient sample size .
Yang evaluated 3305 patients who visited the orthodontic
department at Seoul National University Hospital from 1985 to
1989. He reported that the percentages of class I, class II
division 1, class II division 2, and class III were 35.9%, 13.4%,
1.5% and 49.1% respectively. The higher reported frequency
of class III malocclusion is noticeable and may be attributed to
29
the ethnic differences .
Several genetic and environmental interacting factors are
known to be related to the etiology of malocclusion, soft tissue,
mouth breathing, tongue thrusting, sleeping posture, sucking
and other habits, as well as specific factors, such as skeletal
growth disturbances, muscle dysfunction and disturbances in
embryologic and dental development interact with heredity in
the development of major types of malocclusion, as well as
30
differences in racial and ethnic composition .
The confusing meaning of subdivision has resulted in a
disparity in the classification of a unilateral malocclusion. Angle
says that a subdivision is the occurrence of a unilateral
malocclusion whereby one side is normal and the other is
abnormal, he neglects to specify whether the subdivision is the
31
normal or the abnormal side . As a result, orthodontists in the
United States cannot agree on the meaning of a class II
Division 1, subdivision malocclusion and made did a research
project by surveying 34 chairpersons of the United States
orthodontic departments to determine their view points and
32
ascertain the criteria on which they base them .
They naturally form a point of view based on an
assessment of the replies. Subdivision would refer to the
defective side in the Class I malocclusion. We have supported
this opinion and found in this study % of Class II subdivision
and % of Class III subdivision, this probably had reduced Class
I from % to %.
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-
Angle’s classification has been the topic of many
discussions in the literature. It is limited and does not
incorporate vertical and transverse abnormalities.
This method has been used in this study because it is
a universally accepted and reliable system that is
Al-Jundi et al
Savant. J. Med. Med. Sci.
repeatable and minimizes the examiner’s subjectivity
-
33.
-
-
-
Analyzing incisor segments in both sagittal and
vertical dimensions revealed the highest percentages
in normal groups where overjet was between 0 and 4
mm 46.47% and 50% crown height was displayed in
48.03%.
A statistically significant difference in the overjet,
overbite and transverse distribution according to
gender in the normal groups was found.
The highest percentages characterized females. For
overjet 29.41%, overbite 31.96% and transverse
dimension without cross bite 49.81% and minor
midline deviation 45.89%.
Our results showed that the most common type of
skeletal malocclusion determined by angular
measurement (ANB) was skeletal Class I followed by
Class II then Class III.
These results were in agreement with Jones who
found that the most common skeletal malocclusion
among 132 Saudi orthodontic patients was Class I
(46.4%) followed by Class II (27.5%) and Class III
28
(26.1%) .
Higher percentages of Class III cases reported by
Jones might be the result of examining a small
28
sample size that tends to be less representative .
Our results followed the pattern reported by Farawana
who found that Class I skeletal relationship was
predominant in the Iraqi population (74.5%), while
34
class II consisted 15% and 10% were class III .
Our results revealed that the most common type of
skeletal malocclusion using Wits appraisal was Class
I (82.94%) followed by Class III (11.96%) and Class II
(5.10%).
-Bishara et al described changes in sagittal jaw
relationship, comparing the ANB angle and Wits
method that the interpretation of the results of the two
forms of analysis is dependent on the geometrical
errors inherent in the two methods, they also
suggested that the vertical development of the face
35
will alter the value of the ANB angle .
-Evaluation of the sagittal jaw relationship can be
expressed either as an angle or as a linear
measurement. While angular analysis will include
variation due to facial height, jaw prognathism and
jaw inclination, the Wits appraisal is very sensitive to
36,37,.
changes in the inclination of occlusal plane
Al-Jasser reported that Saudi male and female have
long lower anterior facial height and increased
mandibular plan angle. When skeletal Class I and
Class III determined by ANB and Wits were
evaluated, 51.6% of the cases were Class I and
8.14% were Class III according to ANB, while 27.24%
were Class I and 35.5% were Class III using Wits
38
appraisal .
The downward and backward rotation of the mandible
might explain why some of the cases which
diagnosed as skeletal Class I with ANB
measurement, they were actually Class III with
rotated mandible that masked the true skeletal
relationship. The same argument can be used to
explain the classification of skeletal Class II
relationship. The downward and backward rotation of
the mandible made the diagnosis of some cases lean
toward Class II according to ANB, however, Wits
appraisal showed that these cases were Class I.
-
-
-
| 020
When evaluating severity of antero-posterior Jaw
disharmony. The jaws must of necessity be related to
each other and neither to cranial and extra cranial
landmarks.
Relation of jaws in the antero-posterior dimension
described by two measurements ANB and Wits
appraisal AoBo revealed a significant difference in the
Class I normal ANB (0-4 degree), AoBo (-3 to +7 mm)
group and Class II distal group ANB> 4 degree,
AoBo> +7 mm.
Our results revealed that the Wits appraisal provides
a reliable indication of the extent or severity of anteroposterior skeletal disharmony of the jaw. This was
also confirmed by Jacobson when ANB is 7 degree in
each instance of Class II malocclusion and Class I
normal occlusion, the Wits appraisal whereas the
reading for the Class I normal occlusion is 0 mm.
The relation of jaws in the vertical dimension referred
to three angles FMA, NL/ML, and NSL/ML revealed
no correlation between them, although a significant
39
difference exists according to gender .
Our results showed no gender differences in the
distribution of the molar relationship, this was in
agreement with most of the previous studies, but in
disagreement with the findings of El-Mangoury and
Moustafa who found that normal occlusion and Angle
Class I relationship were more common in female.
40
While Angle Class III was common in male .
This might be due to racial and ethnic differences.
CONCLUSION
In this present retrospective study, the following conclusions
can be drawn:
-
The most common type of molar relation was Class II
followed by Class I relation and the least was Class III
malocclusion.
Using the angular measurement (ANB) the most
common type of skeletal malocclusion was skeletal
Class I followed by Class II, then Class III
The most common skeletal malocclusion determined
by Wits appraisal was Class I, followed by class III,
and the least was Class II.
No correlation in vertical seemed between FMA,
NL/ML and NSL/ML.
In Saudi orthodontic patients, the pattern of dental
and skeletal malocclusion differs based on the
variability of the methods used to assess the anteroposterior jaw-based relationship.
The epidemiological data on the prevalence of malocclusion is
an important determinant in planning appropriate levels of
orthodontic services and further studies are required to provide
accurate estimates of the orthodontic treatment need in Saudi
population.
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