Abstract
Aim:
To evaluate the mean cephalometric values for Steiner Analysis in bihar population.
Objectives:
To evaluate the cephalometric features of a bihar population and to present_an organized, comprehensive cephalometric norms for Steiner cephalometric analysis.. To introduce mean values to assess skeletal, dental and soft tissue relationship using Steiner analysis for orthodontic diagnosis.. To compare standards that will be derived with the earlier established norms for other population.
Materials and Methods:
The study was conducted in the Department of orthodontics and dentofacial orthopedics,Buddha Institute of Dental Sciences And Hospital,Patna(Bihar). The sample was collected from the out patient department of the same college.
Source of the Data:
The present analysis was made on lateral cephalograms of 60 subjects with well balanced and acceptable facial profile of Bihar population. The subjects were informed about the purpose of the study.
Methods of Collection of Data:
Subjects with age group of 18-26 years with dento-alveolar class I malocclusion and acceptable facial profile were selected by trained orthodontists, who belonged to the department of orthodontics and dentofacial orthopedics,Buddha Institute of Dental Sciences And Hospital.
Results and Conclusion:
There was increase in SNA angle, SNB angle, SND angle,in Bihar population than Caucasians. Bihar population has proclined and forwardly placed upper and lower incisors, which was indicative of bimaxillary protrusion as compared to Caucasians. Bihar population had protrusive upper and lower lips as compared to Caucasians. Bihar population males had tendency towards horizontal growth pattern of the mandible than females. Bihar females had more proclined lower incisors than males
KEYWORDS: Bihar population, cephalometric analysis, ethnic group, steiner
INTRODUCTION
Measurements of dental and skeletal variations in different population groups are important. It could determine the priority and the need of orthodontic modalities according to the severity of malocclusion and the available sources. It could be used to estimate the need of treatment in population and an orientation toward possible limitations in carrying out orthodontic protocol.[1,2,3,4]
The skeletal, dental as well as soft-tissue variations exist in different groups of population.[5,6] The cephalometric parameters of hard and soft tissue of one population cannot be applied to another group. Hence, it becomes necessary to understand the cephalometric norms for different groups of population. Thus, the present study was conducted to determine the cephalometric norms for Bihar population.
Aim
The aim of this study is to evaluate the mean cephalometric values for Steiner Analysis in Bihar population.,
Objectives
To evaluate the cephalometric features of a Bihar population and to present an organized, comprehensive cephalometric norms for Steiner cephalometric analysis
To introduce mean values to assess skeletal, dental, and soft tissue relationship using Steiner analysis for orthodontic diagnosis
To compare standards that will be derived with the earlier established norms for other population.
MATERIALS AND METHODS
The study was conducted in the Department of orthodontics and dentofacial orthopedics, Buddha Institute of Dental Sciences and Hospital, Patna (Bihar). The sample was collected from the outpatient department of the same college.
Source of the data
The present analysis was made on lateral cephalograms of 60 participants with well-balanced and acceptable facial profile of Bihar population. The participants were informed about the purpose of the study.
Methods of collection of data
Participants with age group of 18–26 years with dentoalveolar Class I malocclusion and acceptable facial profile were selected by trained orthodontists, who belonged to the Department of orthodontics and Dentofacial orthopedics, Buddha Institute of Dental Sciences and Hospital.
Following were the criteria for the selection of participants:
Participants should be of Bihar population
Acceptable and pleasing profiles
Class I molar relationship on both the sides, with normal overjet and overbite with minimal crowding or spacing
No history of previous orthodontic treatment
No missing teeth
Absence of gross facial asymmetry or deformity.
The radiographic apparatus used was VATECH, PAX 400 X-ray machine from the Department of Oral Medicine and Radiology, Buddha Institute of Dental Sciences and Hospital, Patna.
All lateral cephalometric radiographs were taken in centric occlusion with lips in relax and the Frankfort horizontal plane oriented horizontally according to natural head position.
For the tracing purpose, a 75 pm lacquered polyester paper was used along with a sharp 0.03 mm lead pencil. A protractor and a plastic scale were used to measure the lines and angles. A single operator performed the tracings in a standardized manner to avoid errors due to intraoperation variations. To check the operator's reliability and reproducibility, all lateral cephalograms were retraced by another operator.
RESULTS
Various skeletal, dental, and soft-tissue parameters (Steiner) were checked to establish the cephalometric norms of Bihar population.
To check the operator's reliability and reproducibility, sixty lateral cephalograms were selected and retraced by another operator. Statistically, there was no significant difference found in mean, standard of deviation, “t” value, and “P” value. It indicated that there was no significant intraexaminer variability found.
Steiner analysis
Comparison of Bihar population and Caucasian population
Table 1 and Graph 1 depict the comparison of Steiner analysis parameters between Bihar population and Caucasian population.
Table 1.
Comparative Statistical Analysis of cephalometric norms and present study (Bihar Population)
| Measurement | Caucasian Steiner’s Mean |
S.D | Bihar Population | S.D | t (df=53) | P | |
|---|---|---|---|---|---|---|---|
| 1 | <SNA° | 82 0 | ±3.2 | 83 | ±4.7 | 2.2 | P<0.05 |
| 2 | <SNB* | 80 0 | ±2.9 | 81 | ±3.7 | 2 | P>0.05 |
| 3 | <SND° | 76 0 | ±3.5 | 77 | ±3.8 | 1.8 | P>0.05 |
| 4 | <ANB° | 2 0 | ±1.9 | 2.7 | ±1.6 | 0.37 | P>0.05 |
| 5 | <SL | 51 | ±4.3 | 49.2 | ±5.6 | 1.9 | P>0.05 |
| 6 | <SN to Go Gn° | 32 0 | ±5.1 | 30.1 | ±5.9 | 0.5 | P>0.05 |
| 7 | To SN to Occl° | 14 0 | ±2.9 | 13.2 | ±5.6 | 0.89 | P>0.05 |
| 8 | 1 to NA (angle) | 22 0 | ±1.8 | 24.3 | ±7.1 | 1.6 | P>0.05 |
| 9 | 1 to NA (mm) | 4 mm | ±1.1 | 4.7 | ±2.5 | 0.7 | P>0.05 |
| 10 | 1 to N B (mm) | 4 mm | ±1.2 | 5.9 | ±2.1 | 0.09 | P>0.05 |
| 11 | 1 to N B (Angle) | 25° | ±4.1 | 30.3 | ±6 | 0.07 | P>0.05 |
| 12 | Pog to NB (mm) | 1 | ±0.8 | 0.7 | ±1 | 0.9 | P>0.01 |
| 13 | 1 to 1 (angle) | 131 | ±5 | 121 | ±8 | 0.9 | P>0.05 |
| 14 | SE | 22 | ±2.1 | 23 | ±1.2 | 1.8 | P>0.05 |
| 15 | S line to upper lip | 0 | ±2.2 | 1.5 | ±1.2 | 0.7 | P>0.05 |
| 16 | S line to lower lip | 0 | ±1.2 | 1.8 | ±1.7 | 1.6 | P>0.05 |
*P>0.05 (Non Significant), P<0.05 (Significant at 5% level), P<0.01 (Significant at 1% level)
Graph 1.
Comparative Statistical Analysis (t test) of Cephalometric norms in Bihar Population
There was a significant difference (P < 0.05) seen in SNA angle (83.1 ± 4.7), U1 to LI angle (121° ± 8°), and insignificant difference (P > 0.05) in SNB angle (81.0° ± 3.7°), SND angle (77° ± 3.6°), U1 to N-A angle (24.3° ± 7.1°), LI to N-B angle (30.3° ± 6°), and Go-Gn to SN (25.7° ± 6.3°).
Comparison of Bihar population (male) and Caucasian population
Table 2 and Graph 2 depict the comparison of Steiner analysis parameters between Bihar male and Caucasian population. There was highly significant difference seen in SNA angle (86.3° ± 5.3°), Go-Gn to SN (27.3° ± 5.3°), and LI to N-B (29.4 ± 5) in Bihar male than Caucasians (P < 0.01).
Table 2.
Comparative Statistical Analysis of cephalometric norms and Male subject (Bihar Population)
| Measurement | Caucasian Steiner’s Mean |
S.D | Male Bihar Population |
S.D | t (df=53) | P | |
|---|---|---|---|---|---|---|---|
| 1 | <SNA° | 82 0 | ±3.2 | 86.3 | ±5.3 | 1.8 | P<0.05 |
| 2 | <SNB* | 80 0 | ±2.9 | 82.3 | ±3.2 | 2 | P>0.05 |
| 3 | <SND° | 76 0 | ±3.5 | 79.2 | ±3.1 | 1.9 | P>0.05 |
| 4 | <ANB° | 2 0 | ±1.9 | 3.9 | ±2.7 | 0.35 | P>0.05 |
| 5 | <SL | 51 | ±4.3 | 57.7 | ±5.6 | 1.6 | P>0.05 |
| 6 | <SN to Go Gn° | 32 0 | ±5.1 | 31.2 | ±4.1 | 0.5 | P>0.05 |
| 7 | To SN to Occl° | 14 0 | ±2.9 | 14.92 | ±3.5 | 0.79 | P>0.05 |
| 8 | 1 to NA (angle) | 22 0 | ±1.8 | 22.2 | ±5.4 | 1.9 | P>0.05 |
| 9 | 1 to NA (mm) | 4 mm | ±1.1 | 4.7 | ±1.5 | 0.9 | P>0.05 |
| 10 | 1 to N B (mm) | 4 mm | ±1.2 | 5.9 | ±1.9 | 0.08 | P>0.05 |
| 11 | 1 to N B (Angle) | 25° | ±4.1 | 29.4 | ±5.09 | 0.07 | P>0.05 |
| 12 | Pog to NB (mm) | 1 | ±0.8 | 0.8 | ±1.3 | 0.8 | P>0.01 |
| 13 | 1 to 1 (angle) | 131 | ±5 | 123.8 | ±7.9 | 0.9 | P>0.05 |
| 14 | SE | 22 | ±2.1 | 21.3 | ±1.7 | 2 | P>0.05 |
| 15 | S line to upper lip | 0 | ±2.2 | 1.4 | ±1.4 | 1 | P>0.05 |
| 16 | S line to lower lip | 0 | ±1.2 | 1.3 | ±1.6 | 1.4 | P>0.05 |
*P>0.05 (Non Significant), P<0.05 (Significant at 5% level), P<0.01 (Significant at 1% level)
Graph 2.
Comparative Statistical Analysis (t test) of Cephalometric norms and Male Subject (Bihar Population)
No significant difference was seen in SNB Angle (82.3° ± 3.2°), ANB angle (3.9° ± 2.7°), occlusal plane to S-N angle (14.92° ± 3.5°), and LI to N-A angle (22.2°± 5.4°), LI to N-A (4.7 ± 1.5), LI to N-B (5.9 ± 1.9) in Bihar male than Caucasians, (P > 0.05)
Comparison of Bihar population (female) and Caucasian population
Table 3 and Graph 3 show high significant difference seen in SNA angle (83.02° ± 4.5°), Go-Gn to SN (26.79° ± 6.1°), LI to N-B (30.5 ± 6.6), and 1°–1° (122.5 ± 8.1) in Bihar male than Caucasians (P < 0.04). No significant difference was seen in SNB Angle (80.3° ± 3.9°), ANB angle (3.8° ± 2.2°), Occlusal plane to S-N angle (15.79± 3.3°) and LI to N-A angle (25.2 ± 7.4°), LI to N-A (5 ± 1.8), LI to N-B (6 ± 1.8) in Bihar male than Caucasians, (p > 0.032)
Table 3.
Comparative Statistical Analysis of cephalometric norms and Female subject (Bihar Population)
| Measurement | Caucasian Steiner’s Mean |
S.D | Female Bihar Population |
S.D | t (df=53) | P | |
|---|---|---|---|---|---|---|---|
| 1 | <SNA° | 82 0 | ±3.2 | 83.02 | ±4.5 | 2.2 | P<0.05 |
| 2 | <SNB* | 80 0 | ±2.9 | 80.12 | ±3.9 | 1.8 | P>0.05 |
| 3 | <SND° | 76 0 | ±3.5 | 76.69 | ±3.9 | 1.9 | P>0.05 |
| 4 | <ANB° | 2 0 | ±1.9 | 2.55 | ±1.7 | 0.6 | P>0.05 |
| 5 | <SL | 51 | ±4.3 | 54.6 | ±7.7 | 1.9 | P>0.05 |
| 6 | <SN to Go Gn° | 32 0 | ±5.1 | 30.6 | ±4.1 | 0.8 | P>0.05 |
| 7 | To SN to Occl° | 14 0 | ±2.9 | 15.79 | ±3.3 | 0.82 | P>0.05 |
| 8 | 1 to NA (angle) | 22 0 | ±1.8 | 25.29 | ±7.4 | 1.65 | P>0.05 |
| 9 | 1 to NA (mm) | 4 mm | ±1.1 | 5 | ±1.8 | 0.9 | P>0.05 |
| 10 | 1 to N B (mm) | 4 mm | ±1.2 | 6.01 | ±1.8 | 0.08 | P>0.05 |
| 11 | 1 to N B (Angle) | 25° | ±4.1 | 30.5 | ±6.6 | 0.09 | P>0.05 |
| 12 | Pog to NB (mm) | 1 | ±0.8 | 0.7 | ±0.8 | 0.8 | P>0.01 |
| 13 | 1 to 1 (angle) | 131 | ±5 | 122.5 | ±8.1 | 0.7 | P>0.05 |
| 14 | SE | 22 | ±2.1 | 20.2 | ±1.5 | 1.9 | P>0.05 |
| 15 | S line to upper lip | 0 | ±2.2 | 1.5 | ±1.5 | 1.1 | P>0.05 |
| 16 | S line to lower lip | 0 | ±1.2 | 1.4 | ±1.8 | 1.6 | P>0.05 |
*P>0.05 (Non Significant), P<0.05 (Significant at 5% level), P<0.01 (Significant at 1% level)
Graph 3.
Comparative Statistical Analysis (t test) of Cephalometric norms and Female Subject (Bihar Population)
DISCUSSION
Understanding of facial balance, proportions, and beauty is made simpler by recent trends in diagnosis and treatment planning by means of a combination of clinical facial analysis and hard- and soft-tissue cephalometries. The number of cephalometric studies done in India is lesser.[7,8] With the abovementioned background, this study was conducted to obtain Steiner Analysis cephalometric norms for Bihar population (India). The present study was focused on sixty samples of Bihar characterized by having normal occlusion and well-balanced faces. The adults were examined with age range of 18 to 26 years.
Steiner analysis
Comparison of Bihar population and Caucasian norms
SNA angle shows significant difference (P < 0.05); this finding is in well matched to study done on Chhattisgarh population by Saibel Farishta et al., 2011.[9] Interincisal (U1-L1) angle shows clinically significant difference (P < 0.05) in Bihar population (121° ±8°) with Caucasian norms (131° ±8°) which is well agreement with the finding done by Saibel Farishta et al., 2011. There was clinically insignificant difference (P > 0.05) in skeletal parameters SNB angle, ANB angle, and mandibular plane angle (Go-gn to SN) of Bihar population with Caucasian norms.
Comparison of Bihar (female) population and Caucasian
This study showed no significant differences in Steiner's (Skeletal and Dental) cephalometric parameters between Bihar (Female) and Caucasian population.
When skeletal cephalometric parameters were considered, there was no statistically significant difference was found for the angles such as SNB angle, ANB angle, SND angle, SN to Occl, 1-NA (A), and 1–NA (mm). Few parameters such as SNA angle and Go-gn to SN angle show little significant differences.
ANB angle showed no significant difference and this finding is in agreement with the findings of Rakesh Mohode et al., (2008)[10] 46 who had done study on Marathi population and also the findings observed by Harpreet Grewal et al. (1995) on Indo Aryans.[11] Occlusal plane to SN angle also showed no significant difference. The present study revealed that there was statistically significant increase in dental cephalometric parameters such as LI to N-B angle and LI to N-B distance.
The above finding is in agreement with the findings observed on Lucknow Hindus 5, Indo-Aryans 4, North and South Indians 3, and on Marathi 46, who have proclined as well as forwardly positioned upper and lower incisors.[10,12,13]
Comparison of Bihar (male) and Caucasian
This study showed no significant differences in Steiner's (skeletal and dental) cephalometric parameters between Bihar (Female) and Caucasian population.
When skeletal cephalometric parameters were considered, there was no statistically significant difference was found for the angles such as SNB angle, ANB angle, SND angle, SN to Occl, 1-NA (A), and 1–NA (mm). Few parameters such as SNA angle and Go-Gn to SN angle shows little significant differences.
ANB angle showed no significant difference, and this finding is in agreement with the findings of Rakesh Mohode et al. (2008),[10] who had done study on Marathi population and also the findings observed by Harpreet Grewal et al. (1995) on Indo Aryans.[11] Occlusal plane to SN angle also showed no significant difference. The present study revealed that there was statistically significant increase in dental cephalometric parameters such as LI to N-B angle and 1 to 1° angle.
The above finding is in agreement with the findings observed on Lucknow Hindus,[5] Indo-Aryans,[4] North and South Indians 3 and on Marathi, who have proclined as well as forwardly positioned upper and lower incisors.
CONCLUSION
There was an increase in SNA angle, SNB angle, and SND angle, in Bihar population than Caucasians
Bihar population has proclined and forwardly placed upper and lower incisors, which was indicative of bimaxillary protrusion as compared to Caucasians
Bihar population had protrusive upper and lower lips as compared to Caucasians
Bihar population males had tendency toward horizontal growth pattern of the mandible than females
Bihar females had more proclined lower incisors than males.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Showfety KJ, Wig PS, Matteson S. A simple method of taking natural head position. Am J Orthod. 1983;83(6):495–500. [PubMed] [Google Scholar]
- 2.Holdaway RA. A soft tissue cephalometric analysis and its use in orthodontic treatment planning part I. Am J Orthod. 1983;84(1):1–28. doi: 10.1016/0002-9416(83)90144-6. [DOI] [PubMed] [Google Scholar]
- 3.Haung WJ, Taylo RW, Dasanayake AP. Determining the cephalometric norms for Caucasians and African Americans in Birmingham. Angle Orthod. 1998;68(6):503–12. doi: 10.1043/0003-3219(1998)068<0503:DCNFCA>2.3.CO;2. [DOI] [PubMed] [Google Scholar]
- 4.Bacon W, Girardin P, Turlot JC. A comparison of cephalometric norms for the African Bantu and a Caucasoid population. Eur J Orthod. 1983;5:233–40. doi: 10.1093/ejo/5.3.233. [DOI] [PubMed] [Google Scholar]
- 5.Seddon RP. A cephalometric study of the Romano-British. Eur J Orthod. 1984;6:303–12. doi: 10.1093/ejo/6.4.303. [DOI] [PubMed] [Google Scholar]
- 6.Cooke MS, Wei SH. Cephalometric standards for the Southern Chinese. Eur J Orthod. 1988;10:264–72. doi: 10.1093/ejo/10.3.264. [DOI] [PubMed] [Google Scholar]
- 7.Sherman SL, Woods M, Nanda RS. The longitudinal effects of growth on the Wits appraisal. Am J Orthod. 1988;93:429–36. doi: 10.1016/0889-5406(88)90103-5. [DOI] [PubMed] [Google Scholar]
- 8.Al-Jasser NM. Cephalometric evaluation of craniofacial variation in normal Saudi population according to Steiner analysis. Saudi Med J. 2000;21(8):746–50. [PubMed] [Google Scholar]
- 9.Farishta S, Varma DP, Reddy KS, Chandra S, Nanda Z. Cephalometric Evaluation-based on Steiner's Analysis on Young Adults of Chhattisgarh, India. J Contemporary Dent Pract. 2011;12:174–8. [PubMed] [Google Scholar]
- 10.Mohode R, Betigiri A. An establishment of skeletal and soft tissue norms for Indian Marathi population and relating it with the perception of balanced profiles by lay person. J Ind Orthod. 2008;42:33–40. [Google Scholar]
- 11.Grewal H, Sidhu SS, Kharbanda OP. Cephalometric appraisal of the craniofacial pattern in Indo-Aryans. J Ind Orthod. 1995;26:43–8. [PubMed] [Google Scholar]
- 12.Nanda R, Nanda RS. Cephalometric study of the dentofacial complex of North Indians. Angle Orthod. 1969;39:22–8. doi: 10.1043/0003-3219(1969)039<0022:CSOTDC>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
- 13.Valiathan M, Valiathan A, Ravinder V. Jaraback cephalometric analysis reborn. J Ind Orthod. 2001;34:66–76. [Google Scholar]