Association Of Mandibular Arch Crowding And Vertical Growth Pattern - A Retrospective Study
Nor Syakirah binti Shahroom1, Ravindra Kumar Jain2*, Iffat Nasim3
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Associate Professor, Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Professor, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Ravindra Kumar Jain,
Associate Professor, Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai
600077, Tamil Nadu, India.
Tel: +919884729660
E-mail: ravindrakumar@saveetha.com
Received: July 30, 2021; Accepted: August 11, 2021; Published: August 18, 2021
Citation:Nor Syakirah binti Shahroom, Ravindra Kumar Jain, Iffat Nasim. Association Of Mandibular Arch Crowding And Vertical Growth Pattern - A Retrospective Study. Int J Dentistry Oral Sci. 2021;8(8):4096-4100. doi: dx.doi.org/10.19070/2377-8075-21000836
Copyright: Ravindra Kumar Jain©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Dental arch crowding is one of the most common malocclusions encountered in daily practice by an orthodontist. The most common reason that motivates patients to seek orthodontic treatment is anterior crowding as it has a significant aesthetic problem. A retrospective study was conducted in a dental hospital from July 2019 till March 2020 to evaluate the prevalence of dental arch crowding in subjects with vertical growth patterns in the Chennai population. A sample of 127 subjects with vertical growth patterns were selected from the case records of patients who reported to the University Hospital for orthodontic treatment. Mandibular arch crowding was classified into mild, moderate and severe crowding and cross verified with photographs. All the data was tabulated and analyzed using SPSS Version 20. Descriptive statistics and Chi-Square tests were performed. The overall prevalence of mandibular arch crowding in subjects with vertical growth patterns was 72%. Crowding was common in males (54.3%) than females (45.7%). Mild crowding (48%) was more prevalent followed by moderate crowding (27.6%) and severe crowding (24.4%). Mandibular arch crowding was more common in adults (44.9%) followed by adolescents (31.5%) and children (23.6%). No statistically significant association between age, gender and type of malocclusion of subjects with severity of crowding was noted (p>0.05). It can be concluded that the prevalence of crowding in subjects with vertical growth patterns was 72% and no differences among age, gender and type of malocclusion with crowding was noted.
2.Introduction
3.Conclusion
4.References
Keywords
Crowding; Lateral Cephalograms; Malocclusion; Orthodontic; Vertical Growth Pattern.
Introduction
An individual who faces a problem with socialization due to aesthetic
reasons might visit a dental clinic to consult for aesthetic
enhancement. Most of the patients feel that crowding is non-aesthetic
and that motivates them to seek treatment. Crowding can
be defined as the presence of a discrepancy between teeth size
and the available space for their correct functional and aesthetic
position, which may affect oral health by increasing susceptibility
to dental caries and periodontal disease and further will influence
the dental and facial aesthetics of the patients [1].
There are various etiologic factors for crowding including evolution,
genetics, environment, tooth size, tooth shape, arch length,
intercanine width, intermolar width, and arch dimension [19, 30,
47]. Based on the definition above, crowding occurs not merely
because of tooth-arch discrepancy but discrepancy among many
variables [50]. Several factors can be assumed to affect the development
and severity of crowding such as the direction of mandibular
growth, the early loss of deciduous molars, mesiodistal
tooth and arch dimensions, oral and perioral musculature and incisor
and molar inclination [3, 19, 43].
Relevant to mandibular growth a pattern, the more vertical
growth is, the greater the eruption of incisors to compensate for
the vertical space created. This eruption decreases the likelihood
to maintain contacts between the teeth and increase the risk of
crowding [5]. There was a study which proved that there was a
correlation between skeletal growth pattern with lower incisor
crowding [27].
The most significant diagnostic advancements in orthodontics is radiographic cephalometry [18, 33] . In cephalogram analysis, the
gonial angle is used to determine the growth pattern and rotation
of the mandible in a patient [44]. The drawbacks of the cephalometric
analyses are due to anatomical variation and growth
changes occurring in different anatomical landmarks [14]. Another
imaging modality in orthodontics is cone-beam computed tomography
(CBCT) technology which offers an undistorted view
of the dentition and three dimensional (3D) spatial orientation
of the teeth and roots [18]. Besides that, it can also reveal the
dimensions of alveolar bone and space limitations for intrusion
and expansion [18]. Thus, advance diagnosis is required to ensure
that the treatment planning and outcome are favorable depending
on the various dental or skeletal malocclusions. Moreover,
to predict the outcome of the treatment, it is important to have
knowledge regarding the forces exerted on the orthodontic auxiliaries
in which indigenous apparatus is found to be efficient [7,
13, 40]. Previously our team has a rich experience in working on
various research projects across multiple disciplines [2, 8, 10, 16,
20-25, 31-34, 38, 49, 55, 58]. Now the growing trend in this area
motivated us to pursue this project.
Therefore, the aim of this study was to evaluate the association of
mandibular arch crowding with vertical growth patterns.
Materials and Methods
A retrospective study was conducted involving patients visiting
dental hospitals from July 2019 till March 2020. Ethical approval
was granted by the Institutional Ethics Committee with the following
ethical approval number SDC/SIHEC/2020/DIASDATA/
0619-0320.
Data was collected from the records of the patients who reported
for orthodontic treatment in a University Hospital. Non orthodontically
treated subjects with vertical growth patterns were selected
in the study. Exclusion criteria were subjects with other
growth patterns and undergoing orthodontic treatment. A total
of 127 subjects with vertical growth patterns were selected in this
study. To minimize bias, all data were included and no sorting
process was done. Cross verification was done using photographs.
Sociodemographic data including age and gender, the severity of
crowding, and the type of malocclusion were recorded. The severity
of crowding was classified into mild, moderate and severe
crowding.
Data was analyzed using Statistical Package for Social Science,
SPSS Version 20 (IBM Corporation, New York, USA). A Chisquare
test was done to establish the association between the categorical
variables.
Results & Discussion
In this present study, the prevalence of mandibular arch crowding
in subjects with vertical growth patterns was 72%. In the study
done by Ghulam Rasul et al, 92.6% of patients with hyper divergent
facial growth had lower anterior crowding in which the
value was higher than the present study and there was a significant
difference between growth pattern and anterior crowding [41].
Few studies also reported a positive relationship between crowding
with high mandibular plane angles and facial heights [27, 45].
Meanwhile, another study reported that the prevalence of crowding
was 10% in vertical growth pattern patients and there was no
statistically significant difference, which indicates that there was
no relationship between growth pattern and mandibular crowding
[29]. Miethke et al also concluded that there was no correlation
between primary mandibular anterior crowding with vertical
craniofacial configuration [29]. However, with regard to the mandibular
growth a pattern, the more vertical growth is, the greater
the eruption of incisors to compensate for the vertical space created.
This eruption decreases the likelihood to maintain contacts
between the teeth and increase the risk of crowding [5].
Crowding was more common in males (54.3%) than females
(45.7%). Based on Figure 3, moderate (54.3%) and severe crowding (64.5%) were more common in males than females. Meanwhile,
mild crowding was more common in females (50.8%) than
males (49.2%). However, the present study revealed that there was
no statistically significant association between gender and severity
of crowding, p>0.05. With regard to the severity of crowding,
a previous study reported that severe crowding was common in
males with 26% which was similar to the present study where
64.5% of males had severe crowding [41]. This study also revealed
that there was no statistically significant difference between gender
and crowding which was in line with the present study. However,
in a study done by Hamasha et al, there was a statistically
significant difference between gender and crowding in which the
females were common with 45.5% than males with 32.4% [17].
The present study also found that there was no statistically significant
association between age and severity of crowding, p>0.05.
Mandibular arch crowding was common in adults (44.9%) followed
by adolescents (31.5%) and children (23.6%). Based on
Figure 4, mild crowding (49.2%) and severe crowding (54.8%)
were more common in adults and moderate crowding (37.1%)
was more common in children. A previous study reported that
the prevalence of severe crowding in adolescents and adults in the
Netherlands was 15% [4]. Another study reported that 14.3% of
adolescents had crowding [15]. The incidence as well as the severity
of the crowding increased during adolescence and adulthood
in both normal untreated individuals and orthodontically treated
patients [52]. There was no study reported an association between
the severity of crowding with different age groups.
Based on the type of malocclusion, mandibular arch crowding was common in class I (56.7%) followed by class II (39.4%) and
Class III (3.9%) malocclusion as shown in Figure 5. Based on
Figure 6, mild crowding was common in class I (59%), class II
(54.3%) and class III (54.8%) malocclusion. However, there was
no statistically significant association between types of malocclusion
with the severity of crowding, p>0.05.A previous study
reported the severity of crowding in maxillary and mandibular
arch based on types of malocclusion in which moderate maxillary
crowding and mild mandibular crowding was common in all malocclusion
groups [51]. In contrast to the study done by Shakeel
Qutub et al, the study reported that there was a statistically significant
difference between types of malocclusion and crowding
in which maxillary crowding and mild mandibular crowding were
more common in all malocclusion groups [24].
Numerous treatment protocols have been advocated for the
management of malocclusion. It is important to carefully diagnose
all cases to ensure a good treatment plan and outcomes. For
example, in deep bite cases with vertical growth patterns, mini
implants provide better outcomes in opening the bite [21, 59].
Nowadays, mini implant is considered an essential component in
orthodontic treatment in resistance to unwanted tooth movement
[11, 53]. Meanwhile, a new innovation on mini implants such as
a ball headed mini-implant was created to achieve a proper skeletal
change instead of dental change [22, 58]. However, in skeletal
deep bite cases with a horizontal growth pattern and anterior
crowding, extraction of premolars are not necessarily required
and extraction of lower anterior teeth may provide a favorable
prognosis [11, 26, 46].
The limitations of this study were the small sample size and the
possibility of observer bias. Further study can be done to evaluate
the various treatment approaches in managing cases with different
severity of crowding and vertical growth pattern.
Our institution is passionate about high quality evidence based
research and has excelled in various fields [2, 8, 10, 16, 20-25,
31-34, 38, 49, 55, 58]. We hope this study adds to this rich legacy.
Figure 1. Bar chart showing the frequency distribution of gender. X-axis represents gender and Y-axis represents the number of patients with crowding. Blue color denotes male Patients and purple color denotes female patients. Mandibular arch crowding was common in male patients (54.3%) than female patients (45.7%).
Figure 2. Bar chart showing the frequency distribution age group. X-axis represents the age and Y-axis represents the number of patients with crowding. Purple denotes child, blue denotes adolescent and red denotes adult. Mandibular arch crowding was common in adults (44.9%), followed by adolescent (31.5%) and child (23.6%).
Figure 3. Bar chart depicting the association of gender with the severity of crowding. X-axis represents the gender and Y axis represents the number of patients with crowding. Blue color denotes mild, green color denotes moderate and brown color denotes severe. Chi-Square test was done and association was found to be not statistically significant. Pearson Chi-square value: 1.948a, df: 2, p-value: 0.378 (>0.05). Mild crowding was common in females and moderate and severe crowding were common in males but no significant difference was present.
Figure 4. Bar chart depicting the association of age with the severity of crowding. X-axis represents the age and Y-axis represents the number of patients with crowding. Blue color denotes mild, green color denotes moderate and brown color denotes severe. Chi-Square test was done and association was found to be not statistically significant. Pearson Chi-square value: 7.202a, df: 4, p-value: 0.127 (>0.05). Mild and severe crowding were common in adults and moderate crowding was common in children but no significant difference was present.
Figure 5. Bar chart showing the frequency distribution of types of malocclusion. X-axis represents the type of malocclusion and Y-axis represents the number of patients with crowding. Green color denotes class I, red color denotes class II and pink color denotes class III. Mandibular arch crowding was common in class I (56.7%) followed by class II (39.4%) and class III (3.9%) malocclusion.
Figure 6. Bar chart depicting the association between type of malocclusion and severity of crowding. X-axis represents the type of malocclusion and Y-axis represents the number of patients with crowding. Chi-Square test was done and association was found to be not statistically significant. Pearson Chi-square value: 2.668a, df: 4, p-value: 0.651 (>0.05). Mild (59%), moderate (54.3%) and severe (54.8%) crowding were common in class I malocclusion but no significant difference was present.
Conclusion
Within the limitations of the study, it can be concluded that the
prevalence of crowding in subjects with vertical growth patterns
was 72% and no differences among age, gender and type of malocclusion
with severity of crowding was noted.
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