Open Journal of Stomatology, 2011, 1, 75-83
doi:10.4236/ojst.2011.13013 Published Online September 2011 (http://www.SciRP.org/journal/OJST/
OJST
).
Published Online September 2011 in SciRes. http://www.scirp.org/journal/OJST
Cephalometric norms for a sample of Emirates adults
Huda M. Abu-Tayyem1*, Amna H. Alshamsi2, Sayed Hafez1, Eman Mohie ElDin1
1Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt;
2Ministry of Health, Sharjah, United Arab Emirates.
Received 23 May 2011; revised 21 July 2011; accepted 3 August 2011.
ABSTRACT
Introduction: European-American norms are still
used in the orthodontic treatment of Emirates pa-
tients despite the different ethnic backgrounds of the
Emirates. The purpose of this study was to formulate
cephalometric norms for lateral cephalometric mea-
surements of Emirates adults and to study gender
differences. Methods: Lateral cephalometric radio-
graphs of 176 Emirates adults, 91 males and 85 fe-
males, were selected according to the following crite-
ria; an age range between 19 to 25 years, esthetically
pleasing and harmonious faces with balanced and
acceptable profiles and occlusions, normal skeletal
and dental relationship, all permanent teeth present,
and no history of orthodontic treatment or facial
trauma. The mean values and standard deviations of
91 angular and 21 linear cephalometric variables
were calculated using the Dolphin version 10.5 soft-
ware package. The resulting norms for Emirates
male and female groups were compared using a stu-
dent t-test. Results: Several statistically significant
gender differences were noticeable. Skeletally, Emir-
ates males showed significantly greater (p < 0.001)
total, anterior, and posterior cranial base lengths as
well as longer facial heights, greater SGn-FH (˚), ANS
Xi PM (˚), and FH/MP (˚) angles than females. In
addition, Emirates males had significantly greater (p
< 0.001) Co-A (mm), Co-Gn (mm), and significantly
greater (p < 0.05) Pog-N vert (mm) than females.
Dentally, Emirates males had significantly greater (p
< 0.05) UI-SN (˚) and U1-NA (˚), U1-NA (mm), and
L1-NB (mm) (p < 0.001) than females. For soft tissue
measurements there were significant gender differ-
ences (p < 0.001) for all angular and linear measure-
ments except for lower lip to E-plane and nose
prominence measurements which have no significant
gender difference. Emirates males revealed greater
measurements than females except for soft tissue con-
vexity, Z-angle, and both upper and lower lips pro-
trusion which were significantly greater in Emir-
ates females. Conclusions: The use of specific ce-
phalometric standards for Emirates adults, sepa-
rate for gender, seems to be justified. It is appro-
priate to put these cephalometric norms into daily
orthodontic practice when Emirates adults are be-
ing treated.
Keywords: Emirates Norms; Cephalometric; Norms
1. INTRODUCTION
Since its introduction in 1931 by Broadbent [1] and
Hofrath [2] in the United States and Germany, respec-
tively, radiographic cephalometry has become one of the
most important tools of clinical and orthodontic research
[3]. Cephalometric norms provide useful guidelines to
orthodontists in their diagnosis and evaluation of ortho-
dontic treatment outcomes. Moreover their importance
exists to investigate the average values, shapes and
variations among any population [4].
Harmonious facial esthetics and optimal functional
occlusion have long been recognized as the most impor-
tant goals of orthodontic treatment. Orthodontic treat-
ment is best when the facial and cephalometric charac-
teristics of the ethnic background of patients are consid-
ered [4,5]. The orthodontic literature contains many
studies involving cephalometric and profile standards of
Caucasian and European-American [5-15], African-
American [16-24], Japanese [25-29], Chinese [30-33],
Polish [34], Filipinos [35], Mexican-Americans [36],
Korean [37,38], Turkish populations [39-42], Indians
[43], Brazilians [44], and Puerto Rican Americans [45],
but little published data for Arabs [46-58] and non for
Emirates in specific. This information is considered as a
critical base which should be used for studying growth,
diagnosis, treatment planning and prognosis of such
population.
Hajighadimi et al. [46] studied craniofacial character-
istics of 67 Iranian children (35 females with and 32

H. M. Abu-Tayyem et al. / Open Journal of Stomatology 1 (2011) 75-83 76
males) using Tweed and Steiner analyses. They reported
that Iranians have a more convex soft tissue profile
compared with Tweed’s and Steiner’s standards; whereas
Iranian males had more procumbent dentitions than the
female one. Bishara et al. [49] established cephalometric
standards for Egyptian adolescent males and females and
compared them with a matched Iowa adolescent sample.
There was a great similarity in the overall facial mor-
phology between the Egyptian and Iowan populations.
Hamdan and Rock [51] evaluated the cephalometric
features of a Jordanian population as compared with the
Eastman standards and found different skeletal and den-
tal cephalometric features for the Jordanians. Shalhoub
et al. [52] evaluated lateral cephalometric radiographs of
48 adult Saudis with normal facial proportions, com-
pared them with a North American sample, and estab-
lished a set of cephalometric norms for Saudi adults liv-
ing in Riyadh. Sarhan and Nashashibi [53] compared
cephalometric radiographs of Saudi males (10 - 14 years
old) with a similar British sample. They found slightly
more prognathic Saudi faces, more protruded incisors
and lower gonial and saddle angles as compared with the
British sample.
Al-Jasser [54] described the craniofacial characteris-
tics of 87 Saudi students with acceptable profiles and
occlusions and compared them with Steiner's Euro-
pean-American standards. It was concluded that Saudis
have different craniofacial features when compared with
Steiner norms. Al-Jame et al. [55] studied lateral cepha-
lograms of 162 Kuwaitis (82 males and 80 females of
mean age 13.27 ± 0.42 years and 13.21 ± 0.43 years,
respectively), with normal occlusion to establish lateral
cephalometric hard tissue norms and to compare them
with the published norms. They found that the average
subject in the sample had a steeper mandibular plane, a
more convex profile with a tendency for reduced chin
protrusion, and a more protrusive dentition than the
norms of the common analysis systems. Hassan [56]
evaluated 70 lateral cephalometric radiographs of Saudis
(32 females and 38 males; aged 18 - 28 years) with ac-
ceptable profiles and occlusions living in the western
region of Saudi Arabia and compared them with Euro-
pean-American norms. He found that Saudis tended to
have an increased ANB angle because of retrognathic
mandibles and bimaxillary protrusion as compared with
European-Americans. Hashim and AlBarakati [57] eva-
luated cephalometric radiographs of 56 Saudi adults (30
males and 26 females) with pleasant and balanced facial
profiles. The Saudi females had a greater angle of total
facial convexity and soft tissue facial plane angle and a
shorter lower lip than the males. Their results revealed
significant differences in most of the soft tissue variables
when comparing Saudis with Caucasian Americans as
well as in other ethnic groups. Al-Gunaid et al. [58]
studied 50 adult Yemeni men (with a mean age was 23.1
years) with normal occlusion and esthetically pleasing
profile and compared them with cephalometric standards
of normal North American white people according to
Legan-Burstone and Holdaway analyses. They con-
cluded that soft-tissue facial profiles of white Yemenis
and Americans are different in certain respects and these
racial differences must be considered during diagnosis
and treatment planning.
From this review, it can be concluded that there are
differences in dentofacial relationships between various
ethnic and racial groups. Therefore, it is important to
develop standards for various populations. Accordingly,
the present study was concerned with an ethnic group for
which little cephalometric information was available, the
Emirates adults. The purpose of this study was to for-
mulate cephalometric norms for the Emirates adults with
acceptable facial profile and occlusion and to study
gender differences.
2. MATERIAL AND METHODS
This study was carried out on a total sample of 176
Emirates adults (91 males and 85 females) selected from
individuals who attended the Emirates health centers,
high schools and colleges according to the following
criteria: natural born ethnic Emirates with Emirates
grandparents, ranged in age from 19 to 25 years old,
balanced and acceptable facial profiles, normal skeletal
Class I with well aligned upper and lower dental arches,
permanent dentition stage (the third molars may or may
not be present), no history of previous orthodontic or
prosthodontic treatment , no history of maxillofacial or
plastic surgery, no congenital facial anomalies, and no
history of systemic diseases or chronic illness that may
affect the normal dentofacial growth.
Initially, a clinical examination was made to deter-
mine the status of the occlusion, and those subjects who
were judged to have a normal occlusion were selected.
The procedure of selecting subjects started with filling
personal information by the subject. Then three examin-
ers, including two orthodontists and one postgraduate
orthodontic student, examined overjet, overbite, crowd-
ing, and spacing condition of the teeth. Two hundred
subjects met these criteria in the preliminary examina-
tion and were asked to report to the Department of Or-
thodontics, Sharjah Dental Center, Ministry of Health,
Sharjah, United Arab Emirates for a more detailed ex-
amination. Of these 200 subjects, 24 chose not to par-
ticipate in the study. A closer examination of the subjects
indicated that 15 had different types of malocclusion,
and another 9 were either older or younger than the age
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H. M. Abu-Tayyem et al. / Open Journal of Stomatology 1 (2011) 75-83 77
range specified for this investigation. As a result, a total
of 176 Emirates adults (91 males and 85 females) were
included in the present study. Informed consents were
obtained from all subjects involved in the study. Al Qas-
simi Hospital research Ethics Committee (Ministry of
Health, United Arab Emirates) had reviewed the research
proposal and approved it.
A lateral cephalometric X-ray was taken for each sub-
ject using a cephalometric X-ray machine (Planmeca
Proline XC system, Helsinki, Fenland, at IBIN SINA
Medical Center, United Arab Emirates) according to
Broadbent method [1]. The subject’s head was held in the
so called natural head position (mirror position) [59-61].
All the subjects were radiographed with the same ma-
chine to standardize the magnification. Anatomic land-
marks were identified directly on the digital images and
21 linear and 19 angular cephalometric measurements
were calculated electronically using the Dolphin version
10.5 software package (Dolphin imaging and manage-
ment solutions version 10.5, Eton Avenue, Chatsworth,
USA). Landmarks identification (Figures 1 and 2) and
measurements of the cephalometric radiographs were
made by a single author (H.M.) and reviewed twice by
other investigators. All measurements were taken to the
nearest 0.5 millimeters and degrees.
Cephalometric Measurements [3,39,42,49]:
Skeletal angular and linear measurements:
1) S-N (mm) (Anterior cranial base length): the hori-
zontal distance from sella turcica and anterior point of
the frontonasal suture.
2) S-Ar (mm) (Posterior cranial base length): the hori-
zontal distance from sella turcica and articulare.
3) Ba-N (mm) (Total cranial base length): the hori-
zontal distance from basion to nasion.
4) FH/SN (˚): It represents the inclination of the ante-
rior cranial base.
5) N-Me (mm) (Total anterior facial height): the linear
distance between nasion (N) and menton (Me).
6) N-ANS (mm) (Upper anterior facial height): the
linear distance between nasion (N) and anterior nasal
spine (ANS).
7) ANS-Me (mm) (Lower anterior facial height): the
linear distance between anterior nasal spine (ANS) and
menton (Me).
8) S-Go (mm) (Total posterior facial height): the lin-
ear distance between sella point (S) and gonion (Go).
9) SGn/FH (˚) (Y-axis angle): the lower and anterior
angle of the intersection of Y-axis (S-Gn) and the
Frankfort horizontal plane. It represents the direction of
the mandibular growth in relation to the face.
10) ANB (˚): the difference between SNA and SNB
angles, and defines the mutual relationship, in the sagittal
Figure 1. Cephalometric reference points, hard tissue land-
marks. 1, Anterior nasal spine (ANS); 2, Articulare (Ar); 3,
Basion (Ba); 4, Condylion (Co); 5, Gnathion (Gn); 6, Gonion
(Go); 7, Incisor inferius (Ii); 8, Incisor superius (Is); 9, L1 root;
10, Lower 6 occlusal (L6); 11, Menton (Me); 12, Nasion (N);
13, Orbitale (Or); 14, Pogonion (Pog); 15, Subnasale (Point-A);
16, Supramental (Point-B); 17, Porion (Po); 18, Posterior nasal
spine (PNS); 19, Protuberance menti (PM); 20, Sella Turcica
(S); 21, U1 root; 22, Upper 6 occlusal (U6); 23, Xi point (Xi).
Figure 2. Cephalometric reference points, soft tissue land-
marks. 1, Labrale inferius (Li); 2, labrale superius (Ls); 3,
Pronasale (Pn); 4, Soft tissue glabella (G’); 5, Soft tissue men-
ton (Me’); 6, Soft tissue nasion (N’); 7, Soft tissue pogonion
(Pog’); 8, Soft tissue gnathion (Gn’); 9, Stomion (Sto); 10,
Stomion inferius (Stoi); 11, Stomion superius (Stos); 12, Sub-
nasale (Sn); 13, Supramentale (Sm).
plane of the maxillary and mandibular bases in relation
to the cranium.
11) Ao-Bo/FH (mm): the horizontal distance between
two perpendiculars dropped from points A and B onto
FH plane, measuring the anteroposterior relation of the
maxillary and mandibular bases relative to the face.
12) Ao-Bo (mm) (Wit’s appraisal): the horizontal dis-
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tance between perpendicular lines from point A and B
onto the functional occlusal plane, measuring the anter-
oposterior relation of the maxillary and mandibular
bases relative to the functional occlusal plane.
13) FH/MP (˚) (Frankfort mandibular plane angle): the
angle formed between Frankfort horizontal plane and
mandibular plane.
14) PP/SN (˚) (Palatal plane angle): the angle formed
between anterior cranial base (S-N) and palatal plane
(PP). It represents the cant of the maxillary plane in rela-
tion to anterior cranial base.
15) MP/SN (˚): the angle formed between the man-
dibular plane (Go-Gn) and the anterior cranial base (SN
line). It represents the inclination of the mandibular base
to the cranium.
16) ANS Xi PM (˚) (Lower face height): this is the
angular measurement formed by the intersection of a line
from anterior nasal spine to the center of the ramus and
the corpus axis. It represents the vertical jaw relation i.e.
the depth of the bite.
17) SNA (˚): anteroposterior position of the maxilla
(apical base) relative to the anterior cranial base.
18) Co-A (mm): the horizontal distance between
condylion and point-A. It represents the effective maxil-
lary length.
19) SNB (˚): measuring the anteroposterior position of
the mandibular base in relation to the cranium.
20) Pog-Nv (mm): the linear distance between the
point Pog and a vertical line drawn from nasion perpen-
dicular onto the FH plane. It represents the anteroposte-
rior position of the mandibular chin in relation to the
face.
21) Co-Gn (mm): the horizontal distance between
condylion and point gnathion. It represents the effective
mandibular length.
Dental angular and linear measurements:
22) U1/L1 (˚) (Inter-incisal angle): the angle between
long axes of the upper and lower central incisors.
23) U1/SN (˚): the angle formed between the long axis
of upper central incisor and the anterior cranial base. It
represents the degree of the inclination of upper incisors
relative to the cranium.
24) U1/NA (˚): the angle formed between the long
axis of upper central incisor and the NA line. It repre-
sents the degree of the inclination of upper incisors rela-
tive to the anterior limit of the maxillary base.
25) U1-NA (mm): the linear perpendicular distance
from the incisal tip of the most protruded upper central
incisor and the N-A line. It represents the degree of the
protrusion of upper incisors relative to the anterior limit
of the maxillary base.
26) L1-NB (mm): the linear perpendicular distance
from the incisal tip of the most protruded lower central
incisor and the N-B line. It represents the degree of the
protrusion of lower incisors relative to the anterior limit of
the mandibular base.
27) L1/NB (˚): the angle between long axis of lower
central incisor and NB line. It represents the degree of the
inclination of lower incisors relative to the mandibular
base.
28) L1/MP (˚): the angle between long axis of lower
central incisor and the mandibular plane. It represents the
degree of the inclination of lower incisors relative to the
mandibular base.
Soft tissue angular and linear measurements:
29) H-angle: the angle between soft tissue labrale supe-
rious, soft tissue nasion and Pog’. It represents the promi-
nence of the upper lip in relation to N’pog’ line.
30) Z-angle: the angle between soft tissue labrale supe-
rious, pogonion (profile line) and Frankfort horizontal
plane. It represents the amount of lip protrusion.
31) N’SnPog’ (˚) (soft tissue profile): It represents the
degree of soft tissue convexity regardless the nose promi-
nence.
32) N’PnPog’ (˚) (soft tissue convexity): It represents
the degree of soft tissue convexity including the nose.
33) PnN’Sn (˚) (Nasal prominence): It represents the
degree the nasal prominence.
34) Sn-Stos (mm) (length of upper lip): the length of
the upper lip measured between subnasale and stomion
superius.
35) Stoi-Sm (mm) (length of lower lip): the length of
the lower lip measured between stomion and mentolabial
sulcus.
36) Ls-E line (mm): The horizontal distance between
labrale superious and esthetic line. It represents the rela-
tive protrusion of the upper lip to the esthetic line.
37) Li-E line (mm): The horizontal distance between
labrale inferius and esthetic line. It represents the relative
protrusion of the lower lip to the esthetic line.
38) Pog-Pog’ (mm) (thickness of the soft tissue chin):
the horizontal distance between the hard and soft tissue
pogonion.
39) Ls-SnPog’ (mm) (upper lip protrusion): The hori-
zontal distance between the most anterior point of the
upper lip and subnasale soft tissue pogonion line. It
represents the relative protrusion or retrusion of the upper
lip to the SnPog’ line.
40) Li-SnPog’ (mm) (lower lip protrusion): The hori-
zontal distance between the most anterior point of the
lower lip and subnasale soft tissue pogonion line. It
represents the relative protrusion or retrusion of the lower
lip to the SnPog’ line.
3. RESULTS
Means and standard deviations of cephalometric meas-
urements for Emirates adults are shown in Table 1. A
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student t-test was used to compare males with females.
Concerning the cranial base and facial skeleton meas-
urements, there were highly significant gender differ-
ences (p < 0.001) of the total, anterior, and posterior
cranial base lengths which were greater in Emirates
males than females. While cranial base tipping is sig-
nificantly greater (p < 0.05) in females than males. Emir-
ates males showed significantly longer (p < 0.001) facial
heights and greater SGn-FH (˚) than females.
Regarding the jaw relation there were no significant
gender differences for anteroposterior measurements
except for the Wit's appraisal (p < 0.05) which was
greater in Emirates females than males. Whereas ANS
Xi PM (˚) and FH/MP (˚) were significantly greater (p <
0.001) in males than females, the SN-PP (˚) was signifi-
cantly greater (p < 0.001) in females than males. The rest
of jaw relation measurements showed no significant
gender difference.
OJST
No significant gender difference were reported for
SNA while Emirates males had highly significantly
greater (p < 0.001) Co-A (mm), Co-Gn (mm), and sig-
nificantly greater (p < 0.05) Pog-N vert (mm) than fe-
males.
Regarding the dental measurements, Emirates males
have significant greater (p < 0.05) UI-SN (˚) and U1-NA
(˚), U1-NA (mm), and highly significantly greater (p <
0.001) L1-NB (mm) than females whereas U1-L1 (˚),
L1-NB (˚), and L1-MP (˚) show no significant gender
difference.
For soft tissue measurements there was significant
gender difference for all angular and linear measure-
ments except for lower lip to E-plane and nose promi-
nence measurements which have no significant
gender difference. Soft tissue profile angle and soft
tissue convexity, both upper and lower lips length,
and both upper and lower lips protrusion showed
highly significant gender difference (p < 0.001). The
facial convexity, H-angle, Z-angle, upper lip to
E-plane (mm) and the thickness of soft tissue chin had
significant gender difference (p < 0.05). Emirates
males revealed greater measurements than females
except for soft tissue convexity, Z-angle, and both
upper and lower lips protrusion which were greater in
Emirates females.
Analysis of the Experimental Error
To determine the errors associated with radiographic
measurements, 40 radiographs were selected randomly.
Their tracings and measurements were repeated by the
same researcher three weeks after the first measurements.
Random error was calculated with Dahlberg’s formula
and the systematic error was detected by comparison of
measurements by the paired t-test at a significance level
of 5%. Dahlberg’s formula = 22d
n
where d is
the difference the measurements and n is the number of
duplicates. The method error was considered negligible
(ranged from 0.35˚ to 0.44˚ for angular cephalometric
measurements and from 0.15 to 0.48 mm for linear
measurements). A paired t-test was applied to the first
and second measurements, and the differences between
the measurements were insignificant. Correlation analy-
sis applied to the same measurements showed the high-
est r values for most of the measurements.
4. DISCUSSION
The racial, facial, and skeletal characteristics of the pa-
tient play a critical role in orthodontic treatment plan-
ning. With the increasing number of Emirates seeking
professional treatment from orthodontists, maxillofacial
surgeons, or plastic and reconstructive surgeons, it has
become apparent that there is a need to determine what
constitutes a pleasing or normal face for the Emirates
population. This study focused on samples of untreated
Emirates subjects characterized as having normal occlu-
sions and well-balanced faces. Young adults (19 to 25
years old) of both genders were included because most
orthognathic surgeries are performed in this age group.
Ninety one males and 85 females of Emirates origin
were selected which allowed testing of the significance
of gender difference to obtain more specific and useful
cephalometric normative values. Extreme differences
exist between normal and esthetically pleasing profiles,
thus, normal occlusion, which is not necessarily related
to beauty, was the main criterion used to select the sub-
jects [42].
Not surprisingly, the gender dimorphism was found to
be statistically significant for most of the cephalometric
variables studied. All cranial base measurements as well
as facial height were highly significant (p < 0.001)
greater in Emirates males than females. This was in ac-
cordance to Bishara et al. [49]. Therefore Emirates males
have larger cranial base dimensions than females whereas
females had a steeper cranial base that was of high statis-
tically significance (p < 0.001) than males. Emirates
males also had tendency towards increased vertical jaw
relationship, where total anterior facial height was sig-
nificantly (p < 0.001) more than females. This would con-
clude that Emirates males have a tendency to be dolicho-
facial than Emirates females. These findings are in accor-
dance with those of Scheidman et al. [13] Bishara and
Fernandez [5] found significantly larger measurements for
males in 3 skeletal linear parameters describing the ante-
rior and posterior faces—N-ANS, N-Me, and S-Go. Mi-
yajima et al. [15] indicated that, in a Japanese population,
there were great skeletal differences between male and
female subjects. Japanese women had more vertically

H. M. Abu-Tayyem et al. / Open Journal of Stomatology 1 (2011) 75-83 80
Table 1. Comparison between cephalometric measurements of Emirates males and females.
Emirates males (n = 91) Emirates females (n = 85)
Variables Mean SD Mean SD t-test P-value
Skeletal
Ba-N (mm) 88.95 3.51 71.54 1.60 4.94 <0.001**
S-N (mm) 45.56 4.08 36.95 1.77 4.38 <0.001**
S-Ar (mm) 135.35 5.57 112.17 3.89 3.88 <0.001**
FH-SN (˚) 6.48 3.73 8.56 2.03 –3.56 <0.001**
N-Me (mm) 164.25 5.55 131.93 8.95 4.55 <0.001**
N-ANS (mm) 64.29 9.22 55.02 5.54 3.51 <0.001**
ANS-Me(mm) 87.07 3.63 68.44 8.69 4.83 <0.001**
S-Go (mm) 100.48 3.23 80.18 2.58 4.71 <0.001**
SGn-FH (˚) 60.03 4.67 57.54 4.23 3.69 <0.001**
ANB (˚) 2.03 1.65 1.82 1.53 0.85 >0.05
Ao-Bo /FH (mm) 5.44 1.39 4.26 2.47 1.21 >0.05
Ao-Bo (mm) –0.47 2.46 –1.31 2.66 2.21 <0.05*
FH/MP (˚) 25.44 4.54 23.17 6.01 2.38 <0.05*
MP-SN (°) 31.95 6.47 31.71 6.11 0.26 >0.05
SN-PP (˚) 5.77 3.77 7.87 3.17 –4 <0.001**
ANS Xi PM (˚) 45.36 3.90 42.61 4.75 4.18 <0.001**
SNA (˚) 81.40 2.82 81.14 3.09 0.59 >0.05
Co-A (mm) 112.28 4.14 94.12 4.84 3.58 <0.001**
SNB (˚) 80.52 2.27 79.75 3.57 1.71 >0.05
Pog-N vert (mm) –4.23 1.57 –1.95 3.34 –2.16 <0.05*
Co-Gn (mm) 156.03 5.84 128.10 5.02 4.10 <0.001**
Dental
U1-L1 (˚) 120.01 9.38 121.08 6.87 –0.52 >0.05
UI-SN (˚) 111.49 6.80 108.63 6.31 2.89 <0.05*
U1-NA (˚) 29.20 1.09 26.55 5.86 2.11 <0.05*
U1-NA (mm) 7.64 2.43 6.05 2.23 2.71 <0.05*
L1-NB (˚) 29.82 5.39 28.58 5.09 1.57 >0.05
L1-NB (mm) 8.47 2.74 5.87 2.91 3.73 <0.001**
L1-MP (˚) 96.73 5.46 96.66 7.40 0.07 >0.05
Soft tissue
H-Angle 14.56 4.46 12.98 3.84 2.51 <0.05*
Z-Angle 74.08 8.99 78 7.89 –3.06 <0.05*
N’SnPog’ (˚) 156.91 6.92 133.79 5.51 3.81 <0.001**
N’PnPog’ (˚) 127.48 4.78 136.85 8.03 –4.64 <0.001**
PnN’Sn (˚) 19.99 2.22 20.73 6.29 –1.01 >0.05
Sn-Stos (mm) 27.09 1.53 16.79 2.35 5.92 <0.001**
Stoi-Sm (mm) 25 2.49 21 5.86 6.56 <0.001**
Ls-E line (mm) –5.88 3.56 –1.80 4.03 –2.60 <0.05*
Li-E line (mm) –2.23 4.41 –1.32 4.42 –1.36 >0.05
Pog-Pog’ (mm) 14.50 7.12 11.48 7.24 2.79 <0.05*
Ls-SnPog’ (mm) 3.47 2.20 12.01 2.66 –3.96 <0.001**
Li-SnPog’ (mm) 3.72 2.68 11.74 2.16 –3.80 <0.001**
p = Probability level, not significant. = p > 0.05, * significant = p ≤ 0.05, ** significant = p ≤ 0.01, *** highly significant = p ≤ 0.001. * Student t-test.
oriented facial axis angles, greater mandibular plane
angles, and smaller midfacial lengths, and they were
more protrusive relative to the nasion perpendicular.
Regarding facial growth pattern, the Y-axis with FH
plane angle was significantly greater (p < 0.001) in
males. Therefore, Emirates males have more tendency to
vertical growth pattern (backward mandibular rotation)
than Emirates females as further evidenced by the sig-
nificant (p < 0.05) increase of FMA and the high sig-
nificant (p < 0.001) increase of ANS Xi PM angle. These
findings are agreed with those of Park et al. [37] and
Bishara et al. [49]. Accordingly, the results again explain
the tendency of Emirates males to be more dolichofacial
than females.
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H. M. Abu-Tayyem et al. / Open Journal of Stomatology 1 (2011) 75-83 81
No significant difference was found between males
and females regarding the angular and linear measure-
ments of the anteroposterior jaw relationship. These
findings are agreed with those of Park et al. [37].
Whereas, Wits appraisal was significantly greater (p <
0.05) in males which could be attributed to the steeper
maxilla in females as evidenced by SN-PP (˚), rather
than discrepancy between upper and lower jaws. Maxil-
lary and mandibular anteroposterior positions was sl-
ightly more in males but of no significance but the chin
position was significantly (p < 0.05) more retruded in
males (Pog-Nv mm). Thus, regarding skeletal facial
convexity, Emirates males have more convex profiles
than females, due to retruded chin, rather than retrog-
nathic mandible or prognathic maxilla. These findings
are also disagreed with those of Park et al. [37] and
Scheidman et al. [11]. Moreover, maxillary and man-
dibular sagittal lengths were highly significantly (p <
0.001) longer in Emirates male than females. These
findings disagreed with those of Scheidman et al. [11].
This increase in size of jaws in males is coincident with
their larger skeletal features of skull than Emirates fe-
males.
Concerning dental measurements, Emirates males
showed significantly (p < 0.05) more proclined upper
and lower incisors than females as indicated by the rela-
tionship of the maxillary and mandibular incisors to the
SN, MP, NA, and NB lines. So, Normal angulation of
incisors should be taken into consideration, when incisor
retraction is planned in orthodontic treatment of Emir-
ates adults.
In their study, Swlerenga et al. [36] found that Mexican
American males and females have greater mandibular
incisor proclination than black American or white chil-
dren, and that maxillary incisor inclination of Mexican
American women is more retroclined than that of black
or white women. Miyajima et al. [25] found mandibular
dentoalveolar protrusion in the Japanese men compared
with European-American adults. No statistically sig-
nificant gender dimorphism was found in the dental
measurements of both Anatolian Turkish [42] and Japa-
nese adults [25].
Most probably the soft tissue follows hard tissue
structures, but could also consolidate them. Regarding
soft tissue measurements, Emirates males had signifi-
cantly greater (p < 0.001) soft tissue profile angle
(N’Sn’Pog’) than females whereas females had more (p
< 0.05) soft tissue convexity (N’Pn Pog’) than males. In
spite of retruded bony chin, the soft tissue chin (Pog’)
was more protruded in males than females, ranging from
significant to highly significant. Emirates females had
slightly more prominent noses than males, but of no sig-
nificance. Accordingly, considering soft tissue profile,
females had more convex facial profiles than males,
while skeletally males had more convex profiles than
females. Upper and lower lip lengths were significantly
(p < 0.001) increased in males than females. These find-
ings are in accordance with those of Hashim and AlBa-
rakati [57] and Scheidman et al. [11]. This was attributed
to the greater facial height in males and more to the in-
creased lower facial height. The soft tissue of lip fol-
lowed the hard tissue of upper and lower jaws. Also re-
garding the lip appearance, upper and lower lips were
more protrusive in Emirates males than females. This
was assured by significant (p < 0.05) increase of H-an-
gles, and decreased Z angle in Emirates males. These
findings are disagreed with those of Eraby et al. [39].
The lip protrusion followed the difference in protrusion
of upper and lower incisors. But on using the E-plane as
reference for analyzing lip protrusion, the lips appeared
more retrusive in Emirates males. This could be contrib-
uted more to soft tissue chin protrusion in males, rather
than the actual lips’ procumbency.
Along with the clinical examination and other patient
records, knowledge of normative cephalometric values
of normal samples from different ethnic groups can be
helpful for planning orthodontic or orthognatic surgery.
However, these normal data should not be used as a
template. Orthodontic and orthognathic treatment should
always be planned according to each patient’s needs and
desires. From the previous findings it is recommended to
use the lateral cephalometric norms of the present study
as a reference for orthodontic diagnosis and treatment
planning of Emirates adults, separate for gender.
5. CONCLUSIONS
Emirates adults have distinct cephalometric features,
which should be used as a reference in treating Emirates
orthodontic patients.
Skeletally, Emirates adult males showed longer total,
anterior, and posterior cranial base lengths, indicating
larger cranial base; longer facial heights, greater vertical
jaw relation (more tendency to be dolichocephalic),and
longer midfacial and mandibular lengths than females.
Dentally, Emirates adult males demonstrated more
proclined upper and lower incisors than females.
Considering soft tissue profile, Emirates females had
more convex facial profiles than males, while skeletally
males had more convex profiles than females.
Emirates males had greater upper and lower lip
lengths and soft tissue profile angle due to a greater soft
tissue chin thickness, whereas females had a greater soft
tissue profile convexity due to greater nasal prominence.
The results of the present study support the view that
the norms of specific population should be used as ref-
erence for successful orthodontic treatment and not ap-
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plied to different populations.
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