Assessment of antero-posterior skeletal relationships in adult Korean patients in the natural head position and centric relation

Jang-Hoon Ahn; Kwang-Hak Bae; Young-Ju Park; Ryoon-Ki Hong; Joeng-Hun Nam; Mi-Ja Kim

doi:10.4041/kjod.2010.40.6.421

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Assessment of antero-posterior skeletal relationships in adult Korean patients in the natural head position and centric relation

Original Article

Korean J Orthod 2010;40(6):421-431.

Published online: 19 January 2010

DOI: https://doi.org/10.4041/kjod.2010.40.6.421

Assessment of antero-posterior skeletal relationships in adult Korean patients in the natural head position and centric relation

Jang-Hoon Ahn, DDS, MSD, PhD^a, Kwang-Hak Bae, DDS, MSD, PhD^b, Young-Ju Park, DDS, MSD, PhD^c, Ryoon-Ki Hong, DDS, PhD^d, Joeng-Hun Nam, DDS, MSD, PhD^e, Mi-Ja Kim, DDS, MSD, PhD^f

^aAssociate Professor, Department of Orthodontics, Kangnam Sacred Heart Hospital, Hallym University

^bAssistant Professor, Department of Preventive Dentistry, School of Dentistry, Seoul National University

^cProfessor, Department of Oral and Maxillofacial Surgery, Kangnam Sacred Heart Hospital, Hallym University

^dChairman, Department of Orthodontics, Chong-A Dental Hospital

^eAssistant Professor, Department of Oral and Maxillofacial Surgery, Kangnam Sacred Heart Hospital, Hallym University

^eAssistant Professor, Department of Orthodontics, Hangang Sacred Heart Hospital, Hallym University

Corresponding author: Mi-Ja Kim. Department of Orthodontics, Hangang Sacred Heart Hospital, Hallym University, 94-200 Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul 150-719, Korea. ＋82 2 2639 5580; e-mail, aurora0@hanmail.net.

Received 10 February 2010 Revised 11 June 2010 Accepted 14 June 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

This study aimed to verify the intra-individual reproducibility of the natural head position (NHP) in adult Korean patients in the centric relation (CR) position and to prove the inter-individual variability of the Frankfurt horizontal (FH) plane and sella-nasion (SN) line compared to the true horizontal line (THL). In addition, the study aimed to investigate the correlations between linear measurements from A-point and B-point to the nasion true vertical line (NTVL) and angular measurements from A-point and B-point to the SN line.

Methods:

Two lateral cephalograms were taken of 116 subjects (23 males, 93 females) with CR wax bites in a NHP at a one-week interval.

Results:

Method errors of three variables and intraclass correlation coefficients of six parameters proved the intra-individual reproducibility of NHP (p ＜ 0.001). The angle of the FH to the THL was not significantly different from 0° (p ＞ 0.05), but it was clinically variable (SD 3.89°) on the inter-individual level. Conversely, the angle of the SN line to the THL was significantly different from 7° (p ＜ 0.05). Very low correlation was found between the linear measurements and angular measurements of A-point and B-point (p ＜ 0.01).

Conclusions:

The NTVL could be a useful reference line for assessing the antero-posterior position of the maxilla and mandibleof Korean adult patients in NHP and CR.

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Keywords: Natural head position, Centric relation, Frankfurt horizontal plane, Sella-nasion line, Nasion true vertical line

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Fig 1.

Registration of the centric relation wax bite. A, Guiding the mandible using the tripoding method; B, centric relation wax bite (anterior and posterior portion).

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Fig 2.

Registration in the natural head position and lateral cephalogram. A, Subjects looked into their eyes in the mirror (orthoposition); B, standing position with arms and chin relaxed.

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Fig 3.

Reference points used in this study.

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Fig 4.

Reference planes used in this study. 1, Nasion true vertical line (NTVL) passing through the nasion point perpendicular to the floor; 2, E-line, tip of nose-soft tissue pogonion; 3, cervical vertebrae tangent-plane the posterior tangent to the odontoid process through cv4ip; 4, odontoid process tangent plane, the posterior tangent to the odontoid process through cv2ip; 5, palatal plane, ANS-PNS; 6, true horizontal line passing through nasion point perpendicular to the NTVL; 7, sella-nasion plane; 8, Frankfurt horizontal plane, porion-orbitale.

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Fig 5.

Angular measurements. A, 1, Nasion true vertical line (NTVL) to palatal plane; 2, NTVL to E-Line; 3, NTVL to cervical vertebrae tangent; 4, NTVL to sella-nasion (SN); 5, true horizontal line (THL) to odontoid process tangent (OPT); 6, SN to OPT. B, 1, THL to Frankfurt horizontal plane; 2, THL to SN.

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Fig 6.

Linear measurements. A, 1, Nasion true vertical line (NTVL to A-point); 2, NTVL to B-point. B, 1, Sella nasion A-point (SNA) angle; 2, sella nasion B-point (SNB) angle.

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Table 1.

Digitizing method errors (n = 15)

Variables	Degrees
SN/NTVL	0.22
SN/OPT	0.52
OPT/THL	0.46

NTVL,Nasiontrueverticalline;OPT,odontoidprocess tangent;SN,sella-nasion;THL,truehorizontalline.

Table 2.

Positioning method errors (n = 116)

Variables	This study (n=116)	Huggare³³ (n=33)	Solow & Tallgren¹⁹ (n=120)
SN/NTVL	1.06	1.60	1.43
SN/OPT	1.28	1.35	1.43
OPT/THL	0.77	2.10	1.95

Dateareindegrees.NTVL,Nasiontrueverticalline; OPT,odontoidprocesstangent;SN,sella-nasion;THL, truehorizontalline.

Table 3.

Reproducibility of natural head position (NHP by intraclass correlation coefficients (n = 116)

Variables	Average of raters(α)	p-value
NTVL/E-line	0.9925	<0.001
NTVL/palatalplane	0.6102	<0.001
NTVL/CVT	0.9883	<0.001
NTVL/SN	0.9703	<0.001
SN/OPT	0.9815	<0.001
NTVL/OPT	0.9917	<0.001

Table 4.

Differences in Frankfurt horizontal line (FHL) to true horizontal line (THL) and SN to true horizontal line compared to norms (n = 116)

Variables	N	Mean	SD	Min	Max	p-value
THL/FH	116	−0.16	3.89	−12.43	7.65	<0.05
THL/SN	116	9.73	4.60	−2.11	17.50	<0.05

Norms:THL/FH=0

^o ,THL/SN=7

^o .SD,Standarddeviation;Min,minimum;Max,maximum.

Table 5.

Correlations between linear measurements of A-point to nasion true vertical line (NTVL) and sella-naison (SN)-A angles, and linear measurements of B-point to NTVL and SN-B angles using Pearson correlation coefficients (n = 116)

	NTVLA	NTVLB	NTVLA1	NTVLB1	NTVLA2	NTVLB2
SNA	0.094
SNB		0.314^∗
SNA1			0.328^∗
SNB1				0.314^∗
SNA2					0.309^∗
SNB2						0.287^∗

AandB,MeanofT1andT2data;A1andB1,T1data;A2andB2,T2data.

^∗ p <0.01.

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