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The characteristics of profile facial types and its relation with mandibular rotation in a sample of Iraqi adults with different skeletal relations

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Background: Facial type plays an important role in the information of an orthodontic treatment plan and prognosis that is whether an individual has long, short or average face and it is not possible to apply the same norms and treatment objective to cases with different facial patterns. This study aims to determine the characteristics of Bimler's facial types (dolichoprosopic, mesoprosopic, leptoprosopic) and their relationship with mandibular rotation in Iraqi adults with different skeletal relations. Materials and methods: The sample consisted of 230 digital true lateral cephalometric radiographs of age range between 18-30years (104 males and 126 females), the sample was classified according to ANB angle into three skeletal classes (class I, class II and class III) and each class was classified depended on PP-MP angle into three faces. Thirteen cephalometric measurements (five angular, seven linear and one ratio) were measured for each individual radiograph using AutoCAD program 2006. Results: The mean values of all measurements for males were significantly higher than females, except for the GA, UGA and LGA, The mean values of GA, LGA, AFH and LAFH were high in leptoprosopic face, while their values decreased in dolichoprosopic face and the reversed were found with JR, PFH, RL and MAXL, moreover all these measurements revealed a highly significant difference between the three facial types. Conclusions: The mandibular rotation was not changed in all skeletal classes that belong to the same facial type as it did not affected by the anteroposterior relation within the same profile
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J Bagh College Dentistry Vol. 24(special issue 1), 2012 The characteristics
Orthodontics, Pedodontics, and Preventive Dentistry135
The characteristics of profile facial types and its relation
with mandibular rotation in a sample of Iraqi adults with
different skeletal relations
Sara M. Al-Mashhadany, B.D.S., M.Sc. (1)
Nagham M.J. Al- Mothaffar, B.D.S., M.Sc. (2)
ABSTRACT
Background: Facial type plays an important role in the information of an orthodontic treatment plan and prognosis
that is whether an individual has long, short or average face and it is not possible to apply the same norms and
treatment objective to cases with different facial patterns. This study aims to determine the characteristics of Bimler's
facial types (dolichoprosopic, mesoprosopic, leptoprosopic) and their relationship with mandibular rotation in Iraqi
adults with different skeletal relations.
Materials and methods: The sample consisted of 230 digital true lateral cephalometric radiographs of age range
between 18-30years (104 males and 126 females), the sample was classified according to ANB angle into three
skeletal classes (class I, class II and class III) and each class was classified depended on PP-MP angle into three faces.
Thirteen cephalometric measurements (five angular, seven linear and one ratio) were measured for each individual
radiograph using AutoCAD program 2006.
Results: The mean values of all measurements for males were significantly higher than females, except for the GA,
UGA and LGA, The mean values of GA, LGA, AFH and LAFH were high in leptoprosopic face, while their values
decreased in dolichoprosopic face and the reversed were found with JR, PFH, RL and MAXL, moreover all these
measurements revealed a highly significant difference between the three facial types.
Conclusions: The mandibular rotation was not changed in all skeletal classes that belong to the same facial type as
it did not affected by the anteroposterior relation within the same profile
Keywords: Facial type, mandibular rotation, skeletal classes. (J Bagh Coll Dentistry 2012; 24(sp. Issue 1):135-139).
INTRODUCTION
Facial type plays an important role in the
information of an orthodontic treatment plan and
prognosis, of particular, is the vertical relationship
that is whether an individual has long face
(leptoprosopic) or short face (dolichoprosopic) or
average face (mesoprosopic) and it is not possible
to apply the same norms and treatment objective
to cases with different facial patterns (1,2).
Dentofacial balance, harmony, and growth and
development have been studied by many
investigations in four dimensions: height, depth,
breadth and time using lateral or profile
radiograph (3). A balanced profile should be one of
the key factors in deciding on the methods of
treatment for any form of malocclusion, as good
occlusion does not necessarily mean good facial
balance (4).
The rotation of the mandible resulting from an
inharmony between vertical growth and
anteroposterior or horizontal growth has important
implication in orthodontic treatment, orthodontist
must come to consider, understand and appreciate
the value of the vertical growth as it relates to an
anteroposterior growth. They must constantly
seek a deeper understanding into how the total
effect of growth in these two directions produces
different facial types (5).
(1) MSc student, dep. of Orthodontics, collage of dentistry,
university of Baghdad
(2) Professor, dep. of Orthodontics, collage of dentistry,
university of Baghdad
The possible association between facial
morphology and growth direction is important for
two reasons: it would be possible to predict the
direction of growth from a static analysis of facial
form, if a certain morphological pattern is
typically associated with specific growth
directions of facial landmarks; and the more
important reason is the possibility of predicting
morphological changes that will occur during
growth which are associated with specific known
growth directions (6).
It is important for clinicians to be able to predict
the pattern of mandibular rotation at a relatively
early stage of craniofacial growth, independent of
whether malocclusion has already developed or
not. This is explained by the fact that the more the
mandible rotates during growth, the more serious
the clinical problems that may arise, and this
should be seriously considered both at the initial
diagnosis and the overall treatment planning (7).
MATERIALS AND METHOD
Sample
The sample consists of 230 digital true lateral
cephalometric radiograph (104 males and 126
females) for under and postgraduate students in
the College of Dentistry, University of Baghdad,
and some patients attending the Orthodontic
Department of the same college, that fulfill the
following criteria:
1. The age ranged between 18-30 years.
J Bagh College Dentistry Vol. 24(special issue 1), 2012 The characteristics
Orthodontics, Pedodontics, and Preventive Dentistry136
2. No history of previous orthodontic treatment.
3. No craniofacial disorder, such as cleft palate.
4. Full permanent dentition regardless the third
molars.
5. No history of facial trauma.
Every lateral cephalometric radiograph was
analyzed by AutoCAD program 2006 to calculate
angular and linear measurements.
Sample classification: The radiographs were
classified depended on the sagittal skeletal
relation according to Foster (1990) (16) into Table
(1):
1. Skeletal Class I relation: 2° ANB 4°.
2. Skeletal Class II relation: ANB > 4°.
3. Skeletal Class III relation: ANB < 2°.
Each skeletal relation was classified depended on
Bimler’s facial analysis (17) according to palatal -
mandibular plane angle into:
1. Dolichoprosopic facial type: PP-MP angle
ranged from 0-15°.
2. Mesoprosopic facial type: PP-MP angle
ranged from 15-30°.
3. Leptoprosopic facial type: PP-MP angle
ranged from 30-45°.
Cephalometric Bony Landmarks: Include the
following:
1. Point S (Sella): The midpoint of the
hypophysial fossa (8).
2. Point N (Nasion): The most anterior point on
the nasofrontal suture in the median plane (8).
3. Point ANS (Anterior Nasal Spine): It is the tip
of the bony anterior nasal spine in the median
plane (8).
4. Point PNS (Posterior Nasal Spine): This is a
constructed radiological point, the intersection
of a continuation of the anterior wall of the
pterygopalatine fossa and the floor of the nose.
It marks the dorsal limit of the maxilla (8).
5. Point Me (Menton): The lowest point on the
symphyseal shadow of the mandible seen on a
lateral cephalogram (9).
6. Point Go (Gonion): A point on the curvature of
the angle of the mandible located by bisecting
the angle formed by the lines tangent to the
posterior ramus and inferior border of the
mandible (9).
7. Point Ar (Articulare): The point of intersection
of the external dorsal contour of the
mandibular condyle and the temporal bone (10).
8. Point A (Subspinale): The deepest midline
point on the premaxilla between the Anterior
Nasal Spine and Prosthion (11).
9. Point B (Supramentale): The deepest midline
point on the mandible between Infradentale
and Pogonion (11).
Skeletal Angular Measurements (Figure 1):
1. Basal plane angle (PP-MP): This defines the
angle of inclination of the mandible to the
maxillary base, also serves to determine
rotation of the mandible (8).
2. Gonial Angle (Ar-Go-Me): The angle between
the posterior border of the ramus (Ar-Go) and
the mandibular plane (Go-Me). Gonial angle
was measured to determine the mandibular
growth rotation (8).
3. Upper gonial angle (UGA): The angle formed
by the ascending ramus and the line joining
nasion and gonion (8).
4. Lower gonial angle (LGA): The angle formed
by the mandibular plane (Go-Me) and the line
joining nasion and gonion (8).
5. ANB angle: The angle between lines N-A and
N-B, it measured directly as the angle ANB
(12).
Skeletal Linear Measurements (Figure 2):
1. Total anterior facial height (AFH): It measured
from N to Me (8).
2. Upper anterior facial height (UAFH): It is
measured from N to ANS (13).
3. Lower anterior facial height (LAFH): It is
measured from ANS to Me (5,14).
4. Posterior facial height (PFH): It measured
from S to Go (8).
5. Jarabak ratio (JR) = (PFH / AFH) × 100 (8).
6. Maxillary base length (Maxillary length): It
represents the distance from
7. Anterior Nasal Spine to Posterior Nasal Spine
(15).
8. Mandibular body length (Mandibular length):
It represents the distance from Gonion to
Menton (15).
9. Ramus length (RL): It measured from Ar to
Go (8).
Statistical analysis
All the data of the sample were subjected to
computerized statistical analysis using SPSS
version 15 (2006) computer program. The
statistical analysis included:
1. Descriptive Statistics: Mean, Standard
deviation (SD)
2. Inferential Statistics: Paired t-test,
Independent samples t-test, One way analysis
of variance (ANOVA), Pearson's correlation
coefficient
In the statistical evaluation the following
levels of significance are used:
P > 0.05 NS Non-significant
0.05 P > 0.01 * Significant
0.01 P > 0.001 ** Highly significant
J Bagh College Dentistry Vol. 24(special issue 1), 2012 The characteristics
Orthodontics, Pedodontics, and Preventive Dentistry137
RESULTS AND DISCUSSION
Balanced facial form and function are derived
from a harmonious integration of the various
components of the craniofacial complex. These
components grow and develop throughout life in a
sequential, predictable and orderly fashion, albeit
with a wide range of variation in the amount and
timing of growth (18)
This study dealt with lateral view of the face by
using lateral cephalometric radiographs according
to Bimler analysis, and study the relationship of
profile facial type with some mandibular rotation
parameters in class I, class II and class III skeletal
relation which was determined according to ANB
angle, Table 1 showed the Gender difference for
different measurements in skeletal class I
mesoprosopic facial type, it have been found that
the mean values of all the measurements were
significantly higher in males than females except
GA, UGA and LGA which were a non
significantly higher in females in all facial types
and all skeletal relations, this is due to the fact that
muscle traction exerts a considerable influence on
the bony structure, which is stronger and heavier
muscles mass in males than females.
Table 2 showed the descriptive statistics and the
comparison between the three facial types in
skeletal class I. it have been found that There was
a significant difference in all the measurements
between the three facial types , except in UGA,
UAFH and MANL in which there was a non-
significant difference between the three facial
types
The mean values of GA, LGA, AFH and LAFH
were high in leptoprosopic individuals, while their
values decreased in dolichoprosopic individuals,
and within normal limits in mesoprosopic ones,
while the mean values of Jaraback ratio, PFH, RL
and MAXL decreased in leptoprosopic
individuals and increased in dolichoprosopic
individuals.
Table 3 showed the comparison between skeletal
class I, II and III for different measurements in
mesoprosopic facial type, it have been found that
there was a non significant difference between the
three skeletal relations within the same facial type
in all the measurements except in MAXL and
MANL in mesoprosopic face in which there was a
significant difference between the three skeletal
relations.
The mandibular rotation was not changed in all
skeletal classes (class I, II and III) that belong to
the same facial type giving a picture that the
mandibular rotation did not affected by the
anteroposterior relation within the same profile
facial type and there was anterior mandibular
rotation in dolichoprosopic face, while there was a
posterior mandibular rotation in leptoprosopic
face in all skeletal classes. The correlation
coefficient between the measurements expressed a
considerable amount of variations, some of them
showed positive correlation, while the others
showed negative correlation with varying degrees
of significant, but the best correlation was found
in mesoprosopic facial type compared with
dolichoprosopic and leptoprosopic facial type,
Table 4 described the correlation coefficient in
mesoprosopic facial type. There was a highly
significant positive correlation almost between all
the different measurements, on the other hand GA
and RL, GA and MANL, GA and JR, GA and
PFH, UGA and RL, UGA and PFH, UGA and
AFH, UGA and UAFH, UGA and LAFH, UGA
and LGA, LGA and MANL and between LGA
and JR found to have a high significant negative
correlation with each other.
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Table 1: Gender difference for different measurements in skeletal class I mesoprosopic facial
type.
variables Total (n=72) Male (n=30) Female (n=42) Gender difference
d.f.=70
Mean SD Mean SD Mean SD t-value p-value
GA 123.97 4.47 123.6 4.84 124.23 4.23 -0.59 0.55
UGA 50.77 3.3 50.46 3.2 51 3.39 -0.67 0.5
LGA 73.16 4.02 72.96 4.08 73.3 4.02 -0.35 0.72
UAFH 51.55 3.23 53.51 2.97 50.14 2.63 5.06 0.000
LAFH 65.52 5.42 68.91 5.11 63.1 4.23 5.26 0.000
AFH 115.2 7.11 120.2 5.75 111.4 5.53 6.6 0.000
PFH 77.26 6.5 82.22 5.86 73.71 4.25 7.13 0.000
JR 67.01 3.38 68.26 3.52 66.12 3.02 2.76 0.007
MAXL 51.6 3.36 54.2 2.95 49.74 2.22 7.31 0.000
MANL 69.5 4.47 72.33 4.62 67.48 3.08 5.34 0.000
RL 47.18 4.87 50.29 4.51 44.96 3.82 5.408 0.000
Table 2: Comparison between the three facial types in skeletal class I.
variables Dolicho (n=9) Meso (n=72) Lepto (n=10) ANOVA test
d.f.= 90
Mean SD Mean SD Mean SD F-value p-value
GA 117.33 3.31 123.97 4.47 132.4 4.22 28.95 0.000
UGA 50 2.82 50.77 3.3 50.4 2.59 0.27 0.76
LGA 67.22 2.16 73.16 4.02 82 3.46 36.79 0.000
UAFH 52.62 3.15 51.55 3.23 53.05 4.41 1.159 0.31
LAFH 61.28 4.86 65.52 5.42 73.24 5.91 12.57 0.000
AFH 113.16 8.36 115.24 7.11 124.06 9.02 6.87 0.002
PFH 82.57 7.54 77.26 6.5 74.04 4.65 4.26 0.02
JR 72.91 2.7 67.01 3.38 59.75 2.07 40.32 0.000
MAXL 54.92 3.02 51.6 3.36 51.53 2.3 4.26 0.02
MANL 72.7 4.24 69.5 4.47 69.07 4.02 2.24 0.11
RL 53.11 5.37 47.18 4.87 45.14 2.66 7.69 0.000
Table 3: Comparison between skeletal class I, II and III for different measurements in
mesoprosopic facial type.
variables CL I (n=72) CL II (n=50) CL III (n=34) ANOVA test
d.f.= 155
Mean SD Mean SD Mean SD F-value p-value
GA 123.97 4.47 124.28 4.52 125.44 5.82 1.09 0.33
UGA 50.77 3.3 50.7 3.74 51.61 3.77 0.8 0.44
LGA 73.16 4.02 73.58 3.06 73.79 4.47 0.35 0.7
UAFH 51.55 3.23 51.24 3.35 51.53 3.26 0.14 0.86
LAFH 65.52 5.42 66.26 4.87 65.94 4.96 0.3 0.73
AFH 115.24 7.11 114.77 5.81 117.21 6.85 1.46 0.23
PFH 77.26 6.5 76.04 5.9 78.57 6.153 1.68 0.18
JR 67.01 3.38 66.22 3.45 67.05 3.87 0.89 0.41
MAXL 51.6 3.36 53.05 3.157 51.16 4.12 3.75 0.03
MANL 69.5 4.47 68.53 4.94 72.35 4.83 6.93 0.0013
RL 47.18 4.87 46.29 4.469 48 4.99 1.32 0.26
J Bagh College Dentistry Vol. 24(special issue 1), 2012 The characteristics
Orthodontics, Pedodontics, and Preventive Dentistry139
Table 4: Correlation between the different measurements in skeletal class I mesoprosopic facial
type.
Variables RL MANL MAXL JR PFH AFH LAFH UAFH LGA UGA
GA -0.3** -0.39** -0.12 -0.55** -0.35** -0.03 0.09 -0.14 0.7** 0.5**
UGA -0.32** -0.13 -0.04 -0.02 -0.39** -0.5** -0.41** -0.43** -0.24*
LGA -0.09 -0.35** -0.12 -0.61** -0.09 0.36** 0.43** 0.17
UAFH 0.57** 0.51** 0.53** 0.11 0.65** 0.8** 0.5**
LAFH 0.62** 0.21 0.56** 0.06 0.69** 0.88**
AFH 0.69** 0.45** 0.6** 0.1 0.8**
PFH 0.87** 0.51** 0.7** 0.67**
JR 0.6** 0.3** 0.42**
MAXL 0.59** 0.5**
MANL 0.39**
Figure 1: Cephalometric angular measurements Figure 2: Cephalometric linear measurements.
... Some of these methods applied from the frontal side while the others from the lateral side. 2 In Iraq, many studies had been done to investigate the relation between the facial form and dental arches dimension, [3][4][5] the direction of mandibular rotation 2,6 and masseter muscle thickness and bite force. 7 Saloom and Ali 1 investigated the facial features, proportions and differences in facial types in relation with different classes of malocclusion. ...
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