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A Comparative Evaluation between Cheiloscopic Patterns and Terminal Planes

in Primary Dentition

Article  in  Contemporary Clinical Dentistry · October 2017

DOI: 10.4103/ccd.ccd_48_17

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Saveetha University Meenakshi Ammal Dental College & Hospital
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Original Article

A Comparative Evaluation between Cheiloscopic Patterns and Terminal

Planes in Primary Dentition

Abstract R Vignesh,
Objective: To assess the correlation between different cheiloscopic patterns with the terminal C Vishnu Rekha,
planes in deciduous dentition. Materials and Methods: Three hundred children who are 3–6  years Sankar Annamalai,
old with complete primary dentition were recruited, and the pattern of molar terminal plane was
recorded in the pro forma. Lip prints of these children were recorded with lipstick‑cellophane Parisa Norouzi,
method, and the middle 10  mm of lower lip was analyzed for the lip print pattern as suggested Ditto Sharmin
by Sivapathasundharam et  al. The pattern was classified based on Tsuchihashi and Suzuki Department of Pediatric and
classification. Results: Type  II  (branched) pattern was the most predominant cheiloscopic pattern. Preventive Dentistry, Meenakshi
The predominant patterns which related to the terminal planes were as follows: Type  IV  (reticular) Ammal Dental College and
Hospital, Chennai, Tamil Nadu,
and Type  V  (irregular) pattern for mesial step, Type  IV  (reticular) pattern for distal step, and
India
Type  I  (complete vertical) pattern for flush terminal plane. No significant relationship was obtained
on gender comparison. Conclusion: Lip prints can provide an alternative to dermatoglyphics to
predict the terminal plane in primary dentition. Further studies with larger sample size are required
to provide an insight into its significant correlations.

Keywords: Cheiloscopy, primary dentition, terminal planes

Introduction Materials and Methods

Childhood is the mirror in which the
propensities of adulthood are reflected;
similarly, the type of occlusal characteristics
in primary dentition predicts the occlusal
relationship of the succedaneous dentition.[1]
The understanding of the anteroposterior
changes which occur in between the
primary and permanent dentition is crucial,
particularly for the clinicians involved in
interceptive and preventive orthodontics.[2]
The terminal plane in deciduous dentition
is widely known to have some important
bearing on the development of a normal
occlusal relationship in the permanent
dentition,[3] as any development of
malocclusion primarily starts with the
deciduous dentition. Cheiloscopy is one of
the analytical tools that are used in forensic
dentistry. Studies were performed to assess
the link between these lip prints and
permanent occlusal relationship,[4‑6] but its
association with terminal plane of primary
dentition has not been reported. Hence, this
study was aimed to assess the correlation
between different cheiloscopic patterns with
the terminal planes in deciduous dentition.
This is an open access article distributed under the terms of the
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For reprints contact: reprints@medknow.com
The present study was conducted among
a total of 300 children who were aged
3–6  years attending the Department of
Pediatric and Preventive Dentistry. Ethical
clearance was obtained from institutional
review board. The purpose and procedures
of the study were explained to the
parents/guardians, and informed consent
was obtained to participate in the study.
Inclusion criteria were children with
completely erupted primary dentition.
Exclusion criteria were previous history
of orthodontic treatment, initiation of
first transitional period, previous history
of burn or chemical injury or lesions
on lips, different molar relationships on
either side of the same individual, children Address for correspondence:
Dr. R Vignesh,
with grossly decayed teeth or proximal 131, Medavakkam Tank Road,
caries or premature extraction of primary Kilpauk, Chennai ‑ 600 010,
teeth affecting the molar relation, and Tamil Nadu, India.
uncooperative children. Two calibrated E‑mail: dhanam61@yahoo.co.in
examiners (two of the authors) were trained
to assess the molar relationships based on
Access this article online
the classification given by Baume,[7] as
Website:
mesial step, distal step, and flush terminal www.contempclindent.org
plane. Examination was done using a mouth DOI: 10.4103/ccd.ccd_48_17
mirror and recorded in the pro forma. Quick Response Code:
How to cite this article: Vignesh R, Rekha CV,
Annamalai S, Norouzi P, Sharmin D. A comparative
evaluation between cheiloscopic patterns and terminal
planes in primary dentition. Contemp Clin Dent
2017;8:522-5.

© 2017 Contemporary Clinical Dentistry | Published by Wolters Kluwer - Medknow 522

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Vignesh, et al.: Cheiloscopy and terminal planes in primary dentition

Under each terminal plane, 100 children were taken so as predominant cheiloscopic pattern which was equally
to standardize the number of children under each group; distributed among children with primary dentition.
thereby, the results can be closely related to the patterns An increase in Type IV (reticular) and Type V (irregular)
obtained. patterns was seen in children with mesial step. Type  IV
(reticular) pattern was seen in higher frequency in
Lip print was recorded using the lipstick-cellophane
distal step. Among children with flush terminal plane,
technique as proposed by Sivapathasundaram et al.[8] which
Type  I  (complete vertical) pattern was predominantly
provides good clarity and accuracy.[9] Matte finish lipstick
seen [Table  1]. There was no statistically significant
was applied with disposable cotton buds as suggested by
relationship seen in all three molar patterns when
Amith et al.[10] Children were asked to rub their lips gently
compared with the cheiloscopic patterns  (P  =  0.345). On
against one another and then to keep their lips in rest
comparing between genders, no statistically significant
position. The glue part of the cellophane sheet is placed relationship was noted [Table 2].
over the lips. After few seconds, the cellophane sheet
with lip print was carefully removed and was stuck onto a Discussion
bonded white paper [Figure 1]. Lip print was checked for
clarity, and if any smudging of the print was noticed, the Every human is distinct and unique in the pattern of
procedure was repeated once again. Children were asked to characteristics they exhibit. Lip prints are lines and
wipe off the remnant lipstick using wet tissue paper. fissures that appear as wrinkles and grooves in the zone
of transition between the inner labial mucosa and the outer
The collected lip prints were analyzed using a magnifying skin of human lip. The examination of these fissures is
glass by a forensic specialist who was not involved in the referred to as “cheiloscopy.”[8,12] Although its existence
collection of prints and also was not disclosed about the was noticed as early as 1902, its importance did not reach
terminal planes, thereby blinded from the data obtained. the researchers until it was found in a scene of murder.
The analyst read the lip prints based on the classification
given by Suzuki and Tsuchihashi in 1971.[11] Table 1: Cheiloscopic distribution in primary dentition
• Type  I: Clear‑cut vertical grooves that run across the Cheiloscopic Mesial Distal step, Flush terminal P
entire lips pattern step, n (%) n (%) plane, n (%)
• Type  I’: Similar to Type  I, but do not cover the entire I 8 (8.0) 10 (10.0) 15 (15.0) 0.345
lip I’ 1 (1.0) 2 (2.0) 2 (2.0)
• Type II: Branched grooves II 67 (67.0) 69 (69.0) 66 (66.0)
• Type III: Intersected grooves III 1 (1.0) 3 (3.0) 0
• Type IV: Reticular grooves IV 14 (14.0) 14 (14.0) 11 (11.0)
• Type  V: Grooves do not fall into any of the V 9 (9.0) 2 (2.0) 6 (6.0)
types, i.e.,  Type  I–IV, and cannot be differentiated
morphologically.
Table 2: Gender comparison on distribution of
The middle part of the lower lip (10‑mm wide) was taken as cheiloscopic pattern in primary dentition
the study area, similar to the study by Sivapathasundharam Molar Pattern Gender P
et  al.[8] Lip print pattern was determined by counting the Male, n (%) Female, n (%)
highest number of patterns in the above‑mentioned region. Mesial step I 6 (15.4) 2 (3.3) 0.311
Statistical analysis I’ 0 1 (1.6)
II 25 (64.1) 42 (68.9)
The data values were tabulated and subjected to statistical III 0 1 (1.6)
analysis. For comparison of proportions between all the IV 5 (12.8) 9 (14.8)
groups and also between genders, Chi‑square test was V 3 (7.7) 6 (9.8)
applied. Fisher’s exact test was used when any expected Distal step I 7 (15.6) 3 (5.5) 0.168
cell frequency <5 was obtained.    SPSS version 22.0 (SPSS I’ 0 2 (3.6)
Inc., Chicago, IL, USA)  was used to analyze the data. II 28 (62.2) 41 (74.5)
A P < 0.05 is considered as statistically significant. III 2 (4.4) 1 (1.8)
IV 6 (13.3) 8 (14.5)
Results V 2 (4.4) 0
The mean age of the children was 4.99  ±  0.67  years. Flush terminal I 12 (21.1) 3 (7.0) 0.191
For the children having mesial step, 61% were females plane I’ 1 (1.8) 1 (2.3)
and 39% were males. Among the children having distal II 36 (63.2) 30 (69.8)
step, 55% were females and 45% were males. In children III 0 0
having flush terminal plane, 43% were females and IV 4 (7.0) 7 (16.3)
57% were males. Type  II  (branched) pattern is the most V 4 (7.0) 2 (4.7)

523 Contemporary Clinical Dentistry | Volume 8 | Issue 4 | October ‑ December 2017

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Vignesh, et al.: Cheiloscopy and terminal planes in primary dentition
Figure 1: Method to record lip prints
These patterns, as they are analogous to the prints that are
found in the palms and digits, gained popularity for sex
determination in the field of forensics. The development
of lip, alveolus, and palate occurs at the same period,
i.e., 24th  week of intrauterine life and also from the
same embryonic origin. Any factor that tends to affect
the development of a particular structure will ultimately
affect all the other structures that develop along with it.
Hence, there is a possibility for the developmental changes
that occur in relation to alveolus to be reflected in the
cheiloscopic patterns. This was the basis of analyzing
the terminal plane of primary molars with the different
cheiloscopic patterns.
Cheiloscopic patterns were analyzed for skeletal
malocclusions, but the literature search shows no studies
relating to terminal planes in primary dentition. This study
is an initial attempt to relate them as the terminal plane
of the primary second molars plays a significant role in
determining the occlusion of the permanent dentition.[3,13]
Chukwudi et al. showed that 68.7% of individuals initially
having a flush terminal plane relationship resulted in a
Class  I molar relationship, 61.1% of individuals who
initially had a mesial step relationship became a Class  I
molar relationship, while 27.8% resulted in a Class  III
relationship.[14] Since the primary dentition provides
the framework and foundation for proper eruption and
alignment of the permanent dentition, the prediction
of the terminal planes can help the pediatric dentist in
maintaining a favorable plane which may get affected by
other environmental factors such as dental caries.
The results of the current study have helped us to predict
certain patterns which might be related to specific
terminal planes. In our study, among cheiloscopic patterns,
Type  II  (branched) pattern was predominant among all
the children. This was in accordance to the study done by
Raghav et al.[4] and Madhusudan et al.,[15] who reported the
same predominance in individuals with complete permanent
dentition. The patterns that were seen predominantly in
children with mesial step are both Type  IV  (reticular) and
Type  V  (irregular) patterns, with the predominant pattern
seen in children with distal step being Type  IV  (reticular)
pattern and for flush terminal plane being Type I (complete
vertical) pattern.
Contemporary Clinical Dentistry | Volume 8 | Issue 4 | October ‑ December 2017
These results have provided an insight into specific
cheiloscopic patterns which could be used as an anatomical
tool, thereby helping to predict the future terminal plane of
the primary dentition. This could help the dental practitioner
to establish necessary measures to ensure no further loss
of space occurs which could worsen the situation, if any.
Since we could not elicit any statistical significance, we
acknowledge that further studies with larger sample size
are required to provide a more accurate prediction of the
relationship. If this association can be proved on a larger
scale, it can help as a non-invasive marker to predict
the developing malocclusion which can be prevented,
intercepted, or guided to achieve ideal occlusion in future.
Conclusion
Within the limitations of this study, we could conclude
that Type  II  (branched) pattern was the most predominant
cheiloscopic pattern. The predominant patterns which
related to the terminal planes were as follows: Type  IV
(reticular) and Type  V  (irregular) patterns for mesial step,
Type  IV  (reticular) pattern for distal step, and Type  I
(complete vertical) pattern for flush terminal plane.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not
be published and due efforts will be made to conceal their
identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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