Cephalometric Assessment of Skeletal Class II Malocclusion in a Sample of Kurdish Population in Sulaimani City (Retrospective Study)


  • Havana H. Nadir Orthodontics Department, College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq. Author
  • Anwar A. Amin Orthodontics Department, College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq. Author




Cephalometrics, Kurdish, Skeletal Class II Malocclusion


Objective: This retrospective comparative cephalometric study aims to identify the cephalometric features of skeletal class II
malocclusion in a sample of the Kurdish population, the result of this study willl be useful in diagnosing and treating orthodontic and
jaw surgery.

Methods: A total of 85 pre-treatment lateral cephalometric radiographs with skeletal class II malocclusion (ANB>=4) and 81 with
skeletal class I malocclusion (1=<ANB<4) were obtained from the pre-orthodontic patient records in a private orthodontic clinic in
Sulaimani city. The patients were between 18 and 35 years old. The lateral cephalometric radiographs were analyzed digitally using
FACAD cephalometric software. Twenty-two variables were measured from each cephalometric radiograph. The correlation between
Class I and II was analyzed using the Mann-Whitney Test.

Results: The result showed that the values of SNA, ANB, Y-axis, Convexity angle, Gonial angle, Intermaxillary angle, facial angle
and FMA, posterior cranial base, effective maxillary length, LAFH were higher in skeletal Class II than in Class I cases, which indicates
that skeletal class II Kurdish population have more vertical mandibular growth and prognathic maxilla, retrognathic mandible, and
longer face than class I. Meanwhile, SNB, Mandibular length, TFH, UAFH, Maxillary length, UI-Palatal plane angle, IMPA, and
effective mandibular length values were lower and the difference was statistically significant in the majority of cases.This illustrates
that the incisors are more proclined in class I than skeletal class II, whereas the mandible is shorter in skeletal class II patients. These
results summarize the characteristic features of skeletal class II patients in a sample of the Kurdish population in Sulaimani City, which
are caused by etiological factors (genetic, congenital). This information is useful for enabling orthodontists and maxillofacial surgeons
to attain a diagnosis and treatment plan for skeletal class II patients in a shorter period.

Conclusions: Skeletal class II malocclusion in the Kurdish population is characterized by a prognathic but short maxilla, retrognathic,
short, backward, and downward rotated mandible, and a prominent chin.


Ioi H, Nakata S, Nakasima A, Counts AL.

Comparison of cephalometric norms between

Japanese and Caucasian adults in the

anteroposterior and vertical dimension. Eur J

Orthod. 2007;29(5):493-9.

Helal NM, Basri OA. Significance of

cephalometric radiograph in orthodontic

treatment plan decision. The Journal of

Contemporary Dental Practice.


Littlewood, Simon J., and Laura Mitchell. An

introduction to orthodontics. Oxford

University Press, 2019;5

th ed.;73-85.

Dinçer, B., Yetkiner, E., Aras, I., Attin, T. and

Attin, R. Influence of lateral cephalometric

radiographs on extraction decision in skeletal

class I patients. Head Face Med. 2013:9(1);1-

Al-Khateeb EA, Al-Khateeb SN.

Anteroposterior and vertical components of

class II division 1 and division 2 malocclusion.

Angle Orthod. 2009;79(5):859-66.

Freitas MR, Santos MA, Freitas KM, Janson G,

Freitas DS, Henriques JF. Cephalometric

characterization of skeletal Class II, division 1

malocclusion in white Brazilian subjects. J

Appl Oral Sci. 2005;13(2):198-203.

Hamdan AM, Rock WP. Cephalometric norms

in an Arabic population. J Orthod.


Gonzalez M, Schlenker W, Sugiyama R,

Caruso J. Establishing cephalometric norms for

a Mexican population using Ricketts, Steiner,

Tweed and Arnett analyses. APOS Trends in

Orthodontics. 2013;3(6):171-7.

Gu Y, McNamara JA, Jr., Sigler LM, Baccetti

T. Comparison of craniofacial characteristics

of typical Chinese and Caucasian young adults.

Eur J Orthod. 2011;33(2):205-11.

Moyers RE, Riolo ML, Guire KE, Wainright

RL, Bookstein FL. Differential diagnosis of

class II malocclusions. Part 1. Facial types

associated with class II malocclusions. Am J

Orthod. 1980;78(5):477-94.

McNamara JA, Jr. Components of class II

malocclusion in children 8-10 years of age.

Angle Orthod. 1981;51(3):177-202.

Rothstein TL. Facial morphology and growth

from 10 to 14 years of age in children

presenting Class II, Division 1 Malocclusion: a

comparative roentgenographic cephalometric

study. Am J Orthod. 1971;60(6):619-20.

Ardani I, Sanjaya ML, Sjamsudin J.

Cephalometric characteristic of skeletal class II

malocclusion in Javanese population at

Universitas Airlangga Dental Hospital.

Contemp Clin Dent. 2018;9(Suppl 2):S342-S6.

Gasgoos S, Al-Saleem Na, Awni K.

Cephalometric features of skeletal Class I, II

and III (A comparative study). Al-Rafidain

Dent J. 2007;7(2):122-30.

Yassir YA. Saddle angle and its relationship

with maxillary and mandibular lengths. Iraqi

Orthod J. 2009;5(1):14-6.

Monirifard M, Sadeghian S, Afshari Z, Rafiei

E, Sichani AV. Relationship between

cephalometric cranial base and

anterior‑posterior features in an Iranian

population. Dent Res J (Isfahan).


Chin A, Perry S, Liao C, Yang Y. The

relationship between the cranial base and jaw

base in a Chinese population. Head Face Med.


Abdulla, Chia Abdul, and Trefa Mohammed

Ali Mahmood. A new template for the

evaluation of soft tissue cephalometric finding

for a sample of young adults. Azerbaijan Med

J. 2023;63(5):9369-82.

Björk A. Cranial base development. Am J

Orthod. 1955;41(3):198-225.

Kerr WJ, Adams CP. Cranial base and jaw

relationship. Am J Phys Anthropol.


Kamak H, Senel B, Çatalbas B. Cranial base

features between sagittal skeletal

malocclusions in Anatolian Turkish adults: Is

there a difference? J Orthod Res. 2013;1(2).

Dibbets JM. Morphological associations

between the Angle classes. Eur J Orthod.


Shaji T Varghese, Dr. Jayaraj A A, Dr. Lijo K

Jose, Dr. Hrudya Balachandran, Dr. Pramada

Kishore, Dr. Arun P B, et al. The average

anterior cranial base length, maxillary length

and mandibular length among male and female

adults in Kerala population. IOSR-JDMS.


Bishara SE, Jakobsen JR, Vorhies B, Bayati P.

Changes in dentofacial structures in untreated

Class II division 1 and normal subjects: a

longitudinal study. Angle Orthod.




How to Cite

Cephalometric Assessment of Skeletal Class II Malocclusion in a Sample of Kurdish Population in Sulaimani City (Retrospective Study). (2024). Sulaimani Dental Journal, 11(1), 9. https://doi.org/10.17656/sdj.10183