Establishing Cephalometric Norms in Primary Dentition Using Comprehensive Craniofacial Growth Analysis - A Digital Cephalometric Study

Deshmukh, Seema; Nandlal, Bhojraj

doi:10.1590/pboci.2023.016

Seema Deshmukh Correspondence: Seema Deshmukh, Dept of Pediatric & Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India. 570023. E-mail:seema.pedo@gmail.com

Conceptualization

Methodology

Software

Validation

Formal Analysis

Investigation

Resources

Data Curation and Writing - Original Draft

All authors declare that they contributed to critical review of intellectual content and approval of the final version to be published

Department of Pediatric and Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India

https://orcid.org/0000-0001-5169-7811

Bhojraj Nandlal

Writing - Review and Editing

Visualization

Supervision and Project Administration

All authors declare that they contributed to critical review of intellectual content and approval of the final version to be published

Department of Pediatric and Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India

https://orcid.org/0000-0002-4983-9742

Correspondence: Seema Deshmukh, Dept of Pediatric & Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India. 570023. E-mail:seema.pedo@gmail.com

Conflict of Interest

The authors declare no conflicts of interest.

Parameters	γ	IR (%)
Inter Incisor Angle	0.9986	99.86
Cervico Facial Angle	0.9978	99.78
Lower Facial Height	0.9974	99.74
Sti - Me	0.9968	99.68
Sn - Me	0.9961	99.61
Sts - Me	0.9944	99.44
Li - Me	0.9943	99.43
IMPA	0.9927	99.27
Upper Incisor to SN Plane	0.9915	99.15
Saddle Sella Angle N S Ar	0.9905	99.05
SNA	0.9810	98.10
Facial Convexity	0.9788	97.88
Articular Angle S Ar Go	0.9786	97.86
Maxillary Inclination	0.9767	97.67
Maxillary Dental Height	0.9766	97.66
Facial Angle	0.9726	97.26
SNB	0.9690	96.90
Upper Lip Angle	0.9654	96.54
Gonial Angle Ar Go Me	0.9648	96.48
Posterior Facial Height	0.9640	96.40
MP-ANS PNS	0.9559	95.59
Upper Facial Height	0.9507	95.07
Maxillary Height	0.9507	95.07
Position of Mandibular Molar	0.9368	93.68
Mandibular Posterior Dental Height	0.9241	92.41
Mandibular Anterior Dental Height	0.9228	92.28
FMIA	0.9227	92.27

Upper Craniofacial Measurements
S.No	Measurement	Landmarks Used	Significance	Analysis
	Linear
1	Upper Anterior Facial Height	N-ANS	Describes the skeletal upper facial height.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
2	Sagittal Growth at Nasion	Pt Point-N	Signifies the Sagittal growth at Nasion with respect to stable reference point.	Nanda and Ghosh [¹⁰[10] Nanda RS, Ghosh J. Longitudinal growth changes in the sagittal relationship of maxilla and mandible. Am J Orthod Dentofac 1995; 107(1):79-90. https://doi.org/10.1016/s0889-5406(95)70159-1 https://doi.org/10.1016/s0889-5406(95)70... ]
3	Sagittal Growth at Anterior Nasal Spine	Pt Point-ANS	Signifies the sagittal growth at Anterior Nasal spine with respect to stable reference point	Nanda and Ghosh [¹⁰[10] Nanda RS, Ghosh J. Longitudinal growth changes in the sagittal relationship of maxilla and mandible. Am J Orthod Dentofac 1995; 107(1):79-90. https://doi.org/10.1016/s0889-5406(95)70159-1 https://doi.org/10.1016/s0889-5406(95)70... ]
4	Sagittal Growth at Point A	Pt Point-Pt A	Signifies the sagittal growth at point A with respect to stable reference point.	Nanda and Ghosh [¹⁰[10] Nanda RS, Ghosh J. Longitudinal growth changes in the sagittal relationship of maxilla and mandible. Am J Orthod Dentofac 1995; 107(1):79-90. https://doi.org/10.1016/s0889-5406(95)70159-1 https://doi.org/10.1016/s0889-5406(95)70... ]
	Angular
5	SNA	S-N-Pt A	This angle indicates the horizontal position of the maxilla relative to the cranial base.	Steiner and Hills Analysis [¹¹[11] Steiner CC, Hills B. Cephalometrics for you and me. Am J Orthod 1953; 39(10):729-55. https://doi.org/10.1016/0002-9416(53)90082-7 https://doi.org/10.1016/0002-9416(53)900... ]
6	Maxillary Inclination	Palatal Plane-SN Plane	Provides assessment of the inclination maxillary base with reference to the cranial base	Bjork and Skieller [¹²[12] Bjork A, Skieller V. Facial development and tooth eruption. Am J Orthod 1972; 62(4):339-83. https://doi.org/10.1016/s0002-9416(72)90277-1 https://doi.org/10.1016/s0002-9416(72)90... ]

Lower Craniofacial Measurements
S.No	Measurement	Landmarks Used	Significance	Analysis
	Linear
1	Lower Anterior Facial Height	ANS-Me	Describes the skeletal lower facial height.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
2	Sagittal Growth at Point B	Pt Point-Pt B	Signifies the sagittal growth at point B with respect to stable reference point.	Nanda and Ghosh [¹⁰[10] Nanda RS, Ghosh J. Longitudinal growth changes in the sagittal relationship of maxilla and mandible. Am J Orthod Dentofac 1995; 107(1):79-90. https://doi.org/10.1016/s0889-5406(95)70159-1 https://doi.org/10.1016/s0889-5406(95)70... ]
3	Sagittal Growth at Pogonion	Pt Point-Pg	Signifies the sagittal growth at Pogonion with respect to stable reference point	Nanda and Ghosh [¹⁰[10] Nanda RS, Ghosh J. Longitudinal growth changes in the sagittal relationship of maxilla and mandible. Am J Orthod Dentofac 1995; 107(1):79-90. https://doi.org/10.1016/s0889-5406(95)70159-1 https://doi.org/10.1016/s0889-5406(95)70... ]
4	Mandibular Body Length	Go-Me	Signifies length of mandibular base.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
5	Ramus Height	Ar-Go	Ramus height, as measured on lateral cephalogram, is the distance from the articulare to gonion.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
	Angular
6	Gonial Angle	Ar-Go-Me	Expression for the form of the mandible describes the relation between body and ramus.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
7	SNB	S-N-Pt B	This angle expresses the horizontal position of the mandible relative to the cranial base using B-point as a cephalometric landmark.	Steiner and Hills Analysis [¹¹[11] Steiner CC, Hills B. Cephalometrics for you and me. Am J Orthod 1953; 39(10):729-55. https://doi.org/10.1016/0002-9416(53)90082-7 https://doi.org/10.1016/0002-9416(53)900... ]

Upper/Lower Craniofacial Measurements
S.No	Measurement	Landmarks Used	Significance	Analysis
	Linear
1	Total Anterior Facial Height	N-Me	Describes the skeletal total facial height.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
2	Total Posterior Facial Height	S-Go	Influences facial form, both vertically and horizontally	Tweed’s Analysis [¹³[13] Tweed CH. The diagnostic facial triangle in the control of treatment objectives. Am J Orthod 1969; 55(6):651-7. https://doi.org/10.1016/0002-9416(69)90041-4 https://doi.org/10.1016/0002-9416(69)900... ]
	Angular
3	Angle of Convexity	N Pt A-Pt A Pg’	It reveals the convexity or concavity of the skeletal profile	Downs Analysis [¹⁴[14] Downs WB. Analysis of the dentofacial profile. Angle Orthod 1956; 26:191-212.]
4	Mandibular Inclination	SN-Mandibular Plane	Excessively high or low mandibular plane angles suggest unfavourable growth patterns	Bjork and Skieller [¹²[12] Bjork A, Skieller V. Facial development and tooth eruption. Am J Orthod 1972; 62(4):339-83. https://doi.org/10.1016/s0002-9416(72)90277-1 https://doi.org/10.1016/s0002-9416(72)90... ]
5	Articular Angle	S-Ar-Go	Larger angle indicates retrognathic mandible and smaller angle indicates prognathic mandible.	Bjork and Skieller [¹²[12] Bjork A, Skieller V. Facial development and tooth eruption. Am J Orthod 1972; 62(4):339-83. https://doi.org/10.1016/s0002-9416(72)90277-1 https://doi.org/10.1016/s0002-9416(72)90... ]
6	ANB	Point A-N-Point B	ANB angle measures the relative position of the maxilla to the mandible.	Steiner and Hills Analysis [¹¹[11] Steiner CC, Hills B. Cephalometrics for you and me. Am J Orthod 1953; 39(10):729-55. https://doi.org/10.1016/0002-9416(53)90082-7 https://doi.org/10.1016/0002-9416(53)900... ]

Dental Measurements
S.No	Measurement	Landmarks Used	Significance	Analysis
	Linear
1	Maxillary Anterior Dental Height	Upper Incisor to Palatal Plane	Determines the position of maxillary incisor with respect to the palatal plane.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
2	Mandibular Anterior Dental Height	Lower Incisor to Mandibular Plane	Determines the position of mandibular incisor with respect to the mandibular plane.	COGS Analysis - Burstone et al. [⁹[9] Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg 1978; 36(4):269-77.]
	Angular
3	Frankfurt’s Mandibular Incisor Angle (FMIA)	FH Plane-Lower Incisor	Determines the degree of balance and harmony between the lower face and anterior limit of the dentition	Tweed’s Analysis [¹³[13] Tweed CH. The diagnostic facial triangle in the control of treatment objectives. Am J Orthod 1969; 55(6):651-7. https://doi.org/10.1016/0002-9416(69)90041-4 https://doi.org/10.1016/0002-9416(69)900... ]
4	Incisor Mandibular Plane Angle (IMPA)	Lower Incisor-Mandibular Plane	Determines the balance and harmony in the lower facial profile. Due to the effect of lower incisors on facial esthetics and stability, it is considered a determinant of balance in lower facial harmony.	Tweed’s Analysis [¹³[13] Tweed CH. The diagnostic facial triangle in the control of treatment objectives. Am J Orthod 1969; 55(6):651-7. https://doi.org/10.1016/0002-9416(69)90041-4 https://doi.org/10.1016/0002-9416(69)900... ]
5	U1 Inclination	Upper Incisor-SN Plane	This angular measurement determines the inclination of the upper central incisor relative to the anterior cranial base.	Tweed’s Analysis [¹³[13] Tweed CH. The diagnostic facial triangle in the control of treatment objectives. Am J Orthod 1969; 55(6):651-7. https://doi.org/10.1016/0002-9416(69)90041-4 https://doi.org/10.1016/0002-9416(69)900... ]
6	Interincisal Angle	Ī-ḻ	The interincisal angulation relates the relative position of the maxillary incisor to that of the mandibular incisor.	Downs Analysis [¹⁴[14] Downs WB. Analysis of the dentofacial profile. Angle Orthod 1956; 26:191-212.]

Soft Tissue Vertical Measurements
S.No	Measurement	Landmarks Used	Significance	Analysis
	Linear
1	Upper Facial Height	G-Sn	Signifies the vertical upper facial height.	Legan and Burstone Analysis [¹⁵[15] Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980; 38(10):744-51.]
2	Lower Facial Height	Sn-Me	Signifies the vertical lower facial height.	Legan and Burstone Analysis [¹⁵[15] Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980; 38(10):744-51.]
3	Height of the Upper Lip	Sn-St	Signifies the vertical height of the upper lip.	Soft Tissue Cephalometric Analysis - Arnett et al. [¹⁶[16] Arnett GW, Jelic JS, Kim J, Cummings DR, Beress A, Worley Jr CM, et al. Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity. Am J Ortho Dentofac Orthop 1999; 116(3):239-53. https://doi.org/10.1016/s0889-5406(99)70234-9 https://doi.org/10.1016/s0889-5406(99)70... ]
4	Height of the Lower Lip, including Chin	St-Me	Signifies the vertical height of the lower lip, including chin.	Soft Tissue Cephalometric Analysis - Arnett et al. [¹⁶[16] Arnett GW, Jelic JS, Kim J, Cummings DR, Beress A, Worley Jr CM, et al. Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity. Am J Ortho Dentofac Orthop 1999; 116(3):239-53. https://doi.org/10.1016/s0889-5406(99)70234-9 https://doi.org/10.1016/s0889-5406(99)70... ]
5	Maxillary Prognathism	Vertical Plane Dropped from Glabella-Sn	Measured by drawing a perpendicular towards subnasale to the vertical plane dropped from glabella. Determines the position of soft tissue maxillary base with reference to the glabella.	Legan and Burstone Analysis [¹⁵[15] Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980; 38(10):744-51.]
6	Mandibular Prognathism	Vertical Plane Dropped from Glabella-Pg’	Measured by drawing a perpendicular towards soft tissue pogonion to the vertical plane dropped from glabella. Determines the position of soft tissue chin with reference to the glabella.	Legan and Burstone Analysis [¹⁵[15] Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980; 38(10):744-51.]
7	Upper Lip Position	Sn-Pg’ Line to Ls	It determines the amount of upper lip protrusion or retrusion	Legan and Burstone Analysis [¹⁵[15] Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980; 38(10):744-51.]
8	Lower Lip Position	Sn-Pg’ Line to Li	It determines the amount of lower lip protrusion or retrusion	Legan and Burstone Analysis [¹⁵[15] Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980; 38(10):744-51.]
	Angular
9	Cervicofacial Angle	Sn-Gn’-C	Determines the position of the mandible with respect to the maxilla	Soft Tissue Cephalometric Analysis - Arnett et al. [¹⁶[16] Arnett GW, Jelic JS, Kim J, Cummings DR, Beress A, Worley Jr CM, et al. Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity. Am J Ortho Dentofac Orthop 1999; 116(3):239-53. https://doi.org/10.1016/s0889-5406(99)70234-9 https://doi.org/10.1016/s0889-5406(99)70... ]
10	Facial Angle	G-Sn-Pg’	Describes the convexity/ concavity of the soft tissue profile thereby determining the interjaw harmony.	Legan and Burstone Analysis [¹⁵[15] Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980; 38(10):744-51.]

Upper Craniofacial Measurements	Gender	Primary Dentition	p-value
		Mean (SD)
Linear
Upper Anterior Facial Height (UAFH)	Male	40.91±3.13	0.311
Upper Anterior Facial Height (UAFH)	Female	40.09±2.27	0.311
Sagittal Growth at Nasion	Male	41.52±2.66	0.436
Sagittal Growth at Nasion	Female	40.94±2.35	0.436
Sagittal Growth at ANS	Male	46.08±2.32	0.007^* * Statistically Significant.
Sagittal Growth at ANS	Female	48.37±2.84	0.007^* * Statistically Significant.
Sagittal Growth at point A	Male	43.49±2.31	0.647
Sagittal Growth at point A	Female	43.09±1.94	0.647
Maxillary Length	Male	46.41±3.81	0.756
Maxillary Length	Female	46.69±2.29	0.756
Angular	Male
Maxillary Inclination	Female	6.93±1.21	0.292
Maxillary Inclination	Male	6.16±2.93	0.292
SNA	Female	80.26±3.74	0.776
SNA	Male	80.95±3.57	0.776

Lower Craniofacial Measurements	Gender	Primary Dentition Stage	p-value
		Mean (SD)
Linear
Lower Anterior Facial Height (LAFH)	Male	50.11±4.25	0.349
Lower Anterior Facial Height (LAFH)	Female	49.02±3.59	0.349
Sagittal Growth at Point B	Male	39.56±2.87	0.991
Sagittal Growth at Point B	Female	39.57±2.35	0.991
Sagittal Growth at - Pg	Male	40.72±2.98	0.862
Sagittal Growth at - Pg	Female	40.85±2.23	0.862
Mandibular Length	Male	62.49±3.66	0.146
Mandibular Length	Female	60.95±3.34	0.146
Ramus Height	Male	38.74±5.68	0.028^* * Statistically Significant.
Ramus Height	Female	35.79±3.02	0.028^* * Statistically Significant.
Angular
Gonial Angle	Male	128.96±4.00	0.957
Gonial Angle	Female	128.89±4.31	0.957
SNB	Male	74.11±2.95	0.008^* * Statistically Significant.
SNB	Female	76.74±3.23	0.008^* * Statistically Significant.

Upper/Lower Craniofacial Measurements	Gender	Primary Dentition Stage Mean (SD)	p-value
Linear
Total Anterior Facial Height (TAFH)	Male	94.06±3.93	0.014^* * Statistically Significant.
Total Anterior Facial Height (TAFH)	Female	91.1±3.81	0.014^* * Statistically Significant.
Total Posterior Facial Height	Male	61.89±2.52	0.001^* * Statistically Significant.
Total Posterior Facial Height	Female	58.09±2.25	0.001^* * Statistically Significant.
Angular
Facial Convexity	Male	11.19±4.44	0.249
Facial Convexity	Female	9.84±3.35	0.249
Jaw Relationship	Male	28.26±4.23	0.566
Jaw Relationship	Female	27.63±3.13	0.566
Mandibular Inclination	Male	37.07±3.94	0.001^* * Statistically Significant.
Mandibular Inclination	Female	33.63±2.69	0.001^* * Statistically Significant.
Saddle Sella Angle	Male	124.15±5.21	0.403
Saddle Sella Angle	Female	125.47±5.25	0.403
Articular Angle	Male	143.41±6.29	0.108
Articular Angle	Female	140.37±6.08	0.108
ANB	Male	5.3±1.71	0.065
ANB	Female	4.26±1.88	0.065

Variables	Gender	Primary Dentition Stage Mean (SD)	p-value
Dental Measurements
Upper Incisor to Palatal Plane (mm)	Male	21.94±1.87	0.564
Upper Incisor to Palatal Plane (mm)	Female	22.23±1.46	0.564
Lower incisor to Mandibular Plane (mm)	Male	31.02±1.79	0.702
Lower incisor to Mandibular Plane (mm)	Female	31.23±1.8	0.702
Angular Measurement
FMIA	Male	61.7±7.81	0.133
FMIA	Female	64.95±6.49	0.133
IMPA	Male	90.81±5.96	0.017^* * Statistically Significant.
IMPA	Female	89.53±5.58	0.017^* * Statistically Significant.
Upper Incisor to SN	Male	86.44±6.06	0.521
Upper Incisor to SN	Female	85.37±5.18	0.521
Interincisal Angle	Male	147.11±5.14	0.416
Interincisal Angle	Female	149.42±4.83	0.416

Soft Tissue Vertical Measurements	Gender	Primary Dentition Stage Mean (SD)	p-value
Upper Facial Height	Male	51.14±3.17	0.767
Upper Facial Height	Female	50.89±2.35
Lower Facial Height	Male	51.00±3.72	0.708
Lower Facial Height	Female	51.34±2.36
Height of Upper Lip	Male	16.2±1.77	0.062
Height of Upper Lip	Female	15.37±1.18
Height of Lower Lip Including Chin	Male	34.64±2.87	0.708
Height of Lower Lip Including Chin	Female	34.90±1.71
Maxillary Prognathism	Male	5.27±1.64	0.497
Maxillary Prognathism	Female	4.79±2.70
Mandibular Prognathism	Male	-0.69±0.30	0.716
Mandibular Prognathism	Female	-0.80±0.31
Upper Lip Position	Male	3.23±0.26	0.815
Upper Lip Position	Female	3.38±0.98
Lower Lip Position	Male	1.69±1.17	0.734
Lower Lip Position	Female	1.98±2.74
Cervicofacial Angle	Male	108.67±6.69	0.607
Cervicofacial Angle	Female	103.79±8.56
Facial Angle	Male	164.78±4.68	0.076
Facial Angle	Female	163.11±3.97

[1] Correspondence: Seema Deshmukh, Dept of Pediatric & Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India. 570023. E-mail:seema.pedo@gmail.com

Brasil

Brasil

Establishing Cephalometric Norms in Primary Dentition Using Comprehensive Craniofacial Growth Analysis - A Digital Cephalometric Study

ABSTRACT

Objective:

Material and Methods:

Results:

Conclusion: