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ORIGINAL ARTICLE
Year : 2014  |  Volume : 5  |  Issue : 4  |  Page : 456-460  

Morphometric analysis of cervical vertebrae morphology and correlation of cervical vertebrae morphometry, cervical spine inclination and cranial base angle to craniofacial morphology and stature in an adult skeletal class I and class II population


1 Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Mangalore, Karnataka, India
2 Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka, India
3 Department of Forensic Medicine, Kasturba Medical College, Mangalore, Karnataka, India
4 Department of Orthodontics, Mahe Institute of Dental Sciences, Mahe, Puducherry, India

Date of Web Publication14-Oct-2014

Correspondence Address:
Supriya Nambiar
Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-237X.142809

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   Abstract 

Objective: The study was carried out to compare the morphometry of the cervical column between adult Class I and Class II individuals and between gender and to analyze the correlation between the cervical column morphology, the cranial base angle, the craniocervical inclination with craniofacial morphology and stature of Angles Class I and Class II individuals. Materials and Methods: The data for this institutional retrospective study were systematically selected according to the specified inclusion and exclusion criteria from the pretreatment cephalometric radiographs of 19 male and 30 female patients visiting the Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, Manipal University, based on their ANB angle. The radiographs were traced and digitized. The reliability of the variables describing the cranial base and vertical and sagittal craniofacial dimensions was assessed. Conclusions: Our results showed that there was no statistically significant variation in the cervical vertebrae dimensions between Class I and Class II patients. There was found to be a definite sexual dimorphism, which was not statistically significant. Correlation exists between sagittal skeletal patterns, especially mandibular length and cervicovertebral morphology, but its use to classify the subjects in different sagittal classes is questionable.

Keywords: Angle′s classification, cervical inclination, cervical vertebrae, cranial base angle, craniofacial morphology, morphology, orthodontics, stature


How to cite this article:
Nambiar S, Mogra S, Nair B U, Menon A, Babu C S. Morphometric analysis of cervical vertebrae morphology and correlation of cervical vertebrae morphometry, cervical spine inclination and cranial base angle to craniofacial morphology and stature in an adult skeletal class I and class II population. Contemp Clin Dent 2014;5:456-60

How to cite this URL:
Nambiar S, Mogra S, Nair B U, Menon A, Babu C S. Morphometric analysis of cervical vertebrae morphology and correlation of cervical vertebrae morphometry, cervical spine inclination and cranial base angle to craniofacial morphology and stature in an adult skeletal class I and class II population. Contemp Clin Dent [serial online] 2014 [cited 2020 Jan 17];5:456-60. Available from: http://www.contempclindent.org/text.asp?2014/5/4/456/142809


   Introduction Top


The skeletal sagittal relations of the maxillary and mandibular bases have been proposed as a valuable factor for diagnosis and treatment planning in orthodontics. Cephalometric analyses of the cervical vertebral column have found that the horizontal and vertical dimensions of the cervical vertebra are associated with head posture, the cranial base angulation, and mandibular shape and growth. [1] Previous research has also focused on associations between the dimensions of atlas and craniocervical posture in adults with neutral occlusion and normal craniofacial morphology. However, no previous studies have described morphology of C1-C5, craniocervical inclination, the cranial base associations with craniofacial morphology in adults with Class I and a Class II craniofacial morphology. Sonnesen et al. [2] stated that the cranial base angle was significantly positively correlated with fusion of the cervical column. The cervicohorizontal and cranial base angles were statistically larger in females than in males. Associations were found between fusions of the cervical column and mandibular retrognathia, large cranial base angle, and large horizontal overjet. [3] Hence, the objectives of this study were to assess the morphometric variations of the cervical column between adult Class I and Class II individuals and in different sexes and also to analyze the correlation between the cervical column morphology, the cranial base angle, the craniocervical inclination with craniofacial morphology and stature in Class I and Class II individuals.


   Materials and Methods Top


This retrospective study was carried out at the Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Mangalore (Manipal University). Approval for conducting the study was obtained from the Institutional Ethical Committee. The data for the study were systematically selected according to the specified inclusion criteria from patients (male - 19 and females - 30) visiting the Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Mangalore. The pretreatment cephalometric radiographs of Class I (n = 18) and Class II (n = 31) were selected based on their ANB angle. For a patient to be included in the Class I skeletal pattern group (normal), two criteria had to be met: ANB angle of 2 ± 1°, and a pleasant profile. A patient was classified in the Class II group when the ANB angle was equal to or above 4°.

Inclusion criteria

Patients between 18 and 30 years of age

No history of orthodontic treatment during childhood

Class II group: Patients with Class II skeletal pattern and horizontal maxillary overjet >4 mm (assessed by lateral cephalogram of each patient)

Class I group: Patients with Class I skeletal pattern and minor dental malocclusion.

Exclusion criteria

Patients with craniofacial anomalies or systemic muscle or joint disorders

Nonavailability of a profile radiograph with first five cervical vertebrae visible.

The profile radiographs were taken with the teeth in occlusion and standardized head posture which was determined using a fluid level device. The radiographs were taken at the Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, with a film-to-focus distance of 180 cm and a film-to-median plane distance of 10 cm. The radiographs were traced and digitized [Figure 2]. The reliability of the variables describing the cranial base and vertical and sagittal craniofacial dimensions was assessed by re-measurement of 20 lateral radiographs that were selected at random from the previously recorded radiographs. The radiographs were digitized again, and the differences between the two sets of recordings were calculated. The morphometry of the cervical column was assessed from length and width measurements of the first five cervical vertebrae (C1-C5) as they are normally seen on a standardized lateral cephalogram. The cranial base angle, craniocervical inclination and craniofacial morphology was assessed from the linear and angular measurements.

Reference points of the cephalograms

S: Sella turcica (the midpoint of sella turcica)

N: Nasion (the intersection of the internasal suture with nasofrontal suture in the mid sagittal plane)

ANS: Anterior nasal spine (tip of the ANS seen on the X-ray from the normal lateralis)

PNS: Posterior nasal spine (tip of the posterior spine of the palatine bone in the hard palate)

Cv2tg: Tangent point of odontoid process tangent (OPT) line on the odontoid process of the second cervical vertebra

Cv2ip: The most inferior posterior point on the corpus of the second cervical vertebra

Cv4ip: The most inferior posterior point on the corpus of the fourth cervical vertebra.

Reference lines of the cephalograms [Figure 2]

Ver: True vertical line (true vertical line projected on the film)

Hor: True horizontal line (true horizontal line projected on the film)

NSL: Cranial base (line extending between sella and nasion)

CVT: Cervical vertebra tangent (posterior tangent to the odontoid process through Cv4ip to cranial base)

OPT: Posterior tangent to the odontoid process through Cv2ip to cranial base

Mandibular plane: Tangent to the lower border of the mandible.

Craniocervical angulations [Figure 2]

NSL/OPT: Craniocervical posture (downward opening angle between NSL line and OPT line)

NSL/CVT: Craniocervical posture (downward opening angle between NSL line and CVT line).

Madibular incisor inclination

Incisor mandibular plane angle (upward opening angle between mandibular plane and long axis of mandibular incisor).

The stature was assessed from the height, and weight measurements recorded. The methodological error within the cephalometric analysis was determined by having the measurement values analyzed on randomly chosen cephalograms after a week interval by the same examiner. SPSS 17.0 (SPSS Inc.) was used to statistically analyze the measured values. Descriptive statistics was used to assess the correlation between the craniofacial dimensions, cranial base angle, craniocervical inclination and cervical vertebrae morphology in Class I and Class II patients.


   Results and Observations Top


Our results showed that there was no statistically significant variation in the cervical vertebrae dimensions between Class I and Class II patients. There was found to be a definite sexual dimorphism, which was not statistically significant [Table 1]. The observations were as depicted in [Table 2], [Table 3] and [Table 4] and [Figure 1].
Figure 1: Pictorial depiction of the cervicovertebral measurement

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Figure 2: Descriptive mean statistics based on gender and malocclusion

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Table 1: Cv measurements used in the study Figure 1


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Table 2: Descriptive mean statistics based on gender and malocclusion


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Table 3: Correlation between Cv and CF dimensions in Class I patients


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Table 4: Correlation between Cv and CF dimensions in Class II patients


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   Discussion Top


In orthodontics, the skeletal sagittal relations of the maxillary and mandibular bases have been proposed as a valuable factor for diagnosis and treatment planning. Facial profile of the patients may be well explained by the antero-posterior relations of the jaws regarding the cranial base. [4] Using a parameter of the relative relation of the jaws will be valuable while considering correlation of both jaws simultaneously with another factor such as the cervical column curvature. This would enhance the treatment prognosis. To make these assessments possible, in several studies lateral cephalometric radiography has been used for analysis of the head and neck posture. [5],[6],[7],[8],[9] Inclination of the cervical column in several studies has been measured as an angle like OPT/Hor and CVT/Hor. [4],[7],[10],[11] This study was done on a group of adults belonging to Angles Class I and Class II groups in order to find a relationship if any, between sagittal skeletal pattern of the jaws and cervicovertebral morphology, cranial base angle, craniocervical inclination. The common origin of the spine and posterior part of the cranial base is the background for the hypothesis of associations between craniofacial morphology and the cervical spine, head posture and cranial base. In this study a strong correlation was shown by total body length of first cervical vertebrae (Cv1SL), height of atlas (Cv1HT), axis (Cv2HT) with age in both Angles Class I and Class II patients. Furthermore, a negative correlation was observed between atlas height and SNA and SNB angles in normal skeletal pattern (Class I) and with base plane angle in Angles Class II patients. Apart from this a good correlation was seen between axial height and mandibular length, as well as with the lower facial height (not significant) of Angles Class II patients. Mandibular length and stature also showed a good correlation with a total length of third and fourth cervical vertebrae and height of fourth and fifth cervical vertebrae. There was no correlation between atlas length and length of mandible in this study that is not in accordance with the findings of Huggare and Houghton, [11] whereas a very good correlation exists between the axial height and total skull width. Gonial angle showed a negative correlation with atlas and axial height though not significant, which was in accordance with the findings of Huggare and Houghton. [11] There was also a good correlation though not significant, between gonial angle and the cervical inclination as shown by the angle OPT-Hor, which related more to the inclination of first and second cervical vertebrae to the cranium, whereas there was no correlation between the inclination of the lower vertebrae with the gonial angle. It was also found that a very good correlation exists between the saddle angle and ANB angle which corroborates the fact that the mandible is retrusive in Angle's Class II individuals and also with maxillary length and stature and was negatively correlated with SNB angle.


   Conclusion Top


In this study, there was no statistically significant variation in the cervical vertebrae dimensions between Class I and Class II patients. There was found to be a definite sexual dimorphism, which was not statistically significant. Showed that a correlation exists between sagittal skeletal patterns especially mandibular length and cervicovertebral morphology but its use to classify the subjects in different sagittal classes is questionable. However, the height of the dens of the axis vertebrae and height of the fifth vertebrae showed a good association with the facial height and mandibular length in Angles Class II individuals and stature, maxillary and mandibular length in Class I individuals. Further longitudinal studies in this regard are required to confirm these findings.


   Acknowledgments Top


We would like to acknowledge Dr. Siddarth Shetty, Professor and Head, Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, a constituent College of Manipal University, for all the help provided for the study.

Clinical relevance

The skeletal sagittal relations of the maxillary and mandibular bases have been proposed as a valuable factor for diagnosis and treatment planning in orthodontics. Cephalometric analyses of the cervical vertebral column have found that the horizontal and vertical dimensions of the cervical vertebra are associated with head posture, the cranial base angulation, and mandibular shape and growth. Earlier attempts were carried out to study the association of morphological anomalies of cervical vertebrae with the craniofacial morphology. No previous studies have described morphology of C1-C5, craniocervical inclination, the cranial base associations with craniofacial morphology in adults with Class I and a Class II craniofacial morphology and this study has attempted to provide insight into the sexual dimorphism and correlation between cervical vertebral morphology, cranial base and craniocervical inclination with craniofacial morphology and stature.

 
   References Top

1.Pachì F, Turlà R, Checchi AP. Head posture and lower arch dental crowding. Angle Orthod 2009;79:873-9.  Back to cited text no. 1
    
2.Sonnesen L, Pedersen CE, Kjaer I. Cervical column morphology related to head posture, cranial base angle, and condylar malformation. Eur J Orthod 2007;29:398-403.  Back to cited text no. 2
    
3.Sonnesen L, Kjaer I. Cervical vertebral body fusions in patients with skeletal deep bite. Eur J Orthod 2007;29:464-70.  Back to cited text no. 3
    
4.Hosseinzadeh Nik T, Janbaz Aciyabar P. The relationship between cervical column curvature and sagittal position of the jaws: Using a new method for evaluating curvature. Iran J Radiol 2011;8:161-6.  Back to cited text no. 4
    
5.D'Attilio M, Epifania E, Ciuffolo F, Salini V, Filippi MR, Dolci M, et al. Cervical lordosis angle measured on lateral cephalograms; findings in skeletal class II female subjects with and without TMD: A cross sectional study. Cranio 2004;22:27-44.  Back to cited text no. 5
    
6.Huggare JA, Cooke MS. Head posture and cervicovertebral anatomy as mandibular growth predictors. Eur J Orthod 1994;16:175-80.  Back to cited text no. 6
    
7.Solow B, Sandham A. Cranio-cervical posture: A factor in the development and function of the dentofacial structures. Eur J Orthod 2002;24:447-56.  Back to cited text no. 7
    
8.Solow B, Siersbaek-Nielsen S. Cervical and craniocervical posture as predictors of craniofacial growth. Am J Orthod Dentofacial Orthop 1992;101:449-58.  Back to cited text no. 8
    
9.Solow B, Tallgren A. Head posture and craniofacial morphology. Am J Phys Anthropol 1976;44:417-35.  Back to cited text no. 9
    
10.Huggare J. The first cervical vertebra as an indicator of mandibular growth. Eur J Orthod 1989;11:10-6.  Back to cited text no. 10
    
11.Huggare J, Houghton P. Associations between atlantoaxial and craniomandibular anatomy. Growth Dev Aging 1996;60:21-30.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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[Pubmed] | [DOI]



 

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