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Cephalometric and Malocclusion Analysis of Kadazan Dusun Ethnic Orthodontic Patients (Analisis Sefalometrik Dan Maloklusi Pesakit Ortodontik Etnik Kadazan Dusun)

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Cephalometric and Malocclusion Analysis of Kadazan Dusun Ethnic Orthodontic Patients (Analisis Sefalometrik Dan Maloklusi Pesakit Ortodontik Etnik Kadazan Dusun) Sains Malaysiana 42(1)(2013): 25–32 Cephalometric and Malocclusion Analysis of Kadazan Dusun Ethnic Orthodontic Patients (Analisis Sefalometrik dan Maloklusi Pesakit Ortodontik Etnik Kadazan Dusun) ROHAYA MEGAT ABDUL WAHAB* HARTINI IDRIS, HABIBAH YACOB & SHAHRUL HISHAM ZAINAL ARIFFIN ABSTRACT The aims of this study were to assess the skeletal pattern and the malocclusion of Kadazan Dusun ethnic patients who seek for orthodontic treatment. Cephalometric radiographs (248) and 345 study models were collected from four orthodontic clinics in Sabah. The cephalometric mean values (SNA, SNB, ANB, MMA, SNMxP, UIMxP, LIMnP and ALFH) were measured and the study models were analysed for overjet, overbite, incisor and molar relationships. Some morphological or occlusal features such as shovel shape, Talon cusp, peg shape teeth, midline diastema, canine displacement and supernumerary tooth were also noted. The frequency and correlation of cephalometric mean values and prevalence of malocclusion were analysed using SPSS 18. Class I Skeletal pattern was the most common (48%) followed by Class II (33%) and Class III (18%). There was a strong correlation between SNA and SNB values (>0.70). Class II/1 incisor relationship has the highest frequency (41%) followed by Class III (32%), Class I (21%) and Class II/2 (6%). Class II Molar relationship of both right and left showed highest frequency (38%) followed by Class I (33%) and Class III (30%). Increased of overjet (44%) and reduced overbite (41%) and shovel-shaped incisor were the most common occlusal and dental features. The Kadazan Dusun patients who seek for orthodontic treatment in Sabah were mostly presented with Class I Skeletal pattern with high prevalence in Class II/1 incisor relationship, Class II molar relationship, increased overjet and reduced overbite. The orthodontic treatment pertaining to this ethnicity should be in line with the findings that will benefit patient specifically based on their common presented features. Keywords: Cephalometric; Kadazan Dusun; malocclusion; orthodontic treatment ABSTRAK Penyelidikan ini bertujuan untuk mengkaji corak pola rangka dan kelaziman maloklusi pada pesakit Kadazan Dusun yang mendapatkan rawatan ortodontik. Radiograf sefalometrik (248) dan 345 model kajian telah dikumpulkan daripada empat klinik ortodontik di Sabah. Nilai purata sefalometrik (SNA, SNB, ANB, MMA, SNMxP, UIMxP, LIMnP dan ALFH) telah diukur dan model kajian telah dianalisis untuk melihat hubungan antara ‘overjet’, ‘overbite’, perhubungan insisor dan molar. Beberapa morfologi atau ciri-ciri oklusi seperti gigi bentuk penyodok, kuspa talon, gigi berbentuk pasak, diastema garis tengah, peralihan gigi taring dan lebihan bilangan gigi dicatatkan. Frekuensi dan perkaitan antara nilai purata sefalometrik dan kelaziman maloklusi dianalisis menggunakan SPSS 18. Corak Skeletal Kelas I (48%) adalah yang paling biasa diikuti oleh Kelas II (33%) dan Kelas III (18%). Terdapat perkaitan yang kuat antara nilai SNA dan SNB (>0.70). Perhubungan incisor Kelas II/1 menunjukkan frekuensi yang tertinggi (41%) diikuti oleh Kelas III (32%), Kelas I (21%) dan Kelas II/2 (6%). Perhubungan molar Kelas II pada kanan dan kiri menunjukkan frekuensi yang tertinggi (38%) diikuti oleh Kelas I (33%) dan Kelas III (30%). Peningkatan ‘overjet’ (44%), pengurangan ‘overbite’ (41%) dan insisor berbentuk penyodok adalah ciri-ciri gigi dan oklusi yang lazim. Pesakit ortodontik Kadazan Dusun Sabah kebanyakannya menunjukkan corak pola rangka Kelas I dengan kelaziman yang tinggi pada perhubungan insisor Kelas II/1, perhubungan molar Kelas II, peningkatan ‘overjet’ dan penurunan ‘overbite’. Rawatan ortodontik untuk etnik ini perlu selaras dengan penemuan kajian ini dengan pesakit boleh mendapat faedah khususnya berdasarkan kepada ciri-ciri am mereka. Kata kunci: Kadazan Dusun; maloklusi; rawatan ortodontik; sefalometrik INTRODUCTION from the Mongoloid race that reached Borneo or Brunei from Kadazan Dusun is the predominant ethnic group in Sabah Indochina through Philippines or came directly from the (Department of Statistic Malaysia 2001). Although the tale mainland of Asia (Hose & McDougall 1912). Meanwhile, of origin of this ethnic group is still a big question mark of according to Lee (1930), the Proto-Malay group has many when and how they arrived, but according to a study done similarities with the people on the Island of Borneo in the by Owen Rutter suggested that this population originated aspects of physical, culture as well as languages. 26 There have been many studies conducted to determine the The nature of this sampling procedure does not permit craniofacial morphology and prevalence of malocclusion in the generalization of the findings to the Kadazan Dusun many different races. Analysis of craniofacial morphology population at large. is an essential tool in orthodontic evaluation and clinical In total, there were about 760 Kadazan Dusun patients treatment, where it provides information that enables the who have attended the orthodontic dental clinics from classification of the skeletal as well as dental anomalies 1998 to early of 2010, including those who were in the (Susanti Munandar 1992). Classification of the occlusion, waiting lists. The inclusion and the exclusion criteria in on the other hand is one of the first steps in diagnosing the the data collection for cephalometric analysis as well as relationship between the upper and lower teeth (occlusion) malocclusion, however, had reduced the sample size. The and it is used in evaluation of orthodontics treatment inclusion criteria were both parents are from Kadazan (Angle 1900). Dusun ethnicity from particulars in the patients’ folder and The facial skeleton is known to be influenced by no history of orthodontic treatment. The exclusion criteria both genetic and environmental factors. However, the were cleft lip and palate or other cranio-facial disorders, effect of the environmental factors toward the growth can poor quality radiographs (for cephalometric analysis) depend upon how tightly growth is under genetic control. and broken study model that affects the tooth/teeth of It is undoubtedly that genetic control has a significant interest (for malocclusion analysis). The ethical approval influence in facial growth and the effect is more on the for the study was obtained from the Research and Ethical anterior-posterior facial form than vertical facial form. The Committee, Universiti Kebangsaan Malaysia. vertical growth can be influenced by three main possible environmental factors which are mouth breathing, soft CALIBRATION tissue stretching and the structure/function of muscle of The training and calibration of measurements of lateral mastication (Mitchell 2007). cephalometric radiograph and study model were done Malocclusion, on the other hand, is not a disease but before data collection started, where the examiners one end of the spectrum of normal variation. Research were calibrated under supervision of the supervisor suggested that the etiology of the majority of malocclusion and orthodontist as a gold standard. Fifteen lateral is multi-factorial. It can be due to genetically determined cephalometric radiographs were traced and retraced after factors or environmental factors. Commonly it is a two weeks while 20 study models of patient received combination of both inherited and environmental factors orthodontic treatment were examined by each investigator together. It can be recorded qualitatively and quantitatively. to assess for inter-examiner reliability. The two well-known classifications of malocclusion are the Angle and British Standard Institute (BSI) classifications SAMPLE EXAMINATION of incisor relationship (Mitchell 2007). Studies on craniofacial relations and variations in man The method of this study is divided into two major parts, have long been used to differentiate various racial groups in first, assessment of the skeletal pattern by analyzing the physical anthropology. Morphological features of different lateral cephalometric radiographs and second, assessment races and ethnic groups are not randomly distributed but of the malocclusion of the samples by analyzing the study models. appear in geographic clusters (Argyropoulos & Sassouni 1989). However, there is still no study undertaken regarding the cephalometric morphology and dento-alveolar variation THE SKELETAL PATTERN among the Kadazan Dusun population. The skeletal pattern relationship among Kadazan Dusun sample was determined from the patient’s lateral cephalometric radiographs tracing manually using a grid MATERIALS AND METHODS acetate paper that was superimposed on the radiograph. The tracing was carried out in a darkened room using a light SAMPLE SELECTION viewing box to get a clear view of the various landmarks. This study was a retrospective study of record reviews The presence of excess light around the area being traced of the lateral cephalometric radiographs and study was blocked out using black paper with a rectangular hole. models from the year 1998 to early of 2010. The samples In order to facilitate landmark’s identifications, the best were selected through a non-probability convenience medium, the proprietary acetate sheet is used. The acetate sampling procedures from two government dental clinics was oriented in the same position as the patient when the (Luyang Hospital Dental Clinics and Sandakan Hospital radiograph was taken and it is secured onto the film using Dental Clinics) and from two private orthodontic clinics a tape. The landmarks were then marked
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