Cephalometric standards for Japanese

according to the Steiner analysis

ISTRODUCTION

J N A series of studies reported in 1953, 1959, and 1960, Steine?‘” presented

an advanced method of orthodont,ic diagnosis and case analysis. This method
is designed to evaluate specific types of malocclusion by roentgenographic
ccphalometric means, especially by the analysis of denture pattern. Tt,s purpose
is to estimate t,hc expected result that can be achieved by orthodontic treatment,
and t,hen to determine the necessary treatment procedures, such as anchorage
prepa,ration, extraoral anchorage, and tooth extraction. Such steps in diagnosis
prior to the treatment of malocclusion are somewhat different, when compared
with t,he Downs’ and the Northwestern” analyses, which have also been employed
in our clinic at the Tokyo Medical and Dental Fnirersity.
In Japanese orthodont,ics, as elsewhere! it might bc said that. the need for
a method of case analysis such as Steiner’s has been increasing. This has become:
even more essential since the introduction of multiband systems such as .Jara-
bak’s”, “’ light-wire differential forces and the Bcgg’. ” light-arch-wire procedurc~.
Jn the present study an attempt is nrade to establish reference norms COY
,Ja.panese children, similar to those of tlrc Steiner analysis for Korth ATllC~'i(~i111

Caucasian children, so that this method can bc applietl in tbc diagnosis and
t.reatment of malocclusions in Japanese people.

\IAl%RIAI~S ASD METHODS

The materials used for
grams of *Japanese children
age population of average
and fifty girls with a mean
to 12 rears 4 months).
this study were ninety roentgenographie cephalo-
with normal occlusion, selected from a. normal aver-
orthodontic age. The group consisted of forty boys
age of 10 years 9 months (range : 7 years 11 months

*Professor and Chairman, Department of Orthodontics, School of Dentistry, Tokyo

Medical and Dental University.
 Ccphalometric measurements were made of nine angles and five linear dis-
tances as suggested by Steiner :
1. SNA (angle)
2. SNB (angle)
3. AKB (angle)
4. m-u (angle)
5. 1 to N,4 (linear)
6. 1 to KA (angle)
7. Ito KB (linear)
8. 1 to SB (angle)
9. PO to NB (lincay)
10. 1 to i (angle)
11. &clusal plane to SN (angle)
72. Go-Gn to SN (angle)
13. Sill (linear)
14. SE (linear)

RFS1JI
1 J TS

The means, standard deviations, and rninimurn and maximurn values of each
measurement, for each sex are shown in Table I. IJsing the 3” test on the 95
per cent level of significance, we found no significant sex difference in mean
values in any of the measurements. Therefore, the rnean values for the two sexes
were combined for use as the reference norms of the Steiner anlysis for Japanese
malocclusions.

Table I. I’nlu~s nremured, significance of difference between sexes, creell’cferewr!

norm of Steiner’s analysis for Japamse

SNA (degrees) (angle) 81.0 3.1 75.4 88.4 81.5 3.4 75.0 89.6 - 81.3 3.2
SNR (degrees) (angle) 76.2 3.1 70.1 84.5 77.2 3.0 71.8 84.5 - 76.8 3.0
ANH (tlegrees) (angle) 4.9 1.7 0.5 7.5 4.1 1.8 0.0 8.3 - 4.3 1.i
SNI) (degrees) (angle) 72.8 3.2 66.0 80.5 73.9 3.1 68.5 82.5 - 73.4 3. I
1 to NA (mm.) 5.5 1.7 3.4 10.0 6.2 1.9 2.1 11.0 - 5.9 1 .x
Fto NA (degrees) 23.5 4.7 15.2 35.8 24.7 5.2 12.5 34.3 - 24.1 ‘4.9
1 to NH (mm.) 7.8 1.7 4.4 Il.7 7.8 2.4 2.9 12.4 - i.8 2. 1
I to NH (degrees) 31.5 4.5 22.2 45.2 31.0 6.6 18.7 45.4 - 31.2 3.6
PO to NH (mm.) 0.44 1.4 -2.0 3.3 0.43 1.2 -1.7 3.7 - 0.43 1.x
1 toT (degrees) 120.3 5.8 108.2 134.7 120.3 10.1 97.3 142.6 - 120.:3 8.3
&xlusal plane to SN
(degrees) 21.0 3.8 12.7 27.8 19.2 3.7 11.5 28.2 - 20.0 3.7
GoGn to SN (degrees) 36.4 4.3 25.3 45.7 36.1 4.6 27.2 46.0 - .36.“i 4.5
SL (mm.) 40.1 5.5 25.6 48.1 41.9 6.2 28.8 54.1 41.1 3.0
RF: (mm.) 21.6 3.3 15.0 27.8 20.6 2.7 12.0 28.4 - 21.0 5.9
 Preeent study Steiner’s
Mean S.D. Mean
/
SNA

SNB
ANB
(angle

(%-la)
(=wle)
1 81.3
76.8
4.5
3.2
3.0
1.7
K
3 (
/
02
60
2
SND (=wle) 73.4 3.1 ( >' i 76 or 77

1. to NA ( mm. 1 5.9 1.8 ‘\ 4

~\\
1 to NA (angle) 24.1 4.9 ? 22
i to NB ( Jlml. 1 7.8 2.1 c 4

it0
POto
1 to i
Oocl
NE

to
NB
(=u?le)
( mm.1

(angle)
SN (angle)
31.2
0.4
120.3

20.0
5.6

1.3
8.56

3.7
i
>

a-<
) not
25

established

131

14

GoGn to SN (angle) 36.2 4.5 -Y - 32

SL ( mm* 1 41.1 5.9 51

SE ( ml. 1 21.0 3.0 22

\ +
Fig 1. Comparison of facial and denture patterns between Caucasians and Japanw~.
Table 11. C’onzparison of mean values with. some pre viox~ studies

Iizuka. Oot*ubo,
I k II ka”
Present study tltta Islt~ika wa
Angle (90) ‘* (IS)”
measured (dcgvees) (aegrces)
Mean 81.3 X0.91 80.53 81.47 X1.10
ss*t S.D. 3.2 3.07 3.26 1.23

Mean 76.8 76.15 76.2” 77.08 77.11

SNPI 1 53.1). 3.0 2.x-l 1.66 3.75

Mean 4.5 3.99

ANI3 S.1). 1.7

MGlll 120.3 124.32 12.67 118.71 1:1x19

I to 1
S.D. 8.5 6.85 8.4% 7.49

Occlwal plane to Mein 20.0 21.34 11.19 20.19

SN R.D. 3.7 3.60 ‘4.01 3.54
“Fi~~rt’s in parcntbcscs indicate number of children in snrnplc~.

to note also that the SL value in the Japanese was also considerably smaller
than in the Americans. ANB also showed a difference of 1 S.D. wide, reflecting
the marked difference in lower apical base and retroposition of the chin.
The values of 1 to NA (linear and angle) and 1 to NB (linear and angle)
were larger in .Jacanese than in Americans and rcprcsented the strong labial
inclination of the incisors, namely, the .Japanese tendency toward bimasillary
protrusion as compared to Caucasians. As a result of these strong inclinations,
i
the mean value of 1 to was also smaller by almost 1 SD.
The means anccstandard deviation of linear measurement of PO to NB could
not be evaluated, since no reference norm was castimat,ed by StGner he~ause of
the wide range of variation in individuals.
Both the occlusal plane to SK and Go-Gin to SN angles were about 1 S.1).
greater than in L4mericans. These facts seemed to indicate that the retroposition
of the chin in the Japanese is due mainly to the I,~~tl,oinclirlation of the rnardihlc.
There were no significant differences in $141.
From these data, it can be concluded that the difference between the facial
patterns of dapanese and Americans is dnc principally to the prot,ruded uppet
and lower incisors and t,o the retroposition or retroinclination of the mandible
in the #Japanese. These facts correspond to the opinions of Iizuka and Tshikawa,7
Kayukawa,lO 3Iiura and associates,llj l2 Minushin~a,‘* and Sakamoto.‘”
Concerning these anthropological differences in facial pattern, the treatment,
goal for the *Japanese should also be different from that for Caucasians. There-
fore, using the results of this study, we tried to design a new analysis cha,rt for
*Japanese. To establish the acceptable compromises, as shown in Table III, all
of t.he materials were classified into five groups according to the *4NB values,
with intervals of 2.0 degrees. The means of 1 to NA and 1 to NB for each group
were determined. From this table, accept&le compromises which correspond
with Steiner’s anal,vsis wtw wtahlishcd. ‘I%(~analysis c&hart was cwnposcd of 111~~
reference norms and acceptable c~ornpronrisc3 ( E’ig. _.) ) . The mc,thod of application
Of this chart, is similar to Steincr’s.
As mentioned previousl,v, ;I new analysis chart has been dcxignctl, but ot)-
viously t,here will be problems in its pr*;tcticaal application. Tlrca most importmt
and essential of these problcrns ma)- be rrlatcxl to t trc fact that our tr*~%itnlerlt
objectives are for normal or ideal occlusions. If t,lic racial pattern 0T normal
occlusion is the goal of orthodontic trcatmrnt, and WC believe tha,t it should b(a,
then the analysis chart presented here will b(> cBccti\~t~ and useful. The ncphalo-
metric analysis on the yueen-contest, group r*cportod by lizuka, Ootsuho. ant1
Tshikawa” and the beautiful girls sclect,od hy Yarrra~r(~hi,a’which wwc univcrsall~
accepted as most pleasing in appearance ol’ facial contours, showed that. tlrcl
hcautiful facial pattern in .Japancsc - is rrq- closr to the pattt>rn for’ (%uc;tsiatrs.
cyjeciallp in the value of 1 to 1. Tt is prohnhly true that winners of beauty con-
tests who hart been chosen by the public do not truly rcprescnt a cross section
of’ the people they arc ,judging, The public* is pr~~babl~- inflnenccd in its choice>b>
its contacts with other KICCS via motion pictures, television, and fashion nraga-
xines. This influence llirs appc~arcd wlrorevcr brauiy c*ontcbst winners ha\.(a INYII
c~valuirtcd
R1izushinra1.4 had also reported thirt tlrc facial pattern of’ the *Japanese llOl’IlI?ll
occlusion lies between that of (Caucasians and what is called bimasillary p’*o-
t rusion in Americans. When I~CW i’ac%sart’ vonsidcrcd, what should 1~ the 01).
,jcctive of orthodontic t,reatrrrt~rrt ! Shorrld it bc t,trc racial normal occlusion 01’
“an idcal occlusion,” which, according to Tweed,‘” is “the ultimate in balarr(~c ant1
llil rnron\- of facial. esthetics”? It is our’ opinion, iLlQXl(‘IllfXl by that of Steiner*,
t llat the results of orthodontic trratmcnt for ,Jal)arres(I will not, al\vays bt: tlro
most functional, stable, and desirable if a lcsser~value is used for ANK, .-1 t,o KA.
>t.rrd7 to NB than those specified in Steiner’s r*et’er*cnce rro~‘nrs for* Amer~icans.
Steiner offered his norms for (Caucasian Americans and suggested them only
iIs a, basis from which to \-ary. 1Ir stated cl~ar*ly : “Thcs~ cstimatcs a~’ as~f’rrl
as guides, but they must be modified for* individuals.” ( ‘crtainly, he believed thai
they should be modified for persons of different races.
On the basis of data which we have assrrnhlcd arrd studied. a complete chart
 ROENTGEN CEF'HALOMhTRIC ANALYSIS ( Steiner’s method )

Case No. Name Y m (M.F.) Dr.

I
Japanese Mean S.D. - I 0
1
SNA 81.3 3.7 ’ I 0I
SNB I 1
ANB 4.5, 1.7 ! ’ 6

Ideal Acceptable Compromises

L ----------_---_---_-----------------

E’ig. 2. Analysis chart for Japanese.

of t)he Steiner analysis has been established for the Japanese people. This has
been done by repetitious use of the analysis, by actual treatment, and by careful
appraisal of finished results.
This study might be the first step in the “tl’ial-alid-error” program, as stated
by- Steiner, leading to an approved cephalometric method of diagnosis and treat-
ment planning for Japanese patients.

SUMMARY AND CONCLUSIOK

F’or the purpose of increasing the usefulness of cephalometric procedures

for case analysis and treatment planning in Japancse patients, ninety roent-
gcnographic cephalograms of Japanese children with normal occlusions and of
 Discussion
Those who are csperienccd in thta us(’ of ccphalomcb?cs llavc Irar-ncd that
it is not possible to establish a set of standards or riilrs by which to govern
judgment, of living people. Some basis for comparison is helpful, howcre~~, and
I believe that, it, is necessary. ~‘onsciousl~~or unconscionsl~, our thinking is rclatetl
to something.
By using thr experience and the ,judgment, of many men, T haye ofYerd a
set, of norms f01* sucli comparisons. It is tncrrly a standard from which to vary.
Variances o~ur within ethnic groups. They occur to a grratrr extent h~tuven
ethnic groups. ln the absence of somcthinp hetStvr*,t,his no~‘m still sclTes a useful
purpose if pi-operlp applied. biit Icl it he iwnemhrrrd that its onI)- purpost~ is
2s a hiMiS of comparison.
ln cases such as the ones dealt with in this article. the \-ar5anc.r is great. A
11101’ruseful comparison coultl 1)r ma& to il 1101’111 thal 111orr nearI>. lY~~)rescrltctl
the problem at. hand.
By research and trial, thcsr men Iravc~cleeiclcd upon and haw offcrccl to the
profession a. norm for the .Japanclsc face. It is only a hasis for compar~ison hut,
1kTilIlSt’ it more nearly lY?plWCrltS a greatt~r nutnhcr of .lapanese f;~ccbs,it wil I
serve their purpose hctter. 1 (commend them for* this contribution.
Sornc day othrrs will investigate othtlr groups ot’ pcoplt~ and will dein*mine
IIIOI*C useful norms for thrm. \Vc nerd more pert inetit noi*ms for* \xi*iations within
rthnir groups.
In the mrantimc, let us rcmc1mt)cr that t7-eri one lxisic norn~ is sPl’ving :I
us&l prposc. Thr mrthod will itnprovr in valut~ ant1 r~sefulnrss ~vhrn more
rrsrawh ~~(~11as t,trat, reported in this splendid articalfb is tlonc anti the results of
it arc rrportrcl.
 The authors wish to express their appreciation to Dr. Cecil C. Steiner for his kindness
in proofreading and correcting their English translation and for his discussion of their papet
which, 110wc~~r, praises their work too highly. They also appreciate his kindness in reading
this manuscript for them bcforc thr Hawaiian Society of Orthodontists in FeGruary, 1964.

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