Anterior Cranial Base Length Research Articles

Establishment of Cephalometric Hard Tissue Profile among Bengali and Caucasian Populations for Orthognathic Surgery

ABSTRACT The study aimed to compare cephalometric hard tissue profile values and analysis between Bengali and Caucasian populations. The study included 100 individuals (50 males, 50 females) aged 18–35. Subjects having class I molar occlusions and well-balanced facial profiles were included in the study. Lateral cephalograms were taken with consent, and a prestructured proforma recorded relevant information and cephalometric measurements. Our study found increased posterior cranial base length in Bengali males and increased anterior cranial base length in both sexes. Bengali males had a less convex profile, while females had a more convex profile compared to Caucasians with similar mandibular features. Increased maxillary and mandibular incisor proclination was observed. Our findings indicate the necessity for separate norms for orthognathic surgery in normal ethnic Bengali adults.

The relationship of anterior occlusion and skeletal variables with the frontal sinus index: An analytical cross-sectional study.

To determine the relationship of anterior occlusion and skeletal variables with the frontal sinus index. The retrospective, analytical, cross-sectional, study was conducted from July to November 2020 at Dr Ishratul- Ebad Khan Institute of Oral Health Sciences and Dow Dental College, Dow University of Health Sciences, Karachi, and comprised data from 2015 to 2018 related to pre-treatment lateral cephalograms for determining frontal sinus index and other cephalometric variables. The dental casts were observed for incisor classification. Patients with Class I incisors formed the comparison group, while the rest comprised 5 malocclusion groups. The frontal sinus was traced, and the sinus index was calculated. Data was analysed using STATA 15 and R 3.5.1. Of the 240 subjects, there were 40(16.66%) in each of the 6 groups; 155(64.6%) females and 85(35.4%) males. The mean age of the sample was 21.33±3.52 years (range: 16-29 years). The mean sinus index was higher in all malocclusion groups than the comparison group, but it was significantly higher only in Class II division 2 and anterior open bite groups (p<0.05). The only exception to the trend was Class II division 1 with and without contact in which the value was lower (p>0.05). The anterior cranial base length, sella-nasion mandibular plane angle, and upper incisor palatal plane angle significantly affected the frontal sinus index (p<0.05). The frontal sinus index could be considered an indicator of harmonious anterior occlusion.

Cranial Base Measurements in Skeletal Malocclusion among Orthodontic Patients.

Facial growth and development is necessary for proper orthodontic diagnosis and treatment planning. Growth of cranial base is linked to the overall growth of facial bones, especially the maxilla and mandible. Any change in the amount and direction of growth of the cranial base can have direct or indirect effects on the developing maxilla and mandible. Thus the aim of this study was to determine the linear and angular cranial base measurements in different skeletal malocclusion in Nepalese population. Pretreatment lateral cephalograms of 225 patients aged between 17-30 years were collected. Linear measurements Sella-Nasion (S-N), Sella-Articulare (S-Ar), Articulare-Gonion (Ar-Go), Gonion-Gnathion (Go-Gn) and angular measurements Saddle angle (N-S-Ar), Articular angle (S-Ar-Go) and Gonial angle (Ar-Go-Gn) were measured. In angular measurements statistically significant differences were found in the saddle and gonial angles between class I, II, and III skeletal pattern. In linear measurements, anterior and posterior cranial base lengths were not significantly different among groups however, ramal height and mandibular body length were significantly different among groups with a P value < 0.05. Skeletal class III has a larger gonial angle, ramal height and mandibular length. Males have larger linear measurements and females have larger angular measurements.

Sex differences in craniofacial parameters of children and adolescents: a comparative study with the maturation of cervical vertebrae using a cephalometric method.

This study aimed to investigate sex differences in craniomaxillofacial parameters in children and adolescents. Lateral cephalograms were obtained from 340 subjects (141 male, 199 female) aged 6 to 18 years, and their craniofacial characteristics and cervical vertebral maturity were assessed using the quantitative cervical vertebral maturity (QCVM) method. Age-based stratified analyses on craniofacial parameters and further comparison in QCVM Ⅲ subjects were performed. Among all analyses, male subjects had significantly greater value than females in sex-different parameters except for facial convexity. The overall group had 17 sex-different parameters (ramus height, anterior facial height (AFH), posterior facial height (PFH), upper anterior facial height (UAFH), lower anterior facial height (LAFH), anterior cranial base length, posterior cranial base length, facial convexity, upper lip length, upper lip thickness, lower lip thickness, soft tissue chin thickness, nasion of soft tissue-subnasale (N'-Sn), subnasale-menton of soft tissue (Sn-Me'), subnasale-stomion inferius (Sn-Sto)). The <12 years old group showed 6 significant sex differences (AFH, LAFH, lower lip protrusion, lower lip thickness, N'-Sn, Sn-Me'). While the ≥12 years old group occurred two more parameters (mandibular body length, AFH/PFH) than the overall group. 12 cephalometric parameters had significant sex differences among QCMV III patients. After age adjustment, the number of sex-different parameters only increased in soft tissue. Craniofacial characteristics and cervical vertebrae maturation of the youngsters exhibited significant sex differences. Though females reached an earlier cervical vertebral maturation, they still had smaller craniofacial linear features. Sex differences should be taken into account in developing reference standards for cephalometric measurements and treatment planning in the clinic.

The Outcomes of Endoscopic Suturectomy in Syndromic Craniosynostosis.

Endoscopic suturectomy is a widely practiced surgical option for infants with craniosynostosis. But the efficacy and safety of the procedure remain unclear in syndromic patients. This study aims to evaluate the efficacy and safety of endoscopic suturectomy for patients with syndromic craniosynostosis. From January 2013 to December 2020, 242 patients underwent endoscopic suturectomy at our institution. The surgical outcome was determined to be favorable or unfavorable based upon the necessity of an additional cranial surgery upon the last follow-up. First, we analyzed the outcomes of 26 syndromic craniosynostosis patients who have followed up for over a year. Second, we compared the outcomes between the syndromic (N=12) and nonsyndromic (N=11) patients with bilateral coronal synostosis who have followed up for over a year. Twenty-three out of 26 syndromic craniosynostosis patients (88%) showed favorable outcomes without significant complications. In the analysis for bilateral coronal synostosis patients, 11 of 12 syndromic patients (92%) presented favorable outcomes, and all nonsyndromic patients showed favorable outcomes. No significant differences were observed in various anthropometric indices (cranial index, intracranial volume, anterior cranial height, anterior cranial base length, and cranial height-length index) and surgical outcomes between syndromic and nonsyndromic groups. Endoscopic suturectomy has the potential to be a surgical option for syndromic craniosynostosis. Even for patients with unfavorable outcomes, endoscopic suturectomy could serve as a bridge treatment for infants to counter cranial deformation before additional extensive surgery.

Effects of thalassaemia major on components of the craniofacial complex- a cephalometric study in Andhra Pradesh population

Introduction: The cephalometric study was conducted to evaluate the craniofacial effects of thalassaemia major on the Andhra Pradesh population. Methods: A total of 32 thalassaemic patients (23 male, 9 female) were selected from the Thalassaemia and Sickle Cell Society and 32 controls (19 male, 13 female) from schools of Hyderabad city to eliminate any bias on the ethnic background. All 64 lateral cephalograms were taken under standard conditions with teeth in occlusion and lips in a relaxed position. Forty - two linear and angular cephalometric parameters defining craniofacial morphology (22 skeletal, 13 dentoalveolarand 7 softtissue) were selected. Results: Everypatient with thalassaemia exhibited a skeletal base relationship of class II, accompanied by an average ANB angle of 4°. There was a significant increase in the length of the anterior cranial base. The length of the maxillary and mandibular base was significantly reduced, and the mandible appeared to be retruded in the face. Pronounced vertical growth was evident from linear and angular measurements. The dental deviations seen in thalassaemic patients were proclination, significant over-eruption of the maxillary anterior teeth and increased overjet. A marked increase in the convexity of the lower face, prominent upper lip, reduced nasolabial angle and increased inter-labial angle were evident from soft tissue measurements. Conclusions: The reduced length of the maxillary and mandibular base could be due to chronic anaemia which causes retardation of growth in thalassaemic patients. An increase in the anterior cranial base length resulted in the posterior positioning of the mandible and an increase in anterior facial height led to a skeletal class II pattern.Keywords: Anaemia; craniofacial growth; cephalometry; thalassaemia major.

Association between the occurrence of buccally displaced canine and palatal and craniofacial morphology in adolescents.

The main objective of the present research study is to evaluate the association between the occurrence of buccally displaced canine (BDC) and the palatal as well as the craniofacial morphology in adolescents in accordance at the early permanent dentition. As the experimental group, 100 adolescents of Chinese ethnicity (mean age 13.05 years) with crowding and buccally displaced canine (BDC-c) were selected in comparison with the same number of candidates (mean age 12.59 years) without BDC and crowding as control group. Digital dental casts and cephalograms were collected for three dimensional (3D) and cephalometric measurements. An independent sample T-test was used to compare the cephalometric values between the two groups. Logistic regression as commonly statistical methods used in empirical study including categorical dependent variables was used to identify the joint effects of the dental variables' 3D measurements. When comparing the groups with above analysis, patients with BDC showed a statistically significant narrower and higher palatal vault. For the cephalometric variables, the anterior cranial base length, sagittal position of the maxilla (SNA), sagittal position of the mandible (SNB), and skeletal relationship between maxilla and mandible (ANB) appeared to be smaller, whilst palatal plane angle (SN-PP), Frankfort-mandibular plane angle (FMA), anterior facial height, and lower facial height were larger in BDC-c control group (p < 0.05). A smaller inter-first premolar width was significant in the prediction model (p = 0.002). This study highlights that BDC-c participants in early permanent dentition exhibited a narrower dental arch and higher palatal vault, of which a smaller inter-first premolar width would significantly increase the occurrence of BDC.

Enlarged occipital spur and craniofacial morphology: a cephalometric analysis.

This cross-sectional study aimed to investigate the association between the occipital spur length and craniofacial morphology in individuals with occipital spur (OS). The study included cephalometric images from 451 individuals (196 females, 255 males, age range was 9-84years). The spur length and craniofacial characteristics were evaluated using cephalograms. Based on spur length, subjects were divided into two groups: the OS group (N = 209) and the enlarged occipital spur (EOS) group (N = 242). Descriptive statistics, Independent T-test, Mann-Whitney U test, chi-square test, Kruskal-Wallis test, and age- and sex-based stratified analyses were performed. The level of significance was set at p < 0.05. Males had significantly larger spur length than females. Spur length was shorter in individuals under 18 than the groups over 18. After adjusting for gender and age, ramus height, mandibular body length, effective length of maxilla, effective length of mandible, anterior cranial base length, posterior cranial base length, anterior facial height, posterior facial height, facial height index, and lower anterior facial height had statistically significant differences between OS group and EOS group. Males exhibit greater spur length than females. Patients under 18 had a shorter spur length than adults. Linear craniofacial measurements were found to be greater in subjects with EOS than the individuals with OS. The craniofacial growth and development of an individual might be associated with EOS. The causal relationship between EOS and craniofacial development requires further longitudinal studies.

Effect of Beta Thalassemia Major on Anterior Cranial Base in Cephalometric Analysis

Background: Thalassemia is a group of hemolytic diseases caused by genetic disorders resulting from a decrease in the synthesis of the alpha or beta chains of hemoglobin (Hb). A particular craniofacial cephalometric picture is found in the form of mild skeletal class II clinical manifestations. The anterior cranial base becomes a benchmark or reference sector in the measurement of dentofacial structures on cephalometric radiographs because it is considered relatively stable throughout craniofacial growth. Objective: The purpose of this systematic literature review was to determine the effect of beta thalassemia major on the length of the anterior cranial base observed through cephalometric analysis. Methods: References were selected using the PubMed, Science Direct, and Google Scholar databases published from January 2007 to December 2021. The complete articles that met the inclusion and exclusion criteria were then assessed using the Critical Appraisal Skills Program bias assessment and summarized to obtain demographic data and the length of the patient's anterior cranial base in the journal. Results: This systematic literature review succeeded in synthesizing 6 journals consisting of case-control studies with low bias assessment results in 4 journals and moderate bias assessment in 2 journals. All journals in this systematic literature review stated that the length of the anterior cranial base in patients with beta thalassemia major was not much different from the control group seen in cephalometric analysis. Conclusion: There is no effect on the length of the anterior cranial base in patients with beta thalassemia major based on measurements on cephalometric analysis.

Relationship between the nasal profile and craniofacial structures: does part of the nasal profile reflect some craniofacial structures?

This study aims to evaluate the relationship between the nasal profile and other craniofacial structures. Lateral cephalometric images of 124 adults were collected for this purpose. Statistical analyses such as regression analysis and canonical correlation analysis (CCA) were conducted on nasal and craniofacial anatomical parameters and their relationships. The regression analysis revealed that nasal length was related to maxillary height; nasal depth was related to the position of the maxilla and anterior cranial base length; and nasal base angle was related to upper dentoalveolar height. CCA revealed that nasal parameters (nasal length, depth, and hump) correlated more strongly with craniofacial parameters (maxillary height, anterior-posterior position of the maxilla, and maxillary length). Individuals with maxillary development curved anteriorly upwards had a straighter and smaller nasal profile, while those with maxillary development curved posteriorly downwards had a more arched and large nasal profile. The shape of the nasal dorsum was affected by the maxillomandibular rotation, while the increase in nasal base inclination was accompanied by an upward rotation of the maxillary plane, an increase in the upper dentoalveolar height, and an increase in the lower facial height. While it was observed that each nasal parameter was correlated with the underlying craniofacial structures to some extent, it was also observed that it would be more useful to evaluate the cumulative effects posed by craniofacial parameters. Various combinations of skeletal and dental structures are related to the nasal profile in varying forms and knowing these relationships will help reshape the face and provide aesthetic harmony.

Craniofacial Morphologic Predictors for Passive Myofunctional Therapy of Pediatric Obstructive Sleep Apnea Using an Oral Appliance with a Tongue Bead.

We conducted this retrospective study to identify potential clinical, polysomnographic, and cephalometric predictors for the treatment outcomes of a tongue-beaded oral appliance (OA) in children with obstructive sleep apnea syndrome (OSAS). In total, 63 patients—50 boys and 13 girls ranging in age from 4 to 16 years—underwent OA treatment nightly for at least 6 months. A baseline digital lateral cephalometric radiograph was obtained for each patient. Multivariate logistic regression analysis was performed to examine predictors for the treatment outcome based on the clinical and cephalometric measurements. Overall, 28 patients responded to the treatment (post-treatment improvement > 50% or apnea–hypopnea index (AHI) < 1/h), and 35 did not (post-treatment improvement < 50% and AHI ≥ 1/h). Significantly larger cranial base angle (SNBa), smaller lower gonial angle (LGo Angle), and shorter length of anterior cranial base (SN) were found in responders. Smaller lower gonial angle (LGo Angle) and smaller anterior cranial base (SN) predict a favorable outcome for pediatric OSAS using a tongue-beaded OA. This finding will equip practitioners with additional insights when selecting suitable candidates for OA therapy in pediatric patients.

Cranial base measurements in different anteroposterior skeletal relationships using Bjork-Jarabak analysis.

To assess the linear and angular cranial base measurements (Bjork polygon) in different anteroposterior (AP) skeletal relationships using Bjork-Jarabak analysis. Pretreatment lateral cephalograms of 288 (146 women, 142 men, mean ages 21.24 ± 2.72 years and 22.94 ± 3.28 years, respectively) adult patients were divided into Class I, II, and III skeletal relationships according to their ANB angle. Linear and angular measurements of Bjork polygon were measured and compared among different skeletal relationships. Analysis of variance was performed to detect the differences among groups. Independent-sample t-test was used to detect differences between men and women. The Class II skeletal relationship has a significantly larger saddle angle than Class III does (P < .05), whereas Class III has a significantly larger gonial angle than Class II does (P < .05). The articular angle and sum of Bjork polygon angles were not significantly different among groups (P > .05). Anterior (N-S) and posterior (S-Ar) cranial base lengths were similar in the different AP skeletal relationships (P > .05). The ramal height and body of the mandible length were significantly larger in Class III compared with Class I and II (P < .05). Women had a significantly larger articular angle than men did (P < .05), although men had significantly larger linear measurements of Bjork polygon than women did (P < .05). The Class III skeletal relationship has a smaller saddle angle and larger mandibular length and gonial angle. Men have a larger cranial base and mandibular linear measurements and a smaller articular angle compared with women.

COMPARISON OF TWO CRANIAL BASE LENGTHS AND FOUR ANGLES AMONG THREE SAGITTAL SKELETAL BASES IN ADULT POPULATION OF DISTRICT PESHAWAR, PAKISTAN

Background: Research has shown that cranial base length, flexure and inclination play a role in the skeletal malocclusion in sagittal and vertical dimensions. The objectives of this study were to compare the two cranial base lengths and four angles among three sagittal skeletal bases in adult population of district Peshawar, Pakistan. Material &amp; Methods: This cross-sectional study was conducted in the Department of Orthodontics, Khyber College of Dentistry, Peshawar, Pakistan from February 2020 to March, 2020. Ninety lateral cephalograms were selected for the year 2019 from the database of department, with 30 from each group; Skeletal Class I, II and III. SN length (mm), SBa length (mm), N-S-Ba, N-S-Ar, SN-FH and SBa-FH were our ratio variables and were described by mean, range and SD with 95% CI for mean. Twelve hypotheses were tested each by one-way ANOVA and when it showed significant difference, then by post hoc Dunnett’s t test. Results: Results: The sample included 90 cephalograms; 30 each in Class I, II and III, including 38 men and 52 women with mean age 22.54±5.70 years. SN length (mm) was similar in Class II 68.1±2.15 and Class III 68.7±2.01 to Class I (control) 68.4±1.56 (p=.487). SBa length was similar in Class II 45.5±2.48 and Class III 44.9±2.23 to Class I 44.6±1.76 (p=.281). N-S-Ba angle was similar in Class II 126.7o±2.26 and Class III 127.3o±2.70 to Class I 127.1o±2.22 (p=.614). N-S-Ar angle was significantly greater (p&lt;.0001) in Class II 128.2o±2.45 than Class I 123.3o±1.97, and significantly greater (p=.030) in Class III 124.6o±1.70 than Class I. SN-FH angle was similar (p=.193) in Class II 7.9o±1.32 to Class I 7.4o±1.40 and similar (p=.356) in Class III 7.0o±0.94 to Class I. SBa-FH angle was similar in Class II 57.3o±2.19 and Class III 56.8o±1.45 to Class I 56.1o±1.90 (p=.058). Conclusions: Anterior cranial base length (SN length), posterior cranial base length (SBa length), N-S-Ba angle, SN-FH angle and SBa-FH angle were similar in Skeletal Class II to Class I and in Class III to Class I. N-S-Ar angle was greater in Skeletal Class II than Class I and in Class III than Class 1.

Comparison of Cephalometric Measurements of On-Screen Images by CephX Software and Hard-Copy Printouts by Conventional Manual Tracing

Newer diagnostic methods have become widespread in medicine nowadays as a result of extraordinary advancements in the field of electronics. On computers, various orthodontic programs are available as software. When it comes to orthodontics, diagnosis is critical, with the radiographic study being the most important phase. The goal of this research was to assess the level of liability of direct digital radiograph tracing using CephX and compare with hand tracing digital printouts and evaluate the two techniques concerning measurement reproducibility of individual methods. The material consisted of 25 digital lateral cephalometric images, fourteen linear and angular parameters were measured by a single operator digitally and manually. The intraclass correlation coefficient and confidence interval were used to compare the difference of the measurements obtained from manual and digital tracings, and intra-examiner error was evaluated by the coefficient of variation. A comparison of hand and CephX tracing showed a low level of agreement in the anterior facial height, anterior and posterior cranial base length. Only of (LI to A-Pog) line for both manual and digital methods showed poor intra-examiner duplicability. Thus, it can be concluded that digital tracing with CephX is adequate for clinical uses and similar to manual cephalometric tracings.

Craniofacial Morphology of Orthodontic Patients with and without Temporomandibular Disorders: A Cross-Sectional Study.

Purpose We aimed to explore the relationship between temporomandibular disorders (TMDs) and craniofacial morphology in orthodontic patients. Methods Altogether, 262 orthodontic patients were included and divided into two groups according to their Fonseca Anamnestic Index (FAI) scores: a no-TMD group (control group, FAI < 20) and a TMD group (FAI ≥ 20). Cephalometric parameters including cranial, maxillary, mandibular, and dental parameters were traced on cephalograms. Craniofacial morphology was compared between TMD and control groups, followed by subgroup analyses based on TMD severity, gender, age, and temporomandibular joint (TMJ) symptoms. Results The prevalence of TMDs was 52.7% among included patients (138/262). The mean age of TMD patients was higher than that of the control group. No significant difference in gender distribution between the groups was observed. The most commonly reported FAI items were misaligned teeth, neck pain, and emotional tension. The Frankfort-mandibular plane angle (FMA) was larger in the TMD patients than in the control group, whereas no significant differences in other parameters were observed. Subgroup analysis based on TMD severity revealed that FMA and anterior facial height of moderate/severe TMD patients were significantly larger than those of mild or no-TMD patients. Among male patients, the anterior cranial base length was smaller, and the anterior facial height was larger in the TMD group. Among female patients, no significant differences in craniofacial morphology between the groups were observed. In juvenile patients, overjet and overbite were smaller in the TMD group. In adult patients, SNA, ANB, FMA, and gonial angle were larger in the TMD group. Within the TMD group, patients with TMJ pain or noises exhibited characteristic craniofacial features compared to patients without these symptoms. Conclusions Orthodontic patients with TMDs have specific craniofacial morphology, suggesting a relationship between TMDs and particular craniofacial features in orthodontic patients.

Correlations between mandibular ramus height and occlusal planes in Han Chinese individuals with normal occlusion: A cross-sectional study

Objectives: The objective of the study is to determine the relationships between ramus height and occlusal planes (OPs) in Han Chinese individuals with normal occlusion. Materials and Methods: Two hundred and four participants with normal occlusion were included and their cephalograms were analyzed. The ramus height (Ar-Go), Frankfort horizontal plane-posterior OP (FH-POP), FH-anterior OP (FH-AOP) and FH-OP, anterior and posterior cranial base length, SNA, SNB, ANB, Frankfort-mandibular plane angle, SN-MP, jaw angle, and mandibular body length were measured on the subjects’ cephalograms. Pearson correlation coefficients were calculated among continuous variables. The ramus height was considered as dependent variable and the OPs as independent variables. Age, sex, and other cephalometric parameters were considered as possible confounding factors. Univariate and multivariate analyses were performed to determine whether the relationships were significant. Results: The FH-POP and FH-OP were moderately associated with ramus height, while the FH-AOP showed a weak association (P &lt; 0.001). After adjusting age and sex, FH-POP, FH-AOP, and FH-OP showed significant negative associations with ramus height (β = −0.36, −0.28, and −0.37, respectively, P &lt; 0.001). The OP flattened with the ramus height increased. After adjusting all the confounding factors, FH-POP and FH-OP showed significant negative associations with ramus height. The ramus height increased by 0.19 mm/1° flattening of FHPOP (β = −0.19, P = 0.002). Conclusion: After adjust age, sex, and other possible confounding factors, the FH-POP and FH-OP were associated with the ramus height. The flattening of FH-POP was associated with the increase of ramus height. The results should be treated with caution since it’s a cross-sectional study.

Cranial Base Angle in Patients With Cleft Lip and Palate-A Systematic Review and Meta-Analysis.

Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as "good" and two as "satisfactory." The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.

Appropriateness of standard cephalometric norms for the assessment of dentofacial characteristics in patients with cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is a rare skeletal syndrome affecting craniofacial and dental development. As a consequence, conventional cephalometric landmarks may not be valid for CCD patients, and the appropriateness of norms used for the general population should be critically discussed. Five patients 9- to 22-year-old (three females, two males) with CCD were included. Lateral-cephalograms, orthopantomographies, and intra-oral photos were retrospectively analysed. Lateral-cephalograms of 50 normal controls (ten for each CCD patient) matched for age and sex were selected from an online database. Cephalometric measurements of each CCD patients were compared with average values of matched controls using Wilcoxon signed-rank test for paired values (α = 0.05). In CCD patients, a shortening of the cranial base was present (ΔSN = -17.1 mm, p = 0.043). Thus, the mandible (ΔSNPg = +9.5°, p = 0.043) and the maxilla (ΔSNA = +11.2°, p = 0.043) showed protrusion compared to the cranial base, despite a reduced maxillary (ΔCo-A = -15.1 mm, p = 0.043) and mandibular (ΔCo-Gn = -15.2 mm, p = 0.080) length. The mandibular divergence was reduced (ΔSN/GoGn = -6.4°, p = 0.043), a reduced overbite was present (ΔOverbite = -2.9 mm, p = 0.043), and the interincisal angle was increased (ΔInterincisalAngle = +13.7°, p = 0.043), mainly due to retro-inclination of lower incisors. Standard cephalometric norms for the assessment of horizontal jaw position may not be applicable to CCD patients because of a reduced anterior cranial base length compared to normal subjects. Vertical relationships may not be affected, and mandibular hypodivergency was confirmed.

Dentofacial and skeletal pattern in African descendants from southeastern Brazil: clinical prospective study.

ABSTRACTObjective: The aim of this study was to evaluate characteristics of African-Brazilians young adults with excellent dental occlusion, including bimaxillary protrusion; compare them to European-American Caucasian standards, and determine whether there is sexual dimorphism in the display of this phenotype. Methods: Lateral cephalometric radiographs were obtained from 43 African-Brazilians within military personnel (28 males and 15 females, average age 22.4 ± 3.4 years) with normal occlusion, selected from a group of 394 volunteers. Thirty-one angular and linear measurements were evaluated. Student’s t-test for independent samples was used to compare results with those established by European-American standards, previously described in the literature. Results: Considering the dentoalveolar pattern, seven angular and six linear measurements showed statistically significant differences (p< 0.001) when compared to Caucasian cephalometric standards. African-Brazilians’ subjects showed lower cranial base angle (SNAr = 119.87 ± 5.66º) and anterior cranial base length (SN-distance = 68.63 ± 4.50 mm) (p< 0.001). The maxilla (SNA = 88.51 ± 3.23º) and the mandible (SNB = 85.06 ± 3.24º) were protruded in relation to the SN line (p< 0.001). Sexual dimorphism was significant for L1.NB (degrees) (p< 0.01), and interincisal angle (U1.L1) (p< 0.05). Conclusion: African-Brazilian young adults presented differences regarding dental and craniofacial characteristics, when compared to European-American norms. It can be stated that Caucasian cephalometric norms should not be applied to African-Brazilian faces.

Craniofacial morphology in down syndrome: a systematic review and meta-analysis.

The aim of this study was to evaluate the craniofacial cephalometric characteristics of individuals with Down syndrome (DS), comparing them with healthy subjects. An electronic search was made in Pubmed, Embase, Lilacs, Scopus, Medline and Web of Science without imposing limitations on publication date or language. Studies were selecting following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The PECO acronym was applied as follows: P (population), individuals with DS; E, (exposition) diagnosis of DS; C (comparison), individuals without DS; O (outcomes) craniofacial characteristics based on cephalometric measurements. Independent reviewers performed data extraction and assessed the methodological quality of the articles using the Newcastle–Ottawa Quality-Assessment-scale. Seven case–control studies were included in meta-analysis. Given the variability of the cephalometric measurements used, only those that had been reported in at least three or more works could be included. Anterior cranial base length (SN), posterior cranial base length (SBa), total cranial base length (BaN), effective length of the maxilla (CoA), sagittal relationship between subspinale and supramentale (ANB), anterior facial height (NMe), and posterior facial height (SGo) values were significantly lower in the DS population than among control subjects. No significant differences were found in sagittal position of subspinale relative to cranial base (SNA) and sagittal position of supramentale relative to cranial base (SNB). Summarizing, individuals with DS present a shorter and flatter cranial base than the general population, an upper jaw of reduced sagittal dimension, as well as a tendency toward prognatic profile, with the medium third of the face flattened and a reduced anterior and posterior facial heights.