Research Article Skeletal and Dentoalveolar …downloads.hindawi.com › journals › scientifica › 2016 › 3147972.pdfResearch Article Skeletal and Dentoalveolar Cephalometric

Research ArticleSkeletal and Dentoalveolar Cephalometric Features of AnteriorOpen Bite among Yemeni Adults

Ammar Abdulkareem Daer1 and Amal Hussein Abuaffan2

1Department of Orthodontics Faculty of Dentistry Sanarsquoa University Sanarsquoa Yemen2Department of Orthodontics Pedodontics and Preventive Dentistry Faculty of Dentistry University of Khartoum Khartoum Sudan

Correspondence should be addressed to Amal Hussein Abuaffan amalabuaffanyahoocom

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

Academic Editor Timothy M McCulloch

Copyright copy 2016 A A Daer and A H Abuaffan This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

Objective The aim of this study is to determine the cephalometric features for a sample of Yemeni adults with anterior open biteMaterial and Methods Lateral cephalometric radiographs were taken for 65 Yemeni university students (46 males and 19 females)18ndash25 years old with clinical anterior open bite (vertical overbite le 0mm) and no previous orthodontic treatmentThe radiographsweremanually traced twelve angular five linearmeasurements and facial index were assessed analyzed statistically and comparedto 194 Yemeni norms (89 males and 105 females) as well as cephalometric features of open bite subjects in previous studies ResultsStatistically significant differences were observed in skeletal and dental cephalometric values of Yemeni patients with anterior openbite when compared to Yemeni norms mainly in the anteroposterior relation the open bite individuals had higher significantvalue in SNA SNB and SNPg angles In addition a higher statistical significant difference was recorded in all variables of verticalrelation when compared with norms In contrast NL-NSL angle revealed higher value among normal individuals Dental variablesamong open bite individuals showed a greater degree of dental proclination higher statistically significant value in I-NA∘ I-NAmm and I-NBmm and a lower significant value in U1-L1 in open bite groupConclusionOpen bite Yemeni individualrsquos skeletal anddentoalveolar variables significantly differ from Yemeni norms in the extent of the anteroposterior vertical developmental patternand dental relations

1 Introduction

Anterior open bite is a major occlusal disorder in the verticaldirection which is often associated with defects in theanteroposterior direction It is one of the most difficult mal-occlusions which constitutes a real challenge to orthodontics[1 2] It was defined by several authors as the absence ofcoverage between the incisors (upper and lower) when theposterior teeth are in occlusal position [1ndash4]

According toMcNamara and Burdon open bite was clas-sified into and skeletal Dental open bite is localized to theanterior teeth and the surrounding soft and hard tissueswithout presenting any skeletal defect in cephalometricradiograph whereas skeletal open bite shows vertical dishar-mony in cephalometric radiograph [3] Additional features toMcNamararsquos classification had been added pseudo open bite(presence of incisor protrusion) infantile open bite (involves

all teeth and molar) and iatrogenic (occur due to carelessorthodontic treatment as a result of using inappropriate rapidpalatal expansion) [4]

Numerous studies in previous literature describe theskeletal and dental characteristics of the anterior open biteand discuss the various etiological factors that had a role increating an open bite among different population [5ndash10]

Cephalometric radiograph has been used for the diagno-sis of orthodontic problems in vertical and anteroposteriordirection Authors revealed different findings and measure-ment for open bite cases by using different methods ofcephalometric analysis [11 12]

In 1952 in the cephalometric analysis proposed by Wylieand Johnson the vertical proportions of the normal face weremeasured along the line nasion-menton The anterior nasalspine (ANS) served as the point of separation between theupper and the lower face height [11] Later in 1964 Horowitz

Hindawi Publishing CorporationScientificaVolume 2016 Article ID 3147972 5 pageshttpdxdoiorg10115520163147972

2 Scientifica

and Thompson measured the face height upper face heightand lower face height along the nasion-gnathion line in agroup of untreated normal postadolescent males and females[12]

Klocke et al evaluated the craniofacial growth changesin a longitudinal study for two groups 14 children (5 yearsold) in each one group with anterior open bite and the othercontrol group Cephalometric measurements were analyzedat the ages of 5 9 and 12 years [13]

Numerous studies concerning the cephalometric featuresof anterior open bite have given a vast amount of informationin various parts of the world Data about Yemeni open bitepatients regarding skeletal and dentoalveolar features are rareTherefore the present study is designed to determine theskeletal and dental cephalometric features of anterior openbite among Yemeni adults in comparison to Yamani norms

2 Materials and Methods

First the ethical approval was obtained from the researchcommittee of Sanarsquoa University Science and TechnologyUniversity and Dar Al-Salam University to conduct thisstudy The aims of the study had been explained to all thestudents in the lecture room Initial visual screening wascarried out and the ones who had anterior open bite wereregistered and later on called and asked for further clinicalexamination at the dental clinic

The total number of the students in the three facultieswas 1585 out of these 65 students had anterior open bite (19females and 46 males) and fulfill the inclusion criteria of thecurrent study Yemeni nationality with no previous historyof orthodontic or prosthodontic treatment full permanentdentition and the vertical overbite le 0mm when teeth arein centric occlusion and no craniofacial deformities Thenormal cephalometric radiograph for Yemeni populationhad been studied and analyzed from one hundred ninety-four students (89 males and 105 females) who had normalocclusion and fulfill the inclusion criteria of the current studyYemeni nationalitywith normal occlusion and balanced facialprofile full permanent dentition (except for the thirdmolars)class I molar incisor and canine relationship normal overjetand overbite normal transversal occlusion and well alignedor crowded teeth not more than 2mm and no previoushistory of orthodontic treatment was registered

Cephalograms were taken from each student after theconsent form had been signed Lead apron had been worn forprotection and well trained operator takes the lateral whilethe student head was in natural position and the teeth wereclosed in centric occlusion the lips slightly closed and theright side of the subject face the x-ray source [14]

The cephalograms were traced andmeasured by themaininvestigator Five linear and twelve angular measurementswere analyzed on each radiograph (Figure 1)

21 Statistical Analysis Data were collected summarizedcleaned and coded All statistical analyses were performedwith the Statistical Package for Social Sciences (SPSS) pro-gram (version 20) For each variable the arithmeticmean and

Table 1 Reliability ofmeasurements using reliability Studentrsquos 119905-test

Variable EM 119911 value 119875 value DecisionSNA∘ 0360 100 033 NsSNB∘ 0234 000 100 NsANB∘ 0396 minus136 019 NsSNPg∘ 0308 144 016 NsNSBa∘ 0349 057 057 NsML-NL∘ 0065 000 100 NsNL-NSL∘ 0088 minus100 033 NsML-NSL∘ 0134 minus100 033 NsGn-tgo-Ar∘ 0126 100 033 NsN-Sp1015840 mm 0275 minus100 033 NsSp1015840-Gn mm 0053 000 100 NsPg-NB mm 0219 minus100 033 NsNod angle 0190 minus057 057 NsI-I∘ 0233 057 057 NsI-NA∘ 0243 minus057 057 NsI-NB∘ 0427 100 033 NsI-NA mm 0024 100 033 NsI-NB mm 0247 000 100 Ns

Table 2 The skeletal anteroposterior variables for Yemeni adultswith anterior open bite

Variables Male 46 Female 19119875 value

Mean Max Min SD Mean Max Min SDSNA∘ 7723 87 71 405 7959 85 76 255 0022lowast

SNB∘ 7357 843 68 401 7503 798 695 271 0151ANB∘ 368 7 minus2 227 456 10 1 218 0155SNPg∘ 738 85 67 435 7591 81 71 268 0021lowast

SNBa∘ 13414 143 123 555 13126 142 120 534 0059lowast

119875 lt 005 is significant

standard deviation were calculated Chi-square test was used119875 value of less than 005 was considered as significant

22 Reliability of the Measurements The intraexaminer reli-ability test was carried out for error testing Fifteen percentof the cephalograms were randomly selected and retracedin two-week interval by the same investigator the first andsecond measurements were compared using paired Studentrsquos119905-test

3 Results Reliability and Gender Differences

31 Reliability of the Measurements A strong correlation wasfound between the first and second reading (Table 1)

A total of 65 Yemeni university students 46 males and19 females were clinically diagnosed with anterior open biteCephalometric radiographs were traced and analyzed for theskeletal and dental features of the anterior open bite

Table 2 showed the sagittal relationship statisticallysignificant differences were noted in SNA and SNPg angleswhereas SNB ANB and SNBa angles showed no significant

Scientifica 3

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


Mean Max Min SD Mean Max Min SDML-NL∘ 3753 50 235 802 3269 435 23 531 0006lowast

NL-NSL∘ 78 12 2 319 926 16 4 286 0089ML-NSL∘ 452 56 31 696 4145 54 325 591 0044lowast

Gn-tgo-Ar∘ 12811 144 116 809 12654 141 1165 66 0458N-Sp1015840 mm 7086 77 53 504 6102 713 52 65 0000lowast

Sp1015840-Gn mm 9904 119 788 1093 8511 9828 6457 1225 0000lowast

N-SpSp-Gn 07200 082 062 00567 07242 083 056 00728 0804lowast


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


Mean Max Min SD Mean Max Min SD1-1∘ 12074 1335 110 538 12113 1375 1055 894 0862I-NA∘ 274 35 175 472 2379 35 15 558 0011lowast

I-NB∘ 2801 35 21 45 2966 43 20 602 0230I-NA mm 721 115 35 208 548 1276 174 299 0010lowast

I-NB mm 915 1336 568 219 848 1695 416 38 0477lowast


isaSp

SN

B

A

is

ar

Ba

Gn

Pg

ii

iia

Pm

tgo

Figure 1 Cephalometric lines and angles

difference between genders Moreover all angles measure-ments showed greater value in females than males except forSNBa angle

According to Table 3 the vertical inclination and ML-NL and ML-NSL angles together with the upper and lowerfacial height measurement showed statistically significantdifferences between genders In contrast the facial indexshowed no significant difference

In the dental measurements only the upper incisor to NA(angle and line) showed statistically significant differences

Table 5The skeletal anteroposterior variables for normal and openbite Yemeni adults

Variables Open bite (119873 65) Norm bite (119873 194)119875 value

Mean Std Mean StdSNA∘ 779 381 8086 254 0000lowast

SNB∘ 7399 372 7789 252 0000lowast

ANB∘ 394 226 297 135 0002lowast

SNPg∘ 744 403 7867 26 0000lowast

NSBa∘ 1333 561 13171 605 0063lowast


whereas no significant differences between genders wereobserved in the other dental measurement values (Table 4)

4 Results Open Bite Relative to NormalOcclusion (Yemeni)

41 Skeletal Relationships

411 Anteroposterior In the current study all the skeletalvariables showed significant differences between open biteand norms except for NSBa (Table 5) [15] For SNA andSNB the open bite group had lower value than the normsConcerning SNBa angle the Yemeni open bite had a highervalue than that of norms

412 Vertical Inclination In the present study ML-NL angleshowed higher value in open bite than Yemeni norms andthe opposite was seen with NL-NSL angle which is higherin norms (Table 6) [15] whereas ML-NSL angle was less in

4 Scientifica

Table 6 The skeletal vertical variables for open bite and normYemeni adults


Mean Std Mean StdML-NL∘ 361 762 2136 543 0000lowast

NL-NSL∘ 822 315 987 375 0002lowast

ML-NSL∘ 441 684 3123 553 0000lowast

Gn-tgo-Ar∘ 12765 767 1193 73 0000lowast

lowast


Table 7 The facial height variable for open bite and norm Yemeniadults


Mean Std Mean StdN-Sp1015840 mm 6798 708 6003 648 0000lowast

Sp1015840-Gnmm 9497 1292 7329 882 0000lowast

N-Sp1015840SP1015840-Gn times100

072 006 082 007 0000lowast

lowast


Table 8 Distribution of the dental variable for open bite and normYemeni adults


Mean Std Mean Std1-1∘ 12085 655 12665 719 0000lowast

I-NA∘ 263 521 2157 496 0000lowast

I-NB∘ 2849 5 2796 45 0419I-NA mm 67 248 46 178 0000lowast

I-NB mm 895 274 626 214 0000lowastlowast


value among the Yemeni norms and the Gn-tgo-Ar is higherin Yemeni open bite than in norms

413 Face Height In the current study the upper facialheight (N-Sp1015840) was significantly higher in open bite Yemenisthan in norms (Table 7)

For lower facial height the Yemeni open bite had asignificantly higher value than norms Concerning the facialindex it was found that the Yemeni norms had significantlyhigher value than that of open bite

414 Dental Variables In this study the Yemeni open biteadults had greater bimaxillary proclination of the incisorsindicated by the smaller interincisal angle than norms whichis statistically significant (Table 8)

The angles between the upper central incisor to the NAline and lower central incisor to the NB line showed a highervalue in open bite Yemeni group than that of norms

The liner measurement of I-NA had a higher value inYemeni open bite group than that of norms while the liner

measurement of I-NB is found to be higher in open biteYemenis than in norms

5 Conclusion

(i) This was a cross-sectional study aimed at evaluatingthe skeletal and dental cephalometric features of 65Yemeni university students (19 female and 46 male)aged 18ndash25 years with anterior open bite Statisticallysignificant differences were found in skeletal anddental relationships

(ii) From the results obtained among different popula-tion and Yamani results it can be concluded thatthe Yemeni open bite adults had different skeletaland dentoalveolar cephalometric measurement whencompared to other populationsThese differences canbe attributed partially to ethnic background samplesize and the genetic factors

(iii) The current study proved the results of previousstudies among different population that skeletal anddental features had significant roles in the etiology ofanterior open bite

Competing Interests

The authors declare that they have no competing interests

References

[1] L Mitchel An Introduction to Orthodontic Oxford UniversityPress 2nd edition 2001

[2] W R Proffit and H W Fields Jr Contemporary OrthodonticsMosby St Louis Mo USA 3rd edition 2000

[3] J McNamara and W Brudon Orthodontics and DentofacialOrthopedics Needham Press 1st edition 2001

[4] T Rakosi Orthodontic Diagnosis G Thieme 1993[5] T J Cangialosi ldquoSkeletal morphologic features of anterior open

biterdquoAmerican Journal of Orthodontics vol 85 no 1 pp 28ndash361984

[6] G Lopez-Gavito T R Wallen R M Little and D R Joon-deph ldquoAnterior open-bite malocclusion a longitudinal 10-yearpostretention evaluation of orthodontically treated patientsrdquoAmerican Journal of Orthodontics vol 87 no 3 pp 175ndash1861985

[7] F Hapak ldquoCephalometric appraisal of the open-bite caserdquo TheAngle Orthodontist vol 34 no 1 pp 65ndash72 1964

[8] H I Nahoum ldquoVertical proportions a guide for prognosisand treatment in anterior open-biterdquo American Journal ofOrthodontics vol 72 no 2 pp 128ndash146 1977

[9] J D Subtelny and M Sakuda ldquoOpen-bite diagnosis andtreatmentrdquo American Journal of Orthodontics vol 50 no 5 pp337ndash358 1964

[10] J C Trouten D H Enlow M Rabine A E Phelps and DSwedlow ldquoMorphologic factors in open bite and deep biterdquoAngle Orthodontist vol 53 no 3 pp 192ndash211 1983

[11] W L Wylie and E L Johnson ldquoRapid evaluation of facialdysplasia in the vertical planerdquoThe Angle Orthodontist vol 22no 3 pp 165ndash182 1952

Scientifica 5

[12] S L Horowitz and R H Thompson ldquoVariations of the cranio-facial skeleton in postadolescent males and femalesrdquoThe AngleOrthodontist vol 34 pp 97ndash122 1964

[13] A Klocke R S Nanda and B Kahl-Nieke ldquoAnterior open bitein the deciduous dentition longitudinal follow-up and cranio-facial growth considerationsrdquoAmerican Journal of Orthodonticsand Dentofacial Orthopedics vol 122 no 4 pp 353ndash358 2002

[14] E F Erbay C M Caniklioglu and S K Erbay ldquoSoft tissueprofile in Anatolian Turkish adults part I Evaluation of hori-zontal lip position using different soft tissue analysesrdquoAmericanJournal ofOrthodontics andDentofacialOrthopedics vol 121 no1 pp 57ndash64 2002

[15] D Ammar and A Amal ldquoCephalometric features of yemeniadults normsrdquo International Journal of Recent ScientificResearch vol 9 no 6 pp 6264ndash6269 2015

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2 Scientifica

and Thompson measured the face height upper face heightand lower face height along the nasion-gnathion line in agroup of untreated normal postadolescent males and females[12]

Klocke et al evaluated the craniofacial growth changesin a longitudinal study for two groups 14 children (5 yearsold) in each one group with anterior open bite and the othercontrol group Cephalometric measurements were analyzedat the ages of 5 9 and 12 years [13]

Numerous studies concerning the cephalometric featuresof anterior open bite have given a vast amount of informationin various parts of the world Data about Yemeni open bitepatients regarding skeletal and dentoalveolar features are rareTherefore the present study is designed to determine theskeletal and dental cephalometric features of anterior openbite among Yemeni adults in comparison to Yamani norms

2 Materials and Methods

First the ethical approval was obtained from the researchcommittee of Sanarsquoa University Science and TechnologyUniversity and Dar Al-Salam University to conduct thisstudy The aims of the study had been explained to all thestudents in the lecture room Initial visual screening wascarried out and the ones who had anterior open bite wereregistered and later on called and asked for further clinicalexamination at the dental clinic

The total number of the students in the three facultieswas 1585 out of these 65 students had anterior open bite (19females and 46 males) and fulfill the inclusion criteria of thecurrent study Yemeni nationality with no previous historyof orthodontic or prosthodontic treatment full permanentdentition and the vertical overbite le 0mm when teeth arein centric occlusion and no craniofacial deformities Thenormal cephalometric radiograph for Yemeni populationhad been studied and analyzed from one hundred ninety-four students (89 males and 105 females) who had normalocclusion and fulfill the inclusion criteria of the current studyYemeni nationalitywith normal occlusion and balanced facialprofile full permanent dentition (except for the thirdmolars)class I molar incisor and canine relationship normal overjetand overbite normal transversal occlusion and well alignedor crowded teeth not more than 2mm and no previoushistory of orthodontic treatment was registered

Cephalograms were taken from each student after theconsent form had been signed Lead apron had been worn forprotection and well trained operator takes the lateral whilethe student head was in natural position and the teeth wereclosed in centric occlusion the lips slightly closed and theright side of the subject face the x-ray source [14]

The cephalograms were traced andmeasured by themaininvestigator Five linear and twelve angular measurementswere analyzed on each radiograph (Figure 1)

21 Statistical Analysis Data were collected summarizedcleaned and coded All statistical analyses were performedwith the Statistical Package for Social Sciences (SPSS) pro-gram (version 20) For each variable the arithmeticmean and

Table 1 Reliability ofmeasurements using reliability Studentrsquos 119905-test

Variable EM 119911 value 119875 value DecisionSNA∘ 0360 100 033 NsSNB∘ 0234 000 100 NsANB∘ 0396 minus136 019 NsSNPg∘ 0308 144 016 NsNSBa∘ 0349 057 057 NsML-NL∘ 0065 000 100 NsNL-NSL∘ 0088 minus100 033 NsML-NSL∘ 0134 minus100 033 NsGn-tgo-Ar∘ 0126 100 033 NsN-Sp1015840 mm 0275 minus100 033 NsSp1015840-Gn mm 0053 000 100 NsPg-NB mm 0219 minus100 033 NsNod angle 0190 minus057 057 NsI-I∘ 0233 057 057 NsI-NA∘ 0243 minus057 057 NsI-NB∘ 0427 100 033 NsI-NA mm 0024 100 033 NsI-NB mm 0247 000 100 Ns

Table 2 The skeletal anteroposterior variables for Yemeni adultswith anterior open bite


Mean Max Min SD Mean Max Min SDSNA∘ 7723 87 71 405 7959 85 76 255 0022lowast

SNB∘ 7357 843 68 401 7503 798 695 271 0151ANB∘ 368 7 minus2 227 456 10 1 218 0155SNPg∘ 738 85 67 435 7591 81 71 268 0021lowast

SNBa∘ 13414 143 123 555 13126 142 120 534 0059lowast


standard deviation were calculated Chi-square test was used119875 value of less than 005 was considered as significant

22 Reliability of the Measurements The intraexaminer reli-ability test was carried out for error testing Fifteen percentof the cephalograms were randomly selected and retracedin two-week interval by the same investigator the first andsecond measurements were compared using paired Studentrsquos119905-test

3 Results Reliability and Gender Differences

31 Reliability of the Measurements A strong correlation wasfound between the first and second reading (Table 1)

A total of 65 Yemeni university students 46 males and19 females were clinically diagnosed with anterior open biteCephalometric radiographs were traced and analyzed for theskeletal and dental features of the anterior open bite

Table 2 showed the sagittal relationship statisticallysignificant differences were noted in SNA and SNPg angleswhereas SNB ANB and SNBa angles showed no significant

Scientifica 3






Sp1015840-Gn mm 9904 119 788 1093 8511 9828 6457 1225 0000lowast

N-SpSp-Gn 07200 082 062 00567 07242 083 056 00728 0804lowast





I-NB∘ 2801 35 21 45 2966 43 20 602 0230I-NA mm 721 115 35 208 548 1276 174 299 0010lowast

I-NB mm 915 1336 568 219 848 1695 416 38 0477lowast


isaSp

SN

B

A

is

ar

Ba

Gn

Pg

ii

iia

Pm

tgo








SNB∘ 7399 372 7789 252 0000lowast

ANB∘ 394 226 297 135 0002lowast

SNPg∘ 744 403 7867 26 0000lowast

NSBa∘ 1333 561 13171 605 0063lowast







4 Scientifica




NL-NSL∘ 822 315 987 375 0002lowast

ML-NSL∘ 441 684 3123 553 0000lowast

Gn-tgo-Ar∘ 12765 767 1193 73 0000lowast

lowast





Sp1015840-Gnmm 9497 1292 7329 882 0000lowast

N-Sp1015840SP1015840-Gn times100

072 006 082 007 0000lowast

lowast





I-NA∘ 263 521 2157 496 0000lowast

I-NB∘ 2849 5 2796 45 0419I-NA mm 67 248 46 178 0000lowast










5 Conclusion




Competing Interests


References












Scientifica 5












Biomaterials












Journal of



















Scientifica 3






Sp1015840-Gn mm 9904 119 788 1093 8511 9828 6457 1225 0000lowast

N-SpSp-Gn 07200 082 062 00567 07242 083 056 00728 0804lowast





I-NB∘ 2801 35 21 45 2966 43 20 602 0230I-NA mm 721 115 35 208 548 1276 174 299 0010lowast

I-NB mm 915 1336 568 219 848 1695 416 38 0477lowast


isaSp

SN

B

A

is

ar

Ba

Gn

Pg

ii

iia

Pm

tgo








SNB∘ 7399 372 7789 252 0000lowast

ANB∘ 394 226 297 135 0002lowast

SNPg∘ 744 403 7867 26 0000lowast

NSBa∘ 1333 561 13171 605 0063lowast







4 Scientifica




NL-NSL∘ 822 315 987 375 0002lowast

ML-NSL∘ 441 684 3123 553 0000lowast

Gn-tgo-Ar∘ 12765 767 1193 73 0000lowast

lowast





Sp1015840-Gnmm 9497 1292 7329 882 0000lowast

N-Sp1015840SP1015840-Gn times100

072 006 082 007 0000lowast

lowast





I-NA∘ 263 521 2157 496 0000lowast

I-NB∘ 2849 5 2796 45 0419I-NA mm 67 248 46 178 0000lowast










5 Conclusion




Competing Interests


References












Scientifica 5












Biomaterials












Journal of



















4 Scientifica




NL-NSL∘ 822 315 987 375 0002lowast

ML-NSL∘ 441 684 3123 553 0000lowast

Gn-tgo-Ar∘ 12765 767 1193 73 0000lowast

lowast





Sp1015840-Gnmm 9497 1292 7329 882 0000lowast

N-Sp1015840SP1015840-Gn times100

072 006 082 007 0000lowast

lowast





I-NA∘ 263 521 2157 496 0000lowast

I-NB∘ 2849 5 2796 45 0419I-NA mm 67 248 46 178 0000lowast










5 Conclusion




Competing Interests


References












Scientifica 5












Biomaterials












Journal of



















Scientifica 5












Biomaterials












Journal of


























Biomaterials












Journal of



















Documents

Research Article Skeletal and Dentoalveolar …downloads.hindawi.com › journals › scientifica › 2016 › 3147972.pdfResearch Article Skeletal and Dentoalveolar Cephalometric