RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS /

DR. CHRISTY

POST-GRADUATE STUDENT
Department OF ORTHODONTICS & dENTOfACIAL oRTHOPEDICS
AME’S DENTAL COLLEGE & HOSPITAL
BEJENGERE ROAD,
RAICHUR – 584 103
2. / NAME OF THE INSTITUTION / AME’S DENTAL COLLEGE, HOSPITAL BEJENGERE ROAD,RAICHUR – 584 103
3. / COURSE OF STUDY AND SUBJECT / MASTER OF DENTAL SURGERY (MDS)
IN ORTHODONTICS & dENTOfACIAL oRTHOPEDICS
4. / DATE OF ADMISSION TO COURSE / 28th April 2008.
5. /

TITLE OF THE TOPIC

/ ESTABLISHING AND COMPARING CEPHALOMETRIC NORMS UTILIZING THE COGS (CEPHALOMETICS FOR ORTHOGNATHIC SURGERY) ANALYSIS IN RAICHUR ADULTS
6. / Brief resume of the intended work
6.1 Need for the study
God created man to perfection, close to ‘His’ own image. Ever since than attempts, are being made to change facial appearance more towards this perfection. The question of what is a normal face, as that for what constitutes beauty, will probably never be answered in a free society. Orthodontists, in their attempts to change facio-oro-dental deviation to accepted norms, have adopted various cephalometric measurements define to more objectively the direction of treatment. Soft tissue norms, in the form of facial lines and angles were established in some traditional analyses, but they were limited in their number and description but more emphasis was placed on the skeletal and dental structures within the head films.
Orthodontics generally deals with those Cephalometric analyses that deal with the planning of tooth movement. But surgery deals with skeletal changes in the basal bone and the corresponding changes in the soft tissues. The successful treatment of the orthognathic surgical patient is dependent on careful diagnosis. Cephalometric analysis can be an aid in the diagnosis of skeletal and dental problems and a tool for simulating surgery and orthodontics by the use of acetate over-lays. Cephalometric analysis also allows the clinician to evaluate changes after surgery.
As more information was gathered, it became apparent that Caucasian norms were inadequate for application to different racial or ethnic groups. Various ethnic groups have been subjected to Cephalometric studies and norms derived for orthodontic treatment.8
The diverse nature of the Kannadiga population in the north and south of Karnataka, and the fact that Raichur district, with varied rulers and probable migrants and settlers as evidenced from its history, the people of Raichur, though Dravidians by descent is postulated to be different from the rest of the state. No study has been available to the best of our knowledge wherein cephalometric norms have been derived for the Raichur population with respect to Burstone’s cephalometric for orthognathic surgery(COGS); Hence, the need of the study is being felt and the establishment of specific norms for our localized population as compared to original norms (as given by COGS; Burstone)
6.2 Review of literature
A comparison of a sample of 50 black and 50 white adults with both groups having Angle’s Class I occlusion was carried out. They found greater maxillary and mandibular skeletal prognathism, anterior dental height, lower incisor proclination, upper lip length and throat length in blacks than in whites. Nasolabial angle and lip-chin-throat angle were less in blacks than in whites. Male and female norms were presented. 1
In another study, normal values for the Cephalometric for Orthognathic surgery analysis for American black adults were developed. The Cephalometric radiographs of 33 black American adults with ideal dentition were analyzed and a statistical description of their hard and soft tissue cephalometric measurements is presented. In addition, mean values for black American adults were compared to those of white American adults. In black subjects, there was a greater maxillary skeletal prognathism, skeletal lower facial height, skeletal facial convexity, lower incisor proclination, anterior dental heights, upper and lower lip length and soft tissue thickness of lips and chin than in whites’ subjects.2
A similar study in which lateral cephalometric standards of normal Japanese adults, using the Burstone and Legan comprehensive cephalometric analyses, that is specific for orthognathic surgery was developed. Cephalometric radiographs of 217 Japanese adults were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of white American adults. They found out that statistically significant differences were found in the Japanese sample, which had a shorter maxilla, larger upper anterior face height, and lower posterior dental height than Burstone's white sample. A less prominent chin was observed in the Japanese male group. Soft tissue analysis of the Japanese subjects showed a retrognathic maxilla and mandible in relation to the soft tissue glabella and bilabial protrusion when compared with the white adult standards.3
A study to evaluate the cephalometric features of a Saudi population and to establish cephalometric norms for Saudis living in the western region of Saudi Arabia was conducted. 70 lateral cephalometric radiographs of Saudis (32 females and 38 males) were taken. The study concluded that Saudis have an increased ANB angle because of retrognathic mandibles and bimaxillary protrusions and males were having more prognathic mandible than females.4
A study was conducted to determine whether Kuwaiti adolescents differed from Caucasians adolescents with respect to their cephalometric values, sex differences between the two groups; and had developed cephalometric standards for the Kuwaiti population. They took standardized cephalometric films of 36 females and 32 males. And their result showed that there were significant differences between the Kuwaiti and the Caucasian population. No significant differences were seen between males and females. The Kuwaiti population had fuller lips, more facial convexity, greater dental protrusion, a more retruded and smaller mandible, and shorter posterior face height than the Caucasian populations.5
6.3  Objectives of the study
The objectives of the study are:
1.  To establish cephalometric norms for skeletal and dental relationships utilizing the COGS amongst the Raichur adults and
2.  To compare these norms with those of COGS (Burstone et al -1978).
The objectives of this study are not to set targets but guidelines, in the treatment of patients, as within a given ethnic group, there can be various combinations of dentoskeletal and soft tissue patterns to produce an esthetically pleasing and well balanced face.
Material and methods
7.1  Source of data
A cross sectional study will be conducted in subjects aged 18-25 Years (mean age 21.3 years) of Raichur population.
Method of data collection:
Subject selection criteria:
INCLUSION CRITERIA
1.  Raichur Origin: the Raichur origin of the patient will be asscetrained by following family lineage up to 3 generations.
2.  Have a pleasing Profile: Individuals with good balance and harmony of dentofacial structures with no history of orthodontic treatment will be included.
3.  Having : a class I molar and canine relationship with a full complement of permanent teeth in proper intercuspation. (With possible exception of 3rd molars), acceptable overjet and overbite. Mild-spacing / crowding (not more than 3mm) and negligible rotations.
EXCLUSION CRITERIA
1.  Subjects who had already undergone orthodontic treatment will be excluded from this study.
2.  Subjects with any congenital abnormality will be excluded.
SAMPLE SIZE AND DESIGN
100 subjects from different part of Raichur in the age group 18-25 Years (Mean age 21.3 Years) will be selected at randam for the study. Individuals, younger than 18 years will not be chosen due to possible growth changes. (Out of 100 subjects taken, 50 Will be Males & 50 Females).
METHDOLOGY
Lateral cephalograms of each individual will be taken at the department of oral medicine and radiology, AME Dental College Raichur. Radiographs will be taken in a standardized manner using the Trophy cephalometer cum orthopantomorphographic machine. The head of the patient will be guided in the cephalostat and the natural head posture is obtained by making the patient look into a mirror, which is kept at eye level. The position will be stabilized with the help of ear rods. The distance from the tube to the patient will be standardized at 5 feet.
All the required hard and soft tissue landmarks will be marked and various angles will be measured in accordance to the COGS analysis.
Out of the total 100 cephalograms, 20 will be picked at random and retraced and the same analysis will be redone after a period of 21 days. A paired ‘t’ test will be carried out to determine the tracing error.
The difference between Raichur norms and the Caucasian norms will be calculated using the ‘P’ test and the ‘t’ test.
7.2  Does the study require any investigation or interventions to be conducted on patients or other humans or animals , if so please describe?
No specific investigation are required
7.3 Has ethical clearance been obtained from your institution in case of 7.4 ?
-Not applicable-
8. /

List of references

1.  Connor Andrew M, Farhad Moshiri. Orthognathic Surgery norms for American black patients.Am J Orthod Dentofac Orthop 1985; 87(2): 119-134.
2.  Flynn et al. Cephalometric Norms for Orthognathic Surgery in Black American Adults. J Oral Maxillofac Surg 1989; 47: 30-36.
3.  Alcade RE et al. Cephalometric norms in Japanese adults. J Oral Maxillofac Surg 1998; 56(2):129-34.
4.  Hassan, Ali H. Cephalometric Norms for Saudi Adults living in the western region of Saudi Arabia. The Angle Orthod 2006; 76(1): 109–113.
5.  Behbehani, Faraj, Hicks, E. Preston, Beeman, Cynthia, Kluemper, g. Thomas, Rayens, Mary k. Racial variations in Cephalometric analysis between whites and Kuwaitis. The Angle Orthod 2006; 76 (3):406–411.
9. / SIGNATURE OF CANDIDATE
10. / REMARKS OF THE GUIDE
11. / NAME & DESIGNATION OF
( IN BLOCK LETTERS )
11.1  GUIDE /

DR. NAVEEN REDDY ADMALA

professor AND HOD

DEPT OF ORTHODONTICS & DENTOFACIAL ORTHOPAEDICS
AME’S DENTAL COLLEGE AND HOSPITAL,
BEJENGERE ROAD,RAICHUR – 584 103
11.2  SIGNATURE
11.3  CO-GUIDE ( IF ANY)
11.4  SIGNATURE
11.5  HEAD OF DEPARTMENT /

DR. NAVEEN REDDY ADMALA

professor AND HOD

DEPT OF ORTHODONTICS & DENTOFACIAL ORTHOPAEDICS
AME’S DENTAL COLLEGE AND HOSPITAL
BEJENGERE ROAD,RAICHUR – 584 103
11.6 SIGNATURE
12 / 12.1. REMARKS OF THE CHAIRMAN & PRINCIPAL
12.2. SIGNATURE