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Establishment and Comparison of Skeletal, Dental and Soft Tissue Norms for North and South Tamilnadu Population: A lateral Cephalometric study

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Abstract

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Background & Objectives:

The purpose of this study was to establish cephalometric norms for North and South Tamilnadu population.

Materials and Methods:

100 individuals, 50 from North and 50 from South Tamilnadu with age range of 18-25 years, showing class I skeletal base and ANB 2º were selected. The individuals were named as Group 1 (North Tamilnadu origin) and Group 2 (South Tamilnadu origin). Lateral cephalograms were taken and traced. Skeletal parameters like SNA (º),SNB (º), MP/SN (º), Co – A (mm), Co – Gn (mm), ANS – Me (mm), PFH: AFH, Y – AXIS, FACIAL AXIS, Dental Parameters like U1/L1 (º), U1/SN (º), U1/NA (º), U1- NA (mm), L1-NB (mm), L1/NB (º), L1/MP (º) and Soft tissue Parameters like S-LINE, H-ANGLE, E-LINE, Z-ANGLE are analyzed in Lateral cephalogram and norms were established for Group 1 and Group 2 and gender comparision was done within the groups.

RESULTS:

Norms were established for Group 1 and Group 2 and on comparison two parameters UI/NA (mm) and Z-angle were statistically significant with the p value of 0.033 and 0.012 respectively. Rest all parameters were statistically non significant. On comparing Group 1 male and female, parameters which were statistically significant(p value < 0.05) are: Facial axis (0.012), Co-A (0.000), Co-Gn (0.000), ANS/Me (0.001),

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UI/LI (0.021), LI/MP (0.016), LI/MB (0.021), S-line UL (0.012), S-line LL (0.020). on comparing Group 2 male and female, parameters which were statistically significant (p value < 0.05) are: Co- A (0.002), Co-Gn (0.003), ANS/Me (0.000), LI/MP (0.004), LI/NB (0.027).

CONCLUSION:

South Tamilnadu individuals showed more prognathic maxilla than North. In North and South Tamilnadu individuals, increased effective maxillary length and mandibular length.

Both North and South Tamilnadu showed horizontal growth pattern, shorter lower anterior facial height, proclined and forwardly placed upper and lower incisor. Males have retrusive lip than females in both North and South Tamilnadu population.

Keywords: Cephalometric norms, Lateral cephalogram, Ethnic, North Tamilnadu, South Tamilnadu.

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LIST OFABBREVIATIONS

NS Non Significant S Significant HS Highly significant mm Millimeters MP Mandibular Plane

FH Frankfurt Horizontal SN Sella – Nasion

L1 Lower incisor

U1 Upper incisor Eff Effective

Max Maxillary

LAFH Lower anterior facial height PFH Posterior facial height AFH Anterior facial height

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List of figures

LIST OF FIGURES

Figure No Figures Page No

1 Radiographic apparatus with OPG machine and Cephalostat 24

2 kV and exposure time 24

3. Positioning Of The Patient With Cephalostat – North Tamilnadu

25

4. Positioning Of The Patient With Cephalostat – South Tamilnadu

25

5. Illuminator, Tracing Sheet, Geometry Box , Tracing Pencil, Cephalogram

26

6. Tracing with illuminated tracing table 26

7. Lateral cephalogram and picture of traced cephalogram 27

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LIST OF TABLES

Tables No TABLES PAGE NO

1 Comparison of Group 1(North Tamilnadu) and Group 2 ( South Tamilnadu)

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2 Gender Comparison - Group 1 41

3 Gender Comparison –Group 2 44

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List of Graphs

LIST OF FIGURES

Graphs No GRAPHS PAGE NO

1 Group 1 Skeletal Parameters 47

2 Group 1 Dental and Soft tissue parameters 47

3 Group 2 Skeletal parameters 48

4 Group 2 Dental and Soft tissue parameters 48

5 Gender comparison of Skeletal parameters – Group 1

49

6 Gender comparison of dental & soft tissue parameters – Group 1

49

7 Gender comparison of Skeletal parameters – Group 2

50

8 Gender comparison of dental & soft tissue parameters – Group 2

50 LIST OF GRAPHS

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LIST OF ANNEXURE

S.NO LIST

1 Ethical committee certificate

2 Division of North and South Tamilnadu based on Madras High Court Jurisdiction 3 Information sheet for patients

4 Consent form

5 Proforma for data collection

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Contents

LIST OF CONTENTS

S.NO TITLE PAGE NO

1 INTRODUCTION 1-2

2 AIM AND OBJECTIVES 3

3 REVIEW OF LITERATURE 4-14

4 MATERIALS AND METHODS 15-27

5 STATISTICAL ANALYSIS 28

6 RESULTS 29-50

7 DISCUSSION 51-56

8 SUMMARY AND CONCLUSION 57

9 BIBLIOGRAPHY 10 ANNEXURE

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Introduction

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Introduction

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INTRODUCTION

Current concept in orthodontic diagnosis and treatment planning focus on the balance and harmony of various features.1 Treatment goals should be geared towards the achievements of harmonius facial esthetics, overall facial balance and optimal functional occlusion.

The study of cephalometric norms has been a part of orthodontic treatment for more than half a century. 1 Steiner, Downs, Rickett’s, Margolis, Tweed, Coben, Mcnamara have developed various cephalometric analyses and corresponding norms.

A number of investigators noticed the variation of the craniofacial morphology in different ethnic groups. Richardson defined the term ethnic group as a nation or population with a common bond such as geographical boundary, a culture or language or being racially or historically related2.

Cephalometric studies of different ethinic groups are available including Down’s study for Caucasian3, Suh’s study of Koreans4, Mitani’s study of Japanese5, Chan’s study of Chinese6, Nanda’s study of North Indians7, Garcia’s study of Mexican Americans8 and Drummond’s study of Negroes9.

All these investigators stated that normal measurements of one group should not be considered normal for other racial groups. Different racial group must be treated accordingly to their own individual characteristics. Therefore it is important to develop standards for various populations.

Norms derived for Caucasian populations are routinely used for investigations because well – established Indian ethnic norms are lacking. When these norms are used

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in Indian population, they show a great degree of variation. Here, it is necessary to establish norms for every ethnic group.10, 11.

Hence, the aim of the present study was to establish and set norms for North and South Tamilnadu population. Accordingly, the present study was concerned with an ethnic group for which little cephalometric information was available.

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Aim and Objectives

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AIM AND OBJECTIVES AIM:

Aim of the study is to establish cephalometric norms for North and South Tamilnadu population.

OBJECTIVES:

Ø To set the cephalometric norms for North and South Tamilnadu population.

Ø To investigate the gender differences among the two study groups.

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Review of Literature

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REVIEW OF LITERATURE

Richard et al (1968)2 determined normal measurements of a lateral cephalogram of the American Negro and to determine if, in fact, these measurements are statistically different from those of Caucasian children. The results revealed that the primary difference seems to be the bimaxillary dental protrusion, the steep mandibular plane, and the anterior placement of the maxilla in the American Negro population.

Nanda et al (1969)7 conducted a study on lateral head cephalograms in 50 individuals to study the skeletodental complex and to establish norms for Indian individuals. All planes, landmarks and angles used were according to the descriptions and definition given by Downs. They concluded that there was no statistical significant difference among male and female samples and the female samples presented a slightly protrusive middle face.

William Bacon et al (1983)12 established and compared a standard cephalometric norms for the Africans, Bantu and a Caucasoid population. Totally 80 samples were taken and in that 40 young Cameroonian Africans and 40 white French students were present. Age group is between 20 to 30 years of age. They concluded position and the angulation of the incisors appeared to be the strongest discriminant factors. Higher values for convexity, ANB angle, SNB angle and lower face height were representative racial characters in the Bantu upper face height and facial taper were dominant traits in whites.

Park et al (1989)13 conducted a cephalometric study on 18-year-old Korean subjects with acceptable profile and occlusion by means of the Downs, Steiner, Ricketts, and vertical analyses. The subjects in the study sample consisted of 35 men and 45

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Review of Literature

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women and means and standard deviations were established. Statistical analyses were performed to compare Koreans to Caucasians. They concluded that the skeletal pattern of Koreans is in similar to that of Caucasians, facial convexity of Koreans is slightly larger and the maxillary and mandibular incisors of Koreans are more protrusive and labially inclined. The ratio of lower molar height/lower incisor height is larger in Koreans and the upper and lower lips of Koreans are more protrusive.

Miyajima et al (1996)14 compared two groups of adults from different races who were selected on the basis of having normal ("ideal") occlusions and well-balanced faces.

The lateral cephalometric radiographs of 54 Japanese adults were compared with a sample of 125 adults of European-American ancestry. The results revealed that in comparison to the European-American sample, the Japanese sample, in general, was smaller in anteroposterior facial dimensions and proportionately larger in vertical facial dimensions. The facial axis angle was more vertical in Japanese subjects, indicating a more downward direction of facial development. On average, the subjects in the Japanese sample were more protrusive dentally, with a more acute nasolabial angle and a greater tendency toward bilabial protrusion. These differences, evident even in groups with so- called "well-balanced faces", indicate that fundamental variation exists in the craniofacial structure of Japanese and European-Americans. The results of this study support the premise that a single standard of facial esthetics is not appropriate for application to diverse racial and ethnic groups.

Hwang et al (2002)15 compared the soft tissue profiles obtained from Korean and European-American adults with normal occlusions and well-balanced faces, in order to understand the ethnic differences in the soft tissue profile between these two ethnic

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groups. The lateral cephalograms of 60 Korean and 42 European-American adults were taken and ten angular measurements of facial form and seven linear and angular measurements of lip position were computed. The results revealed that a comparison of the slope of the forehead showed no significant differences between the two groups. The Korean sample, however, had a lower angle of nasal inclination and a higher degree of lip protrusion compared to the European-American adults.

Jitender Singh et al (2007)16 established an organized approach to soft tissue facial analysis based on facial attractiveness in Lucknow population. 60 subjects with reasonable pleasant faces were included in the study. The results of the study highlighted the increased esthetic appeal of straight profile in women, acceptance of mild facial convexity; fuller upper lip and decrease lower face percentage, as well as the intolerance towards increasing lip competence in both sexes.

Anmol et al (2008)17 A study was conducted to establish soft tissue cephalometric norms in South Indian ethnic population with 60 normal subjects (30 men and 30 women) .Results found statistically significant difference between South Indian men and women in certain clinical parameters.

Rakesh Mohode et al (2008)18 established skeletal and soft tissue norms for Indian Marathi population and compared it with Caucasian norms. 100 Marathi adults were taken and cephalometric norms were established using Steiner’s, Tweeds, Wits and Holdaways analysis. They concluded that there was significant result in skeletal and soft tissue measurements and Marathi population preferred flatter profiles and did not prefer the protruded lips.

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Review of Literature

7

M. S. Rani et al (2008)19 established norms for the Libyan population. Sixty students were selected to be the subjects of the study and forty nine angular and linear measurements of skeletal, dental and soft tissue were selected for the study. Three proportions were calculated. Based on these measurements, norms for the Libyan population were established and they concluded that comparison of male and female subjects shows that there is dimensional variation rather than angular and proportional variation

Jawaid Shaikh et al (2009)1 established cephalometric norms of a sample of aesthetically pleasing Pakistani faces and to analyze differences and similarities with accepted standards for Caucasians. Cephalometric tracings were analyzed on a sample of 40 Pakistani young adults, aged 18-25 years, with full complement of permanent teeth, no previous orthodontic treatment and pleasing profile. They concluded that comparisons revealed statistically significant differences in most variables between Pakistanis and Caucasians and between Pakistani males and females and also Pakistanis have distinct cephalometric features, which should be used as a reference in treating Pakistani orthodontic and orthognathic surgery patients.

Arunkumar et al (2010)20 established skeletal cephalometric norms for the South Indian (Karnataka population) based on Burstones’s analysis. Lateral cephalograms taken in natural head position of 100 participants and interpreted using the landmarks and values given by Burstone’s analysis. They concluded that there were statistically significant differences between South Indian men and women when compared with Caucasians in certain key parameters. These differences need to be considered when analyzing the cephalogram for orthognathic surgeries. The values derived from this study

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may be considered to make the deformity assessment and plan surgery to get optimal results for people of south Indian origin conclusive results can be derived after conducting a study with an eager sample size.

Saibel Farishta et al (2011)21 established skeletal and dental parameters for Chhattisgarhi young adults with normal occlusion and comparison of Cephalometric norms of Chhattisgarh population with Caucasians as well as other non- Caucasian groups. A Cephalometric study of 80 young adults with acceptable profile and occlusion was carried out by means of Steiner’s analysis. Results showed that when compared to the Caucasian samples, the Chhattisgarhi samples were more protrusive skeletally and dentally and exhibited a more horizontal growth pattern than the Caucasians and the females reported with an increased incisor procumbency, prominent chin and prognathic maxilla than their male counterparts. Conclusion: The results of the study support the fact that a case of malocclusion cannot be treated to a template of norms which have been derived from mean values of a certain select group of subjects with excellent occlusion and harmonious facial proportions.

Janson et al (2011)22 compared the skeletal, dental and soft tissue characteristics of Caucasian and Afro-Caucasian Brazilian subjects with normal occlusion and also evaluated sexual dimorphism within the groups. The sample comprised lateral cephalograms of untreated normal occlusion subjects in which 40 were Caucasian subjects and 40 were Afro-Caucasian subjects. Results revealed that Afro-Caucasian subjects presented greater maxillary protrusion, smaller upper anterior face height and lower posterior face height, larger upper posterior face height, greater maxillary and mandibular dentoalveolar protrusion as well as soft tissue protrusion than Caucasian

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Review of Literature

9

subjects. The Afro-Caucasian female subjects had less mandibular protrusion and smaller total posterior facial height and upper posterior facial height than males. They Concluded that Brazilian Afro-Caucasian subjects have greater dentoalveolar and soft tissue protrusion than Brazilian Caucasian subjects, with slight sexual dimorphism in some variables.

H. M. Abu-Tayyem et al (2011)23 formulated cephalometric norms for lateral cephalometric measurements of Emirates adults and to study gender differences. 91 angular and 21 linear cephalometric variables were calculated in Lateral cephalometric radiographs of 176 Emirates adults, 91 males and 85 females. Results revealed that there were several statistically significant gender differences. Skeletally, Emirates males showed significantly greater total, anterior, and posterior cranial base lengths as well as longer facial heights, greater SGn-FH (°), ANS Xi PM (°), and FH/MP (°) angles than females. For soft tissue measurements there were significant gender differences (p <

0.001) for all angular and linear measurements except for lower lip to E-plane and nose prominence measurements which have no significant gender difference. Emirates males revealed greater measurements than females except for soft tissue convexity, Z-angle, and both upper and lower lips protrusion which were significantly greater in Emirates females. They Concluded that the use of specific cephalometric standards for Emirates adults, separate for gender, seems to be justified. It is appropriate to put these cephalometric norms into daily orthodontic practice when Emirates adults are being treated.

Ji-Hwan Kim et al (2011)24 established cephalometric norms of Mongolian adults and to compare them with cephalometric norms of Korean adults. Methods:

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Lateral cephalometric radiographs of 74 Mongolian adults and 95 Korean adults with normal occlusions and well-balanced lateral profiles were obtained. Results revealed that compared with Korean adults, Mongolian adults had shorter anterior facial height, more prominent chins, and more upright upper incisors. There were few differences in soft tissue measurements.

Sachan et al (2012)25 did a cephalometric study on North Indian ethnic population to establish norms.with 60 individuals consist of 30 males and 30 females. All of them were aged between 16 to 25 years. Various cephalometric analysis was performed in this study. Result shows that the sexes were not similar in all measurements.

AlBarakati et al (2012)26 assessed the reliability and reproducibility of angular and linear measurements of conventional and digital cephalometric methods. A total of 13 landmarks and 16 skeletal and dental parameters were defined and measured on pre- treatment cephalometric radiographs of 30 patients. They concluded that in general, both methods of conventional and digital cephalometric analysis are highly reliable. Although the reproducibility of the two methods showed some statistically significant differences, most differences were not clinically significant.

Binu Purushothaman et al (2012)27 formulated soft tissue norms for the Malabar population. Subjects with balanced face and pleasing profile with normal overjet and overbite were taken into consideration. Results revealed that Malabar population has a protrusive profile when compared to the Caucasian population which is indicated by an increase in the values of lower lip to H-line, skeletal convexity, upper and lower lip to the Ricketts E plane and H angle. The lip protrusion was found to be acceptable because of the prominent nose and chin.

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Review of Literature

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Ahsan et al (2013)28 determined the cephalometric norm among Bangladeshi adults and investigated the differences in craniofacial morphology compared with Japanese and Caucasian normative data. Cephalometric radiographs were obtained from 46 males and 52 females. Nine angular and five linear measurements were constructed for skeletal hard tissue analysis, four angular and six linear measurements for dental hard tissue analysis, and two angular and seven linear measurements for soft tissue analysis.

Results revealed that Bangladeshi population has a smaller lower face height and the antero posterior position of the maxilla and mandible was more protruded compared with the Japanese and the Caucasian norms and they also presented with more protruded upper incisor, less steep occlusal plane, and thinner soft tissue chin. They Concluded that Relative to the cranial base (SN), the maxilla mandibular complex was more anteriorly placed compared with the Japanese and Caucasian adults and the effective length of the maxilla and mandible was shorter compared with the Japanese and Caucasian adults.

Jay S. Upadhyay et al (2013)29 conducted a study to compare the standard soft tissue cephalometric analysis with normal faces in westerner uttar Pradesh population.

Samples taken for the study is 33 normal subjects in that (16 males and 17 females) .The results females in our study had steeper maxillary occlusal plane, more proclined mandibular incisors, and less protrusive lips. Both males and females showed an overall decrease in facial lengths, less prominent midface and mandibular structures and more convex profile compared with established norms for the White population.

Anbuselvan et al (2013)30 established norms for the soft tissue Dravidian profile utilizing an extra cranial reference plane. The results showed that dravidian females have protrusive lower lip region, shallower labial sulci, more prominent chin than males and

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Dravidian males have exaggerated curvature of upper and lower lips than females. They concluded that true horizontal-subnasale vertical reference plane seemed more reliable.

Ashish Gulati et al (2013)31 compared the cephalometric dentofacial values of the Malwa population of Madhya Pradesh state in India and to compare the craniofacial morphology of Malwa population with other races and Indian ethnic groups. They concluded that when compared to internationally Caucasian norms, Malwa subjects had more protrusive lips, and protruded incisors. The maxillary apical base was found to be more anteriorly placed with normal or comparable mandibular apical base. Subjects exhibited horizontal growth pattern predominantly.

Ahmet arif celebi et al (2013)32 did a study on soft tissue cephalometric standards for Turkish men and women and compared with the cephalometric standards of normal European – American white people with sample size of 96 Turkish adults(48 women and 48 men) at the age of 20 to 27 years. Results showed there is statistically significant difference between the compared groups and there are no statically differences between the genders except three varaiables. Turkish males reveal more obtuse mandibular prognathism and upper lip protrusion, and smaller nasolabial angle than females.

Barathatit et al (2013)33 conducted a cephalometric study for the Maratha ethnic population. He did a comparative cephalometric norms with sample of 60 adults subjects (30 males and 30 females) of Maratha ethnic origin and age ranged between 18 to 26 years .The Steiners, Tweeds, Rickets and Mcanamra cephalometric analysis were performed. Found results of Maratha ethnic population differed significant from the Caucasian population.

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Review of Literature

13

A. M. Hamdan et al (2014)34 identified cephalometric norms for a Jordanian population. 65 subjects were selected from a larger sample on the basis of Class I incisors, a balanced profile and no previous orthodontic treatment. Lateral skull radiographs were digitized directly to produce values for SNA, SNB, ANB, UI/MX, LI/MN, UI/LI, MMPA and LI/A- Pog. Results revealed that SNA and SNB were very close to the Eastman Standards and MMPA was significantly lower in Jordanians whilst UI/MX and LI/MN were significantly higher. Lower incisors were 4·6mm further forward in relation to A-Pog in Jordanians.

Shruti Chhajid et al (2014)35 established cephalometric norms for central Indian population and any significant sexual dimorphism based on Arnett’s soft tissue analysis.

Lateral cephalograms of 100 adults with normal occlusion and well – balanced faces were evaluated. They concluded that there was significant difference between the central Indian and the white samples and there is also significant sexual dimorphism between males and females of the central Indian population.

Tripti Tikku et al (2014)36 determined the soft-tissue cephalometric norms as per Arnett‘s analysis for male and female subjects of North Indian population and compared these cephalometric norms with Arnett‘s norms for Caucasian population. 50-male and 50-female subjects were selected. Arnett‘s soft-tissue cephalometric analysis (STCA) was done on these cephalograms using Nemotech cephalometric software. Results revealed high overjet, thicker soft-tissue, less facial length, retruded lower face and midface and convex profile were observed in the North Indian population as compared to Caucasian population. They concluded that males of North Indian population have thicker soft- tissue structures, more acute nasolabial angle, longer faces and more deep-set facial

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structures than females whereas females have greater interlabial gap and maxillary incisor exposure.

Abbassy et al (2015)37 compared dentofacial characteristics of Class I malocclusion in Saudi and Japanese adult females. Lateral cephalograms of 50 Saudi adult female and 50 Japanese adult female with skeletal Class I, angle Class I malocclusion, arch length discrepancy (−10–10 mm), overjet (1–5 mm), overbite (1–5 mm), absence of congenital anomalies, or significant facial asymmetries or congenitally missing tooth other than the 3rd molar and absence of temporomandibular joint problems were obtained. 16 angular measurements and 13 linear measurements of facial form were used. They concluded that there were significant differences in dentofacial morphology between Saudi and Japanese adult females. Both Asian countries have distinct cephalometric features, which should be considered as a reference in treating patients of varying ethnic backgrounds to optimize the final results.

Kommi PB et al (2016) assess the normal range of nasolabial angle in the South Indian population. Nasolabial angle, lower border of the nose to the FH plane (N/ FH), and upper lip to the FH plane (L/FH) of these subjects were measured in 102 lateral cephalometric radiographs. They concluded that the mean nasolabial angle of 99.76° with SD ± 15.35° was observed in the South Indian population, with no sexual difference. The results were different when compared to other studies reported for Caucasian and other racial group, but it is accordance with the other Asian population.

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Materials and

Methods

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MATERIALS AND METHODS

PATIENT SELECTION:

The samples were collected by using purposive sampling technique. Totally 1000 people were screened and 100 individuals were recruited. In which 50 were from North Tamilnadu population with the mean age of 19.28±1.47 (Male-13 Female-37) and 50 were from South Tamilnadu population with the mean age of 19.94±1.91 ( Male-14 Female-36). The adults of Tamilnadu origin residing in Tamilnadu were included in the study.

All the subjects were from various fraternities like dental, nursing, pharmacy, physiotherapy and engineering students were taken during their educational course and were under the same trust. Subjects were exposed for lateral cephalogram with prior informed consent. Among those chosen subjects who already had their own radiograph were not exposed twice; rather the existing radiograph were used.

The study was approved by the Institutional Ethical Committee and Review Board (Date: 18/11/2014). All the individuals included in the study satisfied inclusion criteria. Consent forms including the outline proposed research and privacy terms were distributed to all chosen subjects.

INCLUSION CRITERIA:

Ø Subjects should be North Tamilnadu and South Tamilnadu origin.

Ø Age – 18 to 24 years.

Ø Class I skeletal base (ANB -2º).

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Materials and methods

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Ø Class I occlusion on both sides, with normal overjet and overbite with an arch length discrepancy less than 2mm.

Ø Fully erupted permanent dentition except 3rd molar.

Ø Acceptable, pleasing and preferably straight profiles.

Ø Radiographs of good quality.

Ø No previous orthodontic treatment.

Ø No prosthetic replacement of teeth.

EXCLUSION CRITERIA:

Ø Class II &Class III skeletal base

Ø Patients underwent orthodontic treatment.

Ø Presence of gross abnormality or severe crowding.

Ø Presence of gross facial asymmetry or deformity.

Ø Missing teeth except III molar.

Ø People belonging to other states were excluded.

ARMAMENTARIUM FOR CLINICAL EVALUATION:

· Mouth mirror.

· Explorer

ARMAMENTARIUM FOR RADIOGRAPHIC EVALUATION:

· Radiographic machine : X- mind Pano D +.

· Digital lateral cephalogram.

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· Trimax printer.

ARMAMENTARIUM FOR TRACING:

· Lateral cephalogram.

· Acetate tracing paper – 0.003 Matte finish.

· Staedtler mars micro – 0.3 mm HB lead pencil.

· Geometry Box – (Scale, Protractor, Setsquares, Erasers, Sharpener).

· Illuminator.

· Calculator.

The samples were divided into two groups.

Group 1 – North Tamilnadu,

Group 2 – South Tamilnadu.

A Pre-structured proforma was used to collect the relevant information and record cephalometric measurements for each subjects. The selected individuals were reevaluated by staff of department of orthodontics to check the criteria. After attaining the inclusive criteria all the individuals were brought to the department of oral Medicine and Radiology, Best Dental Science College and Hospital. Digital lateral cephalograms were taken. Cephalograms were checked by the staff of the departments to ensure that all the individuals were met the above mentioned criteria.

The cephalograms of the patients were obtained by positioning the patient’s head in cephalostat with the teeth in maximum intercspation with relaxed lips in order to

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Materials and methods

18

maintain standardization of radiograph with the Frankfort horizontal plane parallel to the floor and ensured that (NHP) natural head position this obtained by positioning the ear rods and forehead positioning knobs. Distance from the tube to the patient was standardized at 5 feet. Radiographic apparatus was X – Mind pano D+. The tube voltage was 73 kV and scanning time was set at 15 seconds.

Skeletal, dental, soft tissue norms measured by the sample using composite of the following analysis – Steiner’s analysis, McNamara analysis, Rakosi analysis, Rickets analysis.

Totally twenty one parameters in that five Angular parameters, three Linear parameters and one ratio parameter were constructed for skeletal analysis, five angular and two linear measurements for dental hard tissue analysis, and two angular and three linear measurements for soft tissue analysis.

Tracing was done with a 0.3 mm HB lead pencil on acetate matte tracing paper.

To eliminate intra- operator error, each cephalogram was traced twice by the same operator and the mean of the two measurements were taken. Only the tracings that correspond with an accuracy of at least 1 mm or 1° were used. The mean values were rounded off to half a degree or half a millimeter.

LANDMARKS USED:

Hard tissues and soft tissue Landmarks used in the study are mentioned below:

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19 HARD TISSUE LANDMARKS:

1. N – (NASION) The most anterior point of the nasofrontal sutures in the median plane.

2. S – (SELLA) The geometic centre of the pituitary fossa.

3. A – (POINT A OR SUBSPINALE) The deepest midline point in the curved bony outline from the base to alveolar process of the maxilla.

4. B – (POINT B OR SUPRAMENTALE) Most posterior midline point in the concavity of the mandible between the most superior point on the alveolar bone overlying the mandibular incisors and Pog.

5. Gn – (GNATHION) the most anterior and inferior point of the bony chin.

It is constructed by intersecting a line drawn perpendicularly to the line connecting Me and Pog with the bony outline.

6. Go – (GONION) a constructed point, the intersection of the lines tagent to the posterior margin of the ascending ramus and the mandibular base.

7. Me – (MENTON) most caudal point in the outline of the symphysis 8. Ar – (ARTICULARE) the point of intersection of the posterior margin of

the ascending ramus and the outer margin of the cranial base.

9. Cd – (CONDYLION) most superior point on the head of the condyle.

10. Or – (ORBITALE) lower most point of the orbit in the radiograph.

11. ANS – (ANTERIOR NASAL SPINE) point ANS is the tip of the bony anterior nasal spine , in the median plane.

12. Ba – (BASION) lower point on the anterior margin of the foramen magnum in the median plane.

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Materials and methods

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13. Ptm - (PTERYGOMAXILLARY FISSURE) the contour of the fissure projected onto the palatal plane. The anterior wall represents the maxillary tuberosity outline, the posterior wall the anterior curve of the pterygoid process.

14. Pog – (POGONION) the most anterior point on the chin.

15. Po – (PORION) the most superiorly positioned point of the external auditory meatus located by using the ear rods of the cephalostat.

SOFT TISSUE LANDMARKS:

1. N’ – (SOFT TISSUE NASION) is located at the point of maximum convexity between the nose and forehead.

2. Pn – (PRONASAL) – the most protruded point of the nasal tip.

3. Pog’ – (SOFT TISSUE POGONION) the most protruding point of the soft tissue chin contour.

4. Ls – most anterior point of the upper lip.

5. Li – most anterior point of the lower lip.

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21 PARAMETERS:

SKELETAL PARAMETERS:

1. SNA (angle) – (Steiners Analysis) the angle formed between the S - N line to POINT A. It denotes the anteroposterior position of maxilla relative to cranial base.

2. SNB (angle) – (Steiners Analysis) the angle formed between the S- N line to POINT B. It denotes the anteroposterior position of mandible relative to cranial base.

3. Go Gn to SN (angle) – (Steiners Analysis) the angle formed between the Go Gn to S –N. It denotes the mandibular plane to the cranial base.

4. CO – A (mm) – (McNamara analysis) effective midfacial length is measured from the condylion to point A.

5. CO – GN (mm) – (McNamara analysis) the effective length of the mandible is measured from condylion to gnathion.

6. ANS – Me (mm) – (McNamara analysis) it denotes the lower anterior facial height from the anterior nasal spine to menton.

7. PFH : AFH – (Rakosi Jarabak’s) this ratio denotes the direction of the growth.

Posterior facial height (S – Go) × 100 : (N – Me) Anterior facial height.

8. Y – AXIS (angle) – (Rakosi Jarabak’s) the angle formed between the N – S to S – Gn. It denotes the position of mandible relative to cranial base.

9. FACIAL AXIS (angle) – (Rickett’s Analysis) the angle formed between the Ba – N plane and the plane from the foramen rotundum (PT) to gn.

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Materials and methods

22 DENTAL PARAMETERS:

1. UI/NA (angle) – (Steiners Analysis) the angle formed between the NA line to long axis of the maxillary incisor. It gives the angular relationship of the maxillary incisors.

2. UI/NA (mm) – (Steiners Analysis) the distance measured from the most proclined labial surface of the maxillary incisor to the NA line. It denotes whether the maxillary incisor is postioned forward or backward to the NA line.

3. LI/NB (angle) – (Steiners Analysis) the angle formed between the NB line to long axis of the mandibular incisor. It gives the angular relationship of the mandibular incisors.

4. LI/NB (mm) – (Steiners Analysis) the distance measured from the most proclined labial surface of the mandibular incisor to the NB line. It denotes whether the mandibular incisor is postioned forward or backward to the NB line.

5. UI/LI (angle) – (Steiners Analysis) angle formed between the long axis of both the maxillary and mandibular incisor. It denotes the position of the maxillary incisor to mandibular incisors.

6. UI/NS (angle) – (Rakosi Jarabak’s) the angulation of the upper incisor is determined from intersection of the SN line and the long axis of the upper incisor (posterior value is measured).

7. LI/MP (angle) – (Rakosi Jarabak’s)the posterior angle between the long axis of the lower incisor and the mandibular plane is determined for the angulation of the lower incisor.

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23 SOFT TISSUE PARAMETERS:

1. S – LINE – (Steiners Analysis) it determines the soft tissue facial balance. The line extending from the soft tissue of the chin to the middle of an S formed by the lower border of the nose (for both S-Line to upper lip and S-Line to lower lip).

2. H – ANGLE (º) – the H-Line is tangent to Me’ to Ls. The H-Line angle is the angle formed between this line and the soft tissue N’- Pog’ line.

3. E – LINE – (Rickett’s analysis) it is an esthetic line drawn from Pn to pog’( if the Ls lies about 4mm behind , Li lies about 2mm behind it).

4. Z – ANGLE (angle) – the angle is formed by the intersection of FH and the profile line (a line drawn tangent to Pog’).

(47)

X

Fig.1 Radiographic apparatus with OPG machine and Cephalostat.

TECHNICAL SPECIFICATION OF THE X

Fig.2

Materials and method

24

X-RAY MACHINE USED

Fig.1 Radiographic apparatus with OPG machine and Cephalostat.

TECHNICAL SPECIFICATION OF THE X-RAY MACHINE

Fig.2 Shows the kV and exposure time

Materials and methods

(48)

POSITIONING OF THE PATIENT WITH CEPHALOSTAT:

25

POSITIONING OF THE PATIENT WITH CEPHALOSTAT:

Fig.3. North Tamilnadu

Fig.4.South Tamilnadu

(49)

ARMAMENTARIUM USED IN TRACING

Fig.5 Illuminator, Tracing Sheet, Geome

TRACING WITH

Fig.6 Tracing with illuminated tracing

Materials and method

26

ARMAMENTARIUM USED IN TRACING

luminator, Tracing Sheet, Geometry Box , Tracing Pencil, Cephalogram

TRACING WITH ILLUMINATOR TABLE

Fig.6 Tracing with illuminated tracing table

Materials and methods

try Box , Tracing Pencil, Cephalogram

(50)

LATERAL CEPHALOGRAM AND TRACED

Fig.7 Lateral cephalogram

27

OGRAM AND TRACED CEPHALOGRAM

cephalogram and picture of traced cephalogram

(51)

Statistical Analysis

(52)

28

STATISTICAL ANALYSIS

All statistical analysis was carried out using the Statistical Package for social sciences (SPSS) software. Mean and standard deviation was calculated for groups. Student’s t-test was used to compare the values of group1 and group 2. Also comparison between males and females was done using Student’s t-test. p-value of less than 0.05 was considered as statistically significant difference.

(53)

Results

(54)

29

RESULTS

The present study was conducted to establish and compare the skeletal, dental and soft tissue norms for North and South Tamilnadu population based on values obtained from lateral cephalograms.

A total of 100 individuals satisfying the selection criteria were selected. 50 individuals were taken from North Tamilnadu population and 50 from South Tamilnadu population according to High Court of Judicature Madras and Madras High Court Bench at Madurai.

SKELETAL PARAMETERS:

1) SNA:

The mean value of SNA angle for Group 1 was 82.92 & Group 2 was 83.38 with p value of 0.531(NS). The result though non-significant shows that Group 2 has more pronounced SNA than Group 1.

The mean value of SNA angle for Group 1 male was 83.23, Group 1 female was 82.84, Group 2 male was 84.07, Group 2 female was 83.11 with p value of 0.745 (NS) and 0.468(NS) respectively. The result though non-significant shows that SNA of males were more pronounced than females in both the groups.

2) SNB:

The mean value of SNB angle for Group 1 was 80.96 & Group 2 was 81.50 with p value of 0.450 (NS). The result though non-significant shows that Group 2 has more pronounced SNB than Group 1.

The mean value of SNA angle for Group 1 male was 81.23, Group 1 female was 80.89, Group 2 male was 82.07, Group 2 female was 81.28 with p value of 0.774

(55)

Results

30

(NS) and 0.541(NS) respectively. The result though non-significant shows that SNB of males were more pronounced than females in both the groups.

3) MP/SN:

The mean value of MP/SN angle for Group 1 was 27.74 & Group 2 was 28.20 with p value of 0.617(NS). The result shows that both Group 1 and 2 were horizontal growth pattern with no significant difference.

The mean value of MP/SN angle for Group 1 male was 27.62, Group 1 female was 27.75, Group 2 male was 29.50, Group 2 female was 27.69 with p value of 0.914(NS) and 0.168(NS) respectively. The result shows that both genders were horizontal growth pattern with no significant difference.

4) Y- Axis:

The mean value of Y axis angle for Group 1 was 64.50 & Group 2 was 64.64 with p value of 0.826(NS). The result shows that both Group 1 and 2 were horizontal growth pattern with no significant difference.

The mean value of Y axis angle for Group 1 male was 63.62, Group 1 female was 64.80, Group 2 male was 65.79, Group 2 female was 64.19 with p value of 0.186(NS) and 0.156(NS) respectively. The result shows that both genders were horizontal growth pattern with no significant difference.

5) FACIAL AXIS:

The mean value of Facial axis angle for Group 1 was 92.12 & Group 2 was 91.58 with p value of 0.334(NS). The result shows that both Group 1 and 2 were horizontal growth pattern with no significant difference.

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31

The mean value of Facial Axis angle for Group 1 male was 93.08, Group 1 female was 91.80, Group 2 male was 90.71, Group 2 female was 91.92 with p value of 0.012(S) and 0.208(NS) respectively. The result shows that males Group 1 had more pronounced chin than female which was statistically significant. Group 2 had no significant gender difference.

6) Co – A:

The mean value of Co – A distance for Group 1 was 83.84 & Group 2 was 83.20 with p value of 0.426(NS). The result shows that there was no significant difference in effective maxillary length of Group 1 & Group 2.

The mean value of Co – A distance for Group 1 male was 87.85, Group 1 female was 82.36, Group 2 male was 85.50, Group 2 female was 82.31 with p value of 0.000 (S) and 0.002(S) respectively. The result showed that in both Group1 and Group 2 males had increased effective maxillary length than females which was statistically significant.

7) Co – Gn:

The mean value of Co – Gn distance for Group 1 was 107.4 & Group 2 was 107.18 with p value of 0.893(NS). The result showed that there was no significant difference in effective mandibular length between Group 1 & Group 2.

The mean value of Co – Gn distance for Group 1 male was 116.62, Group 1 female was 103.77, Group 2 male was 114.00, Group 2 female was 104.53 with p value of 0.000 (S) and 0.003(S) respectively. The result showed that in both Group1 and Group 2, males had more effective mandibular length than females which was statistically significant.

(57)

Results

32 8) ANS – Me:

The mean value of ANS – Me distance for Group 1 was 63.22 & Group 2 was 63.32 with p value of 0.918(NS). The result showed that there was no significant difference in lower anterior facial height between Group 1 & Group 2.

The mean value of ANS – Me distance for Group 1 male was 68.31, Group 1 female was 61.32, Group 2 male was 66.86, Group 2 female was 61.94 with p value of 0.001 (S) and 0.000(S) respectively. The result showed that both Group1 and Group 2 males had increased lower anterior facial height than females which was statistically significant.

9) JARABAK RATIO (PFH – AFH):

` The mean value of PFH – AFH ratio for Group 1 was 67.33 & Group 2 was 66.40 with p value of 0.332(NS). The result shows that both Group 1 and 2 had horizontal growth pattern with no significant difference.

The mean value of PFH – AFH ratio for Group 1 male was 65.75, Group 1 female was 67.97, Group 2 male was 65.21, Group 2 female was 66.86 with p value of 0.195(NS) and 0.407(NS) respectively. The result showed that both genders presented with horizontal growth pattern with no significant difference.

10) INTERINCISAL ANGLE (UI– LI):

The mean value of UI– LI angle for Group 1 was 123.82 & Group 2 was 118.0 with p value of 0.052(NS). The result shows that both Group 1 and 2 presented with proclined upper and lower incisor with no significant difference.

The mean value of UI– LI angle for Group 1 male was 128.31, Group 1 female was 122.05, Group 2 male was 111.5, Group 2 female was 120.56 with p value

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33

of 0.021(S) and 0.315(NS) respectively. The result shows that males Group 1 had more proclined upper and lower incisor than female which was statistically significant. Group 2 had no significant gender difference.

11) UI/SN:

The mean value of UI– SN angle for Group 1 was 109.04 & Group 2 was 110.68 with p value of 0.316(NS). The result showed that both Group 1 and 2 presented with proclined upper incisor with no significant difference.

The mean value of UI– SN angle for Group 1 male was 107.85, Group 1 female was 109.59, Group 2 male was 111.50, Group 2 female was 110.36 with p value of 0.508(NS) and 0.616(NS) respectively. The result shows that both genders presented with proclined upper incisor with no significant difference.

12) UI/NA:

The mean value of UI– NA angular measurement for Group 1 was 25.44 &

Group 2 was 27.84 with p value of 0.055(NS). The result shows that both Group 1 and 2 presented with proclined upper incisor with no significant difference.

The mean value of UI– NA angular measurement for Group 1 male was 23.85, Group 1 female was 26.09, Group 2 male was 27.07, Group 2 female was 28.14 with p value of 0.258(NS) and 0.526(NS) respectively. The result showed that both genders presented with proclined upper incisor with no significant difference.

(59)

Results

34 13) LI/MP:

The mean value of LI– MP angle for Group 1 was 97.26 & Group 2 was 96.22 with p value of 0.526(NS). The result shows that both Group 1 and 2 were presents with proclined lower incisor with no significant difference.

The mean value of LI– MP angle for Group 1 male was 92.54, Group 1 female was 99.05, Group 2 male was 91.21, Group 2 female was 98.17 with p value of 0.016(S) and 0.004(S) respectively. The result shows that in both Group1 and Group 2 females has more proclined lower incisor than males which was statistically significant.

14) LI– NB:

The mean value of LI– NB angular measurement for Group 1 was 28.22 &

Group 2 was 28.22 with p value of 1.000(NS). The result shows that both Group 1 and 2 were presents with proclined lower incisor with no significant difference.

The mean value of LI– NB angular measurement for Group 1 male was 25.08, Group 1 female was 29.41, Group 2 male was 25.29, Group 2 female was 29.36 with p value of 0.021(S) and 0.027(S) respectively. The result shows that in both Group1 and Group 2 females has more proclined lower incisor than males which was statistically significant.

15) UI– NA(mm):

The mean value of UI– NA linear measurement for Group 1 was 7.10 &

Group 2 was 7.98 with p value of 0.033(S). The result shows that Group 2 has more forwardly placed upper incisor than Group 1 which was statistically significant.

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35

The mean value of UI– NA linear measurement for Group 1 male was 6.62, Group 1 female was 7.23, Group 2 male was 7.07, Group 2 female was 8.33 with p value of 0.298 (NS) and 0.068 (NS) respectively. The result shows that both genders presented with more forwardly placed upper incisor with no significant difference.

16) LI– NB(mm):

The mean value of LI– NB linear measurement for Group 1 was 6.94 &

Group 2 was 7.34 with p value of 0.243(NS). The result shows that both Group 1 and 2 presented with more forwardly placed lower incisor with no significant difference.

The mean value of LI– NB linear measurement for Group 1 male was 6.69, Group 1 female was 7.02, Group 2 male was 7.00, Group 2 female was 7.47 with p value of 0.431 (NS) and 0.456 (NS) respectively. The result shows that both genders presented with more forwardly placed lower incisor with no significant difference.

17) H – ANGLE :

The mean value of H – angle for Group 1 was 15.12 & Group 2 was 14.90 with p value of 0.708(NS). The result shows that both Group 1 and 2 had normal soft tissue profile with no significant difference.

The mean value of H – angle for Group 1 male was 14.92, Group 1 female was 15.39, Group 2 male was 14.39, Group 2 female was 14.89 with p value of 0.552(NS) and 0.969(NS) respectively. The result shows that both genders presented with normal soft tissue profile with no significant difference.

.

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Results

36 18) Z – ANGLE:

The mean value of Z – ANGLE for Group 1 was 82.82 & Group 2 was 86.26

with p value of 0.012(S). The result shows that Group 2 has protrusive upper lip than Group 1 which was statistically significant.

The mean value of Z – ANGLE for Group 1 male was 84.69, Group 1 female was 82.00, Group 2 male was 84.86, Group 2 female was 86.81 with p value of 0.298 (NS) and 0.428 (NS) respectively. The result showed that group I male and group 2 female presented with more protrusive upper lip and had no significant difference

19) S –LINE to UL:

The mean value of S –LINE to UL for Group 1 was -3.20 & Group 2 was -1.24 with p value of 0.074 (NS). The result shows that both Group 1 and 2 had no significant difference.

The mean value of S –LINE to UL for Group 1 male was -9.5, Group 1 female was -0.93, Group 2 male was -2.07, Group 2 female was -1.17 with p value of 0.012

(S) and 0.291 (NS) respectively. The result shows that Group 1 males had retrusive upper lip than female which was statistically significant. whereas in Group

2 there was no significant gender difference.

20) S –LINE to LL:

The mean value of S –LINE to LL for Group 1 was 0.64 & Group 2 was 0.92 with p value of 0.560(NS). The result shows that both Group 1 and 2 presented with no significant difference.

The mean value of S –LINE to LL for Group 1 male was -0.69, Group 1 female was 1.14, Group 2 male was 0.50, Group 2 female was 1.08 with p value of 0.020 (S) and 0.464 (NS) respectively. The result shows that Group 1 males had retrusive

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37

lower lip than female which was statistically significant. whereas Group 2 had no significant gender difference.

21) E – LINE:

The mean value of E – LINE for Group 1 was -3.12 & Group 2 was -3.78 with p value of 0.108(NS). The result shows that both Group 1 and 2 had retrusive upper lip and had no statistically significant difference.

The mean value of E – LINE for Group 1 male was -3.77, Group 1 female was - 2.82, Group 2 male was -4.36, Group 2 female was -3.56 with p value of 0.103 (NS) and 0.317 (NS) respectively. The result shows that there is no significant gender difference.

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Results

38 Table No 1: Comparison of Group 1(North Tamilnadu) and Group 2 ( South Tamilnadu)

S.NO PARAMETERS Mean ± SD p value - *

NORTH TAMILNADU SOUTH TAMILNADU

1

SKELETAL

PARAMETERS SNA 82.92 ± 3.56 83.38 ± 3.75 0.531(NS)

2 SNB 80.96 ± 3.56 81.50 ± 3.56 0.450(NS)

3 MP/SN 27.74 ±4.28 28.20±4.86 0.617(NS)

4 Y-AXIS 64.50 ±2.95 64.64 ± 3.40 0.826(NS)

5 FACIAL AXIS 92.12 ± 2.40 91.58 ± 3.12 0.334(NS)

6 CO-A 83.84 ± 4.23 83.20 ± 3.76 0.426(NS)

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Results

39 7 CO-GN 107.4 ± 10.1 107.18 ± 9.13 0.893(NS)

8 ANS-ME 63.22 ± 5.22 63.32 ± 4.47 0.918(NS)

PFH : AFH 67.33 ± 4.51 66.40 ± 5.09 0.332(NS)

DENTAL

PARAMETERS UI/LI 123.82 ± 9.19 118.0 ± 18.6 0.052(NS)

UI/SN 109.04 ± 8.01 110.68 ± 8.26 0.316(NS)

UI/NA 25.44 ± 6.81 27.84 ± 5.45 0.055(NS)

LI/MP 97.26 ± 7.69 96.22 ± 8.64 0.526(NS)

LI/NB 28.22 ± 5.82 28.22 ± 6.42 1.000(NS)

UI/NA 7.10 ± 2.08 7.98 ± 1.99 0.033(S)

LI/NB 6.94 ± 1.45 7.34 ± 1.92 0.243(NS)

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Results

40 18

SOFT TISSUE

PARAMETERS H-ANGLE 15.12 ± 2.55 14.90 ± 3.25 0.708(NS)

19 Z-ANGLE 82.82 ± 6.09 86.26 ± 7.28 0.012(S)

20 S-LINE UL -3.20 ± 6.62 -1.42 ± 1.96 0.074(NS)

21 S-LINE LL 0.64 ± 2.50 0.92 ± 2.28 0.560(NS)

22 E-LINE -3.12 ± 2.03 -3.78 ± 2.04 0.108(NS)

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Results

41 Table No.2 Gender Comparison - Group 1

PARAMETERS Mean ± SD

(NORTH TAMILNADU) p value - *

MALE FEMALE

1

SKELETAL

PARAMETERS SNA 83.23 ± 3.79 82.84 ± 3.55 0.745 (NS)

2 SNB 81.23 ± 3.79 80.89 ± 3.55 0.774 (NS)

3 MP/SN 27.62 ± 3.78 27.75 ± 4.32 0.914 (NS)

4 Y-AXIS 63.62 ± 2.66 64.80 ± 2.95 0.186 (NS)

5 FACIAL AXIS 93.08 ± 1.12 91.80 ± 2.52 0.012 (S)

6 CO-A 87.85 ± 3.29 82.36 ± 3.50 0.000 (S)

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Results

42 7 CO-GN 116.62 ± 9.28 103.77 ± 8.18 0.000 (S)

8 ANS-ME 68.31 ± 5.68 61.32 ± 3.57 0.001 (S)

10 PFH:AFH 65.75 ± 5.46 67.97 ± 3.98 0.195 (NS)

11

DENTAL

PARAMETERS UI/LI 128.31 ± 7.62 122.05 ± 9.06 0.021 (S)

12 UI/SN 107.85 ± 8.23 109.59 ± 8.02 0.508 (NS)

13 UI/NA 23.85 ± 5.81 26.09 ± 7.08 0.258 (NS)

14 LI/MP 92.54 ± 7.95 99.05 ± 6.69 0.016 (S)

15 LI/NB 25.08 ± 5.47 29.41 ± 5.40 0.021 (S)

16 UI/NA 6.62 ± 1.71 7.23 ± 2.16 0.298 (NS)

17 LI/NB 6.69 ± 1.25 7.02 ± 1.47 0.431 (NS)

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Results

43 SOFT TISSUE

PARAMETERS H-ANGLE 14.92 ± 2.36 15.39 ± 2.64 0.552 (NS)

Z-ANGLE 84.69 ± 8.62 82.00 ± 4.67 0.298 (NS)

S-LINE UL -9.5 ± 10.5 -0.93 ± 1.99 0.012 (S)

S-LINE LL -0.69 ± 2.25 1.14 ± 2.43 0.020 (S)

E-LINE -3.77 ± 1.64 -2.82 ± 2.18 0.103(NS)

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Results

44 Table No.3 Gender Comparison –Group 2

S.NO PARAMETERS Mean ± SD

(SOUTH TAMILNADU) p value - *

MALE FEMALE

1

SKELETAL

PARAMETERS SNA 84.07 ± 4.32 83.11 ± 3.54 0.468 (NS)

2 SNB 82.07 ± 4.32 81.28 ± 3.26 0.541 (NS)

3 MP/SN 29.50 ± 3.50 27.69 ± 5.25 0.168 (NS)

4 Y-AXIS 65.79 ± 3.49 64.19 ± 3.30 0.156 (NS)

5 FACIAL AXIS 90.71 ± 2.87 91.92 ± 3.18 0.208 (NS)

6 CO-A 85.50 ± 2.74 82.31 ± 3.76 0.002 (S)

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Results

45 7 CO-GN 114.00 ± 9.04 104.53 ± 7.78 0.003 (S)

8 ANS-ME 66.86 ± 3.66 61.94 ± 4.01 0.000 (S)

PFH:AFH 65.21 ± 6.70 66.86 ± 4.33 0.407 (NS)

DENTAL

PARAMETERS UI/LI 111.5 ± 31.9 120.56 ± 9.19 0.315 (NS)

UI/SN 111.50 ± 6.30 110.36 ± 8.97 0.616 (NS)

UI/NA 27.07 ± 5.14 28.14 ± 5.61 0.526 (NS)

LI/MP 91.21 ± 6.36 98.17 ± 8.69 0.004 (S)

LI/NB 25.29 ± 5.15 29.36 ± 6.56 0.027 (S)

UI/NA 7.07 ± 2.16 8.33 ± 1.84 0.068 (NS)

LI/NB 7.00 ± 2.00 7.47 ± 1.90 0.456 (NS)

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Results

46 18

SOFT TISSUE

PARAMETERS H-ANGLE 14.93 ± 3.12 14.89 ± 3.34 0.969 (NS)

19 Z-ANGLE 84.86 ± 7.85 86.81 ± 7.09 0.428 (NS)

20 S-LINE UL -2.07 ± 2.97 -1.17 ± 1.36 0.291 (NS)

21 S-LINE LL 0.50 ± 2.59 1.08 ± 2.17 0.464 (NS)

22 E-LINE -4.36 ± 2.71 -3.56 ± 1.71 0.317 (NS)

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47 GRAPHS

Graph No.1: GROUP 1 SKELETAL PARAMETERS

Graph No.2: GROUP 1 DENTAL AND SOFT TISSUE PARAMETERS

82.92 83.38

27.74 64.5

92.12 83.84

107.44

63.22 67.33

0 20 40 60 80 100 120

GROUP 1 SKELETAL

SNA SNB MP/SN Y AXIS FACIAL AXIS C0-A C0-GN ANS-ME PFH:AFH

123.82 109

25.4 97.2

28.2

7.1 6.94 15.12 82.82

-3.2 0.64

-3.12 -20

0 20 40 60 80 100 120 140

GROUP 1 DENTAL AND SOFT TISSUE

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Results

48 Graph No.3 GROUP 2 SKELETAL PARAMETERS

Graph No.4 GROUP 2 DENTAL AND SOFT TISSUE PARAMETERS

83.38 81.5

28.2

64.6

91.58

83.2

107.18

63.32 66.4

0 20 40 60 80 100 120

SNA SNB MP/SN Y AXIS FACIAL

AXIS C0-A C0-GN ANS-ME PFH : AFH

GROUP 2 SKELETAL

118 110

27.8 96.22

28.22

7.9 7.34 14.9

86.26

-1.42 0.92 -3.78

-20 0 20 40 60 80 100 120 140

GROUP 2 DENTAL AND SOFT TISSUE

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49

Graph No.5 GENDER COMPARISON OF SKELETAL PARAMETERS – GROUP 1

Graph No.6 GENDER COMPARISON OF DENTAL AND SOFT TISSUE PARAMETERS – GROUP 1

0 20 40 60 80 100 120 140

SNA SNB MP/SN Y AXIS FACIAL

AXIS C0-A C0-GN ANS-ME PFH : AFH

COMPARISION OF GROUP 1 SKELETAL - MALE AND FEMALE

Male Female

-20 0 20 40 60 80 100 120 140

COMPARISION OF GROUP 1 DENTAL AND SOFT TISSUE - MALE AND FEMALE

Male Female

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Results

50

Graph No.7 GENDER COMPARISON OF SKELETAL PARAMETERS – GROUP 2

Graph No.8 GENDER COMPARISON OF DENTAL AND SOFT TISSUE PARAMETERS – GROUP 2

0 20 40 60 80 100 120

SNA SNB MP/SN Y AXIS FACIAL

AXIS C0-A C0-GN ANS-ME PFH : AFH

COMPARISION OF GROUP 2 SKELETAL - MALE AND FEMALE

Male Female

-20 0 20 40 60 80 100 120 140

COMPARISION OF GROUP 2 DENTAL AND SOFT TISSUE - MALE AND FEMALE

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Discussion

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Discussion

51

DISCUSSION

As improvement of facial aesthetics has rapidly become one of the desirable objectives of orthodontic treatment, the concept of normal has become indispensable for an orthodontist. Despite the formulation of many hard tissue norms, and the treatment according to them, it was found that the soft tissues of the patient did not respond as expected to give a pleasing profile. Hence, it was understood that the hard tissue measurements can deviate considerably from the facial form the patient expresses with the soft tissues. As treatment mechanics became more effective, there has been increased emphasis on the soft tissue in both diagnostic and treatment results.

However since skeletal, dental, soft tissue structures exhibit different patterns for different ethnic groups, it becomes relevant to define the norms for successful diagnosis and treatment planning.

The norms established for the population of western countries may not be apparently applicable to Indian population on account of ethnographic difference in the constitution, structural build, nutritional habits, socio – economic status, cultural background, genetic and manifold environmental factors which exert influence on the development and morphology of dentofacial structures.

India is one of the largest countries in Asia with four different zones – east, west, north and south. All the four zones have different population having different facial characteristics. Over the centuries, Indians has received large groups of people of different ethnical and cultural origins. Thus, these will lead to dispersion of different

References

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