You are on page 1of 4


discussions, stats, and author profiles for this publication at:

Cephalometric Study of Pakistani Population

Using McNamara Analysis

Article in International Medical Journal (1994) · February 2017


0 103

8 authors, including:

Mohammad Khursheed Alam Irfan Qamruddin

Al-Jouf University Aga Khan University, Pakistan


Some of the authors of this publication are also working on these related projects:

Prevalence of Third Molar Agenesis, Impaction and Mandibular Morphology in Bangladeshi

Population View project

Effect of outdoor weathering on Surface topography and Physical properties of maxillofacial

prosthetic silicone elastomers subjected to Malaysian environment. View project

All content following this page was uploaded by Mohammad Khursheed Alam on 23 April 2017.

The user has requested enhancement of the downloaded file.

144 International Medical Journal Vol. 24, No. 1, pp. 144 - 146 , February 2017

Cephalometric Study of Pakistani Population Using

McNamara Analysis

Shafiqullah Azad Khan1), Parwiz Akhtar Mohammad1), Jawaria Tariq1),

Fahad khan1), Talha Khursheed2), Sabahat Jehan2),
Mohammad Khursheed Alam3), Irfan Qamruddin1)

Objectives: To determine cephalometric norms of Pakistani population according to McNamara's analysis and to evaluate
differences existing between Pakistani adult male and females and to compare the mean difference between present study and
established values of McNamara’s norms.
Materials and methods: The present study was carried out on 100 standardized lateral cephalometric radiographs. The sub-
jects included 40 males and 60 females. The ages of the subjects ranged from 15 to 30 years with the mean age of 22.5 years. The
criteria of selection were Class I incisor relationship without any crowding, no skeletal abnormality, and no previous orthodon-
tic treatment. Lateral cephalometric radiographs were traced and produced the values to assess the McNamara's Variables.
Results: There was a significant difference between the genders in some values. Generally in Pakistani males, both the maxil-
la and mandible were positioned forward. The values were consistently larger than the McNamara's established cephalometric
Conclusion: The cephalometric norms are specific for race and gender. The values provided here would aid in the diagnosis
and treatment planning of orthodontic/orthognathic patients of Pakistani adults.

lateral cephalometric radiographs, cephalometric norms, Pakistani adults, McNamara's analysis

INTRODUCTION and ethnic groups (McNamara 1984, Conner et al 1985, Lew et al

1992). To date cephalometric norms for Pakistani population using
McNamara analysis has not been established. The main purpose of this
The assessment of craniofacial anatomy is an indispensible practice study is to determine cephalometric norms (Alam et al. 2012b) in
in research and clinical practice and can be achieved by different meth- Pakistani adults according to McNamara analysis and to compare mean
ods. Cephalometric radiographs are most commonly used for this difference with McNamara norms of both males and females.
approach. Cephalometric radiographs are not only important in diagno-
sis and treatment planning in orthodontics but also help clinicians to
predict and evaluate the final outcome of treatment (Alam et al 2013a, SUBJECT AND METHOD
Alam et al 2013b). Usual practice is to measure and analyze the cranio-
facial morphology of the person (Alam et al. 2014) who is under inves-
tigation and to compare with the established norms. Studies show that This study included collection and analysis of cephalometric radio-
'norms' should be based on ethnicity, sex and age difference (Alam et al. graphs of patients (students and non teaching staffs) from the depart-
2012 d). Studies have shown that there is significant difference (Alam et ment of orthodontics, Baqai Dental Collage and hospital. The age was
al. 2013a) in the craniofacial features among various populations due to ranging from 15 to 30 (mean age 22.5) years. Selection criteria was
ethnicity (Alam et al 2012a). Since the principal of cephalometric anal- patients with full dentition from second molar to second molar with nor-
ysis is to compare the patient's measurements (Alam et al. 2013b) with mal occlusion, based on the British standards institutes (Stephens &
normal reference group (Alam et al 2014) therefore the analysis of the Williams 1992). Occlusion satisfying the requirements of functions and
patient should be compared with his own racial and ethnic group esthetic with the class 1 incisor relationship (lower incisors edges
(Qamruddin et al 2012). occludes below the cingulum plateau of the upper central incisors). No
Genetics play a major role in producing the face and dentition previous orthodontic treatment history. Patients with crowding or skele-
(Mills 1982). The variations of different populations in their craniofacial tal malocclusions were excluded. All the subjects had Pakistani back-
morphology motivate researchers to investigate the cephalometric ground since three generations without any history of interracial mar-
norms (Alam et al. 2012b, 2012c and 2013c) of different populations riages.

Received on July 29, 2015 and accepted on March 17, 2016

1) Orthodontic Department, Baqai Medical University Karachi, Pakistan
2) Liaquat College of Medicine and Dentistry
Karachi, Pakistan
3) College of Dentistry, Al Jouf University
Sakaka, Kingdom of Saudi Arabia
Correspondence to: Irfan Qamruddin

C 2017 Japan Health Sciences University

& Japan International Cultural Exchange Foundation
Alam M. K. et al. 145

Table 1. Comparison of McNamara's variables between Table 2. Craniofacial morphology of Pakistani population
Pakistani males and females and McNamara's established values
Variables Number Gender Mean SD Mean p Present study McNamara's
Difference value established values
Mc- A 40 M 0.65 0.05 0.207 0.002 Variables Mean SD Mean SD
60 F 0.45 0.08 Mc- A M0 0.53 0.12 0.75 2.50
Mid F. 40 M 97.89 3.92 0.990 0.555 Mid F. Length 97.30 2.40 95.40 5.15
Length Mc- Pog 0.21 0.05 -1.05 4.15
60 F 96.90 0.81 Man. Length 134.01 2.33 127.25 6.05
Mc- Pog 40 M 0.23 0.02 0.040 0.285 Max. Man. Difference 36.71 2.08 31.85 3.65
60 F 0.19 0.06 LAFH 76.03 2.29 70.65 4.55
Man. 40 M 133.66 0.63 -0.585 0.721 MPA 22.70 1.63 22.00 4.10
Length U1A 4.28 0.38 5.35 1.85
60 F 134.24 3.06 L1APog 3.21 0.38 2.00 2.25
Max. Man. 40 M 35.76 4.08 -1.576 0.546
60 F 37.34 3.74
LAFH 40 M 76.00 1.66 -0.052 0.974
60 F 76.06 2.79
Samples of untreated Pakistani adult male and female were com-
MPA 40 M 23.50 1.29 1.333 0.226 pared to determine cephalometric norms using Mcnamara's analysis
60 F 22.16 1.72 (McNamara 1984). The samples were from skeletal class I students and
dental patients with the age group between 18 to 24 years. The sample
U1A 40 M 4.40 0.41 0.204 0.447 size in this study was 100 which were greater than many of the previous
60 F 4.19 0.38 studies (Foo and Woon, 1983 and 1984, Miyajima et al. 1996, Ji-Hwan
et al. 2011, Purmal et al. 2012). However the sample size was similar to
L1APog 40 M 3.34 0.47 0.201 0.451
the study conducted in Bangladeshi population (Alam et al, 2013a).
60 F 3.13 0.33 Subjects with normal occlusion, full dentition from second molar to sec-
ond molar, had no previous orthodontic treatment, no skeletal abnormal-
ity and no incisor crowding were used. The mean values for Pakistani
adults were quite different in almost all measurable parameters when
A total of 100 standardized lateral cephalometric radiographs (40 compared to the means of McNamara's norms (McNamara 1984). In
males and 60 females) were analyzed in this study. Analysis was accom- Pakistani population all the variables showed insignificant difference.
plished according to McNamara analytic rules. Each one was positioned There is a significant difference in the readings of mandible which
in the cephalostat with the head oriented to the Frankfort horizontal shows that the mandible is positioned forward in Pakistani population if
plane and the teeth in centric occlusion relation with the lips relaxed. compared with McNamara established values. This gives a clinical
Tracing accomplished in a systemic manner with smooth continuous impression of Class III skeletal pattern among the Pakistani population
pressure on the pencil without stopping and lifting pencil. Single handed (McNamara 1984). These features, we assume are the reason for
radiographs and tracing. Eraser was avoided as much as possible. All patients to seek orthodontic/orthognathic treatment and resemble the
points were standardized and oriented to the Frankfort horizontal plane Caucasian profile. Similar findings have been reported in the African-
(Ricketts et al 1976). American race (Huang et al. 1998), the maxillary and alveolar protru-
sions are greater with more opened interincisal angle, which confer a
Control of error more convex profile in comparison with any other race. The Asian pop-
ulation of both genders shows bimaxillary characteristics of dental pro-
The validity of the method was analyzed by calculating the trusion, according to Talib et al. (2014) and Wu et al. (2007) in a
Dalhberg's formula, ME = (x1 - x2)/2n, for determination between two Chinese population, Moldez et al. (2006) in a Japanese population, and
measurement made at least a month apart in which x1 was the first mea- Sevilla and Rudzki (2005) in a Philippine population. Previous cephalo-
surement and x2 was the second measurement, and the number of metric studies show that there are measurable skeletal and dental differ-
repeated records (Houston WJB, 1983). Twenty randomly selected later- ences between racial groups. Ethnic facial features of the patients play a
al cephalometric radiographs were rechecked to calculate the method vital role in setting objectives for successful orthodontic treatment and
error. therefore should be highly considered. In order to achieve an esthetical-
ly pleasing face, each different population would be best treated accord-
ing to its individual's characteristics. It is indispensable to use a special
Statistical analysis
standard for each age group, genders and population. The established
After data collection, it was analyzed statistically using SPSS 20 norms should be used as a reference in the orthodontic/orthognathic
(Chicago, USA) program, with confidence level set at 5% (p < 0.05) to treatment of Pakistani adults.
test for significance among the sexes. Sexual dimorphism was evaluated
by the t-test.
Alam MK, Basri R, Purmal K, et al. (2013a). Cephalometric for orthognathic surgery
(COGS) for Bangladeshi population. International Medical Journal, 20, 345-348.
Descriptive statistic (means and standard deviation) of Pakistani Alam MK, Basri R, Purmal K, et al. (2013b). Cephalometric lip morphology in Bangladeshi
population and comparison with McNamara established values are population. International Medical Journal, 20, 201-203.
shown in table 1. Aziz A, Shaheera N, Ab Talib M, et al. (2014). Linear and angular cephalometric lip mor-
Comparison of Pakistani males and females is depicted in table 2. phology in Malaysian Chinese population. International Medical Journal, 21, 45-48.
The mean values of the McNamara variables for Pakistani males Alam MK, Basri R, Purmal K, et al. (2012d). A soft tissue cephalometric analysis for
were larger than females. All the variables had insignificant sexual Bangladeshi adult using Holdway's analysis. International Medical Journal, 19, 333-
dimorphism. 336.
146 McNamara Cephalometric Analysis

Alam MK, Basri R, Purmal K, (2013a). Cephalometric norm study in a Bangladeshi popula- Houston WJB. (1983). The analysis of error in orthodontic measurements. Am J
tion using Mcnamara analysis. International Medical Journal, 20, 84-86. Orthodontics, 83, 382-390.
Alam MK, Basri R, Purmal K, et al. (2012a). Cephalometric evaluation for Bangladeshi Foo GC, Woon KC. (1983). Some cephalometric norms in young adult Malaysian Chinese
adult by Steiner analysis. International Medical Journal, 19, 262-265. male with harmonious facial appearances. Dent J Mal, 6, 113-116.
Alam MK, Basri R, Purmal K, et al. (2013b). Cephalometric norms in Bangladeshi adults Foo GC, Woon KC. (1984). Some cephalometric norms in young adult Malaysian Chinese
using Harvold’s analysis. International Medical Journal, 20, 92-94. female with harmonious facial appearances. Dent J Mal, 7, 33-39.
Alam MK, Qamruddin I, Muraoka R, et al. (2014). Validity of W Angle and YEN Angle in Miyajima K, McNamara JA, Kimura T, et al. (1996). Craniofacial structure of Japanese and
a sample from Pakistani and Bangladeshi populations. Journal Hard Tissue Biology, European-American adults with normal occlusions and well-balanced faces. Am J
23, 351-356. Orthod Dentofacial Orthop, 110, 431-438.
Qamruddin I, Shahid F, Firzok H, et al. (2012). Beta angle: a cephalometric analysis per- Ji-Hwan K, Odontuya G, Bazar A, et al. (2011). Comparison of cephalometric norms
formed in a sample of Pakistan population. JPDA, 21, 206. between Mongolian and Korean adults with normal occlusions and wellbalanced pro-
Mills JR. (1982). Principles and practice of orthodontics. London: Churchill Livingstone, files. Korean J Orthod, 41(1), 42-50.
Longman Group Ltd. Purmal K, Mohammad KA, Norzakiah MZ. (2012). Cephalometric norms of Malaysian
Alam MK, Basri R, Purmal K, et al. (2012c). Determining cephalometric norms for adult Indian. International Medical Journal.
Bangladeshi adults using Bjork-Jarabak's analysis. International Medical Journal, 19, Huang WJ, Taylor RW, Dasanayake A. (1998). Determining cephalometric norms for
329-332. Caucasians and African Americans in Birmingham. Angle Orthod, 68(6), 503-12.
Alam MK, Basri R, Purmal K, et al. (2013c). Craniofacial morphology of Bangladeshi Talib MA, Aziz A, Shaheera N, et al. (2014). Linear and angular cephalometric measure-
adult using Tweed's and Wit's analysis. International Medical Journal, 20, 197-200. ment of lip morphology among Malaysian Malay. International Medical Journal, 21,
Alam MK, Basri R, Kathiravan P, et al. (2012b). Cephalometric evaluation for Bangladeshi 41-44.
adult by Down's analysis. International Medical Journal, 19, 258-261. Wu J. Urban H, Barkr AM. (2007). Chinese norms of McNamara's cephalometric analysis.
McNamara JA. (1984). A method of cephalometric evaluation. Am J Orthod, 86, 449-469. Angle Orthod, 77(1), 12-20.
Conner AM, Moshiri F. (1985). Orthognathic surgery norms for American black patients. Moldez MA, Sato K, Sugawara J, et al. (2006). Linear and angular Filipino cephalometric
Am J Orthod, 87, 119-134. norms according to age and sex. Angle Orthod, 76(5), 800- 5.
Lew KK, Ho KK, Keng SB, et al. (1992). Soft-tissue cephalometric norms in Chinese Sevilla NMA, Rudzki JI. (2005). Cephalometric features of Filipinos with angle class I
adults with esthetic facial profiles. J Oral Maxillofac Surg, 50, 1184-11. occlusion according to the Munich analysis. Angle Orthod, 75(1), 63-8.

View publication stats