SHORT COMMUNICATION

Cephalometric norms of Nigerian children

Emmanuel Olubusayo Ajayi
Benin City, Nigeria

Introduction: The purpose of this study was to develop cephalometric standards for Nigerian children.
Methods: The average values of 7 dentoskeletal angles were determined from standardized lateral head
radiographs of 100 schoolchildren (aged 11 to 13 years; mean, 12.6 years) in Enugu, a city in southeastern
Nigeria. The children, born to Nigerian parents of Igbo ancestry (Igbo is 1 of the 3 major ethnic groups in
Nigeria), were selected on the basis of a well-balanced face and acceptable profile, Class I occlusion with
normal overjet and overbite, minor or no crowding or spacing, and no history of orthodontic treatment.
Results: There were no statistically significant differences in cephalometric measurements between boys
and girls; thus, the data were combined for analysis. The mean values and standard deviations obtained for
the measured variables were: SNA, 85.5 ( 4.3); SNB, 81.2 ( 4.0); ANB, 4.3 ( 2.5); UI-FP, 122.8 (
7.5); Ll-MP, 98.8 ( 5.8); Ul-LI, 109.1 ( 8.0); and FMA, 26.1 ( 5.0). Conclusions: Compared with the
norms for other ethnic groups, Igbo children have a prognathic relationship of the maxilla and the mandible
to the anterior cranial base with a tendency toward a protrusive skeletal pattern. The children also exhibited
prominent bimaxillary proclination with procumbent and protrusive maxillary and mandibular incisors and a
steep Frankfort-mandibular plane angle. The findings emphasize the need for group-specific norms for
orthodontic diagnosis and treatment planning, and provide cephalometric standards for Igbo children. (Am
J Orthod Dentofacial Orthop 2005;128:653-6)

R
adiographic cephalometry has been used exten-
sively to study facial form and develop norms
to aid in orthodontic diagnosis and treatment
planning. It is also used to assess treatment progress
and craniofacial growth, to predict growth for individ-
ual patients, and for other tasks in orthodontic research.
Many cephalometric analyses have been made to
establish norms for ideal facial proportions and occlu-
sion, presenting average measurements of skeletal or
dental patterns and their ranges.1-8
The cephalometric norms of different ethnic and
racial groups established in various studies show that
normal measurements for 1 group are not necessarily
normal for another group; each racial group must be
treated according to its own characteristics. A number
of standards have been developed for various racial and
ethnic groups.9-20 It is important to compare a patients
cephalometric findings with the norms for his or her
ethnic group for an accurate diagnostic evaluation,
while considering his or her treatment goals and needs.
Miyajima et al19 also noted that a patient might seek a
treatment plan that is based in part on norms for his or
her racial or ethnic group.
Lecturer and consultant orthodontist, Orthodontic Unit, Department of Preventive
Dentistry, College of Medical Sciences, University of Benin, Benin City, Nigeria.
Reprint requests to: Dr Emmanuel O. Ajayi, PO Box 7272, Surulere, Lagos,
Nigeria; e-mail, buskyet@yahoo.com.
Submitted, February 2005; revised and accepted, May 2005.
0889-5406/$30.00
Copyright 2005 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2005.07.002
Attempts to establish cephalometric norms for the
Nigerian population have been made. Nigeria has the
largest population of blacks in the worldabout 120
million people. Isiekwe and Sowemimo21 published
cephalometric values for adult Nigerians based on a
study of 15 men and 5 women, aged 18 to 25 years,
with ideal occlusions. Isiekwe22,23 also assessed antero-
posterior skeletal jaw relationships and incisor angula-
tions in a Nigerian sample. Nigeria has 3 major ethnic
groups: Yoruba, Hausa, and Igbo. Variations in their
craniofacial morphologies were evaluated by Duros-
inmi-Etti24 and Utomi,25 using samples of 12- to
14-year-olds in Lagos and 11- to 13-year-olds in
Kaduna, respectively. These studies evaluated similar
cephalometric parameters and showed variations in the
cephalometric standards.
The purposes of this study were (1) to establish
cephalometric standards of children from the largest
ethnic group of southeastern Nigeria, the Igbo, that
can be used as baseline data for diagnostic purposes
and planning orthodontic treatment; (2) to identify
sex differences between Igbo boys and girls; and (3)
to compare Igbo norms to the published standards of
related Nigerian ethnic groups and other similar
studies.
MATERIAL AND METHODS
The material consisted of standardized lateral ceph-
alometric radiographs of 100 volunteer Igbo children
from public and private secondary schools in Enugu in
653
654 Ajayi American Journal of Orthodontics and Dentofacial Orthopedics
November 2005

Table I.
Comparison of mean and standard deviation of
cephalometric measurements between Nigerian Igbo
boys and girls
Boys (n 66) Girls (n 34)

Measurement () Mean SD Mean SD P

SNA 85.63 4.30 85.35 4.33 NS

SNB 81.30 4.14 81.07 3.81 NS
ANB 4.35 2.50 4.28 2.42 NS
UI-FP 123.08 7.68 122.38 7.22 NS
LI-MP 99.21 5.53 98.03 6.36 NS
UI-LI 108.10 8.36 111.03 7.10 NS
FMA 26.14 4.74 25.99 5.58 NS

NS, Not significant.

*Significant difference at P .05.

Table II. Cephalometric norms of Igbo children

Measurement () Mean SD Minimum Maximum

SNA 85.54 4.29 82 88

Figure. Landmarks, planes, and angles measured in SNB 81.22 4.01 79 84
Igbo children. SNA, sella-nasion-A-point; SNB, sella- ANB 4.33 2.46 3 6
nasion-B-point; ANB, A-point-nasion-B-point; UI-FP, UI-FP 122.84 7.50 119 128
upper incisor axis to Frankfort plane angle; LI-MP, lower LI-MP 98.81 5.82 95 102
incisor axis to mandibular plane angle; UI-LI, interincisal UI-LI 109.10 8.04 104 115
FMA 26.09 5.02 23 30
angle; FMA, Frankfort mandibular plane angle.

southeastern Nigeria. There were 66 boys and 34 girls,
aged 11 to 13 years (mean, 12.6 0.6 years). Attempts
were made to select children with balanced faces and
acceptable profiles, Class I occlusions with normal
overjet and overbite, minor or no crowding or spacing,
and no history of orthodontic treatment, and born of
Nigerian parents of Igbo ancestry from any of the 5
states of defunct Eastern Nigerian (presently southeast-
ern Nigeria). Authorization and consent were obtained
from the principals of the schools and the parents of the
children.
Lateral cephalograms of 100 children were taken.
Each subject was positioned in the cephalostat with the
head oriented to the Frankfort horizontal plane and the
teeth in centric occlusion with the lips relaxed.
The cephalometric radiographs were traced onto
0.003-in matte finish acetate sheets over an illuminated
viewing box by using a standard technique. All radio-
graphs were traced by the author, and angular measure-
ment were made with a protractor and recorded to the
nearest 0.5.
The following landmarks were identified on each
cephalogram (Figure): sella turcica (S), nasion (N),
orbitale (O), porion (P), gnathion (Gn), pogonion (Pog),
gonion (Go), menton (M), anterior nasal spine (ANS),
posterior nasal spine (PNS), A-point, B-point, maxil-
lary incisor apex (MxIA), mandibular incisor apex
(MIA), upper incisor tip (UIT), and lower incisor tip
(LIT). The definitions of the various landmarks have
been reported previously.14 From these landmarks, the
following skeletal and dental angles were measured:
sella-nasion-A-point angle (SNA), sella-nasion-B-point
angle (SNB), A-point-nasion-B-point angle (ANB),
upper incisor axis to Frankfort plane angle (UI-FP),
lower incisor axis to mandibular plane angle (LI-MP),
interincisal angle (UI-LI), and Frankfort mandibular
plane angle (FMA).
Statistical analysis
The error during tracing, landmark selection, and
measuring was determined by repeating the tracings of
25 randomly selected radiographs 1 month later. Dahl-
bergs formula,26 d2/2n, where d is the difference in
the measurement between the first and second tracings
and n is the sample size, was used to calculate mea-
surement error. The error of the measurements, 0.1 to
0.4, for the variables was minimal. Systematic error
was estimated by using a paired t test; the differences
between the first and second measurements were sta-
tistically insignificant.
The EPI INFO version 6 statistical software27 was
used for further statistical analysis. The basic descrip-
tive statistics, including the means, standard deviations,
and maximum and minimum values were computed for
American Journal of Orthodontics and Dentofacial Orthopedics Ajayi 655
Volume 128, Number 5

Table III. Comparison of Igbo means with Lagos and Hausa-Fulani cephalometric norms
Lagos standards Igbo standards Hausa-Fulani
(n 100) (n 100) standards (n 100)

Angle Mean SD P Mean SD P Mean SD

SNA 88.90 4.15 0.00* 85.54 4.30 0.00* 82.35 3.50

SNB 84.48 3.71 0.00* 81.22 4.00 NS 80.35 3.30
ANB 4.39 2.30 NS 4.33 2.46 0.00* 2.07 2.80
UI-FP 126.03 6.77 0.00* 122.84 7.50 NS 122.3 12.80
LI-MP 100.69 5.45 0.01* 98.81 5.80 0.03* 97.1 5.50
UI-LI 108.91 9.66 NS 109.10 8.00 0.00* 113.6 12.8
FMA 24.38 5.64 0.02* 26.10 5.00 0.05* 24.80 4.40

NS, Not significant.

*Significant difference at P .05.

From Durosinmi-Etti.24

From Utomi.25

each cephalometric variable. The Student t test was
used to assess sex differences in the measured values
and to evaluate any differences between the craniofa-
cial dimensions of Igbo children and related Nigerian
children and other norms established by other investi-
gators. The differences in the mean values were re-
garded as statistically significant if P .05.
RESULTS
The cephalometric findings by sex are listed in
Table I. There was no statistically significant sex
difference between the measurements of boys and girls;
therefore, the combined data were analyzed, and the
means, standard deviations, and ranges are given in
Table II as the norms for Nigerian Igbo children.
These norms were further compared with Lagos and
Hausa-Fulani childrens norms (Table III). There were
statistically significant differences (P .05) in most of
the measured cephalometric variables between the 3
groups, with the exception of SNB and UI-FP between
Igbo and Hausa-Fulani children, and ANB and UI-LI
between Igbo and Lagos children, respectively.
DISCUSSION
The cephalometric values obtained in this study did
not show any significant statistical difference between
Igbo boys and girls; this agreed with previous findings
for other major ethnic groups in Nigeria.22,24,25
The numerical values determined for the dental and
skeletal variables showed some statistically significant
differences in cephalometric norms of Igbo children in
Enugu in southeastern Nigeria when compared with
children from Lagos in southwestern Nigeria, where
Yoruba is the predominant ethnic group, and Hausa-
Fulani children in Kaduna in northern Nigeria. The
mean SNA and SNB values show that Igbo children
also have prognathism of the maxilla and mandible
relative to anterior cranial base, which was observed by
Isiekwe and Sowemimo21 and Durosinmi-Etti24 in
adults and children, respectively, from southern Nige-
ria. The mean SNA value obtained in this study for
Igbo children is also similar to that of black American
children (P .05) and showed prognathism of the
maxilla when compared with American whites.11,12
However, SNB was similar in both Igbo and Hausa-
Fulani children (P .05).
The anteroposterior skeletal relationship of the
maxilla and the mandible to the anterior cranial base
was similar for Igbo and Lagos children. However,
ANB in the Igbo is 2.26 significantly higher than that
of the Hausa-Fulani. Utomi25 observed that Hausa-
Fulani children have less prognathic maxillae, with
their denture bases slightly more posterior in relation to
the cranial base than children from southern Nigeria.
The value obtained was 1.5 significantly higher than
that of American whites.11
This study also showed protrusive dentoalveolar
relationships with associated bimaxillary proclination
in Igbo children; this has been described as a feature of
the Nigerian profile.23-25 UI-LI was similar in Igbo and
Lagos children, and also the inclination of UI-FP
between Igbo and Hausa-Fulani children (P .05).
Alexander and Hitchcock28 reported similar findings of
procumbent and protrusive maxillary and mandibular
incisors in American blacks. Savage29 reported bimax-
illary protrusion as a general feature of Bantu children
of West Lake Province of Tanganyika. Chan30 ob-
served bimaxillary dental protrusion in Cantonese peo-
ple when compared with white standards, matched only
by the American black and the Australian aborigine.
Igbo children have significantly steeper FMAs than
other Nigerian ethnic groups. Drummond12 and
656 Ajayi
Kapila18 also reported high values for FMA in black
American children and Kenyan children of Kikuyu
descent.
CONCLUSIONS
The profiles of Igbo children differ from those of
other ethnic and racial groups. Their basal arches are
more anteriorly placed in relation to the anterior cranial
base. They also have prominent bimaxillary proclina-
tion, which is consistent with the southern Nigerian
population, and a tendency toward a protrusive skeletal
pattern. Cephalometric standards for Igbo children will
aid in diagnostic evaluation and treatment planning for
Nigerian orthodontic patients of Igbo descent.
Because the various published cephalometric stan-
dards represent population averages, it is important to
consider each patients treatment goals and needs
during evaluation and treatment planning.
It would further be desirable to evaluate linear
measurements and the soft tissue profiles of Nigerian
children for use in planning orthodontic treatment and
orthognathic surgery.
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