|Year : 2017 | Volume
| Issue : 1 | Page : 16-21
Correlation between morphological facial index and canine relationship in adults − An anthropometric study
Himanshu Trivedi, Aftab Azam, Ragni Tandon, Pratik Chandra, Rohit Kulshrestha, Ankit Gupta
Department of Orthodontics and Dentofacial Orthopedics, Saraswati Dental College, Lucknow, Uttar Pradesh, India
|Date of Web Publication||14-Jun-2017|
Post Graduate Student, Saraswati Dental College, Room No. 3, PG Boys Hostel, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to correlate the morphological facial index and canine relationship in adults. Materials and Methods: The research was conducted on 1000 randomly selected subjects of Indo-Aryan North Indian population (563 males and 437 females), aged 18–40 years. The parameters were morphological facial height and morphological facial width. The standard, spreading caliper with its scale was used for the measurement of facial parameters. Canine relationship was observed intra-orally with the subjects seated on the dental chair. Results: Euryprosopic facial type (53.2%) was most common in majority of the subjects followed by mesoprosopic (21.6%), hypereuryprosopic (19%), and leptoprosopic (5.6%), and the least common was hyperleptoprosopic (0.6%). The canine relation was mostly class I in both the genders, but females showed a higher value of class II and class III canine relations. Conclusion: The overall majority owned the euryprosopic facial type, and there was no significant association between facial morphologic types and canine relationship in both the genders in different age groups at either side. The canine relationship association with facial morphologic type was significant only for the left side.
Keywords: Canine relationship, facial height, facial width, morphological facial index
|How to cite this article:|
Trivedi H, Azam A, Tandon R, Chandra P, Kulshrestha R, Gupta A. Correlation between morphological facial index and canine relationship in adults − An anthropometric study. J Orofac Sci 2017;9:16-21
|How to cite this URL:|
Trivedi H, Azam A, Tandon R, Chandra P, Kulshrestha R, Gupta A. Correlation between morphological facial index and canine relationship in adults − An anthropometric study. J Orofac Sci [serial online] 2017 [cited 2017 Nov 21];9:16-21. Available from: http://www.jofs.in/text.asp?2017/9/1/16/207939
| Introduction|| |
In forensic applications, persons identity is one such field where facial measurements play a very important role, particularly in different techniques of facial reconstruction, where the measurements help the forensic team to make the final face irrespective of the methods used. Anthropometric measurements, especially facial measurements, are important in determining the various face shapes. The prosopic index (PI) classifies individuals into hypereuryprosopic (very broad face), euryprosopic (broad face), mesoprosopic (round face), leptoprosopic (long face), and hyperleptoprosopic (very long face) shapes based upon the ratio of the length of the face to the facial width (FW). Variations in facial types are encountered in every population. Studies indicate ethnic variations in the face type among individuals.
Because malocclusion affects a large number of the populations, it is by definition a public health problem. Malocclusion is endemic and wide spread throughout the world; however, it is found widely in different communities, and knowledge of the nature of malocclusion is an essential step in planning orthodontic services on community.
Angle’s classification system was introduced by Edward Angle, an American orthodontist, in 1899. This classification is still in use after almost more than a century since its introduction considering its simplicity in application. The prevalence of canine asymmetries is also very limited; such information may be more relevant in determining the morphological facial index, because the aim of everyday clinical practice is to achieve a perfect class I canine relationship, with the accompanying molar relationship being a consequence of the extraction alternative. It is widely accepted that maxillary and mandibular canines constitute an integral part of facial and dental esthetics, important for canine guidance, and important for occlusal stability. This study aims in correlating the morphological facial index and Angle’s canine relationship in adults.
| Materials and Methods|| |
Ethical approval for this study was taken from the Institutional Human Ethics Committee of Saraswati Dental College and Hospital Lucknow (SDC/IHEC/2013/MDS-P/18) on 28th November 2013. The study was conducted on 1000 subjects Indo-Aryan North Indian population (563 males and 437 females), aged 18–40 years, who were selected randomly. The subjects were asked to sit on a dental chair in a relaxed manner yet with upright position. Measurements were recorded under natural light. All measurements were repeated three times, and the mean value of the measurements was taken for further analysis. The measurements were connived with a permissible error of 1 mm. A standard, spreading caliper with scale was used for the measurement of facial parameters. Landmark points used in measuring the parameters were listed as follows [Figure 1]:
- N = nasion: the midpoint of the nasofrontal suture.
- gn = gnathion: in the midline, the lowest point on the lower border of the chin.
- Zy = zygion: zygomatic prominences, the most lateral point on the zygomatic arch.
Morphological facial height (FH) is the distance between nasion and gnathion. It was measured by spreading caliper with scale as follows [Figure 2]:
- The fixed tip of the spreading caliper was placed at the subject’s gnathion, and the movable part was moved and placed on the nasion. The morphological maximum FW is the distance between the two bilateral zygomatic prominences (zygion to zygion). By using a spreading caliper with its scale, FW was also measured in the following way [Figure 3].
- After palpation by fingers, the respective, most lateral points of the zygomatic arch (arcus zygomaticus) on both sides of the face were located, as well as the ends of spreading caliper were placed at these points, with enough pressure to feel the bone under the caliper. The caliper was slightly moved up and down as well as back and forth, until the maximum value was shown.
Facial index (FI) is the ratio of morphological FH and maximum FW and can be calculated according to the formula:
The values of FI were used to determine the incidence of certain facial types according to Martin–Saller’s scale. On the basis of the FI, the facial phenotype was classified as follows:
The patients were placed in their respective categories based on their index values. The subject’s canine and molar relation were recorded with the help of mouth mirror using the Angle’s classification of malocclusion. Assessment of the antero-posterior relationship of canine was based on modified Angle’s classification, which included three basic classes:
- Class I: The tip of the maxillary canine lies in the embrasure between the mandibular canine and the first premolar.
- Class II: The tip of the maxillary canine lies mesial to the embrasure between the mandibular canine and first premolar.
- Class III: The tip of the maxillary canine lies distal to the embrasure between the mandibular canine and first premolar.
The statistical analysis was performed using the Statistical Package for Social Sciences (version 15) software (SPSS Inc., Released 2008, Chicago, IL, USA). The data were subjected to descriptive analysis for mean, standard deviation, and median. A Student t-test was applied to test the significance of two means.
| Results|| |
Overall, majority of the subjects owned euryproscopic type (53.2%) followed by those having mesoprosopic type (21.6%), hypereuryprosopic type (19%), leptoprosopic (5.6%), and hyperleptoprosopic type (0.6%) shapes [Table 1]. However, in males, though majority were euryprosopic (58.4%); however, at next sequence hypereuryprosopic and mesoprosopic types had equal distribution (18.8% each) followed by leptoprosopic (3.6%) and hyperleptoprosopic types (0.4%), respectively. Among females, maximum were euryprosopic, they comprised 46.5% of total females followed by mesoprosopic (25.2%) and hypereuryprosopic (19.2%) types. Leptoprosopic and hyperleptoprosopic type shapes comprised the 8.2 and 0.9% of total females enrolled in the study. Statistically, there was a significant difference between two genders with respect to facial morphological type (P < 0.001).
|Table 1: Distribution of cases according to facial morphological classification and its association with gender|
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With reference to canine relationship for both right and left sides, class I was most common. However, for the prevalence on both the sides of class II and class III was significantly higher in females as compared to males (P < 0.05) [Table 2]. Irrespective of facial morphologic type, class I canine relationship was most common. Although, the prevalence of class I canine relationship was maximum for hyperleptoprosopic type as compared to other facial morphologic types, yet this association was not significant statistically for canine relationship of either side (P > 0.05) [Table 3].
|Table 3: Association between facial morphologic types and canine relationship|
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| Discussion|| |
Humans are constantly striving to improve their fate. Using facial, craniofacial, and maxillofacial surgical techniques, our main aim is to obtain esthetically superior results for our patients. To judge the appeal of a face, it is compared with norms that are today defined by canons or anthropometric proportions. The availability of values for facial sizes and proportions enables us to reproduce cosmetically attractive proportions for our patients. Craniofacial anthropometry is used for the determination of the morphological characteristics of the head and face. Face shape is dependent on many factors, such as gender, race and ethnicity, climate, socioeconomic, nutritional, and genetic factors. The facial parameters are used to determine the facial trauma, congenital and traumatic deformities, and easier identification of many congenital malformations. The collected data can be used in anthropology and forensic medicine for the identification of racial and sexual differences as well as in reconstructive surgery for facial reconstruction.
Diversity and individuality of people are seen owing to variations in the physical shape of their faces. Studies on craniofacial relations and variations in human beings will assist in understanding the frequency and distribution of human morphologies. Craniofacial anthropometry has become an important tool for genetic counselors to identify any dysmorphic syndromes. Measurements taken from a patient can be compared with the normal values obtained from a reference population, and these deviations from the normal values can be evaluated. Cephalic and PIs are important parameters that are used in anthropological studies for showing the variation between both the genders as well as among the ethnic groups.
In this study, the maximum FH observed was 133 and 129 mm in males and females, respectively. On comparing the data statistically, the difference was found to be significant. Similar result was obtained from the study conducted by Jeremić et al. in Central Serbian population, where they observed FH to be 121.4 mm in males and 110.8 mm in females. The present study shows that males have higher FH than females.
The maximum FW in males was 137 mm, and in females, it was 135 mm. The minimum FW observed in males was 103 mm, and in females, it was 100 mm. On comparing the data statistically, the difference was found to be significant (P < 0.001). These findings were in accordance to the results obtained by the study conducted by Young et al., where the maximum FW was 139.9 mm in bruxers and 131.9 mm in non-bruxers. Jeremić et al. measured FWs of 129.1 mm in males and 119.9 mm in females showing that males have a higher FW than that in females.
Overall, facial index values ranged from 70.4 to 121% with a mean value of 89.94 ± 4.54%. In males, the values ranged from 76.6 to 114.6% with a mean value of 90.16 ± 3.97%, whereas in females, the values ranged from 70.4 to 121% with a mean value of 89.65 ± 5.16%. On comparing the data statistically, the difference was found to be significant (P < 0.001).
These findings were similar to the results obtained by the study of Shetti et al., who observed mean facial index of 87.19% in males and marginally higher value of 86.71% in females indicating mesoprosopic facial form. Similar findings were found in a study conducted by Kurnia et al., with the facial index of 89.5% in males and 86.6% in females. In another study, it was observed that the facial index was 85.4% in females and 85.5% in males, which is dissimilar to the observation of our study. The probable reason could be that their study was on a different race (Malaysian Indian).
Overall, as well as for both the genders, majority of the subjects were 18–25 years old. However, proportion of females in the age group of 18–25 years (83.1%) was higher as compared to corresponding proportion of males (68.4%). A relatively higher proportion of males was aged between 26–30 and 31–40 years (20.8 and 10.8%, respectively) as compared to females (11.7 and 5.3%, respectively). Statistically, there was a significant difference between two genders with respect to distribution in different age groups (P < 0.001). This is in accordance with the study conducted by Rexhepi and Meka in 2008 on Albanian Kosova population.
In the present study, the overall majority had euryproscopic facial type (53.2%) followed by those having mesoprosopic type (21.6%), hypereuryprosopic type (19%), leptoprosopic (5.6%), and hyperleptoprosopic type (0.6%).
However, in males, majority were euryprosopic (58.4%), at the next sequence hypereuriprosopic and mesoprosopic types had equal distribution (18.8% each) followed by leptoprosopic (3.6%) and hyperleptoprosopic types (0.4%), respectively.
Among females, although maximum were of euryprosopic type, yet they comprised 46.5% of total females followed by mesoprosopic (25.2%) and hypereuryprosopic (19.2%) types. Leptoprosopic and hyperleptoprosopic types comprised the 8.2 and 0.9% of total females enrolled in the study, respectively. Statistically, there was a significant difference between two genders with respect to facial morphological type (P < 0.001).
Jeremić et al. on Central Serbian population found that the dominant facial type was leptoprosopic (81.7%), which was followed by mesoprosopic (14.28%) and hyperleptoprosopic (4%), respectively. These results were different from the results of our study. In 2003, Golalipour et al. observed the Turkman and Fars population and found that the dominant and rare facial type was hypereuriprosopic and leptoprosopic, respectively. The findings of Golalipour et al. study were different from that of the present study in terms of dominant facial type which was euryprosopic.
In the study conducted by Heidari et al., they found that in 18–25 years old Baluchi and Sistani young women, the dominant and rare facial type was euryprosopic and hyperleptoprosopic, respectively in both the populations. This is in accordance with the present study as in females of 18–25 years old age group, majority of the subjects were euryprosopic, and hyperleptoprosopic facial type was found to be less common.
According to the study conducted by Rexhepi and Meka in 2008, they found that the leptoprosopic was the dominant facial type in males followed by hyperleptoprosopic, while in females, hyperleptoprosopic was more common in the age group of 18–35 years of Kosova Albanian population. Hypereuriprosopic was the least common followed by euryprosopic facial type between both the genders. This result was dissimilar with our study.
The study conducted by Bayat and Ghanbari in 2009, in Ark, Fars, and Turkmen (newborn population of central Iran and Iranian racial subgroups) found that the dominant facial type was hypereuryprosopic for Fars and Ark while mesoprosopic for Turkmen. In 2010, Raji et al. found in North-eastern Nigerian population that the dominant and rarest facial type in both the genders was hyperleptoprosopic and hypereuryprosopic. With respect to the canine relationship for both the right and left sides, class I was most common. However, for both the sides, prevalence of class II and class III was significantly higher in females as compared to males (P < 0.05). When association between morphological facial type and canine relationship was observed, it was found that class I canine relationship was most common. On comparison of different facial types, canine relationship, euryprosopic was found to be the dominant facial type supported by the study conducted by Young et al. Irrespective of facial morphologic type, class I canine relationship was most common. Although prevalence of class I canine relationship was maximum for hyperleptoprosopic type as compared to other facial morphologic types, yet this association was not significant statistically for canine relationship of either side (P > 0.05). In terms of canine relationship, a significant association between canine relationship and facial morphologic type was observed at both the right and left sides (P < 0.05). On comparing the data, there was no significant association found between facial morphologic types and canine relationships in both genders in different age groups on either side. Only canine relationship association with facial morphologic type was significant for the left side.
| Conclusion|| |
The following conclusion may be drawn from the present study:
- The general facial morphological types did not show any significant association with canine relationship except for gender. The age-confounded relationship did not show an empirical pattern for all the age groups when evaluated independently.
- Euryprosopic facial type (53.2%) was most common in majority of the subjects followed by mesoprosopic (21.6%), hypereuryprosopic (19%), and leptoprosopic (5.6%), and the least common was hyperleptoprosopic (0.6%).
- Males and females both showed majority of 58.4% and 46.5%, respectively, of euryprosopic facial type on comparing the data with gender. This showed a significant difference between two genders with respect to the facial morphology.
- The canine relationship was class I in both the genders, Class II and Class III relationship was seen slightly higher in females.
- The association between morphological facial type and canine relation was observed, it was found that Class I canine relationship was most commonly seen.
- In males, the prevalence of class I canine relationship was significantly higher in mesoprosopic and hyperleptoprosopic types as compared to other types for both the sides.
- In females, there was no significant association seen between morphological facial types and canine relationship on either side.
- There was no significant association between facial morphologic types and canine relation in both the genders at either side. The canine relationship in association with facial morphological type was significant for the left side.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]