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Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 28-33
Cephalometric norms for Central Indian population using Burstone and Legan analysis


1 Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), District Wardha, Maharashtra, India
2 Department of Orthodontics, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), District Wardha, Maharashtra, India

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Date of Submission27-Dec-2009
Date of Decision26-Feb-2010
Date of Acceptance10-Sep-2010
Date of Web Publication25-Apr-2011
 

   Abstract 

Background: Lateral cephalometric standards of normal Central Indian adults having class I occlusion and acceptable facial profile were studied using the Burstone and Legan comprehensive cephalometric analyses that are specific for orthognathic surgery.
Aim: To study normal dentofacial patterns of adult population belonging to Central India.
Materials and Methods: Cephalometric radiographs of 76 Central Indian adults (38 males and 38 females) having class I occlusion with acceptable facial profile were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of Caucasian adults as reported in the literature.
Results: The Central Indian males demonstratedgreater anterior cranial base length and ramal length and a reduced chin depth. The inclination of the upper and lower incisors was also greater. The females demonstrated greater posterior cranial base length, increased upper anterior and posterior facial heights, and an increased maxillary length. Both mandibular body and ramal lengths were increased and there was greater mandibular protrusion and a reduced chin depth. The lower incisors were found to be proclinated.
Conclusion: This study reveals that some of the cephalometric parameters in the Central Indian population are significantly different than that of the Caucasian population, especially in the females.

Keywords: Burstone and Legan analysis, Caucasians, Central Indians, cephalometric norms

How to cite this article:
Yadav AO, Walia CS, Borle RM, Chaoji KH, Rajan R, Datarkar AN. Cephalometric norms for Central Indian population using Burstone and Legan analysis. Indian J Dent Res 2011;22:28-33

How to cite this URL:
Yadav AO, Walia CS, Borle RM, Chaoji KH, Rajan R, Datarkar AN. Cephalometric norms for Central Indian population using Burstone and Legan analysis. Indian J Dent Res [serial online] 2011 [cited 2020 Jul 10];22:28-33. Available from: http://www.ijdr.in/text.asp?2011/22/1/28/79970
Cephalometrics is a reliable and reproducible diagnostic modality for orthognathic surgical planning. Numerous osseous cephalometric analyses are reported in the literature to diagnose and plan orthognathic surgery. By placing the skeletal parts within the range of skeletal normal cephalometric norms, best facial balance and facial harmony can be achieved. [1]

A number of investigators noticed the variation of the craniofacial morphology in different ethnic groups. Richardson (1980) defined the term "ethnic group" as a "nation or population with a common bond such as geographical boundary, a culture or language, or being racially or historically related". [2]

It is apparent from the review of literature that most of the studies are done on Caucasian populations and the norms developed by the use of numerous cephalometric analyses may be inadequate for application to different racial or ethnic groups. [2]

A specialized cephalometric appraisal for orthognathic surgery (COGS) was developed at the University of Connecticut by Burstone and Legan. [3] Normal values for cephalometric analysis of dental and facial forms have been extensively developed for North American and north-western European populations. [4],[5],[6],[7],[8] These analyses have been extensively used for research [9],[10],[11],[12],[13] and in treatment planning for orthgnathic surgery.

The present study was carried out in the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Sawangi, to derive the normal cephalometric norms of the normal, well-balanced and esthetically pleasing faces from the adult Central Indian population, which will be useful in providing racially specific values for diagnosis and treatment planning for orthognathic surgery.


   Materials and Methods Top


Seventy six-Central Indian adults (38 males and 38 females), of age between 18 and 28 years, were included in the study. All had class I occlusion with acceptable facial profile. The subjects were shieldedappropriatelyfrom the radiation using a lead apron while taking lateral cephalograms. The lateral cephalograms were standardized using a fluid/spirit level device (Showfety et al., 1983) [14] on the subject's head to attain the natural head position and also to orient Frankfort horizontal (FH) plane parallel to the fluid deviceand the cephalograms were obtained [Figure 1]. Manual tracings of the cephalometric radiographs were made on 0.003 lead acetate tracing sheets. The cephalometric landmarks were identified according to the definitions used by Burstone and Legan in their publications [3],[15] [Figure 2].
Figure 1: Subject positioned in the cephalostat with lead apron and fluid level device on head to attain natural head position

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Figure 2: Hard and soft tissue landmarks

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   Results Top


Statistical analysis

Various angular and linear measurements for hard and soft tissues in both males and females are tabulated. All readings obtained were subjected to statistical analysis for calculating mean and standard deviation (SD) for both hard and soft tissues using the following formulae.



95% confidence interval, mean - 2SD - mean + 2SD

Z -test

Assumptions

  • Equality of variances, tested by using the Z-test
  • Samples may b independent or dependent, depending on the hypothesis and the type of samples, as follows:
    • Independent samples are usually two randomly selected groups
    • Dependent samples are either two groups matched on some variable (e.g., age) or are the same people being tested twice (called repeated measures)


For equal sample sizes

This equation is only used when the two sample sizes (i.e., n or number of participants of each group) are equal:



where s is the grand SD (or pooled sample SD). Z-test is equivalent to t-test. (When sample size is more than 30, Z-test is applied.)

When Z> 1.96, the result is significant [Table 1], [Table 2], [Table 3], [Table 4] and [Table 5]
Table 1: Descriptive statistics for hard tissue in males

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Table 2: Descriptive statistics for hard tissue in females

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Table 3: Descriptive statistics for soft tissue in Central Indian population

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Table 4: "Z" value of hard tissue for Central Indian population

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Table 5: "Z" value of soft tissue for Central Indian population

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   Discussion Top


Most of the cephalometric analyses [3],[6] which are used today in India have originated in White North American adults. The cephalometric norms of one ethnic group need not necessarily apply to another ethnic group because of noticeable variation of the craniofacial morphology in different ethnic groups. Most importantly, in a country like India where the intra-country variation in population is found to a great extent morphogenetically as well as linguistically, developing a specific normative standard for the entire population can be erroneous in nature.

Previous studies have established specific cephalometric norms with different ethnic backgrounds, showing different facial features. The racial, facial, and skeletal characteristics of the patient play a critical role in orthognathic surgery planning. Therefore, existence of such database becomes an absolute necessity for carrying out these surgical procedures and to produce acceptable results.

Similar study using COGS analysis was done by Flynn [16] for Black American adults and by Alcalde [17] for Japanese adults. In the Black American adults, conclusion was drawn that the subjects had greater maxillary skeletal prognathism, skeletal lower face height, skeletal facial convexity, lower incisor proclination, anterior dental heights, upper and lower lip lengths, and soft tissue thickness of the lips and chin, less nasal depth and projection, less bony chin depth, and a smaller nasolabial angle than in White subjects. In the Japanese adults, there was a shorter maxilla, less prominent chin, larger upper anterior face height, and lower posterior dental height than Burstone's White sample. Soft tissue analysis showed retrognathic maxilla and mandible and bilabial protrusion when compared with the White adult standards.

The Central Indian population is different from Caucasians in several aspects. There are marked differences in the soft tissue cephalometric parameters [Table 5], namely, they exhibit increased facial convexity (mean 13.06° ± 3.03°), greater mandibular prognathism (mean 2.25 ± 3.99 mm), more obtuse lower face-throat angle (mean 110.04° 6.31°) and greater amount of upper lip (mean 4.74 ± 2.83 mm) and lower lip protrusion (mean 4.00 ± 2.62 mm). These differences were evident when comparison was made between these two individual populations. These differences were also evident when the analysis of the skeletal tissues was carried out using Burstone and Legan COGS analysis.

The hard tissue parameters for central Indian male population [Table 4] like anterior cranial base length (55.19 ± 4.90 mm), ramal length (55.02 ± 4.97 mm), inclination of the upper incisors (116.65 ± 4.72 mm), and inclination of the lower incisors (102.36 ± 5.31) were found to be greater than their Caucasian counterparts, while the chin depth was found to be reduced (5.98 ± 4.85 mm). A significant difference was obtained on statistical analysis applying Z-test at 1.96 level of significance, which could be of use in diagnostic importance during treatment planning.

The Central Indian female population [Table 4] demonstrated greater posterior cranial base (37.77 ± 2.98 mm), greater mandibular protrusion (-4.5 ± 4.7 mm), retrusive chin (-3.48 ± 5.09 mm), greater upper anterior facial height (53.02 ± 2.99 mm), greater upper posterior facial height (52.14 ± 3.20 mm), greater maxillary length (54.69 ± 3.16 mm), greater ramal length (49.81 ± 3.96 mm), greater mandibular body length (77.06 ± 4.29 mm), reduced chin depth (5.47 ± 4.05 mm), greater inclination of lower incisors (100.96° ± 6.39°), than their female Caucasian counterparts and these were also significantly differing when subjected to statistical analysis applying Z-test at 1.96 level of significance.

Further, gender-based intrapopulation skeletal differences were also seen between the male and female population as follows.

  • Males showed larger cranial base length, both anterior and posterior, while there was increased tendency toward straighter profile in females than in males.
  • Vertical positioning of maxilla was greater in males, which was evident from increased maxillary anterior skeletal height. The maxillary anterior and posterior dental heights were also greater than the females.
  • The length of the maxilla was found to be greater in males than in females.
  • The ramal length, body length and the chin prominence were all greater in males.
  • On dental analysis, females tend to have lesser proclined anterior teeth to their respective jaw bases as compared to their male counterparts where the level of proclination was more.
  • The Wits appraisal also displayed greater tendency toward the straighter profile with reduced skeletal discrepancy infemales.

   Conclusion Top


Orthognathic surgery has become more prevalent today in the treatment of adult patients with facial deformities. Currently, the cephalometric norms used for assessment of the deformity and the treatment planning are those for the Caucasian population, and thus, all patients, regardless of race, are evaluated by these established standards. In the present study, surgically useful rectilinear cephalometric norms for the diagnosis and treatment planning of orthognathic surgery in adult Central Indian population are developed for its practical implementation in the treatment of the facial deformities. Thus, the study reveals that some of the cephalometric parameters in the Central Indian population are significantly different than those of the Caucasian population, especially the female gender. These racial differences are evident in this study and can be of clinical importance, and the authors suggest their use while charting out plan for the orthognathic surgery for Central Indian population.

 
   References Top

1.Arnett GW, Gunson MJ, McLaughlin RP. The Essence of Beauty. Available from: http://www. braces.Org/healthcareprofessionals/dentists/upload/The-Essence-of-Beauty.pdf-microsoft internet explorer. [last accessed on 2007 Sep 20].  Back to cited text no. 1
    
2.Park IC, Bowman D, Klapper L. A cephalometric study of Korean adults. Am J Orthod Dentofacial Orthop 1989;96:54-9.   Back to cited text no. 2
[PUBMED]    
3.Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978;36:269-77.  Back to cited text no. 3
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4.Bowker WE, Meredith HV. A metric analysis of the facial profile. Angle Orthod 1959;29:149-160.   Back to cited text no. 4
    
5.Ricketts RM. Cephalometric analysis and synthesis. Angle Orthod 1961;31:141-156.  Back to cited text no. 5
    
6.Burstone CJ. The integumental profile. Am J Orthod 1958;44:1.  Back to cited text no. 6
    
7.Burstone CJ. Integumental contour and extension patterns. Angle Orthod 1959;29:93.  Back to cited text no. 7
    
8.Burstone CJ. Lip posture and its significance in treatment planning. Am J Orthod 1967;53:262-84.  Back to cited text no. 8
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9.Connor AM, Moshiri F. Orthognathic surgery norms for American black patients. Am J Orthod 1985;87:119-34.  Back to cited text no. 9
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10.Lew KK, Ho KK, Keng SB, Ho KH. Soft-tissue cephalometric norms in Chinese adults with esthetic facial profiles. J Oral Maxillofac Surg 1992;50:1184-9.  Back to cited text no. 10
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11.Scheideman GB, Bell WH, Legan HL, Finn RA, Reisch JS. Cephalometric analysis of dentofacial normals. Am J Orthod 1980;78:404-20.  Back to cited text no. 11
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12.Wallen T, Bloomquist D. The clinical examination: Is it more important than cephalometric analysis in surgical orthodontics? Int J Adult Orthodon Orthognath Surg 1986;1:179-91.  Back to cited text no. 12
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13.Wylie GA, Fisch LC, Epker BN. Cephalometrics. A comparison of five analyses currently used in the diagnosis of the dentofacial deformities. Int J Adult Orthodon Orthognath Surg 1987;2:15-36.  Back to cited text no. 13
    
14.Raju NS, Prasad KG, Jayade VP. A modified approach for obtaining cephalograms in natural head position. J Orthod 2001;28:25-8.  Back to cited text no. 14
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15.Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980;38:744-51.  Back to cited text no. 15
[PUBMED]    
16.Flynn TR, Ambrogio RI, Zeichner SJ. Cephalometric norms for orthognathic surgery in black American adults. J Oral Maxillofac Surg 1989;47:30-9.  Back to cited text no. 16
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17.Alcalde RE, Jinno T, Pogrel MA, Matsumura T. Cephalometric norms in Japanese adults. J Oral Maxillofac Surg 1998;56:129-34.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Abhilasha O Yadav
Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), District Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.79970

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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