Hindawi Publishing Corporation

Scientica
Volume 2016, Article ID 3147972, 5 pages
http://dx.doi.org/10.1155/2016/3147972

Research Article
Skeletal and Dentoalveolar Cephalometric Features of Anterior
Open Bite among Yemeni Adults

Ammar Abdulkareem Daer1 and Amal Hussein Abuaffan2

1
Department of Orthodontics, Faculty of Dentistry, Sanaa University, Sanaa, Yemen
2
Department of Orthodontics, Pedodontics and Preventive Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan

Correspondence should be addressed to Amal Hussein Abuaffan; [email protected]

Received 2 December 2015; Revised 13 February 2016; Accepted 9 March 2016

Academic Editor: Timothy M. McCulloch

Copyright 2016 A. A. Daer and A. H. Abuaffan. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Objective. The aim of this study is to determine the cephalometric features for a sample of Yemeni adults with anterior open bite.
Material and Methods. Lateral cephalometric radiographs were taken for 65 Yemeni university students (46 males and 19 females),
1825 years old, with clinical anterior open bite (vertical overbite 0 mm) and no previous orthodontic treatment. The radiographs
were manually traced; twelve angular, five linear measurements, and facial index were assessed, analyzed statistically, and compared
to 194 Yemeni norms (89 males and 105 females) as well as cephalometric features of open bite subjects in previous studies. Results.
Statistically significant differences were observed in skeletal and dental cephalometric values of Yemeni patients with anterior open
bite when compared to Yemeni norms; mainly in the anteroposterior relation, the open bite individuals had higher significant
value in SNA, SNB, and SNPg angles. In addition, a higher statistical significant difference was recorded in all variables of vertical
relation when compared with norms. In contrast, NL-NSL angle revealed higher value among normal individuals. Dental variables
among open bite individuals showed a greater degree of dental proclination, higher statistically significant value in I-NA , I-NA
mm and I-NB mm, and a lower significant value in U1-L1 in open bite group. Conclusion. Open bite Yemeni individuals skeletal and
dentoalveolar variables significantly differ from Yemeni norms in the extent of the anteroposterior, vertical developmental pattern
and dental relations.

1. Introduction all teeth and molar) and iatrogenic (occur due to careless
orthodontic treatment as a result of using inappropriate rapid
Anterior open bite is a major occlusal disorder in the vertical palatal expansion) [4].
direction, which is often associated with defects in the Numerous studies in previous literature describe the
anteroposterior direction. It is one of the most difficult mal- skeletal and dental characteristics of the anterior open bite
occlusions which constitutes a real challenge to orthodontics and discuss the various etiological factors that had a role in
[1, 2]. It was defined by several authors as the absence of creating an open bite among different population [510].
coverage between the incisors (upper and lower) when the Cephalometric radiograph has been used for the diagno-
posterior teeth are in occlusal position [14]. sis of orthodontic problems in vertical and anteroposterior
According to McNamara and Burdon, open bite was clas- direction. Authors revealed different findings and measure-
sified into and skeletal. Dental open bite is localized to the ment for open bite cases by using different methods of
anterior teeth and the surrounding soft and hard tissues cephalometric analysis [11, 12].
without presenting any skeletal defect in cephalometric In 1952, in the cephalometric analysis proposed by Wylie
radiograph, whereas, skeletal open bite shows vertical dishar- and Johnson, the vertical proportions of the normal face were
mony in cephalometric radiograph [3]. Additional features to measured along the line nasion-menton. The anterior nasal
McNamaras classification had been added: pseudo open bite spine (ANS) served as the point of separation between the
(presence of incisor protrusion), infantile open bite (involves upper and the lower face height [11]. Later in 1964, Horowitz
2 Scientifica

and Thompson measured the face height, upper face height, Table 1: Reliability of measurements using reliability Students -test.
and lower face height along the nasion-gnathion line in a
group of untreated normal postadolescent males and females Variable EM value value Decision
[12]. SNA 0.360 1.00 0.33 Ns
Klocke et al. evaluated the craniofacial growth changes SNB 0.234 0.00 1.00 Ns
in a longitudinal study for two groups, 14 children (5 years ANB 0.396 1.36 0.19 Ns
old) in each, one group with anterior open bite and the other SNPg 0.308 1.44 0.16 Ns
control group. Cephalometric measurements were analyzed NSBa 0.349 0.57 0.57 Ns
at the ages of 5, 9, and 12 years [13]. ML-NL 0.065 0.00 1.00 Ns
Numerous studies concerning the cephalometric features NL-NSL 0.088 1.00 0.33 Ns
of anterior open bite have given a vast amount of information ML-NSL 0.134 1.00 0.33 Ns
in various parts of the world. Data about Yemeni open bite
Gn-tgo-Ar 0.126 1.00 0.33 Ns
patients regarding skeletal and dentoalveolar features are rare.
Therefore, the present study is designed to determine the N-Sp mm 0.275 1.00 0.33 Ns
skeletal and dental cephalometric features of anterior open Sp -Gn mm 0.053 0.00 1.00 Ns
bite among Yemeni adults in comparison to Yamani norms. Pg-NB mm 0.219 1.00 0.33 Ns
Nod. angle 0.190 0.57 0.57 Ns
I-I 0.233 0.57 0.57 Ns
2. Materials and Methods I-NA 0.243 0.57 0.57 Ns
First, the ethical approval was obtained from the research I-NB 0.427 1.00 0.33 Ns
committee of Sanaa University, Science and Technology I-NA mm 0.024 1.00 0.33 Ns
University, and Dar Al-Salam University, to conduct this I-NB mm 0.247 0.00 1.00 Ns
study. The aims of the study had been explained to all the
students in the lecture room. Initial visual screening was Table 2: The skeletal anteroposterior variables for Yemeni adults
carried out and the ones who had anterior open bite were with anterior open bite.
registered and later on called and asked for further clinical
examination at the dental clinic. Male, 46 Female, 19
Variables value
The total number of the students in the three faculties Mean Max. Min. SD Mean Max. Min. SD
was 1585; out of these, 65 students had anterior open bite (19 SNA 77.23 87 71 4.05 79.59 85 76 2.55 0.022
females and 46 males) and fulfill the inclusion criteria of the SNB 73.57 84.3 68 4.01 75.03 79.8 69.5 2.71 0.151
current study: Yemeni nationality with no previous history
ANB 3.68 7 2 2.27 4.56 10 1 2.18 0.155
of orthodontic or prosthodontic treatment, full permanent
dentition and the vertical overbite 0 mm when teeth are SNPg 73.8 85 67 4.35 75.91 81 71 2.68 0.021
in centric occlusion, and no craniofacial deformities. The SNBa 134.14 143 123 5.55 131.26 142 120 5.34 0.059

normal cephalometric radiograph for Yemeni population < 0.05 is significant.
had been studied and analyzed from one hundred ninety-
four students (89 males and 105 females) who had normal
occlusion and fulfill the inclusion criteria of the current study: standard deviation were calculated. Chi-square test was used.
Yemeni nationality with normal occlusion and balanced facial value of less than 0.05 was considered as significant.
profile, full permanent dentition (except for the third molars),
class I molar, incisor and canine relationship, normal overjet 2.2. Reliability of the Measurements. The intraexaminer reli-
and overbite, normal transversal occlusion, and well aligned ability test was carried out for error testing. Fifteen percent
or crowded teeth not more than 2 mm; and no previous of the cephalograms were randomly selected and retraced
history of orthodontic treatment was registered. in two-week interval by the same investigator; the first and
Cephalograms were taken from each student after the second measurements were compared using paired Students
consent form had been signed. Lead apron had been worn for -test.
protection and well trained operator takes the lateral, while
the student head was in natural position and the teeth were
closed in centric occlusion, the lips slightly closed and the 3. Results: Reliability and Gender Differences
right side of the subject face the x-ray source [14] .
3.1. Reliability of the Measurements. A strong correlation was
The cephalograms were traced and measured by the main
found between the first and second reading (Table 1).
investigator. Five linear and twelve angular measurements
A total of 65 Yemeni university students, 46 males and
were analyzed on each radiograph (Figure 1).
19 females, were clinically diagnosed with anterior open bite.
Cephalometric radiographs were traced and analyzed for the
2.1. Statistical Analysis. Data were collected, summarized, skeletal and dental features of the anterior open bite.
cleaned, and coded. All statistical analyses were performed Table 2 showed the sagittal relationship; statistically
with the Statistical Package for Social Sciences (SPSS) pro- significant differences were noted in SNA and SNPg angles,
gram (version 20). For each variable, the arithmetic mean and whereas, SNB, ANB and SNBa angles showed no significant
Scientifica 3

Table 3: The skeletal vertical variables for Yemeni adults with anterior open bite.

Male, 46 Female, 19
Variables value
Mean Max. Min. SD Mean Max. Min. SD
ML-NL 37.53 50 23.5 8.02 32.69 43.5 23 5.31 0.006
NL-NSL 7.8 12 2 3.19 9.26 16 4 2.86 0.089
ML-NSL 45.2 56 31 6.96 41.45 54 32.5 5.91 0.044
Gn-tgo-Ar 128.11 144 116 8.09 126.54 141 116.5 6.6 0.458
N-Sp mm 70.86 77 53 5.04 61.02 71.3 52 6.5 0.000
Sp -Gn mm 99.04 119 78.8 10.93 85.11 98.28 64.57 12.25 0.000
N-Sp/Sp-Gn 0.7200 0.82 0.62 0.0567 0.7242 0.83 0.56 0.0728 0.804

< 0.05 is significant.

Table 4: Distribution of dental variables among Yemeni adults with anterior open bite.

Male, 46 Female, 19
Variables value
Mean Max. Min. SD Mean Max. Min. SD
1-1 120.74 133.5 110 5.38 121.13 137.5 105.5 8.94 0.862
I-NA 27.4 35 17.5 4.72 23.79 35 15 5.58 0.011
I-NB 28.01 35 21 4.5 29.66 43 20 6.02 0.230
I-NA mm 7.21 11.5 3.5 2.08 5.48 12.76 174 2.99 0.010
I-NB mm 9.15 13.36 5.68 2.19 8.48 16.95 4.16 3.8 0.477

< 0.05 is significant.

Table 5: The skeletal anteroposterior variables for normal and open

bite Yemeni adults.
Open bite ( 65) Norm bite ( 194)
N Variables value
S Mean Std. Mean Std.
SNA 77.9 3.81 80.86 2.54 0.000
SNB 73.99 3.72 77.89 2.52 0.000
ANB 3.94 2.26 2.97 1.35 0.002
ar
SNPg 74.4 4.03 78.67 2.6 0.000
Sp
Pm NSBa 133.3 5.61 131.71 6.05 0.063
Ba isa A

< 0.05 is significant.

ii is
tgo
whereas no significant differences between genders were
iia observed in the other dental measurement values (Table 4).
B
Pg
4. Results: Open Bite Relative to Normal
Gn Occlusion (Yemeni)
Figure 1: Cephalometric lines and angles.
4.1. Skeletal Relationships
4.1.1. Anteroposterior. In the current study, all the skeletal
difference between genders. Moreover, all angles measure- variables showed significant differences between open bite
ments showed greater value in females than males except for and norms except for NSBa (Table 5) [15]. For SNA and
SNBa angle. SNB, the open bite group had lower value than the norms.
According to Table 3, the vertical inclination and ML- Concerning SNBa angle, the Yemeni open bite had a higher
NL and ML-NSL angles together with the upper and lower value than that of norms.
facial height measurement showed statistically significant
differences between genders. In contrast, the facial index 4.1.2. Vertical Inclination. In the present study, ML-NL angle
showed no significant difference. showed higher value in open bite than Yemeni norms and
In the dental measurements, only the upper incisor to NA the opposite was seen with NL-NSL angle which is higher
(angle and line) showed statistically significant differences, in norms (Table 6) [15], whereas ML-NSL angle was less in
4 Scientifica

Table 6: The skeletal vertical variables for open bite and norm measurement of I-NB is found to be higher in open bite
Yemeni adults. Yemenis than in norms.
Open bite ( 65) Norm bite ( 194)
Variables value
Mean Std. Mean Std. 5. Conclusion
ML-NL 36.1 7.62 21.36 5.43 0.000
(i) This was a cross-sectional study aimed at evaluating
NL-NSL 8.22 3.15 9.87 3.75 0.002
the skeletal and dental cephalometric features of 65
ML-NSL 44.1 6.84 31.23 5.53 0.000 Yemeni university students (19 female and 46 male)
Gn-tgo- aged 1825 years with anterior open bite. Statistically
127.65 7.67 119.3 7.3 0.000
Ar significant differences were found in skeletal and

< 0.05 is significant. dental relationships.

(ii) From the results obtained among different popula-
Table 7: The facial height variable for open bite and norm Yemeni
tion and Yamani results, it can be concluded that
adults.
the Yemeni open bite adults had different skeletal
Open bite ( 65) Norm bite ( 194)
value
and dentoalveolar cephalometric measurement when
Variables
Mean Std. Mean Std. compared to other populations. These differences can
N-Sp mm 67.98 7.08 60.03 6.48 0.000 be attributed partially to ethnic background, sample
size and the genetic factors.
Sp -Gn 0.000
94.97 12.92 73.29 8.82
mm (iii) The current study proved the results of previous
N-Sp /SP - studies among different population that skeletal and
Gn 0.72 0.06 0.82 0.07 0.000 dental features had significant roles in the etiology of
100 anterior open bite.

< 0.05 is significant.

Competing Interests
Table 8: Distribution of the dental variable for open bite and norm
Yemeni adults. The authors declare that they have no competing interests.
Open bite ( 65) Norm bite ( 194)
Variables value
Mean Std. Mean Std. References

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Scientifica 5

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