Craniofacial morphology in overweight and obese orthodontic adolescent patients

Chair and Department of Paedodontics, Medical University in Lublin, Poland
JPCCR 2017;11(1):42–45
Introduction and objective:
There is an evidence suggesting that obesity may influence the timing of puberty and growth patterns. There are few research on the reactions of the craniofacial complex to an overall increase in the body mass. Thus the objective of the study was to investigate if overweight or obesity may influence craniofacial morphology in adolescent orthodontic patients.

Material and Methods:
In total, 77 patients aged 11–16 years were selected for the retrospective analysis. The study group comprised 37 overweight or obese individuals (mean age: 13,45±2,15). The control group included 40 normal-weight subjects (mean age: 13.79±1.81). Body mass index (BMI) percentile of each patient was assessed with the use of BMI score and age- and sex specific growth charts in accordance with International Obesity Task Force (IOTF). Craniofacial measurements included in the study were performed on the tracings of lateral cephalometric radiographs. The data was analyzed by STATISTICA 10 for Windows Software.

Both females and males of the study group exhibited significantly greater mandible length (Cd-Gn), corpus length (Go-Pg), midfacial length (Cd-A) and lower anterior facial height (Ans-Me) (p<0.05), as well as SNB, SNPg and ML/SN angles (p<0.05) compared to the normal-weight controls. Moreover, high BMI females showed greater maxillary length (Pm-A) and SNA angle (p<0.05), whereas males exhibited greater posterior facial height (S-Go) (p<0.05) compared to the controls.

Weight status is an important factor that can affect craniofacial growth pattern and should be taken into consideration when planning orthopaedic treatment in adolescent patients.

1. Ng M, Fleming T, Robinson M. Global, regional and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384 (9945): 766–781.
2. World Health Organization: Prioritizing areas for action in the field of population-based prevention of childhood obesity. WHO, Geneva 2102.
3. Żukiewicz-Sobczak W, Wróblewska P, Zwoliński J, Chmielewska- Badora J, Adamczuk P, Krasowska E, Zagórski J, Oniszczuk, A, Piątek J, Silny W. Obesity and poverty paradox in developed countries. Ann Agric Environ Med 2014; 21(3): 590–594.
4. Bac A, Woźniacka R, Matusik S, Golec J, Golec E. Prevalence of overweight and obesity in children aged 6–13 years – alarming increase in obesity in Cracow, Poland. Eur J Pediatr 2012; 171: 245–251.
5. Mazur A, Klimek K, Telega G, Filip R, Małecka-Tendera E. Ten-year secular trend of overweight and obesity in school children in South- Eastern Poland. Ann Agric Environ Med 2014; 21(3): 634–638.
6. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z: 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 2002; 246: 1–190.
7. Cole TJ, Lobstein T. Extended internationl (IOTF) body mass index cut-offs for thinnes, overweight and obesity. Pediatr Obes 2012; 7: 284–294.
8. Neeley WW, Gonzales DA. Obesity in adolescence: Implications in orthodontic treatment. Am J Orthod Dentofacial Orthop 2007; 131: 581–8.
9. Giuca MR, Pasini M, Tecco S, Marchetti E, Giannotti E, Marzo G. Skeletal maturation in obese patients. Am J Orthod Dentofacial Orthop 2012; 142: 774–9.
10. Sandhu J, Ben-Shlomo Y, Cole TJ, Holly J, Smith GD. The impact of childhood body mass index on timing of puberty, adult stature and obesity: a follow-up study based on adolescent anthropometry recorded at Christ’s Hospital. Int J Obesity 2006; 30: 14–22.
11. Ahmed ML, Ong KK, Dunger DB. Childhood obesity and the timing of puberty. Trends Endocrin Met 2009; 20(5): 237–242.
12. Dunger DB, Ahmed ML, Ong KK. Effects of obesity on growth and puberty. Best Pract Res Clin Endocrinol Metab 2005; 19(3): 375–390.
13. Bradner Jasik C, Lustig LH. Adolescent obesity and puberty: the perfect storm. Ann NY Acad Sci 2008; 1135: 265–279.
14. Mack K, Philips C, Jain N, Koroluk LD. Relationship between body mass index percentile and skeletal maturation and dental development in orthodontic patients. Am J Orthod Dentofac Orthop 2013; 143: 228–234.
15. Kaplowitz PB. Link between body fat and the timing of puberty. Pediatrics 2008; 121(Suppl. 3): S208–S217.
16. Hilgers KK, Akridge M, Scheetz JP, Kinane DF. Childhood obesity and dental development. Pediatr Dent 2006; 28: 18–22.
17. De Leonibus C, Marcovecchio ML, Chiavaroli V, de Giorgis T, Chiarelli F. Timing of puberty and physical growth in obese children: a longitudinal study in boys and girls. Pediatr Obes 2013; 9: 292–299.
18. Zhang Y, Proenca R, Maffei M. Positional cloning of the mouse obese gene and its human homologue. Nature 1994; 372: 425–432.
19. Yagasaki Y, Yamaguchi T, Watahiki J, Konishi M, Katoh H, Maki K. The role of craniofacial growth in leptin deficient mice. Orthod Craniofacial Res 2003; 6: 233–241.
20. Oliveira-Neto LA, Melo Mde F, Franco AA. Cephalometric features in isolated growth hormone deficiency. Angle Orthod 2011; 81: 578–583.
21. Litsas G. Growth hormone therapy and craniofacial bones: a comprehensive review. Oral Diseases 2013; 19: 559–567.
22. Partyka M, Dunin-Wilczyńska I, Chałas R. Zaburzenia układu stomatognatycznego u osób z niskorosłością. Pol Med J 2014; 211: 63–67.
23. Öhrn K, Al-Kahlili B, Huggare J, Forsberg CM, Marcus C. Craniofacial morphology in obese adolescents. Acta Odontol Scand 2002; 60: 193–197.
24. Sadeghianrizi A, Forsberg CM, Marcus C, Dahllöf G. Craniofacial development in obese adolescents. Eur J Orthod 2005; 27: 550–555.
25. Ferrario V, Dellavia C, Tartaglia G, Turci M, Sforza C. Soft tissue facial morphology in obese adolescents: a three dimensional non-invasive assessment. Angle Orthod 2004; 74: 37–42.
26. Buschang PH, Jacob HB, Demirjian A. Female adolescent craniofacial growth spurts: real or fiction? Eur J Orthod 2013; 35: 819–825.