Printer Friendly

The effect of growth hormone treatment on craniofacial growth in short stature children. (INTERNATIONAL DENTISTRY).

INTRODUCTION

The stature of children is an important index reflecting genetic influences, health and nutritive conditions. A child is considered to have short stature when he or she is -2SD shorter than the average stature of a child the same age or gender, or if within the shortest three percent.

After birth, craniofacial growth is determined by complex interactions among genes, hormones and nutrients. Since the order, size, proportion and onset age of craniofacial growth are different for each person, growth with age does not occur at the same proportion over the same period. (1) Many studies on craniofacial growth suggest various causes for reducing growth, such as endocrine metabolic and chromosomal diseases, GHD and prenatal causes related to serious craniofacial growth problems, etc. (2-4) Among these, GH not only influences the growth of stature or craniofacial area, but also internal growth, bone metabolism, muscles and adipocyte tissue. (5)

Among researchers studying short stature, Spiegel et al, (2) found that the facial proportion of short-statured children shown by angles is not significantly different from those of the same aged NC, though the linear measurement value is relatively smaller. Van Erum et al (6) said

the characteristics of short-statured children (average age 5.1) without GHD were small submaxillary, short basis cranii length, normal anterior facial height and increased lower anterior facial height. By conducting cephalometric radiation analysis on short-statured children (average age one to two), Kjellberg et al (7) reported that both children with or without GHD are influenced identically in the growth and development of stature and face. The linear measurement values of facial structure were small for most short-statured children with characteristics such as small and flat basis cranii, and mandible relatively located posterior. Although reports have been released on the influence of GH on long-term skeletal growth, (5) few studies have been done on the influence of GH on craniofacial structure.

After conducting treatment of relatively high-dosage GH for two years on young girls suffering from Turner's syndrome, Rongen-Westerlaken et al (8) said the length of the mandible was increased mostly by the vertical growth of the mandibular ramus, and that the mandible used to rotate the posterior started to rotate to the front. Although the maxilla seemed less influenced than the mandible, both the maxilla and mandible showed a tendency of rotation, increasing facial convexity. The length and angle of the anterior/ posterior cranial base also showed differences. Injecting GH in children with ISS, Cantu et al (9) observed catch up growth occurring in stature, facial height, skeletal age and posterior cranial base. In Korea, Jeong et al (10) compared between the results of GH treatment for short-statured children and the growth of NC to report that GH treatments show catch-up growth without signs of unbalanced craniofacial growth. Most of these studies are limited in that they do not classify the specific causes of short stature in children due to various causes.

This paper divides short stature caused by GHD and other causes, then compares and analyzes the influence of GH treatment on craniofacial structure.

MATERIAL AND METHODS

Subjects

From 2006, children diagnosed with short stature by the Pediatrics Department of Yeungnam University Hospital were asked if they would agree to allow measuring their craniofacial structure from a dentist before getting GH treatment. For those who agreed, a lateral cephalometric radiograph was taken under a standard condition of occluding the teeth as much as possible. Fourteen of the subjects were male and eight female. Among them, 11 were in the short-statured group in which the cause was GHD, while the other 11 were in the idiopathic group matched with their GHD counterpart based on age and gender and using data on ISS children.

Children with normal occlusion were selected from elementary schools in Daegu and had Class 1 molar relationships. Using data traced and surveyed for 10 years from May 1983 by the Orthodontics Department of Kyungbuk National University Hospital, 11 children were matched based on age and gender to fit those of the short-statured children. Without an irregular teaching arrangement or asymmetry, the children had good and healthy facial profiles. Therefore, the subjects had an average age of 11, with 21 being male and 12 female (Table 1).

Methods

Lateral cephalometric radiographs of the subject children were taken under the standard condition of occluding the teeth as much as possible. Radiograph was taken twice, once before GH treatment and again after two years of treatment. To confirm the growth of the craniofacial area, 12 caphalometric landmarks were selected (Figure 1). Using these landmarks, 12 linear and seven angular measurements were made (Table 2). The cephalometric measurement was made by one dentist.

1. S (Sella): The center of the sella turcica.

2. Na (Nasion): The most anterior point of the frontonasal suture.

3. A (Subspinale): The most posterior point on the curvature from the anterior nasal spine to the crest of the maxillary alveloar process.

4. B (Supramentale): The most posterior point on the curvature of the mandible between the pogonion and the crest of the mandibular alveloar process.

5. Pog (Pogonion): The most anterior point on the contour of the chin.

6. Gn (Gnathion): A bony point by bisecting the line of angle formed by the facial plane and mandibular plane.

7. Me (Menton): The most inferior point on the symphyseal outline.

8. Go (Gonion): A bony point by bisecting the line of angle formed by the ramal plane and mandibular plane.

9. Ar (Articulare): The point of intersection of the inferior cranial base surface (basioccipital) and the posterior surface of the mandibular condyle.

10. Ba (Basion): The most inferior posterior point on the anterior margin of the foramen magnum.

11. PNS (Posterior nasal spine): The most posteior point on the bony hard palate.

12. ANS (Anterior nasal spine): The most anterior point on the maxilla at the level of the palate.

Statistical Analysis

In the comparison of the craniofacial structures of the two short-statured groups and normal group, an independent sample verification was used. To compare the treatment's effects in the two short-statured groups, repeated two-way ANOVA was used. Also, in order to compare the two groups before and after treatment with the normal group, a one way ANOVA was used while conducting the bonferroni test for post-verification. The statistical significance level was set at p<0.05, and SPSS ver.19.0 was used as a statistical processing program.

RESULTS

Comparing Growth of Linear Craniofacial Structure following GH Treatment

Comparing the Linear measurements, among two short-statured groups before treatment and NC, significant differences were shown in TCB(p<0.01), UAFH(p<0.05), UPFH(p<0.05), PTFH(p<0.05), MaxL(p<0.05), MandRL(p<0.05), MandCL(p<0.01), OMandL(p<0.01).

In the post-verification, significant differences between two short-statured groups were shown in TCB(p<0.01). Between the short-statured children with GHD and NC, significant differences were shown in PCB(p<0.05), TCB(p<0.01), UAFH(p<0.05), UPFH(p<0.05), MaxL(p<0.05), MandRL(p<0.01), MandCL(p<0.01) and OMandL(p<0.05). Between the ISS children and NC, significant differences were shown in PCB(p<0.05), UPFH(p<0.05), PTFH(p<0.05), MandRL(p<0.05) and MandCL(p<0.05). For the two groups that received treatments, the effects of treatment were significant for all linear-measurement values(p<0.01). No differences, however, were observed in treatment between the two groups. After two years of treatment, values that showed significant differences among the three groups were TCB(P<0.01) and MandCL(p<0.01). After two years of treatment, the values that showed significant differences between two short-statured groups were TCB(p<0.01) and MandCl(p<0.05). After two years of treatment, the values that showed significant differences between short-statured children with GHD and NC were TCB(p<0.01) and MandCl(p<0.05). After two years of treatment, no significant differences were detected between ISS children and NC(Table 3).

Comparing Growth of Angular Craniofacial Structure following GH Treatment

Comparing the angular measurements among short-statured children with GHD before treatment, ISS children before treatment and NC, no significant differences were found. The same went for the post-verification as well. After two years of treatment, no significant differences were detected among the three groups in angular measurements. The two groups that received treatments showed significant effects in SA(p<0.01), MPA (p<0.01), SNB(p<0.01) and ANb(p<0.01), but none from treatment between the two groups(Table 4).

DISCUSSION

Prior studies on effect of GH treatment on craniofacial growth in short stature children have limits of not classifying the specific causes for children suffering from short stature.

Therefore, this study divided short-statured children into those with GHD and those who were ISS to examine their growth aspects and observe the influence of growth catalyst (GH treatment) on growth.

When comparing the craniofacial structures of two short-statured groups, the TCB value was significantly low for short-statured children with GHD. Other than that, no significant differences were discovered but when comparing short-statured children with GHD and NC, significant differences were shown in PCB, TCB, UAFH, UPFH, MaxL, MandRL, MandCL and OMandL. This data is consistent with the results of previous research except for MaxL. When comparing ISS children and NC, significant differences appeared in PCB, UPFH, PTFH, MandRL and MandCL. The result suggests that influence is characteristically shown solely on the posterior cranial base, posterior facial height and mandible. The characteristics described above are connected with one another, and the phenomena is caused by a failure in the growth of mandible and posterior cranial base.

Comparing the craniofacial structures of two short-statured groups, differences were only recognized in cranial bases. Nonetheless, when the two short-statured groups were compared with the normal group, the differences were greater in short-statured children with GHD because the craniofacial structures of short-statured children with GHD are smaller. In 1986, Takano et al[11]. studied the growth condition of craniofacial structures of patients with GHD and ordinary children with small stature, and found no significant differences between the two groups. The measurements for the craniofacial structures of the two groups were found to be small not because of GHD, but rather of small physical characteristics.

The two-year GH treatment, which took place in this study, had growth promotion effects on both groups, and no significant difference in the effects of treatment was seen between the two groups. The major factor behind growth is the increase of length in the skeletal system. The vertical increase of bones is caused by enchondral ossification, and bone growth occurs when cartilaginous tissue changes to osseous tissue. Generally, bone length is increased during chondrification or enchondral ossification, while bone circumference expands during periosteal ossification. (12)

After two years of treatment, differences between the two groups were shown in TCB and MandCL, suggesting that the growth of the cranial base and mandible for short-statured children with GHD was insufficient compared to that for ISS children. On the effect of GH on the cranial base, treatment after age 7 is known to be unable to bring the values up to normal range since ACB is integrated around age 7, and growth after that point is made by bone infiltration at nasion. The result of this study showed that ISS children are no different from NC after two years of treatment, suggesting that catch-up growth occurred in all measurements. On the other hand, short-statured children with GHD had differences with NC in TCB and MandCL even after two years of treatment, suggesting that although catch-up growth happened in the cranial base and mandible, it failed to reach normal levels. Ranly13 said synchondrosis closed by ossification cannot be reacted again by injecting GH which indicates that GH treatments for short-statured children should start before the spheno-occipital synchondrosis closes to ensure more growth promotion effects.

The limit of this study was that the size of the subjects was too small-scale to show differences based on age and gender, making the results difficult to generalize. In the future, more subjects are needed to observe the long-term effects of GH treatments on the craniofacial complex, specifically for each age group, gender, factor and period. In conclusion, Delayed growth and failed catch-up growth for short-statured children influence not only height but also the growth of craniofacial area. In addition, GH treatments are safe and effective treatments for spurring growth in short-statured children. The treatments were shown to effect general craniofacial catch-up growth, which was most clearly seen in areas related to in-between cartilaginous growth.

CONCLUSIONS

Short-statured children generally have small and degenerative faces due to their short and flat cranial base and small mandible located posterior. As a result, delayed growth and failure of catch-up growth for short-statured children are related not only to height but also to growth of the craniofacial area. In addition, GH treatments are safe and effective for normalizing the growth of short-statured children. They resulted in general craniofacial catch-up growth, which was most clearly seen in areas related to in-between cartilaginous growth. No significant differences, however, were found between two short-statured groups.

REFERENCES

(1.) L. J. Van, "A new view on the control of the morphogenesis of the skull", Acta Morphologica Neerl-Scandinavia, vol. 8, no. 2, pp. 143-161, Nov 1970.

(2.) R. N. Spiegel, A. H. Sather, A. B. Hayles, "Cephalometric study of childeren with various endocrine diseases", Am J Orthod, vol. 59, pp. 362-375, Apr 1971.

(3.) R. Konfino, A. Pertzeland, Z. Laron, "Cephalometricmeasurements of familial dwarfism and high plasma immunoreactive growth hormone" Am J Orthod, vol. 68, no. 2, pp. 196-201, Aug 1975.

(4.) S. Pirinen, A. Majurin, H. L. Lenko, K. Koski, "Craniofacial features in patients with deficient and excessive growth hormone", J Craniofac Genet Dev Biol, vol. 14, no. 3, pp. 144-152, Jul-Sep 1994.

(5.) O.G. Isaksoon, A. Lindahl, A. Nilsson, J. Isgaard, "Mechanism of the stimulatory effet of growth hormone on longitudinal bone growth" Endocr Rev, vol. 8, no. 4, pp. 426-438, Nov 1987.

(6.) E. R. Van, M. Mulier, C. Carels, G. Verbeke, F. Dezegher, "Craniofacial growth in short children born small for gestational age: effect of growth hormone treatment", J Dent Res, vol. 76, no. 9, pp. 1579-1586, Sep 1997.

(7.) H. Kjellberg, M. Beiring, K. A. Wikland, "Craniofacial morphology, dental occulusion, tooth eruption, and dental maturity in boys of short stature with or without growth hormone deficiency1", Eur J Oral Sci, vol. 108, no. 5, pp. 359-367, Oct 2000.

(8.) C. Rogen-Westerlaken et al, "Effect of greowth hormone treatment on craniofacial growth in Turner's syndrome", Acta Paediatr, vol. 82, no. 4, pp. 364-368, April 1993.

(9.) G. Cantu, P. H. Buschang, J. L. Gonzalez, "Differential growth and maturation in idiopathic growth-deficient children", Euro J Orthod, vol. 19, no. 2, pp. 131-139, Apr 1997.

(10.) S. H. Chung, J. W. Kim, Y. H. Park, C. J. Hwang, H. K. Lee, "The effect of growth hormone treatment on craniofacial growth in short stature children", Korean J Orthod, vol. 40, no. 4, pp. 227-237, 2010. 11 12 13

(11.) K. Takano, H. Oguichi, N. Hizuka, Y. Sangu, K. Shizume, "Oro-maxillofacial development in patients with growth hormone deficiency and in normal short children", Endocrinology of Japan, vol. 33, no. 5, pp. 655-664, Oct 1986.

(12.) T. M. Graber, "Orthodontics: Principles and practice", W B Saunders Co, Philadelphia, pp. 27-128, 1972.

(13.) D. M. Ranley, "Craniofacial growth-longitudinal description: A synopsis of craniofacial growth", ed 2, Norwalk, Appleton & Lange, pp. 124-141, 1984.

AUTHOR BIOS

J. Jang received Ph.D degree in Kyungpook National University, Daegu Korea. Currently doing professor, Department of Dental Hygiene, Suseong College. Her research interest includes Health Science.

K. Lee received the D.D.S. and Ph.D degree in Kyungpook National University, Daegu Korea. Currently doing professor, School of Dentistry, Department of prosthodontics, Kyungpook National University. His research interest includes Prosthodontics.

Dong Fan received the B.E. degree in Hunan University of Chinese Medicine. Currently doing graduate student in department of Dentistry, college of Medicine, Yeungnam University.

M.Hwang received the M.D. and Ph.D degree in Yonsei University, Seoul Korea. Currently doing Professor in department of Radiology, college of medicine, Yeungnam University. Her research interest includes Pediatric Radiology.

H.Lee received the D.D.S. and Ph.D. degree in Yonsei University, Seoul Korea. Currently doing Professor in department of Dentistry, college of Medicine, Yeungnam University. Her research interest includes Orthodontics.

Table 1. Demographic characteristics of subjects

                                 Groups                     Total
                   GHD-SS         I-SS          NC         n=33(%)
Variables          n=11(%)      n=11(%)      n=11 (%)

Gender
  Male            7 (73.6)      7 (73.6)     7 (73.6)     21 (73.6)
  Female          4 (36.4)      4 (36.4)     4 (36.4)     12 (36.4)
Age, (years,
  mean           11.0 [+ or    11.0 [+ or   11.7 [+ or    11.2 [+ or
  [+ or -] SD)     -] 2.0        -] 2.0       -] 11.5      -] 11.8

GHD-SS; Growth hormone-deficient short stature, I-SS; Idiopathic short
stature, NC; Normal children, SD; standard deviation

Table 2. Linear and angular craniofacial measurements

                                               Cephalometric
Linear                          Abbreviation    Land marks

Anterior cranial base length        ACB             N-S
Posterior cranial base length       PCB            S-Ba
Total cranial base length           TCB            N-Ba
Upper anterior facial height        UAFH           N-ANS
Upper posterior facial height       UPFH           S-PNS
Lower anterior facial height        LAFH          ANS-Me
Anterior total facial height        ATFH           N-Me
Posterior total facial height       PTFH           S-Go
Maxillar length                     MaxL          ANS-PNS
Mandibular ramus length            MandRL         Art-Go
Mandibular corpus length           MandCL         Go-Pog
Overall mandibular length          OMandL         Art-Pog

                                               Cephalometric
Angular                         Abbreviation    Land marks

Saddle angle                         SA           N-S-Art
Gonial angle                         GA          Art-Go-Me
Mandibular plane angle              MPA          S-N-Go-Gn
Position of maxilla                 SNA            S-N-A
Position of mandible                SNB            S-N-B
Maxilla/ Mandible                   ANB            A-N-B
Posterior position                 PPMand       S-N-Art-Go
  of mandible

Table 3. Comparison of mean ([+ or -] SE) for linear craniofacial
variables among 11 GHD-SS children, 11 I-SS children treated
with GH and 11 NC

                 Mean  [+ or -] SE (mm) at Start

Linear                GHD-SS                   I-SS

ACB       65.82 [+ or -] 0.46    66.46 [+ or -] 0.85
PCB       44.32 [+ or -] 0.86    45.44 [+ or -] 2.54
TCB      100.59 [+ or -] 2.81   103.05 [+ or -] 3.39
UAFH      51.36 [+ or -] 1.70    52.82 [+ or -] 4.01
UPFH      46.59 [+ or -] 1.63    46.64 [+ or -] 1.45
LAFH      64.68 [+ or -] 3.22    65.77 [+ or -] 4.06
ATFH     113.50 [+ or -] 3.14    117.1 [+ or -] 16.81
PTFH      69.18 [+ or -] 3.73    68.18 [+ or -] 6.18
MaxL      43.50 [+ or -] 2.35    45.95 [+ or -] 4.54
MandRL    37.45 [+ or -] 3.70    39.09 [+ or -] 4.74
MandCL    69.05 [+ or -] 4.25    71.14 [+ or -] 2.72
OMandL    96.59 [+ or -] 4.13   100.14 [+ or -] 4.92

          Mean  [+ or -] SE     Mean [+ or -] SE (mm)
            (mm) at Start         after two years

Linear                    NC                 GHD-SS

ACB       68.23 [+ or -] 0.47    68.09 [+ or -] 2.17
PCB       48.14 [+ or -] 3.92    48.68 [+ or -] 1.91
TCB      104.77 [+ or -] 3.63   101.91 [+ or -] 2.88
UAFH      52.55 [+ or -] 0.72    54.36 [+ or -] 1.85
UPFH      49.23 [+ or -] 3.44    49.45 [+ or -] 2.12
LAFH      65.03 [+ or -] 3.80    69.27 [+ or -] 3.00
ATFH     118.42 [+ or -] 6.05   121.18 [+ or -] 4.42
PTFH      74.87 [+ or -] 6.01    79.46 [+ or -] 4.61
MaxL      47.41 [+ or -] 3.37    48.36 [+ or -] 2.40
MandRL    43.36 [+ or -] 5.09    44 95 [+ or -] 4.28
MandCL    74.91 [+ or -] 4.07    73.64 [+ or -] 4.84
OMandL   103.05 [+ or -] 5.86   103.00 [+ or -] 2.56

              Mean [+ or -] SE (mm) after two years    p (a)   p(b)

Linear                  I-SS                     NC

ACB       70.0Q [+ or -] 2.72    69.50 [+ or -] 1.36    .061    .066
PCB       48.95 [+ or -] 3.03    49.09 [+ or -] 3.99    .127     --
TCB      107.32 [+ or -] 3.21   107.68 [+ or -] 3.87    .001    .010
UAFH      55.77 [+ or -] 3.30     57.4 [+ or -] 3.61    .046    .886
UPFH      50.27 [+ or -] 2.10    51.09 [+ or -] 3.63    .019     --
LAFH      71.64 [+ or -] 3.84    67.51 [+ or -] 3.73    .782     --
ATFH     125.86 [+ or -] 7.41   123.10 [+ or -] 6.02    .116     --
PTFH      77.00 [+ or -] 3.41    80.50 [+ or -] 6.24    .015     --
MaxL      50.14 [+ or -] 3.72    49.39 [+ or -] 3.77    .045    .341
MandRL    45.55 [+ or -] 3.36    46.95 [+ or -] 5.56    .014     --
MandCL    77.91 [+ or -] 3.01    78.59 [+ or -] 3.46    .004    .187
OMandL   106.23 [+ or -] 4.96   107.46 [+ or -] 4.64    .011    .644

Linear   p(c)    p(d)    p(e)    p(f)    p(g)    p(h)    p(i)    p(j)

ACB      .061    .160    .001    .309    .116      --      --      --
PCB      .045    .043    .001    .283    .952      --      --      --
TCB      .001    .686    .001    .957    .003    .013    .007      --
UAFH     .043    .408    .001    .933    .076      --      --      --
UPFH     .040    .044    .001    .261    .379      --      --      --
LAFH       --      --    .001    .296    .055    .385    .757    .203
ATFH       --      --    .001    .722    .209      --      --      --
PTFH     .059    .021    .001    .358    .243      --      --      --
MaxL     .044      --    .001    .522    .471      --      --      --
MandRL   .014    .040    .001    .379    .568      --      --      --
MandCL   .003    .047    .001    .335    .010    .043    .015      --
OMandL   .016    .058    .001    .693    .605    .055    .055     987

SE; standard error, GHD-SS; Growth hormone-deficient short
stature, I-SS; Idiopathic short stature, NC; Normal children,
(a); p value of two-way ANOVA among groups at start,
(b); p vale of bonferroni test between GHD-SS and I-SS
at start, (c); p vale of bonferroni test between GHD-SS
and NC at start, (d); p vale of bonferroni test between
SS-I and NC at start, (e); p value of main effects between
 treatment period and group in repeated two-way ANOVA,
(f); p value of interaction effects between treatment period
and group in repeated two-way ANOVA, (g); p value of one way
ANOVA among groups after two years, (h); p value of bonferroni
test between GHD-SS and I-SS after two years, (i); p value of
bonferroni test between GHD-SS and NC after two years,
(j); p vale of bonferroni test between I-SS and NC after
two years.

Table 4. Comparison of mean ([+ or -] SE) for angular
craniofacial variables among 11 GHD-SS children, 11
I-SS children treated with GH, and 11 NC

                  Mean  [+ or -] SE (mm) at start

Angular          GHD-SS                  I-SS

SA        126.32 [+ or -] 5.43   126.32 [+ or -] 3.64
GA        127.91 [+ or -] 3.93   125.50 [+ or -] 1.34
MPA        35.91 [+ or -] 3.67    36.14 [+ or -] 2.88
SNA        79.41 [+ or -] 2.93    80.59 [+ or -] 2.83
SNB        75.86 [+ or -] 4.24    76.32 [+ or -] 2.83
ANB         3.55 [+ or -] 1.60     4.27 [+ or -] 1.21
PPMand     88.64 [+ or -] 4.71    87.36 [+ or -] 2.03

          Mean  [+ or -]         Mean  [+ or -]  SE
          SE (mm) at start       (mm) after two years

Angular            NC                         GHD-SS

SA        123.73 [+ or -] 3.09   127.36 [+ or -] 4.77
GA        124.32 [+ or -] 5.18   125.68 [+ or -] 3.23
MPA        32.91 [+ or -] 5.45    33.91 [+ or -] 3.36
SNA        80.32 [+ or -] 2.92    79.59 [+ or -] 2.94
SNB        77.59 [+ or -] 2.43    77.14 [+ or -] 3.49
ANB         2.68 [+ or -] 1.49     2.45 [+ or -] 1.37
PPMand     87.36 [+ or -] 2.03    89.46 [+ or -] 3.65

          Mean  [+ or -]  SE (mm) after two years

Angular                  I-SS                     NC    P (a)   P (b)

SA        128.32 [+ or -] 1.95   124.09 [+ or -] 3.94    .259      --
GA        126.05 [+ or -] 4.31   123.41 [+ or -] 5.82    .098      --
MPA        34.00 [+ or -] 3.03    31.64 [+ or -] 6.36    .143      --
SNA        81.27 [+ or -] 2.28    81.03 [+ or -] 3.22    .610      --
SNB        78.09 [+ or -] 2.02    78.69 [+ or -] 2.87    .446      --
ANB         3.18 [+ or -] 1.37     2.34 [+ or -] 1.61    .059    .740
PPMand     86.82 [+ or -] 2.83    87.32 [+ or -] 2.85    .569      --

Angular   P (c)   P (d)   P (e)   P (f)   P (g)

SA          --      --    .012    .395     .052
GA          --      --    .329    .115     .355
MPA         --      --    .001    .828     .390
SNA         --      --    .340    .578     .338
SNB         --      --    .002    .554     .447
ANB       .513    .055    .001      --     .348
PPMand      --      --    .806    .227     .129

Angular     P (h)      P (i)      P (j)

SA             --       .148       .058
GA             --         --         --
MPA            --         --         --
SNA            --         --         --
SNB            --         --         --
ANB            --         --         --
PPMand         --         --         --

SE; standard error, GHD-SS; Growth hormone-deficient short stature,
I-SS; Idiopathic short stature, NC; Normal children, (a); p value
of two-way ANOVA among groups at start, (b); p vale of bonferroni
test between GHD-SS and I-SS at start, (c); p vale of bonferroni
test between GHD-SS and NC at start, (d); p vale of bonferroni test
between I-SS and NC at start, (e); p value of main effects between
treatment period and group in repeated two-way ANOVA, (f); p value
of interaction effects between treatment period and group in
repeated two-way ANOVA, (g); p value of one way ANOVA among groups
after two years, (h); p vale of bonferroni test between GHD-SS and
I-SS after two years, (i); p vale of bonferroni test between GHD-SS
and NC after two years, (j); p vale of bonferroni test between I-SS
and NC after two years.
COPYRIGHT 2015 American Dental Assistants Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2015 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Jang, J.; Lee, K.; Fan, Dong; Hwang, M.; Lee, H.
Publication:The Dental Assistant
Geographic Code:1USA
Date:Nov 1, 2015
Words:4170
Previous Article:12th District Trustee representing: CA, GU, HI, NV Ruby Roach.
Next Article:Editor's desk.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters