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Jarabak 'S Cephalometric Analysis of Brazilian Black Patients
Jarabak 'S Cephalometric Analysis of Brazilian Black Patients
Mayury KURAMAE
Maria Beatriz Borges de Araújo MAGNANI
Eloísa Marcantonio BOECK
Adriana Simoni LUCATO
The treatment of skeletal disharmonies presents better results when performed during the growth period. The physical changes that
occur in every individual express growth, which is ruled by genetic, general and environmental factors. In order to identify such
disharmonies and hence concentrate the clinical actions during treatment and influence facial growth, cephalometrics appears as a useful
a diagnostic tool for identifying facial growth patterns or growth direction. Jarabak’s cephalometric analysis is used to assess facial
growth pattern of subjects with normal occlusion or malocclusions. The purpose of this study was to obtain mean values for
cephalometric measurements from Jarabak’s cephalometric analyses of black Brazilian subjects resident in the city of Piracicaba, São
Paulo state, Brazil and vicinities, who presented Class I molar relationship with normal overjet and overbite, mild or no tooth crowding
or spacing, and no history of orthodontic treatment. A sample of 37 stone plaster casts and 37 lateral teleradiographs from both male
and female individuals aged 10 to 14 years was evaluated. Data were analyzed statistically by Student’s t-test at 5% significance level.
There was no significant differences between genders. The cephalometric measurements obtained in this study were similar to the
Jarabak’s standards, except for S-N mean value in females (66.50 mm ± 3.16), which was significantly lower than the standard.
Correspondence: Dra. Mayury Kuramae, Rua Itaipu, 422, apto 304, 04052-010 São Paulo, SP, Brasil. Tel: +55-11-5594-1224. e-mail:
mayury@bol.com.br
growth pattern, thus knowing its directions and possi- Human Research Committee (protocol #127/2001).
bilities. Only after this an orthodontic mechanics will be The lateral cephalograms were separated by
chosen for better results and with less difficulties. gender. Cephalometric tracings were performed on
Jarabak’s cephalometric analysis can also predict standard acetate paper (17.5 x 17.5 cm and 0.07 mm
the results of different orthodontic approaches. The thickness) with a 0.3 mm graphite mechanical pencil,
analysis of lines and angles that define this analysis transparent ruler to the nearest 0.5 mm, protractor to the
provides the clinician with the skeletal characteristics nearest 0.1º, template, adhesive tape and illuminator. All
and, as a result, identification of muscular pattern. tracings were done in a darkened room by the same
These can be directly applied on the selection of investigator. The cranial and facial structures were
orthodontic or orthopedic devices, in such a way that outlined and then the investigator traced lines and planes
the clinician can be able to evaluate the facial growth to compose Jarabak’s cephalometric analysis (Fig. 1).
response from these therapeutic procedures. Student’s t-tes at 5% significance level was used
The variety of craniofacial characteristics present for data analysis (means, standard deviations, maximum
in the different racial and ethnic groups have been and minimum values) and to assess gender differences.
investigated in several studies (4-14), which mention Tracings were performed twice, with a mini-
the adoption of standard normality mean values for each mum interval of 10 days, according to the method
specific group. Thus, each group should be evaluated described by Midtgard et al. (15), aiming to eliminate
separately, according to its individual characteristics. possible investigator’s error.
Black subjects have craniofacial characteristics
that are distinct from those of other races, especially
Caucasians. As the cephalometric analysis routinely
used for diagnosis and treatment planning in Orthodon-
tics is generally based on Caucasian cephalometric
standards, there has been concern on elaborating a
cephalometric analysis more specific to young Brazilian
Black patients.
The purpose of this study was to determine mean
values of Jarabak’s cephalometric analysis for Brazilian
Black youngsters with clinically excellent occlusion and
to verify the differences between males and females.
Table 1. Means (±SD) of the cephalometric measurements obtained Table 2. Comparison between the obtained cephalometric
for both genders in the studied population. measurements and Jarabak’s standards by gender.
N-S-Ar (º) 121.56 A 6.91 124.38 A 6.34 N-S-Ar (º) 121.56 123 ± 6 124.38 123 ± 6
S-Ar-Goc (º) 148.00 A 8.21 144.88 A 8.49 S-Ar-Goc (º) 148.00 143 ± 5 144.88 143 ± 5
Ar-Goc-Me (º) 122.19 A 4.17 122.06 A 5.40 Ar-Goc-Me (º) 122.19 130 ± 7 122.06 130 ± 7
S+Ar+Go (º) 391.75 A 6.02 391.31 A 4.81 S+Ar+Go (º) 391.75 396 ± 6 391.31 396 ± 6
Ar-Goc-N (º) 50.63 A 4.15 50.31 A 5.31 Ar-Goc-N (º) 50.63 52 - 55 50.31 52 - 55
N-Goc-Me (º) 71.56 A 4.82 71.75 A 3.57 N-Goc-Me (º) 71.56 70 - 75 71.75 70 - 75
S-N (mm) 68.44 A 2.56 66.50 A 3.16 S-N (mm) 68.44 71 ± 3 66.50* 71 ± 3*
Goc–Me (mm) 73.25 A 3.89 72.94 A 3.07 Goc–Me (mm) 73.25 71 ± 5 72.94 71 ± 5
S–Ar (mm) 33.56 A 2.39 33.19 A 3.17 S–Ar (mm) 33.56 32 ± 3 33.19 32 ± 3
Ar–Goc (mm) 44.44 A 4.52 44.50 A 3.90 Ar–Goc (mm) 44.44 44 ± 5 44.50 44 ± 5
S–Goc (mm) 74.81 A 5.83 73.94 A 3.70 S–Goc (mm) 74.81 70-85 73.94 70 - 85
N–Me (mm) 112.38 A 7.46 111.94 A 5.23 N–Me (mm) 112.38 105-120 111.94 105-120
% Jarabak 66.83 A 5.11 66.11 A 3.03 % de Jarabak 66.83 62-65% 66.11 62-65%
Same letters indicate no statistically significant difference at 5% * = Indicates statistically significant difference at 5% (Student’s
by Student’s t-test. t-test).
is the need to evaluate cephalometric patterns and continua sendo um grande desafio para os ortodontistas. As
characteristics of the whole dentofacial complex indi- desarmonias esqueléticas apresentam melhores resultados se
corrigidas no período de crescimento. As transformações ocorridas
vidually for each group. em um indivíduo representam a expressão do crescimento, que é
Cotton et al. (5) compared Blacks to three other regulado por fatores genéticos, gerais e ambientais. A fim de
ethnic groups. When compared to Caucasians, the localizar as desarmonias, para concentrar as ações clínicas du-
Black individuals demonstrated a protrusion of maxilla, rante o tratamento e influenciar o crescimento facial, a cefalometria
é um recurso diagnóstico útil na identificação do padrão facial ou
a convex profile, a steep mandibular plane and flared na sua tendência de crescimento. A análise de Jarabak é utilizada
maxillary and mandibular incisors. Bialveolar protru- para estudar o padrão de crescimento facial de indivíduos com
sion, often referred to as bimaxillary protrusion, is a oclusão normal ou com maloclusões. O objetivo do presente
common occurrence in some ethnic groups because of trabalho foi determinar os valores médios para as grandezas
cefalométricas utilizadas na análise cefalométrica de Jarabak em
the forward positioning of the teeth and its effect on the indivíduos melanodermas, brasileiros, da região de Piracicaba, e
facial profile (12). com relação molar em Classe I com trespasse horizontal e vertical
The cephalometric guidelines for the different normal, com mínimo ou nenhum apinhamento ou diastemas e
ethnic and racial groups established in various studies sem histórico de tratamento ortodôntico. Para tanto, foi utilizada
uma amostra de 37 modelos de gesso pedra e 37 telerradiografias
show that normal measurements for one group are not de cabeça, em norma lateral, de indivíduos de ambos os gêneros,
necessarily normal for another group, which means that compreendidos na faixa etária entre 10 a 14 anos. Os resultados
each racial group must be treated according to its own foram submetidos ao teste “t” de Student, com nível de
characteristics. A number of standards have been significância de 5%. Não houve diferenças significantes entre os
gêneros. As medidas encontradas na população estudada foram
developed for the various racial and ethnic groups (5- semelhantes ao padrão, diferindo somente o S-N para o gênero
7,9,14). feminino, que foi de 66,50 mm (± 3,16), significantemente menor
In the Table 1, it can be observed that the values que a média padrão.
obtained in this study were similar for both genders, as
previously described by Gianelly (18). When Table 2 is REFERENCES
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15. Midtgard J, Björk G, Linder-Aronson S. Reproducibility of Accepted September 4, 2006