Cephalometric study of the relationship between

Translational Research in Anatomy 12 (2018) 20–24

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Translational Research in Anatomy journal homepage: www.elsevier.com/locate/tria

Cephalometric study of the relationship between facial morphology and ethnicity: Review article

T

Williams Kweku Darkwaha,b,∗, Alhassan Kadrib, Buanya Beryl Adormaaa,b, Gideon Aidoob,c a Key Laboratory of Integrated Regulation and Resource Development on Shallow Lakes, Ministry of Education, Environmental Engineering Department, College of Environment, Hohai University, Nanjing, China b Clinical Research Laboratory Department, Holy Family Hospital, Nkawkaw, Ghana c Clinical Research Laboratory Department, 37- Military Teaching Hospital, Accra, Ghana

A R T I C LE I N FO

A B S T R A C T

Keywords: Preliminary cephalometric Facial morphology Cephalometric analysis Cephalometrics indices Cephalometrics methods

Morphology of the face depends on many factors such as sex, ethnicity, race, climate, nutrition, genetic constitution and socio-economic status. The goal of cephalometrics, at its most fundamental level, is to compare the patient or victim with a normal reference group, so that differences between the person's actual facial morphology and those expected for his or her racial or ethnic group are revealed. This study therefore, was designed to examine the review on a preliminary cephalometric study of the relationship between facial morphology and ethnicity. Here, we review contemporary advancement in the importance of cephalometry, cephalometric analysis, cephalometric methods and cephalometric indices in relation to facial morphology and ethnicity. The present study gives an account of full knowledge of the use of the outstanding knowledge of preliminary cephalometric study of the relationship between facial morphology and ethnicity in anatomy, forensic study and related.

1. Introduction Anthropometry is an essential tool of biological anthropology which involves a series of standardized measuring techniques that express quantitatively the dimensions of human body. Cephalometry is one of the disciplines of anthropometry which deals with the measurement of the head and face of living human beings and cadavers. Direct facial anthropometry is considered a gold standard method in assessing facial dimensions [17] (see Tables 1 and 2). Cephalometry has been widely used by many researchers for sex estimation. Determination of sex is of fundamental importance both for personal identification in forensic science as well as population data studies [56]. Sex is generally inferred from facial morphology which is highly reliable. The ultimate aim of determining sex in forensic science is to help law enforcement agencies in achieving personal identity in medico-legal cases like mutilated and decomposed body parts. In many cases cephalofacial dimensions are the only means of evidence for forensic examination. Such studies are also useful in forensic and clinical medicine, plastic and oral surgery, facial reconstruction and research. The goal of cephalometrics, at its most fundamental level, is to

compare the patient or victim with a normal reference group, so that differences between the patient's or victim actual facial morphology and those expected for his or her racial or ethnic group are revealed. This type of cephalometric analysis was first popularized after World War II in the form of the Downs analysis, developed at the University of Illinois and based on skeletal and facial proportions of a reference group of twenty-five untreated white adolescents selected [36]. Cephalometric measurements enjoy several unique characteristics that will simplify the work necessary to add them to an existing terminology standard. The set of cephalometric index study is relatively small. Comprehensive atlases [10,46] [50]; list fewer than 200 cephalometric study; current research papers commonly list twenty to thirty separate studies on cephalometry. Over the last decade, there has been a rise in the occurrence of disasters such as floods, earthquakes, typhoons, fire, road traffic accidents etc. In such situations, it becomes difficult to determine the sex of the dead victims especially bodies that have decomposed. In most countries, facial recognition systems based on cephalometry are used in combination with dental records to identify such victims. Therefore, the present study was designed to examine the review on a preliminary cephalometric study of the relationship between facial morphology and

∗ Corresponding author. Key Laboratory of Integrated Regulation and Resource Development on Shallow Lakes, Ministry of Education, Environmental Engineering Department, College of Environment, Hohai University, Nanjing, China. E-mail addresses: [email protected], [email protected], [email protected] (W.K. Darkwah).

https://doi.org/10.1016/j.tria.2018.07.001 Received 5 April 2018; Received in revised form 9 May 2018; Accepted 21 July 2018 Available online 24 July 2018 2214-854X/ © 2018 Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).


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Table 1 Comparison of selected Cephalometric analysis tools. Cephalometric Analysis Tool 1. Steiner's analysis 2. Downs analysis 3. McNamara analysis 4. Riketts analysis

Comparison 1 Gives an interrelationship of measurement from lateral radiography into patterns. 2 This provided better comparison among Bangladesh and Caucasians subjects 1 Provides comparison between an ideal profile, skeletal relationship and occlusion of patient based on specific linear and angular measurement. 1 This is mainly use to determine jaw and tooth 2 It does not provide an accurate analysis for craniofacial relationships 1 It determines the proper spatial relationship of the jaw and the tooth.

Table 2 Summary of the Cephalometric indices in relation to Ethnicity and Sex. Cephalometrics Indices in Relation to Sex

Cephalometrics Indices in Relation to Ethnicity

1. Filipino males have longer anterior cranial base, total facial height, longer lower anterior facial height, longer ramus height, longer lower posterior dentoalveolar height and total mandibular length than the females 3. Nigerian males have protrusive upper and lower lips than the females

2. Chinese subjects when compared with European-Americans had less convex faces, retrognathic chin, acute nasolabial angle and more protrusive lips than the EuropeanAmerican subjects 2. Bangladeshi adults had smaller mandibular plane angle and larger facial axis angle compared with the Japanese group 3. There is also a significant facial soft tissue profile difference between adolescents from Nigeria, Ghana and Senegal compared to Caucasian adolescents

4. Upper and lower lips were more protrusive in the Chinese males and a more convex facial profile was seen compared with the Caucasian males

2.2. Importance of cephalometry

ethnicity. In this review, we mainly concentrated on the most contemporary advances on the preliminary cephalometric study of the relationship between facial morphology and ethnicity. We happen to present the novel ideal on cephalometric analysis, and cephalometric methods approaches for forensic, anthropology and related studies and then emphasized the enlightened concepts on extending the importance of cephalometry. Next, the general review on cephalometric indices in relation to facial morphology and ethnicity were summarized. Also, the research challenges on cephalometric indices in relation to facial morphology and ethnicity and the perspectives in future researches were also advocated.

The face is used as the first step in the evaluation of patients who present for facial cosmetics or reconstructive surgery [64]. It is an important aspect of the initial encounter, as it helps to formulate the goal and desired outcome of the proposed surgical procedure. This is because the facial beauty arises from the symmetric balance and the harmonious proportion of the skeletal, dental and the soft tissue [32]. Cephalometric evaluation of the soft tissue facial profile is used to determine which surgical modalities will lead to a favorable function and aesthetic outcome, especially in more complex cases involving orthogenetic surgery [39]. In recent years, it is getting very important to establish identity to an individual. Biometric is superior to any other authentication system. But such systems are weak and disposed to a number of attacks like storage template attack which is the most common [30]. There has been a lot of improvement to develop the systems, but some issues related to its use by a disabled person also exist. In disabled persons who cannot be identified biometrically, facial recognition using cephalometry can be used to identify them. A new strong and reliable cephalometric system for facial recognition has been proposed. The system takes human skull x-ray as input, extract it features and then compares it with the real time x-ray image [58]. The most reliable method used in identifying dead persons is DNA analysis. This method however is time consuming as well as expensive, and may not be possible if the remains are extremely degraded or expose to extreme environmental conditions. In such cases radiographic cephalometric evaluation of the frontal sinuses becomes valuable especially where only the skull of the remains can be used for identification [45]. The frontal sinuses are absent at birth, but are generally fairly well developed between the seventh and eight years, only reaching their full size after puberty [24]. Skeletal components play a significant role in sex determination in forensic investigation. The skull is considered the best, after the pelvis in determination of sex. Methods based on morphological characteristics and morphometrics are already in used with reasonable accuracy. But standardized radiographic techniques like cephalometry have advantages of being more precise and objective when compared with morphometric methods. For this reason, cranio-mandibular parameters of lateral cephalometric radiograph can be used to determine sex in forensic investigations [12].

2. Review 2.1. Cephalometry Cephalometry is the scientific measurement of the dimensions of the head, taken either directly or by radiography with relation to specific reference points and sufficient standardization to assess facial growth and development [49]. Cephalometry is a reliable and reproducible diagnostic technique mostly used in clinical orthodontics research. Beside its use in orthodontic treatment and orthognatic surgery, analysis of cephalometry is also used in the evaluation of ethnic groups in forensic science [35]. A reliable and reproducible cephalometric measurement and analysis depends on the position of the head [48]. Standardized and reproducible natural head position in an upright posture with the eyes focused on a point in a distance at eye level is taken into consideration. This implies that the cephalometric measurement is more effective when visual axis is horizontal [41]. Natural head position provides the key for meaningful cephalometric analysis. This is because an extra cranial reference line is used instead of intracranial reference line, which is known to be subjective to considerable biological variations in its inclination. Although the principle of natural head position is being recognized in orthodontic literature, its registration may contain an element of unavoidable errors that require corrections. These errors are as a result of variations in the position of the head during cephalometric measurements. To maximize the contribution of natural head position in cephalometry, clinicians and researchers try to eliminate or reduce to the bearest minimum these errors such that the measurements taken are almost closer to the true values [38]. 21


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shorter maxilla, larger upper anterior face height and lower posterior dental height than Burstone white. The soft tissue analysis showed a retrognathic maxilla and mandible in relation to soft tissue glabella and bilabial protrusion [4]. The soft tissue of both Yemeni esthetically pleasing men and Yemeni esthetically non-pleasing men showed differences in mandibular prognathism, lower face-throat- angle, nasolabial angle, mentolabial sulcus depth and interlabial gap. Yemeni esthetically pleasing men showed less obtuse facial convexity angle than the Yemeni esthetically non-pleasing men [5]. McNamara analysis [65] is specifically used to determine jaw and tooth. As with all the analyses, McNamara is not a completely accurate analysis for craniofacial relationships. Analysis of Anatolian Turkish showed shorter midfacial and mandibular lengths, and more protrusive maxilla and mandible [22]. Chinese subjects exhibited mandibular plane and maxillomandibular difference, upper incisor and lower incisor line which were larger than Caucasians. On the other hand, effective midfacial length, facial axis angle and pogonion-to-nasion perpendicular were larger in Caucasians compared to the Chinese [34]. Riketts analysis [62] determines the proper spatial relationship of the jaw and the tooth. Using Riketts analysis Iranian adults showed retruded upper and lower lip position in). Both sexes and more convex profile than European standard. This may be due to a more retruded position of the chin and lips or more prominence of the nose in Iranian samples [18]. Since Broadbent [9] and Hofrath [25] introduced the cephalometer in 1931, cephalometric analysis has contributed to the analysis of malocclusion and related, and it has become a standardized diagnostic method in orthodontic, forensic practice and anatomy research [7,19].

2.3. Cephalometric methods Cephalometric measurements can be done using either a digital tracing method or a manual (conventional) hand tracing method. The conventional cephalometric measurement is done by either tracing radiographic landmarks or measuring linear or angular values or by directly measuring specific landmarks on the facial soft tissue. However, despite its widespread use in orthodontics and research, the technique is time-consuming and has several drawbacks, including a high-risk of error in tracing landmarks, identification and measurement. Cephalometric errors can be divided into those related to the acquisition, identification and technical measurement. Reproducibility of measurement by the operator is also a significant factor in determining the accuracy of any method of analysis [2]. In the conventional cephalometric measurements, tools such as cephalometre, transparent graded ruler and sliding calipers can be used. The transparent graded ruler can be used to measure nasal width, whiles the sliding calipers can be used to measure head length, head width, skull height, upper and lower facial length and total facial length [59]). The use of digital method is expected to reduce the incidence of personal errors due to operator fatigue and provide standardized, fast and effective evaluation with high rate of reproducibility. With the rapid evolution of computer radiography, digital tracing has slowly replaced the manual tracing method. The use of both digital radiography and conversion of manual films to digital format offers several advantages. It is easy to use, saves time, promises convenience when generating treatment prediction, provides the option to manipulate the size and contrast of the image and also provides the ability to archive and improves access to image to overcome the problem of film deterioration [15]. For instance, A plethora of in vitro and in vivo studies have been carried out on the subject of root canal anatomy using a range of investigative techniques to analyze morphology, including tooth demineralization [3,13,42,51,52], inspection of cross-sections [20], scanning electron microscopy, classic [43] and digital [14] radiographic techniques and cone beam computed tomography (CBCT) [8,14] and these are new digital techniques for cephalometric analysis. Both the digital tracing and the conventional tracing methods when used simultaneously, showed reproducibility for most of the parameters [44]. The digital method has an advantage over the conventional method because it is user friendly and time saving thus, making it the preferred method [11]. The advancement from full manual or conventional cephalometrics to computer assisted-cephalometric or digital analysis is aimed at improving the diagnostic value of cephalometric analysis by reducing errors and saving time. Errors in cephalometric analysis are usually systematic or random errors [26,27].

2.5. Cephalometrics indices in relation to ethnicity The facial profile of the human is classified into three shapes namely straight, convex and concave. These facial profiles are used in the recognition of individuals [60]. Cephalometrics of soft tissue profile differs from one ethnic group to the other. Because of these differences, ethnicity must be considered when formulating orthodontic treatment plan for patients from varying ethnic background [28]. Craniofacial cephalometric analysis of Bangladeshi and Japanese adults showed that, the mandibular antero-posterior position in the Bangladeshi was more protrusive compared with that of the Japanese. In the vertical plane, Bangladeshi adults had smaller mandibular plane angle and larger facial axis angle compared with the Japanese group. Furthermore, the Bangladeshi adults had smaller lower facial height and a more protruded upper incisor than the Japanese group. The thickness of the soft tissue chin in the Bangladeshi adults was thinner than that of the Japanese group [6]. Chinese subjects when compared with European-Americans had less convex faces, retrognathic chin, acute nasolabial angle and more protrusive lips than the European-American subjects [33]. North Indian subjects showed convex profile, more obtuse lower face-throat angle, acute nasolabial angle, protrusive lips and shorter interlabial gap when compared with the European-American subjects [31]. Comparison of black Brazilian subjects with white Brazilian subjects showed that, the black Brazilian subjects had a more protruded maxilla and mandible, a smaller chin prominence and a greater maxillomandibular discrepancy than the white Brazilian subjects. A more horizontal craniofacial growth pattern and a more protruded and proclined maxillary and mandibular incisor was seen among the black Brazilian subjects. The black Brazilian subjects also had smaller nasolabial angle and a more protrusive upper and lower lip than the white Brazilian subjects [37]. Soft tissue cephalometric analysis of Saudis and Caucasian Americans showed significant differences in most of the soft tissue variable [23]. There is also a significant facial soft tissue profile difference between adolescents from Nigeria, Ghana and Senegal compared to Caucasian adolescents. The greatest interethnic variability in

2.4. Cephalometric analysis Steiner's analysis [57] provides an interrelationship of measurement from lateral radiography into patterns. In this analysis, angles are connected to define hard and soft tissue landmarks. Comparison of Bangladesh subjects and Caucasians using Steiner's analysis [57] showed that the Bangladesh subjects had more protrusive cranial and dental features than Caucasians. Furthermore their mandibular plane angle was larger than that of the Caucasians, suggesting more prominent horizontal growth in the Bangladeshi subjects [47]. On other hand, Mewari children had retrusive mandible relative to cranial base, proclined maxillary and mandibular teeth, with greater convexity of face. They also showed anteriorly placed occlusal plane to cranium and less prominent chin [55]. Downs analysis [53] is based on the skeletal and facial proportion of adolescents with ideal occlusion and facial proportion. In this analysis specific linear and angular measurements are chosen to the basis for specific comparison between an ideal profile, skeletal relationship and occlusion of patient. Downs analysis [53] of Japanese adults showed 22


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Acknowledgements

facial proportions exists in the height of the forehead. More pronounced differences among ethnic groups are also present in the measurement of the eyes, nose and the mouth [16].

The authors are grateful to the College of International Education, Hohai University, Nanjing, China and Clinical Research Laboratory Department, Holy Family Hospital, Nkawkaw, Ghana for their support. Williams Kweku Darkwah was the recipient of a scholarship from the China Scholarship Council (CSC) for the duration of this work.

2.6. Cephalometrics indices in relation to sex Soft tissue profile shape variability relates mainly to the convexity of face, relative lip protrusion and lower lip shape. These shape differences seemed to exist between sexes even before the puberty growth spurt, but were small [21]. The skeletal components also play a significant role in sex determination in forensic science and anthropological fields. Cephalometric craniofacial parameters such as bizygomatic width, ramus height, upper facial height and depth of face have contributed in sex determination among South Indians and immigrant Tibetans [61]. Relevant quantification of cephalometric parameters for Filipinos showed that, the males have longer anterior cranial base, total facial height, longer lower anterior facial height, longer ramus height, longer lower posterior dentoalveolar height and total mandibular length than the females. Convexity due to dentoalveolar protrusion is the naturally occurring facial profile for Filipinos [40]. Cephalometric investigation of horizontal lip protrusion in Nigerian adults showed that, the males have protrusive upper and lower lips than the females [29]. Central Indian females showed a greater posterior cranial base, greater mandibular protrusion, retrusive chin and a greater upper anterior facial height when compared with Caucasian females. They also showed a greater maxillary lip length, greater ramal length, greater mandibular body length, reduced chin length and greater inclination of the lower incisor than the Caucasian females [1]. When Chinese young adults were compared with the Caucasians young adults, the Chinese females had smaller midfacial and mandibular length than the Caucasian females. The average value of the lower anterior face height was longer in the Chinese females than the Caucasian females. A greater vertical dimension was also seen in Chinese males compared with Caucasian males when evaluated by analysis of the facial axis angle. Furthermore the upper and lower lips were more protrusive in the Chinese males and a more convex facial profile was seen compared with the Caucasian males [63].

References [1] O.Y. Abilasha, S.W. Chanjyot, M.B. Rajiv, H.C. Kivan, R. Ritesh, N.D. Abhay, Cephalometric norms for central Indian population using Burstone and Legan analysis, Indian J. Dent. Res. 22 (1) (2011) 28–33. [2] N. Agarwal, D.K. Bagga, P. Sharma, A comparative study of cephatometric, EJO (Eur. J. Orthod.) 30 (2011) 586–591. [3] A.M. Alavi, A. Opasanon, Y.-L. Ng, K. Gulabivala, Root and canal morphologyof Thai maxillary molars, Int. Endod. J. 35 (2002) 478–485. [4] R.E. Alcalde, T. Jinno, M.A. Pogrel, T. Matsumura, Cephalometric norm in Japanese adults, J. Oral Maxillofac. Surg. 56 (2) (1998) 129–134. [5] T. Al-Gunaid, K. Yamada, M. Yamaki, I. Jaito, Soft tissue cephalometric norm in Yemeni men, Am. J. Orthod. Dentofacial Orthop. 132 (5) (2007) E7–E14 576. [6] A. Ali, Y. Massaki, H. Zakir, S. Isao, Craniofacial cephalometric analysis of Bangladeshi and Japanese adults with normal ocllusion and balanced faces: a comparative study, J. Orthod. Sci. 2 (1) (2013) 7–15. [7] S. Baumrind, D.M. Miller, Computer-aided head film analysis: the University of California San Francisco method, Am. J. Orthod. 78 (1980) 41–65. [8] T.C. Blattner, N. George, C.C. Lee, V. Kumar, C.D.J. Yelton, Efficacy of cone-beam computed tomography as a modality to accurately identify the presence of second mesiobuccal canals in maxillary first and second molars: a pilot study, J. Endod. 36 (2010) 867–870. [9] B.H. Broadbent, A new x-ray technique and its application to orthodontia, Angle Orthod. 1 (1931) 45–66. [10] B.S. Broadbent, B.H. Broadbent Jr., W.H. Golden, Bolton standards of Dentofacial Developmental Growth, Mosby, St. Louis, 1975. [11] E. Celik, O. Polat-Ozsoy, T.U. Toygar Meminkoglu, Comparison of cephalometric measurement with digital versus conventional cephalometric analysis, EJO (Eur. J. Orthod.) 31 (3) (2009) 241–246. [12] D.D. Darshan, J. Jacod, A.A. Abdulaziz, K.R. Ravi, M. Seem, A.A. Obaid, Craniomandibular parameters of lateral cephalometric radiograph to determine sex in forensic investigation, J. Forensic Sci. 21 (2) (2015) 98–104. [13] Q. De Deus, B. Horizonte, Frequency, location, and direction of the lateral, secondary, and accessory canals, J. Endod. 1 (1975) 361–366. [14] J.D. Domark, J.F. Hatton, R.P. Benison, C.F. Hildebolt, An ex vivo comparison of digital radiography and cone-beam and micro computed tomography in the detection of the number of canals in the mesiobuccal roots of maxillary molars, J. Endod. 39 (2013) 901–905. [15] D.P. Dvortsin, A. Sardham, G.J. Pruin, P.U. Dijkstra, A comparison of the reproducibility of manual tracing and on-screen digitization for cephalometric profile variable, EJO (Eur. J. Orthod.) 30 (2008) 586–591. [16] P. Fang, P.J. Clapham, C.K. Chung, A systematic review of interethnic variability in facial dimension, Plast. Reconstr. Surg. 127 (2) (2011) 874–881. [17] L.G. Farkas, M.J. Katic, C.R. Forest, K.W. Alt, I. Bagic, G. Baltadjev, International anthropometric study of facial morphology in various ethnic group/race, J. Craniofac. Surg. 126 (2005) 615–646. [18] G.J. Fataneh, K. Mashaallah, Soft tissue facial profile and anteroposterior lip position in Iranians, J. Dent. Sch. 32 (2) (2014) 90–95. [19] D.B. Forsyth, W.C. Shaw, S. Richmond, C.T. Roberts, Digital imaging of cephalometric radiographs, Part 2: image quality, Angle Orthod. 66 (1996) 43–50. [20] D. Green, Double canals in single roots, Oral Surg. Oral Med. Oral Pathol. 35 (1973) 689–696. [21] D. Halazonetis, Morphometric evaluation of soft tissue profile shape, Am. J. Orthod. Dentofacial Orthop. 131 (4) (2007) 481–489. [22] A. Halise, N. Zaur, T.M. Unfule, Turkish norm of McNamara's cephalometric analysis, Turkish J. Orthod. 27 (3) (2014) 100–105. [23] H.A. Hashim, S.F. Al-Baraka, Cephalometric soft tissue profile analysis between two different ethnic groups; a comparative study, J. Contemp. Dent. Pract. 4 (2) (2003) 60–73. [24] M. Hemant, M. Aditi, A. Junaid, K. Manisha, T. Payal, Conventional frontal sinus imaging in identification of sex: original study in population of Udaipur City India, J. Med. Sci. Clin. Res. 1 (1) (2013) 33–37. [25] H. Hofrath, Die Bedeutung der Röntgenfern- und Abstandsaufnahme fü r die Diagnostik der Kieferanomalien, Fortschr Orthod. 1 (1931) 232–258. [26] W.J. Houston, R.E. Maher, D. McElroy, M. Sherriff, Sources of error in measurements from cephalometric radiographs, Eur. J. Orthod. 8 (1986) 149–151. [27] W.J. Houston, The analysis of errors in orthodontic measurements, Am. J. Orthod. 83 (1983) 382–390. [28] H.S. Hwang, W.S. Kim, J.A. McNamara Jr., Ethnic differences in the soft tissue profile of Korean and European – American with normal occlusion and well balanced faces, Angle Orthod. 72 (1) (2002) 72–80. [29] G. Ikenna Isiekwe, O. Olatokunbo DaCosta, M.A. Chukwudi Isiekwe, Cephalometric investigation of horizontal lip position in adult Nigerians, J. Orthod. 39 (3) (2012) 160–169. [30] A.K. Jain, A. Ross, S. Prabakar, Biometrics: a tool for information security, Forensic

3. Conclusions In conclusion, this review climaxes the current advances on the preliminary cephalometric indices of the relationship between facial morphology and ethnicity. Understandably, cephalometric index study has been one of the greatest promising research areas in anatomy and forensic science. From the review, the discussion provided a better understanding of cephalometric indices in relation to ethnicity. It is expected to serve as a valuable source of information for scientists that would enlighten them in understanding the need to adhere to practices and to employ an alternative procedure that is in forensic science, anatomy, physiology and related. In view of that, more studies are also needed on measurement and analysis of the cephalometric index. Conflicts of interest The Authors declare that they have no conflict of interest. Ethical statement Research was performed in accordance with the laboratory ethics in Hohai University, Nanjing, China. Financial statement There was no funding for this research. 23


W.K. Darkwah et al.

[48] W.P. Rock, A.M. Sabieha, R.I.W. Evans, A cephalometric comparison of skulls from the fourteenth, sixteenth and twentieth centuries, Br. Dent. J. 200 (2006) 33–37. [49] J. Rustemeyer, A. Martin, Assessment of soft tissue changes by cephalometry and Two-Dimensional photometry in bilateral sagittal split ramus oesteotomy cases, J. Oral Maxillofac. Res. 2 (3) (2011) e2. [50] S.S. Saksena, G.F. Walker, D. Bixler, P. Yu, A Clinical Atlas of Roentgenocephalometry in Normalateralis, Liss, New York, 1987. [51] S. Sert, G. Sahinkesen, u, F.T. Topc, S.E. Ero˘glu, E.A. Oktay, Root canal con-figurations of third molar teeth. A comparison with first and second molars in the Turkish population, Aust. Endod. J. 37 (2011) 109–117. [52] S.J. Sidow, L.A. West, F.R. Liewehr, R.J. Loushine, Root canal morphology of human maxillary and mandibular third molars, J. Endod. 26 (2000) 675–678. [53] C. Sforza, G. Grani, M. De Menezes, G.M. Tartagila, V.F. Ferrario, Age and sex related changes in the human external nose, Forensic Sci. Int. 204 (2010) 205.e1–205.e9. [55] R.A. Singh, V. Dhar, R. Arora, A. Diwanji, Cephalometric norm for Mewari children using Steiner's analysis, Int. J. Clin. Pediatr. Dent. 5 (3) (2012) 173–177. [56] C.N. Stephan, R.M. Norris, M. Hennegerg, Does sexual dimorphism in facial soft tissue depth justify sex distinction in craniofacial identification? J. Forensic Sci. 50 (2005) 513–518. [57] C. Steiner, Cephalometric for you and me, Am. J. Orthod. 39 (10) (1953) 729–755. [58] T. Uma, Cephalometric analysis of the skull for Biometric, Int. J. Eng. Res. Gen. Sci. 3 (4) (2015) 359–362. [59] M.B.F. Umar, R. Singh, A.I. Shugaba, Cephalometric indices among Nigerians, J. Appl. Sci. 6 (2006) 934–942. [60] H. Utsuno, J. Kageyama, K. Uchid, K. Kibayashi, Facial soft tissue thickness differences among three skeletal class in Japanese population, Forensic Sci. Int. 236 (2014) 175–180. [61] G.N. Vankatesh, S. Rahul, M. Sunil, Determination of sex in South Indians and immigrating Tibetans from cephalometric analysis and discriminant functions, Forensic Sci. Int. 197 (1–3) (2010) 122.e1–122.e6. [62] A. Verdnock, M. Gaethof, C. Carels, F. Zegher, Effect of low dose testosterone treatment on craniofacial growth in boys with delayed puberty, EJO (Eur. J. Orthod.) 21 (1999) 137–143. [63] G. Yan, A.M. James, M.S. Lauren, B. Tiziano, Comparison of craniofacial characteristics of typical Chinese and Caucasian young adults, EJO (Eur. J. Orthod.) 3 (2) (2011) 205–211. [64] J.K. Young, W.P. Jang, M.K. Jeong, H.P. Sun, H.H. Jae, S.K. Kwang, Y.L. Sam, H.S. Jun, The functioning of facial appearance and its importance to Korean population, Arch. Plast. Surg. 40 (6) (2013) 715–720. [65] A. Zankl, L. Eberle, L. Molinari, A. Schinzel, A growth chart for nose length, nasal protrusion and philitrum length from birth to 97 years, Am. J. Med. Genet. 111 (2002) 388–391.

Sci. Int. 14 (1) (2004) 4–20. [31] P. Jain, J.P.S. Kalra, Soft tissue cephalometric norms for north Indian population group using Legan and Burstone analysis, Int. J. Oral Maxillofac. Surg. 40 (3) (2011) 255–259. [32] P. Jennifer, L.O. Krista, Anthropometric facial analysis of the African – American women, J. Facial Plast. Surg. 3 (2001) 191–197. [33] T. Jinno, M.G. Orsina, A. Sasaki, R.E. Alcalde, R.M. Sugiyama, T. Matsumura, Soft tissue caphalometric norms in Japanese adults, Am. J. Orthod. Dentofacial Orthop. 118 (1) (2000) 84–89. [34] Wu John, Hagg Urban, A. Black, M. Rabie, Chinese McNamara's cephalometric analysis, Angle Orthod. 77 (1) (2007) 12–20. [35] L. Kavitha, K. Karthik, Comparison of cephalometric norms of Caucasians and NonCaucasions: a forensic aid in ethnic determination, J. Forensic 4 (1) (2012) 53–55. [36] S. Kazandjian, S. Kiliaridis, A. Mavropoulos, Validity and reliability of a new edgebased computerized method for identification of cephalometric landmarks, Angle Orthod. 76 (4) (2006) 619–624 [PubMed: 16808568]. [37] M.A.F. Livia, M.S.F. Karina, P. Arnaldo, J. Guilherme, R.F. Marcos, A comparison of skeletal, dentoalveolar and soft tissue characteristics in white and black Brazilian subjects, J. Appl. Oral Sci. 18 (2) (2010) 135–142. [38] A. Lundstrom, F. Lundstrom, L.M.L. Labret, C.F.A. Moorrees, Natural head position and natural orientation: basic consideration in cephalometric analysis and research, Eur. J. Orthod. 17 (2) (1995) 111–120. [39] A.G.N. McCollum, W.G. Evans, Facial tissue: the alpha and omega of treatment planning in orthognatic surgery, Semin. Orthod. 15 (3) (2009) 196–216. [40] M.A. Moldez, K. Sato, J. Sugawara, H. Mitani, Linear and angular Filipino cephalometric norms according to age and sex, Angle Orthod. 7 (5) (2006) 800–805. [41] B. Naveen, S. Jaefinder, G. Gumeet, G. Monika, K. Gurpreat, Reliability of natural head position in orthodontic diagnosis; A cephalometric study, Contemp. Clin. Dent. 3 (2) (2012) 180–183. [42] J.D. Pecora, J.B. Woelfel, M.D. Sousa Neto, E.P. Issa, Morphologic study of the maxillary molars. Part II—internal anatomy, Braz. Dent. J. 3 (1992) 53–57. [43] F. Pineda, Y. Kuttler, Mesiodistal and buccolingual roentgenographic inves-tigation of 7,275 root canals, Oral Surg. Oral Med. Oral Pathol. 33 (1972) 101–110. [44] O. Polat-Ozsoy, A. Gokcelik, M.T.U. Toygar, Differences in cephalometric measurements: a comparison of digital versus hand tracing methods, EJO (Eur. J. Orthod.) 31 (3) (2009) 254–259. [45] A. Pretty, D. Sweet, The role of teeth in the determination of human ientity, Br. Dent. J. 190 (2001) 359–366. [46] M.L. Riolo, R.E. Moyers, J.A. McNamara Jr., W.S. Hunter, Craniofacial Growth Series vol. 2, Center for Human Growth and Development, Ann Arbor, MI, 1974 (An atlas of craniofacial growth). [47] H.M. Rizvi, M.Z. Hossain, Cephalometric norm of young adults of Bangladesh (Steiner's analysis): preliminary report, Bangladesh J. Orthod. Dento. Facial Orthop. 2 (1) (2011) 11–15.

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