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Cephalometric norms for hyderabad population in natural head position using extracranial reference lines.

INTRODUCTION:

Natural head position is a standardized and reproducible position of the head in an upright position, the eyes focused on a pointing the distance at eyelevel that implies the visual axis is horizontal (FA Moorrees). (1)

Natural head position is the reproducible, natural, physiologic position of the head obtained with relaxed subject looks ahead at an external eye reference-like wall mirror (Cooke & Wei). (2)

Traditional cephalometric analysis use the S-N or FH planes as reference lines. As the position of Sella can vary both antero posteriorly and vertically, it was cited the claim of Downs and Rickets that Sella is totally unrelated to the structure of face. Downs and Rickets recommended the use of FH plane as reference plane. But measurements based on FH plane do not correlate with clinical examination.

The high interpersonal variability of intracranial reference planes (SN and FH) to each other within the individual provide different interpretations with different analysis (2,3,4,5) Hence Cooke & Wei and Michiels suggested use of natural head position.

The natural head position analysis present the patient as they appear in life. As stated by Chanan et al, awareness of deviation of facial structure could modify craniocervical posture ex. too protrusive chin and retrusive chin.

Techniques to obtain NHP for better analysis are demanding, expensive and time consuming. (6, 7) Pedro and Nanda (8) and N.M. Bass (9) made the profile angle the basis for recording and transferring NHP to radiograph.

AIMS AND OBJECTIVES:

To establish cephalometric norms for Hyderabad population in NHP using extra cranial reference lines. To compare with cephalometric norms derived for Caucasian population in NHP using extra cranial reference lines. To compare the male and female norms obtained for local Hyderabad population.

METHODS OF RECORDING:

NATURAL HEAD POSITION Target on mirror method, (5) the fluid level device, (6) the photographic technique, (10) modified approach, (11) Bass method, Pedro Leitao Ram S Nanda method, incline meter metho etc.

MATERIALS AND METHODS:

This is a descriptive and comparative study carried in Hyderabad, A.P. The sample include 30 adults (15 males and 15 females) table 1. Criteria include, local residents, age 18 to 30 years presenting clinically normal occlusion, esthetically acceptable profiles, facial symmetry, no previous orthodontic treatment, no history of trauma or any related surgery. A simple technique suggested by Pedro and Nanda used making use of a true vertical represented by a free hanging plumb attached to nylon thread and photograph used to record profile angle.

Recording NHP and True Vertical on the photograph: Standard photographs taken with natural head position, centric relation and relaxed lip posture. All photographs taken Nikon EM camera with Nikkor 105 lens.

To get NHP the subject is asked to stand in front of a mirror which is placed 2 meters in front of the subject. Subject keep the feet slightly a part and divergent anteriorly with arms relaxed and is looking straight in to the mirror in its eyes with its tilting head up and down with decreasing amplitude unless they felt they were relaxed (fig 2).

A nylon thread with a plumb suspended from a L shaped clamp fixed at a height of 9ft, in front of the subject served as a true vertical (fig1). The subject was made to stand as close as possible to the thread. The camera was fixed with a tripod at a distance of 1.7 meters on the lateral aspect of subject and photograph taken (fig 3). 6x4 print was taken and E-plane (pogonion to prenasale) was drawn. The difference between true vertical (nylon thread) and E-line was noted.

STANDARIZATION OF CEPHALOMETRIC TECHNIQUE AND ARMENTARIUM: a 8X10 Kodak green sensitive head film with intensifying screen with "ROTOGRAPH 230 EUR" by VILLA SYSTEM MEDICALI INDIA, advanced panaromic and cephalometric equipment manufactured in 1995 made in MILANO Italy was used. All instructions as per manufacturer were strictly fallowed.

TRACING TECHNIQUE: All tracings were done by single operator. Garware 36 microns acetate paper was used. Tracings are made as per standards (fig 4).

TRANSFER OF PROFILE ANGLE TO TRACING: A photocopy 1:1 of the cephalometric tracing was made and then E-plane was drawn on it. With the help of the angle noted from noted from the photograph (fig3), true vertical was drawn at the same angle to the E-plane on the tracing. A line drawn perpendicular to the true vertical serves as true horizontal (fig 5).

A total of 25 parameters--12 skeletal (nine angular and six linear); 4 dental (two leniar and two angular) and 5 soft tissue were evaluated.

Skeletal Evaluation (Angular measurements):

1. Antero posterior position of maxilla (Maxillary angle)

2. Antero posterior position of chin (Chin angle)

3. AB-T.H

4. Vertical position of maxilla (palatal plane angle)

5. Vertical position of mandible (mandibular plane angle)

6. NSL-T.H

7. SNA

8. SNB

9. ANB

SKELETAL (Leniar measurements)

10. Nasion perpendiculars to point A

11. Nasion perpendiculars to point Pogonion

12. Nasion perpendicular to point B

13. AB projected on to true horizontal

14. N-ANS

15. ANS-Me

16. N-ANS/ANS-Me ratio

DENTAL (Linear):

17. Upper incisor to through verticqal through subnasale

18. Lower incisor to True vertical through point A

DENTAL EVALUATION (ANGULAR)

19. Upper incisor to true horizontal

20. Lower incisor to true horizontal

SOFTTISSUE EVALUATION

21. Upper lip prominence

22. Lower lip prominence

23. Chin position

24. Nasal projection

25. Viazi's V-angle

STATISTICAL ANALYSIS: Mean is the sum of observation divided by number of Observation [bar.x] = [SIGMA]X/N. (tables 4&5).

T-Test was used to calculate the difference between the Caucasian and local population means(table-3). The statistical software by name MATLAB was used. To generate tables, Microsoft word and excel were used for tabulations.

ANOVA TEST(table -6) : If calculated value of "F"

(F= Estimate of variance based on the variation between the groups/ Estimate of variance based on the variation within the groups)

Is more than table value of F at required level of significance, usually .05 0r .01 then we reject the null hypothesis.

RESULTS:

SKELETAL EVALUATION (Angular measurements) (table -6)

1. Anteroposterior position of Maxilla (Maxillary angle): (2) It is not effected by position of Sella. Rickets estimate was 90 [+ or -] 3[degrees] In this study the over all mean was 91.45 [+ or -] 2.93[degrees] with mean for males 90.6 [+ or -] 2.16[degrees] and for female 92.30[+ or -]3.4[degrees]. Statistically significant difference was found in the position of maxilla. One way analysis of variance shown that no difference exist between the Hyderabad males and females (table 4&5).

2. Anteropostero position of chin (Chin angle) (12) Angle between N-Pog and TH. Similar to Down's Facial angle, used to measure chin prominence. The conventional angle describes the dentoskeletal architecture; where as the angle in the study denotes the architecture what appears to others.For Caucasians the over all mean was 87.7 [+ or -] 2.5.The value in the present study was 89.38 [+ or -] 2.47(table -3). No significant difference was found between male and female in Hyderabad population with values of 89.60 [+ or -]3 and 89.17 [+ or -] 1.8(table-6).

3. AB-T.H: (13) The methods so far available may not be so accurate because of difficulties in reproducing some plane. For example the difficulty to reproduce the functional occlusal plane in Wits appraisal. The present AB/ horizontal measure is simple and practical. It eliminates Nasion and intracranial planes.In the present method the overall value is 6.80[+ or -]-3.1. No significance difference was between males and females with values of 5.83[+ or -]1.78 and 7.77[+ or -]3.91 respectively.

4. VERTICAL POSITION OF MAXILLA(Palatal plane angle): (8) Possible rotation of maxilla or anterior or posterior inclination of maxilla is revealed by this angle. The mean value obtained by Nanda in his study was 89.52[+ or -]4.38[degrees]. The mean value in the present study was 90.45[+ or -]1.33[degrees].For male it was 90.47[+ or -]2.5 and for female 90.43[+ or -]1.33[degrees](table -6).

5. VERTICAL POSITION OF MANDIBLE

(Mandibular plane angle):12 A high angle indicates open bite tendancy and low angle indicates deep bite. A. Viazi found this angle to be 24[+ or -]4. In the present study the overall mean was 18.87[+ or -]4.47, indicating significantly high difference. For males this is 17.33[+ or -]4,6 and for females 20.33[+ or -]3.9 (table -6).

6. NSL-T.H: (8 14) Used to determine the inclination of anterior cranial base. The over all mean in the present study is 8.65[+ or -]1.83 which was significantly different from considered to be normal value of 7 degrees. In male it is 8.83[+ or -]1.4 and in female 8.47[+ or -]2.16 (table -6).

SKELETAL (Linear measurements)

7. Nasion perpendicular to point A (N [perpendicular to]L A): (15 8 14) According to Proffit and White, for most Caucasians point A is ahead by 2mm to nasion perpendicular line. In this study the overall mean is 1.8[+ or -]3.39mm. No statistical significant difference found between Hyderabad population and above study. But males and females shown marked difference with values of 1,2[+ or -]3.3 and 2,46[+ or -]3.6mm in present study.

8. Nasion perpendicular to Pogonion: (15 8 14) It reveals the relation of mandible to cranial base. According to Mc Namara, it is -2 to [+ or -]4. Proffit and White proposed it to be 2mm. In the present study it is -,52 [+ or -] 3.99. No significant difference between males and females with values .7[+ or -]4.5; .97[+ or -]3.4.

9. Nasion perpendicular to point B: (15 8 14) Proffit and White found it to be -2mm. In the present study it is -3[+ or -]3.7mm. No significant difference found within the groups or in between males and females in the present study with values males -3.27[+ or -]-4.1 and females -2.73[+ or -]3.6mm.

10. AB projected on to true Horizontal: According to Proffit and White14 and Viazi's (16) mean value of 4mm with SD of 2mm with true horizontal plane consideration. In the present study the mean value was found to be 4.8[+ or -]2.1mm. Compared with Caucasian value the difference was found to be significant. Mean value in males was 4.46[+ or -]1.9 and females 5.167[+ or -]2.3mm.

11. N-ANS/ANS-Me Ratio: According to Pedro Lei Tao & Ram S.Nanda (8) facial axis, lower face height and facial ratio are morphological variables often associated with NHP. In the present study the ratio was .79[+ or -].06 which within the range suggested by burstone. (17) Significant difference was found between males and females.

DENTAL EVALUATION (Linear) (table -6)

12. Upper Incisor to True vertical through Subnasale (SN Ver-T.H): The Arnett (4) analysis ratio this distance was -12mm for males and - 9mm for females. In this study it was -10.83mm for males and -8.37mm for females. Significant difference was found between males and females.

13. Lower incisor to True vertical through point A (Aver-L-1):According to N.MBass (9) the anterior contour of lower incisor will touch this line. In the present study the mean value was found to be 2.68[+ or -]2.1mm.

DENTAL EVALUATION

14. Upper incisor to True horizontal(U,I to T,H) (13):This angle shows the inclination of upper incisor as it appears in life. Mean value was 12.38[+ or -]5.6

15. Lower Incisor to True Horizontal (L.I to T.H): (13) This angle reveals the true proclination of lower incisor in life. The mean value was 122[+ or -]4.5

SOFT TISUE EVALUATION:

16. Upper Lip Prominance (SNver- U.I.): Bell et al Arnet (18) and Bass (9) measured the Upper lip position in relation to true vertical through subnasale. According to Bell et al it should be 1 or 2 mm ahead of this line. In the present study it was 3.08 mm suggesting more prominent upper lip in local population.

17. Lower Lip Prominence (SNver--L.I.): Bell et al, Arnett and Bass found that the lower lip should be 0 to -1mm to SN vertical. In our study it was .45mm reflecting similar lip prominence.

18. Chin Position: Bell et al (19) Bass (9) and Arnett (18) related the soft tissue chin to a true vertical through subnasale. According to Bell et al the range is -1 to -4mm but according to Arnett and Bergman it is -2.6[+ or -] 1.9; -3.5[+ or -] 1.8mm for males and females.In the present study over all mean was -5.75mm with males -5.80[+ or -]3.29 and females -5.7[+ or -]2.84mm.

19. Nasal Projection: Horizontal distance from nasal tip to SN vertical in the present study for males it was 16.50mm for females 15.68mm. For Caucasian males it is 17.4mm (18) and females 16mm. (18)

20. Viazi's "V angle": It concentrates on the lower half of the face and concentrates on nose. According to Anthony D. Viazi (20) it is -12.5[+ or -]4 for Caucasian. In the present study it was found to be -13.19[+ or -]3.2; no statistically significant difference. However statistically significant difference was found between males and females in local population with values -12.96[+ or -]2.9m, - 14.1[+ or -]3.2 respectively.

Discussion and Summary: The study shows that the anteroposterior position of maxilla and mandible closely resembles values presented by Proffite and White (table 2).

The value obtained for the AB-TH angle in this study closely matches values of Cooke & Vei suggestive of skeletal class III(<12[degrees]).

The facial height ratio was found to be within the ratio by Burstone. Males displayed large facial height over females (table-6).

The inclination of palatal plane (90,45[+ or -]1.9) found to be similar to Caucasian (90.48[+ or -]4.3) as observed bt Pedro, Nanda (39) (table-3).

The mandibular plane angle was found to be much lower in comparison to Caucasian(table-3). Males displayed much less angle over females (table-6).; which is in accordance with previous studies on local population.

Inclination of SN line was found to be higher than normal 7 degrees. Males and females displayed marked similarity in inclination reinforcing Steiner's analysis (table-6).

Lip values are higher side compared to previous studies. (9) Chin position was less prominent both in males and females compared with Bell et al, Arnett & Bregman (18) (table-3). This is in contrast to chin angle of Viazi.

Nasal projection values are correlating with Caucasian values.

Upper incisor position matches with that of Caucasian.

'V' angle predicted same profile for both Caucasian and local population. Statistically significant difference was found between male and female with values -12.16[+ or -]2.9 and -14.1[+ or -]3,2 respectively. Prominent maxilla observed in females might be the contributor for this difference.

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Bibilography

1. Moorrees: Natural head position- A revival Apr 1994 spl. Article

2. Cole Sc.Natural head position, posture and prognathism: the Chapman prize essay 1986 Br. J. Orthod. 1988; 57:99- 100.

3. Foster Td: Variations in cephalometric reference lines Br. J. Orthod, 1981; 8:181-187.

4. Moorrees C.F.A and Kean MR: Natural position a basic consideration in the interpretation of cephalometric radiographs, Amer. J. Phys. Anthropol, 1958; 16:213-234.

5. Solow B and Tallgren A: a natural head position in standing subjects Acta. Odont. Scand,1971; 29: 591-607.

6. Showfety, Vig and Matteson : Siple method for taking natural head position cephalogram Am. J. Orthod. Dentofacial Orthop. 1983; 495-500.

7. Marcotte MR : Head posture and dentofacial proportions, Angle Orthod 1981; 51: 208-214.

8. Pedro Leitao -Ram S Nanda : Relationship of natural head position to craniofacial morphology Am. J. Orthod Dentofacial Orthop, 2001; 117:406-417.

9. Bass N M : Measurement of the profile angle and esthetic analysis & facial profile, J. of Orthod 2003; 30:9.

10. Virgilio F. Ferrari, Chiarella S forza, Domenica Germano, Luca L Dalloca: Head position and cephalometric analysis : an integrated phographic/radiographic technique : Am J Orthod Dentofacial Orthop, 1994; 257-266.

11. Sleeva raju, Gangadhara Prasad, Jayade: A modified approach for obtaining cephalograms in the natural head position: J. of Orthod. vol 125 march 2001.

12. Anthon D.Viazi : A cephalometric analysis based on natural head position, J, Clin. Orthod, 1991; 25: 172-182.

13. Cooke &Wei : A summnary five-factor analysis based on natural head position Am. J. Orthod Dentofacial Orthop, 1988; 93:213-223.

14. Profit and White: A text book of contemporary treatment of dentofacial deformity. St.louis:mosby:1991.

15. Mc Namara Jf, Jr : A method of cephalometric evaluation Am. J. Orthod, 1987; 92:117-122.

16. Anthony. D Viazi : Atlas of Orthodontic : Principles & Clinical applications, Philadelphia WB Saunders, P:94,1993.

17. Legan HL, Burston CJ: Soft tissue cephalometric analysis for Orthognathic surgery, Am J Orthod Dentofacial Orthop. 1980; 38:744-757.

18. Arnett & Robert Bergman : Soft tissue cephalometric analysis, Am. J. Orthod. 1999; 116:373-379.

19. Bell WH, Jacobs : Simultanious repositioning of Maxilla, Mandible & Chin : Am. J. Orthod, 1986; 89:28-56.

20. Anthony D Viazi : A new measurement of profile esthetics, J.Clin.Orthod. 1991; 25:9-15.

doi: 10.5866/4.3.926

Hari Prasad Rao G (1) (1) Professor and HOD

Md. Hafeez (2) (2) P.G. in Orthodontics

Received: July 16, 2012; Review Completed: August, 16, 2012;

Accepted: September 12, 2012 Published Online: October, 2012 (www. nacd. in) (c) NAD, 2012--All rights reserved

Email for correspondence: harigutti@gmail.com
TABLE 1
SEX DISTRIBUTION

Sex                  Number   Percentage

MALES                  15         50
Female                 15         50
Total                  30        100

TABLE 2
COMPOPSITE NORMS

S.No.   Variables                       Mean             S.D.

1.      AB PROJ TH                      4.81             2,15
2.      N [perpendicular to] A          1.85             3.39
3.      N [perpendicular to] B          -3.0             3.74
4.      N [perpendicular to] Pog        -.52             3.99
5.      N-ANS                           55.45            3.61
6.      ANS-ME                          68.70            5.31
7.      N-ANS/ANS/ME                     .79              .06
8.      NA-TH                      91.45[degrees]    2.93[degrees]
9.      NPog-TH                    89.38[degrees]    2.47[degrees]
10.     AB-TH                       6.80[degrees]    3.14[degrees]
11.     GO-GN-TH                   18.83[degrees]    4.47[degrees]
12.     NSL-TH                      8.65[degrees]    1.83[degrees]
13.     PP-TV                      90.45[degrees]    1.99[degrees]
14.     SNver-U.I                       9.60             2.38
15.     Aver-LI                         2.68             2.19
16.     U.I-TH                     113.95[degrees]   5.52[degrees]
17.     L.I-TH                     1220.6[degrees]   5.62[degrees]
18.     SN-VER/UL                       3.08             1.43
19.     SN-VER/L.L                       .45             2.22
20.     SN-VER/CHIN                     -4.37            5.00
21.     NASAL PROJ                      16.10            1.63
22.     V ANGLE                    13.29[degrees]    3.25[degrees]
23.     SNA                        83.17[degrees]    3.96[degrees]
24.     SNB                        79.53[degrees]    2.77[degrees]
25.     ANB                         3.63[degrees]    2.04[degrees]

                                                   95% Confidence
S.No.   Variables                       S.E         Interval For
                                                        Mean

1.      AB PROJ TH                      39              4.01
2.      N [perpendicular to] A          .62              .56
3.      N [perpendicular to] B          .68             -4.40
4.      N [perpendicular to] Pog        .73             -2.01
5.      N-ANS                           .66             54.10
6.      ANS-ME                          .96             66.71
7.      N-ANS/ANS/ME                    .11              .77
8.      NA-TH                      .53[degrees]     9035[degrees]
9.      NPog-TH                    .45[degrees]    88.46[degrees]
10.     AB-TH                      .57[degrees]     5.63[degrees]
11.     GO-GN-TH                   .81[degrees]         17.16
12.     NSL-TH                     .33[degrees]     7.96[degrees]
13.     PP-TV                      .36[degrees]    89.71[degrees]
14.     SNver-U.I                       .43             8.71
15.     Aver-LI                        .400             1.86
16.     U.I-TH                     1.00[degrees]   111.89[degrees]
17.     L.I-TH                     1.02[degrees]   118.52[degrees]
18.     SN-VER/UL                       .26             2.55
19.     SN-VER/L.L                      .40             -3.8
20.     SN-VER/CHIN                     .91             -6.24
21.     NASAL PROJ                     .304             15.48
22.     V ANGLE                    .60[degrees]    12.02[degrees]
23.     SNA                        .72[degrees]    81.68[degrees]
24.     SNB                        .50[degrees]    78.50[degrees]
25.     ANB                        .37[degrees]     2.87[degrees]

S.No.   Variables                                        Min

1.      AB PROJ TH                      5.62             -.5
2.      N [perpendicular to] A          3.10             -6.0
3.      N [perpendicular to] B          -1.60            -14
4.      N [perpendicular to] Pog         .98             -11
5.      N-ANS                           56.80            48.5
6.      ANS-ME                          70.68            60.0
7.      N-ANS/ANS/ME                     .82             .67
8.      NA-TH                      92.55[degrees]    86[degrees]
9.      NPog-TH                    90.31[degrees]    85[degrees]
10.     AB-TH                       7.97[degrees]    -1[degrees]
11.     GO-GN-TH                   20.50[degrees]    8.0[degrees]
12.     NSL-TH                      9.34[degrees]     3[degrees]
13.     PP-TV                      91.19[degrees]    83[degrees]
14.     SNver-U.I                       10.49             5
15.     Aver-LI                         3.50             -1.0
16.     U.I-TH                     116.01[degrees]   103[degrees]
17.     L.I-TH                     122.72[degrees]   106[degrees]
18.     SN-VER/UL                       3.62              1
19.     SN-VER/L.L                      1.28              -5
20.     SN-VER/CHIN                     -2.50            -12
21.     NASAL PROJ                      16.73             13
22.     V ANGLE                    14.53[degrees]    8.0[degrees]
23.     SNA                        84.65[degrees]    76[degrees]
24.     SNB                        80.57[degrees]    74[degrees]
25.     ANB                         4.40[degrees]    -1[degrees]

S.No.   Variables                       Max

1.      AB PROJ TH                      9.0
2.      N [perpendicular to] A          9.0
3.      N [perpendicular to] B          8.5
4.      N [perpendicular to] Pog         4
5.      N-ANS                            7
6.      ANS-ME                         64.0
7.      N-ANS/ANS/ME                   82.0
8.      NA-TH                           .94
9.      NPog-TH                     98[degrees]
10.     AB-TH                       98[degrees]
11.     GO-GN-TH                    14[degrees]
12.     NSL-TH                     27.0[degrees]
13.     PP-TV                       11[degrees]
14.     SNver-U.I                   93[degrees]
15.     Aver-LI                         14
16.     U.I-TH                          8.0
17.     L.I-TH                     127[degrees]
18.     SN-VER/UL                  132[degrees]
19.     SN-VER/L.L                       7
20.     SN-VER/CHIN                      5
21.     NASAL PROJ                       8
22.     V ANGLE                    19.0[degrees]
23.     SNA                         91[degrees]
24.     SNB                         83[degrees]
25.     ANB                         8[degrees]

TABLE -3
COMPARISON OF HYDERABAD AND CAUCASIAN POPULATION

                                      T-test

S.No.   Variables              Sample           Caucasian
                                Mean              Mean
1.      AB proj TH              4.817               4
2.      NI to a                 1.833               2
3.      NI to B                 -3mm               -2
4.      NI to Pog              -.52mm               0
5.      N-ANS                 55.450mm             N A
6.      ANS-ME                 68.,7mm             N A
7.      N-ANS/ANS-ME            .79mm              N A
8.      NA-T H             91.45[degrees]      90[degrees]
9.      NPog- T H          89.38[degrees]     87.5[degrees]
10.     AB-T H              6.8[degrees]           N A
11.     GO-GN-T H          18.83[degrees]          24
12.     NSL-T H             8.65[degrees]         8.19
13.     PP-RV              90.45[degrees]         89.52
14.     SN-VER/UL              3.08mm               2
15.     SN-VER/LL               .45..            0-(-1)
16.     SN VERT/CHIN           -4.37mm           1-(-4)
17.     NASAL/Projection        16mm         16(F) & 17.4(M)
18.     VIAZIS ANGLE       13.19[degrees]         12.5
19.     SN vert UI             -9.60mm        9(F) & 12(M)
20.     A vert LI              2.68mm               0
21.     UI--T H           113.95[degrees]         N A
22.     LI -T H            120.62[degrees]         N A
23.     SNA                83.17[degrees]          82
24.     SNB                79.53[degrees]          80
25.     ANB                 3.63[degrees]           2

                                          T-test

S.No.   Variables          Standard    Min    Max   'P Value
                           Deviation
1.      AB proj TH           2.15      1.5     8      <.05
2.      NI to a              3.39       -6    8,5     >.05
3.      NI to B              3.74       -8     2      >.05
4.      NI to Pog            3.99      -11     7
5.      N-ANS                 3.6      48.5   64
6.      ANS-ME                5.1       60    82
7.      N-ANS/ANS-ME          .06      .67    .94     >.05
8.      NA-T H               2.93       86    98      <.05
9.      NPog- T H             2.5       85    98      <.05
10.     AB-T H               3.14       -1    14
11.     GO-GN-T H            4.47       8     27      <.05
12.     NSL-T H              1.83       3     11
13.     PP-RV                1.99       83    93
14.     SN-VER/UL            1.43       -1     7
15.     SN-VER/LL            2.22       -5     5
16.     SN VERT/CHIN           5       -12     1
17.     NASAL/Projection     1.63       13    20
18.     VIAZIS ANGLE          3,2       8     19      >.05
19.     SN vert UI           2.38       -5    -14
20.     A vert LI            2.19       -1     8
21.     UI--T H             5.52      103    127
22.     LI -T H              5.62      106    132
23.     SNA                  3.96       76    91
24.     SNB                  2.77       74    84
25.     ANB                  2.04       -1     8      <.05

N A- not available p [less than or equal to] .05= significant

F- female AB-T H angle available only for 12 yrs olds

U.I-T H & L.I--T H value available for 12 yrs olds

UL-upper lip, LL- lower lip

UI & LI upper & lower incisors M--male

TABLE 4
MALE NORMS

S.No.   Variables                       Mean             S.D.

1.      AB proj T H                     4.46             1.93
2.      N [perpendicular to] A          1.20             3.14
3.      N [perpendicular to] B          -3.27            4.18
4.      N [perpendicular to] Pog        -.07             4.57
5.      N-ANS                           57.43            2.84
6.      ANS-ME                          71.66            5.17
7.      N-ANS/ANS-ME                     .79              .06
8.      NA-T H                          90.60            2.16
9.      N-Pog-T H                       89.60            3.06
10.     AB-T H                      5.83[degrees]    1.78[degrees]
11.     GO-GN-TH                   17.33[degrees]    4.61[degrees]
12.     NSL-T H                     8.83[degrees]    1.49[degrees]
13.     PP-TV                      90.47[degrees]    2.53[degrees]
14.     SN vert-U I                     10.83            2.51
15.     A vert LI                       3.00             2.07
16.     UI T H                     113.7[degrees]    5.30[degrees]
17.     LI T H                     120.17[degrees]   4.65[degrees]
18.     SN vert U L                     3.17             1.39
19.     SN vert LL                       .20             2.61
20.     SN vert CHIN                    -5,80            3.29
21.     NASL/Projection                 16.50            1.86
22.     Viazis angle               12.16[degrees]    2.90[degrees]
23.     SNA                        82.27[degrees]    3.12[degrees]
24.     SNB                        79.33[degrees]    2.52[degrees]
25.     ANB                         2.93[degrees]    1.45[degrees]

                                                   95% Confidence
S.No.   Variables                     S.Error       Interval For
                                                        Mean

1.      AB proj T H                     .49             3.39
2.      N [perpendicular to] A          .81             -.54
3.      N [perpendicular to] B         1.08             -5.59
4.      N [perpendicular to] Pog       1.18             -2.60
5.      N-ANS                           .73             55.85
6.      ANS-ME                         1.33             68.79
7.      N-ANS/ANS-ME                    .01              .75
8.      NA-T H                         .559             89.0
9.      N-Pog-T H                  .78[degrees]    87.91[degrees]
10.     AB-T H                     .45[degrees]     4.85[degrees]
11.     GO-GN-TH                   1.19[degrees]   14.77[degrees]
12.     NSL-T H                    .38[degrees]     8.00[degrees]
13.     PP-TV                      .65[degrees]    89.06[degrees]
14.     SN vert-U I                     .64             9.44
15.     A vert LI                       .53             1.84
16.     UI T H                     1.36[degrees]   110.53[degrees]
17.     LI T H                     1.20[degrees]   117.59[degrees]
18.     SN vert U L                    .361             2.39
19.     SN vert LL                      .67             -1.25
20.     SN vert CHIN                    .85             -7.63
21.     NASL/Projection                 .48             15.47
22.     Viazis angle               .75[degrees]    10.55[degrees]
23.     SNA                        .80[degrees]    80.54[degrees]
24.     SNB                        .65[degrees]    77.93[degrees]
25.     ANB                        .37[degrees]     2.13[degrees]

S.No.   Variables                                        Min

1.      AB proj T H                     5.53             1.5
2.      N [perpendicular to] A          2.94             -6.0
3.      N [perpendicular to] B          -.95             -14
4.      N [perpendicular to] Pog        2.47             -11
5.      N-ANS                           59.01            53.0
6.      ANS-ME                          74.53            63.0
7.      N-ANS/ANS-ME                     .83             .69
8.      NA-T H                          91.80             86
9.      N-Pog-T H                  91.29[degrees]    85[degrees]
10.     AB-T H                      6.82[degrees]     3[degrees]
11.     GO-GN-TH                   19.89[degrees]    8.0[degrees]
12.     NSL-T H                     9.66[degrees]     7[degrees]
13.     PP-TV                      91.87[degrees]    83[degrees]
14.     SN vert-U I                     12.22             6
15.     A vert LI                       4.15              .0
16.     UI T H                     116.40[degrees]   103[degrees]
17.     LI T H                     122.74[degrees]   111[degrees]
18.     SN vert U L                     3.94              1
19.     SN vert LL                      1.65              -5
20.     SN vert CHIN                    -3.97            -11
21.     NASL/Projection                 17.53             13
22.     Viazis angle               13,77[degrees]    8.0[degrees]
23.     SNA                        84.00[degrees]    76[degrees]
24.     SNB                        80.73[degrees]    74[degrees]
25.     ANB                         3.74[degrees]     1[degrees]

S.No.   Variables                       Max

1.      AB proj T H                     8.0
2.      N [perpendicular to] A          8.5
3.      N [perpendicular to] B           4
4.      N [perpendicular to] Pog         7
5.      N-ANS                          64.0
6.      ANS-ME                         82.0
7.      N-ANS/ANS-ME                    .94
8.      NA-T H                          94
9.      N-Pog-T H                   98[degrees]
10.     AB-T H                      9[degrees]
11.     GO-GN-TH                   22.5[degrees]
12.     NSL-T H                     11[degrees]
13.     PP-TV                       93[degrees]
14.     SN vert-U I                     14
15.     A vert LI                       6.0
16.     UI T H                     123[degrees]
17.     LI T H                     128[degrees]
18.     SN vert U L                      6
19.     SN vert LL                       5
20.     SN vert CHIN                     1
21.     NASL/Projection                 20
22.     Viazis angle               17.5[degrees]
23.     SNA                         88[degrees]
24.     SNB                         84[degrees]
25.     ANB                         7[degrees]

TABLE 5
FEMALE NORMS

S.No.   Variables                        Mean             S.D.

1.      AB proj T H                      5.16             2.36
2.      N4 [perpendicular to] A          2.46             3.62
3.      N4 [perpendicular to] B          -2.73            3.36
4.      N4 [perpendicular to] Pog        -0,7             3.43
5.      N-ANS                            53.46            3.24
6.      ANS-ME                           65.73            3.57
7.      N-ANS/ANS ME                      .8               .05
8.      NA- T H                      92.3[degrees]    3.4[degrees]
9.      N-Pog -T H                  98.17[degrees]    1.80[degrees]
10.     AB- T H                      7.77[degrees]    3.91[degrees]
11.     GO-GN-T H                   20.33[degrees]    3.91[degrees]
12.     NSL-T H                      8.47[degrees]    2.16[degrees]
13.     PP-TV                       90.43[degrees]    1.33[degrees]
14.     SN vert UL                       8.37             1.48
15.     A vert LL                        2.36             2.32
16.     U I -T H                    114.43[degrees]   5.87[degrees]
17.     L I-T H                     121.7[degrees]    6.59[degrees]
18.     SN-vert/UL                        3.0         1.52[degrees]
19.     SN vert/LL                        .7              1.81
20.     SN -vert-CHIN                    -2.93            6.05
21.     NASAL/Projection            15.68[degrees]        1.29
22.     VIAZIS ANGLE                 14.5[degrees]    3.26[degrees]
23.     SNA                         84.07[degrees]    4.59[degrees]
24.     SNB                         79.73[degrees]    3.07[degrees]
25.     ANS                          4.33[degrees]    2.35[degrees]

                                                    95% Confidence
S.No.   Variables                      S.Error       Interval For
                                                         Mean
1.      AB proj T H                      .61             3.85
2.      N4 [perpendicular to] A          .93              .46
3.      N4 [perpendicular to] B         .86.             -4.60
4.      N4 [perpendicular to] Pog        .88             -2.87
5.      N-ANS                            .83             51.66
6.      ANS-ME                           .92             63.75
7.      N-ANS/ANS ME                     .01              .77
8.      NA- T H                      87[degrees]    90.41[degrees]
9.      N-Pog -T H                  .46[degrees]    88.16[degrees]
10.     AB- T H                     1.01[degrees]    5.6[degrees]
11.     GO-GN-T H                   1.01[degrees]   18.16[degrees]
12.     NSL-T H                     .55[degrees]     7.27[degrees]
13.     PP-TV                       .34[degrees]    89.69[degrees]
14.     SN vert UL                  .38[degrees]         7.55
15.     A vert LL                        .6              1.07
16.     U I -T H                    1.51[degrees]   111.18[degrees]
17.     L I-T H                     1.7[degrees]    117.41[degrees]
18.     SN-vert/UL                  .39[degrees]     2.16[degrees]
19.     SN vert/LL                  .46[degrees]          -.3
20.     SN -vert-CHIN                   1.56             -6.29
21.     NASAL/Projection                 .36             14.93
22.     VIAZIS ANGLE                .87[degrees]    12.61[degrees]
23.     SNA                         1.18[degrees]   81.52[degrees]
24.     SNB                         .79[degrees]    78.03[degrees]
25.     ANS                         .60[degrees]     3.03[degrees]

S.No.   Variables                                          Min

1.      AB proj T H                      6.47              -5
2.      N4 [perpendicular to] A          4.47              -2
3.      N4 [perpendicular to] B          -.87              -8
4.      N4 [perpendicular to] Pog         .93              -7
5.      N-ANS                            55.26            48.5
6.      ANS-ME                           67.71             60
7.      N-ANS/ANS ME                      ,83              .67
8.      NA- T H                     94.19[degrees]     88[degrees]
9.      N-Pog -T H                  90.17[degrees]     86[degrees]
10.     AB- T H                      9.93[degrees]     -1[degrees]
11.     GO-GN-T H                    22.5[degrees]    14.5[degrees]
12.     NSL-T H                      9.67[degrees]     3[degrees]
13.     PP-TV                       91.17[degrees]     89[degrees]
14.     SN vert UL                       9.19               5
15.     A vert LL                        3.65              -1
16.     U I -T H                    117.69[degrees]   108[degrees]
17.     L I-T H                     124.72[degrees]   106[degrees]
18.     SN-vert/UL                   3.84[degrees]     1[degrees]
19.     SN vert/LL                        1.7              -3
20.     SN -vert-CHIN                     .42              -12
21.     NASAL/Projection                 16.43             14
22.     VIAZIS ANGLE                16.38[degrees]    9.5[degrees]
23.     SNA                         86.61[degrees]     78[degrees]
24.     SNB                         81.44[degrees]     75[degrees]
25.     ANS                          5.63[degrees]     -1[degrees]

S.No.   Variables                       Max

1.      AB proj T H                      9
2.      N4 [perpendicular to] A          8
3.      N4 [perpendicular to] B          2
4.      N4 [perpendicular to] Pog        4
5.      N-ANS                            59
6.      ANS-ME                           72
7.      N-ANS/ANS ME                     .9
8.      NA- T H                     98[degrees]
9.      N-Pog -T H                  91[degrees]
10.     AB- T H                     14[degrees]
11.     GO-GN-T H                   27[degrees]
12.     NSL-T H                     11[degrees]
13.     PP-TV                       93[degrees]
14.     SN vert UL                       11
15.     A vert LL                        8
16.     U I -T H                    127[degrees]
17.     L I-T H                     132[degrees]
18.     SN-vert/UL                   7[degrees]
19.     SN vert/LL                       5
20.     SN -vert-CHIN                    8
21.     NASAL/Projection                 1
22.     VIAZIS ANGLE                19[degrees]
23.     SNA                         91[degrees]
24.     SNB                         84[degrees]
25.     ANS                              8

TABLE -6
ANOVA TEST

Variables            Mean + S.D.              Range
                        Males                Females

AB proj T H          4.46+/-1.93              1.5-8
NI_to A               1.2+/-3.1              -6-(8.5)
NI_to B              -3.27+/-4.18            -14-(4)
NI_to Pog             -.07+/-4.5             -11-(7)
N--ANS               57.43+/-2.8              53-64
ANS--ME             71.6+/-5.17              63-82
N-ANS/ANS-ME          .79+/-.06              .69=.94
NA-T H           90.60+/-2.1[degrees]     86-94[degrees]
NPog-TH         89.60+/-3.05[degrees]     85-98[degrees]
AB-T H           5.83+/-1.78[degrees]      3-9[degrees]
GO-GN-TH         17.33+/-4.6[degrees]    8-22.5[degrees]
NSL-TH           8.83+/-1.49[degrees]     7-11[degrees]
PP-TV            90.47+/-2.5[degrees]     83-93[degrees]
SN-VER/UL            3.17+/-1.39              -1-(6)
SN-VER/LL             .20+/-2.6               -5-(5)
SN-VER/CHIN          -5.80+/-3.2
NASAL/Proj           16.50+/-1.86             13-20
VIAZIS ANGLE          12.16-2.9                6-14
SNverUI              10.83+/-2.51              6-15
AverLI                 3+/-2,07               0-(6)
UI-TH           113.47+/-5.3[degrees]    103-123[degrees]
LI-TH           120.17+/-4.65[degrees]   111-128[degrees]
SNA              82.27+/-3.1[degrees]     76-88[degrees]
SNB             79.33+/-2.52[degrees]     74-84[degrees]
ANB              2.93+/-1.4[degrees]       1-7[degrees]

Variables            Mean + S.D.          Range    Significance
                                                     P Value

AB proj T H          5.16+/-2.36         -5-(9)        .382
NI_to A               2.4+/-3.6          -2-(8)        .316
NI_to B              -2.73+/-3.36        -8-(2)        .703
NI_to Pog             -.97+/-3.4         -7-(4)        .547
N--ANS               53.46+/-3.2         48.5-59     .001 sig
ANS--ME             65.73+/-3.57         60-72      .001sig
N-ANS/ANS-ME          .80+/-.05          .67-.90       .695
NA-T H           92.3+/-3.4[degrees]      88-98        .114
NPog-TH          89.17+/-1.8[degrees]     86-91        .640
AB-T H           7.77+/-3.91[degrees]    -1-(14)       .093
GO-GN-TH        20.33+/-3.91[degrees]    14.5-27       .065
NSL-TH           8.47+/-2.16[degrees]     3-11         .594
PP-TV           90.43+/-1.33[degrees]     89-93        .964
SN-VER/UL              3+/-1.5             1-7         .757
SN-VER/LL             .70+/-1.8          -3-(5)        .548
SN-VER/CHIN          -5.7+/-2.84         -8-(1)        .119
NASAL/Proj           15.68+/-1.2          14-18        .182
VIAZIS ANGLE          14.1+/-3.2          5-11       .003sig
SNverUI               8.5+/-1.6          5-12.5      .001sig
AverLI               2.36+/-2.32         -1-(8)        .438
UI-TH           114.43+/-5.87[degrees]   108-127       .640
LI-TH            121.07+/6.5[degrees]    106=132       .669
SNA              84.07+/4.4[degrees]      78-91        .220
SNB               79.53+/-3[degrees]      75-84        .700
ANB              4.33+/-2.3[degrees]     -1-(8)        .060
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Author:Rao G., Hari Prasad; Hafeez, Md.
Publication:Indian Journal of Dental Advancements
Date:Jul 1, 2012
Words:5980
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