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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 53-56

Growth changes in two age groups with different malocclusions in individuals of Central India


Department of Orthodontics and Dentofacial Orthopaedics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India

Date of Web Publication12-Jun-2019

Correspondence Address:
Dr. Shail Kumari
Department of Orthodontics and Dentofacial Orthopaedics, Rishiraj College of Dental Sciences and Research Centre, Bhopal - 462 037, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_15_19

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  Abstract 


Objective: Comparative evaluation of McNamara's analysis in Class I, Class II, and Class III individuals of Central India in two different age groups. Materials and Methods: 240 individuals belonging to Central India were divided into two main groups: Group I comprised 120 children (10–14 years) and Group II comprised 120 adults (18–22 years). McNamara's analysis was used to assess skeletal, dental, and soft tissue parameters. Results: Statistically significant difference was found for facial axis angle, mandibular length, and maxillary length in children and adults in dental/skeletal Class I individuals. In Class II division 1 individuals, statistically significant difference was found in children and adults for maxillary length, mandibular length, and lower anterior facial height. In Class II division 2 individuals, statistically significant difference was found in children and adults in maxillomandibular difference and lower anterior facial height. In Class III individuals, the difference was in nasolabial angle. Conclusion: The growth of maxilla is usually completed by 10-14 years of age. The present study suggests that the growth of maxilla is continuous in adults, and nasolabial angle decreases with age in Class III individuals. Hence, planning of extractions in earlier age should be decided with caution.

Keywords: Cephalometric, dentoalveolar protrusion, malocclusion, mandibular length, McNamara's analyses, retrognathic


How to cite this article:
Kumari S, Bapat SM, Gupta K. Growth changes in two age groups with different malocclusions in individuals of Central India. Arch Med Health Sci 2019;7:53-6

How to cite this URL:
Kumari S, Bapat SM, Gupta K. Growth changes in two age groups with different malocclusions in individuals of Central India. Arch Med Health Sci [serial online] 2019 [cited 2019 Aug 25];7:53-6. Available from: http://www.amhsjournal.org/text.asp?2019/7/1/53/260005




  Introduction Top


The skeletal analysis relates the upper and lower jaws to the skull and to each other. The dental analysis relates the upper and lower incisor teeth to their respective jaws and to each other. The soft tissue analysis provides the balance and harmony of the facial profile. The skeletal and dental craniofacial features are either genetically and nutritionally acquired or acquired from dietary patterns from parents and are specific to ethnic, race, subrace, or in different communities.[1] The principle of the analysis is to compare the patients with a normal reference group to find the actual dentofacial relationship for his/her race and ethnic group. Patients' dentofacial problems are identified by comparing cephalometric values to a standard database.[2],[3]

McNamara analysis was introduced to analyze the position of teeth within a given bone and also to find the relationship of jaw elements and cranial base structures among each other. Since years, clinical orthodontics has seen numerous orthognathic surgery procedures which facilitate the three-dimensional repositioning of bony structure in the facial region to promote new possibilities in the treatment of skeletal discrepancies. McNamara analysis is suitable for both conventional orthodontic patients as well as in patients with skeletal discrepancies and requires dentofacial orthopedics and orthognathic surgery.[4]

The aim of this study was to evaluate McNamara analyses in Class I, Class II, and Class III individuals of Central India, belonging to two age groups: 10–14-year-old children and 18–22-year-old adults. The study was done to establish mean values for different skeletal, dental, and soft tissue parameters. This study was also done to compare the gender and malocclusions difference in two age groups from the original norms.


  Materials and Methods Top


A prospective study involving 240 individuals of Central India was done in-between July 2016 and July 2018. The individuals were divided into two main groups according to age. Group I comprised 120 children in the age group of 10–14 years and Group II comprised 120 adults in the age group of 18–22 years. The main group was further divided into four subgroups according to skeletal class based on ANB angle as shown in [Table 1]. The study was approved by institutional ethical committee.
Table 1: Population distribution based on ANB angle

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The individuals in the age group of 10–14 years and 18–22 years were only included. Both male and female individuals with permanent dentition and had not undergone any orthodontic treatment were included. Individuals with missing teeth, long span crown and bridges, and large proximal caries were excluded from the study.

Cephalometric standards given by Broadbent Jr were followed, and lateral cephalograms of all the 240 individuals were taken. Same X-ray machine was used, with the individual in the natural head position, relaxed lip position with maximum intercuspation. The films were exposed at 85 kV/10 mA for 17.6 s, with effective dose/exposure – 3–6 μSv, with all precautionary measures. The film to source distance was 5 ft 2” and the film to patient's midsagittal plane was 6”. The magnification of all the cephalogram was uniformly adjusted to 1:1, to eliminate error of measurement by magnification.[5] The cephalometric tracings for all the individuals were carried out by a single observer on a 0.003” matt lead acetate paper, with a black HB pencil to eliminate interobserver error. The McNamara analysis was used to assess the skeletal, dental, and soft tissue parameters in Central India population from the data collected.

The data were tabulated for each subgroup, and mean, range, and standard deviation with standard error of mean was calculated. The gender difference and differences in group were calculated using paired t-test.


  Results Top


The result of McNamara's analysis was enumerated in [Table 2], [Table 3], [Table 4]. Statistically significant difference was found in facial axis angle (2.63°) in children compared to adults (5.2°). Mandibular length was 103.2 mm in children and 107.2 mm in adults and maxillary length 80.07 mm in children and 83.9 mm in adults.
Table 2: Comparison of McNamara's analysis of in Class I individuals

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Table 3: Comparison of McNamara's analysis of Class II division 1 and Class II division 2 individuals

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Table 4: Comparison of McNamara's analysis in Class III individuals

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In Class II Division 1 individuals, statistically significant difference was found in maxillary length in children (80.07 mm) and adults (83.13 mm). Mandibular length in children was 99.4 mm and in adults was 103.4 mm. Lower anterior facial height was 59.67 mm in children and 62.4 mm in adults.

In Class II Division 2 individuals, statistically significant difference was found in maxillomandibular difference in children (80.37 mm) and adults (20.9 mm). Lower anterior facial height was 57.03 mm in children and 60.27 mm in adults.

In Class III individuals, statistically significant difference was found in nasolabial angle in children (94.2°) and adults (82.87°).


  Discussion Top


The growth of maxilla is considered to be completed earlier than the mandible, but does this really occurs in different populations is a matter of debate. The present study was done to find the same so that guidelines would be provided for diagnosis and treatment planning of patients requiring orthodontics in Central India population in different age groups.

In present study, mandibular length in Class I individuals was more in adult males (110.33 mm) than adult females (104.13 mm). Maxillary length was also more in adult males (87.6 mm) than adult females (80.2 mm), and this may be attributed to sexual dimorphism. Similar results were obtained by Ibrahim Ali[4] in Iraqi Population in Mosul City and Poosti et al.[6] in Iranian population. In the present study, statistically significant difference was found in combined mean of children (2.63°) and adults (5.2°) for facial axis angle, which was due to more forward growth rotation during growth. Significant difference was found in mandibular and maxillary length in children (103.2 mm; 80.07 mm) and adults (107.2 mm; 83.9 mm) due to involvement of growth.

Contradictory result was obtained in the study by Wu et al.[7] where they found no significant difference in the length of the mandible in Chinese males and females. The mandible was more retrognathic, with steeper mandibular plane and facial axis angle. Lower face height was larger in males. Effective maxillary length was larger, which leads to longer maxillomandibular length in males than in females.

In Class II Division 1 individuals, significant difference was found in maxillary length of male (81.47 mm) and female (78.6 mm) children. Lower anterior facial height was 61.6 mm in male and 57.73 mm in female children, and this may be attributed to sexual dimorphism. Lower incisor to Apo line was 4.8 mm in males and 3.07 mm in female children which may be attributed to more lower incisor proclination in males. Nasion perpendicular (Nasion perp) to point A was −2 mm in males and 1.8 mm in female children; this may be attributed to more prognathism in females.

Nasion perp to Point A was 1.33 mm in male and 2.53 mm in female adults, facial axis angle was 3.13° in males and 5.4° in female adults, and lower anterior facial height was 64.47 mm in male and 60.33 mm in female adults. These results were similar to findings in children. Similar results were obtained by Ali[4] in Iraqi Population in Mosul City except for Nasion perp to Point A where he found no significant difference in male and female individuals. Maxillary length was 80.07 mm in children and 83.13 mm in adults, mandibular length was 99.4 mm in children and 103.4 mm in adults, and lower anterior facial height was 59.67 mm in children and 62.4 mm in adults. These results show that there was more growth in adults compared to children in Central India population.

In Class II Division 2 individuals, maxillary length was 83.87 mm in male and 80.07 mm in female children. Nasion perp to Point A was 3.23 mm in male and −0.4 mm in female children, lower incisor to Apo line was −1.63 mm in males and 2.33 mm in female children, and it is the same as in Class II division 1. Nasion perp to Point A was −1.9 mm in male and 0.33 mm in female adults, maxillary length was 84.8 mm in male and 80.6 mm in female adults, maxillomandibular difference was 22.93 mm in male and 18.87 mm in female adults, and it is the same as class II division 1. Nasion perp to Pog was −11.53 mm in male and −5.27 mm in female adults which may be attributed to short and retrognathic mandible in Class II Division 2. Mandibular length was 107.73 mm in male and 99.53 mm in female adults, lower anterior facial height was 64.47 mm in male and 56.07 mm in female adults, and lower incisor to Apo line was 2.83 mm in male and −1.3 mm in female adults and it is the same as Class II Division 1. Similar results were obtained by Ali[4] in Iraqi population in Mosul City except for Nasion perp to Pog where he found no significant difference in male and female individuals. Maxillomandibular difference was 80.37 mm in children and 20.9 mm in adults, lower anterior facial height was 57.03 mm in children and 60.27 mm in young adults, and it is the same as class II division 1.

In Class III individuals, Nasion perp to Pog was −4.4 mm in male and −1.3 mm in female children, and this may be due to partial growth expression of mandible in males in this age group. Mandibular length was 110.67 mm in male and 104.13 mm in female adults, and maxillomandibular difference was 29.47 mm in male and 24.26 mm in female adults and it is the same as in Class I and Class II. Upper incisor to point A was 7.67 mm in adult males and 10.57 mm in adult females and lower incisor to Apo line was 3.97 mm in adult males and 6.03 mm in females which may be attributed to proclination of upper and lower incisors in Class III adult females. Mandibular plane angle was 18.13° in adult males and 25.07° in female; this may be attributed to forward growth rotation of mandible in males. Similar results were obtained by Ramezanzadeh et al.[8] in Iran Population in Mashhad, City.. Nasolabial angle was 94.2° in children and 82.87° in adults which may be due to upper incisor proclination increases with age.

This is the first study in Central India population involving all the three malocclusions and with more number of sample size. The growth of maxilla is usually completed by 10-14 years of age. The present study suggests that the growth of maxilla is continuous in adults, and nasolabial angle decreases with age in Class III individuals. Hence, planning of extractions in earlier age should be decided with caution. The findings of the study suggest that a fixed parameter cannot be applied in all the populations, and while planning orthodontic treatment, population-specific analysis should be done to plan and execute any treatment.


  Conclusion Top


Distinct differences in skeletal, dental, and soft tissue parameters were found in individuals of Central India among the two age groups of different classes. A distinct difference between the sexes clearly indicates the presence of sexual dimorphism. Growth of maxilla usually completes in earlier age group, but the present study found that growth of maxilla continues in adults in individuals of Central India. While planning orthodontic treatment in these populations, important findings of the present study must be taken into considerations. As the nasolabial angle decreases with age in Class III individuals, extractions in these classes in earlier age should be decided with caution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh Rathore A, Dhar V, Arora R, Diwanji A. Cephalometric norms for Mewari children using Steiner's analysis. Int J Clin Pediatr Dent 2012;5:173-7.  Back to cited text no. 1
    
2.
Zegan G, Dascalu CG, Golovcencu L, Anistoroaei D. Cephalometric features of class II malocclusion. Int J Med Dent 2014;4:222-8.  Back to cited text no. 2
    
3.
Saraswat N, Kambalyal P, Patel N. Esthetic norms for Udaipur population in India. Int J Curr Res 2016;8:26246-9.  Back to cited text no. 3
    
4.
Ali AI. McNamara's cephalometric analysis for Iraqi population in Mosul city. Int J Enhanc Res Sci Tech Eng 2014;3:287-99.  Back to cited text no. 4
    
5.
Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning – Part II. Am J Orthod Dentofacial Orthop 1993;103:395-411.  Back to cited text no. 5
    
6.
Poosti M, Amini F, Mokhnefi AD. Normal standards of McNamara analysis in Iranian adult population. Iran J Orthod 2012;7:1-5.  Back to cited text no. 6
    
7.
Wu J, Hägg U, Rabie AB. Chinese norms of McNamara's cephalometric analysis. Angle Orthod 2007;77:12-20.  Back to cited text no. 7
    
8.
Ramezanzadeh B, Pousti M, Bagheri M. Cephalometric evaluation of dentofacial features of class III malocclusion in adults of Mashhad, Iran. J Dent Res Dent Clin Dent Prospects 2007;1:125-30.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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