Pattern of Malocclusion in Patients Seeking Orthodontic Treatment at Medical Colleges & Teaching Hospitals of Chitwan , Nepal

Introduction: Various forms of malocclusion is most common dentofacial abnormality found in human population. People seek tteatment for such abnormalities based on the severity. The objective of this research is to evaluate Pattern of Malocclusion in Patients Seeking Orthodontic Treatment at Medical Colleges and Teaching Hospitals of Chitwan, Nepal. Materials & Method: Two hundred thirty nine pre-operative study casts of orthodontic patients aged from 12-50 years selected from 550 patient’s records of departments of orthodontics of Chitwan Medical Colleges and Colleges of Medical Sciences, Bharatpur of Chitwan. Standard protocol of Angle’s classification of malocclusion was used to classify malocclusion and its attributes were recorded. Pearson’s Chi square test was performed to justify the result. Result: The prevalence of malocclusion were 61.92% , 33.47% and 4.60% for Angle’s class I, Angle’s class II and Angle’s class III malocclusion respectively. Among various attributes of malocclusion, deep bite had highest frequency with 67.36% followed by overjet 58.99%, crowding 53.13% and spacing 35.98%, Anterior cross bite 11.71% reverse overjet 4.6%, posterior cross bite 1.2% and scissor bite 0.041%. Pearson Chi square test showed no relation among these attributes and sex and age at p < .05. Conclusion: Angle’s class I malocclusion is most prevalent followed by Angle’s class II and Angle’s class III.


INTRODUCTION
People strive for healthy and beautiful smile.Unlike old days, situation is changing with much advanced treatment modalities available in the field of dentistry today.The demand for orthodontic treatment is increasing in different regions of different countries.This increase may be due to modernization and economic development.The need of data to understand the prevalence of the condition and people's perception of the malocclusion is imperative and gives us the guidance to allocate the services to the needy.This study will also help in understanding the need of resources.WHO (1987)defined malocclusion as an handicapping dento-facial anomalies causing disfigurement or impending function and may require treatment when the defect was likely to be a cause of patients' physical Dr Bashu Raj Pandey, 1 Dr Shailendra Kumar Singh, 2 Dr Rajan Singh, 3 Dr Rajeev Mishra, 4 Dr Srijana Mishra, 5 Dr Bimala Gharti 6 and emotional wellbeing.This study provides a good picture of the malocclusion in middle part of Nepal and its need of treatment.
The study consists of an analysis of data on over jet, crowding, spacing, and deep bite.It also includesopen bite, bimaxillaryproclination and scissor bite.

DISCUSSION
For the management of any problem, knowledge of prevalence of the particular problems is mandatory.
The prevalence of malocclusion in different parts of world is varied from 39% to 93%. 4  The result of the present study showed that females were more interested toward orthodontic treatment with the frequency of 71.3% in the central part of Nepal as in western and eastern part of Nepal where the frequency of interested female to male ratio was 2:1. 5,6milar study done in Bangladesh found that females between the age of 15 to 20 were most prevalent Every geographical area has different prevalence of malocclusion .Study on prevalence of malocclusion in central part of Nepal had not been carried out till the date.So the study on pattern of malocclusion in OPD patient of orthodontic departments of two medical colleges in Chitwan had been done.Prevalent age groups of orthodontic patients weremostly 18-30 years which were usual finding as in other studies.
Pandey BR, Singh SK, Singh R, Mishra R, Mishra S, Gharti B : Pattern of Malocclusion in Patients Seeking Orthodontic Treatment at Medical Colleges & Teaching Hospitals of Chitwan, Nepal

Table 1 : Distribution of sample according to Gender Gender Class 1 (No and percent) Class 2 (No and percent) Class 3 (No and percent) Percentage
BR, Singh SK, Singh R, Mishra R, Mishra S, Gharti B : Pattern of Malocclusion in Patients Seeking Orthodontic Treatment at Medical Colleges & Teaching Hospitals of Chitwan, Nepal This is the retrospective study done in study cast of patients who visited departments of Orthodontics and Dentofacial Orthopedics of Chitwan Medical College and College of Medical Sciences in Chitwan, Nepal from 2014 to 2018.Two hundred thirty nine acceptable study casts were selected from 550 case recordsof orthodontic patients.The subjects ranged from 12 to 50 years with the following criteria: (1) permanent dentition with fully erupted intact first molar, (2) patient willing for orthodontic treatment with all pretreatment records, (3) no history of previous orthodontic treatment,(4) absenceof craniofacialanomalies.A standard guidance of Angle's classification was used to classify the cases and casts were measured to record the data.Different Angle's classification of malocclusion with discrepancies in all three planes was studied.Several attributes of malocclusion included for the study of the nature of malocclusion were:over I, 33.47% of Angle's class II and 4.60% of Angle's class III malocclusion (Table 1).Among various attributes of malocclusion, deep bite was the most common trait with 67.36% prevalence and scissor bite was least common trait with prevalence of 0.041%.Increased over jet was found in 58.99 % subjects and 4.6 % patient had negative over jet.Under space discrepancies analysis, crowding and spacing were found in 53.13% and 35.98% cases respectively.Anterior cross bite was found in 11.71% and posterior cross bite was found in 1.2 % cases.In 1.67% cases bimax protrusion was present.Open bite was found in 4.60 % of observed sample.In Angle's class I malocclusion, the most frequent trait was deep bite (66%)whereas increased over jet(77.5%)and crowding in (66.63%) in Angle's class II and class III respectively.Pearson Chi square test was conducted in more frequently observed attributes to find out the relation among these attributes and sex and age which showed that none of the attributes of malocclusion were significantly related with gender and age at p < .05(table2-3).Pandey Fig.1: Distribution of sample according to Age

Table 2 : Distribution of different attributes of malocclusion according to gender
Inference:The results are not statisticallysignificant at p < .05

Table 3 : Distribution of different attributes of malocclusion according to age
Akbari et al also reported the higher prevalence of malocclusion in girls in their systematic review and meta-analysis on prevalence of malocclusion among Iranian children.12Thestudyconducted in western part of Nepal showed the relation between distribution of malocclusion and age was statistically significant but the association of distribution of malocclusion with gender was not statistically significant. 5ONCLUSION Angles Class I malocclusion was most prevalent with least common class III malocclusion .Deep bite was most common attributes with least prevalent scissor bite.No statistically significant relationship was found between different attributes of malocclusion and gender and age of patients.OJN Pandey BR, Singh SK, Singh R, Mishra R, Mishra S, Gharti B : Pattern of Malocclusion in Patients Seeking Orthodontic Treatment at Medical Colleges & Teaching Hospitals of Chitwan, Nepal