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    Jaot 01 I 2 P 41 o

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    © All Rights Reserved
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    4 Indian Soc Pedo Prov Oent ne 200% Cephalomet norms for Bunt and Brahmin children of Dakshina Kannada based on McNamara’s analysis ‘Bhat M., * Sudha P.,» Tandon S. «, Manipal COLLEGE OF DENTAL SURGERY Computerised cephalometrics, the key technique in measuring skeletal and dental relationship was used inorder to establish norms for Bunt and Brahmin chidren of Dakshina Kannada using McNamara's analysis. Anew landmark App-Gpp distance was also evaluated and taken as a norm for Both Bunt and Brahmin chien. | (J Indian Soc Pedo Prev Dent 2001;19:2:41-51) Keywords: Computerised cephatometrics, McNamara's analysis Coinica: ecodontics na ommodonics nave seen te advent of numerous preventive as well as interceptive procedures, which allow three dimensional repositioning of almost every bony structure inthe facial region and of functional appliance therapy which presents new possibilities in the treatment of skeletal discrepancies. The craniofacial features, both skeletal and dental are either of genetic origin, nutritionally acquired (effect of dietary patterns acquired) or are specific to some ethnic, racial, sub-racial as well different community groups. In current orthodontic practice, it has become imperative for the clinician to recognise the infinite varieties of human race and craniofacial morphology in dierent ethnic groups especially in a country lke India with heterogenous ethnic, cial and religious mixtures. Richardson’ defined the term ‘ethnic group’ as a nation or population with common bond such as geographical boundary, a culture or language or being racially or historically related, whereas, race can be defined as groups of persons connected by common descent or origin; a family, tribe or people. The cephalometric norms established for Caucasians using various analysis?* show that these values differ from one race to another. The Assistant Protessor b. Prot Professor and Head, College of Dental Surgery, Mangalore, Manipat s20t and Head, cephalometric norms for American of African Origin race also reported greater mandibular inclination relative to Frankfort horizontal plane and more prognathic relation of maxilla to the anterior cranial base with incisors in a protrusive position. It was further established that Egyptian boys had a tendency towards bimaxillary dental protrusion and decreased overbite’. The Greeks have a prognathic profile, a larger upper posterior height, but the antero- posterior, vertical dimension, and cranial base angles are smalier®, Indian children differ from Western children in growth, maturation, dentition, etc. which could be due to factors morphogenetic pattern and nutritional status, therefor the cephalometric standards for one ethnic and racial group do not necessarily apply to the other ethnic or racial group’, The ultimate form of dentofacial complex is the consequence of the genetic-enviormental interaction, Where certain familial characteristics do play a role. Hence for any individual, age, sex, race or other parameters which influence facial growth can be considered. Cephalometric norms have been established using various analysis for the Indian population like for the Gujeratis,® North Indians,?"° Maharashtrians,"* Bunts,"? Gurkhas,"? ‘Madras city population, Aryo-Dravidians,"® North Indian preschool childrens,'® South Kanara Children,"” South Indians,* indo-Aryans."® Most of the analysis available today were conceived when significant alterations in craniofacial structural relationships were thought impossible. McNamara's analysis®? is sensitive not only to the position of the teeth within a given bone but also to the cranial base structures. Since growth takes place in both vertical and horizontal directions, taking any angular measurements may tend to misidentify jaw discrepancies. It uses linear measurements so that the treatment planning and diagnosis can be made easier. Computers in cephalometrics have long been applied 2 Bhat M., Sudha P, Tandon S, and were found to be more accurate and fast in data processing and digitizing?’ as compared to manual methods®2, with several advantages of computer assisted cephalometric analysis systems over manual tracing methods? ‘Sagittal jaw retationships are dificult to evaluate because of lack of validity of various methods for evaluation, especially ANB angles®25 and Wits appraisal®°272. Because of unreliability of occlusal plane to measure anteroposterior jaw relationships, the palatal plane®, appears to be discernible and a reliable stable plane 80 that maxilla and mandible could be related to each ‘other on the palatal plane to measure antero-posterior jaw relationships. The dentofacial characteristics ditter according to races and geographical locations. Therefore any knowledge gained about dentofacial characteristics according to races™ will be of interest to the orthodontists in clinically assessing and planning the treatment for specific ethnic groups. Theretore, a study was undertaken with following objectives: 1. To compare the dentofacial pattern of Bunt and Brahmin children using McNamara’s analysis and to develop a cephlometric norm for each of these groups. 2. To assess the reliability of A and B points on palatal plane (App-Bpp distance) in these groups of children. MATERIALS AND METHODS This cephalometric radiographic study was carried out in the Department of Pedodontics and Preventive Dentistry, Coltege of Dental Surgery, Manipal in association with Institute of Dental and Orthodontic Radiography, Chennai. Sample: 200 children belonging to Bunts and Brahmins of Dakshina Kannada within the age group of 10-14 years (mean ago 12.8 years) were screened. The experimental sample consisted of 40 children, 20 Brahmin afd 20 Bunts wi ‘equal distribution of sex for both the groups. The following criteria were applied to each sample before it was included in the study: The subjects had Angle's class | occlusion with normal ‘overjet and overbite, no crassbite or crowding. To ascertain the place of origin of the subject, the family linkage of ‘each subject was traced upto three generations. Families with Intercaste marriages were excluded from the study. History of any systemic disease also lod to exclusion trom study. Children with full complement of dentition were selected. Lateral cephalograms of each patients in the experimental sample were taken with a panex-EC OPG machine with a cephalostat (J. Morita Corporation Co. Japan). Tracing technique: Radiographs in which there was no intercuspation were. ot considered. Each cephalogram was placed on an illuminated tracing table, with the profile facing to the Tight side. The landmarks and points to be used in the analysis were marked with the lateral cephalogram on a polyester acetate tracing paper using 3H pencil (Fig.1) Each landmark and point was then rechecked by the ‘guide and then the landmarks and points that were traced on the tracing paper was kept on the digitizer and were digitized by the digitizer on a computer and later on cephalometric analysis were done by the use of computer. The computer system at the computer centre had the following configuration: ‘The hardware consisted of a PC486 with a 20MB hard disk and a floppy drive, EGA monitor (Fig.2), Digitizer- Houston Hipad (Fig.3), a Houston Plotter and a NEC printer (Fig. 4) ‘The basic software used was autocad with Lisp facilites. A programme was written to suit our specific needs, The landmarks and angles used for McNamara's analysis which were/ identified and digitized are depicted in Fig 5 All the obtained data was put to statistical analysis by the computer to obtain mean, standard deviation, for each Parameter. A comparison was done between the groups ‘namely Group | Brahmins (boys and girls), and Group Il Bunts (boys and gitls) using student ‘t’ test and p value for each of the parameter was calculated. Then group | was divided into subgroups A and B i.e, Brahmin girls ‘and Brahmin boys respectively. Group Il was divided into subgroups C and D i.e, Bunt girls and Bunt boys respectively. After the comparison between various subgroups, statistical analysis using Oneway Analysis of Variance was carried out. RESULTS AND DISCUSSION ‘The overall mean values of various parameters used in McNamara’s analysis as well as App-Bpp distances between group | and group Il as well as between various ‘Hiedian See Pade Prov Dent June 200 8 Figure 1, Matevals used with Memitied lanamarks on the vacig Figure 2 EGA monter paper Figure 4: NEC printer subgroups (A,B,C,D) are tabulated in Tables 1 to 6 respectively, 1. Nasion perpendicular to point A (mm): It usually indicates the antero-posterior position of maxilla relative to nasion perpendicular. In a well balanced face, point A should be on or slightly ahead of this line. An increase will indicate maxilary prognathism and decrease will Indicate maxillary retregnathism. In the presant study Figure 5: Landmarks ana anges used for weNvamara’s analysis wricn were identified and digieted maxillary prognatiiem wae marked in bunt childron to that of Brahmin children with mean values showing 4.11 Table 1 : Cepalometric norms for Brahmins and Bunts, (boys and girls) based on McNamara's pat Group | ~ Brahmins (boys and girls) Group Il - Bunts (boys and girls) Parameters Group | Group T Value ‘pivalue Mean SD Mean SD Nasion perpendicular to point A an 72 41 162 6.03 P<0.0018 Effective mandibular length (mm) Condylion to Gnathion 109.85 2.72 109.19 7.10 39 pP0.05 * Effective midtacial length (mm) Condylion to point A 85.36 398 © 89.58 360 «= 3.51 P<0.0014 Maxillo-mandibular differential (mm) 2124 210 2141 481 0.13 p>0.05* Lower anterior facial height (mm) ‘ANS to Menton 62.40 4.44 6588 231 3.11 P0.05* Pogonion to nasion perpendicular (mm) 492 217 789 8.27 3.04 P00 ® Upper incisor to point A vertical (mm) 443° 198 6412.14 3.48 PeO.0014 Lower incisor to A-Po line (rm) ger 171 394 177 0.23 0.05 * Upper pharynx (mm) 12.94 4.38 11.92 953 0.94 p>0.05* Lower pharynx (mm) 19.22 3.08 11.64 282 1.69 p>0.05* + Highty significant “significant ——_* Not significant Table 2 : App-Bpp distance values for Brahmins and Bunts Group |- Brahmins. Group i ~ Bunts Parameters Group | Group I! Value pvalue Mean SD Mean SD ‘App-Bpp distance (mm) 743-253-820 2191.43 pPO.05* * Not significant ‘Fiadian Soe Pode Prev Dent June 2001 “6 Table 3 : Comparison of measurements between Brahmins and Bunts (boys and girls) Parameters. Subgroup B (Brahmin boys) Mean sD ‘Subgroup ¢ (Bunt girls) Mean SD P value Subgroup A Subgroup D (Brahmin ils) (Bunt boys) Mean SD Mean SD P Value Nasion perpendicular to point A Effective mandibular tength (mm) Condylion to Gnathion Ettective midtaciat length (mm) Condylion to point A Maxillo-mandibular differential (mm) Lower anterior facial height (mm) ANS to Menton Mandibular plane angle Facial axis angle Pogonion to Nasion perpendicular (mms.16 Upper incisor to point A vertical (mm) Lower incisor to Po line (mm) Upper pharynx (mm) Lower pharynx (mm) 1.93 109.51 85.25 21.58 63.16 27.37 89.08 2.18 474 422 11.76 13.93 0.75 4.34 3.29105.28 4.79 81.51 2.34 19.17 483 64.87 3.62 29.91 3.40 87.10 8.22 3.29P>0.05 * 1.63 6.59 1.63 4.39 5.65 10.32 3.16 11.22 2.13 3.57 2.85 4.82 1.94 2.23 1.67 2.01 1a 3.33 2.85 P<0.05® 2.30 p>0.05 * 110.20 P>0.05* 85.47 0.05 * 20.93 P>0.05* 61.84 20.05 * 27.41 pP0.05 * 90.32 468 225 p05 4.11 p05" 3.41 pP0.05 * 12.92 0.05 * 12.51 0.67 2.12 3.24 3.64 413 4.36 351 6.96 1.08 17 277 2.98 3.88 113.10 89.64 23.65 66.89 25.94 89.37 3.30 6.23 3.49 13.51 12.06 0.94 P<0,05% 7.73 p>0.05 * 437 3.81 2.29 2.42 2.49 P>0.05 * 2.38 2.04 3.09 2.87 P>0.05 * 0.05 * P<0.05 1 0.05 * 0.05 * 0.05 * 0.05 * 0.05 * 0.05 * ‘Significant * Not significant Table 4: Comparison of measurements between Brahmins and Bunts (boys and girls) Parameters ‘Subgroup A ‘Subgroup Cp value Subgroup 8 Subgroup D (Brahmin girls) (Bunt girls) (Brahmin boys) (Bunt boys) Mean SD Mean SD Mean SD Mean SD p Value Nasion Perpendicular to point A 230 087 434 213 P<0.05 193 075 9.88 Effective mandibular length (mm) Condylion to Gnathion 110.20 2.12105.28 3.57 pP0.05* 108.51 3.29 113.10 Effective midfacial length (mm) Condytion to point A 85.47 3.24 89.51 285 P>0.05* 85.25 4.79 89.64 Maxillo- mandibular differentia! (mm) 2093 364 9.17 4.82 pP0.05* 21.56 2.94 29.65 Lower anterior facial height (mm) ANS to Menton 61.64 4.19 64.87 1.94 P>0.05* 63.16 4.83 66.89 Mandibular plano angle 2741 4.96 20.31 223 pP0.05* 2797 3.62 25.94 Facial axis angle 90.32 3.51 8710 1.67 p>0.05* 89.08 3.40 ° 89.37 Pogonion to Nasion Perpendicular (mm) 468 225 822 9.29 P0.05* 1393 3.16 12.06 0.94 7.73 4.37 3.81 2.29 2.42 2.49 3.30 2.36 2.04 3.09 2.87 P<0.051 P<0.05 i P>0.05 * 0.05 * P>0.05 * p>0.05 * 0.05 * P>0.05 * P>0.05 * 0.05 * 0.08 * 0.05 * ‘Significant * Not significant 4 indian S0e Pedo Prov Dent June 200% a Table § : Comparison of measurements between Brahmins and Bunts (boys and girls) Parameters ‘Subgroup A ‘Subgroup Cp value Subgroup B Subgroup Dp Value (Brahmin girls) (Bunt girls) (Brahmin boys) (Bunt boys) Mean SD Mean SD Mean SD Mean SD Nasion Perpendicular to point A 434 213 3.88 0.94 P>0.05* 230 067 1.93 0.75 P>0.05* Effective mandibular length (mm) Condylion to Gnathion 105.28 © 3.57113.10 7.73 P<0.051110.20 2.12 109.51 3.30 P>0.05* Effective midtacial length (mm) Condytion to point A 89.51 2.85 89.64 4.37 P>0.05* 85.47 3.24 85.25 4.79 P>0.05* Maxillo- mandibular differential (mm) 19.17 4.82 23.65 3.81 p>0.05* 2093 3.64 21.56 2.34 p>0.05* Lower anterior facial height (mm) ANS to Menton 61.87 1.94 66.89 2.29 P»0.05* 61.64 413 63.16 4.83 P>0.05* Mandibular plane angle 29.31 2.23 25.94 2.42 p>0.05* 27.41 4.96 27.97 9.62 p>0.05* Facial axis angle 87.01 1.67 89.37 2.49 p>0.05* 90.32 351 89.08 3.40 p>0.05* Pogonion to Nasion Perpendicular (mm) 822 9.29 6.96 330 P>0.05* 468 225 516 2.18 P>0.05* Upper incisor to point A vertical (mm) 6.69 2.01 6.23 2.38 P>0.05* 411 1.06 474 1.63 P>0.05* Lower incisor to A-Po line (mm) 438 141 349 2.04 p>005* 341 1.77 422 1.63 p>0.05* Upper pharynx (mm) 10.32 9.33 19.51 3.09 p>0.05* 1292 2.77 11.76 5.65 p>0.05* Lower pharynx (mm) 11.22 2.85 12.08 2.87 p>0.05* 1251 2.98 1393 3.16 p>0.05* ‘Significant * Not significant es ‘Bhat M Sudha P, Tandon 6 ‘Table 6 : Comparison of App-Bpp distance values for various subgroups (A,8,C,0) Parameter - App-8pp distance (mm) ‘Subgroup B ‘Subgroup D P value Mean SD Mean SD 776 2.52 824 2.73 0.05 * ‘Subgroup B Subgroup C Mean SD. Mean SD 776 2.52 815 1.69 p>0.05 * ‘Subgroup A ‘Subgroup D Mean SD Mean SD 650 2.51 a24 273 0.05 * ‘Subgroup A Subgroup C Mean SD Mean SD 650 251 815 1.63 p>0.05 * ‘Subgroup C Subgroup D Mean SD Mean SD 815 1.63 824 2.73 p>0.05 * ‘Subgroup A Subgroup B Mean SD Mean SD 650 251 7.76 2.52 20.05 * * = Not significant mm 4 1.62 and 2.11 2 0.72 respectively (Table 1), which ‘agreement to that reported by Thomas and Valiathan'®, who observed that South Indian children especially have advanced maxilla than to that of North Indian chitdren Various studies® explaining that increased masticatory function with increased condylar growth and cranial base which may lead to protrusive maxillary base is similar to ‘observations being made in the present study. Korath ‘and Tandon"? also reported protrusive maxillary bases, especially in females of South Kanara children which is in concurrent with the present study. 2. Effective mandibular length: Effective mandibular length is used to indicate a small or a large mandible. Average measurements with respective ages were given by McNamara®. This measurement averages a minimum of 105 mm + 6.0 to a maximum of 120 mm to 130 mm + 6.0. An increase will indicate a longer mandible like in class ill and decrease will indicate 1a smaller mandible like in class I cases. In the present study when intergroup comparison was done between Bunt boys to Bunt girls the effective mandibular length was found to be greater in Bunt boys than the Bunt girls in comparison to overall Brahmin children (Table 5). Thomas and Valiathan'® showed maximum values for effective mandibular length on adult South Indian and North indian population, with South Indians showing longer mandible than North indians. The larger mandibular length in Bunts could be due to a resultant of te forces generated during mastication with hard and fibrous

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