Document Type : Original Article
Authors
1 Postgraduate Student, Dept. of Orthodontics, School of Dentistry, Islamic Azad university, Isfahan (khorasgan) Branch, Isfahan, Iran.
2 Dept. of Orthodontics, School of Dentistry, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran.
3 Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Islamic Azad university, Isfahan (Khorasgan) Branch, Isfahan, Iran.
Abstract
Statement of the Problem: Determination of remaining growth potential of patients is the most important factor in orthodontic treatment.
Purpose: This study aimed to assess the correlation of clivus length and angle with age, gender, sagittal growth pattern of the jaws, and skeletal maturation using lateral cephalometry.
Materials and Method: This cross-sectional study was conducted on 390 lateral cephalograms (Vatech, paX-i3D Green, South Korea) of patients aged 6 to 25 years. The patients were assigned to three groups of skeletal class I, II, III (n=130) with equal gender distribution. The clivus length and angle, Welcher angle, maxillary and mandibular effective length, sella turcica to Nasion (SN), and the angles between SN and point A (SNA), between SN and point B (SNB), and between NA and NB (ANB )were measured. Correlations of variables with age and gender, and cervical vertebral maturation stage (CVMS) were analyzed using the Pearson and Spearman’s correlation tests, independent t-test, and one-way ANOVA at 0.05 level of significance.
Results: Clivus length had a significant correlation with SNA (r= 0.103, p= 0.042), SNB (r= 0.108, p= 0.033), maxillary (r= 0.547, p< 0.001) and mandibular (r= 0.589, p< 0.001) effective lengths, SN length (r= 0.586, p< 0.001), and CVMS (r= 0.697, p< 0.001). Clivus angle had a significant correlation with SNA (r= 0.105, p= 0.039), SNB (r= 0.155, p= 0.002), maxillary (r= 0.507, p< 0.001) and mandibular (r= 0.596, p= 0.001) effective lengths, SN length (r= 0.566, p< 0.001), and CVMS (r= 0.699, p< 0.001). The mean clivus length (p= 0.006) and angle (p= 0.002) were significantly higher in males, and had a significant correlation with age (r= 0.636 and r= 0.718, p< 0.001). The mean clivus length and angle were not significantly different in class I, II, III (p> 0.05).
Conclusion: All parameters were greater in males, and increased with age (except Welcher angle). Clivus length and angle had significant correlations with position of both jaws but not with sagittal relationship.
Keywords
- Baccetti T, Mcnamara JA. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. 2002; 72: 316-323.
- Roman PS, Palma JC, Oteo MD, Nevado E. Skeletal maturation determined by cervical vertebrae development. Euro J Orthod. 2002; 24: 303-311.
- Polat OO, Kaya B. Changes in cranial base morphology in difference malocclusions. Orthod Craniofac Res. 2007; 10: 216-221.
- Neelakantan A, Rana AK. Benign and malignant diseases of the clivus. Clin Radiol. 2014; 69: 1295-1
- Chaurasia A, Katheriya G, Patil R. Radio-morphometric evaluation of Clivus in Indian ethinicity-A cone beam computed tomography study. J Oral Med Oral Surg Oral Pathol. 2017; 3: 35-41.
- Joaquim AF, Fernandes YB, Mathias RN, Batista UC, Ghizoni E, Tedeschi H, et al. Incidence of basilar invagination in patients with tonsillar herniation? A case control craniometrical study. Arq Neuropsiquiatr. 2014; 72: 706-711.
- Hofmann E, Prescher A. The Clivus normal Variants and Imaging Pathology. Clinical Neuroradiology. 2012; 22: 123-139.
- Axelsson S, Kjaer I, Bjørnland T, Storhaug K. Longitudinal cephalometric standards for the neurocranium in Norwegians from 6 to 21 years of age. Eur J Orthod. 2003; 25: 185-198.
- Proffit WR, Fields HW, Larson BE, Sarver DM. Contemporary Orthodontics. 6th ed. Philadelphia: Elsevier; 2019. p: 67-68.
- Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB. Designing clinical research: an epidemiologic approach. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 79.
- Baccetti T, Franchi L, McNamara JA. The cervical vertebralmaturation (CVM) method for the assessment of optimal treatmenttiming in dentofacial orthopedics. Semin Orthod. 2005; 11: 119-129.
- Graber LW, Vanarsdall RL, Vig KWL, Huang GL. Orthodontics: current principles and techniques. 6th ed. S Louis: Elsevier; 2017. p. 20-27.
- Bayrak S, Bulut DG. Assessment of foramen magnum and clivus for estimation of age and gender using Cone-beam CT. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2019; 29: 244-251.
- Monirifard M, Sadeghian S, Afshari Z, Rafiei E, Sichani AV. Relationship between cephalometric cranial base and anterior-posterior features in an Iranian population. Dent Res J (Isfahan). 2020; 17: 60-65.
- Henneberke M, Prahl-Andersen B. Cranial base growth for Dutch boys and girls: a multilevel approach. Am J Orthod Dentofacial Orthop. 1994; 106: 503-512.
- Malta LA, Ortolani CF, Faltin K. Quantification of cranial base growth during pubertal growth. J Orthod. 2009; 36: 229-235.
- Andria LM, Leite LP, Prevatte TM, King LB. Correlation of the cranial base angle and its components with other dental/skeletal variables and treatment time. Angle Orthod. 2004; 74: 361-366.
- Dhopatkar A, Bhatia S, Rock P. An investigation into the relationship between the cranial base angle and malocclusion. Angle Orthod. 2002; 72: 456-463.
- Sayin MO, Türkkahraman H. Cephalometric evaluation of nongrowing females with skeletal and dental Class II, division 1 malocclusion. Angle Orthod. 2005; 75: 656-660.
- Proff P, Will F, Bokan I, Fanghänel J, Gedrange T. Cranial base features in skeletal Class III patients. Angle Orthod. 2008; 78: 433-439.
- Mouakeh M. Cephalometric evaluation of craniofacial pattern of Syrian children with Class III malocclusion. Am J Orthod Dentofacial Orthop. 2001; 119: 640-649.
- Hopkin GB, Houston WJ, James GA. The cranial base as an aetiological factor in malocclusion. Angle Orthod. 1968; 38: 250-255.
- Obaidi HA. The variation of the cranial base parameters in Class I, II and III skeletal relationships. Rafidaindent J. 2006; 7: 6-13.
- Botelho RV, Ferreira ED. Angular craniometry in craniocervical junction malformation. Neurosurg Rev. 2013; 36: 603-610.
- Martin JE, Bookland M, Moote D, Cebulla C. Standardized method for the measurement of Grabb's line and clival-canal angle. J Neurosurg Pediatr. 2017; 20: 352-356.
- Hirunpat S, Wimolsiri N, Sanghan N. Normal value of skull base angle using the modified magnetic resonance ımaging technique in Thai population. J Oral Health Craniofac Sci. 2017; 2: 17-21.
- Järvinen S. Saddle angle and maxillary prognathism: a radiological analysis of the association between the NSAr and SNA angles. Br J Orthod. 1984; 11: 209-213.
- Klocke A, Nanda RS, Kahl-Nieke B. Role of cranial base flexure in developing sagittal jaw discrepancies. Am J Orthod Dentofacial Orthop. 2002; 122: 386-391.
- Sanborn RT. Differences between the facial skeletal patterns of class III malocclusion and normal occlusion. Angle Orthod. 1955; 25: 208-222.
- Krishnaswamy N, Jnaneshwar P, Kannan R. Evaluation and comparison of planum clival angle in three malocclusion groups: A CBCT study. J Orofac Orthop. 2024; 85: 340-349.
)