Cephalometric analysis of the middle part of the face in patients with mandibular prognathism

Tatjana Čutović; Nebojša Jović; Ružica Kozomara; Julija Radojičić; Mirjana Janošević; Irena Mladenović; Stevo Matijević

doi:10.2298/4527

Tatjana Čutović Department of Orthodontics, Military Medical Academy, Belgrade, Serbia
Nebojša Jović Department of Maxillofacial Surgery, Military Medical Academy, Belgrade, Serbia
Ružica Kozomara Department of Maxillofacial Surgery, Military Medical Academy, Belgrade, Serbia
Julija Radojičić Department of Orthodontics, Faculty of Medicine, University of Niš, Niš, Serbia
Mirjana Janošević Department of Orthodontics, Faculty of Medicine, University of Niš, Niš, Serbia
Irena Mladenović Department of Prosthodontics, Faculty of Medicine, University of East Sarajevo, Bosnia and Herzegovina
Stevo Matijević Department of Oral Surgery, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/4527

Keywords: prognathism, mandible, malocclusion, angle class III, cephalometry, maxilla, face, orthodontics,

Abstract

Background/Aim. The middle part of the face, that is the maxilla, has always been mentioned as a possible etiologic factor of skeletal Class III. However, the importance of the relationship of maxillary retroposition towards the cranial base is still unclear, although it has been examined many times. The aim of this study was to conduct cephalometric analysis of the morphology of maxilla, including the whole middle part of the face in patients with divergent and convergent facial types of mandibular prognathism, as well as to determine differences betweeen them. Methods. Lateral cephalometric teleradiograph images of 90 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18–35 years, not previously treated orthodontically. On the basis of dentalskeletal relations of jaws and teeth, the patients were divided into three groups: the group P1 (patients with divergent facial type of mandibular prognathism), P2 (patients with convergent facial type of mandibular pragmathism) and the group E (control group or eugnathic patients). A total of 9 cephalometric parameters related to the middle face were measured and analyzed: the length of the hard palate – SnaSnp, the length of the maxillary corpus – AptmPP, the length of the soft palate, the angle between the hard and soft palate – SnaSnpUt, the angle of inclination of the maxillary alveolar process, the angle of inclination of the upper front teeth, the effective maxillary length – CoA, the posterior maxillary alveolar hyperplasia – U6PP and the angle of maxillary prognathism. Results. The obtained results showed that the CoA, AptmPP and SnaSnp were significally shorter in patients with divergent facial type of mandibular prognathism compared to patients with convergent facial type of the mandibular prognathism and also in both experimental groups of patients compared to the control group. SnaSnp was significantly shorter in patients with divergent facial type of mandibular prognathism compared to the control group, whereas SnaSnp was significantly smaller in patients with convergent facial type of mandibular prognathism compared to the control group. Additionally, there was a pronounced incisor dentoalveolar compensation of skeletal discrepancy in both groups of patients with mandibular prognathism manifested in the form of a significant upper front teeth protrusion, but without significant differences among the groups, while the maxillary retrognathism was present in most patients of both experimental groups. A pronounced UGPP was found only in the patients with divergent type of mandibular prognathism. Conclusion. The maxilla is certainly one of the key factors which contributes to making the diagnosis, but primarily to making a plan for mandibular prognathism treatment. Accurate assessment of the manifestation of abnormality, localization of skeletal problems and understanding of the biological potential are key factors of the stability of the results of surgical-orthodontic treatment of this abnormality.

References

Nakasima A, Ichinose M, Nakata S. Genetic and enviromental factors in the development of soccaled pseudo- and true mesiocclusion. Am J Orthod Dentofacial Orthop 1986; 90(2): 106−16.

Thompson EM, Winter RM. Another family with the “Habsburg jaw”. J Med Genet 1988; 25(12): 838−42.

Mackay F, Jones JA, Thompson R, Simpson W. Craniofacial form in class III cases. Br J Orthod 1992; 19(1): 15−20.

Mouakeh M. Cephalometric evaluation of craniofacial pattern of Syrian children with Class III malocclusion. Am J Orthod Dentofacial Orthop 2001; 119(6): 640−9.

Singh GD. Morphologic determinants in the etiology of class III malocclusions: a review. Clin Anat 1999; 12(5): 382−405.

Jacobson A, Evans WG, Preston CB, Sadowsky PL. Mandibular prognathism. Am J Orthod 1974; 66(2): 140−71.

Diewert VM. Development of human craniofacial morphology during the late embrionic and early fetal periods. Am J Orthod 1985; 88(1): 64−76.

Singh GD, McNamara JA, Lozanoff S. Localisation of deforma-tions of the midfacial complex in subjects with class III maloc-clusions employing thin-plate spline analysis. J Anat 1997; 191(Pt 4): 595−602.

Troy BA, Shanker S, Fields HW, Vig. K., Johnston W. Comparison of incisor inclination in patients with class III malocclusion treated with orthognathic surgery or orthodontic camouflage. Am J Orthod Dentofacial Orthop 2009; 135(2): 146.e1−9; dis-cussion 146−7.

Kim DK, Baek SH. Change in maxillary incisor inclination dur-ing surgical-orthodontic treatment of class III malocclusion: comparison of extraction and nonextraction of the maxillary first premolars. Am J Orthod Dentofacial Orthop 2013; 143(3): 324−35.

Guyer EC, Ellis EE, McNamara JAIr, Behrents RG. Components of class III malocclusion in juveniles and adolescents. Angle Orthodontics 1986; 56(1): 7−30.

Chang HP, Lin HC, Liu PH, Chang CH. Midfacial and mandi-bular morphometry of children with Class II and Class III malocclusions. J Oral Rehabil 2005; 32(9): 642−7.

Reyes BC, Baccetti T, McNamara JAIr. An estimate of craniofacial growth in Class III malocclusion. Angle Orthod 2006; 76(4): 577−84.

Ellis E, McNamara JAIr. Components of adult Class III maloc-clusion. J Oral Maxillofac Surg 1984; 42(5): 295−305.

Abu Allhaija ES, Al-Khateeb SN. Uvulo-glosso-pharyngeal di-mensions in different anteroposterior skeletal patterns. Angle Orthod 2005; 75(6): 1012−8.

Joseph AA, Elbaum J, Cisneros GJ, Eisig SB. A cephalometric comparative study of the soft tissue airway dimensions in per-sons with hyperdivergent and normodivergent facial patterns. J Oral Maxillofac Surg 1998; 56(2): 135−9.

Dostalova S, Sonka K, Smahel Z, Weiss V, Marek J. Cephalometric assessment of cranial abnormalities in patients with acro-megaly. J Craniomaxillofac Surg 2003; 31(2): 80−7.

Čutović T, Jović N, Kozomara R, Stojanović LJ, Radojičić J, Mladenović I. A cephalometric analysis of the cranial base and frontal part of the face in patients with mandibular prognathism. Vo-jnosanit Pregl 2014; 71(6):

Bailey LT, Proffit WR, White RP Jr. Trends in surgical treatment of Class III skeletal relationships. Int J Adult Orthodon Or-thognath Surg 1995; 10(2): 108−18.

Espeland L, Høgevold HE, Stenvik A. A 3-year patient-centred follow-up of 516 consecutively treated orthognathic surgery patients. Eur J Orthod 2008; 30(1): 24−30.

Chen F, Wu LP, Terada K, Saito I. Longitudinal intermaxillary relationship in class III malocclusion with low and high mandibular plane angles. Angle Orthod 2007; 77(3): 397−403.

Alexander AE, McNamara JA Jr, Franchi L, Baccetti T. Semilon-gitudinal cephalometric study of craniofacial growth in un-treated Class III malocclusion. Am J Orthod Dentofacial Or-thop 2009; 135(6): 700.e1−14; discussion 700−1.

Ramezanzadeh B, Pousti M, Bagheri M. Cephalometric Evaluation of Dentofacial Features of Class III malocclusion in adults of Mashhad, Iran. J Dent Res Dent Clin Dent Prospects 2007; 1(3): 125−30.

Baccetti T, Reyes BC, McNamara JAIr. Craniofacial changes in Class III malocclusion as related to skeletal and dental matura-tion. Am J Orthod Dentofacial Orthop 2007; 132(2): 171−8.

Chang JZ, Chen Y, Chang FH, Yao JC, Liu P, Chang C, et al. Morphometric analysis of mandibular growth in skeletal Class III malocclusion. J Formos Med Assoc 2006; 105(4): 318−28.

Miyajima K, McNamara JA, Sana M, Murata S. An estimation of craniofacial growth in the untreated Class III female with ante-rior crossbite. Am J Orthod Dentofacial Orthop 1997; 112(4): 425−34.

Kwon TG, Mori Y, Minami K, Lee SH, Sakuda M. Stability of si-multaneous maxillary and mandibular osteotomy for treatment of class III malocclusion: an analysis of three-dimensional ce-phalograms. J Craniomaxillofac Surg 2000; 28(5): 272−7.

Joss CU, Thüer UW. Stability of hard tissue profile after mandi-bular seatback in sagital split osteotomies: a longitudinal and long term follow up study. Eur J Orthod 2007; 30(4): 352−8.

Jakobsone G, Stenvik A, Sandvik L, Espeland L. Three-year follow up of bimaxillary surgery to correct class III malocclusion: Stability and risk factors for relapse. Am J Orthod Dentofacial Orthop 2011; 139(1): 80−9.

McCance AM, Moss JP, James DR. Stability of surgical correction of patients with skeletal III and II anterior open bite with in-creased maxillary mandibular planes angle. Euro J Orthod 1992; 14(3): 198−206.

Baek S, Kim K, Choi J. Evaluation of treatment modality for skeletal Class III malocclusion with labioversed upper incisors and/or protrusive maxilla: surgical movement and stability of rotational maxillary setback procedure. J Craniofac Surg 2009; 20(6): 2049−54.

Iannetti G, Fadda MT, Marianetti TM, Terenzi V, Cassoni A. Long-term skeletal stability after surgical correction in Class III open-bite patients: a retrospective study on 40 patients treated with mono- or bimaxillary surgery. J Craniofac Surg 2007; 18(2): 350−4.

Mucedero M, Coviello A, Baccetti T, Franchi L, Cozza P. Stability factors after double-jaw surgery in class III maloccilusion. A systematic review. Angle Orthod 2008; 78(6): 1141−52.