Craniofacial morphology of Upper Shimla Hill Population – A cephalometric study

orthodontic waves 74 (2015) 1–9

Available online at www.sciencedirect.com

ScienceDirect journal homepage: www.elsevier.com/locate/odw

Original article

Craniofacial [189_TD$IF]morphology of Upper Shimla Hill Population [190_TD$IF]– A cephalometric study P. Sood BDS, MDSa, S.K. Verma MDSb,*, [19_TD$IF]K.S. Negi a, J.R. Kaundal a, S. Sood a a b

Department of Orthodontics and Dentofacial Orthopedics, H.P. Dental College & Hospital, Shimla, India Department of Orthodontics and Dentofacial Orthopedics, Kothiwal Dental College & Research [194_TD$IF]Centre, Moradabad 244001, India

article info

abstract

Article history:

Aim: The aims of the present study were [197_TD$IF]to study the hard and soft tissue cephalometric

Received 3 May 2013

morphology and establish norms for the Upper Shimla Hill Population, Himachal Pradesh,

Received in revised form

India, to find similarity with any other racial group and to compare gender differences[198_TD$IF].

20 August 2014

Materials and methods: Lateral cephalometric radiographs were obtained of Sixty Upper

Accepted 4 November 2014

Shimla Hill subjects (30 male and 30 female; mean age 20.6 years and 19.6 years, respec-

Available online 24 December 2014

tively) with Angle’s Class I molar relationship, well[19_TD$IF]-aligned arches, and full complement of teeth except third molars. The lateral cephalograms were traced and [20_TD$IF]15 linear and 11

Keywords:

angular variables were obtained[201_TD$IF].

Upper Shimla Hill Population norms

Results: A comparison with the Caucasians[16_TD$IF]’ norm showed that Upper Shimla Hill subjects

Lateral [206_TD$IF]head cephalogram

had longer Anterior cranial base length and increased [160_TD$IF]cranial base angle, retrognathic

Craniofacial [207_TD$IF]morphology

maxilla, horizontal growth pattern, [20_TD$IF]and proclined upper incisors but reduced lip prominence[203_TD$IF]. Female sample presented shorter anterior and posterior cranial base length, had shorter mandible, less total anterior and posterior face height and reduced [204_TD$IF]lower anterior face height. Males had protrusive upper incisors and acute [205_TD$IF]interincisal angle. Conclusion: It was concluded that to evaluate any Upper Shimla Hill Population orthodontic patient, Upper Shimla Hill norms, and not Caucasians[16_TD$IF]’ norm must be used as a yardstick. # 2014 Elsevier Ltd and the Japanese Orthodontic Society. All rights reserved.

1.

Introduction

Since the introduction of cephalometrics by Broadbent [1] in 1931, cephalometric standards have been derived for various population groups. The use of cephalometrics extends from the study of facial form or craniofacial morphology to the development of cephalometric norms [2]. However it is apparent that Caucasian norms are inappropriate for application to other racial groups, as racial characteristics lead to important cephalometric variations. There are a number of

previous cephalometric studies of Indian population, including Nanda [208_TD$IF]and Nanda [3] who studied North Indian Lucknow population, Kannappan [209_TD$IF]and Balasubramanian [4] who investigated Madras city population, Bhat et al. [5] whose research looked at Bunt and Brahmin children of Dakshina Kannada and [210_TD$IF]Kapila [6] studied Kikuyu children. It has been shown that differences within the same racial group can exist. Uesato [21_TD$IF]et al. [7] noted that the craniofacial form of American-Japanese was different from native counterparts. The different racial groups will have to be treated according to their own individual characteristics. Shimla lies in the

* Corresponding author[196_TD$IF]. Tel.: +91 9456814845. E-mail address: [email protected] (S.K. Verma). http://dx.doi.org/10.1016/j.odw.2014.11.001 1344-0241/# 2014 Elsevier Ltd and the Japanese Orthodontic Society. All rights reserved.

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orthodontic waves 74 (2015) 1–9

[(Fig._1)TD$IG]

Fig. 1 – Frontal and profile view of male and female subjects.

north-western ranges of the Himalayas. It has been observed that patients from a particular region of Himachal Pradesh[21_TD$IF], that is Upper Shimla Hill Population (Kotgarh and nearby areas) [213_TD$IF][8], have peculiar feature of class III skeletal pattern accompanied by class I occlusion. The availability of local data on craniofacial morphology of this Upper Shimla Hill Population group will assist in their diagnosis, management and outcome assessment of orthodontic care. Thus the aim of this study is to establish a cephalometric description of the craniofacial morphology of Upper Shimla Hill Population.

2.

Materials and methods

The study sample comprised of 6 F]I$DT_14[2 0 subjects (30 females, average age 19.6 years and 30 males, average age 20.6 years) with age ranging from 17 t]FDI$_T15[2 o 25 years (average age 20.1 years). Subjects were included in the study if they belonged to Upper Shimla Hill Population (Kotgarh and nearby areas) of Himachal Pradesh, had both parents and grandparents belonging to the same population group, had full complement of teeth –]FDI$_T16[2 third molars are not taken into consideration, had no previous history of

Table 1 – Double determination test for hard tissue variables. [75_TD$IF]S. no.

Parameters

Cranial base parameters [76_TD$IF]1. S-N (mm) 2. S-Ba (mm) [7_TD$IF]3. N-S-Ba (8) Jaws (sagittal) parameters [78_TD$IF]4. ANS-PNS (mm) 5. Go-pogperp (mm) [80_TD$IF]6. Co-Gn (mm) [81_TD$IF]7. Go-pogperp: ANS-PNS [82_TD$IF]8. SNA (8) [83_TD$IF]9. SNB (8) [84_TD$IF]10. ANB (8) 11. A-N perp (mm) 12. Pog-N perp (mm) 13. B perp-Pogperp (mm) 14. ANS-A perp (mm) [87_TD$IF]15. FH/N-Pog (8) [8_TD$IF]Jaws (vertical) parameters [89_TD$IF]16. SN-MP(S) (8) 17. N-Me (mm) 18. S-Go (mm) [91_TD$IF]19. N-ANS (mm) [92_TD$IF]20. ANS-Me (mm) [93_TD$IF]21. Jarabak ratio (%) [94_TD$IF]22. N-ANS (%) [95_TD$IF]23. ANS-Me (%) Dental parameters [97_TD$IF]24. IL(i)-MP(T) (8) [98_TD$IF]25. IL(s)-PP (8) [9_TD$IF]26. IL(s)-SN (8) [10_TD$IF]27. IL(s)-IL(i) (8)

(Mean) first measurement

(Mean) second measurement

t-Value

p-Value

73 50 132

74 49 132

1 0.095 0.709

NS NS NS

55.10 85.60 127.1 1.51 80.95 82.10 1.15 3.85 [85_TD$IF]0.75 9.40 8.70 89.70

55.20 85.30 126.4 1.48 80.45 81.80 1.35 4.30 1.15 9.50 8.60 89.30

[79_TD$IF]0.429 1.0 3.2 1.152 2.121 1.5 0.70 1.711 1.5 [86_TD$IF]0.318 0.318 1.177

NS NS NS NS NS NS NS NS NS NS NS NS

25.70 124 87.90 58 68.40 70.92 45.7 [96_TD$IF]55.07

26.00 124 87.40 58 68.40 70.70 45.5 55.55

1.406 [90_TD$IF]1 1.627 0.532 0 0.588 0.802 1.65

NS NS NS NS NS NS NS NS

88.30 66.70 107.10 136

88.30 66.60 106 135

0 0.429 1.206 0.818

NS NS NS NS

orthodontic waves 74 (2015) 1–9

Orthodontic, Orthognathic and Plastic surgery treatment, had Angle’s Class I Molar relationship with proper intercuspation or satisfactory occlusion and pleasing facial profile (Fig. 1). E F]I$D_T17[2 thical clearance was taken from the Himachal Pradesh government dental college and hospital ethical committee before carrying out the research. Informed consent was taken from all subjects. Standardized 8  1 F]DI$_T18[2 000 Kodak lateral radiographic films were used for each subject on Cranex Excel Ceph Machine (]FDI$_T19[2 Soredex, Helsinki, Finland) r]FDI$_T20[ adiographic unit with ear-posts. The [(Fig._2)TD$IG]magnification was calculated to be 10% for mid-[s]FDI$_T21 agittal

3

structures. The X-ray source to subject distance was kept at a constant distance of 5 feet; the film was kept at a constant distance of 16 c F]I$DT2_[ m away from the mid-[s]FDI$_T23 agittal plane. Exposure parameters were kept at 71 kVp at 10 m F]ID$_T24[ A for 0.08 s. Each radiograph was taken with teeth in maximum intercuspation and lips in relaxed position. All the lateral cephalometric films were traced on 36 m ]FDI$_T25[ m citizen acetate tracing sheets using 4H lead pencil. Fourteen hard tissue skeletal points, four dental points and six soft tissue points were marked. Seven reference planes were constructed. F ]FDI$_T26[ rom the above-mentioned points and

Fig. 2 – Hard [1_TD$IF]and soft tissue cephalometric parameters. [2_TD$IF]Hard tissue cephalometric landmarks [2]; Point A subspinale: the most posterior point on the anterior contour of the upper alveolar process. [3_TD$IF]ANS: Anterior Nasal Spine[4_TD$IF]: the apex of anterior nasal spine. [5_TD$IF]678910234POINT B: supramentale: the most posterior point on the anterior contour of the lower alveolar process. Gn: gnathion: the most antero-inferior point on the symphysis of the chin constructed from a line drawn perpendicular to line connecting menton and pogonion. Go:gonion: the most postero-inferior point on the angle of the mandible. PNS: posterior nasal spine: the intersection between the nasal floor and the posterior contour of the maxilla. Me: menton: the most inferior point on the mandibular symphysis. N: NASION: situated at the frontonasal suture. Or: Orbitale: the most inferior point on the inferior orbital margin. PO: porion: the most superior point on the external auditory meatus. POG: pogonion: the most anterior point on the mandibular symphysis. S: Sella: the center of sella turcica. Ba: Basion: the most postero-inferior point on the margin of the foramen magnum. CO: condylion: the most supero-posterior point on the condylar head. Dental landmarks [2]; Ai: apex inferius: the apex of the root of the most prominent lower central incisor. [18_TD$IF]As: apex superius: the apex of the root of the most prominent upper central incisor. [19_TD$IF]Li: incision superius: the midpoint of the incisal edge of the most prominent upper central incisor. [20_TD$IF]Is: incision superius: the midpoint of the incisal edge of the most prominent upper central incision. [21_TD$IF]Soft tissue cephalometric landmarks [2_TD$IF][2]; N’: soft tissue nasion: THE POINT of greatest concavity in the midline between the forehead and the nose. [23_TD$IF]Ct: chin tangent point: the lower tangent point on the chin of the nose chin line. [24_TD$IF]Int: upper nasal tangent point: the upper tangent on the nose of the nose-chin line. [19_TD$IF]Li: labrale inferius: the most prominent point of the prolabium of the lower lip. [25_TD$IF]Ls: labrale superius: the most prominent point on the prolabium of the upper lip. [26_TD$IF]Pog: soft tissue pogonion: the most prominent point on the chin. [27_TD$IF]Reference planes; FH: Frankfort horizontal plane [28_TD$IF][2]: a line drawn from the superior point of the anatomic porion to the inferior point of the orbitale[29_TD$IF]. Mandibular plane; MP(T) Tweed’s[29]: it is drawn along the lower border of the mandible, anteriorly connects with the menton [1_TD$IF]and posteriorly it bisects the distance between the right [1_TD$IF]and left lower borders of the mandible in the region of the gonial angle. [30_TD$IF]MP(S): steiner’s: it is drawn between gonion [31_TD$IF]and gnathion. SN: sella-Nasion plane [32_TD$IF][2]: a line from sella to nasion, representing the anterior cranial base. [3_TD$IF]PP: palatal plane [2]: a line through spinale [34_TD$IF]and pterygomaxillare. NCL: soft tissue nose-chin line [35_TD$IF][2]: also called the aesthetic line. Drawn from upper tangent point on nose (lnt) to lower tangent point on chin(ct[36_TD$IF]). IL: long axis of incisors [2]: it is obtained by joining point Ai and As with point Li and Ls.

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orthodontic waves 74 (2015) 1–9

planes, 1 ]FDI$_T27[ 5 linear and 11 angular variables were obtained. All the tracings were done by t]FDI$_T28[ he same operator. Where the bilateral structures casted double shadows on the film the average of the two images was taken (F]ID$_T29[ Fig. 2). Cephalometric planes (Fig. 3): [230_TD$IF]1. S-N, 2. S-Ba, 3. N-S-Ba, 4. IL(s)-PP, 5. IL(s)-SN, 6. IL(i)-MP(T), 7. IL(s)-IL(i), 8. ANS-PNS, 9. Go-Pogperp, 10. S-N-A, 11. S-N-B, 12. A-N-B, 13. Bperp-Pogperp, 14. ANS-A perp. Cephalometric parameters (Fig. 4):

[(Fig._3)TD$IG]

1. Co-Gn[231_TD$IF], 2. A-N perp, 3. Pog-N perp, 4. FH/N-Pog, 5. S-Go,

6. N-Me, 7. SN-MP(S), 8. Ls-NCL, 9. Li-NCL, 10. FH/N’-Pog’. Comparison of Upper Shimla Hill Population was done with Caucasian control [23_TD$IF][12]. The SD of Caucasian is taken from this study. Measurement of cephalometric error: 1. [23_TD$IF]Error due to fatigue: 8–10 cephalograms were analyzed on an average in a day to eliminate the error due to fatigue of investigator[234_TD$IF]. 2. Inter-investigator error: To avoid this type of error all the cephalograms were traced [1_TD$IF]and analyzed by a single investigator.

Fig. 3 – Hard [37_TD$IF]8tissue cephalometric skeletal and dental parameters. Hard tissue variables used: Cranial base; S-N [2]: anterior cranial base linear dimension[39_TD$IF]. S-Ba [2]: posterior cranial base linear dimension[40_TD$IF]. N-S-Ba: nasion sella basion angle representing the cranial base angle[41_TD$IF]. Dental [2]; IL(i)-MP(T): lower incisor proclination relative to mandibular base[42_TD$IF]. IL(S)-PP: upper incisor proclination relative to mandibular base[43_TD$IF]. IL(S)-SN: axial inclination of upper incisors relative to SN plane[4_TD$IF]. IL(S)-IL(i): interincisal angle. [45_TD$IF]Jaws (sagittal); ANS-PNS [2]: maxillary length, it is obtained by joining two point, PNS [46_TD$IF](constructed radiologic point obtained by intersecting the anterior wall of the pterygopalatine fossa [1_TD$IF]and the floor of the nose) [47_TD$IF]and point ANS. Go-pogperp [10]: mandibular length, obtained by joining two points, the constructed gonion [1_TD$IF]and pogonion (projected perpendicular to the mandibular plane[48_TD$IF]). Co-Gn [2]: mandibular length, obtained [49_TD$IF]by joining point Co and point Gn. Go-pogperp: ANS-PNS [10]: mandibular length: maxillary length[50_TD$IF]. S-N-A: sella-nasion-point A angle, representing maxillary protrusion in relation to anterior cranial base. [51_TD$IF]S-N-B: sella-nasion-point B angle, representing mandibular protrusion in relation to anterior cranial base[52_TD$IF]. A-N-B: point A-nasion-point B angle, representing relationship between maxilla [53_TD$IF]and mandible. A-N perp: maxillary protrusion, it is a linear distance measured between nasion perpendicular (obtained by drawing a perpendicular line from point nasion to FH plane) [54_TD$IF]and point A. Pog-N perp: mandibular protrusion, it is determined by measuring the distance from pogonion to nasion perpendicular [5_TD$IF]B perp-pogperp: chin length, it is determined by measuring distance between two points, B perp (obtained [56_TD$IF]by drawing a perpendicular from point B on mandibular plane) and [57_TD$IF]pogperp (obtained by drawing a perpendicular from point pog on mandibular plane[58_TD$IF]). ANS-A perp: anterior nasal spine length, it is determined by measuring a distance between two points, ANS and A perp [59_TD$IF](obtained by drawing a perpendicular from point A on palatal plane[60_TD$IF]). FH/N-Pog: this is the inferior inside angle in which the facial line (nasion-[61_TD$IF]pogonion) intersects the Frankfort horizontal.

orthodontic waves 74 (2015) 1–9

[(Fig._4)TD$IG]

5

3. [235_TD$IF]Intra-investigator: 10 randomly selected [236_TD$IF]cephalograms were retraced and analyzed at two separate occasions. The parameters were measured randomly and the error was calculated by using Dahlberg’s formula [237_TD$IF][9]: SX ¼ standard deviation of the differences of each of the replicates from it0 mean d = differences between first and second reading [238_TD$IF]N = number of radiographs in the sample recorded After the method error for each parameter was determined; the 95% lower [1_TD$IF]and upper confidence limits of the method error were calculated with the [239_TD$IF]SPSS Statistical Software 15, ICL Corporation, Chicago[240_TD$IF], IL. A double determination test was employed to determine statistical significance between 1[241_TD$IF]st and 2nd measurements.

3.

[62_TD$IF]Fig. 4 – Hard tissue and soft tissue cephalometric parameter. [63_TD$IF]Jaws (sagittal); ANS-PNS [2]: maxillary length, it is obtained by joining two point, PNS (constructed radiologic point obtained by intersecting the anterior wall of the pterygopalatine fossa and the floor of the nose) and point ANS. Go-pogperp [10]: mandibular length, obtained by joining two points, the constructed gonion and pogonion (projected perpendicular to the mandibular plane). Co-Gn [2]: mandibular length, obtained by joining point Co and point Gn. Go-pogperp: ANS-PNS [10]: mandibular length: maxillary length. S-N-A: sella-nasionpoint A angle, representing maxillary protrusion in relation to anterior cranial base. S-N-B: sella-nasion-point B angle, representing mandibular protrusion in relation to anterior cranial base. A-N-B: point A-nasion-point B angle, representing relationship between maxilla and mandible. A-N perp: maxillary protrusion, it is a linear distance measured between nasion perpendicular (obtained by drawing a perpendicular line from point nasion to FH plane) and point A. Pog-N perp: mandibular protrusion, it is determined by measuring the distance from pogonion to nasion perpendicular B perp-pogperp: chin length, it is determined by measuring distance between two points, B perp (obtained by drawing a perpendicular from point B on mandibular plane) and pogperp (obtained by drawing a perpendicular from point pog on mandibular plane). ANSA perp: anterior nasal spine length, it is determined by measuring a distance between two points, ANS and A perp (obtained by drawing a perpendicular from point A on palatal plane). FH/N-Pog: this is the inferior inside angle in which the facial line (nasion-pogonion) intersects the Frankfort horizontal. Jaws (vertical) [2]; SN-MP(S): relates mandibular plane to the anterior cranial base[64_TD$IF]. N-Me: total anterior face height[65_TD$IF]. S-Go: total posterior face height[6_TD$IF]. NANS: UPPER anterior face height[67_TD$IF]. ANS-Me: lower anterior face height[68_TD$IF]. Jarabak ratio: (total posterior face height/total

Statistical analysis

Standard descriptive statistics (mean, standard deviation and standard error) were generated for both the male and female subjects. The variance of distribution was compared using tests of skewness and kurtosis. Comparison was made between the male and female subjects and also between the present established norms and standard norms by mean of independent [24_TD$IF]t test.

4.

Results

Measurement of cephalometric error[243_TD$IF]: The error for the angular measurements was 0.28 for SNB angle to 1.9868 for the inclination of upper incisor to palatal plane. Linear measurements demonstrated error from 0.026 for mandibular length to maxillary length ratio to 1.048 mm for the posterior cranial base length. No statistically significant differences were detected in duplicate determination (Tables 1 and 2) for various hard and soft tissue variables [24_TD$IF](Table 3). The study group consisted of 60 subjects out of which 30 were males (50%) and 30 were females (50%). Tables 4 and 5 demonstrate that no statistically significant differences were observed between male and female subjects except for the following: Anterior and [245_TD$IF]posterior cranial base length (S-N) was greater for male subjects ([246_TD$IF]p value = 0.01). Males had longer mandibular length (Go-Pogperp) when compared to females ([247_TD$IF]p value = 0.01). Co-Gn measurement also showed greater length for male subjects. Total anterior and posterior facial height was greater for males with [248_TD$IF]p value = 0.01. Upper and [204_TD$IF]lower anterior facial height was greater for males. Inclination of upper incisor to Sella Nasion plane was greater for males with [249_TD$IF]p value = 0.01. Interincisal angle (IL(s)-IL(i)) was greater for females with [250_TD$IF]p value = 0.01 (Tables 6–10[251_TD$IF]).

anterior face height) [69_TD$IF]T 100. N-ANS (%): (upper anterior face height/total anterior face height[70_TD$IF]). ANS-Me (%): (lower anterior face height/total anterior face height) [71_TD$IF]T 100. Soft tissue variable used [72_TD$IF][2]; Ls-NCL: upper lip prominence[73_TD$IF]. LiNCL: lower lip prominence[74_TD$IF]. FH/N’-Pog’: facial convexity.

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orthodontic waves 74 (2015) 1–9

Table 2 – Double determination test for soft tissue variables. S. [10_TD$IF]no.

Parameters

(Mean) first measurement

(Mean) second measurement

t-Value

p-Value

1. 2. 3.

Ls-NCL (mm) Li-NCL (mm) FH/N’-Pog’ (8)

[102_TD$IF]6.9 [103_TD$IF]4.85 90.4

6.7 4.44 90.6

0.802 1.87 0.802

NS NS NS

The Upper Shimla Hill Population possessed longer anterior cranial base compared to Caucasians. The mean value in the present study was 74.12 mm  [25_TD$IF]3.28, which was larger than the mean value reported by Rakosi [253_TD$IF]et al. [10] (71 mm) and the difference [254_TD$IF]was significant ( p = 0.01). The mean anterior cranial base length for male subjects was 75.67 mm and for female subjects was 71.07 mm. The gender comparison was highly significant ([25_TD$IF]p = 0.01). The mean value of the Sella Nasion Pt.A angle in the present study was 79.980  4.19, which was lesser than the mean value as presented by Steiner’s [21] (828) for a Caucasian group and the difference was highly significant ([25_TD$IF]p = 0.01). The mean value of the Pt. A Nasion Pt. B angle in the present study was [256_TD$IF]0.890  1.74, which was lesser than the mean value as

Table 3 – Mean, [104_TD$IF]SD and SEM for hard and soft tissue variables of the 60 subjects belonging to Upper Shimla Hill Population group. [105_TD$IF]S. no.

Parameters

Cranial base parameters [107_TD$IF]1. S-N (mm) [108_TD$IF]2. S-Ba (mm) [109_TD$IF]3. N-S-Ba (8) [10_TD$IF]Jaws (sagittal) parameters 4. ANS-PNS [1_TD$IF]5. Go-pogperp (mm) 6. Co-Gn (mm) [13_TD$IF]7. Go-pogperp: ANS-PNS [14_TD$IF]8. S-N-A (8) [15_TD$IF]9. S-N-B (8) [16_TD$IF]10. A-N-B (8) 11. A-N perp (mm) 12. Pog-N perp (mm) 13. B perp-Pogperp (mm) [17_TD$IF]14. ANS-A perp (mm) [18_TD$IF]15. FH/N-Pog (8) [19_TD$IF]Jaws (vertical) parameters [120_TD$IF]16. SN-MP(S) (8) [12_TD$IF]17. N-Me (mm) [12_TD$IF]18. S-Go (mm) [123_TD$IF]19. N-ANS (mm) [124_TD$IF]20. ANS-Me (mm) [125_TD$IF]21. Jarabak ratio (%) 22. N-ANS (%) [127_TD$IF]23. ANS-Me (%) Dental parameters 24. IL(i)-MP(T) (8) [128_TD$IF]25. IL(s)-PP (8) [129_TD$IF]26. IL(s)-SN (8) [130_TD$IF]27. IL(s)-IL(i) (8) [13_TD$IF]Soft tissue parameters [132_TD$IF]28. Ls-NCL (mm) 29. Li-NCL (mm) [13_TD$IF]30. FH/N’-Pog’ (8)

Mean

[106_TD$IF]SD

SEM

74.12 50.92 131.75

3.279 4.014 5.021

0.423 0.518 0.648

56.37 85.60 127.07 1.521 79.98 80.88 0.89 4.46 2.01 10.17 8.22 89.25

3.314 5.761 6.16 0.1 4.194 4.145 1.744 3.930 5.995 4.338 1.923 2.753

0.428 [12_TD$IF]0.744 0.79 0.013 0.541 0.535 0.225 0.507 0.774 0.560 0.248 0.355

26.98 125.25 87.68 56.78 69.33 70.07 44.66 55.34

4.497 7.106 6.555 3.55 5.772 4.448 2.44 3.130

0.581 0.917 0.846 0.46 0.745 [126_TD$IF]0.574 0.315 0.404

88.42 67.95 105.90 136.40

6.277 7.843 7.341 10.561

0.810 1.012 0.948 1.363

6.86 4.78 91.83

2.365 2.515 2.964

0.305 0.325 0.383

reported by Steiner’s [21] (28) and highly significant difference was found when the result was compared with Steiner’s norm ([25_TD$IF]p = 0.01). The mean value of the SellaNasion Pt. B angle in the present study was 80.880  [257_TD$IF]4.14, which was slightly higher than the mean value as reported by Steiner’s [21] (80) for a Caucasian group but there was no statistically significant difference.

5.

Discussion

The gender comparison was highly significant ([25_TD$IF]p = 0.01). The Upper Shimla Hill Population possessed longer anterior cranial base compared to Caucasians. Similar results were reported by Scheideman [208_TD$IF]and Legan [11] in his study on Caucasian population, [258_TD$IF]and by Baccon et al. [12] for Bantus and Caucasoids. The mean [160_TD$IF]cranial base angle for the present study group was more than [259_TD$IF]the norm given by Bjork [13] (1318) and the difference was highly significant ([260_TD$IF]p = 0.01). Similar results were reported by [261_TD$IF]Obloj et al. [14] in the Polish population, by Naranjilla [26_TD$IF]and Janson [15] in Filipino females and German males, by El-Batouti [253_TD$IF]et al. [16] for Norwegian females, by Segner [17] in Europeans and by Riolo [263_TD$IF]et al. [18] in Americans. The Upper Shimla Hill subjects possess average mandibular length. Similar results were reported by Shalhoub [253_TD$IF]et al. [19] in his study on Saudi population, by Obloj [253_TD$IF]et al. [14] on Polish population and Riolo [263_TD$IF]et al. [18] on American population. Both, maxilla and mandible are in proportion to each other in the present study group, as shown by mean value of [264_TD$IF]mandibular length: Maxillary length of 1.52  [265_TD$IF]0.1. This ratio is slightly greater than the norm given by Rakosi [26_TD$IF]et al. [10] (1.5) but the difference was statistically non-significant. The Upper Shimla Hill subjects had prognathic mandible when compared to maxilla. The difference found in the Pt. A Nasion Pt. B angle in the present study could be due to racial variation. Similar results were reported by Naranjilla [26_TD$IF]and Janson [15] in German population. The mean [267_TD$IF]maxillary protrusion (A-N perp) for the Upper Shimla Hill Population was less than the value established by McNamara [26] (1 mm). The difference was highly significant ([25_TD$IF]p = 0.01). Similar results were reported by Obloj [253_TD$IF]et al. [14] in Polish population. The mean m F]I$DT4_6[2 andibular protrusion for the Upper Shimla Hill Population was within the range given by McNamara [26] (]FDI$_T68[2 2 mm to 4 mm). The comparison with McNamara’s norm was not statistically significant. The mean value of the Facial angle in the present study was larger than the mean value as reported by Downs [27] for a Caucasian group and there was statistically highly significant difference present ([p ]FDI$_T472 value = 0.01). The mean [264_TD$IF]mandibular plane angle for the Upper Shimla Hill Population was less than the value established by Steiner’s [21] (328). The difference was highly significant ([25_TD$IF]p = 0.01). The

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orthodontic waves 74 (2015) 1–9

Table 4 – [134_TD$IF]Demonstrating the comparison between male and female hard tissue variables. S. [135_TD$IF]no.

Parameters

Male

Cranial base parameters [138_TD$IF]1. S-N (mm) 2. S-Ba [139_TD$IF](mm) 3. N-S-Ba (8) Jaws (sagittal and vertical) parameters 4. ANS-PNS (mm) 5. Go-[14_TD$IF]pogperp (mm) 6. Co-Gn (mm) 7. Go-[142_TD$IF]pogperp: ANS-PNS 8. S-N-A (8) 9. S-N-B (8) 10. A-N-B (8) 11. A-N perp (mm) 12. Pog-N perp (mm) 13. B perp[147_TD$IF]-Pogperp (mm) 14. ANS-A perp (mm) 15. FH/N-Pog (8) 16. SN-MP(S) (8) 17. N-Me (mm) 18. S-Go (mm) 19. N-ANS (mm) 20. ANS-Me (mm) 21. Jarabak Ratio(%) 22. N-ANS (%) 23. ANS-Me (%) Dental parameters 24. IL(i)-MP(T) (8) 25. IL(s)-PP (8) 26. IL(s)-SN (8) 27. IL(s)-IL(i) (8)

Female

[136_TD$IF]t-Value

p-Value

Significance

[137_TD$IF]Mean

SD

Mean

SD

75.67 52.40 131.4

3.010 3.673 5.322

71.07 49.43 132

9.127 3.839 4.770

2.622 3.058 [140_TD$IF] 0.485 

0.01 0.003 0.629

** ** NS

57.06 87.50 130.0 1.536 79.68 80.93 [14_TD$IF]1.25 [145_TD$IF]5.10 [146_TD$IF]2.22 10.03 8.30 89.07 26.47 129.03 91.07 58.2 71 70.59 45 55

3.383 5.947 6.441 0.1 4.990 4.826 2.083 4.419 6.213 2.092 2.168 2.599 3.937 6.037 6.264 3.468 5.639 3.997 2.155 3.121

55.66 83.70 124.1 1.507 80.27 80.83 0.53 3.82 1.80 10.30 8.13 89.43 27.50 121.47 84.30 55.367 67.67 69.54 44.32 55.68

3.144 4.970 4.205 0.102 3.271 3.415 1.259 3.323 5.869 5.820 1.676 2.932 5.009 6.056 4.949 3.068 5.498 4.868 2.711 3.154

1.66 2.686 4.225 1.12 [143_TD$IF]0.535 0.093 1.613 1.27 0.267 [148_TD$IF]0.24 0.333 [149_TD$IF]0.513 [150_TD$IF]0.888 4.847 4.643 3.352 2.318 0.921 [15_TD$IF]0.086 [152_TD$IF]0.840

0.102 0.009 0.000 0.268 0.594 0.927 0.112 0.209 0.790 0.814 0.740 0.610 0.378 0.000 0.000 0.001 0.024 0.361 0.411 0.405

NS ** ** NS NS NS NS NS NS NS NS NS NS ** ** ** * NS NS NS

89.73 66.13 108.20 132.67

5.192 7.709 6.970 9.928

87.10 69.77 103.60 140.13

7.04 7.67 7.07 9.97

1.648 [153_TD$IF]1.83 2.536 [154_TD$IF]2.906

0.105 0.072 0.014 0.005

NS NS * **

mean Total posterior face height for the present study group was larger than that reported for Polish, Slovenian, Norwegian, Swedish, English and American populations by Obloj [269_TD$IF]et al. [14], El-Batouti et al. [16] and Riolo et al. [18] respectively. The males possessed greater Upper anterior facial height as compared to females. Similar results were reported by Obloj [270_TD$IF]et al. [14] for Polish and El-Batouti et al. [16] in Iowan and Norwegian population. The males possessed greater lower anterior [271_TD$IF]face height as compared to females. Yeong [27_TD$IF]and Huggare [2] also reported longer Lower anterior face height for

boys in Singaporian Chinese when compared to girls but the gender difference was not statistically significant. The Upper Shimla Hill subjects had horizontal growth pattern. The mean Jarabak ratio for the present study group was larger than in Polish, Norwegian and American populations (as reported by Obloj e F]I$DT3_27[ t al. [14], El-Batouti et al. [16] and Riolo et al. [18] respectively) and also larger than the average given by Jarabak a ]FDI$_T74[2 nd Fizzell [28] (62–65%). The Upper Shimla Hill population had well-proportioned upper face. The mean Upper anterior face height percentage for the Upper Shimla Hill

Table 5 – [134_TD$IF]Demonstrating the comparison between male and female soft tissue variables. S. [15_TD$IF]no.

1. 2. 3.

Parameters

Ls-NCL (mm) Li-NCL (mm) FH[158_TD$IF]/N’-Pog’ (8)

Male

Female

Mean

SD

Mean

SD

[156_TD$IF]6.817 [157_TD$IF]4.616 91.8

2.284 2.664 2.858

6.9 4.933 91.867

2.482 2.392 3.115

t-Value

p-Value

Significance

0.135 0.484 [15_TD$IF] 0.086 

0.89 0.63 0.93

NS NS NS

* [159_TD$IF]p < 0.05; ** p < 0.01, NS = not significant.

Table 6 – Comparison of [160_TD$IF]cranial base parameters of Upper Shimla Hill Population with Caucasians[16_TD$IF]’ norm Graph 7. S. [162_TD$IF]no.

Parameters

1. 2.

S-N (mm) N-S-Ba (8)

Caucasians[16_TD$IF]’ norm

Upper Shimla Hill Population value

Mean

Range

Mean

Range

[164_TD$IF]– –[165_TD$IF]

74.12 131.75

67–81 24

71 131

[163_TD$IF]t-Value

p-Value

Significance

7.36 2.700

0.000 0.009

** **

8

orthodontic waves 74 (2015) 1–9

Table 7 – Comparison of [16_TD$IF]sagittal parameters of Upper Shimla Hill Population with Caucasians[16_TD$IF]’ norm. S. [135_TD$IF]no.

Caucasians[16_TD$IF]’ norm

Parameters

Mean 1. 2. 3. 4.

SN-MP (8) Jarabak ratio ANS-Me (%) N-ANS (%)

32

Upper Shimla Hill Population value

Range

Mean

Range

[168_TD$IF]– [169_TD$IF] 2–65% 6

26.98 70.07 55.34 44.66

19–41 58–80 [170_TD$IF]57–86 [17_TD$IF]41–51

55% 45%

[167_TD$IF]t-Value

x Value

8.642 82.3 0.837 1.22

p-Value

Significance

0.00 0.00 0.406 0.226

** ** NS NS

Table 8 – Comparison [172_TD$IF]6of vertical parameters of Upper Shimla Hill Population with Caucasians’ norm. S. [173_TD$IF]no. 1. 2. 3. 4. 5. 6. 7.

Jaws (sagittal)

Mean

Range

Mean

Range

[174_TD$IF]t-Value

p-Value

Significance

Go-pogperp: ANS-PNS S-N-A (8) S-N-B (8) A-N-B (8) A-N perp (mm) Pog-N perp (mm) FH/N-Pog (8)

1.5 82 80 2 1

– 175_TD$IF]–[ [176_TD$IF]– –[17_TD$IF] –[178_TD$IF] [179_TD$IF]–2 to +4 [180_TD$IF]82–95

1.521 79.98 80.88 0.89 4.46 2.01 89.25

1.3–1.7 70–96 71–97 9 to 1 14 to 2 17 to 11 83–95

1.622 3.740 1.651 12.84 10.76 0.538 4.079

0.11 0.00 0.10 0.00 0.00 0.93 0.00

NS ** NS ** ** NS **

87.8

Population was slightly smaller than the norm given by Jarabak a F]I$DT5_7[2 nd Fizzell [28]. The difference was statistically non-significant. The Upper Shimla Hill population had well-proportioned lower face. The mean lF]I$DT_04[2 ower face height percentage for the Upper Shimla Hill Population was slightly greater than the norm given by Jarabak a F]I$DT_76[2 nd Fizzell [28]. The difference was statistically nonsignificant. The lower incisors were tipped forward or proclined in the present study group. The mean inclination of lower incisor to mandibular plane for the Upper Shimla Hill Population was more than the value established by Tweed [29] (86.938). The difference was statistically non-significant. The Upper Shimla Hill subjects had proclined upper incisors. The mean inclination of upper incisor to palatal plane for the Upper Shimla Hill Population was slightly lesser than the norm given by Rakosi e ]FDI$_T53[2 t al. [10] (708). The difference was significant ([p ]FDI$_T52 = 0.05). Similar result was reported by Riolo e F]DI$_T63[2 t al. [18] for American population. Saudis’ also showed reduced upper incisor inclination to palatal plane as reported by H F]ID$_T7[2 asan [24]. The Upper Shimla Hill Population had proclined upper incisors. The mean inclination of upper incisor to SellaNasion plane for the Upper Shimla Hill Population was more than the value recorded by Rakosi e ]FDI$_T53[2 t al. [10] (1028). The difference was highly significant ]FID$_T782 = 0.01). Similar result was reported by H F]I$DT_7[2 asan [24] in his study ([p on Saudi Arabian population and by El-Batouti e F]I$DT9_27[ t al. [16] in Norwegian population. The Upper Shimla Hill Population had

less protrusive dentition. The mean interincisal angle for the Upper Shimla Hill Population was greater than the value established for the Caucasian population by Downs [27] (135.48). The difference was statistically non-significant. The interincisal angle was largest for the Upper Shimla Hill Population group; this meant that they had less acute dentition. The Upper Shimla Hill [280_TD$IF]Population showed retrusive upper lip. The mean Upper lip prominence for the Upper Shimla Hill Population was lesser than the standard value given by [281_TD$IF]Ricketts [30] (4 mm). The difference was highly significant ([28_TD$IF]p = 0.01). El-Batouti et al. [16], in his study on Norwegian population[283_TD$IF], showed slightly protrusive upper lip in male population and slightly retrusive upper lip in female population. The Upper Shimla Hill Population had more retrusive lower lip. The mean [204_TD$IF]lower lip prominence for the Upper Shimla Hill Population was lesser than the standard value given by [284_TD$IF]Ricketts [30] (2 mm). The difference was highly significant ([28_TD$IF]p = 0.01). El-Batouti et al. [16], in his study on Norwegian population[283_TD$IF], showed retrusive lower lip in males and slightly protrusive lower lip in females. Chin position for present study group was more anterior as compared to normal. The mean Soft tissue facial angle for the Upper Shimla Hill Population was greater than the standard value given by [285_TD$IF]Holdway [31,32] (918). The difference was significant ([25_TD$IF]p = 0.05).

Table 9 – Comparison of [18_TD$IF]dental parameters of Upper Shimla Hill Population with Caucasians[16_TD$IF]’ norm. S. [135_TD$IF]no.

Parameters

1. 2. 3.

IL(i)-MP(T) (8) IL(s)-PP (8) IL(s)-SN (8)

Caucasians[16_TD$IF]’ norm

Upper Shimla Hill Population value

Mean

Range

Mean

Range

86.93 70 102

[183_TD$IF]85–95

88.42 67.95 105.90

72–102 [184_TD$IF]50–83 91–123

[182_TD$IF]t-Value

p-Value

Significance

1.835 2.025 4.115

0.072 0.047 0.000

NS * **

9

orthodontic waves 74 (2015) 1–9

Table 10 – Comparison of Soft tissue parameters of Upper Shimla Hill Population with Caucasians[16_TD$IF]’ norm. S. [135_TD$IF]no,

Parameters

1. 2. 3.

Ls-NCL (mm) Li-NCL (mm) FH[18_TD$IF]/N’-Pog’ (8)

Caucasians[16_TD$IF]’ norm Mean

6.

[186_TD$IF]4 [187_TD$IF]2 91

Upper Shimla Hill [185_TD$IF]Population value

Range

Mean

Range

– – –

6.86 4.78 91.83

12 to 3 11 to 1 86–98

Conclusion

Craniofacial morphology was studied and norms were established for Upper Shimla Hill Populations which were not similar to the Caucasians[16_TD$IF]’ norm. Upper Shimla Hill subjects had longer anterior cranial base length and slightly increased cranial base angle, retrognathic maxilla with concave profile. The upper incisors are more proclined but interincisal angle showed no statistically significant difference. The [286_TD$IF]upper and lower lip prominence was reduced[287_TD$IF]. Female sample presented shorter anterior and [245_TD$IF]posterior cranial base length, had shorter mandible, less total anterior and posterior face height and reduced [204_TD$IF]lower anterior face height. Males possessed more protrusive upper incisors and more acute interincisal angle. It was evident that to evaluate any Upper Shimla Hill orthodontic, orthognathic and plastic surgery patients, Upper Shimla Hill Population norms, not the Caucasians[16_TD$IF]’ norm should be used as a yardstick.

Conflict of interest

[10] [11] [12]

[13] [14]

[15]

[16]

[17] [18]

None declared.

references

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** ** *

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