A comparative study of cephalometric and arch width characteristics of Class II division 1 and division 2 malocclusions

Comparative assessment of various cephalometric facial planes with intercanine width in orthodontic patients

OBJECTIVE:

The study was conducted to evaluate the relationship of various cephalometric skeletal patterns in the vertical and anteroposterior planes with intercanine width in untreated orthodontic patients.

METHOD AND MATERIAL:

This study included dental cast and cephalometric radiographs of 100 patients (69 females and 31 males) of the age range 13 to 33 years. Skeletal parameters including SNA, SNB, SNMP angles were found from lateral cephalometric radiographs. Intercanine widths including upper intercanine widths (UICW) and lower intercanine widths (LICW) were measured by a digital caliper.

RESULTS:

The correlation of intercanine width with SNA, SNB, and SNMP angles was analyzed by applying Pearson correlation coefficient. According to statistical analysis, the only insignificant correlation was analyzed between UICW with SNB and LICW with SN-MP.

CONCLUSIONS:

The overall result showed statistically significant relationship of various cephalometric skeletal patterns in the sagittal and vertical planes with intercanine width.

Craniofacial characteristics of Syrian adolescents with Class II division 1 malocclusion: a retrospective study

Background

Malocclusion characteristics vary across different ethnic groups and populations. Limited data are available regarding the characteristics of Syrian adolescents with Class II division 1 (Class II-1) malocclusion, and the recent inflow of Syrian refugees and immigrants into Europe and many areas worldwide demonstrate the need for updated studies to discover the craniofacial characteristics of these new immigrants.

Objectives

The present compound cephalometric and tooth-size study sought to assess the dentofacial morphology, upper-airway dimensions, and tooth-size characteristics of Syrian adolescents with Class II-1 malocclusion and compare the results with established Syrian population norms.

Materials and Methods

The study sample consisted of 43 Syrian patients including 24 females and 19 males with Class II-1 malocclusion (age: 14.3 (±1.5) years, mean (±SD)). Cephalometric radiographs and orthodontic casts were analyzed using special orthodontic software (OnyxCeph3^™) and a universal digital caliper, respectively. Statistics were calculated using the SPSS software.

Results

In Syrian adolescents with Class II-1 malocclusion, the position of the mandible relative to the nasion perpendicular (mean (95% confidence interval)) was −11.01 (−12.45, −9.57) mm. Facial axis angle showed a negative value: −6.25 (−7.65, −4.85) degrees. An obtuse nasolabial angle was observed: 104.05 (101.77, 106.33) degrees. The average width of the upper pharynx was 11.50 (10.53, 12.47) mm; however, there was no prevalence of an upper-pharyngeal width of 5 mm or less. The average value of the anterior tooth-size ratio was 80.69 (79.85, 81.53) percent. In total, 39.5% of the investigated subjects had anterior ratios outside two standard deviations from Bolton’s norm, while 25.6% of the investigated subjects had anterior ratios outside two standard deviations from Syrian population norm.

Conclusions

In this study, the inter-maxillary discrepancy of Class II-1 Syrian adolescents was a consequence of their hyperdivergent facial pattern. The observed small pharyngeal widths were not clinically significant, while the anterior tooth-size discrepancy might be clinically relevant.

Dentoskeletal and tooth-size differences between Syrian and Hungarian adolescents with Class II division 1 malocclusion: a retrospective study

Objectives

Malocclusion features differ across various populations and ethnicities. At this time, no data are available regarding the dentofacial differences between Syrian and European adolescents with Class II division 1 malocclusion, which is one of the most frequently treated pathologies in orthodontic practice. The present combined cephalometric and tooth-size study aimed to compare the dentoskeletal and tooth-size characteristics of Syrian and Hungarian adolescents with Class II division 1 malocclusion.

Results

Class II division 1 malocclusion in Hungarian adolescents was a sagittal discrepancy, while in Syrian adolescents, it was a result of excessive vertical development. Syrian adolescents had a significantly excessive vertical development when compared with Hungarian adolescents, regardless of sex (p < 0.01). Hungarian boys had significantly more protruded maxillae (p < 0.001) and less retruded mandibles (p < 0.01) when compared with Syrian boys, while Hungarian girls had significantly shorter mandibles relative to those of Syrian girls (p < 0.01). Syrian girls had significantly more protrusive lower incisors (p < 0.001), accompanied by significantly larger anterior tooth-size ratios when compared to Hungarian girls (p < 0.001). In conclusion, these findings underscore the importance of considering ethnic differences during orthodontic diagnosis and may have implications for optimizing orthodontic treatments in Syrian and Hungarian adolescents with Class II division 1 malocclusion.

Mandibular posterior space in class II division 1 and 2 malocclusion in various age groups

PURPOSE

The aim of this study was to compare the mandibular posterior space in subjects with skeletal class II division 1 and division 2 malocclusions in two different age groups.

METHODS

Pretreatment cephalometric radiographs of 160 patients from 9 to 13 years of age (n = 80) and 15 to 18 years of age (n = 80) with class II division 1 or division 2 malocclusion were used for the study. Equal numbers of male and female patients (n = 20) were included in the two age groups in each of the malocclusion groups. Eight linear and six angular measurements were taken for mandibular posterior space evaluation. The data obtained from the study were compared using the independent t-test.

RESULTS

In the present study, the mandibular posterior space was greater in both malocclusion groups in subjects aged 15-18 years than in those aged 9-13 years (p < 0.05). The available posterior spaces behind the mandibular first molars were 4.4 mm and 6.3 mm in females (class II divisions 1 and 2, respectively) and 5.3 mm and 7 mm in males (class II divisions 1 and 2, respectively) in the 9‑ to 13-year-old age group. This space increased significantly by 6.9 mm (p < 0.001) and 3.2 mm (p < 0.01) in females (class II division 1 and 2, respectively) and 3.8 mm (p < 0.01) and 3 mm (p < 0.01) in males (class II division 1 and 2, respectively) in the 15- to 18-year-old age group.

CONCLUSION

Class II division 1 and division 2 malocclusions had similar and inadequate posterior space dimensions for the eruption of the third and an unknown portion of the second molars.

Differential skeletal and dental effects after orthodontic treatment with bite jumping appliance or activator: a retrospective cephalometric study

OBJECTIVES

The aim of this retrospective cephalometric study was to compare treatment outcomes with "bite jumping appliance" (BJA) or Andresen-Häupl type activator. It especially focused on skeletal and dental structures in patients with class II malocclusion. The study hypothesis was that differences in treatment-related changes would occur between patients treated with BJA or activator.

MATERIAL AND METHODS

Pre- and posttreatment lateral cephalograms of 73 patients with a class II malocclusion were analyzed. Thirty-seven patients (22 females, 15 males) received treatment with a BJA (pretreatment age 11.1 ± 1.07 years) and 36 patients (20 females, 16 males) with an activator (pretreatment age 11.3 ± 1.12 years). Treatment time was 14.0 ± 1.8 months with BJA and 12.0 ± 2.0 months with activator. Paired t tests were used for intragroup and t tests for independent samples for intergroup comparisons. Results were considered statistically significant at P < 0.05.

RESULTS

The comparison of sagittal and vertical skeletal changes after BJA and activator treatment did not reveal significant differences. Significant changes occurred for lower incisor inclination (P = 0.0367) and overjet (P = 0.0125) only. The reduction of overjet and proclination of lower incisors were more pronounced in BJA patients.

CONCLUSIONS

Both "bite jumping appliance" (BJA) and Andresen-Häupl type activator were able to improve the occlusion of patients with a class II malocclusion. Dental effects were more pronounced for the BJA.

CLINICAL RELEVANCE

Marked lower incisor proclination contributed significantly to overjet correction in BJA patients. This ought to be respected when choosing a removable functional appliance for patients whose lower incisors are already proclined prior to treatment.

Dentoskeletal morphology in adults with Class I, Class II Division 1, or Class II Division 2 malocclusion with increased overbite

INTRODUCTION

The treatment options for adults with increased overbite are limited to dentoalveolar changes that camouflage the condition. Because of high relapse tendency, defining the problem area is important when creating a treatment plan. This study aimed to evaluate dentoskeletal morphology in skeletal Class I and II anomalies associated with Angle Class I, Class II Division 1 (Class II/1), and Class II Division 2 (Class II/2) malocclusions with increased overbite compared with normal occlusion.

METHODS

Pretreatment cephalograms of 306 patients (131 men, 175 women; overall ages 18-45 years) were evaluated. Four groups were constructed. Three groups had increased overbite (>4.5 mm): group 1 (n = 96) skeletal Class I (ANB = 0.5°-4°), group 2 (n = 85) skeletal Class II (ANB >4.5°) with Class II/1; and group 3 (n = 79) skeletal Class II with Class II/2 malocclusion. Group 4 as a control (n = 46) skeletal Class I normal overbite. Dental and skeletal characteristics of the groups were compared by sex. For statistical evaluations, analysis of variance followed by Tukey post hoc, Mann-Whitney U, and Kruskall-Wallis tests were used. Additionally correlation coefficients between overbite and skeletal/dental parameters were calculated.

RESULTS

Between sexes, with regard to skeletal parameters, the men had greater values in millimetric measurements, and the women had higher SN/GoGn values. Maxillary/mandibular molar heights and the mandibular incisor heights were higher in men. In group 1, decreased lower anterior facial height (LAFH), retrusive mandibular incisors, and increased interincisal degree were determined. The maxillary molars were intrusive, whereas the vertical position of the mandibular molars and incisors in both jaws were normal. In group 2, retrognathic mandible, increased LAFH and mandibular plane angle, extrusive maxillary/mandibular incisors, protrusive mandibular incisors, and decreased interincisal degree were found. In group 3, decreased LAFH, increased interincisal degree, and retrusive incisors in both jaws were determined. There were significant negative correlations between SN/GoGN, palatal plane, and overbite in group 2 and between ANS-SN and overbite in group 3, and positive correlation between interinsical angle and overbite in all increased overbite groups.

CONCLUSIONS

Dental morphology seems to be the main factor of increased overbite. Differences between groups were related primarily to inclinations and vertical positions of the incisors, rather than molar positions.

Correlation between vertical components and skeletal Class II malocclusion in ethnic Javanese

Introduction

The dentoskeletal morphology of Class II malocclusion has been analyzed in several cephalometric investigations. It is crucially important to understand the vertical components in orthodontic treatment. Defining the facial type of an individual is an essential key to obtain an accurate orthodontic diagnosis.

Aim

The aim of this study was to understand the correlation of vertical components in Class II skeletal malocclusion.

Materials and methods

This is a observational descriptive study. This study used lateral cephalograms of Class II skeletal malocclusion from Universitas Airlangga Dental Hospital, between April 2015 and 2016. Cephalometric analysis was performed using digital software by a single examiner. This analysis measured gonial (Go), upper gonial (Go₁), lower gonial (Go₂), Yaxis-SN angle, the length of anterior face height, and posterior face height. The correlation between each variable was analyzed using the Pearson correlation test (P<0.01).

Results

There was a correlation between vertical components and Class II skeletal malocclusion.

Conclusion

Vertical components were correlated with Class II skeletal malocclusion. The greater ANB angle will be followed by greater Go₂, which worsens the condition of Class II skeletal malocclusion.

Three-dimensional analysis of dental arch forms in Italian population

BACKGROUND

The aim of this study was the comparison of male and female upper and lower dental arch form in untreated Italian patients by 3D analysis, to find differences in shape, in transversal and longitudinal diameters between sexes, and to give a representative set of population's dental arch to clinicians in order to provide suitable orthodontic treatment.

METHODS

The sample consisted of 3D scans of dental casts deriving from 104 Italian untreated patients (Male = 35, Female = 69) in permanent dentition. An evaluation of the arch form was performed by angular and linear values on every patient using a 3D software (SolidWorks®). A Student's two-tailed t test was used to determine if the differences in measurements between the male and female groups were significant and the level of significance was set at P < 0.05.

RESULTS

Statistically significant differences in upper and lower transversal and longitudinal diameters were found. Male arch widths were significantly larger than those of females. Male intercanine, intermolar, and interpremolar diameters were significantly greater than females. Dental arch depth was significantly smaller in the female group. Anterior upper dental arch form was flatter, wider, and less sharp in the female group.

CONCLUSIONS

Basing on the anatomical arches differences found between sexes concerning Italian patients, it is suggested to have regard to each patient pre-treatment arch form, width, and depth during orthodontic treatment according to gender.

Craniofacial growth studies in orthodontic research — lessons, considerations and controversies

The distinguishing features of Class I, Class II and Class III craniofacial growth have been subjects of orthodontic research since the middle of the 20th century. However, the moral and practical issues related to studying craniofacial growth in modern times have presented unresolved challenges to researchers. While previous longitudinal growth investigations are typically based on historical data sets, the cephalometric growth studies of contemporary populations must now rely on cross-sectional data. Furthermore, clinical orthodontic research has faced similar ethical challenges in which therapeutic outcomes are analysed using historical control data. These limitations, amongst others, have obscured the conclusions that can be drawn from both types of studies. This article begins with a review of the defining characteristics of Class I, Class II and Class III growth and then explores the limitations of growth studies and the use of historical control groups in orthodontic research.

Maxillary and mandibular contribution to the establishment of class II malocclusion in an adult Lebanese population

INTRODUCTION

The main aim of this study was to describe the contribution of the maxilla and the mandible to the establishment of a Class II skeletal malocclusion in an adult Lebanese population. Secondary aims were to detect the presence of sex-based dimorphism and to study the influence of the vertical dimension on the Class II skeletal pattern.

MATERIAL AND METHOD

A sample of 90 adults in skeletal Class II was recruited and equally distributed according to sex and vertical typology. The study describes the skeletal and dentoalveolar cephalometric characteristics of the Class II sample, essentially according to Coben's cephalometric analysis.

RESULTS

The total effective depth of the cranial base and the anterior cranial base angle (SN-BaH) were both greater in the Class II sample. In females, the effective depth of the maxilla (Ptm-A) was larger than normal while SNB was smaller. The parameters describing the size and shape of the body of the mandible were significantly different from those of normal subjects. The upper incisors were in a retrusive position, while the axis of the lower incisors was located normally. The mandibular molars had a more distal sagittal position. Hyperdivergent subjects had more significant posterior alveolar growth, a more retrusive mandibular position and smaller mandibular dimensions than the other two vertical sub-groups.

CONCLUSION

The cranial base contributes to the establishment of a Class II malocclusion, and mandibular retrusion cannot be considered as a characteristic shared by all skeletal Class II subjects. Lessening of the absolute length of the mandibular body is the second most frequent etiological factor noted in the Class II sample studied. Most individuals in skeletal Class II have an associated dental Class II malocclusion, and the vertical dimension has an influence on the Class II skeletal pattern.

Diagnostic features of Angle's Class II div 2 malocclusion

Statement of Problem:

A thorough knowledge of the salient features of malocclusion makes the practitioner to come to a proper diagnosis and to formulate proper mechanotherapy. It also helps to predict the prognosis, prior to the onset of treatment process. Among the various malocclusions, Class II div 2 occurs the least often. The literature review does not clearly describe the classical skeletal and dental features of Angle's Class II div 2 malocclusion.

Purpose of Study:

The aim of this study is to describe the unique features of Angle's Class II division 2 malocclusion.

Materials and Methods:

A total of 612 pre-treatment records (study models and cephalograms), with age ranging from 14 to 25 years, were obtained from the hospital records of Drs Sudha and Nageswar Rao Siddhartha Institute of Dental Sciences. Among these samples, 317 were Class II div 1 and 295 were Class II div 2. The lateral cephalograms were analyzed by using Kodak software and the arch width analysis was calculated by using digital vernier calipers.

Results:

Student's t test was used for the study. On the cephalograms, the vertical skeletal measurements and few of the dental variables showed a significant difference. On the plaster models, the maxillary transverse measurements revealed a notable discrimination between the groups.

Conclusion:

Angle's Class II div 2 malocclusion has a marked horizontal growth pattern with decreased lower facial thirds, palatally inclined upper anteriors, and remarkably increased transverse maxillary arch dimensions.

Pathognomonic features of Angle's Class II division 2 malocclusion: A comparative cephalometric and arch width study

Background:

A thorough knowledge of the salient features of malocclusion helps the clinician in arriving at a proper diagnosis and treatment plan, and also to predict the prognosis, prior to the onset of treatment process. Among the four classes of Angle's classification of malocclusion, Class II division 2 occurs with the least frequency. There is still continuing debate in the literature whether the Class II division 2 patients ascribe the pathognomonic skeletal and dental features.

Aim of the study:

The aim of this study is to describe the unique features of Angle's Class II division 2 malocclusion to differentiate it from Angle's Class II division 1 malocclusion.

Materials and Methods:

A total of 582 pre-treatment records (study models and cephalograms), with the age of patients ranging from 15 to 22 years, were obtained from the hospital records of Vishnu Dental College, Bhimavaram and Geetam's Dental College, Visakhapatnam. Out of these, 11 pre-treatment records were excluded because of lack of clarity. In the rest of the sample, 283 were Class II division 1 and 288 were Class II division 2. The lateral cephalograms were analyzed by using digiceph and the arch width analysis was done based on the anatomical points described by Staley et al. and Sergl et al.

Results:

An intergroup evaluation was done by using unpaired Student's “t” test. The skeletal vertical parameters, dental parameters, and the maxillary arch width parameters revealed a statistically significant difference between the two groups of malocclusion.

Conclusion:

Angle's Class II division 2 malocclusion has a pronounced horizontal growth pattern with decreased lower anterior facial height, retroclined upper anteriors, and significantly increased maxillary arch width parameters.

The use of three-dimensional cephalometric references in dentoskeletal symmetry diagnosis

OBJECTIVE:

The aim of this study is to assess dentoskeletal symmetry in cone-beam computed tomography (CBCT) scans of Brazilian individuals with Angle Class I malocclusion.

MATERIAL:

A total of 47 patients (22 females and 25 males) aged between 11 and 16 years old (14 years) seen in a private radiology service (CIRO, Goiânia, GO, Brazil) were assessed. All CBCT scans were obtained from January, 2009 to December, 2010. Cephalometric measurements were taken by multiplanar reconstruction (axial, coronal and sagittal) using Vista Dent3DPro 2.0 (Dentsply GAC, New York, USA). Minimum, maximum, mean and standard deviation values were arranged in tables, and Student t-test was used to determine statistical significance (P < 0.05).

RESULTS:

Data were homogeneous, and differences between the right and left sides were not significant.

CONCLUSIONS:

Cephalometric measurements of Brazilian individuals with Angle Class I malocclusion can be used to establish facial symmetry and three-dimensional standard references which might be useful for orthodontic and surgical planning.

Association of dentoskeletal morphology with incisor inclination in angle class II patients: a retrospective cephalometric study

Introduction

The purpose of this study was to identify possible dentoskeletal parameters associated with variation of anterior tooth inclination in Angle Class II subdivisions.

Methods

Pre-treatment lateral radiographs of 144 Class II patients (68 males, 76 females) aged 9 to 17 years were classified for upper incisor inclination into three groups (proclined, normally inclined, retroclined) homogeneous for gender and skeletal jaw relationship. The effect of age on the 22 cephalometric variables was controlled by covariance analysis.

Results

Multivariate analysis of the cephalometric parameters indicated significant inter-group differences. Systematic associations with incisor inclination were revealed using rank correlation: Lower incisor proclination, Wits appraisal and gonial angle significantly decreased (0.04 ≥ p ≥ 0.002), while intercisal angle, mandibular total and corpus length and nasolabial angle increased (0.04 ≥ p ≥ 0.001) with decreasing incisor proclination.

Conclusions

Clear-cut classification criteria and control of confounding effects may clarify conflicting previous findings on dentoskeletal differences between Class II subdivisions in the mixed dentition. Only minor dentoskeletal differences appear to be associated with incisor inclination. The increased interincisal and nasolabial angle in Class II division 2 subjects are due to reclination of both upper and lower incisors. Jaw positions and chin prominence are not significantly different between the subdivisions. However, Wits appraisal is decreased in Class II division 2. The increased mandibular length observed in Class II division 2 requires further scrutinization.

Intra-arch widths: a meta-analysis

OBJECTIVE

To determine and compare the mean values of various intra-arch distances in Class I, Class II division 1 and Class II division 2 patients.

MATERIALS AND METHODS

The search engines PubMed, Embrace and Cochrane were employed to select articles for further study, and the sample thereby selected comprised adult subjects with full permanent dentition, without missing teeth, malformations or previous orthodontic treatment. Only subjects from articles published during the last 10 years were included in the study.

RESULTS

The search located a total of 628 articles regarding arch form. However, only eight articles were chosen for the study. We observed that: the distance between mandibular canines is smaller in Class I than in Class II division 1; mandibular inter-molar distance is similar in Class I and Class II division 1; maxillary inter-canine distance is similar in Class I, Class II division 2 and Class II division 1; maxillary inter-premolar width is greater in Class I than in Class II division 1; and that maxillary inter-molar width is similar in Class I and Class II division 2.

CONCLUSIONS

No statistically significant differences in arch width were found between the different classes analysed (there are only slightly differences between classes), except in the case of mandibular inter-canine width (L3), which was smaller in Class I than in Class II,1, and maxillary inter-premolar width (U4), which was smaller in Class II-I than in Class I.

Different manifestations of Class II Division 2 incisor retroclination: a morphologic study

INTRODUCTION

The aims of this study were to investigate whether there is a different transverse morphologic pattern of dental arches among patients with different manifestations of Class II Division 2 incisor retroclination and to evaluate to what extent the pattern of smaller-than-average teeth in Class II Division 2 malocclusion is common to all groups studied. This information might clarify whether different Class II Division 2 phenotypes represent a single etiology or multiple etiologies.

METHODS

The sample comprised 108 subjects with Class II Division 2 malocclusions, divided into 2 groups according to the type of incisor retroclination: group I included 43 Class II Division 2 subjects with retroclination exclusively of the maxillary central incisors, and group II included 65 Class II Division 2 subjects with retroclination of the 4 maxillary incisors. Maxillary and mandibular intercanine and intermolar widths as well as mesiodistal crown dimensions of the 4 maxillary and mandibular incisors were determined from the patients' initial study models. Mean values of all variables were compared between the 2 groups by sex with analysis of variance.

RESULTS

From the comparison between these 2 groups, no statistically significant differences were found for all transverse measurements (P >0.05). For all mesiodistal measurements analyzed, statistically significant differences between the groups were only found for the mean value of both maxillary lateral incisors' mesiodistal dimensions in both sexes (P <0.05).

CONCLUSIONS

It is not possible to attribute a characteristic pattern of dental arch-width and incisor mesiodistal dimensions to the different manifestations of incisor retroclination in Class II Division 2 malocclusion.

Anteroposterior and Vertical Components of Class II division 1 and division 2 Malocclusion

Objective: To describe and analyze the skeletal and dental characteristics associated with Class II division 1 (Class II/1) and Class II division 2 (Class II/2) malocclusions in the anteroposterior and vertical dimensions.

Materials and Methods: A total of 551 lateral cephalograms were used; 293 films of Class II/1 and 258 films of Class II/2 malocclusions. Lateral cephalographs were traced and analyzed. Parameters for both malocclusions were compared with each other and with the norms calculated for the Jordanian population in another study.

Results: The maxilla was prognathic in both malocclusions. The mandible was retrognathic in Class II/1 and orthognathic in Class II/2. Vertically, LAFH was significantly reduced in patients with Class II/2 compared with subjects with Class II/1 who exhibited a significantly increased LAFH. In Class II/1, the lower incisors were proclined and the interincisal angle was reduced, while in Class II/2 the lower incisors were at a normal inclination and the interincisal angle was significantly increased.

Conclusions: Class II/2 may be considered as a separate entity which differs in almost all skeletal and dental features from Class I and Class II/1. A Class II skeletal pattern and reduced interincisal angle were common features of Class II/1 malocclusion, while a Class II skeletal pattern, increased interincisal angle, and skeletal deep bite were common features of Class II/2 malocclusion.

Dental arch widths of Southern Chinese

OBJECTIVE

To investigate the dental arch width of the Southern Chinese across buccal cusps, central fossae, or lingual cusps and compare these values with study findings in different populations and using different definitions.

MATERIALS AND METHODS

The dental arch dimensions of study casts of an unselected sample from a 12-year-old Hong Kong Oral Health Survey of 12-year-old children (n = 358; 210 boys and 148 girls) were measured.

RESULTS

When compared with Caucasians, the Southern Chinese were characterized by a wider dental arch width. However, variations were great. All maxillary and mandibular male arch widths were significantly larger than female arch widths, except at the incisor regions.

CONCLUSION

This study yielded a database about dental arch widths by which different studies on these widths can be compared.