1

Synopsis

RELATIONSHIP BETWEEN DENTAL ARCH WIDTH AND

HORIZONTAL CEPHALOMETRIC PARAMETERS IN

ORTHODONTIC PATIENTS

By: Dr. Muhammad Uzair

PGR Orthodontics

Sharif medical and Dental College,

Lahore

Supervisor: Prof Col. Dr. Iffat Batool Syed

(BDS, DCPS, FICCED, FICD, MCPS, FCPS)

 2

RELATIONSHIP BETWEEN DENTAL ARCH WIDTH AND

HORIZONTAL CEPHALOMETRIC PARAMETERS IN

ORTHODONTIC PATIENTS

INTRODUCTION

The dental arch width has significant implication in orthodontic diagnosis and treatment

planning as it affects the arch length discrepancy, dental esthetics and stability of the

occlusion.1 Dental arch width especially the intercanine should be maintained during

orthodontic treatment to ensure stability. 1, 2

Changes in the dental arch dimensions occur due to growth and development as well

as dental treatment. 3 The mandibular arch length in sagittal plane increases until 8 years of

age while maxillary arch length increases until 13 years, and then continues to decrease

gradually until age 45. In the same way, the intercanine width in the transverse plane

increases rapidly from 5 to 9 years of age and decreases after 14 years of age, this

developmental pattern is particularly noticeable in the mandibular arch. It is also well

proven that the intercanine distance is also strongly affected by gender and its value is

slightly greater in males than in females. 4 Therefore, to determine the factors affecting the

form and dimension of dental arch is useful in orthodontic treatment planning in order to

achieve better results with regards to function, stability and aesthetics.

The dental arch width is associated with gender, race and vertical facial

morphology. By introduction of pre-adjusted edgewise appliance and wide application of

prefabricated arch wires, determining the factors which influence arch form and dimension
 3

has become more important for both orthodontists and orthodontic appliance manufacturing

companies.5 Thus using customized arch wires according to each patient's pretreatment arch

form and width is recommended during orthodontic treatment. 6

Many investigations have been performed on vertical facial form and dental arch

width.6-8 Sharma A et al. reported that patients with vertical growth pattern have a narrower

arch form and those with horizontal growth pattern have a wider one. 6 Similarly, Aggarwal

et al. reported that the dental and skeletal arch widths were increased in hypodivergent

patients and decreased in hyperdivergent patients. 8

Shahroudi et al. studied the correlation between the transverse dental arch width and

sagittal skeletal parameters in orthodontic patients in Iran. 5 They reported that the maxillary

intercanine width (MxICW) was significantly correlated with sagittal cephalometric

parameters (SNA and SNB) but was non-significant with ANB angle. While the correlation

of mandibular intercanine width (MnICW) with SNA and SNB was not significant. A local

study conducted on Correlation of intercanine width with sagittal skeletal cephalometric

parameters in 150 untreated orthodontic patients reported that there was statistically

significant but negative and weak correlation of MxICW with SNA (r=-0.254) and SNB

angles(r=-0.209). MnICW had significant weak positive correlation with SNA (r=0.260) and

SNB angles(r=0.293). 9

The rationale of this study is that majority of previous studies are on the relationship

between vertical pattern and intercanine width. The studies on relation between sagittal

pattern and intercanine width are very few. There is limited local literature on this subject.

The results of our population may vary from other populations due to genetic, ethnic and
 4

environmental variation. There is also variation in results in previous studies. This study

will help to predict dental arch width from skeletal sagittal pattern as skeletal pattern is

established early in life, and contribute towards orthodontic diagnosis and treatment

planning considerations.
 5

OBJECTIVE

To determine the correlation between maxillary and mandibular intercanine widths and

sagittal cephalometric parameters in untreated orthodontic patients.

OPERATIONAL DEFINITIONS

1. Sagittal cephalometric parameters

The sagittal cephalometric parameters include (SNA, SNB, ANB) which are measured on
pre-treatment lateral cephalograms by manual tracing on acetate paper on light illuminator.
They are recorded in degrees.

i) SNA: Angle between Sella (S), nasion (N) and point A (Norm: 82° ± 2°)
ii) SNB: Angle between Sella (S), nasion (N) and point B (Norm: 80° ± 2°)
iii) ANB: Angle between point A, nasion(N) and point B (Norm: 2° ± 2°)

2. Skeletal Sagittal Classification

It is the relative anteroposterior position of maxilla and mandible with respect to the cranial
base. It can be determined from the ANB value on Lateral Cephalogram.

i) Skeletal Class I: ANB = 0° - 4°

ii) Skeletal Class II: ANB > 4°
iii) Skeletal Class III: ANB < 4°
 6

3. Intercanine width

The intercanine width is the distance from canine cusp tip on one side to the canine cusp tip

on other side in each dental arch. Intercanine widths will be measured on dental cast of both

maxillary and mandibular arches using Vernier caliper having a least count of 0.01mm.
 7

Fig. 1 Cephalometric tracing for measuring SNA, SNB and ANB angles

i) SNA: Angle between Sella (S), nasion (N) and point A (Norm: 82° ± 2°)

ii) SNB: Angle between Sella (S), nasion (N) and point B (Norm: 80° ± 2°)

iii) ANB: Angle between point A, nasion(N) and point B (Norm: 2° ± 2°)
 8

MATERIALS AND METHODS

Study design: Cross sectional study

Setting: Department of Orthodontics, Sharif Medical and Dental College, Lahore

Duration: Minimum six months after approval of synopsis

Sample size: The sample size of 150 was taken by keeping α-error as 5% and β-errors as

10% and expected correlation between SNB angle and lower intercanine width as r=

0.2939.

Sampling technique: Non-probability, consecutive sampling

Selection criteria

Inclusion criteria:

1. Good quality casts

2. Clear cephalometric radiographs with high contrast

3. Age 13 to 28 years

4. Well-aligned arches

5. Full dentition except third molars

6. Patients of both genders

7. Any skeletal class

8. Pakistani population assessed on the basis of CNIC.

Exclusion criteria:

1. History of previous orthodontic treatment

2. Crowding, supernumerary teeth (may affect arch width)
 9

3. Missing or un-erupted permanent canine/s

4. Deformed arch, ectopic canine (may affect arch width)
5. History of trauma in the head and neck region
6. Cleft lip and palate patient or any other dento-facial deformity

DATA COLLECTION PROCEDURE

Approval from the hospital ethical committee will be taken for the study ( Annex-A).

Subjects will be selected from patients visiting orthodontic department of the hospital.

Informed consent will be taken from subjects fulfilling the inclusion criteria.

Standardized Lateral Cephalograms will be taken with “SoreDex Carnex-D Ceph”

machine in natural head position with lips relaxed. Source to subject distance will be kept

constant i.e. 5–feet for all patients. All Lateral Cephalograms will be traced in a standard

manner on 0.003 inches thick acetate tracing paper with a 0.3 mm mechanical pencil, placed

on illuminator in a dark room by principal researcher for the measurements required. SNA

and SNB in degrees will be measured for each subject, as shown in fig 1.

Alginate impressions of the dental arches will be taken with Cavex CA37, Normal

Set, and dental stone casts will be made using ISI, KOPO-HARD CKH-52, dental stone.

Intercanine widths will be measured on dental cast of both maxillary and mandibular arches

using Vernier caliper, having a least count of 0.01mm, from canine cusp tip on one side to

the canine cusp tip on other side in each dental arch. All data will be recorded in

predesigned data collection proforma (Annex-C).

 10

DATA ANALYSIS

Data will be analyzed using SPSS (statistical package for social sciences) for Windows

version 25.0. Mean and standard deviation will be calculated for numerical variables like

age, intercanine widths (maxillary and mandibular arch), SNA and SNB. Frequency &

percentage will be calculated for qualitative variable like gender and skeletal class. Pearson

correlation test will be applied to see relationship of SNA and SNB, each with intercanine

widths (both maxillary and mandibular arch). P<0.05 will be considered significant. These

analyses will be performed for the whole sample and for each gender and age group (13-19

and 20-28) separately to see effect modifiers. Post stratification Pearson correlation co-

efficient will be applied at P≤0.05 as significant.

 11

References

1. Saeed HK, Mageet AO. Dental Arch Dimensions and Form in a Sudanese Sample. J

Contemp Dent Pract. 2018;19(10):1235-41.

2. Oz A, Oz A, Yazicioğlu S, Arici N, Ozer M, Arici S. Comparison of arch width

changes following orthodontic treatment with and without extraction using three-

dimensional models. Niger J Clin Pract. 2017;20(5):581-6.

3. Yang D, Liang S, Zhang K, Gao W, and Bai Y. Evaluation of Growth and

Development of Late Mixed Dentition Upper Dental Arch with Normal Occlusion Using 3-

Dimensional Digital Models. J Healthc Eng. 2019;19(4):1-8.

4. Adamek A, Minch L, Kawala B . Intercanine Width – Review of the Literature. Dent.

Med. Probl. 2015;52(3):336–340

5. Shahroudi AS, Etezadi T. Correlation between dental arch width and sagittal dento-

skeletal morphology in untreated adults. J Dent (Tehran). 2013;10(6):522.

6. Sharma A, Phor D, Upadhyay S. Correlation Between Vertical Facial Patterns And

Dental Arch Forms In Different Types Of Skeletal Malocclusions. J of Dent and Med

Sciences. 2018;17(9):67-88.

7. Ilyas M, Shaheen A. Relationship of vertical proportions and arch forms In skeletal

class II in a sample of local population. Pak Oral Dent J. 2017;37(3):439-443.

8. Aggarwal I, Chhatwalia S, Mittal S, Bhullar MK, Singla D. Evaluation in Arch

Width Variations among Different Skeletal Patterns in District Solan Population. Dent J

Advan Stud. 2018;6(03):112-7.

 12

9. Rasool G, Afzal S, Bano S, Afzal F, Shahab A, Shah AM. Correlation of intercanine

width with sagittal skeletal pattern in untreated orthodontic patients. Pak Orthod J.

2019;11(1):25-8.

10. Wahaj A, Ahmed I. Comparison of Intercanine and Intermolar Width Between Cleft

Lip Palate and Normal Class I Occlusion Group. J Coll Physicians Surg Pak.

2015;25(11):811-4

11. D Sacks. Age limits and adolescents. Paediatr Child Health. 2003; 8(9):577.
 13

ANNEX-C

DATA COLLECTION PERFORMA

RELATIONSHIP BETWEEN DENTAL ARCH WIDTH AND

HORIZONTAL CEPHALOMETRIC PARAMETERS IN

ORTHODONTIC PATIENTS

Orthodontic Case No: Date / /

Age: Years

Gender: Male Female

Address:

1. Sagittal cephalometric parameters

0
a. SNA __________
0
b. SNB __________

2. Intercanine widths

a. Maxillary intercanine width _____mm

b. Mandibular intercanine width _____mm

14