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ABSTRACT
Background: This study aimed to establish the cephalometric norms for Iraqis using McNamara's analysis and to verify
the existence of sexual dimorphism.
Materials and Methods: 75 dental students, (33 males and 42 females) having normal occlusion, were chosen for this
study. Each student was subjected to clinical examination and digital true lateral cephalometric X-ray. The
radiographs were analyzed using AutoCAD program 2006 to measure the distances and angles. Descriptive statistics
was obtained for the measured variables for both genders and independent- samples t-test was performed to
evaluate the genders difference.
Results and Conclusions: The maxilla is protrusive in males in comparison with females, the effective midface and
mandibular lengths, lower facial height are significantly higher in males, and the Frankfort mandibular plane angle is
significantly higher in females. The females show retrusive mandibles with slight retrusive upper incisors in comparison
with males, while both genders show the same lower incisor position.
Key words: McNamara's analysis, cephalometric norms. (J Bagh Coll Dentistry 2010;22(3):123-127).
INTRODUCTION
Since the introduction of cephalometrics
by Broadbent (1) in 1931, a number of different
analyses have been devised such as that of
Downs (2-4), Steiner (5-7), Harvold (8) and Ricketts
(9-11)
.
McNamara (12) suggested that a need has
arisen for a method of cephalometric analysis
that is sensitive not only to the position of the
teeth within a given bone but also to the
relationship of the jaw elements and cranial base
structures one to another because he felt that
clinical orthodontics has seen the advent of
numerous orthognathic surgery procedures which
allow three-dimensional repositioning of almost
every bony structure in the facial region and of
functional appliance therapy which presents new
possibilities in the treatment of skeletal
discrepancies. So, in 1984, McNamara (12)
introduced his analysis which was derived, in
part, from the principles of the cephalometric
analyses of Harvold (8) and of Ricketts (9-11),
although other aspects, such as the construction
of the Nasion perpendicular and the point A
vertical, are presumed to be original. He thought
that his method of analysis represents an effort to
relate teeth to teeth, teeth to jaws, each jaw to the
other, and the jaws to the cranial base.
In an effort to create a clinically useful
analysis, McNamara (12) divided the craniofacial
skeletal complex into five major sections:
maxilla to cranial base, maxilla to mandible,
mandible to cranial base, dentition, and airway.
The Instruments
1.
2.
3.
Kidney dish.
Dental mirrors.
Sterilizer (Memmert, Germany).
The Equipments
1.
2.
Method
Each student was examined clinically and
subjected to the digital true lateral cephalometric
X-ray. The individual was positioned within the
cephalostat with the sagittal plane of the head
vertical, the Frankfort plane horizontal, and the
teeth were in centric occlusion. Every lateral
cephalometric radiograph was analyzed by
AutoCAD program to calculate the linear and
angular measurements. Once the picture was
imported to the AutoCAD program, it will
appear in the master sheet on which the points
4.
NS
*
**
***
P > 0.05
0.05 P > 0.01
0.01 P > 0.001
P 0.001
RESULTS
Table 1 showed the descriptive statistics
and genders difference. For ease the
measurements were divided into 4 major groups:
1.
Maxilla to cranial base
The mean value of the measurements
relating the maxilla to the cranial base are higher
in males than in female with a highly significant
difference between both genders regarding SNA
angle and non-significant difference regarding
NP point A.
2.
Maxilla to Mandible
In all of the measurements representing the
relation between the maxilla to mandible in
McNamara's analysis, the males showed
significantly higher mean values than females
except for FMA when the mean value of this
angle is higher significantly in females. On the
other hand, the facial axis angle is higher in
males with a non-significant difference.
3.
Mandible to cranial base
The females showed higher mean value of
Pogonion to Nasion perpendicular than males
with a non-significant difference between both
genders.
4.
Dentition
The mean value of position of upper
incisor relative to PNP is insignificantly higher in
males than females, while the position of lower
incisor relative to A-Pog line is the same in both
genders with a non-significant difference.
DISCUSSION
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
REFERENCES
1.
2.
3.
20.
21.
Genders difference
d.f.= 73
t-test
p-value
1.53
2.72
9.03
9.32
3.02
4.97
-2.19
-0.48
1.21
1.15
-0.03
0.12 (NS)
0.008 **
0.000 ***
0.000 ***
0.003 **
0.000 ***
0.03 *
0.62 (NS)
0.22 (NS)
0.25 (NS)
0.97 (NS)
Table 2: The mean values of the variables comprising the McNamara's analysis in different
populations
Al-Barakati
Present study
and Talic (21)
Year
1984
1996
2007
2007
2010
Age
Adults
Adults
12 years
Adults
Adults
Country
Iraq
USA
Japan
China
Arabia Saudi
Sex
Male Female Male Female Male Female Male Female Male Female
38
73
26
28
200
205
36
29
33
42
Number
2.5
2.3
-0.75 -0.53 -2
1.6
0.67
NP-A (mm)
1.1
0.4
-0.2
82.2
82.1
81.78 81.97
83.75 81.8
SNA (degree)
83.9 82.4
118.8 113.95 113.32 133.4 124.9 121.37 111
Co-Gn (mm)
134.3 120.2 125.5
91.4
86.3
87.90 85.93 101.7 98.2 93.22 85.5
Co-A (mm)
99.8
91
34.1
32.5
26.06 27.39 31.8 26.8 28.15 25.7
MM diff. (mm) 34.5 29.2
75.1
72.7
66.14 64.39 76.1 68.9 68.75 63.4
LAFH (mm)
74.6 66.7
22.3
26.1
27.81 26.10 24.9
21.69 23.9
FMA (degree) 21.3 22.7
25
-4.2
-3.5
-5.51 -3.83 2.8
-0.61 -0.19
FAA (degree)
0.5
0.2
2.9
0.3
-1.7
-7.45 -4.88 -6.1 -5.9 -0.09 -1.44
Pog-NP (mm)
-0.3
-1.8
5.7
6
7.34 7.86 6.2
6.44 5.91
U1-PNP (mm)
5.3
5.4
4.3
4
4.9
6.35 6.26 4.4
3.99 4.01
L1-A-Pog (mm) 2.3
2.7
3.6
Author (s)