dr. ramesh g.c.-dissertation

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Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

CEPHALOMETRIC EVALUATION OF OVERBITE AND VERTICAL CHANGES FOLLOWING FIRST PREMOLAR EXTRACTION IN HIGH ANGLE CASES A RETROSPECTIVE STUDY By

Dr. RAMESH G.C. Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

In Partial fulfillment

of the requirements for the degree of

MASTER OF DENTAL SURGERY

In Speciality of

ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS

Under the Guidance of

Dr. ARUNKUMAR G.Associate Professor Department of Orthodontics and Dentofacial Orthopedics

College of Dental Sciences,

Davangere.

2006- 2009

ACKNOWLEDGEMENT

This Dissertation represents the assistance and efforts of many individuals, the contributions of whom I acknowledge and to whom I give my thanks.

I bow my head to the supreme force THE ALMIGHTY, driving me to my destinations, I thank them for having blessed me with his choicest blessings and opening the doors of opportunity to this adobe of knowledge and having blessed me with most loving family and teachers.

Words are inadequate to express my indebtedness and infinite respect for my Guru and Guide, DR ARUN KUMAR G. Associate Professor, Department of Orthodontics, College of Dental Sciences, Davangere. His unfailing willingness to render help and loving guidance, coupled with his rich knowledge and keen interest have been a constant source of inspiration and backbone of this study. Lucky are the few who are privileged to work under him and imbibe priceless insights into life. I find myself deeply indebted to him for teaching me the true values of life, imbibing in me his virtues of hard work, truthfulness and love towards fellow human beings.

It is with utmost sincerity that I thank my beloved Professor and Head, Dr.G Shivaprakash. A mere word of thanks is not sufficient to express his solid support, inspiration and unswerving guidance, during my post graduation and in the preparation of this dissertation. As his post graduate student, I have not only inculcated knowledge in the art and science of orthodontics but also other human qualities of life. His discipline, principles, scientific approach and logical explanation to this art of orthodontics shall always be my guiding star.

It is with utmost sincerity that I thank my beloved former Professor and Head, Dr.Anmol S.Kalha. A mere word of thanks is not sufficient to express his solid support, inspiration and unswerving guidance, during my post graduation and in the preparation of this dissertation. To be his post graduate student definitely gives me immense pleasure and honour.

The unflinching support and guidance I received from all the faculty members during my post-graduate course leaves me with an overwhelming sense of profound humbleness.

Let me at this juncture, pen down my deepest appreciation towards my teachers, Dr.(Mrs) Mala Ram Manohar, Professor, Dr. Naveen Shamnur, Associate Professor, Dr.Prabhuraj, Associate Professor, Dr.Umashankar, Reader, Dr. Shashi Kumar, Asst. Professor, Dr. Anvar Latif, Asst. Professor, College of Dental Sciences, Davangere for being my wheel of support and encouragement over the last three years. It is with sincerest gratitude that I thank Dr. Litesh Singla & Dr. Thomas, Assistant Professors, for giving valuable insights during the study and during my post graduation course.

At this juncture my deepest gratitude goes to Sri. Shamanur Shivashankarappa (Hon. Secretary), and Dr.V.V. Subba Reddy (Principal), for providing me the kind of atmosphere, fully equipped with the near latest technologies.

This acknowledgement would be incomplete if I fail to mention my Father Sri. CHANNAVEERAPPA, Mother Smt. GIRIJA, Brother in-laws, DR A.R HANUMANTHAPPA and A.G NATRAJ GOWDA, and Sisters Smt. SUDHA and Smt. REKHA and my Family Members. It is their love, prayers, many sacrifices and encouragement both morally and emotionally made it possible to me what I am today. It would be unfair on my part if I do not mention my batch mates, Dr.Aravind, Dr. Naveen, Dr. Murtuza, Dr. Ankush and Dr. Divya, without them this dissertation would have not been successful.

I would like to thank all my friends and especially juniors for their whole hearted support in completion of my post graduate course.

With out the help of Mr. Sangam, our esteemed biostatistician, my work would have gone unappreciated.

I also thank Mr.Surendra, Dyna Computers for organizing and neatly typing this manuscript and Aruna Printers, for their services rendered.

A special word of thanks to the non teaching staff, especially sister Jesline, Jagdish, Santosh and Neelappa, Geetha and Manjula for the help rendered whenever required from them.

Place: Davangere.

Date: Dr. RAMESH G.CLIST OF ABBREVIATIONS USED

ANSAnterior nasal spine

BL1Bodily movement of the mandibular incisors

FHFrankfort horizontal

GnGnathion

GoGonion

HSHighly significant

I PMfirst premolar

II PMSecond premolar

L1Mandibular Central Incisor

L6Mandibular first molar

LAFHLower anterior face height

MNSKMandibular skeletal change

MPAMandibular plane angle

MXSKMaxillary skeletal change

NNasion

NSNot significant

OPOcclusal plane

PEAPre adjusted edgewise appliance

PFHPosterior face height

PogvPogonion vertical

SSella

SSignificant

SvSella vertical

TAFHTotal anterior face height

TL1Tipping movement of the mandibular incisors

TU1Tipping movement of the maxillary incisors

U1Maxillary Central Incisor

U6Maxillary first molar

UAFHUpper anterior face height

ABSTRACT

Back ground & objectives : Orthodontists generally agree that non-extraction treatment is associated with downward and backward rotation of the mandible and an increase in the LAFH. They also agree that extraction line of treatment is associated with upward and forward rotation of the mandible and decrease in the LAFH. The intent of this cephalometric investigation was to examine the popular hypothesis, (wedge hypothesis) that the vertical dimension collapses after first bicuspid extraction. The present study was undertaken to evaluate the cephalometric overbite and vertical changes following first premolar extraction in high angle cases.

Methods : A total of 25 adult patients having high mandibular plane angle i.e. Gogn SN more than or equal to 32 degrees having class I molar and canine relation were included. Pre and post treatment lateral cephalograms were measured and compared to analyze the cephalometric changes.

Results : There was a significant increase in the MPA. There was no significant change in the pre and post treatment overbite, total anterior face height, lower anterior face height and posterior face height.

Interpretation & Conclusion : The study concluded that, There was no increase in the vertical facial dimension and overbite and no clinically significant increase in the mandibular plane angle. However it should be interpreted with caution, given the small sample size. The facial complex does increase in size with growth, but mandibular plane while moving inferiorly, remain essentially parallel to its pretreatment position, due to residual growth and treatment.

Key words: I premolar extraction; High angle; Wedge hypothesis; Lateral cephalograms; Adult.TABLE OF CONTENTS

PAGE NO.

1. INTRODUCTION

012. OBJECTIVES

033. REVIEW OF LITERATURE

044. METHODOLOGY

245. RESULTS

386. DISCUSSION

447. CONCLUSION

508. SUMMARY

519. BIBLIOGRAPHY

5210. ANNEXURES

58LIST OF TABLES

SL.NO.TITLEPAGE NO.

Table 1DEFINITION OF CEPHALOMETRIC LANDMARKS AND MEASUREMENTS USED IN THE STUDY25

Table 2PRE AND POST TREATMENT COMPARISON OF ANGULAR MEASUREMENTS 39

Table 3PRE AND POST TREATMENT COMPARISON OF LINEAR MEASUREMENTS40

Table 4PRE AND POST TREATMENT COMPARISON OF OVERBITE MEASUREMENTS41

LIST OF FIGURESSL.NO.TITLEPAGE NO.

Fig. 1ARMAMENTARIUM USED FOR TRACING RADIOGRAPHS26

Fig. 2OVERBITE MEASUREMENTS USED IN THE STUDY28

Fig. 3

ANGULAR MEASUREMENTS USED IN THE STUDY29

Fig. 4LINEAR MEASUREMENT USED IN THE STUDY30

Fig. 5LAND MARKS USED TO EVALUATE MOLAR CHANGES31

Fig. 6PRE TREATMENT EXTRA ORAL PHOTOGRAPHS33

Fig. 7PRE TREATMENT INTRA ORAL PHOTOGRAPHS33

Fig. 8PRE TREATMENT LATERAL CEPHALOGRAM34

Fig. 9MID TREATMENT INTRA ORAL PHOTOGRAPHS35

Fig. 10POST TREATMENT EXTRA ORAL PHOTOGRAPHS36

Fig. 11POST TREATMENT INTRA ORAL PHOTOGRAPHS36

Fig. 12POST TREATMENT LATERAL CEPHALOGRAM37

LIST OF GRAPHS

SL.NO.TITLEPAGE NO.

Graph Ipre post significant angular measurements 42

Graph IIpre post insignificant angular measurements42

Graph III

pre post insignificant linear measurements42

Graph IVPRE POST ANTERIOR TOOTH MOVEMENTS43

Graph VPRE POST MOLAR MOVEMENTS43

ANNEXURES

SL.NO.TITLEPAGE NO.

Master Chart 1PRE POST ANGULAR CEPHALOMETRIC MEASUREMENTS57

Master Chart 2PRE POST LINEAR CEPHALOMETRIC MEASUREMENTS58

Master Chart 3PRE POST OVERBITE CEPHALOMETRIC MEASUREMENTS