Difference of Bigonial Width Batak Tribe in Medan City According

to Age Groups in Terms of Panoramic Radiograph

Maria Sitanggang

, Trelia Boel

, Sondang Pintauli

Master of Program, Faculty of Dentistry, Universitas Sumatera Utara, Medan 20155, North Sumatra, Indonesia

Unit of Oral and Maxillofacial Radiology, Faculty of Dentistry, Universitas Sumatera Utara, Medan 20155, North

Sumatra, Indonesia

Department of Dental Public Health, Faculty of Dentistry, Universitas Sumatera Utara, Medan 20155, North Sumatra,

Indonesia

Keywords: Bigonial Width, Panoramic Radiograph.

Abstract: Changes in mandibular morphology will occur during life-long growth and development, such as the

bigonial width, which is one of the parameters of growth and development of the mandible. The changes of

bigonial width can be measured using panoramic radiograph. The objective of this research was to

determine the difference of bigonial width of Batak tribe in Medan according to age groups based on

panoramic radiograph. The type of this research is analytical research using cross-sectional study with a

total sample of 150 people divided into five age groups, according to inclusion and exclusion criteria. Group

1 (age 4-12 years), group 2 (13-24 years, group 3 (25-34 years), group 4 (35-60 years), and group 5 (> 60

years). Measurements on the digital panoramic radiograph are done by computerized. Data that obtained

was analyzed with Oneway ANOVA and LSD. The mean value from the highest to the lowest of bigonial

width, sequentially, were in group 3 (163,283 mm ± 9,947 mm), group 4 (157,580 mm ± 7,776 mm), group

5 (155,623 mm ± 12,597 mm), group 2 (147,787 mm ± 9,108 mm), group 1 (141.917 mm ± 10.992 mm).

1 INTRODUCTION

Craniofacial is a very specific part of the body,

which is easily recognizable and distinguished

between one individual to another, and can be used

to assess one's growth and development. (Bourzgui,

2012). The mandible is one of the craniofacial parts,

where many potential landmarks provide diagnostic

information about growth and development related

to age, sex, and race. (Rachmadiani, et al., 2017).

Physical assessment of one's growth can be done

one of them by radiographic measurement.

Measurement of the mandible as one of the

parameters of growth and development with

radiography can use panoramic radiography

(Durtschi, et al., 2009) but it can also be used as an

estimate of age in forensics. (Leversha et al., 2015).

Study by means of radiographic measurements on

the mandible for an estimated age apart from the

gonial angle, the height of the ramus was also

performed on the bigonial width. (Manigandan et

al., 2015) Bigonial width is the horizontal distance

between two right and left gonial points. Bigonial

width measurements were performed on panoramic

radiographs.(Al-Shamout et al., 2012)

Indonesia is an archipelagic country, with

multicultural or multi-ethnic groups with a very large

number. (Tumonggor et al., 2013) Batak nation is

one of the tribe inhabiting the province of North

Sumatra, with a sizeable population. The Batak tribe

has five sub-tribes and each major area. Batak sub-

tribe in question are: Batak Karo, Batak Simalungun,

Batak Dairi, Batak Toba, Batak Mandailing. In the

Batak tribe (sub-Ras Proto Melayu), there is a

customary group Dalihan Na Tolu, although the term

is different but the same meaning. (Manurung, 2016)

This study was conducted to determine the

differences size of mandibular bigonial width in

Batak tribe at Rumah Sakit Gigi dan Mulut Faculty

of Dentistry, Universitas Sumatera Utara according

to age group in terms of panoramic radiography. The

purpose of this study was to find out the difference

mean value of bigonial width mandibular of Batak

tribe in Medan according to age group in terms of

panoramic radiograph, which can be used and

Sitanggang, M., Boel, T. and Pintauli, S.

Difference of Bigonial Width Batak Tribe in Medan City According to Age Groups in Terms of Panoramic Radiograph.

DOI: 10.5220/0009901100002480

In Proceedings of the International Conference on Natural Resources and Sustainable Development (ICNRSD 2018), pages 261-266

ISBN: 978-989-758-543-2

261

become a guideline in the care and growth of a

person.

2 METHODS

This analytical research conducted using cross-

sectional design, carried out at Oral-Maxillo Facial

Radiology, Faculty of Dentistry, Universitas

Sumatera Utara. The population of this study was

Batak tribe with three generations above who came

to Rumah Sakit Gigi dan Mulut Faculty of

Dentistry, Universitas Sumatera Utara and live in

Medan City. The total sample size was 150 people,

divided into five age groups. Group 1 consists of 4-

12 years old, group 2 consists of 13-24 years old,

group 3 consists of 25-34 years old, group 4

consists of 35-60 years old, and group 5 consists of

>60 years old. Each age group of samples consisted

of 30 people.

Sample selection method was done by purposive

sampling method by fulfilled inclusion and

exclusion criteria. Inclusion criteria: complete teeth

(in primary dentition period consisting of 20 teeth

and in permanent dentition period consisting of 28

teeth, except for third molar) never received

orthodontic treatment, did not use dentures.

Particularly in the age at mixed tooth period, there

is no premature loss deciduous teeth and missing of

permanent teeth, and in group 5 (age> 60 years):

full edentulous. Exclusion criteria: suffered from

systemic diseases or received treatment,

experienced of jaw surgery, odontectomy, suffered

from micrognathia, pathological conditions in the

mandible, persistence of deciduous teeth,

experienced deep caries with exposure to the pulp

and crown loss, received fullcrown or space

maintainer/space regainer treatments.

After completing the questionnaire and informed

consent, a digital of the panoramic radiography was

performed on the sample using Orthopantomograph

Instrumentarium, model QC 200 D 1-4-1, 2012. The

parameters are computerized on digital panoramic

radiograph (Fig. 1). The one-way Anova and

Multiple Comparison LSD test was done to analyze

the calculated data. Ethical clearance was obtained

from the Research Ethics Committees of Faculty of

Medicine, Universitas Sumatera Utara No.

345/TGL/KEPK FK USU-RSUP HAM/2017.

3 RESULTS

The results of normality test using one-sample

Kolmogorov-Smirnov Test showed that the variables

have normal distribution with p>0.05. Table 1

showed the mean value of bigonial width in each age

group (ANOVA test, p value = 0.000 < 0.05). The

mean value of bigonial width from the highest to the

lowest, sequentially, were in group 3 (25-34 years),

group 4 (35-60 years), group 5 (>60 years), group 2

(13-24 years), and group 1 (4-12 years).

Multiple comparison test was performed after

ANOVA analysis. Table 2 showed the significant

differences (Multiple Comparison LSD Test result)

according to age groups (p< 0.05).

Figure 1: Bigonial width in panoramic radiograph (private document).

ICNRSD 2018 - International Conference on Natural Resources and Sustainable Development

262

Table 1: The mean value of the result of the measurement

of bigonial width Batak tribe.

Groups

ears

)

Mean ± Std.

Deviation

(

4-12

)

30 141.917±10.992

.000

(

13-24

)

30 147.787±9.108

3 (25-34y) 30 163.283±9.947

4 (35-60y) 30 157.580±7.776

5 (>60y) 30 155.623±12.611

Total 150 153.238±12.597

*One-way Anova test, sig. p<0.05

Table 2: Multiple Comparison LSD Test between five age

groups in mandibular bigonial width Batak tribe in Medan

according to age groups.

(I) Group

(years)

(J) Group

(years)

1 (4-12y)

2 (13-24) .028

3 (25-34) .001

(

35-60

)

.001

(

>60

)

.001

2 (13-24y)

(

4-12

)

.028

3 (25-34) .001

4 (35-60) .001

(

>60

)

.003

3 (25-34y)

(

4-12

)

.001

(

13-24

)

.001

4 (35-60) .032

5 (>60) .004

4 (35-60y)

1 (4-12) .001

(

13-24

)

.001

(

25-34

)

.032

(

>60

)

.460

5 (>60y)

1 (4-12) .001

2 (13-24) .003

(

25-34

)

.004

(

35-60

)

.460

4 DISCUSSION

In this study the average values of bigonial width

Batak tribe of five age groups showed the mean

value from the highest to the lowest, sequentially,

were in group 3 (25-34 years), group 4 (35-60

years), group 5 (>60 years), group 2 (13-24 years),

and group 1 (4-12 years). There was a significant

difference in bigonial width from group 1 (4-12

years) to other groups, from group 2 (13-24 years) to

other groups, and group 3 (25-34 years) to other

groups, but there was not significant difference in

bigonial width from group 4 (35-60 years) to group

5 (>60 years) (Table 2). A study conducted by Al-

Shamout et al.,, showed that there was a significant

difference in the mean values of bigonial width

between the age group of 11-19 years with the age

group of 20-29 years, 30-39 years, 40-49 years, and

50- 59 years old. Bigonial width will change with

age change.[6] The results of the same study also by

Ghaffari et al., which mentions a significant

decrease in bigonial width size from the 21-30, 31-

40, to 41-50 year age groups

. (Ghaffari et al., 2013).

The remodeling process is the process by which

old bone is removed from the skeleton (resorption)

replaced with new bone (ossification/ new bone

formation). The remodeling process occurs

throughout life, by removing old bone continuously

with new protein matrix and mineralization matrix to

form new bone. (Kini et al., 2012) The time of

children and adolescents is a very important time to

maximize accumulation of bone formation, due to

the process of growth, development, and remodeling

of bone. In both men and women, it is generally

believed that bone mass increased substantially

during the first two decades to reach peak bone mass

in adolescence or young adulthood. Several studies

have shown that peak mass bone is achieved at the

early age of 20 years but other data suggest that

bone mineral still accumulates in the third decade of

life. (Baxter-Jones et al., 2011)

After birth, the mandibular body gradually

extends towards the horizontal especially behind the

foramen mentale to produce a place for the

permanent teeth. (Al-Shamout et al., 2012) During

the process of tooth eruption in the mandible, in the

process of growth and development of the mandible,

in addition to the process of remodeling, there is also

anterior and inferior displacement. The

endocondrium of the condyle has hardening, and

affects the growth of the posterior mandible.

Apposition and remodeling will cause the mandible

to grow larger. (Reynolds et al., 2011; Ghosh et al.,

2009)

The results of this study indicate the maximum

growth of mandibular to lateral direction occurs in

the age group 13-24 years, to reach the optimal size

of bigonial width in the age group 25-34 years. This

is likely due to the mandibular basal bone

morphology generally altered by bone aposition on

the outer (buccal and labial) surfaces of the

mandible to provide a spot of tooth eruption, and

resorption on the lingual surface of the mandible. At

the age after 35 years the mandible will experience a

minimum growth that occurs until age> 60 years

(there is menopause period for the woman) which is

likely due to a greater resorbtion than bone

apposition, especially in the age group> 60 years

who have teeth lost entirely. (Ghosh et al., 2009)

Difference of Bigonial Width Batak Tribe in Medan City According to Age Groups in Terms of Panoramic Radiograph

263

From the transverse aspect, after the first year of

life, the growth in the posterior region of ramus is in

the form of the letter "V". Changes in the function of

chewing muscles, especially in the angle of gonial

regions may also be the cause of the bigger width

increase. The gonial angle is a part of the mandible

that is directly related to the massetter and internal

pteryigoid muscles. During the craniofacial growth

period, the mandible undergoes continuous

repositioning in order to perform optimally function.

The rami grows in divergent direction, in order to

obtain a connection with the maxilla in order to

function normally. (Singh, 2007) A study conducted

by Bishara et al., on the mandible arch, showed

mandibular growth in the lateral direction, with an

increase in 3.7 mm intercanine width between 3-13

years, but decreased by 1.2 mm by 13 to 45 years.

The intermolar width increases by 1.5 mm at the age

between 3-5 years and 1 mm between 8-13 years but

decreases 1 mm at the age of approximately 45

years. (Standring, 2008) The results of this study are

also supported by Leversha et al., examined the

bigonial width that grew from 18-29 years old to 30-

39 years old, and decreased in the 40-49, 50-59, and

60-69 years age group. (Leversha et al., 2015)

In adolescence, there is an increase in the

acceleration of growth, changes in size and shape,

and changes in the proportion of muscle, fat, and

bone. During puberty, there is a considerable

increase in bone mass due to increased bone size

(Sharma et al., 2014) where the rate of bone

formation process is faster than resorption.

However, this growth rate will stop when the linear

growth stops, and bone mass peaks someone is

reached, occurring at the age of 15-25 years. Total

bone mass usually remains constant for about 10

years, because the rate of bone formation and

resorption is balanced. Then the bone mass will

slowly decrease as a result of the dominance of the

resorbsi process in the third decade of life to the

fourth. (Lau et al., 2011)

There was not significant difference in bigonial

width from group 4 (35-60 years) to group 5 (>60

years). This is likely due to the large age range in the

sample used in group 4 (35-60 years). Where the

number of samples used with age 35-40 years as

many as 5 people and ages 41-60 years as many as

25 people, the age at which bone loss is more, and

minimal bone growth. The dominant effect of aging

on bone is the loss of bone mass and strength. At the

age of the third decade to the fourth decade of life,

total bone mass will begin to decline. By age 80, it is

estimated that the body’s total bone mass will be

about 50% of its peak value. Loss of bone mass from

the jaw is caused not only by the teeth, decreased

bone density is caused by the age factor, so the

bones become more fragile. Fractures occur more

easily and the healing process becomes slower. (Lau

et al., 2011; Boskey et al., 2010)

Parathyroid hormone (PTH), an 84-amino acid

peptide secreted by the parathyroid gland is

important as a systemic regulator of calcium

homeostasis, serves to regulate the concentration of

calcium and serum phosphorus through receptor-

mediation, combined actions in the bones, intestines,

and kidneys. High serum PTH levels, increase

osteoclastic bone absorption, as seen in primary and

secondary hyperparathyroidism. Low PTH levels,

increase osteoblastic bone formation, especially if

delivered episodically. The skeletal effect of PTH is

mediated through osteoblasts, because it is the main

expression of PTH receptors. However, osteoblasts

communicate with osteoclasts to mediate the effects

of PTH. Many factors may be involved in increasing

serum PTH levels in the elderly. Vitamin D

deficiency is quite common which can contribute to

elevated serum PTH levels by decreasing calcium

resorption from the gastrointestinal tract. Moreover

estrogen deficiency results in reducing intestinal

calcium absorption as well as renal tubular calcium

disrupted reabsorption, which leads to chronic

negative calcium balance. Vitamin D is an important

factor in the regulation of calcium metabolism. 1,25-

Dihydroxy vitamin D3, the active form of vitamin D

which has the effect of increasing intestinal calcium

absorption, decreasing serum PTH levels through

direct inhibition of PTH secretion, and also

indirectly, through inhibition of PTH secretion with

elevated serum calcium levels. Therefore, vitamin D

has the overall effect of decreasing bone resorption

mediated by PTH. Vitamin D deficiency often

occurs with advanced aging, and this may be another

contributor to the pathogenesis of senile

osteoporosis. Although severe vitamin D deficiency

results in the development of osteomalacia in adults,

mild deficiencies can cause a secondary state of

hyperparathyroidism, with the result of developing

osteoporosis. (Kini et al., 2012; Lau et al., 2011;

Boskey et al., 2010; Feng et al., 2011)

The facial skeleton has a profound effect on one's

appearance. The main characteristic of adolescents is

good skeletal structural support. The result of facial

aging is a combination of soft tissue and bone

changes, with bone loss in certain areas of the facial

bone contributing significantly to aging facial

features. Conceptually it is important to appreciate

that in most individuals with premature aging, facial

frames can be inherently inadequate. Thus, changes

ICNRSD 2018 - International Conference on Natural Resources and Sustainable Development

264

in the facial bone resulting from the aging process

must be resolved to get a natural facial rejuvenation.

(Mendelson et al., 2012)

The mandible is the bone that forms the lower

part of the face, chin, and mandibular angle. The

mandible provides attachment for the mastication

muscles, tongue, and the floor of the mouth. (Burns,

2013) According to Enomoto et al.,, mastication

affects the growth and development of the mandible.

The mechanical stress induced by mastication

greatly affects the condyle cartilage and the

mandible around the mastication muscle, and alters

the growth and development pattern of the mandible.

(Enomoto et al., 2010) Many researches have been

done to evaluate mandibular morphology by age,

such as measurements of height and width of ramus,

condyle height, and bigonial width. The

morphological changes of the mandible after birth

are affected by the teeth (mastication) and age. Age,

systemic factors, and tooth loss may lead to changes

in mandibular morphology. (Liu et al., 2010;

Huumonen et al., 2010; Shaw et al., 2010; Chole et

al., 2013; Shilpa et al., 2014) Increasing age,

changes in the function and structure of mastication

muscles that occur in edentulous patients lead to

reduced contraction in activity and decreased muscle

density compared with toothed patients. The strength

of the masseter and medial pterygoid muscle

contractions that work in the area of the gonial

angle, also affect the basic form of the

mandible.(Thakur et al., 2013; Oksayan et al., 2014)

In computed tomographic scans can be seen the

activity of electromyography and lower muscle

density on the edentulous subject than the dentulous

subject. The occurrence of masticatory muscle

atrophy may be one of the factors that cause

mandibular changes. (Baxter-Jones et al., 2011;

M.Reynolds et al., 2011; Shaw et al., 2010; Chole et

al., 2013; Shilpa et al., 2014) Another factor that

may cause the changes is the loss of intermaxillary

support due to missing teeth, allowing the masseter

and medial pterygoid muscles to draw an

unobstructed pull on the mandible. (Baxter-Jones et

al., 2011) A significant limitation with currently

available uses is data obtained from digital

panoramic radiographs. The ideal study is linear to

show the aging changes in the same individual.

However, the study that can be done in this field is

cross-sectional population research based on the

comparison between individuals in different age

groups, so it cannot see significant changes in the

age-related mandibular of the same individual.

5 CONCLUSION

The conclusion of this study is that group 3 (25-34

years old) has the highest mean value of bigonial

width. There is difference of bigonial width Batak

tribe in Medan according to age group in terms of

panoramic radiography that can be affected by teeth

and age. Statistically significant differences in

bigonial width was group 1 (4-12 years), 2 (13-24

years), and 3 (25-34 years) to the other groups, but

there is not significant differences in bigonial width

for group 4 (35-60 years) to group 5 (>60 years).

ACKNOWLEDGMENT

This research was conducted with the support my

family and all of my friends, Bu Erna from Faculty

of Public Health and Prof. Harlem Marpaung from

Faculty of Math and Science, Universitas Sumatera

Utara.

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