Abstract
Aim:
To evaluate cephalometric parameters of orthodontic population in an urban setup in Odisha using Steiner's, Tweed's and Rakosi's analysis and compare it with the established Caucasian norms.
Methodology:
Pre-treatment patient records from a dental hospital were collected. Lateral cephalograms of the normal and supernormal sample were traced. Cephalometric features relating to various facial hard tissue that determine balance and harmony were measured using Steiner's, Tweed's and Rakosi's analysis. The values obtained were compared with the established Caucasian norms. Comparison of mean values were done via independent sample t test and ANOVA. Subsequently post hoc Tukey's was used to establish the significance of the mean difference of all the variables used.
Results:
Significant differences were obtained for lower incisor to NB, mandibular plane angle, FMA, FMIA, articular angle, basal plane angle, inclination angle, Rakosi Jarabak ratio and interincisal angle.
Conclusion:
Fundamental variations were seen in various parameters. Perception of lay persons can be of aid to the clinician in assembling commendations for alternative treatment plans.
KEYWORDS: Lateral cephalogram, perception of lay persons, Rakosi analysis, Steiner analysis, Tweed analysis
INTRODUCTION
The basis of orthodontics is based on orthodontist testing and cognitive esthetics. Proper diagnosis can provide important information on clinical decisions that influence the outcome of various malocclusions. Cephalometric analysis is utilized to determine treatment to get better and craniofacial growth, predict individual patient growth and other orthodontic studies. Cephalometric practices of various groups of people namely Japanese,[1,2] White Americans,[3,4,5] Chinese,[6,7] Aborigines of Australia,[8,9] Swedes,[10] Africans,[11] Hawaiians,[12] and Canadians have been established.[13] Dentists consider a good closure and a straight profile to be a beauty treat. It is also important to consider and understand the concept of the beauty of a non-dental professional in addition to discriminating against the beauty of the dentist. The concept of beauty differs from human to human as it is prejudiced by proficiency and social environment. It is for this pretext that both patient expectations and expert opinions regarding facial beauty tests may be inconsistent. With this perspective in mind, the current trial was devised to discover the principles of orthodontic population in a city built in Odisha while taking into account a person's insignificant view of a pleasing facial profile.
MATERIALS AND METHODS
Pre-treatment patient records from 1 January 2016 to 1 January 2018, available in the Department of Orthodontics and Dentofacial Orthopedics, KIDS, were collected. Facial profile photographs that fulfilled the inclusion criteria were selected from the pre-treatment records. Inclusion criteria included good quality cephalometric records, bilateral Class I molar relationship, normal overjet and overbite with no or minimal crowding or spacing. Exclusion criteria included cases with history of previous orthodontic treatment, presence of gross abnormality or severe crowding, missing teeth except third molars and presence of gross facial asymmetry or deformity. Using Adobe Photoshop, the photographs were darkened and trimmed to obtain a black profile over the white background extending from most prominent point over forehead to superior cervical crease. These profiles were systematized to minimalize the upshot of other facial features such as hair styles, makeup etc.[14,15] A panel of 10 judges who were not artists, dentists, medical professionals or their personnel, were selected to evaluate the prepared profiles [Figure 1]. This panel evaluated the collected profile photographs projected on the screen for a duration of 10 seconds. Each profile was evaluated as the following: very pleasant (5 points), pleasant (4 points), average (3 points), below average (2 points) and unpleasant (1 point). The score for each profile was then evaluated and analyzed for all the 10 judges. Only profiles that scored more than 44 points were included as the part of supernormal sample.[14] Lateral cephalograms of the normal and supernormal sample were traced on transparent cellulose acetate sheet of 36 μm thickness using a 0.03 mm lead pencil [Figure 2]. Cephalometric features relating to various facial hard-tissue that determine balance and harmony were measured using Steiner's, Tweed's and Rakosi's analysis. The values obtained were compared with the established Caucasian norms. Total sample of orthodontic population in an urban setup in Odisha were also compared with established Caucasian norms.
Figure 1.
To evaluate profiles
Figure 2.
Manual tracing of lateral cephalogram
RESULTS
Data on 100 samples of Angle's class I malocclusion cases in the age range of 18–25 years were analyzed using SPSS v. 20. Comparisons of means were done by independent sample t test and ANOVA. Subsequently post hoc Tukey's was used to establish the significance of the mean difference of all the variables used. Table 1 shows the comparison of various cephalometric parameters of Rakosi's analysis in Super normal and Caucasian populations. Comparison of various cephalometric parameters of Steiner's analysis in super normal and Caucasian populations is depicted in Table 2. Comparison of various cephalometric parameters of Tweed's analysis in super normal and Caucasian populations is presented in Table 2.
Table 1.
Comparison of various cephalometric parameters of Rakosi’s analysis in super normal and Caucasian populations
| Measurements (in degrees) | Caucasian Value | Super normal | Super normal vs Caucasian | |||
|---|---|---|---|---|---|---|
|
|
|
|||||
| Mean | Std. Deviation | Std. Error of Mean | Mean Difference | P | ||
| Gonial angle | 130 | 126.13 | 0.64 | 0.23 | 3.87 | 0.00 |
| NGoMe angle | 70 | 75.75 | 1.75 | 0.62 | -5.75 | 0.02 |
| Pal-OcP | 11 | 10.00 | 0.00 | 0.00 | 1.00 | 0.00 |
| SN-Me Go | 34 | 31.75 | 0.46 | 0.16 | 2.25 | 0.00 |
| SeN-Pal (incl. angle) | 85 | 88.75 | 0.46 | 0.16 | 3.75 | 0.00 |
| NS-Gn (Y-axis) | 66 | 65.13 | 0.35 | 0.13 | 0.87 | 0.05 |
| SGo: NMe ×100 (%) | 62 | 63.13 | 0.35 | 0.13 | -1.13 | 0.02 |
| Lower 1 to SN | 102 | 112.00 | 3.55 | 1.25 | -10.00 | 0.03 |
| Lower 1 to SpP | 70 | 74.00 | 0.53 | 0.19 | -4.00 | 0.00 |
| N-Pog to Upper 1 (mm) | 0 | 2.00 | 0.00 | 0.00 | -2.00 | 0.00 |
| Interincisal angle | 135 | 107.50 | 0.93 | 0.33 | 27.50 | 0.00 |
Table 2.
Comparison of various cephalometric parameters of Steiner’s and Tweed’s analyses in super normal and Caucasian populations
| Measurements | Caucasian Value | Super normal | Super normal vs Caucasian | |||
|---|---|---|---|---|---|---|
|
|
|
|||||
| Mean | Std. Deviation | Std. Error of Mean | Mean Difference | Sig. | ||
| Steiner’s Analysis | ||||||
| Upper 1 to NA (mm) | 4 | 5.25 | 0.46 | 0.16 | -1.25 | 0.00 |
| Upper 1 to NA (angle) | 22 | 28.13 | 0.35 | 0.13 | -5.87 | 0.00 |
| Lower 1 to NB (angle) | 25 | 31.63 | 3.93 | 1.39 | -5.37 | 0.00 |
| Tweed’s Analysis | ||||||
| IMPA | 90 | 101.00 | 3.38 | 1.20 | 11.00 | 0.02 |
| FMIA | 65 | 50.00 | 4.04 | 1.43 | -15.00 | 0.01 |
DISCUSSION
In this study when norms for hard-tissue cephalometric measurements of orthodontic population in an urban setup Odisha were compared with established Caucasian norms then significant differences were seen in Steiner's and Tweed's as well as in Rakosi's analyses. In Rakosi's analysis, articular angle describes about the placement of mandible, whether it is placed forward or backward.[16] Nowadays improvement of hard-tissue profile is much in demand in current orthodontic treatment. The hard-tissue cephalometric analyses developed by Steiner, Tweed and Rakosi are the analyses that correlate various hard tissue structures. Dental and skeletal factors have a large influence on the facial profile of an individual. Kokich et al.[17] conducted a study to determine the views of uneducated people and dentists regarding the slight variations in the size of the front teeth and their shape and their perception of the surrounding soft tissues. The results of this study showed that dentists, general practitioners, and the general public experience some degree of dental ailment at different levels of deviation, which may assist the dentist in making specific treatment recommendations. Hall et al.[18] conducted a study to evaluate the best-known profiles of African-Americans against white Americans using the silhouette of 30 African American profiles and 30 White patients, ranging in age from 7 to 17 years. The models preferred the African-American sample with the upper and lower lips which were more prominent compared to the White sample. White dentists gave very high scores on the chosen profile, while African-Americans gave very low scores. Mir et al.[19] conducted a study to compare the esthetic point of view of the distinctive external closure in the different appearance of the face and teeth. They concluded that the common people saw that the effect of the beauty of the visible exterior was greater on the appearance of the teeth compared to the view of the full face. Previous visual occlusion, photographing subject and type of look are factors that influence the visual perception of a smile. Turkkahraman H and Gokalp H[20] conducted research to determine the general beauty preferences of the Turkish people and to determine whether these preferences were influenced by gender, age, education, social status, location, or personal profile. The community praised full and bright lips for women and retractable lips with a prominent nose and chin for men. Gender, age, education, social status, location, and personal profile have also been shown to affect the public profile. Soh et al.[21] conducted a study comparing the beauty profile of Chinese men and women between dentists, dental students, and the general public. Dentists, dental students, and the general public had similar tendencies toward beauty of men and women. The view of women profiles for all three groups was highly correlated and significant. Only the masculine perception of dentists and the general public could be closely linked to the dentist. When comparison of various cephalometric parameters of Steiner's, Tweed's and Rakosi's analyses were done in super normal and Caucasian populations, significant differences were seen in various parameters. This comparison was done for the perception of a lay person towards the facial profile of orthodontic population in an urban setup in Odisha. Lay persons were not at all related to dentist or dental professionals. The silhouette profile picture of subjects were given to 10 judges and those profiles that got 44 or more than 44 points out of 50 were considered as super normal sample. It was done to check the perception of lay persons. When cephalometric tests were performed on such samples, significant differences were observed in the gonial angle, NGOMe angle, Pal-Oc angle, SN MeGo angle, inclination angle, axis Y, Jarabak rating, lower incisor in SN and SPP, NPog to upper incisor, interincisal angle, upper incisor in NA (angular and linear), lower incisor in NB, IMPA and FMIA.[15] Gonial angle is the angle formed by the tangents in the body of the mandible and the rear border of the ramus which is the SAr Go point. NGOMe is a low gonial angle formed by a line connecting the nasion with the gonion and the lower border of the mandible. A large number of these angles indicate a direct growth pattern. The Pal-OcP angle is the angle between the major plane and the occlusal plane. The SNMeGo angle is the angle between the anterior cranial base (SN) and the mandibular line (MeGo). Angle indicates the angle between the Pn line perpendicular to the main line (Pal). The Y axis indicates the position of the chin down or forward relative to the upper face. The Jarabak scale is the percentage between the rear (SGo) and the front face length (NMe). The interincisal angle is the angle between the long axis of the upper incisor and the lower incisor. The upper incisor to NA explains about the placement of the upper incisor relative to the cranial base, and the lower incisor to the NB explain about the placement of the lower incisor relative to the mandibular plane. IMPA (incisor-mandibular plane angle) establishes the position of mandibular incisors relative to the mandibular plane. FMIA (Frankfort-mandibular incisor angle) value indicates the level of balance and hormone between the lower face and the front end of the tooth extraction. It has been shown that in such cases, the view of the common orthodontic people was as follows: they found a long face and a standing farmer as pleasing profiles. When the proclination reaches a certain level, they find the profile interesting. The anteclination of the maxilla also seems to delight them.
CONCLUSION
Axial inclination, angular measurement of lower incisor, and mandibular plane angle were found to be more in the orthodontic population in an urban setup in Odisha than that of early established Caucasian norms. Frankfort-mandibular incisor angle was less and Frankfort-mandibular plane angle was more than that of established Caucasian norms. Articular angle, lower gonial angle, inclination angle, Rakosi Jarabak ratio, position of maxillary incisor with respect to pogonion, basal plane angle, and anterior cranial base were more while interincisal angle were less than that of established Caucasian norms. The results of this study showed that fundamental variations are seen in various parameters. So while doing cephalometric analyses in orthodontic population in an urban setup in Odisha, these findings would help the clinician in diagnosis and treatment planning. After comparing super normal group with established Caucasian norms, it could be concluded that lay persons found long faces and vertical grower to be pleasant profiles; skeletally class I profiles were found pleasant by lay persons; lay persons found prominent chin to be attractive. Lay people's perspectives can aid clinicians in making recommendations for alternative treatment methods. As orthodontists, we must keep in mind that not everything we believe should be rectified for the sake of esthetics. Because of the differing level of detectability, certain little deviations may not be of great significance to lay people.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Miyajima K, McNamara JA, Jr, Kimura T, Murata S, Iizuka T. Craniofacial structure of Japanese and European-American adults with normal occlusions and well-balancedfaces. Am J Orthod Dentofacial Orthop. 1996;110:431–8. doi: 10.1016/s0889-5406(96)70047-1. [DOI] [PubMed] [Google Scholar]
- 2.Miura F, Inoue N, Suzuki K. Cephalometric standards for Japanese according to Steiner's analysis. Am J Orthod Dentofacial Orthop. 1965;51:288–95. doi: 10.1016/0002-9416(65)90103-x. [DOI] [PubMed] [Google Scholar]
- 3.Obloj B, Fudalej P, Dudkiewicz Z. Cephalometric standards for Polish 10-year-olds with normal occlusion. Angle Orthod. 2008;78:262–9. doi: 10.2319/011207-14.1. [DOI] [PubMed] [Google Scholar]
- 4.Downs WB. Variation in facial relationships: Their significance, treatment and prognosis. Am J Orthod. 1948;34:812–40. doi: 10.1016/0002-9416(48)90015-3. [DOI] [PubMed] [Google Scholar]
- 5.Steiner CC. Cephalometrics for you and me. Am J Orthod. 1953;39:729–55. [Google Scholar]
- 6.Walker G, Kowalski C. On the use of the SNA and SNB angles in cephalometric analysis. Am J Orthod. 1973;64:517–23. doi: 10.1016/0002-9416(73)90265-0. [DOI] [PubMed] [Google Scholar]
- 7.Zeng ZS, Zheng XD, Zhu YL, Wang ZQ, Xiang ZD, Meng XS, et al. Population genetic data of 15 STR loci in Han population of Henan province (central China) Legal Med (Tokyo) 2007;9:30–2. doi: 10.1016/j.legalmed.2006.08.002. [DOI] [PubMed] [Google Scholar]
- 8.Craven AH. A radiographic cephalometric study of the Central Australian Aboriginal. Angle Orthod. 1958;28:12–35. [Google Scholar]
- 9.Barrett MJ, Brown J, Mcdonald MR. Dental observations on Australian Aborigines: A roentgenographic study of prognathism. Aust Dent J. 1963;8:418–27. [Google Scholar]
- 10.Bjork A. The nature of facial prognathism and its relation to normal occlusion of the teeth. Am J Orthod. 1951;37:106–24. doi: 10.1016/0002-9416(51)90024-3. [DOI] [PubMed] [Google Scholar]
- 11.Cotton WN, Takano WS, Wong WM. The Down's analysis applied to three other ethnic groups. Angle Orthod. 1951;21:213–20. doi: 10.1043/0003-3219(1951)021<0213:TDAATT>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
- 12.Choy OWC. A cephalometric study of the Hawaiian. Angle Orthod. 1969;39:93–108. doi: 10.1043/0003-3219(1969)039<0093:ACSOTH>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
- 13.Beaton WD, Cleall JF. Cinefluorographic and cephalometric study of class I acceptable occlusion. Am J Orthod. 1973;64:469–79. doi: 10.1016/0002-9416(73)90260-1. [DOI] [PubMed] [Google Scholar]
- 14.Mohode R, Betigiri AV. An establishment of skeletal and soft tissue norms for Indian Marathi population and relating it with the perception of balanced profiles by lay persons. J Indian Orthod Soc. 2008;42:33–40. [Google Scholar]
- 15.Tweed CH. Clinical Orthodontics. Vol. 1. St Louis: Mosby; 1966. The diagnostic facial triangle; pp. 6–60. [Google Scholar]
- 16.Rakosi T, Jonas I, Grabber TM, editors. New York: Thieme Medical Publishers; 1993. Orthodontic – Diagnosis; p. 184. [Google Scholar]
- 17.Kokich VO, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental aesthetics. Esthet Dent. 1999;11:311–24. doi: 10.1111/j.1708-8240.1999.tb00414.x. [DOI] [PubMed] [Google Scholar]
- 18.Hall D, Taylor RW, Jacobson A, Sandowsky PL, Bartolucci A. The perception of optimal profile in African Americans versus white Americans as assessed by orthodontists and the lay public. Am J Orthod Dentofacial Orthop. 2000;118:514–25. doi: 10.1067/mod.2000.109102. [DOI] [PubMed] [Google Scholar]
- 19.Mir CF, Barriga MI, Lagravere MO, Major PW. Lay person's perception of smile aesthetics in dental and facial views. J Orthod. 2004;31:204–9. doi: 10.1179/146531204225022416. [DOI] [PubMed] [Google Scholar]
- 20.Turkkahraman H, Gokalp H. Facial profile preferences among various layers of Turkish population. Angle Orthod. 2004;74:640–7. doi: 10.1043/0003-3219(2004)074<0640:FPPAVL>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
- 21.Soh J, Chew TM, Wongc HB. A comparative assessment of the perception of Chinese facial profile esthetics. Am J Orthod Dentofacial Orthop. 2005;127:692–9. doi: 10.1016/j.ajodo.2004.02.018. [DOI] [PubMed] [Google Scholar]