Cephalometric comparison between male and female using Tweed's analysis in solan population

Mandeep K Bhullar; Sonam Lhamu Bhutia; Sanjay Mittal; Isha Aggarwal; Tanzin Palkit; Merry Goyal

doi:10.4103/ijohr.ijohr_29_20

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ORIGINAL ARTICLE

Year : 2021 | Volume : 7 | Issue : 1 | Page : 36-39

Cephalometric comparison between male and female using Tweed's analysis in solan population

Mandeep K Bhullar, Sonam Lhamu Bhutia, Sanjay Mittal, Isha Aggarwal, Tanzin Palkit, Merry Goyal
Department of Orthodontics and Dentofacial Orthopedics, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India

Date of Submission	17-Dec-2020
Date of Acceptance	24-Mar-2021
Date of Web Publication	12-Jul-2021

Correspondence Address:
Dr. Sonam Lhamu Bhutia
Bhojia Dental College and Hospital, Baddi, Himachal Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijohr.ijohr_29_20

Abstract

Aim: The purpose of this study aimed to verify the mean values of cephalometric values of Tweed's facial triangle: Frankfort-mandibular plane angle (FMA), Frankfort mandibular incisor angle (FMIA), and Incisal mandibular plane angle (IMPA) of Class II malocclusion patients in Solan population and conduct comparison between male and female. Materials and Methods: Cephalometric radiographs of eighty patients having Class II malocclusion, taken from the Department of Orthodontics and Dentofacial Orthopedics, Bhojia Dental College and Hospital, Baddi. Samples were divided on the basis of gender that is 40 males and 40 females. The following three angles formed in Tweed's triangle were measured for all the subjects: FMA, FMIA, and IMPA. Taking these angles, the mean of all the Tweed's parameters of male and female was depicted. Result: The mean value indicates that the people of Solan district show an average growth pattern. The FMA in males (23.625) was less than that of females (26.3), FMIA was slightly more in male (56.33) than female (55.8) and the IMPA was also more in males (100.1) than females (97.9). Conclusion: The study showed no significant difference in the values between male and female; therefore, it is not desirable to have separate norms for diagnosis and treatment planning for the treatment of Class II malocclusion in male and female.

Keywords: Cephalometric, Class II malocclusion, Tweed's triangle

How to cite this article:
Bhullar MK, Bhutia SL, Mittal S, Aggarwal I, Palkit T, Goyal M. Cephalometric comparison between male and female using Tweed's analysis in solan population. Indian J Oral Health Res 2021;7:36-9

How to cite this URL:
Bhullar MK, Bhutia SL, Mittal S, Aggarwal I, Palkit T, Goyal M. Cephalometric comparison between male and female using Tweed's analysis in solan population. Indian J Oral Health Res [serial online] 2021 [cited 2023 Jun 6];7:36-9. Available from: https://www.ijohr.org/text.asp?2021/7/1/36/321119

Introduction

Radiographic cephalometrics introduced by Brodbant provides a research and clinical tool to study the malocclusion and their underlying skeletal structures.^[1] The cephalometric values mostly vary from one ethnic group to others, and even variance occurs between genders.^[2] Various studies^{[3],[4],[5],[6],[7]} have already established cephalometric norms based on different populations of the world. Therefore, different racial groups should be treated based on their racial characteristics. Tweed's analysis was coined by Dr. Charles Tweed. He also introduced the diagnostic triangle, to help in guiding and determining the normal position of the teeth in relation to their jaw bones and head structure.^[8] Tweed's analysis has been formulated to help in determining the diagnosis, treatment plan, anchorage sites, and ultimately deciding the prognosis of the treatment.^[9] Therefore, Tweed's facial triangle is a feasible diagnosis, classification, and prognosis establishing method.^[10] Dr. Charles Tweed had developed a guide in the form of diagnostic facial triangle^[5] which provided the clinician with simple and basic definite guidelines in the treatment planning of malocclusion. Tweed using cephalometric radiographs introduced new norms to achieve facial esthetics. Of which his standards led orthodontics into the extraction of first premolars to achieve posttreatment stability, better facial esthetics, and harmony.^[11] Standard value of Tweed's analysis was believed to be significant in stabilizing balance and harmony of lower face. The Frankfort-mandibular plane angle (FMA) is considered the most significant value for analysis; it shows the direction of lower face growth in horizontal and vertical dimensions.^[12] Incisal mandibular plane angle (IMPA) is considered the most important angle, as it provides balance and harmony of lower facial profile.^[13] Tweed emphasized that, for the desirable facial esthetics and stability, the lower incisors should be “upright over the basal bone.”^[14] FMA greater or equal to 30° mandibular incisors are compensated by so that Frankfort mandibular incisor angle (FMIA) ranges from 65° to 70°. Prognosis – Fair and extraction are usually indicated. FMA is equal to 25° plus minus 4°, efforts should be maintained to attain FMIA 68°–70°. FMA equal or lesser than 20° then IMPA should not exceed 94°. In this analysis, Tweed stressed the importance of FMIA angle and recommended that FMIA should be maintained at 65°–70°.^[15]

Aims and objectives

The purpose of this study aimed to:

Verify the mean values of cephalometric norms of Tweed's facial triangle (i.e., FMA, FMIA, and IMPA) of Class II malocclusion patients in Solan population
Conduct comparison between male and female.

Materials and Methods

Eighty subjects (40 males and 40 females) from district Solan, Himachal Pradesh, were selected for this study which was done in the Department of Orthodontics and Dentofacial Orthopedics of Bhojia Dental College and hospital, Baddi, district Solan, Himachal Pradesh. The average age of males and females taken in the study was 16.18 and 17.78 years, respectively.

The inclusion criteria were:

Male and female patients of Solan population
Class II molar relationship
Acceptable profile
No history of previous orthodontic treatment.

The materials used in this study consist of cephalometric radiographs (lateral cephalograms) of all the selected subjects (40 males and 40 females), cellulose acetate tracing paper (0.003 mm), lead pencil (0.5 mm), millimeter Scale, and a radiograph illuminator. Lateral cephalograms were traced upon a 0.003 mm matte acetate tracing paper the tracings were analyzed using linear and angular measurements according to Tweed”s analysis.

The following three planes that form Tweed's diagnostic triangle [Figure 1] were used:

Figure 1: Diagnostic facial triangle

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Frankfort horizontal plane: Plane line connecting a point over the center of the ear and joining from external auditory meatus to the left and right lower borders of the orbitale
Mandibular plane: Line passing tangent to the lower border of mandible, connecting the menton anteriorly and bisects posteriorly the lower border of mandible in the gonial angle.
Long axis of lower incisor: A plane line extending from the long axis of mandibular central incisor downward to the mandibular plane and upward to the Frankfort plane.

The following three angles formed in Tweed's triangle [Figure 1] was measured:

FMA
FMIA
IMPA.

Angles

FMA: The mandibular plane extending to the Frankfort horizontal plane forms the FMA
IMPA: The long axis of the mandibular incisor extending to the mandibular plane forms the incisor mandibular plane angle
Frankfort-mandibular incisor angle: The long axis of the mandibular incisor extending to the Frankfort horizontal plane forms the Frankfort-mandibular incisor angle.

Statistical analysis

Analysis was conducted using IBM SPSS STATISTICS windows (version 22.0). All statistical tests were two sided and performed at a significance level of ≤0.05.

Normality of quantitative data was checked by measures of Kolmogorov–Smrinov test of Normality. As the data were normally distributed, so data were given a mean, ± Standard deviation, and range.

Student's t-test was applied to compare two groups of variables. Gender was reported as counts and percentages. Pearson correlation coefficient was calculated to see relation of the variables.

Results

The samples comprised of forty males and 40 females, in which the average age of males was 16.18 years, while female was 17.78 years [Table 1].

Table 1: Grouping of sample on age

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The study shows no significant difference in the mean value between male and female participants, suggesting of similar growth pattern [Table 2].

Table 2: Discriptive statistics of males and females

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However:

The FMA in males (23.625) was less than that of females (26.3)
FMIA was slightly more in male (56.33) than female (55.8) and the
IMPA was also more in males (100.1) than females (97.9) [Table 2].

Discussion

The FMA for the males and females under the present study was found to be 23.625° and 26.300°, respectively. Males exhibited a mean incisor mandibular plane angle of 100.050° and females exhibited a mean IMPA of 97.9°. The study showed a mean Frankfort Mandibular Incisor angle for male subjects to be 56.325° and mean FMIA for female subjects was found to be 55.8°. When comparisons were made between the sexes in Solan population, there was no significant difference between the mean values of male and female subjects.

Tukasan et al.^[16] in the Brazilian population were they found a significant difference in IMPA. IMPA was found to be significantly more in Class I than Class III, this may be attributed to dental compensation associated with prognathic mandible in ClassIII participants, and a similar trend was seen for Class II div1 with Class III. Similar results were obtained in a study by Zegan et al.^[17] in the Romania population. IMPA was found to be significantly more in Class III than Class II div 2, obviously attributed to retroclination of lower incisor in Class II div2.

Kapila (1989),^[18] Mayury Kuramae et al (2004).,^[19], Bhattarai and Shrestha,^[12] Nanda and Shrestha,^[4] and Hassan^[20] found statistically nonsignificant differences between the sexes.

Conclusion

The mean of all the Tweed's parameters of male and female is depicted. The mean shows that the people in the Solan population show the average growth pattern of face.

There was no significant difference in the mean value between male and female participants, showing similar growth pattern [Table 3].

Table 3: Comparison between males and females

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Therefore, no need for separate norms for the diagnosis and treatment planning for treatment of Class II malocclusion in male and female patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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