26 Iraqi Orthod J 1(2) 2005 Palatal Depth and Arch Parameter in Class I Open Bite, Deep Bite and Normal Occlusion Ahmad A. Abdulmawjood, a Mahmood K. Ahmed, a and Ne am R. Al-Saleem a Abstract: This study aimed to measure the palatal depth, maxillary and mandibular arch widths and circumferences in three groups: class I open bite, class I deep bite and class I normal, to compare the results among the three groups and to find the correlation coefficient among the different variables in each group separately to identify any possible correlation among palatal depth, maxillary and mandibular arch widths and arches circumferences. Seventy two sets of casts divided into 3 groups (class I open bite mal, class I deep bite mal and class I normal ) were used. Palatal depth, maxillary and mandibular arch widths and arches circumferences were measured using a sliding gauge caliper, readouts were rounded to 0.1 mm. The palatal depth was the highest in open bite followed by normal and then in deep bite. The intermaxillary widths were the highest in normal followed by deep bite and then open bite. No significant differences were seen in the mandibular widths among the three groups. Correlation coefficient among variables expressed considerable variation. Keywords: Palatal depth, open bite, deep bite (Iraqi Orthod J 2005; 1(2): 26-31). I ncisor overbite is the amount of vertical overlap of maxillary and mandibular central incisors measured perpendicular to the occlusal plane, open bite (opertognathia) was assigned a negative value while deep bite is an excessive overbite. 1 Overbite is a measurement the clinician uses frequently before, during and after treatment, since its an elusive occlusal characteristics that is most difficult to predict in the growing child, most difficult to correct orthodontically and often relapses following orthodontic treatment. 2,3 Vertical mals result from the interplay of many different etiological factors during growth period. These factors include; growth of the maxilla and mandible, function of the lips and tongue and dentoalveolar development with the eruption of teeth. 4 It can be divided into those that are dentoalveolar in origin and these that are predominantly skeletal due to the growth patterns of the jaws. 5 Many studies have investigated the skeletal features of subjects with anterior open bite and deep bite, most of them were cephalometric in nature. Although in orthodontic treatment, a wealth of information obtained from dental casts plays a significant role in diagnosis, treatment planning and evaluation a little work has been done with study casts.6,7,8 The human craniofacial skeleton and its associated dental arches undergo visible alterations as they grow, adopt, and age. 9 Changes in the size and shape of skeletal dental - craniofacial complexes do not cease with the attainment of biologic maturity. 10 a B.D.S. M.Sc, Assistant lecturer, Pedodontics, Orthodontics and Preventive Dentistry Department, College of Dentistry, University of Mosul. Nanda 11 examined the patterns of facial growth development in subjects with open bite and deep bite faces and found that, the female open bite subjects were earliest in the timing of adolescent growth spurt, followed in succession by deep bite female subjects, open bite male subjects and finally the deep bite male subjects. Sassouni and Nanda 12 have reported on the vertical difference between open bite and deep bite subjects and found that there was a greater maxillary alveolar height in open bite than in deep bite. Johnson et al. 13 compared the palatal dimensions (width, length and depth) in adult and mals (class I crowded, class II 1, class II 2, and class III) and found that class II 1 palates were narrowest in width and class II 2 plates were shortest in length, class III and class I crowded subjects had the deepest palates and class II 2 had the shallowest palates. Adkin et al. 14 analyzed the relationship between changes in the dental arch perimeters dental arch widths (intercanine, interpremolar, and intermolar distances) resulting from rapid palatal expansion and found an increase in dental arch perimeters. However, Salman 15 found a poor correlation between the palatal vault depth and maxillary arch circumference and widths. The aim of this study was to measure the palatal depth and maxillary and mandibular dental arches parameters including arch circumferences, intercanine, interpremolar, and intermolar widths in Class I open bite, deep bite and normal and to compare the measurements among the three groups. Also to find the correlation coefficient among the different variables in each group separately to identify the possible relations among palatal depth, arches widths and circumference.
Palatal depth and arch parameter in class I open bite, deep bite and normal Abdulmawjood, Ahmed, Al-Saleem 27 MATERIALS AND METHODS The sample consisted of 72 sets of casts which were divided into 3 groups: 1. Group one: casts of subjects had Class I deep bite mal consisted of 24 sets (12 males and 12 females). 2. Group two: casts of subjects had Class I open bite mal, 24 sets (12 males and 12 females). 3. Group three (control group): casts of subjects with Class I normal 24 casts (12 males and 12 females). The patients with deep bite had the following criteria: 1. Full dentition with no extraction or impaction (except for the third molar). 2. Angle class I molar relation. 3. No gross facial deformity. 4. No history of orthodontic treatment. 5. Overbite 4mm. For patients with open bite, the same criteria were used with the exception of (point 5) where opening between upper and lower anterior teeth > zero. The same criteria were implied for control group but normal overbite 1 3 mm was implicated. The patients of the 3 groups had no breathing disorder. The patient age ranged from 12.2 20.3 with average of about 15.2 for group one, 16.1 for group two and 15.4 for group three. The overbite was measured by marking the extent of overlap of the upper incisor on the lower and the distance from the incisal edge of the lower incisor to the mark represents the overbite. The following landmarks were demarcated on the cast using 0.5 mm HB pencil for better identification: 1. The cusp tips of the right and left upper and lower canines. 2. The cusp tips of the buccal cusp of the right and left upper and lower first premolars. 3. The cusp tips of the mesiobuccal cusp of the right and left upper and lower first molars. 4. The cusp tips of the distobuccal cusp of the right and left upper and lower first molar. Linear measurements of arch dimensions and palatal depth were made with sliding calipers; readouts were rounded to 0.1 mm. These measurements include: 1. intercanine width: the distance between upper canines cusp tips. 2. intercanine width: the distance between lower canines cusp tips. 3. interpremolar width: the distance between upper first premolar buccal cusp tips. 4. interpremolar width: the distance between lower first premolar buccal cusp tips. 5. intermolar width: the distance between mesiobuccal cusp tips of the upper first molars. 6. intermolar width: the distance between mesiobuccal cusp tips of the lower first molar. 7. arch perimeter: the distance from distobuccal cusp tips of the upper first molar to the distobuccal cusp tip of the upper first molar at the opposite side. 8. Palatal depth: the distance from the palatal vault opposite the canines, first premolars and first molars to the occlusal plane, measured perpendicular to a rigid template resting on the occlusal surfaces of the maxillary teeth. Statistical Analysis Statistical analysis was performed including descriptive statistics (mean and standard deviation). ANOVA and Duncan tests were used to determine the presence of significant differences between the groups. Pearson s correlation coefficient was determined between all combinations of variables for each group separately. RESULTS For males statistical analysis using F- value at p<0.05 significance level expresses a significant differences in the interpremolar palatal depth between the three groups (open bite, normal and deep bite) with the largest depth for open bite followed by normal and then by deep bite (Tables 1 and 2). In females a highly significant differences were seen between the three groups concerning intercanine and palatal depth with the highest value for open bite followed by normal and then by deep bite, also a highly significant difference between the three groups were seen in the maxillary intercanine and interpremolar width (Tables 3 and 4). In tables 5 and 6, total sample (males and females) demonstrated a highly significant difference between the three groups in the intercanine and interpremolar palatal depth, intercanine and interpremolar maxillary width. Tables 7, 8 and 9 showed significant correlation between variables related to arch width and arch perimeters in each arch and between the two arches. DISCUSSION Concerning the palatal depth, there was a significant difference between the three groups: open bite casts demonstrated the highest depth in the intercanine and interpremolar region followed by normal while the deep bite casts showed the lowest depth. These differences can be related to the various rates of posterior dentoalveolar growth. The posterior dentoalveolar overgrowth is responsible for the anterior open bite, while its undergrowth is the cause of deep bite. Although, most studies agrees with our finding. 13,14 Some of them found no significant difference in palatal depth between open bite and normal. 5
28 Iraqi Orthod J 1(2) 2005 Table 1: Descriptive (mean ±SD) and ANOVA test for males with open bite, deep bite and normal. Type of Normal Table 2: Duncan s multiple range test for males with open bite, deep bite and normal. Type of premolar Normal A B A Different letters vertically mean significant difference at p<0.05. Arch circumference Table 3: Descriptive (mean ±SD) and ANOVA test for females with open bite, deep bite and normal. Palatal Depth Intermolar Intermolar premolar canine 21.56 15.8 8.71 52.46 42.56 36.43 47.03 36.6 28.06 99.55 ±1.05 ±2.75 ±1.48 ±3.26 ±4.50 ±2.17 ±4.19 ±2.31 ±1.39 ±4.47 21.42 12.57 7.5 51.35 40.89 35.32 47.26 36.78 28.39 100.17 ±1.81 ±1.60 ±0.53 ±4.27 ±2.67 ±2.79 ±3.41 ±1.87 ±1.59 ±8.05 21.94 16.0 9.22 51.72 40.72 33.94 45.00 37.05 28.88 97.33 ±3.63 ±3.87 ±1.98 ±4.54 ±2.84 ±2.89 ±2.34 ±3.25 ±1.29 ±4.02 F 0.13 3.85 2.98 0.23 0.84 1.85 1.35 0.08 0.70 0.58 p 0.876 0.033* 0.067 0.780 0.441 0.176 0.276 0.928 0.507 0.569 * Significant (p<0.05), d.f.=30. Palatal Depth Type of Arch interpremolacaninmolapremolacaninmolapremolacanine inter- circumference molar Normal 20.27± 1.35 15.16 ±3.84 8.12 ±1.36 53.19 ±4.70 44.45 ±4.04 36.42 ±2.76 46.32 ±3.71 36.45 ±3.49 28.8 ±2.00 97.09 ±5.37 19.66 12.60 5.78 51.04 41.16 33.87 45.83 35.91 26.58 95.66 ±3.26 ±2.25 ±1.52 ±3.60 ±3.77 ±3.30 ±3.43 ±2.74 ±1.96 ±8.16 21.28 16.03 8.35 49.25 39.46 32.10 46.0 35.0 27.64 94.8 ±1.79 ±3.95 ±2.27 ±3.34 ±2.76 ±2.73 ±2.66 ±2.57 ±3.21 ±6.13 F 1.64 2.86 6.73 3.07 5.98 6.26 0.06 0.77 2.08 0.34 p 0.209 0.072 0.004** 0.060 0.006** 0.005** 0.939 0.471 0.141 0.714 ** highly significant (p<0.01), d.f.=30. Table 4: Duncan s multiple range test for females with open bite, deep bite and normal. Type of canine premolar canine Normal A A A B B B A B B Different letters vertically mean significant difference at p<0.05. No significant differences were seen in the maxillary distances (intermolar, interpremolar and intercanine) between the three groups, Linder Anderson, 16 related the narrow maxillary arch and widened mandible seen in patients with open bite to the large tongue due to airway obstruction and breathing problems which usually accompany open bite. Since, the samples did not have any breathing problems this might explain our findings. In contrast to the results obtained by Hsu, 6 who reported that patients with open bite had a significant wider mandibular intermolar and interpremolar width
Palatal depth and arch parameter in class I open bite, deep bite and normal Abdulmawjood, Ahmed, Al-Saleem 29 than those of control group, no significant difference were seen between the three groups. This can give the impression that tongue position in the three groups is the same as long as no breathing problems is existed in any of the three groups, as the tongue position is lowered in habitual mouth breathers. The arch perimeter demonstrated a positive correlation varied from strong to highly strong with maxillary interpremolar width, mandibular interpremolar width and maxillary intermolar width in all the three groups, which means that with the increase of arch perimeter the maxillary interpremolar, mandibular interpremolar and maxillary intermolar widths will increase and vise versa. This can be explained by the fact that the transverse growth in the maxillary intermolar and interpremolar region will increase the arch circumference. With the increase in the mandibular interpremolar width, a compensatory increase in the apposing arch width will occur leading to increase in its perimeter. In deep bite and open bite groups a strong positive correlation was noticed between interpremolar palatal depth and intercanine palatal depth as the two variables are related to the maxilla, their growth will be simultaneous. A strong positive correlation was seen in the maxillary and mandibular interpremolar widths in both normal and open bite groups compensatory growth between the two apposing arches can give an explanation for this strong positive correlation and to a similar correlation noticed between the foowing: and mandibular intermolar widths: open bite and normal. interpremolar and mandibular intercanine widths in open bite and normal. intercanine and mandibular interpremolar widths in open bite and normal. and mandibular intermolar in normal and deep bite. A positive correlation varied from strong to highly strong was noticed between the foowing: intercanine width and maxillary interpremolar width in the three groups. interpremolar and mandibular intercanine width in open bite and normal. intermolar width with both maxillary interpremolar and maxillary intercanine widths in both normal and deep bite. As the above correlation variables related to the same structure either maxilla or mandible, their growth will be simultaneous. A poor correlation were noticed between palatal depth and arch widths in open bite, deep bite and normal which simulate the findings of Salman, 15 who reported a poor correlation between palatal depth and maxillary arch width in class I normal. Table 5: Descriptive (mean ±SD) and ANOVA for total sample (males and females) with open bite, deep bite and normal. Palatal Depth Type of Normal Molar 20.84 ±1.38 20.61 ±2.68 21.54 ±2.61 interpremolar 15.50 ±3.25 12.58 ±1.93 16.02 ±3.83 Intercanine 8.44 ±1.43 6.54 ±1.45 8.69 ±2.16 50.04 ±3.89 interpremolar 43.61 ±4.22 41.01 ±3.16 39.95 ±2.80 Intercanine 36.42 ±2.44 34.65 ±3.06 32.82 ±2.88 C Intermolar 52.86 ±4.03 51.21 ±3.90 Intermolar 46.63 ±3.83 46.60 ±3.43 45.60 ±2.54 interpremolar 36.51 ±2.94 36.38 ±2.30 35.80 ±2.97 Intercanine 28.47 ±1.75 27.55 ±1.96 28.13 ±2.66 Arch circumference 98.18 ±5.01 98.09 ±8.26 95.79 ±5.45 F 0.98 6.61 9.11 2.60 6.14 8.13 0.72 0.42 1.00 0.95 p 0.381 0.003** 0.000** 0.082 0.004** 0.001** 0.490 0.658 0.375 0.392 ** highly significant (p<0.01), d.f.=30. Table 6: Duncan s multiple range test for total sample (males and females) with open bite, deep bite and normal. Type of premolar canine remolar canine Normal A A A A B B B B A A B C Different letters vertically mean significant difference at p<0.05.
30 Iraqi Orthod J 1(2) 2005 Palatal Depth Table 7: Correlation coefficient for total sample with deep bite. Palatal Depth Table 8: Correlation coefficient for total sample with open bite. Palatal Depth Table 9: Correlation coefficient for total sample with normal. Palatal Depth Intercaninmolar molar premolar molar 1.00 premolar 0.51** 1.00 canine 0.16 0.53** 1.00 molar 0.38* -0.09-0.01 1.00 premolar 0.25 0.12 0.05 0.8** 1.00 canine 0.34 0.00 0.04 0.67** 0.70** 1.00 molar 0.52** 0.42* 0.15 0.43* 0.61** 0.50** 1.00 premolar 0.27 0.45* 0.16 0.26 0.49* 0.49* 0.67** 1.00 canine 0.37 0.25 0.22 0.29 0.55** 0.59** 0.72** 0.61** 1.00 Arch circumference 0.45* 0.18 0.19 0.60** 0.56** 0.68** 0.37 0.42* 0.64** * significant (p<0.05), ** hghly significant (p<0.01) Palatal Depth Intercaninmolar molar premolar molar 1.00 premolar 0.31 1.00 canine 0.19 0.55** 1.00 molar 0.30 0.21 0.67** 1.00 premolar -0.16 0.29 0.53** 0.32 1.00 canine 0.02 0.46* 0.44* 0.17 0.68** 1.00 molar 0.26 0.15 0.15-0.04 0.24 0.26 1.00 premolar 0.14 0.22 0.35 0.06 0.61** 0.73** 0.64** 1.00 canine 0.01 0.15 0.35 0.25 0.60** 0.61** 0.41* 0.73** 1.00 Arch circumference 0.41 0.32 0.57** 0.63** 0.51* 0.37 0.28 0.51* * significant (p<0.05), ** highly significant (p<0.01) Palatal Depth Intercaninmolar molar premolar molar 1.00 premolar 0.39 1.00 canine 0.31 0.34 1.00 molar -0.40 0.12 0.20 1.00 premolar -0.41-0.04 0.09 0.80** 1.00 canine -0.48* -0.10 0.17 0.83** 0.81** 1.00 molar -0.33 0.07 0.47* 0.87** 0.75** 0.79** 1.00 premolar -0.37-0.01 0.28 0.89** 0.79** 0.80** 0.85** 1.00 canine -0.32 0.35 0.31 0.83** 0.64** 0.65** 0.81** 0.73** 1.00 Arch circumference -0.19 0.01 0.36 0.67** 0.68** 0.86** 0.70** 0.71** * significant (p<0.05), ** highly significant (p<0.01)
Palatal depth and arch parameter in class I open bite, deep bite and normal Abdulmawjood, Ahmed, Al-Saleem 31 CONCLUSIONS - The palatal depth was the highest in open bite followed by normal and then in deep bite. - The intermaxillary widths were the highest in normal followed by deep bite and then open bite. - No significant differences were seen in the mandibular widths among the three groups. - Correlation coefficient among variables expressed considerable degrees of variation. REFERENCES 1. Baume LJ, Bailit HL. Variation in dental and arches among Melanesians of Bougainville Island, Papua New Guinea. Am J Phys Anthropol 1977; 47: 195-208. 2. Richmond S. Recording the dental cast in three dimensions. Am J Orthod Dentofac Orthop 1987; 92: 199-206. 3. Bergersen EO. A longitudinal study of anterior vertical overbite from eight to twenty years of age. Angle Orthod 1988; 3: 237-56. 4. Skieller V. Cephalometric analysis in the treatment of overbite. Trans Eur Orthod Sos 1967; 147-57. 5. Nielsen IL. Vertical mal: etiology, development, diagnosis and some aspects of treatment. Angle Orthod 1991; 4: 247-60. 6. Hsu BS. The nature of arch width differences and palatal depth of anterior open bite. Am J Orthod Dentofac Orthop 1998; 113: 344-50. 7. Hayashi K, Uechi J, Mizoguchi I. Three dimensional analysis of dental casts based on a newly defined palatal reference plane. Angle Orthod 2002; 37(5): 539-44. 8. Iwasaki LR, Haack JE, Nickel JC, Morton J. Human tooth movement in response to continuous stress of low magnitude. Am J Orthod Dentofac Orthop 2000; 117: 175-83. 9. Carter GA, McNamara JR. Longitudinal dental arch changes in adults. Am J Orthod Dentofac Orthop 1998; 114: 88-99. 10. Harris EF. A longitudinal study of arch size and form in untreated adults. Am J Orthod Dentofac Orthop 1997: 111: 419-27. 11. Nanda SK. Pattern of vertical growth in the face. Am J Orthod Dentofac Orthop 1988; 93: 103-16. 12. Sassouni V, Nanda S. Analysis of dentofacial vertical proportions. Am J Orthod 1964; 50: 801-23. 13. Johnson JG, Kuntz TR, Staley RN, Jakobsen JR. Comparison of palatal dimensions in adult normal and malooclusion. J Dent Res 1994: 73-83. 14. Adkin MD, Nanda RS, Currier GF. Arch perimeter changes on rapid palatal expansion. Am J Orthod Dentofac Orthop 1990; 97(3): 323-35. 15. Salman KA. The relationship between the maxillary dental arch width, depth and circumference. Al-Rafidain Dent J 2001; Sp Issue: 401-10. 16. Linder-Aronson S. Adenoids. Their effect on the mode of breathing and nasal airflow, and their relationship to characteristic of the facial skeleton and the dentition. Acta Otolaryngol 1970; 265: 130-2.