“CEPHALOMETRIC EVALUATION BASED ON STEINER’S ANALYSIS

ON YOUNG ADULTS OF ASSAM”

Authors :
Dr. Nabanita Baruah, B.D.S.
Post graduate student
Department of Orthodontics
Regional Dental College, Guwahati
E-mail: nabanita.baruah@yahoo.co.in
Ph. No. : 09864091022
Dr. Nabanita Baruah
Dr. Mitali Bora, MDS, FICD (U.S.A.)
Professor and HOD
Department of Orthodontics
Regional Dental College, Guwahati
E-mail: mitalibora@hotmail.com
Ph. No. : 09864032051
Dr. Mitali Bora

Abstract:
A cephalometric study of 70 Assamese young adults (35 male and 35 female) within age range of 18 – 25 years
with acceptable profile and occlusion was carried out by means of the Steiner’s analysis. The purpose of the study
was to establish skeletal & dental parameters for Assamese young adults using Steiner’s analysis, evaluation of
variability between male & female Assamese normal occlusion subjects and comparison of cephalometric norms
of Assamese population with the Caucasians as well as other non-Caucasian groups. Finally all the measurements
were computed statistically. Results showed that in comparison to the Caucasian samples the Assamese samples
were more protrusive skeletally and dentally with a greater tendency towards bimaxillary protrusion. These
differences indicate that fundamental variation exists in the craniofacial structure of Assamese and the Caucasians.
The results of the study support the fact that norms and standards of one racial group could not be used without
modification for other racial group and each different racial group would have to be treated according to its
individual characteristics.

Roentgenographic Cephalometrics was first
introduced as an armamentarium to study craniofacial
growth and development. Later on; it was being used
to study about facial form and its use gradually
extended to development of cephalometric norms to
define the objectives of orthodontic treatment. The
introduction of the cephalometer then started providing
avenues for creation of cephalometric analysis for
clinical diagnosis and treatment planning and soon the
cephalogram became an indispensable weapon in the
armory of an orthodontist for correct diagnosis,
treatment planning, prognostic evaluation and
comparative studies. The Cephalometric norms for
Caucasians for many decades were being applied on
the population groups all over the world. But with time
many investigator’s concluded that there was variation
of the craniofacial morphology between different ethnic
groups.
Thus it became apparent that the widely studied
Caucasian norms which were established by using
various cephalometric analyses were not sufficient to
apply to different racial or ethnic groups Cephalometric
studies on different ethnic groups including those of
Chan’s on Chinese, Garcia’s on Mexican Americans,
Drummond’s on Negroes & Park’s on Korean adults
have indicated that normal measurements of one group
cannot be considered normal for other racial groups.
Investigators such as fujio Miura in Japan, and Carlos J
Garcia in USA. have established their norms on the
basis of Steiner’s analysis. The first cephalometric study
on the Indian population was done by Kotak on
Gujrathi girls and thereafter Nanda, John and Valiathan,
and others have done cephalometric studies on various
population groups of India.
But till date no study has been conducted on the
population of Assam. It was therefore thought pertinent
to undertake such a study for young population of
Assam and observe various hard tissues cephalometric
values by means of Steiner’s analysis with a view to
clinical application of the findings.

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AIM AND OBJECTIVES
The following objectives are accomplished by this
study.1) Establishment of skeletal & dental parameters
for Assamese young adults using Steiner’s analysis. 2)
Evaluation of variability between male & female
Assamese normal occlusion subjects. 3) Comparison
of cephalometric norms of Assamese population the
Caucasians and other groups. Finally all the
measurements are computed statistically.
cephalogram was traced twice and the average
measurement taken into account to minimize the error.
The linear measurements were recorded with a
measuring scale up to 0.05mm correction. The angular
measurements were recorded with a protractor up to
0.05mm correction. Statistical calculations performed
included mean, standard deviation, standard error and
student’s‘t’ test for each parameter. Statistical
comparisons were done by the‘t’ test.

The mean values of this study had been compared with

MATERIALS AND METHOD
The material for this study consisted of standardized
lateral head roentgenograms of 35 Assamese young
boys and 35 girls residing in Guwahati. They were
selected as per the following criteria.
the Steiner’s norms for Caucasian Subjects. On the basis
of this data, a complete chart of the STEINER’S
ANALYSIS was established for Young Assamese adult
population.

A normal acceptable and pleasing profile, Age 18-25

years of age, Angle Class I molar relationship with full
complement of erupted teeth up to 2nd molar in proper
intercuspation, No history of orthodontic treatment,
gross carious lesion and periodontal disease and no
history of facial trauma.

A panel was formed to check the samples required for

the study and they gave their consent regarding the Photograph showing Cephalometric Head Plate.
fulfillment of the criteria of the samples

Landmarks used in the study

ANGULAR MEASUREMENTS: Angle SNA, SNB, ANB,
SND, Maxillary I to NA. Mandibular I to NB, Maxillary
I to Mandibular I, Occlusal Plane to SN, Go-Gn to SN.

LINEAR MEASUREMENTS (mm): Maxillary I to NA line,

Mandibular I to NB line, Pog to NB Line, SL Line and
SE Line.

The subject’s head was positioned in the Pantos 16 xp

roentgenographic cephalostat maintaining a target-film A male subject’s head positioned in the Cephalostat.
distance of 5 feet or 152.4 cms. The PSP plate which is (Lateral View)
enclosed in a light tight cassette was positioned parallel
to the midsagittal plane of the subject such that the
X-ray beam was directed perpendicular to it. The ear
rods were used to stabilize the head in a vertical plane.
The subject’s head was positioned so that the Frankfort
Horizontal plane would be parallel to the floor and
was instructed to look straight and maintain a relaxed
posture with teeth in centric occlusion during the
exposure of the films. The kilo voltage used for X-ray
exposure was 61-85 Kvp. Milliamperge was 4-10 mA
and time required for the exposure was 2.5 seconds.

The lateral cephalogram were traced upon an A4 size

Acetate matt tracing sheet with a 3HB hard lead pencil A female subject’s head positioned in the
over a well-illuminated viewing screen. Each Cephalostat. (Frontal View)

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The results are shown in the following tables :
TABLE 2 : COMPARISONS BETWEEN THE MEAN ANGULAR AND LINEAR PARAMETERS
OF 35 MALE AND 35 FEMALE ASSAMESE SUBJECTS

Sl. No. Parameters Male Female Significance

Average S.D. S.E. Average S.D. S.E. ‘t’ value ‘p’ value
1 < SNA° 84.86 3.29 0.56 84.14 2.91 0.49 0.96 NS
2 < SNB° 81.31 3.64 0.61 81.51 2.99 0.51 0.251 NS
3 < ANB° 3.37 1.29 0.21 2.65 1.47 0.25 2.15 P< .05
4 < SND° 78.66 3.13 0.53 78.68 2.97 0.50 0.04 NS
5 < SN-GoGn° 26.23 3.88 0.66 26.97 5.82 0.98 0.63 NS
6 < Sn-Occ° 12.83 3.52 0.59 14.43 4.02 0.68 1.77 P< 0.05
7 < I To NA° 25.4 4.53 0.77 24.68 6.01 1.02 0.71 NS
8 <T To NB° 29.94 6.27 1.06 28.57 6.24 1.05 0.92 NS
9 < I To 1 ° 121.4 7.88 1.33 124.03 9.21 1.56 1.28 NS
10 I To NA (mm) 4.03 1.79 0.30 4.2 1.79 0.30 0.39 NS
11 T To NB (mm) 5.11 1.98 0.33 4.14 2.36 0.39 1.86 P<0.05
12 SE (mm) 22.26 3.48 0.59 19.68 1.84 0.31 3.88 P<0.001
13 SL (mm) 54.77 5.52 0.93 51.57 2.26 0.38 3.17 P<0.01
14 Pog-NB (mm) 2.66 1.26 0.21 2.00 2.32 0.39 1.48 NS
N.S. = Not significant (P>0.05) P<0.05 = Significant at 5% level P<0.01 = Significant at 1% level P< 0.001 = Significant at 0.0 1% level.

TABLE 4: COMPARATIVE STATISTICAL EVALUATION OF STEINER’S NORM AND THE PRESENT STUDY

Sl. No Parameters Caucasian Assamese Sample (N=70) Statistical Evaluation

Norms
Mean S.D. S.E. ‘t’ value ‘P’ value
d.f.=69
1 < SNA° 82 84.5 3.11 0.37 6.76 P<0.05
2 < SNB° 80 81.41 3.31 0.30 4.67 P<0.05
3 < ANB° 2 3.01 1.42 0.17 5.94 P<0.001
4 < SND° 76 78.67 3.06 0.37 7.22 P<0.001
5 < SN- GoGn° 32 26.6 4.93 0.59 9.15 P<0.001
6 < Sn -Occ° 14 13.63 3.83 0.46 22.5 P<0.001
7 < I To NA° 22 25.04 5.30 0.63 4.83 P<0.001
8 < T To NB° 25 29.26 6.25 0.75 5.68 P<0.001
9 < I To T° 131 122.71 8.61 1.03 8.05 P<0.001
10 1 To NA linear (mm) 4 4.11 1.78 0.22 0.5 NS
11 T To NB Linear (mm) 4 4.63 1.97 0.24 2.63 P<0.05
12 SE (mm) 22 20.97 3.64 0.15 2.34 P<0.05
13 SL (mm) 51 53.17 6.65 0.44 2.71 P<0.05
14 Pog-NB (mm) 2.33 1.27 0.80

N.S = Not significant (P>0.05) P<0.05= Significant at 5% level P<0.01= significant at 1% level P<0.001 = significant at 0.01% level.

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 TABLE 5: COMPARISON OF CEPHALOMETRIC VALUES OF PRESENT STUDY (ASSAMESE POPULATION),
WITH CAUCASIANS, JAPANESE, ISRAELI, NEGROES, KOREANS AND MEXICAN AMERICANS USING
STEINER’S REFERENCE NORMS
Sl. No. Cephalometric analysis Caucasian Present study Japanese Israeli Negroes Korean Mexican-
Steiner (Assamese (Miura et a.) (Ruth (Richard (In-Chool Americans)
Population) Gleis, A.Drummond) Park. et al) (C.J. Garcia)
et al.)
1 < SNA° 82 84.5 81.3 81.63 84.7 81.15 83.6
2 < SNB° 80 81.41 76.8 78.2 79.2 78.7 80.8
3 < ANB° 2 3.01 4.5 3.43 5.5 2.5 2.8
4 < SND° 76 78.67 73.4 75.31 75.8 75.8 77.3
5 < SN-GoGn° 32 26.6 36.2 34.63 38.2 33.4 31.1
6 < Sn-Occ° 14 13.63 20 17.68 16.9 15.8
7 < 1ToNA° 22 25.04 24.1 23.8 24.1 23.4 20.5
8 < TToNB ° 25 29.25 31.2 28.46 36.7 27.4 26.7
9 <TTo 1° 131 122.71 120.3 124.34 113.8 126.55 130
10 1 To NA linear (mm) 4 4.11 5.9 5.2 7.4 7 5.5
11 T To NB Linear (mm) 4 4.63 7.8 6.46 11.4 7.2 5.7
12 SE (mm) 22 20.97 21 21.3
13 SL (mm) 51 53.17 41.1 53.9
14 Pog-NB (mm) 2.33 0.43 5.38 1.8 0.9
The mean for the various cephalometric values of Steiner’s analysis.
Richard A Drummond: Mean values for 40 Negro samples.
Present study: Mean values for 70 Assamese samples.
Miura et al: Mean values for 90 Japanese samples. In Chool Park et al: Mean values for 80 Korean samples.
Ruth Gleis et al: mean values for 40 Israeli samples. Garcia: Mean values for 59 Mexican-American samples.
TABLE 6: COMPARISON OF CEPHALOMETRIC VALUES OF PRESENT STUDY (ASSAMESE POPULATION), CAUCASIAN
AND OTHER INDIAN RACES USING THE STEINER‘S REFERENCE NORMS
Sl. No. Cephalometric CAUCASIAN PRESENT KERALA INDIAN KARNATAKA HARYANA GUJARATHIS
analysis STEINER STUDY (JOHN K.K) RESIDENTS IN (SAVADI.S.C) (Late Dr PATEL.H.M.
(ASSAMESE) U.S.A V.K. Grover et.al)
(VALIATHAN A) et. al)
1 < SNA° 82 84.5 84.14 81.77 83.45 82.78 81.26
2 < SNB° 80 81.41 81.85 77.9 80.50 79.6 78.25
3 < ANB° 2 3.01 2.27 4.32 2.95 3.18 3.01
4 < SND° 76 78.67 79.36 75.6 77.85 75.6
5 < SN-GoGn ° 32 26.6 27.91 29.35 29.01 26.34 29.06
6 < Sn-Occ ° 14 13.63 11.79 15.97 14.36 15.7
7 < 1To NA° 22 25.04 27.44 22.85 25.85 23.75 25.34
8 < T To NB° 25 29.26 30.75 33.12 28.45 28.01 30.67
9 <TTo 1 ° 131 122.71 119.69 119 122.95 123.97 120.63
10 I To NA ( mm) 4 4.11 7.46 7 6.65 5.21 6.48
11 T-NB (mm) 4 4.63 7.5 8.9 6.85 6.48 7.13
12 SE (mm) 22 20.97 21.46 12.40 20.6
13 SL (mm) 51 53.17 59.66 57.40 51.7
14 Pog-NB (mm) 2.32 1.06 2.25 2.13
The mean for the various cephalometric values of Steiner’s analysis.
Present study: mean values for 70 Assamese samples. Savadi S.C: mean values for Karnataka samples
John. K. K: mean values for 50 samples from Kerala. Late Dr V.K. Grover et al: Mean values for 100 Haryana samples.
Valiathan: mean values for 20 Indian residents of U.S.A Samples. Patel. H.M et al: Mean values for 30 Gujrathi samples.

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DISCUSSION
The present study tries to establish a norm or standard
for the skeletal and dental pattern of Assamese young
adults according to Steiner’s Analysis. The results were
compared with the Steiner’s norm for the Caucasians
samples. A comparison was also made between the
values of the various parameters with other population
groups and also Indian population groups as studied
by various Indian workers. Cephalometerically nine
angular and five linear measurements were used by
Steiner. The Steiner’s parameters on Caucasian samples
have been taken from Cecil.C Steiner’s original article
“Cephalometrics for you and me” published in the
American Journal of orthodontics, October (1953). The
present study revealed that the mean values for the
Assamese sample were significantly different in all
measurable values from the means of Steiner’s analysis
of Caucasians.
Skeletal; Evaluating Angle SNA and SNB it is interesting
to note that the Maxillary and the Mandibular apical
base in the Assamese population were more prognathic
(PL<. 05) when compared to Caucasians. But there was
no statistically significant difference between male and
female Assamese population.
Angle ANB which is the most common indicator to
determine the relative positions of the upper and lower
jaws to each other showed an increased value than
the Caucasians which meant a greater tendency
towards bialveolar protrusion (P< .001). There was
significant difference in the ANB value between male
& female Assamese subjects. (P < .05),
The Mean value of Angle SND was more in Assamese
subjects indicating that the position of the centre of
the symphysis was placed more forwards than the
Caucasian sample. On comparison between male &
female Assamese subjects it was seen that there was
no significant difference between them.
The Mandibular plane to the cranial base plane of
Assamese adults revealed that the angle was smaller
than the Steiner’s norm. From this study it can be said
that the Assamese group pattern exhibited a more
horizontal growth pattern than the Caucasians. The
study recorded that there was no significant difference
in the mean values between the male boys & girls.
Assamese population showed a lesser inclination of
occlusal plane (13.63,) than the Caucasians (p<0.001)
and this study also exhibited marked variation between
male & female subjects.
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Dental
The dental measurements except for the linear value
of Mx I to NA, rest of the parameters were significantly
different. Angle I to NA, mandibular I to NB, (both
angular and linear) recorded a greater value for the
Assamese subjects These findings along with a more
acute interincisal angle of the Assamese young adults
demonstrated the fact that the upper & lower incisors
of Assamese subjects were more procumbent &
protracted when compared with that of Caucasian
subjects. As far as the comparison between male and
female subjects was concerned, except for the linear
measurement of mandibular I to NB, rest of the
parameters namely I to NA ( angular and linear), Angle
I to NB, Angle I to I and I to NA, (linear) did not bear
any statistically significant difference.
This study also suggested wide divergence in the SE
distance in the Assamese population. Mean SE distance
being less than that of Steiner’s value as well as that of
other researchers. This study also depicted that the
anteroposerior length of the mandible in relation to
the cranial base was larger in Assamese sample than
Caucasians. Both SL & SE distance depicted a
statistically significant difference between male &
female subjects with a value of P <0.001 respectively
In Assamese samples, the mean value of bony chin
position in relation to the NB plane (Pog to NB) was
2.33mm; with a S.D. of ± 1.27 mm. Steiner remarked
that this value was less important because the pogonion
was influenced greatly by growth. So he did not
establish any reference norm for this parameter. There
was statistically no significant difference between the
male (2.66 mm ± 1.26 mm) and female (2.00 mm
± 2.32 mm) Assamese subjects.
Summary and Conclusion
In view of the findings of the current study it is evident
that in the Assamese population with so called well
balanced faces, there are some fundamental variations
in the craniofacial structure of Asamese when
compared with Steiner’s norms. These should be
established to serve in the diagnosis and treatment of
the Assamese patients. The results of the present study
also support the view that a single standard of facial
esthetics should not be supplied to all racial and ethnic
groups. The following differences and similarities were
demonstrated in the Assamese samples as compared
to the Caucasian samples
1. The antero-posterior position of the apical base of
the maxilla and mandible in relation to the anterior
cranial base was more anteriorly placed or
 prognathic as compared to the Caucasian samples.
An increased ANB angle indicated a greater
tendency towards bialveolar protrusion.
2. The angular relationship of the mandibular plane
in relation to the cranial base plane (SN-GoGn
angle) was smaller which was suggestive of a strong
horizontal growth pattern in the Assamese.
3. The Assamese population has a protrusive
alveodental pattern when compared to the
Caucasians.
4. Study suggested wide divergence of the SE and SL
distance in the Assamese population when
compared to the Caucasians.
The study concluded that most of the cephalometric
measurements of the Assamese subjects were
significantly different from the Steiner’s Caucasian
samples and also from other ethnic groups because
the various published methods represent population
averages, it is important to consider each patient’s
treatment goals and needs during evaluation and
treatment planning.
To draw a decisive conclusion of the Steiner‘s analysis
on Assamese population for diagnosis, treatment
planning and prognostic evaluation further study should
be done on greater number of samples after proper
screening of facial types.
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