Cephalometric values for adult Mexican-Americans

Donald Swlerenga, DDS, MA, EdD: Larry J. Oesterle, DDS, MS,b and
Marion L Messersmith, DDS, MSc
McChord AFB, Wash., and Lack/and AFB, Texas
Cephalometric studies of adult Mexican-Americans are incomplete. The purpose of this study was to
evaluate whether significant cephalometric differences exist between adult Mexican-American, black
American, and white patients. Lateral cephalometric radiographs were taken of 48 Mexican-American
adults (23 men, 25 women). All subjects met the following criteria: parents, grandparents, or greatgrandparents were born in Mexico; 18 to 50 years of age; Class I occlusion with minor or no crowding;
good facial balance; no significant medical history or history of facial trauma; no previous orthodontic
treatment or maxillofacial surgery. Twenty-five cephalometric measurements were analyzed. Significant racial and sexual differences were found in the following areas: skeletal measurement (SNA,
ANB, Po-N.l, Co-A, Co-Gn, ANS-Me, MP-FH, MP-SN); dental measurement (U1-A.l, L1-APo, U1-L1,
IMPA); soft tissue measurement (NLA, FCA, UFH (pu), ULL). Orthodontists and oral surgeons will find
the cephalometric values of help in the diagnosis and treatment planning of potential orthognathic surgery patients. (AM J ORTHOD DENTOFAC ORTHOP 1994;106:146-55.)

Americans of Mexican heritage make up a

significant segment of the population in some areas
of the United States. Although cephalometric studies have been done on Mexican-American children,
very little has been studied on adults. In particular,
there are no data available using some of the
cephalometric measurements for hard and soft tissue that are useful for treatment planning orthognathic surgery cases. This study was performed to
examine surgically valuable measures in adult
Americans of Mexican heritage and to determine
whether significant cephalometric differences exist
between adult Mexican-Americans, black Americans, and white Americans.
Cephalometic standards for Mexican-Americans
have been studied by several investigators. Velarde!
conducted a child and adult study in 1974 to obtain
normative data for Northern Mexicans ranging in
age from 12 to 25 years. He selected persons with
clinically normal Class I occlusions. Thirty-one male
and 9 female subjects from Chihuahua, Mexico,
were compared with North Americans by means of
the Ricketts, Steiner, and Tweed analyses. He found

The views expressed in this article are those of the authors and do not
refl~ct the official policy of the Department of Defense or other Departments of the United States Government. The voluntary fully informed
consent of the subjects used in this research was obtained as required by
AFR 169-6.
'Lt Colonel, USAF, DC, General Clinical Dentist, USAF Clinic
McChord/SGD, McChord AFB, Wash.
"Colonel, USAF, CD, Chairman, Department of Orthodontics, Wilford
Hall USAF Medical Center, Lackland Air Force Base, Texas.
'Lt Colonel USAF, DC, Resident Training Officer, Department of Orthodontics, Wilford Hall USAF Medical Center, Lackland Air Force Base,
Texas.
8/1/43789

146

the Mexican group had a more protrusive dental and

skeletal pattern compared with the white group.
Garcia," in 1975, studied 34 Mexican-American
boys and 25 girls from Los Angeles, Calif., ranging
in age from 14.4 to 17.2 years. Selection criteria
were children with complete permanent dentitions
in excellent occlusion and minimal crowding, spacing, rotations, or overjet. Profile was not a selection
criterion, Garcia found more protrusive dental and
skeletal patterns for Mexican-American children
than for white children by means of the Downs,
Steiner, and Alabama analyses.
Garcia-Fernandez.':" in 1984, conducted a longitudinal study of adolescent children. He compared 36 North Mexican boys and 45 girls with 20
boys and 15 girls who were living in Iowa (average
age 13 years). Selection criteria included persons
with normal occlusion, an acceptable facial relationship, Class I molar and canine relationship,
little or no incisor crowding, no apparent dental or
skeletal discrepancies, good health, and at least
four generations in the same family residing in the
northern states of Mexico. He found mean differences between males and females within each
population in anterior and posterior facial heights.
Both North Mexican and Iowan adolescent males
had significantly larger skeletal linear parameters
of anterior and posterior faces than females. Both
North Mexican boys and Iowan boys had a convex
soft tissue profile. The North Mexican girls were
found to have a relatively protrusive mandible
compared with the white girls.
A review of the literature indicates adolescent
and young adult North Mexican and MexicanAmerican cephalometric values differ from white

American Journal of Orthodontics and Dentofacia! Orthopedics

Volume 106. No.2

North Americans. There is, however, insufficient

published data to establish cephalometric values
useful in diagnosis and orthognathic surgery treatment planning for adult Mexican-Americans. The
purpose of this study therefore is to examine adult
Mexican-American patients with hard and soft tissue measurements useful for treatment planning
orthognathic surgery patients and to determine
whether significant cephalometric differences exist
among adult Mexican-Americans, black, and white
Americans.
MATERIALS AND METHODS

Mexican-American patients from three Air Force

dental clinics were informed of the study at dental
screening appointments. Potential study participants were screened by the principal investigator and a
consent obtained for a dental examination, clinical
photos, a panoral radiograph (General Electric Panelipse
Model 46-137660GlO, Milwaukee, Wis.), and a lateral cephalogram. Women who were pregnant or breast
feeding were excluded. All female participants were
offered pregnancy tests or had their own negative results before radiographs to assure they were not
pregnant.
Potential study participants met the following criteria: Mexican-American descent with parents, grandparents, or great-grandparents born in Mexico; 18 to 50
years of age; Class I occlusion with minor or no crowding;
majority of teeth present except third molars; good facial
balance; no significant medical history, no history of
facial trauma; no previous orthodontic treatment or
maxillofacial surgery. Twenty-three men and 25 women
met the selection criteria. One man and four women
were missing teeth other than third molars, but had
normal occlusion and good interdigitation.
Standard orthodontic photographic views were
taken: Facial views; frontal (with lips in repose and teeth
in maximum intercuspation); frontal smiling, right profile
(with lips in repose); dental views (anterior, right and left
buccal); and occlusal views.
A right lateral cephalogram was taken, standardized
with the patient's Frankfort horizontal plane parallel to
the floor and the spine slightly extended. The film was
exposed with the patient in maximum intercuspation and
lipsin repose. Earrods were placed firmly in the external
auditory meatus and the film exposed at 15 rnA, 80 kV
power, at 21 to 30 impulses, with a Wehmer Cephalostat
W-105 (Wehmer Co., Inc., Franklin Park, 111.), in conjunctionwith a Gendex GX 1000 source (Gendex Corp., Milwaukee, Wis.). A 60-inch tube target distance to the midsagittalplane was used. A 5-inch (13 em) midsagittal plane
to filmdistance was used resulting in an 8% enlargement.
An aluminum attenuating shield was used to render the
soft tissue more visible. A lead apron was worn by the
patient. A Kodak X-Omatic intensifying screen (Eastman
Kodak Co., Rochester, N.Y.) was used with Kodak
GBX-Z Diagnostic film (Eastman Kodak Co., Rochester,
N.Y.) to reduce the total patient radiation.

Swierenga, Oesterle, and Messersmith

147

The clinical slides and cephalograms were reviewed by

a three-member panel of orthodontists to ensure the
screened participants met the criteria. Twenty-three men
and 25 women were accepted. Three orthodontists were
standardized in point identification during a 3-hour training and feedback session using practice cephalograms. An
81/2 X 101/2 X 1/16 clear acrylic template with three posts
(similar to a three-ring binder) was constructed to standardize tracing sheet and film placement. The template
was used independently by three orthodontists on the
panel, who used uniformly punched acetate tracing paper
to independently identify landmarks. The three tracing
sheets per patient were superimposed using the posts of
the acrylic plate. Landmarks were compared for coincidence. Landmarks that varied by more than 1 mm were
circled and relocated a second time. Centroids of very
close landmarks were used.
Hard tissue landmarks are defined in Table I, soft
tissue landmarks in Table II, hard tissue angular and linear measurement in Table III, dental measurements in
Table IV, and soft tissue angular and linear measurements
in Table V. A millimeter ruler and Baum protractor were
used to measure angular and linear values. Data were
grouped by sex. Means and standard deviations were calculated. Statistical comparison of the Mexican-American
sample was made with previously published white adult
(Table VII) and black adult (Table VIII) values with t
tests.
RESULTS

Table VI contains the Mexican-American findings for this study including maximum, minimum,
and mean group values for skeletal, dental, and soft
tissue variables. Table VII contains the comparison
data for the white male and female groups. Table
VIII contains the comparison data for comparing
the black male and female group. Table IX contains Mexican-American male cephalometric values
compared with white and black males. Table X
contains Mexican-American female cephalometric
findings compared with white and black females.
DISCUSSION

The results in Tables VI to X are presented

under three major headings: skeletal variables,
dental variables, and soft tissue variables. Each
section had subtle differences to adult MexicanAmericans for unique skeletal, dental, and soft
tissue cephalometric values.
Skeletal

Adult Mexican-Americans are not as maxillary

protrusive by the SNA angle as adult male black
Americans and were similar to adult male white
Americans. Mexican-American women were more
maxillary protrusive (SNA) than white women but
similar to black women. The difference, however,
was subtle. No significant differences were found for

148

Swierenga, Oesterle, and Messersmith

American Journal of Orthodontics and Dentofacial Orthopedics

August 1994

Table I. Hard tissue landmarks

Sella turcica (S)-Center of the bony crypt occupied by the hypophysis cerebri or the hypophyseal gland.
Nasion (N)-Intersection of the frontonasal suture with the internasal suture in the midsagittal plane.
Orbitale (O)-Lowest point on the inferior bony margin of the orbit. The point used is halfway between the right and the left
orbitale.
Anterior nasal spine (ANS)-Spinous process of the maxilla forming the most anterior projection of the floor of the nasal cavity.
Posterior nasal spine (PNS)-Tip of the posterior spine at the midline junction of the palatine bones.
Point A (A)-Most posterior midline point in the anterior concavity of the maxilla between the anterior nasal spine and the crest of
the maxillary alveolar process.
Point B (B)-Most posterior midline point in the concavity of the incisive fossa of the anterior of the mandibular symphysis between
the crest of the alveolar process and the symphysis.
Pogonion (Po)-Most prominent point on the anterior aspect of the symphysis of the mandible.
Menton (M)-Most inferior point on the symphysis of the mandible.
Gnathion (Gn)-Most outward and everted point on the profile curvature of the symphysis of the mandible.
Porion (P) (anatomic porion)-Most superior point of the bony external auditory meatus, if two can be seen, the point used is
halfway between the right and the left porion.
Pterygoid point (Pt)-Anatomic point representing the radiolucent foramen rotundum from which the maxillary nerve exits and
makes its entrance into the sphenopalatine fossa. Located at the junction of foramen rotundum with the upper left region of the
pterygomaxillary fissure.
Condylion (Co)-Most posterior, superior point on the outline of the mandibular condyle. The point used is halfway between the
right and left image.
Gonion (Go)-Most outward and everted point on the angle formed by the junction of the ramus and body of the mandible on its
posteroinferior aspect. Point used is halfway between the right and the left point.
Basion-Lowest point on the anterior margin of the foramen magnum in the midsagittal plane.

Table II. Soft tissue landmarks

Glabella-Most prominent midsagittal point on the smooth prominence of the forehead between the eyebrows.
Eye (pupil)-The most prominent or anterior point on the globe of the eye.
Subnasale-Point at which the nasal columella (the fleshy distal margin of the nasal septum) merges with the upper cutaneous lip in
the midsagittal plane.
Stomion-Located at the junction of the upper and lower lips. When the lips are not touching, the lowest point on the upper lip in
the midsagittal plane.
Soft tissue pogonion-A constructed point located where lines passing through subnasale and hard tissue pogonion meet at a right
angle on the soft tissue chin outline.
Soft tissue menton-A constructed point found by drawing a line from nasion through hard tissue pogonion (facial plane). Construct
the mandibular plane using hard tissue menton as the anterior point. Extend the mandibular plane and the facial plane to the soft
tissue outline, bisect the angle formed, and locate soft tissue menton where the bisector meets the soft tissue.

the SNB angle. Average ANB angle difference for

Mexican-Americans and white Americans was approximately 2versus 5 for black adult male Americans. The ANB angle of Mexican-American, black,
and white women was not statistically different.
Mexican-American and white men had less maxillary and mandibular anteroposterior difference than
black men by A-N..l and the SNA angle. Maxillary
protrusion (A-N..l) for Mexican-American women
was slightly greater than that of white women.
Mexican-American men had a slightly more retrusive mandible (Po-N..l) than white men, however,
the actual difference was less than 1 mm. Although
the data indicate the mandible of white women was
more prominant than Mexican-Americans, the difference was not statistically significant. This finding
differs from the Garcia-Fernandez study,3,4 which

found North Mexican women to have a statistically

more prominent mandible. Mexican-American male
maxillary length (Co-A), however, was significantly
longer than white or black men. The opposite was
true for Mexican-American women; MexicanAmerican women had a shorter maxillary length
(Co-A) than black women, but approximately the
same as white women.
Mexican-American men had a significantly
longer mandibular length (Co-Gn), than white or
black men. Mexican-American women were shorter
in mandibular length (Co-Gn) than black women,
but approximately the same as white women. Skeletal lower facial height (ANS- Me) was statistically
shorter for Mexican-American than white men, but
the little over 1 mm difference is probably not
clinically apparent. Mexican-American women had

AmericanJournal of Orthodontics and Dentofacial Orthopedics

Volume 106, No.2

Swierenga, Oesterle, and Messersmith

149

Table III. Hard tissue angular and linear measurements

SeUa nasion plane (SN)-Constructed from point sella turcica to nasion.
Mandibular plane (MP)-Constructed from menton to gonion.
Frankfort horizontal plane (FH)-Constructed from anatomic porion to orbitale.
Palatal plane (PP)-Constructed from anterior nasal spine to posterior nasal spine.
SNA angle (SNA)-Inward angle toward the cranium between the NA line and the SN plane.
SNB angle (SNB)-Inward angle toward the cranium between the NB line and the SN plane.
ANBangle-Angle between NA and NB line obtained by subtracting SNB from SNA.
SeUa nasion plane to mandibular plane angle (SN-MP)-Angle between the SN plane and the mandibular plane (MP).
Nasion perpendicular-Constructed from a line drawn perpendicular to Frankfort horizontal plane through nasion. Line is extended
below the image of the mandible.
A point to nasion perpendicular-Distance between A point and the nasion perpendicular line measured perpendicular to the nasion
perpendicular line.
Pogonion to nasion perpendicular (Po-Na.L)-Distance between pogonion and N.L measured from the perpendicular to the nasion
perpendicular line.
Condylion to A point (Co-A)--Effective Midface Length-Measurement is made on a line drawn from condylion to A point.
Condylion to gnathion (Co-Gn)--Effective Mandibular Length-Measurement is made on a line drawn between condylion and
gnathion.
Anterior nasal spine to menton (ANS-Me)--Lower Face Height-Measured in millimeters from anterior nasal spine (ANS) to
menton.
Mandibular plane to Frankfort horizontal (MPFH)-Angle between the Frankfort horizontal plane (FH) and the mandibular
plane (MP).
Basion-nasion to pterygoid point-gnathion (Ba-N to Pt-Gn)-facial axis angle-A line drawn between pterygoid point and gnathion, which forms the central axis of the face or the Facial Axis. The facial axis is related to a line drawn between nasion and
basion. Where these two lines cross is point "cc" (cranial center) and forms the facial axis angle, the angle measured is the most
posterior inferior angle.
Palatal plane to Frankfort horizontal (ANS-PNS to FH)-Angle measured between palatal plane and Frankfort horizontal plane.

Table IV. Dental measurements

Maxillary incisor to sella nasion plane (Ul-SN)-The most inferior inward angle formed by the extension of the long axis of the
maxillary incisor to the SN plane.
Maxillary central incisor to mandibular central incisor (UI-Ll)-Angle is measured between the extension of the maxillary and
mandibular incisor long axis lines-most posterior angle is measured.
Mandibular incisor to mandibular plane (LI-MP)-Long axis of the mandibular incisor is measured to the mandibular plane.
Most inward angle toward the body of the mandible is measured.
Maxillary incisor to A point perpendicular-A line perpendicular to the Frankfort horizontal line is drawn through point A. Measurement is made from the A Point perpendicular to the most prominent point on the labial surface of the maxillary incisor.
Maxillary incisor to lip (Ul-Lip)-Measurement made from stomion to the tip of the maxillary incisor. Measurement made parallel
to nasion perpendicular.

Table V. Soft tissue angular and linear measurements

Nasolabial angle (NLA)-Formed by two lines intersecting at subnasale. Measure angle formed by line tangent to the base of the
nose through subnasale and the line from the upper vermilion border through subnasale.
Facial contour angle (FCA)-Angle measured between the lower facial plane (subnasale to soft tissue pogonion) and the extension
of the upper facial plane (glabella to subnasale).
Upper face height (UFH) (pupil)-Construct perpendicular to the upper facial plane to the middle of the eye. Measurement is made
on the upper facial plane between the pupil perpendicular and subnasale.
Upper face height (UFH) (glabella)-Measured on upper facial plane between gabella and subnasale.
Lower face height (LFH)-A perpendicular is drawn to the lower facial plane through soft tissue menton. Measure the distance on
the lower facial plane between soft tissue menton perpendicular and subnasale.
Upper lip length (ULL)-A perpendicular to the lower facial plane is drawn through stomion. Linear measurement made between
stomion perpendicular and subnasale.
Lower lip length (LLL)-A perpendicular to the lower facial plane is drawn through stomion and another through soft tissue menton. Linear measurement is made between stomion perpendicular and soft tissue menton perpendicular on the lower facial plane.

150

American Journal of Orthodontics and Dentofacial Orthopedics

August 1994

Swierenga, Oesterle, and Messersmith

Table VI. Adult Mexican-American variables-men and women

Men
Variable

Mean

SD

Women

Minimum

Maximum

Mean

SD

Minimum

Maximum

Skeletal

SNA
SNB
ANB
A-N.l
Po-N.l
Co-A
Co-Gn
ANS-Me
MP-FH (FMA)
MP-SN
Ba-N-Pt-Gn
Palatal P1-FH

81.83
79.83
2.00
.61
- 1.13
99.09
130.78
72.91
20.70
28.91
89.87
.13

3.41
3.11
2.47
2.92
4.66
5.03
4.80
3.95
5.91
5.23
3.63
2.90

75.00
73.00
-3.00
-6.00
- 10.00
87.00
120.00
66.00
10.00
21.00
82.00
- 8.00

90.00
84.00
6.00
6.00
9.00
109.00
139.00
80.00
32.00
39.00
96.00
4.00

82.36
78.84
3.60
1.72
-2.92
90.52
119.04
69.32
25.20
34.36
86.20
.96

3.28
2.91
1.87
2.41
4.77
3.81
4.55
4.19
3.97
4.33
3.92
3.95

76.00
75.00
.00
-3.00
-13.00
83.00
111.00
59.00
18.00
26.00
79.00
- 8.00

88.00
86.00
7.00
6.00
10.00
98.00
129.00
76.00
37.00
45.00
93.00
8.00

105.39
6.39
3.09
129.48
96.30
2.78

8.10
1.83
2.84
8.26
5.40
1.81

89.00
3.00
-1.00
112.00
86.00
.00

122.00
10.00
9.00
144.00
112.00
7.00

103.08
6.52
4.12
124.96
97.24
2.64

6.60
2.45
2.28
8.25
4.20
1.60

89.00
2.00
-1.00
110.00
90.00
-1.00

113.00
13.00
8.00
141.00
105.00
5.00

94.30
-11.35
75.30
75.30
51.22
24.04
51.04

10.56
6.09
3.44
4.22
4.18
1.72
3.44

75.00
- 20.00
70.00
69.00
44.00
20.00
44.00

116.00
3.00
82.00
82.00
63.00
27.00
56.00

100.24
-13.08
72.92
71.40
47.20
23.56
47.96

8.38
3.57
4.98
3.18
4.09
1.56
2.84

82.00
- 21.00
64.00
67.00
38.00
20.00
43.00

117.00
-7.00
81.00
79.00
55.00
26.00
54.00

Dental

U1-SN
VI-A.l
Ll-APo
UI-Ll
IMPA
UI-Lip
Soft tissue

NLA
FCA
UFH (gl)
LFH
UFH (pu)
ULL
LLL

a longer lower facial height (ANS-Me) than white

women.
The Frankfort mandibular angle (MP-FH) was
statistically flatter for Mexican-American men than
white men; however, at less than 1 difference, it
probably is not clinically observable.
The mandibular plane to sella nasion (MP-SN)
was significantly less divergent for Mexican-American men compared with white and black men. This
difference was pronounced with a 6 and 8 difference. Mexican-American women showed no
MP-SN differences compared with white and black
women. Neither Mexican-American men or women
showed any difference in the facial axis angle
(Ba-N-Pt-GN) or the palatal plane to Frankfort
horizontal plane (ANS-PNS-FH) compared with
white or black Americans.
The overall skeletal trend of Mexican-American
men was a longer maxillary and mandibular length
than black or white men (Co-A, Co-Gn) and a flatter
mandibular plane (MP-SN). Mexican-American
women, like black women, were slightly more rnaxil-

lary protrusive (SNA and A-N.l) than white

women. Mexican-American women, like white
women, had a shorter maxillary and mandibular
length (Co-A and Co-Gn) than black women; but
Mexican-American women had a longer lower facial
height (ANS-Me) than white women. The findings
of this study do not support the findings of significant
skeletal protrusion of Velarde' and Garcia" in
Mexican-American children.
Dental

The second major comparison category was dental variables. In this area more white adult data were
available for comparison than black adult data. No
significant male differences were found for upper
incisor angulation (Ul-SN). The maxillary incisors
of Mexican-American women were more retroclined than those of white or black women. However,
the black comparison group" combined 50 males and
females. Statistical analysis could not be conducted
without knowing the sample size for each sex. The
study evaluated only black children. Black Ul-SN

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 106, No, 2

Swierenga, Oesterle, and Messersmith

151

Table VII. White male and female comparison group

Variable

Value

Skeletal
SNA
SNB
ANB
A-N.1
Po-N.1
Co-A
Co-On
ANS-Me
MP-FH (FMA)
MP-SN
Ba-N-Pt-On
Palatal PI-FH

80,63
78,75
2,04
0,96
-0.43
89.78
125.12
74.54
21.55
34.91
90.30
-0.38

3,52
3,14
1.53
2.67
3.69
4.69
5.18
5.41
3.95
4.97

Dental
VI-SN
UI-A.1
Ll-APo
UI-Ll
IMPA
VI-lip
Soft tissue
NLA
FCA
UFH (pu)
ULL
LLL

SD

Comparison
sample size

Female

Male

Source of
data*

SEM

Male

0.60
0.72
0.40

25
25
25
44
44
25
25
44
44
25

25
25
25
81
81
25
25
81
81
25

2.79

44

81

1,4
1,4
1,4
2, 5
2, 5
1,4
1,4
2,5
2,6
1,7
3, 8
2

1.20
0.56

107.10
5.44
1.79
127.34
93.18
4.09

5.62
1.70
1.68
7.40
5.91
2.27

1.18
0.45

44
44
44
44,
25
25

81
81
81
81
25
25

2,4
2,5
2,8
2, 7
1,7
1

2.39
1.09
0.84
0.52
0.63

107.34
-10.83
43.17
21.50
47.13

7.33
4.08
3.92
3.55
2.40

1.47
0.82
0.78
0.71
0.48

25
25
25
25
25

25
25
25
25
25

1,9
I, 10
1
1
1

SEM

Value

0.70
0.63
0.34

2.89

80.05
77.45
3.00
0.52
-1.72
91.56
120.31
66.88
22.71
35.36
90.30
-0.35

105.68
5.35
1.32
133.51
92.06
1.82

6.56
1.96
2.29
10.83
6.01
2.80

101.19
-12.45
43.39
24.13
49.20

11.95
5.46
4.22
2.59
3.14

0.94
1.04

0.99

SD

3.02
3.59
2.01
2.29
4.42
4.52
4.78
4.16
4.40
5.34

0.90
0.96

1.07

Female

*Sources:
1. Data from Connor AM, Moshiri F.'
2. Data from McNamara lA."
3. Data from Ricketts RM.'
4. Original source, Steiner CC!
5. Original source, McNamara lA. 'O
6. Original source, Tweed CH."
7. Original source, Downs WR. 12
8. Original source, Ricketts RM. 13
9. Original source, Worms FW. 14
10. Original source, Burstone C."

values from this study were nearly equal to white

values. The maxillary incisors of Mexican-American
were more retroclined than those of black women.
Statistically, adult Mexican-American male and
female maxillary teeth were more protrusive (VIA 1.) than their white comparison group. Lower
incisor prominence (Ll-APo and IMPA) of Mexican-American men and women compared with
white male and female subjects reflect greater
Mexican-American lower incisor protrusion. Although numerically greater in Mexican-American
women than in white women, the difference was
not statistically significant.
Mexican-American men exposed more of their

maxillary teeth at rest (VI-Lip) than black men and

about the same as white men. Mexican-American
women showed less maxillary tooth at rest (VI-Lip)
than white women and about the same as black
women. The incisor exposure was nearly the same
in both the male and female samples.
The results of this study demonstrated a mildly
more dentally protrusive pattern in MexicanAmericans than white Americans. This matches the
findings of Velarde! and Garcia" in children.
Soft tissue

The third major comparison category was soft

tissue variables. Mexican-American male and fe-

American Journal of Orthodontics and Dentofacial Orthopedics

August 1994

152 Swierenga, Oesterle, and Messersmith

Table VIII. Black male and female comparison group
Male
Variable
Skeletal
SNA
SNB
ANB
A-N.l
Po-N.l
Co-A
Co-Gn
ANS-Me
MP-FH (FMA)
MP-SN
Ba-N-Pt-Gn
Palatal PI-FH
Dental
Ul-SN
Ul-A.l
Ll-APo
UI-Ll
IMPA
Ul-lip
Soft tissue
NLA
FCA
UFH (gl)
LFH
UFH (pu)
ULL
ILL

Value

SD

Comparison
sample size

Female

SEM

Value

SD

SEM

Male

Female

85A2
80.60
4.82

4.18
4.26
2.44

0.84
0.85
OA9

83.23
79.75
3.94

3.08
4.87
2.08

0.62
0.97
OA2

25
25
25

25
25
25

91.63
124.86

4.98
5.17

1.00
1.03

93.38
125.36

5.21
6.67

1.04
1.33

25
25

25
25

36A9

5.59

1.12

36.72

6AO

1.28

25

25

108Al

6.04

108Al

6.04

98.84
1.52

5.66
1.70

1.13
-2.10

98.72
2.61

7.01
1.51

lAO
-1.80

25
25

25
25

76.27
-11.94

18.01
6.53

3.60
1.31

77.05
-9A2

15.2
5.00
5.85

3.05
1.17

25
25

25
25

44.31
27.72
50.94

4.27
2.46
3.60

0.85
0.49
0.72

43.22
26.34
49.52

0.82
0.58
0.78

25
25
25

25
25
25

4.08
2.89
3.89

Source of
data"

*Sources:
1. Data from Connor AM, Moshiri F.'
2. Data from Alexander TL, Hitchock HP (8 to 13 year olds, combined male/female data).'

male nasolabial angles (NLA) were very different

from white and black male and female subjects.
Mexican-American male and female subjects had
more protrusive upper lips (NLA) than white subjects, but less than black subjects. The MexicanAmerican female profile (FCA) was more convex
than white women or black women. Male facial
contour angles were not statistically different between races. No comparative white or black data
were available for upper facial height from glabella
(UFH(gl)) or lower facial height (LFH). There
were data available for upper facial height from
pupil (UFH(pu)). Both Mexican-American men
and women subjects had longer upper facial heights
than their respective comparison groups. MexicanAmerican men had shorter upper lip lengths than
black men, but were comparable to white men.
Mexican-American women had slightly longer up-

per lip lengths than white women, but shorter than

black women. Lower lip lengths were not statistically different among the races within male and
female groups.
Clinical Implications

The results of this study have clinical implications in the diagnosis and treatment planning of
adult Mexican-American patients. Skeletally,
Mexican-American men tend to be very close to
white men. The only significant difference being
greater jaw length and a somewhat flatter mandibular plane angle in Mexican-American men. Hence,
little difference exists in the diagnosis and treatment
planning of Mexican-American men and white
men. Mexican-American women demonstrated
mildly more protrusive maxillae that was only
slightly less protrusive than the maxillae of black

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 106. No.2

Swierenga, Oesterle, and Messersmith

153

Table IX. Adult Mexican-American male variables versus white and black male variables
Mexican-American
males
Variables

Mean

Skeletal
SNA
SNB
ANB
A-N.l
Po-N.l
Co-A
Co-Gn
ANS-Me
MP-FH (FMA)
MP-SN
Ba-N-Pt-Gn
Palatal PI-FH
Dental
Ul-SN
UI-A.l
L!-APo
UI-L!
IMPA
UI-lip
Soft tissue
NLA
FCA
UFH (gl)
LFH
UFH (pu)
ULL
LLL

White males

SD

Black males

SD

Mean

81.83
79.83
2.00
0.61
-1.13
99.09
130.78
72.91
20.70
28.91
89.87
0.13

3.41
3.11
2.47
2.92
4.66
5.03
4.80
3.95
5.91
5.23
3.63
2.90

80.63
78.75
2.04
0.96
-0.43
89.78
125.12
74.54
21.55
34.91
90.30
-0.38

3.52
3.14
1.53
2.67
3.69
4.69
5.18
5.41
3.95
4.97

0.24
0.24
0.95
0.26
0.02*
0.0001*
0.0003*
0.0001*
0.0006*
0.0002*

2.00

0.12

105.39
6.39
3.09
129.48
96.30
2.78

8.10
1.83
2.84
8.26
5.40
1.81

105.68
5.35
1.32
133.51
92.06
1.82

6.56
1.96
2.29
10.83
6.01
2.80

0.13
0.04*
0.0001*
0.002*
0.02*
0.17

94.30
-11.35
75.30
75.30
51.22
24.04
51.04

10.56
6.09
3.44
4.22
4.18
1.72
3.44

101.19
-12.45

11.95
5.46

0.04*
0.51

43.39
24.13
49.20

4.22
2.59
3.14

t test

0.0001*
0.89
0.06

Mean

SD

t test

85.42
80.60
4.82

4.18
4.26
2.44

0.002*
0.48
0.0002*

91.63
124.86

4.98
5.17

0.0001*
0.0002*

36.49

5.59

0.0001*

108.41

6.04

98.84
1.52

5.66
1.70

76.27
-11.94

18.01
6.53

0.0001*
0.75

44.31
27.72
50.94

4.27
2.46
3.60

0.0001*
0.0001*
0.92

0.12
0.02*

'Statistically significant.

women. Therefore, in the diagnosis and treatment

planning of Mexican-American women, more maxillary skeletal protrusion is acceptable than in white
women.
Dentally, Mexican-American patients should be
treated slightly more bimaxillary protrusive than
white patients. The mild bimaxillary protrusion results in the more acute nasolabial angle seen in the
Mexican-Americansample. The mild maxillary protrusion seen in Mexican-American women results
ina more convex profile as compared with white and
black women. Hence, Mexican-American women
should be treatment planned to be mildly more dentally protrusive than white patients with a slightly
more convex profile than either white or black
women.
SUMMARY

This study compared angular and linear skeletal,

dental, and soft tissue measurements from a sample

of adult Mexican-Americans to white and black

samples. Not all statistically significant differences
are clinically significant because of the small size of
the measurement differences. Skeletally, MexicanAmerican men had longer maxillary and mandibular
lengths than black or white men (Co-A, Co-Gn) and
a flatter mandibular plane angle (MP-SN). MexicanAmerican women were slightly more maxillary protrusive (SNA and A-N 1.) than white women, similar
to black women. Mexican-American women had a
shorter maxillary and mandibular length (Co-A and
Co-Gn) than black women, but a longer lower facial
height (ANS-Me) than white women. However, the
findings of this study did not support the findings of
previous studies of a significant skeletal protrusion
in Mexican-Americans as compared with white
Americans. Dentally, both Mexican-American sexes
had more protrusive (Ll-APo) and proclined
(IMPA) lower incisors than their white counterparts. This study, like previous studies in children,

154

American Journal of Orthodontics and Dentofacial Orthopedics

August 1994

Swierenga, Oesterle, and Messersmith

Table X. Adult Mexican-American female variables versus white and black female variables
Mexican-American
females
Variables

White females

Black females

SD

Mean

82.36
78.84
3.60
1.72
-2.92
90.52
119.04
69.32
25.20
34.36
86.40
0.96

3.28
2.91
1.87
2.41
4.77
3.81
4.55
4.19
3.97
4.33
3.92
3.95

80.05
77.45
3.00
0.52
-1.72
91.56
120.31
66.88
22.71
35.36
90.30
-0.35

3.02
3.59
2.01
2.29
4.42
4.52
4.78
4.16
4.40
5.34

0.01*
0.14
0.28
0.03*
0.25
0.38
0.34
0.01*
0.01*
0.47

2.79

0.07

103.08
6.52
4.12
124.96
97.24
2.64

6.60
2.45
2.28
8.25
4.20
1.60

107.10
5.44
1.79
127.34
93.18
4.09

5.62
1.70
1.68
7.40
5.91
2.27

100.24
-13.08
72.92
71.40
47.20
23.56
47.96

8.38
3.57
4.98
3.18
4.09
1.56
2.84

107.34
-10.83

43.17
21.50
47.13

Mean

SD

t test

Mean

SD

t test

Skeletal

SNA
SNB
ANB
A-Nl.
Po-Nl.

Co-A
Co-Gn
ANS-Me
MP-FH (FMA)
MP-SN
Ba-N-Pt-Gn
Palatal PI-FH

83.23
79.75
3.94

3.08
4.87
2.08

0.34
0.43
0.55

93.38
125.36

5.21
6.67

0.03*
0.0003*

36.72

6.40

0.13

0.003*
0.02*
0.0001
0.17
0.007*
0.01*

108.41

6.04

98.72
2.61

7.01
1.51

7.33
4.08

0.002*
0.04*

77.05
-9.42

15.25
5.85

0.0001*
0.01*

3.92
3.55
2.40

0.001*
0.01*
0.27

43.22
26.34
49.52

4.08
2.89
3.89

0.001*
0.0001*
0.11

Dental

Ul-SN
Ul-Al.
L!-APo
VI-L!
IMPA
VI-lip

0.37
0.95

Soft tissue

NLA
FCA
VFH (gl)
LFH
VFH (pu)
VLL
LLL
*Statistically significant.

did find a mild dental protrusion in MexicanAmericans compared with white Americans.
Mexican-American men and women had a more
protrusive upper lip (NLA) than white men and
women, but less than black men and women. The
Mexican-American female profile (FCA) was more
convex than white or black female subjects. Finally,
in both the Mexican-American men and women
the upper facial height was longer with one measurement (LFH(pu)) than the white and the black
values.

2.

3.

4.

5.

Special thanks is given to LTC Richard D. Davis,

DDS, MS, for reviewing the protocol, Maj. Sara M.
Devine, DDS, MS,for point location, Dr. Cliff A. Butzen,
PhD, for statistical analysis, and Ms. Velma Grantham
and the Clinical Investigation Directorate secretarial
staff for editorial assistance and typing.
REFERENCES

6.

1. Velarde EA. Cephalometric norms for the Mexican population using the Ricketts, Steiner and Tweed analyses.

10.

7.
8.
9.

[Thesis.] Lorna Linda, California: Lorna Linda University

Graduate School, 1974.
Garcia CJ. Cephalometric evaluation of Mexican-American
using the Downs and Steiner analyses. AM J ORTHOD
1975;68:67-74.
Garcia-Fernandez A. Cephalometric analysis for the North
Mexican adolescent. [Thesis.] Iowa City: University of Iowa,
1984.
Bishara SE, Fernandez AC. Cephalometric comparisons of
the dentofacial relationships of two adolescent populations
from Iowa and Northern Mexico. AM J ORTHOD 1985;88:
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Connor AM, Moshiri F. Orthognathic surgery norms for
American black patients. AM J ORTHOD 1985;87:119-34.
McNamara JA. Cephalometric analysis of untreated adults
with ideal facial and occlusal relationships. Inter J Adult
Orthod Orthog Surg 1988;3:221-31.
Ricketts RM. Perspectives in the clinical application of
cephalometries. Angle Orthod 1981;51:11550.
Alexander TL, Hitchcock HP. Cephalometric standards for
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Steiner Cc. Cephalometries for you and me. AM J ORTHOD
1953;39:729-55.
McNamara JA. A method of cephalometric evaluation. AM
J ORTHOD 1984;86:449-69.

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 106, No.2

11. Tweed CH. The Frankfort-mandibular incisor angle

(FMIA) in orthodontic diagnosis, treatment planning and
prognosis. Angle Orthod 1954;24:121-69.
12. Downs WB. Variations in facial relationships: their significance in treatment and prognosis. AM J ORTHOD 1948;34:
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13. Ricketts RM. The influence of orthodontic treatment on
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14. Worms FW, Isaccson RJ, Speidel TM. Surgical orthodontic

Swierenga, Oesterle, and Messersmith

155

treatment planning: profile analysis and mandibular surgery.

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15. Burstone C. The integumental profile. AM J ORTHOD 1958;
44:1-25.
Reprint requests to:
LTC Marion L. Messersmith

Wilford Hall USAF Medical Center/DSR

1615 Truemper St.
Lackland AFB, TX 78236-5551

AAO MEETING CALENDAR

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