Orthognathic surgical norms for a sample of Saudi adults: Hard tissue measurements

AlBarakati, Sahar F.; Baidas, Laila F.

doi:10.1016/j.sdentj.2010.04.007

« Previous Next »The Saudi Dental Journal
Volume 22, Issue 3 , Pages 133-139, July 2010

Orthognathic surgical norms for a sample of Saudi adults: Hard tissue measurements

Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, P.O. Box 5967, Riyadh 11432, Saudi Arabia

Received 4 March 2009; received in revised form 3 July 2009; accepted 9 January 2010.

Abstract

Objective

The aim of the study is to establish hard tissue cephalometric norms for orthognathic surgery for a sample of Saudi adults.

Materials and methods

Sixty-two lateral cephalometric radiographs for 31 females and 31 males, age range of 22–24years, were analysed. The mean values of the hard and dental measurements were compared with those of European-American adults using Burstone analysis, as well as comparison between Saudi males and females.

Results

Saudi males had an increased cranial base length, the mandible lied more posterior to maxilla, increased mandibular plane angle and backward rotation of the mandible with less prominent chin, shorter maxillary length, and also less proclination of lower incisors compared to those of European Americans. Saudi females had similar cranial base length and shorter maxillary length than European Americans. In both gender; lower anterior and posterior dental heights were smaller when compared with the European-Americans’ values. A significant difference between Saudi males and females was found. Saudi males showed longer cranial base length, larger vertical skeletal proportion, increased dental values, longer maxillary and mandibular length than the female group.

Conclusion

This study may be useful in providing racially specific cephalometric norms for diagnosis and treatment planning for orthognathic surgery for a sample of Saudi adults.

Keywords: Cephalometric norms, Orthognathic surgery, Saudi adults

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1. Introduction

Successful treatment of the orthognathic surgery is dependent on careful diagnosis of facial, skeletal and dental problems. For this reason a specialized cephalometric appraisal system called cephalometric for orthognathic surgery analysis (COGS) concerning the hard tissue of the face had been developed by Burstone and colleagues (Burstone et al., 1978). The COGS system of the hard tissue describes the horizontal and vertical position of facial bones by the use of constant coordinate system; the sizes of bones are represented by direct linear measurements and the shape by angular measurements. This analysis has been widely used for research (Conner and Moshiri, 1985, Scheideman et al., 1980, Wylie et al., 1987, Flynn et al., 1989, Rafael et al., 1998) and in treatment planning for orthognathic surgery.

It is well established that cephalometric standard values provide useful guideline in orthodontic diagnosis and treatment planning. Therefore, the orthodontic literature contains many studies involving cephalometric and profile standards of European-Americans (Scheideman et al., 1980; Wylie et al., 1987), African Americans (Conner and Moshiri, 1985, Flynn et al., 1989) and Japanese (Rafael et al., 1998). Although Arabs are Caucasian (Coon et al., 1950), there are few published scientific research related to Arab population (Bishara et al., 1990, Mouakeh, 2001, Hamdan and Rock, 2001, Al-Jame et al., 2006) and Saudis in specific (Shalhoub et al., 1987, Sarhan and Nashashibi, 1988, Al-Jasser, 2000, Al-Jasser, 2005, Hassan, 2006, AlBarakati and Talic, 2007). Shalhoub et al. (1987) evaluated lateral cephalometric radiographs of 48 adult Saudis with normal facial proportions, compared them with a North American sample, and established a set of cephalometric norms for Saudi adults living in Riyadh city. Sarhan and Nashashibi (1988) compared cephalometric radiographs of Saudi boys (10–14years old) with a similar British sample. It was found slightly more prognathic Saudi faces, more protruded incisors and low gonial and saddle angles as compared with the British sample. Al-Jasser (2000) described the craniofacial characteristics of 87 Saudi students with acceptable profiles and occlusions and compared them with Steiner’s European-American standards. He concluded that Saudis have a tendency toward bimaxillary protrusion. In another study, Al-Jasser (2005) compared the cephalometric norm of Saudi to Caucasian patients using Down’s and Steiner analyses. The results also showed normal Saudis have slightly protrusive maxillae, a tendency to Class II facial pattern, and a high mandibular plane angle. AlBarakati and Talic (2007) studied 65 lateral cephalometric radiographs according to McNamara’s analysis. It was revealed that Saudis have a greater convex profile with reduced chin prominence, steeper mandibular plane angle, and more bimaxillary protrusion.

Nowadays, an increasing number of adult Saudis are looking for orthognathic and plastic surgery. It has become important to determine the cephalometric norms that could be useful in clinical applications for this ethnic group. Therefore, the purpose of the study was to establish hard tissue cephalometric norms for orthognathic surgery for a sample of Saudi adults and to compare the results to European-Americans’ norms (COGS) obtained originally by Burstone et al. (1978).

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2. Materials and methods

2.1. Subjects

The sample consisted of 62 lateral cephalometric radiographs of 31 females and 31 males Saudi national adults. Age range was 22–24years with a pleasing and harmonious face, Angle Class I molar and Class I canine, normal overjet (1–4mm), normal overbite (35–50%), average skeletal relationship (ANB=1–4.5°), no history of trauma or jaw fracture, no craniofacial malformation and syndromes and no previous orthodontic treatment. These radiographs were selected at King Saud University from the archives of cephalometric radiograph files taken by the 4th year dental students used as part of their undergraduate orthodontic course; (the students were informed about their rights to take or refuse the radiographs).

2.2. Cephalometric analysis

All lateral cephalometric radiographs were obtained with the teeth in centric occlusion, head in natural head position and lips were in repose. Each radiograph was scanned into an X–Y coordinate system using Epson® perfection 4990 photo scanner (Seiko Epson Corporation, Nagano, Japan), and was digitized by a single investigator in a darkened room using specific points required by the software. Linear and angular hard tissue measurements; skeletal and dental were calculated electronically using the Dolphin® version 10 software (Dolphin Imaging and Management Solutions, Chatsworth, CA, USA) based on Burstone et al. (1978) analysis and recorded in print out. Landmarks and reference planes were illustrated in Fig. 1. The magnification factor of the radiographic image was adjusted in the computer by marking two points on the radiograph at a distinct distance.

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Figure 1.
The major landmarks and reference planes used in Burstone et al. analysis: nasion (N), sella (S), anterior nasal spine (ANS), posterior nasal spine (PNS), pterygomaxillary fissure (PTM), point A (A), point B (B), pogonion (PG), gnathion (GN), menton (ME), gonion (GO), articular (AR), mesiobuccal cusp tip of upper first molar (UMT), mesiobuccal cusp tip of lower first molar (LMT). The reference planes: mandibular plane (MP), nasal floor plane (NF), horizontal plane (HP) a line 7° from SN plane, occlusal plane (OP) a line from buccal groove of both 1st molars through a point 1mm apical of incisal edge of lower central incisor.

2.3. Cephalometric measurements

From the digitized points, six angular and 17 linear measurements were obtained:Cranial base (Fig. 2):

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Figure 2.
Cranial base length and vertical skeletal measurements: 1; posterior cranial base (AR–PTM), 2; anterior cranial base (PTM–N), 3; upper anterior facial height (N–ANS), 4; lower anterior facial height (ANS–GN), 5; upper posterior facial height (PNS–N), 6; mandibular plane angle (MP–HP).

1.Posterior cranial base (AR–PTM) mm: a distance from AR to PTM, parallel to HP.

2.Anterior cranial base (PTM–N) mm: a distance from PTM to N, parallel to HP.

Horizontal skeletal relationship:

1.Facial convexity (N–A–PG): an angle formed by the line N–A and the line A–pG.

2.Maxillary protrusion (N–A) mm: a distance from point A to perpendicular line from N, parallel to HP.

3.Mandibular protrusion (N–B) mm: a distance from point B to perpendicular line from N, parallel to HP.

4.Chin protrusion (N–PG) mm: a distance from pogonion to a perpendicular line from N, parallel to HP.

Vertical skeletal relationship (Fig. 2):

1.Upper anterior facial height (N–ANS) mm: a distance from N to ANS, perpendicular to HP.

2.Lower anterior facial height (ANS–GN) mm: a distance from ANS to GN, perpendicular to HP.

3.Upper posterior facial height (PNS–N) mm: a perpendicular distance from HP to PNS.

4.Mandibular plane angle (MP–HP): an angle formed between GO–GN line and HP.

Vertical dental relationship (Fig. 3):

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Figure 3.
Vertical dental and maxilla/mandible measurements: 1; upper anterior dental height (U1–NF), 2; lower anterior dental height (L1–MP), 3; upper posterior dental height (UM–NF), 4; lower posterior dental height (LM–MP), 5; maxillary length (PNS–ANS), 6; chin depth (B–PG), 7; gonial angle (AR–GO–GN).

1.Upper anterior dental height (U1–NF) mm: a perpendicular line from the incisal edge of upper incisor to NF.

2.Lower anterior dental height (L1–MP) mm: a perpendicular line from the incisal edge of lower incisor to MP.

3.Upper posterior dental height (UMT–NF) mm: a perpendicular line from the mesiobuccal cusp tip of upper first molar to NF.

4.Lower posterior dental height (LMT–MP) mm: a perpendicular line from the mesiobuccal cusp tip of lower first molar to MP.

Maxilla and mandible (Fig. 3):

1.Maxillary length (PNS–ANS) mm: a distance from PNS to ANS, parallel to HP.

2.Mandibular ramus length (AR–GO) mm: a line from AR to GO.

3.Mandibular body length (GO–PG) mm: a distance from GO to PG.

4.Chin depth (B–PG) mm: a distance from B point to a perpendicular line to MP through PG.

5.Gonial angle (AR–GO–GN): an angle between ramal length and MP.

Dental relationship:

1.Occlusal plane angle (OP–HP): an angle between OP and HP.

2.Wits analysis (A–B/OP) mm: two perpendicular lines from points A and B to OP.

3.Upper incisor inclination (U1–NF): an angle between the lines from the upper incisal edge through the tip of the root to NF.

4.Lower incisor inclination (L1–MP): an angle between the lines from the lower incisal edge through the tip of the root to MP.

2.4. Error of the method

A random selection of 15 cephalometric radiographs was redigitized two weeks interval by the same investigator for evaluating the error of measurement method using coefficient of reliability (Guilford and Fruchter, 1984).

Coefficient of reliability=1−(Se²÷St²), where Se² is the variance due to random error, and St² is the total variance of the measurements. The results indicated that the measurements were highly correlated and ranged between 0.99 and 0.95.

2.5. Data analysis

Data was transferred to the computer for analysis using SPSS program for Windows (version 16 SPSS Inc., Chicago, USA). Descriptive statistics (mean, standard deviations) were performed for each measurement in both sexes separately. An independent Student’s t-test was employed to test for gender differences and to find out whether there was significant difference between Saudi males, females and European-American mean values obtained by Burstone et al. (1978) at 5% level (p<0.05).

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3. Results

The comparative results using the descriptive statistics (means and standard deviations) for COGS analysis of skeletal and dental cephalometric values in Saudis and European Americans are presented in Table 1, Table 2. Table 3 demonstrates a comparison between Saudi males and females.

Table 1. Statistical comparison of cephalometric values between Saudi and European-American males for the COGS analysis.

Skeletal/dental measurements	Code	Saudi males		European-American males		t-test
		Mean	SD	Mean	SD	t-value	Level of sig.
Cranial base
Posterior cranial base	AR–PTM	33.87	3.24	37.1	2.8	3.403	0.003^⁎⁎
Anterior cranial base	PTM–N	57.61	4.42	52.8	4.1	3.554	0.002^⁎⁎

Horizontal skeletal relation
Facial convexity	N–A–PG	3.17	5.18	3.9	6.4	0.376	1.418
Maxillary protrusion	N–A(HP)	−0.85	5.00	0	3.7	0.635	1.057
Mandibular protrusion	N–B(HP)	−6.29	7.15	−5.3	6.7	0.449	1.311
Chin protrusion	N–PG	−4.87	7.38	−4.3	8.5	0.217	1.658

Vertical skeletal and dental
Upper anterior face height	N–ANS	56.30	2.88	54.7	3.2	1.597	0.235
Lower anterior face height	ANS–GN	70.48	4.20	68.6	3.8	1.487	0.289
Upper posterior face height	PNS–N	55.58	3.02	53.9	1.7	2.370	0.045^⁎
Mandibular plane angle	MP–HP	27.01	3.77	23	5.9	2.335	0.049^⁎
Upper anterior dental height	UI–NF	29.89	2.80	30.5	2.1	0.809	0.846
Upper posterior dental height	U6–NF	25.33	1.81	26.2	2	1.397	0.339
Lower posterior dental height	L6–MP	31.10	3.31	35.8	2.6	5.143	0.000^⁎⁎⁎
Lower anterior dental height	L1–MP	41.34	3.29	45	2.1	4.488	0.000^⁎⁎⁎

Maxilla and mandible
Maxillary length	PNS–ANS	53.92	3.60	57.7	2.5	4.063	0.000^⁎⁎⁎
Mandibular ramus length	AR–GO	51.37	5.38	52	4.2	0.425	1.346
Mandibular body length	GO–PG	82.12	4.86	83.7	4.6	1.048	0.601
Chin depth	B–PG	6.92	1.66	8.9	1.7	3.637	0.001^⁎⁎
Gonial angle	AR–GO–GN	123.26	6.14	119.1	6.5	2.024	0.098
Dental relationships
Occlusal plane	OP–HP	6.15	3.97	6.2	5.1	0.031	1.950
Upper incisors inclination	UI–NF	111.49	6.52	111	4.7	0.286	1.553
Lower incisors inclination	L1/GO–ME	91.24	5.98	95.9	5.2	2.652	0.022^⁎
Wits analysis	A–B(//OP)	−0.56	2.49	−1.1	2	0.778	0.882

⁎p<0.05.

⁎⁎p<0.01.

⁎⁎⁎p<0.001.

Table 2. Statistical comparison of cephalometric values between Saudi and European-American females for the COGS analysis.

Skeletal/dental measurements	Code	Saudi females		European-American females		t-test
		Mean	SD	Mean	SD	t-value	Level of sig.
Cranial base
Posterior cranial base	AR–PTM	29.43	3.4	32.8	1.9	4.337	0.000^⁎
Anterior cranial base	PTM–N	52.29	4.05	50.9	3	1.336	0.377

Horizontal skeletal relation
Facial convexity	N–A–PG	4.88	4.56	2.6	5.1	1.504	0.279
Maxillary protrusion	N–A(HP)	0.12	3.82	−2	3.7	1.840	0.145
Mandibular protrusion	N–B(HP)	−5.24	6.12	−6.9	4.3	1.080	0.572
Chin protrusion	N–PG	−4.22	7.34	−6.5	5.1	1.241	0.442

Vertical skeletal and dental
Upper anterior face height	N–ANS	50.89	3.31	50	2.4	1.053	0.596
Lower anterior face height	ANS–GN	62.62	4.92	61.3	3.3	1.091	0.562
Upper posterior face height	PNS–N	49.8	2.710	50.6	2.2	1.089	0.564
Mandibular plane angle	MP–HP	27.79	5.58	24.2	5	2.240	0.060
Upper anterior dental height	UI–NF	27.97	2.94	27.5	1.7	0.689	0.989
Upper posterior dental height	U6–NF	22.81	2.36	23	1.3	0.362	1.439
Lower posterior dental height	L6–MP	28.17	3.08	32.1	1.9	5.382	0.000^⁎
Lower anterior dental height	L1–MP	37.46	3.52	40.8	1.8	4.289	0.000^⁎

Maxilla and mandible
Maxillary length	PNS–ANS	50.32	3.75	52.6	3.5	2.059	0.091
Mandibular ramus length	AR–GO	45.35	4.12	46.8	2.5	1.491	0.286
Mandibular body length	GO–PG	75.63	6.11	74.3	5.8	0.732	0.936
Chin depth	B–PG	6.11	1.39	7.2	1.9	2.013	0.100
Gonial angle	AR–GO–GN	122.6	5.94	122	6.9	0.285	1.555

Dental relationships
Occlusal plane	OP–HP	7.87	4.31	7.1	2.5	0.781	0.878
Upper incisors inclination	UI–NF	112.6	6.23	112.5	5.3	0.054	1.914
Lower incisors inclination	L1/GO–ME	92.74	6.74	95.9	5.7	1.692	0.195
Wits analysis	A–B(//OP)	0.15	2.29	−0.4	2.5	0.737	0.930

⁎p<0.001.

Table 3. Statistical comparison of cephalometric values between Saudi males and females for the COGS analysis.

Skeletal/dental measurements	Code	Saudi males		Saudi females		t-test
		Mean	SD	Mean	SD	t-value	Level of sig.
Cranial base
Posterior cranial base	AR–PTM	33.874	3.240	29.432	3.421	5.249	0.000^⁎⁎
Anterior cranial base	PTM–N	57.610	4.420	52.297	4.056	4.931	0.000^⁎⁎

Horizontal skeletal relation
Facial convexity	N–A–PG	3.168	5.183	4.881	4.568	1.380	0.345
Maxillary protrusion	N––A(HP)	−0.848	4.998	0.119	3.820	0.856	0.790
Mandibular protrusion	N–B(HP)	−6.290	7.152	−5.239	6.126	0.622	1.073
Chin protrusion	N–PG	−4.871	7.378	−4.223	7.346	0.347	1.460

Vertical skeletal and dental
Upper anterior face height	N–ANS	56.297	2.884	50.890	3.318	6.847	0.000^⁎⁎⁎
Lower anterior face height	ANS–GN	70.481	4.198	62.619	4.924	6.765	0.000^⁎⁎⁎
Upper posterior face height	PNS–N	55.577	3.021	49.800	2.710	7.926	0.000^⁎⁎⁎
Mandibular plane angle	MP–HP	27.006	3.766	27.790	5.584	0.648	1.039
Upper anterior dental height	UI––NF	29.890	2.803	27.968	2.950	2.630	0.022^⁎
Upper posterior dental height	U6–NF	25.326	1.812	22.806	2.367	4.706	0.000^⁎⁎⁎
Lower posterior dental height	L6–MP	31.097	3.310	28.171	3.087	3.599	0.001^⁎⁎
Lower anterior dental height	L1–MP	41.342	3.290	37.468	3.526	4.472	0.000^⁎⁎⁎

Maxilla and mandible
Maxillary length	PNS–ANS	53.923	3.600	50.326	3.753	3.851	0.001^⁎⁎
Mandibular ramus length	AR–GO	51.371	5.380	45.355	4.127	4.940	0.000^⁎⁎⁎
Mandibular body length	GO–PG	82.119	4.860	75.632	6.117	4.623	0.000^⁎⁎⁎
Chin depth	B–PG	6.923	1.662	6.119	1.394	2.061	0.087
Gonial angle	AR–GO–GN	123.265	6.136	122.577	5.948	0.448	1.312

Dental relationships
Occlusal plane	OP–HP	6.152	3.971	7.877	4.313	1.639	0.213
Upper incisors inclination	UI–NF	111.490	6.517	112.594	6.233	0.681	0.997
Lower incisors inclination	L1/GO–ME	91.242	5.979	92.735	6.745	0.923	0.720
Wits analysis	A–B(//OP)	−0.558	2.487	0.152	2.295	1.168	0.495

⁎p<0.05.

⁎⁎p<0.01.

⁎⁎⁎p<0.001.

Table 1 shows the comparison of mean values of cephalometric measurements between the Saudi and European-American males (Burstone et al., 1978). Of the 23 measurements, nine were significantly different. Saudi males showed significantly longer anterior cranial base length (PTM–N) as well as posterior cranial base length (AR–PTM) than European-American males. Among the vertical skeletal and dental relations, the upper posterior facial height (PNS–N) and the mandibular plane angle (MP–HP) were significantly greater in Saudi males (p<0.05). The comparison of mean values for Anterior and posterior dental height (L1–MP, L6–MP), the maxillary length (PNS–ANS) and the chin prominence (B–PG) were highly significant between Saudi and European-American males (p<0.001). Saudi males were found to have smaller lower Anterior and posterior dental height (L1–MP, L6–MP), shorter maxillary length (PNS–ANS), and less prominent chin (B–PG), in addition to Lower incisors position (L1–MP) was also significantly less protrusive than European-American sample (p<0.001).

Table 2 Demonstrates statistical comparisons of mean values between Saudi and European-American females (Burstone et al., 1978). Of the 23 measurements, three were highly significantly different between Saudi and European-American females. The Saudi females showed no significant difference for anterior cranial base length (p>0.05), while posterior cranial base length (AR-PTM) was larger than European-American females (p<0.001). Anterior and posterior dental heights of the mandible, respectively (L1–MP, L6–MP) were greater in European Americans than Saudis (p<0.001).

Table 3 displays the sexual dimorphism found in Saudi adults. Most of the values were significantly different. The three measurements of Saudi males were larger than Saudi females. Saudi males showed longer posterior and anterior cranial bases than the female group, maxillary length (PNS–ANS), mandibular ramus length (AR–GO), and mandibular body length (GO–PG) were found to be greater in the male group. Moreover Saudi males showed larger vertical skeletal and dental values than the female group. Upper anterior facial height (N–ANS), lower anterior facial height (ANS–GN), and upper posterior facial height (PNS–N), were greater in males than females. Also upper anterior dental height (UI–NF), upper posterior dental height (U6–NF), lower posterior dental height (L6–MP) and lower anterior dental height (L1–MP) were highly greater in Saudi males than females.

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4. Discussion

Racial skeletal and dental characteristics of the face play a critical role in orthodontic and orthognathic treatment planning. Therefore, the mean values for measurements of one racial group could not be considered normal for others. Numerous studies (Scheideman et al., 1980; Conner and Moshiri, 1985, Wylie et al., 1987, Shalhoub et al., 1987, Sarhan and Nashashibi, 1988, Flynn et al., 1989, Bishara et al., 1990, Rafael et al., 1998, Mouakeh, 2001, Hamdan and Rock, 2001, Al-Jasser, 2000, Al-Jasser, 2005, Al-Jame et al., 2006, Hassan, 2006, AlBarakati and Talic, 2007) have shown the differences between racial groups were evident.

The mean values for Saudi males were significantly different in many of the measurable parameters when compared to European-American values (Burstone et al., 1978). These findings were in accordance with Flynn et al., 1989, Rafael et al., 1998. Cephalometric studies which reported the existence of ethnic differences when Japanese and African Americans were compared with European Americans using Burstone analysis.

It had been observed that Saudi males had an increased cranial base length, the mandible lied more posterior to maxilla, slight backward rotation of the mandible, shorter maxillary length, less prominent chin, and also less proclination of lower incisors than European-American males. These skeletal measurements can be interpreted as Saudis are having Class II facial pattern. This may be explained by the posterior position of mandible to maxilla, less prominent chin, and backward rotation of the mandible. The present findings were in agreement with Al-Jasser, 2000, Al-Jasser, 2005, AlBarakati and Talic, 2007, Hassan, 2006 who reported same findings that Saudis have a tendency toward bimaxillary protrusion although different samples and analyses were used.

The mean values of the whole skeletal parameters of Saudi females compared with the European-American female sample had no significant differences except posterior cranial base length which was significantly smaller. Saudi females showed similar cranial base length as the European-American females but the pterygomaxillary fissure was located more anteriorly producing a shorter maxillary length, however this was not statistically significant (p>0.05). Similar observations were reported by Rafael et al. (1998) when the study was conducted on different ethnic groups.

In both gender lower posterior and anterior dental heights were significantly smaller when compared with European-American values. These two measurements define how far the incisor and molar erupt to the mandibular plane, respectively; molar eruption also should be related to lower facial height and to mandibular plane angle to establish the origin of vertical discrepancies. In Saudi males, mandibular plane angle was significantly larger than the European Americans. This could be due to the increase in the upper posterior facial height which may lead to backward rotation of the mandible. Similar findings were reported by Al-Jasser, 2000, Al-Jasser, 2005, Hassan, 2006, AlBarakati and Talic, 2007.

The present study showed a significant difference between Saudi males and females for most of the cealometric measurements. This was in accordance with other previous studies for other ethnic groups (Flynn et al., 1989, Rafael et al., 1998) and in disagreement with others studies (Gianelly, 1970, Chan, 1972, Cooke and Wei, 1988, Hamdan and Rock, 2001) who found no significant difference between males and females. Saudi males showed longer cranial base length, larger vertical skeletal proportion, increased dental values, longer maxillary and mandibular length than the female group. The increase in vertical dysplasia in Saudi males could be considered as a combination of skeletal and dental origin.

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5. Conclusion

From the results of this study the following conclusions could be drawn:

1.Statistical significant differences were found between cephalometric mean values of Saudis and European Americans for orthognathic surgery analysis (COGS).

2.Saudi males had an increase in the cranial base length, the mandible lied more posterior to maxilla, increase in mandibular plane angle, backward rotation of the mandible with less prominent chin, shorter maxillary length, and less proclination of lower incisors than European Americans.

3.Saudi females had significantly smaller posterior cranial length than European Americans.

4.Both gender had significantly smaller lower posterior and anterior dental heights compared to the European-American values.

5.Saudi males and females had significant differences in most of the cephalometric measurements; males had larger measurements than females.

This study can be clinically useful in the diagnosis, and treatment planning of orthognathic surgical cases. It should be realized that orthodontic and orthognathic treatment could be planned according to the established cephalometric norms for Saudi subjects in the current study as a guide along with the clinical examinations and patient’s records.

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