Burstone Analysis Research Articles

Correlation between Cranial Base, Mandible, and Hyoid Bone Position in Different Anteroposterior Skeletal Malocclusions: A Cephalometric Study

Abstract Background Development of malocclusion can be promptly recognized through an understanding of the optimal position of the bone structures in the orofacial system and their relationship to the cranial base and jaw base. The aim of this study was to assess the relationship between the cranial base, mandible, and hyoid bone in different anteroposterior skeletal malocclusions. Materials and Methods This retrospective study evaluated 120 lateral cephalometric radiographs of individuals aged between 15 and 30 years. The subjects were classified using Burstone's analysis into three groups based on the N perpendicular to point A and N perpendicular to point B. The collected lateral cephalograms of the selected individuals were analyzed using Nemoceph v.12 software (Nemotec, Spain). The nasion-sella-articulare (NSAr), hyoidale angle (C3HyD), sella-articulare-hyoid angle (SArHy), and nasion-sella-hyoid (NSHy) angles were measured and compared among all the three groups. Results In the present study, considering the various angles among the three study groups, a statistically significant difference was observed for the SArHy angle (p < 0.05). However, the saddle angle (NSAr) and hyoidale angle (C3HyD) showed no statistically significant difference between the three study groups. Post hoc Bonferroni test was applied to compare the differences between two groups. A statistically significant difference (p < 0.05) was observed between class I and class II and between class II and class III groups. Conclusion Though the findings of the present study concluded that there is no variation in saddle angle among the three groups, the significant association of SArHy angle among class I, class II, and class III skeletal relationships, suggests an adaptation of the hyoid bone position in various skeletal patterns. We also suggest that the posterior positioning of the hyoid bone is related to skeletal class II malocclusion, whereas a forward positioning of the hyoid bone is related to skeletal class III malocclusion.

Comparative manual and digital analysis of gonial angle in lateral cephalograms for gender determination.

Human skull has always been used for victim identification in forensic odontology. The gender-dimorphic bone of the skull is the mandible. The gonial angle has frequently been investigated for gender estimation with variable results and requires further exploration. We aim to compare the efficacy of gonial angle estimation by ancient methods of lateral cephalometric tracing compared with more recent digital analysis methods for gender estimation in the Indian population. Lateral cephalograms of 191 (96M and 95F) cases above the age of 17years were retrieved. Cephalometric analysis of gonial angle on radiographs was done using both manual cephalometric tracing method and digitally using Adobe Photoshop software. The results were subjected to statistical analysis for evaluation. The mean gonial angle was higher in females (125.05; 123.77 and 125.28) than in males (122.583; 121.715 and 122.008) using both manual and digital methods. On applying the logistical regression analysis (LRA), the digital method showed the highest gender estimation accuracy of 60.7% followed by Burstone's analysis (57.1%) and manual conventional analysis (56.5%). Burstone's analysis (57.9%) correctly identified increased females, whereas digital analysis (62.5%) and manual conventional analysis (59.4%) accurately recognised increased males. The present study showed a higher gender estimation accuracy using digital methods as compared to manual methods, but it still lacks the credibility to be used as a sole factor for predicting the gender of an individual. Hence, a cumulative factor must be taken into consideration for gender identification which would provide more promising results.

Iatrogenic retroposition of the lips sequel after bicuspid extraction-a retrospective study

AimThis study aims to explore the prevalence of Iatrogenic retroposition of the lips sequel (IRLS) after bicuspid extraction, associated dentofacial characteristics and the effectiveness of surgical treatment. Materialand methods: Patients with bicuspid extraction as part of an orthodontic treatment plan were retrospectively included. IRLS was identified by clinical evaluation and cephalometric Legan and Burstone analysis. Association of demographic and cephalometric variables were assessed. The effectiveness of combined orthodontic-orthognathic correction of the retroposition of the lips was evaluated. ResultsOut of 144 patients with extracted bicuspids, eight Class I patients, nine Class II patients and five Class III patients were seeking treatment because their lips had retruded as a consequence of compensating orthodontic treatment. Lower jaw bicuspid extraction and a decreased vertical facial height in Class II patients correlated significantly more with IRLS development. Postoperative cephalometric analysis of orthodontic-orthognathic treated patients reported improvement in lip projection and naso-labial angle. Only two Class I patients reported postoperative normalization of the lip position according to Legan and Burstone. ConclusionThe consequence of bicuspid extractions on soft tissue profile differs according to skeletal jaw relation. The impact of orthognathic surgery on IRLS is beneficial, although insufficient to completely correct the facial profile when judged on cephalometric standards.

Establish soft tissue cephalometric standard norms of Legan – Burstone (COGS) Analysis for ethnic Himachalli population – A cephalometric study

Establish soft tissue cephalometric standard norms of Legan – Burstone (COGS) Analysis for ethnic Himachalli population – A cephalometric study - JCO- Print ISSN No: - Online ISSN No:- 2582-0478 Article DOI No:- 10.18231/j.jco.2021.003, Journal of Contemporary Orthodontics-J Contemp Orthod

Improving lip aesthetics in the face profile after treatment of class II, division 2 malocclusion.

The aims of our research were as follows: 1) Description of changes in the position of the upper and lower lips, as a result of the change in the position of upper and lower incisors after orthodontic treatment of malocclusion of Class II, division 2 type. 2) Determination of correlation between changes in the position of lips and incisors in the profile of the face after orthodontic treatment of malocclusion of Class II, division 2 type.MATERIALS ANDMETHODS: Our study analyses the documentation of 115 patients with malocclusion of Class II, division 2 type treated with a fixed orthodontic appliance in the upper and lower dental arches at the Orthodontic Department of the Clinic of Dentistry in Olomouc from January 1, 1996 to December 31, 2017. There were 78 women and 37 men aged 11 to 36 years included in the database. Cephalometric images of patients from the group taken before and after the treatment were used for the purpose of cephalometric analysis according to Kamínek (1) and Burstone's analysis (2) of soft tissues. Subsequently, all output data were processed statistically. While the protrusion of the incisors after treatment of malocclusion of Class II, division 2 type was 3 mm, the facial profile showed statistically significant changes in soft tissues in the ventral direction by 1 mm on average just in the area of the upper and lower lips, which means a shift corresponding to one third of teeth movement. A statistically significant change in the position of incisors, soft tissues as well as correlation between changes in hard and soft tissues in the face profile after orthodontic treatment of malocclusion of Class II, division 2 type were demonstrated. The more the incisors were inclined, the more the lips moved forward, and the patient's profile turned out to be aesthetically improved (Tab. 2, Fig. 3, Ref. 39).

Do We Vary from Caucasians! Cephalometric Analysis for Orthognathic Surgery in Chhattisgarhi Population.

The aim of this study is to deduce the cephalometric norms for orthognathic surgery in Chhattisgarh population by comparing with the analysis given by Burstone et al. for hard tissue and Legan and Burstone for soft tissue. Lateral cephalograms of 70 subjects (35 male and 35 female) aged between 18 and 25years having class I malocclusion, acceptable facial profile were recorded and traced for the analysis and interpretation using landmarks and values given by Burstone's analysis were obtained and further comparison was done for the values obtained for the Chhattisgarh population with that of Caucasians. Findings of our study were statistically significant as considerable skeletal differences were found between men and women of Chhattisgarh origin compared to Caucasian origin. Many contrasting findings were discovered in our study group from that of the Caucasian population with respect to the maxillo-mandibular relation, vertical hard tissues parameters. Less differences were found in horizontal hard tissue parameters and dental parameters among the two study populations. The differences found must be kept in consideration during analysis of cephalogram for orthognathic surgeries. Values obtained can be considered to assess deformities and surgical planning to achieve optimal results for Chhattisgarh population. The understanding of normal human adult's facial measurements are important to assess craniofacial dimensions and facial deformities and to monitor postoperative results in orthognathic surgeries. Cephalometric norms can be a beneficial abet to clinicians in ascertaining the patient abnormalities. Norms define the ideal cephalometric measurements for patients based on factors such as age, sex, size and race. It has become apparent over years that significant variations do occur among and between the individuals of different racial origins.

Cephalometric norms for north indian population using burstone analysis

Cephalometric norms are extremely useful to the orthodontist for providing guidance during diagnosis and treatment planning. But they are subjected to variability in morphologic characteristics in different ethnic and racial groups. The study was conducted on 76 subjects of 18-28 years of age with class I occlusion with acceptable facial profile. Standardized lateral cephalograms were taken in a natural head position and analyzed.North Indians exhibit increased facial convexity, greater mandibular prognathism, more obtuse lower face- throat angle and greater amount of upper lip - lower lip protrusion. Males showing larger cranial base length, vertical positioning and length of maxilla, ramal length, and the chin prominence. On dental analysis, females tend to have lesser proclined anterior teethThe present study was an attempt to provide better knowledge of facial morphology in the North Indians hence a comprehensive treatment planning can be done based on the norms derived for the correction of skeletal discrepancies.

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Soft tissues cephalometric norms for a sample of Sudanese adults. Part I: Legan and Burstone analysis

ABSTRACT Purpose: To establish soft tissues cephalometric norms for orthognathic surgery in a sample of Sudanese adults. Materials and Methods: A total of 106 lateral cephalograms of Sudanese adults (55 females and 51 males) aged between 18 and 25 years (mean 22.8 years) were manually traced and analysed using Legan and Burstone Cephalometric analysis for orthognathic Surgery (COGS). Results: Sudanese sample, in comparison to Caucasian, had a more convex profile with larger angle of convexity and more prognathic maxillae, obtuse lower face-throat angle, more acute nasolabial angle, protrusive upper and lower lips with deeper labiomental sulci and greater maxillary incisors exposure with larger interlabial gap. Males had greater maxillary and mandibular prognathism, more obtuse lower face-throat angle and vertical height depth ratio than females. Females had larger vertical lip chin ratio, maxillary incisor exposure and interlabial gap. Conclusion: Considerable differences between the soft tissue profile configuration of Sudanese and Caucasian adults exist and also between Sudanese and other populations. These variations should be taken into account during diagnosis and treatment planning of orthognathic surgery.

Correlation Between Sex and Facial Soft Tissue Characteristics Among Young Saudi Patients with Various Orthodontic Skeletal Malocclusions.

BackgroundThere is a debate over the influence of sex on facial soft tissue physiognomies. Therefore, the present study used teleradiographs to assess and compare the soft tissue physiognomies between males and females in a sample from Saudi Arabia who have various orthodontic malocclusions.Material/MethodsWe obtained 221 lateral cephalometric radiographs taken from orthodontic clinics of patients ages 16–26 years (114 males and 107 females) living in the central and eastern regions of Saudi Arabia. OnyxCeph3TM digital software was used to analyze the dentoskeletal classification of the sample as class I (n=84), class II division 1 (n=42), class II division 2 (n=33), and class III (n=62). Burstone analysis of 6 linear measurements for facial soft tissue thickness (FSTT) was used. We used descriptive analysis and the independent-samples t test using SPSS version 25 for Windows (Chicago, IL) with p<0.05 set as the level of statistical significance.ResultsMale patients with a class I dento-skeletal relationship showed thicker FSTT; the most significant thickness was seen near the glabella, followed by the upper/lower lip and sub-labiomental sulcus areas. Male patients with class II division 1 showed a substantial difference in FSTT at subnasal, lower lip, and sub-labiomental sulcus areas. No significant difference in FSTT was found between males and females among class II division 2 and class III patients.ConclusionsThese observations of significant changes in facial structures of Saudis between males and females should be of great help for diagnosis of orthodontic cases in Saudi adults.

Computer-Aided Planning in Orthognathic Surgery: A Comparative Study with the Establishment of Burstone Analysis-Derived 3D Norms.

Three-dimensional (3D) computer-aided simulation has revolutionized orthognathic surgery treatment, but scarce 3D cephalometric norms have been defined to date. The purposes of this study were to (1) establish a normative database of 3D Burstone cephalometric measurements for adult male and female Chinese in Taiwan, (2) compare this 3D norm dataset with the two-dimensional (2D) Burstone norms from Caucasian and Singaporean Chinese populations, and (3) apply these 3D norms to assess the outcome of a computer-aided simulation of orthognathic surgery. Three-dimensional Burstone cephalometric analysis was performed on 3D digital craniofacial image models generated from cone-beam computed tomography datasets of 60 adult Taiwanese Chinese individuals with normal occlusion and balanced facial profile. Three-dimensional Burstone analysis was performed on 3D image datasets from patients with skeletal Class III pattern (n = 30) with prior computer-aided simulation. Three-dimensional Burstone cephalometric measurements showed that Taiwanese Chinese males had significantly (p < 0.05) larger anterior and posterior facial heights, maxillary length, and mandibular ramus height than females, with no significant (p > 0.05) difference for facial soft-tissue parameters. The 3D norm dataset revealed Taiwanese Chinese-specific facial characteristics, with Taiwanese presenting (p < 0.05) a more convex profile, protrusive maxillary apical bases, protruding mandible, protruding upper and lower lips, and a shorter maxillary length and lower facial height than Caucasians. Taiwanese had significantly (p < 0.05) larger maxillary projection, vertical height ratio, lower face throat angle, nasolabial angle, and upper lip protrusion than Singaporean Chinese. No significant (p > 0.05) difference was observed between 3D norms and computer-aided simulation-derived 3D patient images for horizontal skeletal, vertical skeletal, and dental measurements, with the exception of two dental parameters (p < 0.05). This study contributes to literature by providing gender- and ethnic-specific 3D Burstone cephalometric norms, which can assist in the multidisciplinary-based delivery of orthodontic surgical care for Taiwanese Chinese individuals worldwide, including orthodontic management, computer-assisted simulation, and outcome assessment.

Effect of Oral Submucous Fibrosis on Jaw Dimensions.

The disuse of the jaws owing to the restricted movement of the mandible in advanced cases of oral submucous fibrosis (OSMF) may have an effect on the morphologic features of the jaw bones. The purpose of the present study was to determine the jaw bone measurements in patients with OSMF and to compare the measurements in normal subjects and Caucasian norms. The lateral cephalograms of 59 subjects (43 males and 16 females) with OSMF and 44 normal subjects (23 males and 21 females) in the age group of 18-45 years were collected. The jaw measurements were performed using Burstone analysis, and the relevant linear measurements of jaw sizes included were N-A, N-B, N-ANS, ANS-PNS, ANS-Gn, Ar-Go, and Pg-Go. The sex-wise comparison was performed using unpaired t-test, and measurements were compared with other studies using Z test. In the present study, sex-wise comparison was found to be significant with greater jaw measurements in males than in females in patients with OSMF. Overall, the measurements were less or equal in patients with OSMF than in normal subjects except for N-ANS and Pg-Go. When study measurements were compared with Burstone measurements, differences were significant with greater and less measurements. Overall, the jaw measurements were less or equal in patients with OSMF than in normal subjects except for mandibular body length and middle third facial height that may need further evaluation.

Male and Female Characteristics of Facial Soft Tissue Thickness in Different Orthodontic Malocclusions Evaluated by Cephalometric Radiography.

BackgroundThe facial profile is determined by the facial soft tissue thickness (FSTT) and dentoskeletal characteristics. The aim of this study was to compare male and female characteristics of FSTT in different orthodontic malocclusions using cephalometric radiography.Material/MethodsOne hundred and twenty lateral cephalometric radiography-derived cephalograms of adult male (n=47) and female (n=73) orthodontic patients, aged between 16–22 years were classified according to their dentoskeletal relationships as Class I (n=30), Class II Division 1 (n=30), Class II Division 2 (n=30), Class III (n=30). Burstone analysis of seven linear dimensions of FSTT was used.ResultsMen had a thicker FSTT in dentoskeletal relationships Class I, Class II Division 2, and Class III. Sex differences varied from significant (t=2.056; p<0.05) for the sub-nasal area in Class II Division 2, to highly significant (t=3.772; p<0.001) for the upper lip sulcus in Class II Division 2. Women in Class II Division 1 had significantly thicker FSTT in the lower jaw area (t=2.800; p<0.01) and for the lower lip sulcus and the chin area (t=3.961; p<0.001).ConclusionsMen with orthodontic malocclusions were characterized by thicker facial soft tissue compared with female patients in Class I and Class II Division 2; female patients in Class II Division 1 were characterized by thicker facial soft tissue of the mentolabial sulcus and chin. Men and women with a skeletal jaw relationship in Class III showed no significant difference in their FSTT.

Assessment of mandibular retrognathism and maxillary prognathism as contributory factors for skeletal Class II malocclusion: A cephalometric study

Aim: The aim of this study is to evaluate the skeletal factor (maxillary excess and/or mandibular deficiency) contributing for the skeletal Class II malocclusion. Materials and Methods: Lateral cephalograms of 100 individuals (50 males and 50 females) in the age group of 18–30 years, having skeletal Class II malocclusion with ANB of more than 4, were evaluated. The parameters to be used for prediction of maxillary prognathism include linear measurement of Nasion perpendicular to point A, and for the mandibular retrognathism, it is linear measurement of Nasion perpendicular to Pogonion, as suggested by Burstone analysis. Results: The 34% of the studied sample size had the Class II skeletal pattern (ANB >4), but their observed values for the maxilla and the mandible (with respect to the cranium) were in the normal range according to Burstone's cephalometric norms. Mandibular retrognathism with 68% prevalence in the final studied sample size is the major contributory factor for the skeletal Class II malocclusion which is followed by maxillary prognathism with 27% prevalence in the studied sample size, and the last contributory factor is the combination of the above two which accounts for the 5% of the studied sample size. Conclusion: The cephalometric study of skeletal Class II participants suggests mandibular retrognathism to be the major component in the given sample size. The other important conclusion from this study is that the ANB angle is not a reliable indicator to assess the skeletal malocclusion.

Evaluation of soft tissue parameters for adults with accepted occlusion using Legan and Burstone analysis

ObjectiveThe purpose of this study was to evaluate soft tissue parameters for adults, and applying a new method for soft tissue analysis to provide good diagnosis and treatment planning. Material and methodsCephalometric radiograph of 100 adult subjects randomly selected with accepted facial proportions and normal occlusion aged 18–25 years. It's evaluated with Legan and Burstone analysis and compared with their study on white sample. ResultsEgyptian population group were found to have more convex faces, protrusive lips and acute nasolabial angles. Males had more convex faces and protrusive lips than females. It can be concluded that the Egyptian populations group had significant deviations from the White standard soft tissue.

"Are we similar to caucasians": orthognathic surgery for north indians.

To establish the cephalometric standards for hard and soft tissues of the facial skeleton for north Indian population. The sample comprised of lateral cephalograms taken in natural head position of 100 participants (50 men, 50 women). The cephalograms were traced, analyzed and interpreted using the landmarks and values given by Burstone's analysis for hard tissue and Legan and Burstone analysis for soft tissue respectively. The Student's t test, standard deviation and mean deviation were calculated to compare between the groups. Statistically significant results were found in various parameters between intra and inter group comparison. The results obtained in the north Indian population can be used as cephalometric norms for orthognathic surgery.

“Are We Similar to Caucasians” – Orthognathic Surgery for North Indians

Primary aim - To establish the cephalometric standards for hard and soft tissues of the facial skeleton for north Indian population. Methods – The sample comprised of lateral cephalograms taken in natural head position of 100 participants (50 men, 50 women). The cephalograms were traced, analyzed and interpreted using the landmarks and values given by Burstone’s analysis for hard tissue and Legan & Burstone analysis for soft tissue respectively. The student’s t test, standard deviation and mean deviation were calculated to compare between the groups. Results – Statistically significant results were found in various parameters between intra and inter group comparison. Conclusion – The results obtained of the north Indian population can be used as cephalometric norms for orthognathic surgery.

Skeletal Stability after Bilateral Sagittal Split Advancement and Setback Osteotomy of the Mandible with Miniplate Fixation

The purpose of this study was to evaluate intraorally placed mini plates and monocortical screws in terms of postoperative skeletal stability after bilateral sagittal split advancement and setback osteotomy of the mandible. Ten patients were included in this study with five requiring advancement (group I) and five requiring setback of the mandible (group II). Bell and Epker modified surgical technique was followed for all the patients. All the patients underwent pre- and postsurgical orthodontics. Cephalometric radiographs were taken preoperatively, immediate, 3, 6, and 12 months postoperatively. Cephalometric tracings were performed by one individual examiner using a modified burstone analysis. Statistical analysis was performed using the student paired t-test. In advancement patients, SNB (sella, Nasion, B point) angle showed relapse at 12th month postoperative period which was statistically significant (2.4 degrees). No changes were observed in anterior facial height, posterior facial height, Frankfort-mandibular incisor angle (FmiA), and overjet during the follow-up period. In setback patients, posterior facial height (p < 0.05), angles between the lower incisors and mandibular plane and pogonion had a statistically significant change position of 1.4 mm (paired t-test, p = 0.03). The SNB angle, anterior facial height, interincisal angle, and FmiA remained constant (0.8-1.2 degrees) during the follow-up period. In advancement cases, the relapse was seen from the third month postoperative period but in setback cases, the relapse was noted from the sixth month onward and the skeletal relapse in these cases were noticed cephalometrically.

Comparison of conventional and digital cephalometric analysis: A pilot study

Aim: The aim of the study was to analyze and compare the manual cephalometric tracings with computerized cephalometric tracings using Burstone hard tissue analysis and McNamara analysis. Materials and Methods: Conventional lateral cephalograms of 20 subjects were obtained and manually traced. The radiographs were subsequently scanned and digitized using Dolphin Imaging software version 11.7. McNamara analysis and Burstone hard tissue analysis were performed by both conventional and digital method. No differentiations were made for age or gender. Data were subjected to statistical analysis. Statistical analysis was undertaken using SPSS 17.0 version (Chicago, Illinois, USA) statistical software program. A paired t-test was used to detect differences between the manual and digital methods. Statistical significance was set at the P < 0.05 level of confidence. Results: (A) From Burstone analysis variables N-Pg II Hp show statistically very significant difference, and ANS-N, U1-NF, N-B II Hp, L1-Mp, and Go-Pg shows the statistically significant difference. (B) From McNamara analysis variables Nasolabial angle and L1-APog show statistically significant differences and the Mandibular length shows the statistically very significant difference. Conclusion: According to this study, is reasonable to conclude that the manual and digital tracings show the statistically significant difference.

Craniofacial Morphologic Variations and Its Association with Hypodontia Pattern (Anterior) in South Indian Female Population

The aim of this study was to survey the association of congenitally missing anterior tooth and variations in craniofacial morphology in South Indian female patients. A total of 15 female patients with congenitally missing tooth in the maxillary anterior region were selected. 16 linear and 6 angular measurements were done on the lateral cephalograms of each subject with Legan and Burstone analysis. The cephalometric data was statistically analyzed and compared among each patient and against the cephalometric norms for the South Indian standards using Legan and Burstone analysis. The anterior hypodontia pattern showed shorter posterior cranial base length, significantly more retrognathic maxilla and prognathic mandible, flat chin, decreased upper anterior facial height, decreased mandibular angle and elongation of upper incisors. Patients with anterior hypodontia pattern have characteristic variations in craniofacial morphology. The dentofacial variations seen in persons with congenitally missing tooth is actually a functional compensation.