THE INTRODUCTION OF A NEW LATERAL CEPHALOMETRIC METHOD AND ITS POTENTIAL APPLICATION IN OPEN BITE DEFORMITIES . DAWJEE , SALAHUDDIEN MOHAMED BC HD (UWC), BC HD (H ONS ) (U.P RETORIA ), MS C ODONT (U.P RETORIA ), MD ENT (O RTHO ) (UL), PG DIP IRE (UCT) A THESIS SUBMITTED TO THE SCHOOL OF DENTISTRY OF THE UNIVERSITY OF LIMPOPO IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR IN PHILOSOPHY . CHIEF PROMOTOR : PROF . THEUNS G. OBERHOLZER CO- PROMOTOR : PROF . PHUMZILE HLONGWA CO- PROMOTOR : PROF . WILLIAM A. WILTSHIRE UNIVERSITY OF LIMPOPO MARCH 2010 Declaration STATEMENT BY CANIDATE I, Salahuddien Mohamed Dawjee, hereby declare that the work on which this thesis is based is original (except where acknowledgements indicate otherwise) and that neither the whole work nor any part of it has been, or shall be submitted for another degree at this or any other university. The work reported in this thesis was performed in the Department of Orthodontics, University of Limpopo, Medunsa Campus, Republic of South Africa. All opinions or statements expressed in this thesis do not necessarily reflect that of the University of Limpopo, the supervisors of the thesis or the external examiners. Signature: Date: SM Dawjee ii Dedication To my parents Cassim and Mariam Dawjee May God be pleased with us all? Verily His contentment is the Greatest. iii Acknowledgement My sincere gratitude and appreciation is extended to: 1. God Almighty – The Creator and Sustainer of the universe. Nothing happens without His permission. 2. My wife, Ghyroonnisha, and my three children, Haajierah, Maryam and Muhammad for their love, inspiration, respect and support. 3. My grandmother Kulsum Amod for always finding the good in me. 4. Kader and Jamilla for helping me through my pre-graduate studies. 5. My supervisors Profs. Oberholzer, Wiltshire and Hlongwa for their encouragement and unselfish assistance and guidance. 6. Professor Piet J Becker of the Medical Research Council (MRC) (South Africa) for his statistical input and expertise. 7. My family, friends, teachers and associates who have helped me reach this point in my life. 8. All patients with a dentofacial malady – May God grant us the wisdom and means to serve you better. iv Keywords South Africa South African Blacks Malocclusion Open bite Anterior open bite Cephalometric tracing Cephalometric methods Cephalometric analysis Facial dimensions Vertical facial dimensions v Contents TITLE.................................................................................................................................... I DECLARATION .................................................................................................................II DEDICATION ................................................................................................................... III ACKNOWLEDGEMENT..................................................................................................IV KEYWORDS........................................................................................................................ V CONTENTS ........................................................................................................................VI LIST OF FIGURES............................................................................................................IX LIST OF TABLES............................................................................................................XII LIST OF ABBREVIATIONS .........................................................................................XIV SUMMARY......................................................................................................................XVI CHAPTER 1..........................................................................................................................1 INTRODUCTION ................................................................................................................1 CHAPTER 2..........................................................................................................................6 LITERATURE REVIEW ....................................................................................................6 PREVALENCE ......................................................................................................................6 AETIOLOGY AND PATHOGENESIS ........................................................................................8 Craniofacial growth ......................................................................................................9 Habits and the neuromuscular system.........................................................................20 Dentoalveolar factors..................................................................................................27 Other causes................................................................................................................28 CLINICAL PRESENTATION ..................................................................................................29 TREATMENT ......................................................................................................................32 Myofunctional Therapy ...............................................................................................35 Orthodontic Mechanotherapy .....................................................................................39 Orthognathic Surgery..................................................................................................43 Combination Therapy..................................................................................................47 Relapse........................................................................................................................48 CHAPTER 3........................................................................................................................51 CEPHALOMETRICS AND ITS APPLICATION TO ANTERIOR OPEN BITE DEFORMITIES..................................................................................................................51 THE CEPHALOMETRIC RADIOGRAPH ..................................................................................51 DENTOFACIAL APPRAISAL ................................................................................................56 Artistic appraisal.........................................................................................................57 Craniometry ................................................................................................................57 Anthropometry.............................................................................................................58 Cephalometry ..............................................................................................................58 Photography................................................................................................................60 vi Facial and dental casts ...............................................................................................62 Laminagraphy .............................................................................................................62 Pantomography...........................................................................................................63 Computer aided tomography (CAT) scans and magnetic resonance imaging (MRI)..63 The future: three dimensional imaging .......................................................................64 OPEN BITE ANALYSIS USING THE LATERAL CEPHALOGRAM ..............................................70 The Downs’ analysis ...................................................................................................70 The Sassouni analysis..................................................................................................71 Facial proportions ......................................................................................................75 The overbite depth indicator (ODI).............................................................................81 CHAPTER 4........................................................................................................................84 DEVELOPMENT AND INTRODUCTION OF A NEW LATERAL CEPHALOMETRIC METHOD: THE PROPOSED DAWJEE ANALYSIS...............84 INTRODUCTION .................................................................................................................84 THE ANALYSIS ..................................................................................................................88 Lateral cephalometric landmarks ...............................................................................89 Lateral cephalometric planes and lines ......................................................................90 Lateral cephalometric measurements..........................................................................92 APPRAISAL .......................................................................................................................93 CHAPTER 5......................................................................................................................111 CLINICAL APPLICATION OF THE PROPOSED DAWJEE ANALYSIS..............111 CASE PRESENTATION ......................................................................................................111 CEPHALOMETRIC ANALYSIS ...........................................................................................117 CASE DISCUSSION ...........................................................................................................120