Cephalometric Radiographs Research Articles

Occlusal and Cephalometric Outcomes of Cleft Orthognathic Surgery: A Retrospective Cohort Study.

Aberrant facial growth in individuals affected by orofacial clefts can result in maxillary retrusion and class III malocclusion, with a proportion requiring surgical correction at cessation of growth. This study aimed to evaluate occlusal and cephalometric outcomes of combined orthodontic-orthognathic treatment. Retrospective cohort study in a United Kingdom cleft center. Participants included twenty-seven patients (20 males, 7 females) with cleft (n = 16 UCLP :7 BCLP :4 ICP) who consecutively underwent combined surgical treatment for Class III malocclusion between January 2013 and December 2017. Records were collected pre-treatment (T0), pre-surgery (T1) and at debond (T2). Models were scored using the Peer Assessment Rating (PAR) index and cephalometric radiographs were traced and analyzed. Outcomes were assessed by an independent rater. Mean age at surgery was 21.4 years (SD 4.9). Le Fort 1 advancement (mean 6.1 mm, SD 4.0) was performed in all cases. Additional procedures included mandibular setback (n = 2), cortico-cancellous bone grafting (n = 6) and genioplasty (n = 1). Mean T0 PAR score was 44.8 (SD 11.7), reducing to 3.6 (SD 2.0) at T2, indicating a mean % PAR score reduction of 91.6% (SD 4.7). Class III skeletal profiles improved from a mean T0 ANB of -2.1º (SD 2.2), to 2.8º (SD 1.6) at T2. Mean T0 overjet was -3.3 mm (SD 2.3), increasing to 2.6 mm (SD 1.3) at T2. Cleft orthognathic surgery differs in complexity and approach to routine orthognathics, however, these results demonstrate that occlusal outcomes can still be comparable with non-cleft populations. Outcome data can be used for comparison with other centers providing cleft orthognathic treatment.

Convolutional Neural Network-Based Deep Learning Methods for Skeletal Growth Prediction in Dental Patients

This study aimed to predict the skeletal growth maturation using convolutional neural network-based deep learning methods using cervical vertebral maturation and the lower 2nd molar calcification level so that skeletal maturation can be detected from orthopantomography using multiclass classification. About 1200 cephalometric radiographs and 1200 OPGs were selected from patients seeking treatment in dental centers. The level of skeletal maturation was detected by CNN using the multiclass classification method, and each image was identified as a cervical vertebral maturation index (CVMI); meanwhile, the chronological age was estimated from the level of the 2nd molar calcification. The model’s final result demonstrates a high degree of accuracy with which each stage and gender can be predicted. Cervical vertebral maturation reported high accuracy in males (98%), while females showed high accuracy of 2nd molar calcification. CNN multiclass classification is an accurate method to detect the level of maturation, whether from cervical maturation or the calcification of the lower 2nd molar, and the calcification level of the lower 2nd molar is a reliable method to trust in the growth level, so the traditional OPG is enough for this purpose.

The reliability of a modified three-stage cervical vertebrae maturation method for estimating skeletal growth in males and females.

Reliability of the six-stage cervical vertebrae maturation method to evaluate skeletal growth was evaluated on the combined male and female samples and revealed diverse results. The current study aimed to determine the reliability of the modified three-stage cervical vertebrae maturation method for estimating the skeletal growth of males and females. Pretreatment lateral cephalometric radiographs of 137 orthodontic patients were utilized to evaluate the intra- and inter-observer reliability of a modified cervical vertebrae maturation method. Four independent examiners categorized each radiograph into one of the three skeletal growth stages according to the cervical vertebrae morphology: (1) a pre-peak group (combining the CS1 and CS2 stages), (2) a peak group (combining the CS3 and CS4 stages), and (3) a post-peak group (combining the CS5 and CS6 stages). The Kappa index and the Fleiss multirater Kappa test were carried out to determine the reproducibility of this method. The studied sample included cephalometric radiographs of 68 males (49.6%) and 69 females (50.4%) aged between 7 and 58 years; no significant age difference was found between the sexes (p = 0.189). The overall inter-observer reliability was 0.689 (p < 0.001), and the inter-observer reliability for the post-peak stage showed only Kappa = 0.896 (p < 0.001). The Kappa values were significantly greater in males than in females during the peak stage (0.626 and 0.488, respectively). A modified three-stage cervical vertebrae maturation method showed substantial overall inter-examiner agreement; however, differential reliability for diverse skeletal maturation stages and sexes was found.

Comparative evaluation of commercially available AI-based cephalometric tracing programs

ObjectivesCompare the accuracy and diagnostic concordance of three commercially available AI-based lateral cephalometric tracing software.Materials and methodsSixty-three lateral cephalometric radiographs were analyzed using semi-automatic (Dolphin Imaging Systems LLC) and AI-based software programs (WebCeph™, Cephio, and Ceppro DDH Inc.). Intra- and inter-observer reliability were assessed for human expert measurements, and repeated-measures one-way ANOVA was used to compare the AI and human expert measurements. The diagnostic performance was evaluated using sensitivity and specificity tests.ResultsHuman expert reliability was excellent (ICC > 0.9) for most cephalometric parameters. Compared to human experts, significant differences were observed for all three AI-based cephalometric programs (WebCeph™ – 10 of 11, Cephio – 7 of 11, and Ceppro DDH Inc. – 7 of 11 cephalometric measurements). Variations exceeding two units were noted for most parameters, and differences in defining the sagittal and vertical skeletal patterns, dental, and soft tissue characteristics were observed.ConclusionAll three AI-based tracing programs showed inaccuracies compared to human expert measurements and lacked reliability in measuring key cephalometric parameters. Clinicians should exercise caution when relying solely on AI-based analyses for orthodontic treatment planning and assessment.

Evaluation Of Accuracy And Reliability Of Artificial Intelligence-Based Fully Automated And Semi-Automated Cephalometric Analysis Software In Comparison With Manual Cephalometric Analysis

Introduction: Lateral cephalometric analysis stands as a pivotal diagnostic tool within the realm of Orthodontics, often regarded as the gold standard. Over time, several computerised programs have surfaced, aiming to streamline the process of digital cephalometric analysis, thereby offering efficiency gains and time savings. The current study sought to assess the diagnostic accuracy and reliability of four computerised cephalometric analysis programs. These encompassed three digital software solutions alongside an online artificial intelligence platform. The objective was to compare the digital approaches against the traditional method of manual cephalometric tracing. Materials and methodology: This study analysed thirty pre-treatment lateral cephalometric radiographs of individuals undergoing orthodontic treatment. Four computer programs—Dolphin Imaging software, Nemoceph, and FACAD for semi-automated cephalometric analysis, and WebCeph for artificial intelligence-based cephalometric analysis—were evaluated and compared with manual cephalometric tracing. Measurements were taken for five skeletal, four dental, and one soft tissue parameters, including six angular and four linear measurements derived from Steiner, McNamara, and Tweed cephalometric analysis. Fifteen cephalometric radiographs were remeasured to assess the intra-examiner correlation coefficient. One-way ANOVA was used to compare different cephalometric points among the various tracing methods, and multiple comparisons were performed using the Post Hoc Tukey’s test. Results: No significant difference was noted in SNA, SNB, ANB, FMA, IMPA, 1 to Pt A, 1 to N-A and nasolabial angle between the software. While 1 to A Pog and 1 to N-B revealed significant differences between the software. FACAD vs. NemoCeph showed a significant difference with a mean difference of -0.30 and -0.30 and a p-value of 0.03 and 0.02 for 1 to A Pog and 1 to N-B values respectively and this variability was noted between FACAD and NemoCeph. Conclusion: Digital and AI-based software have shown accuracy comparable to manual tracing. Among the software, Dolphin Imaging proved to be the most reliable, followed by WebCeph and NemoCeph, with FACAD showing the most variability. The variability, which lacked clinical significance, was primarily due to challenges in identifying certain landmarks.

Evaluation of Upper Airway Growth Patterns With Cephalometric Analysis Based on Cervical Vertebral Maturation in the Japanese: A Cross-Sectional Study.

Objective This study aims to establish standard values for the upper airway cross-sectional area and evaluate growth patterns using the cervical vertebral maturation stage (CVMS) in a Japanese population. Methods A cross-sectional sample of 400 patients, aged 6-20 years, was selected randomly from the Orthodontic Clinic at Tokyo Medical and Dental University (TMDU) dental hospital. Cervical vertebral maturation stages (CVMS I-V) guided the classification of participants into five equal groups. Lateral cephalometric radiographs taken prior to orthodontic treatment were used to measure the upper airway's cross-sectional area. The growth spurt and sex differences in growth patterns were assessed through these measurements. Results Standard values for the upper airway dimensions at each CVMS stage were established. Significant growth spurts were noted between CVMS II-III and CVMS III-IV in males and at CVMS II-III in females. The weighted kappa coefficient (κ) demonstrated almost perfect intra- and inter-evaluator agreement, confirming the reliability of CVMS in growth assessment. Conclusion CVMS provides a reliable framework for assessing growth patterns of the upper airway, with distinct variations between sexes noted. These findings support the utility of CVMS in clinical growth evaluation and orthodontic treatment planning.

Reference points to evaluate changes in the upper lip after labial incisor movement between tipping and translation in crowding patients: A retrospective study

ObjectiveThis study aimed to compare the changes of reference points on the labial surface of upper incisors (U1) to upper lip (UL) after U1 labial movement between a translation group (TSL) and tipping group (TIP). Correlations between changes in U1 and UL were determined. MethodsLateral cephalometric radiographs were selected and divided into TSL and TIP groups by pre- and post-treatment superimpositions. Skeletal, dental, and soft tissue of pre- and post-treatment treatment and variables were evaluated. Independent t-test and Wilcoxson test were applied for the statistical analysis between TSL and TIP. Spearman’s correlation coefficients and multiple linear regression analysis were used to verify the association between lip profile changes and other variables in TSL and TIP group separately. ResultsAfter U1 labial movement, the incisal edge (LaU1e), middle (LaU1m), and cervical (LaU1c) points of TSL moved evenly labially, whereas the TIP group had incisal edge that moved greater labially than the middle and cervical points. UL moved more labially in TSL (0.87–1.05 mm) than the TIP (0.31–0.41 mm). UL changes to the E-line in TSL showed significant positive correlations to all three LaU1(e, m, c)-SnTV changes. In the TIP group, only a positive correlation presented for the LaU1m-SnTV and LaU1c-SnTV changes. Nevertheless, Multiple linear regression analysis indicated the unfeasibility of predicting the upper lip changing ConclusionLaU1e in TSL and TIP moved almost equally labially but less labially in TIP at the middle and cervical points. The UL moved more labially in TSL than TIP. Rather than using the incisal edge to estimate upper lip changes, it would be better to use the middle and cervical points of U1, which coincide with Labrale superioris (Ls).

A Novel Approach for Improving Midface Aesthetics: A Pilot Study.

Asian individuals often seek solutions to address midface depression and enhance nasal alar base morphology to achieve Western facial aesthetics. Current treatment options, including injections and invasive procedures, have limited efficacy and safety. To address these challenges, we introduced the "modified A-10 surgery," which integrates the Point A-Koji method, titanium plates, and artificial dermis insertion. The efficacy of the modified A-10 surgery was illustrated using a case study of a 22-year-old woman. Surgical planning was based on dental cone-beam computed tomography data, with lateral cephalometric radiographs used to determine the titanium plate dimensions. The surgery involved customized plate alignment, fixation, and artificial dermis insertion. The modified A-10 surgery substantially improved facial aesthetics and structural parameters. Facial convexity increased from 15.5 degrees to 23.2 degrees, enhancing the 3-dimensionality. The nasolabial angle shifted from 91.9 degrees to 110.2 degrees, achieving the desired mouth projection. Other measurements, such as the E-line to the lower lip and the distance from point A to the subnasal point, contributed to refined aesthetics. The nasal alar base thickness increased by 2.2 mm (19.5%), correcting the depression. The modified A-10 surgery represents a minimally invasive and comprehensive solution for midface depression and nasal alar base enhancement. By combining the Point A-Koji method, titanium plates, and artificial dermis insertion, this surgery successfully achieved improved facial aesthetics and contours. The results validate its potential as a long-term solution, with implications for antiaging interventions and promising avenues for future research.

A Cephalometric Study Of Vertical Skeletal Changes After Extraction And Non-Extraction Fixed Orthodontic Treatment Of Class I Malocclusion In North Indian Population

Background: Orthodontic treatments frequently involve tooth extractions to address crowding and protrusion, but the effects of these extractions on vertical skeletal changes are still debated. Research has extensively covered aspects like soft tissue response and smile aesthetics, yet there is no consensus on their impact on vertical dimensions. This issue is particularly pertinent for hyperdivergent individuals, who make up about 22% of orthodontic patients. A proposed technique for such cases includes counterclockwise rotation of the lower jaw and advancement of posterior teeth to manage open bites or excessive vertical facial height. This study aims to compare vertical skeletal changes in Class I malocclusion patients undergoing extraction versus non-extraction fixed orthodontic treatments. Material and Methods: We analysed pre- and post-treatment lateral cephalometric radiographs from 60 Class I crowding patients, evenly split into extraction and non-extraction groups. Eight vertical skeletal parameters were assessed and compared statistically between the two groups. Superimposition analysis of radiograph tracings was used to explore vertical changes related to molar mesialization, particularly in the extraction group. Results: The extraction group demonstrated significant reductions in vertical skeletal dimensions compared to the non-extraction group. Measurements including FMA, SN-GoGn, Y-axis, SN-PP, and PP-MP showed significant differences, with reductions in the extraction group (P = 0.001). Procrustes superimposition indicated effective molar mesialization in the extraction group, which was not observed in the non-extraction group. Conclusion: Extraction of first premolars in fixed orthodontic treatment leads to a notable decrease in vertical skeletal dimensions, in contrast to the slight increase seen with non-extraction treatments. This reduction is largely due to molar mesialization, which enhances vertical skeletal dimensions and treatment stability in Class I crowding cases.

Evaluation of Maxillary Protraction Using a Mini Screw-Retained Palatal C-Shaped Plate and Face Mask.

To evaluate a newly designed minimally invasive palatal-plate face mask combination for the management of developing Class III malocclusion due to maxillary deficiency. A sample of 16 Class III patients due to maxillary deficiency in the early mixed dentition (8 boys and 8 girls) aged between 7 and 9 years participated in this study and were treated with a combination of palatal plate face masks. Extra-oral elastics were attached between the intra-oral and extra-oral appliances; the elastics were set at 30° to the occlusal plane. The force magnitude was 250-300 g per quadrant. Cephalometric radiographs were taken before and immediately after maxillary protraction. In addition, skeletal measurements were measured, tabulated, and statistically analyzed. The pre- and post-protraction measurements were compared using the Student's t-test, and the significance level was set at a p-value <0.05. A statistically significant increase in SNA angle and maxillary length was observed by 3.13±1.52 degrees and 2.60±0.75 mm (p<0.05), respectively, indicating forward maxillary growth. The skeletal and soft tissue patterns were also improved, as evidenced by the statistically significant increase in the ANB angle, Wits appraisal, and H angle by 4.50±1.28 degrees, 5.30±1.86 mm, and 5.02±3.24 degrees (p<0.05), respectively. A favorable clockwise mandibular rotation was observed as evidenced by the increase in the SN/MP angle and the decrease in the SNB angle by 1.46±1.96 degrees and -1.38±1.86 degrees (p<0.05), respectively. The palatal-plate facemask combination is an effective treatment alternative for Class III malocclusion due to maxillary deficiency with minimal pain and discomfort.

Skeletal and dental features of class II malocclusion among Palestinian population: a retrospective cephalometric study

Aim. This study aims to assess the dentofacial characteristics for a sample of palestinian population with skeletal Class II malocclusion. Methods. A total of 170 lateral cephalograms for non-growing patients (age ranged between 19 and 32 years) with skeletal Class II malocclusion were retrieved. The lateral cephalograms were analyzed using virtual cephalometric analysis software - WeDoCeph® (Audax®, Ljubljana, Slovenia) to assess sagittal and vertical Skeletal parameters including SNA, SNB, ANB, SN/Mandibular Plane angle SN/Go-Gn, FMA and the Y axis angle were measured. Moreover, the upper and lower dental angular parameters (Maxillary incisor long axis with Sella - Nasion line (U1-SN), Maxillary incisor long axis with Nasion - point A angular (U1-A Point), Mandibular incisor long axis with mandibular plane (L1-MP), Mandibular incisor with nasion-point B (L1- NB) angular were also measured. The mean and standard deviation for each measurement were calculated using the Statistical Package for Social Sciences (Minitab) for Windows. Gender differences were analyzed using the independent t-test. Results. One-hundred and seventy lateral cephalometric radiographs were retrieved and analyzed. The Class II skeletal value (ANB value of 6.7 degrees) was mainly due to retrognathic mandible (SNB 75.5 degrees) rather than prognathic maxilla (SNA 82.2 degrees). In the vertical dimension, the Y axis angle, SN/Go-Gn angle, and FMA were generally increased. Regarding the dental parameters, the upper incisors were mostly retroclined, while the lower incisors were mostly proclined. There was a significant gender difference in two parameters (SN/Go-Gn and the L1-MP), where females showed more vertical growth and more lower incisors proclination. Conclusions. Skeletal class II malocclusion in the studied sample was characterized by retrognathic mandible, increased vertical growth, and compensated upper and lower incisors. Compared with male subjects, females significantly had more vertical growth and more lower incisor proclination.

Comparison of semi and fully automated artificial intelligence driven softwares and manual system for cephalometric analysis

BackgroundCephalometric analysis has been used as one of the main tools for orthodontic diagnosis and treatment planning. The analysis can be performed manually on acetate tracing sheets, digitally by manual selection of landmarks or by recently introduced Artificial Intelligence (AI)-driven tools or softwares that automatically detect landmarks and analyze them. The use of AI-driven tools is expected to avoid errors and make it less time consuming with effective evaluation and high reproducibility.ObjectiveTo conduct intra- and inter-group comparisons of the accuracy and reliability of cephalometric tracing and evaluation done manually and with AI-driven tools that is WebCeph and CephX softwares.MethodsDigital and manual tracing of lateral cephalometric radiographs of 54 patients was done. 18 cephalometric parameters were assessed on each radiograph by 3 methods, manual method and by using semi (WebCeph) and fully automatic softwares (Ceph X). Each parameter was assessed by two investigators using these three methods. SPSS was then used to assess the differences in values of cephalometric variables between investigators, between softwares, between human investigator means and software means. ICC and paired T test were used for intra-group comparisons while ANOVA and post-hoc were used for inter-group comparisons.ResultsTwelve out of eighteen variables had high intra-group correlation and significant ICC p-values, 5 variables had relatively lower values and only one variable (SNO) had significantly low ICC value. Fifteen out of eighteen variables had minimal detection error using fully-automatic method of cephalometric analysis. Only three variables had lowest detection error using semi-automatic method of cephalometric analysis. Inter-group comparison revealed significant difference between three methods for eight variables; Witts, NLA, SNGoGn, Y-Axis, Jaraback, SNO, MMA and McNamara to Point A.ConclusionThere is a lack of significant difference among manual, semiautomatic and fully automatic methods of cephalometric tracing and analysis in terms of the variables measured by these methods. The mean detection errors were the highest for manual analysis and lowest for fully automatic method. Hence the fully automatic AI software has the most reproducible and accurate results.

Predicting Mandibular Growth Potential Based on Cervical Vertebral Bone Age Using Lateral Cephalometric Radiographs in a Sample of the Saudi Population

Background: This study estimated the predictive accuracy of the mandibular growth potential based on cervical vertebral bone age using digital lateral cephalograms in a sample of the Saudi population. Methods: This study included digital lateral cephalograms of eighty subjects aged 10–21 years divided into adult and young groups. Cervical vertebral age was calculated by tracing and measuring the third and fourth cervical vertebrae on lateral cephalograms, and the mandibular growth potential was estimated using the Mito et al. regression equation. The accuracy of the calculated CVB age was verified via comparison with the chronological age. The data analyses included independent sample t-tests for testing the differences in mean values and Pearson correlation coefficients to examine the relationship between dependent and independent variables. Results: A significant difference was noted between the mean cervical vertebral age and chronological age in the young group for both males (p = 0.0003) and females (p = 0.033). The correlation coefficient between cervical vertebral age and chronological age in the young male group was higher (r = 0.934) than that in the young females (r = 0.254). Conclusions: The mandibular growth potential prediction based on CVB age using the regression equation of Mito et al. was applicable only to the young Saudi males. Further studies are needed to develop new multiple regression models to obtain cervical vertebral age more accurately for both genders in the Saudi population.

Assessment of Zygomaticomaxillary Suture Maturation in Patients With Unilateral Cleft Lip and Palate: Implications for Orthodontic Treatment Planning.

Introduction The zygomaticomaxillary suture (ZMS) is vital for craniofacial development and orthodontic treatment planning. Located at the junction of the zygomatic and maxillary bones, the ZMS undergoes significant changes during growth, affecting midfacial morphology and stability. Understanding ZMS maturation is essential for optimizing orthodontic interventions, especially in patients with cleft lip and palate (CLP), who often exhibit altered craniofacial growth patterns due to congenital deformities and surgical interventions. Methodology A retrospective analysis was conducted with 50 participants, including 25 patients with unilateral CLP and 25 age-matched controls. Clinical and radiographic data, including lateral cephalometric radiographs and cone-beam computed tomography (CBCT) scans, were collected to assess ZMS maturation stages. The stages, ranging from immature (stage 0) to fully mature (stage 4), were evaluated using established radiographic criteria. Statistical analyses, including Chi-square tests and logistic regression, were performed to compare the distribution of maturation stages between groups. Results Significant differences were observed in ZMS maturation stages between the cleft side, non-cleft side, and control group. The cleft side exhibited a higher prevalence of immature (stage 0) and early maturation (stage 1) stages compared to the control group, with mean values of 4 ± 1.2 and 5 ± 1.3, respectively. The control group showed a higher prevalence of fully mature (stage 4) sutures, with a mean value of 8 ± 1.4. The p-values for stages 0, 1, and 4 were 0.045, 0.034, and 0.039, respectively, indicating statistical significance. The findings highlight distinct maturation patterns in CLP patients, with delayed ZMS maturation on the cleft side. This suggests the need for tailored orthodontic interventions to accommodate prolonged growth phases in CLP patients. The study underscores the importance of detailed ZMS assessments for personalized treatment planning. Future research should focus on longitudinal studies to further understand CLP's impact on craniofacial development. Conclusion Assessing ZMS maturation provides critical insights for optimizing orthodontic and surgical treatment outcomes in CLP patients. By identifying specific developmental delays and tailoring interventions accordingly, clinicians can improve the effectiveness and stability of treatments. This study contributes to the growing body of evidence supporting individualized treatment plans based on precise developmental assessments.

A Computer-Aided Model for Dental Image Diagnosis Utilizing Convolutional Neural Networks

A Convolutional Neural Network (CNN) is an artificial neural network that is primarily utilized for the purposes of image recognition and processing, owing to its remarkable ability to recognize patterns within images. CNNs have found widespread application in diverse areas of computer vision, including but not limited to object tracking and recognition, security, and military and biomedical image analysis. CNN in orthodontic medical imaging technologies to reduce orthodontic treatment planning time, including automatic landmark search on cephalometric radiographs, cone beam computed tomography (CBCT) tooth segmentation, and CBCT tooth segmentation. This paper describes the strategy and the architecture of deep convolutional neural networks applied to DICOM datasets to distinguish between X-ray pictures with and without teeth. This work focuses on the application of the CNNs to a DICOM dataset in orthodontics as pre-processing for CNNs using fuzzy C-means clustering to construct a reasonable prediction that results in improved accuracy of this system. The aforementioned proposal has shown encouraging outcomes and visual representations, indicating that utilizing methods based on convolutional neural networks can greatly enhance the computational planning of orthodontic treatments by decreasing the time required for analysis. In many cases, this approach's analysis surpasses the accuracy of a manual orthodontist. This model achieved an accuracy exceeding 98% in applying the CNNs to differentiate between X-ray images with teeth and others with no teeth to focus any further work only on useful images which helps in diagnosis planning.

Changes in the curvature of upper and lower lips following the first premolar extraction in Class I bimaxillary protrusion - A cephalometric study

Bimaxillary dentoalveolar protrusion is a condition characterized by protrusion of the maxillary and mandibular incisors with increased procumbency of the lips. The treatment of choice for these patients is fixed orthodontic treatment after extraction of four first premolars. This treatment would result in the retraction of anterior teeth with a resultant decrease in soft tissue convexity. Objective of the study is to find out how the curvature of upper and lower lip change following fixed appliance therapy in patients with class I Bimaxillary protrusion following extraction of first premolars. A total of 32 subjects, 13 males and 19 females in the age group of 13-21 years diagnosed with BMP were included in the study. Pre-treatment and post-treatment cephalograms were obtained from subjects satisfying the inclusion and exclusion criteria. Cephalometric landmarks, lines used in the study were marked and analysed. The soft tissue parameters were measured and compared using paired t test and Pearson’s correlation coefficient. The overall effect of orthodontic correction of bimaxillary protrusion from subjects were analysed by evaluating the soft tissue changes between pre-treatment and post treatment cephalometric radiographs. There is a statistically significant difference with decrease in ULST, B`-PM line, B`-LiPog`, A`-PM line, LLIT, LLVT, Pog-Pog` and no statistically significant difference in A`-NtLs and ULVT. The results showed a reduction in lip procumbency. Among the soft tissue parameter studied, there is a statistically significant decrease observed for ULST, B`-PM line, B`-LiPog`, A`-PM line, LLIT, LLVT and Pog-Pog`.

Runx2 gene single nucleotide polymorphism in Class II and Class III malocclusions

To assess the prevalence of RUNX2 gene polymorphism in skeletal class II and class III malocclusions. : Unstimulated salivary samples of 36 patients (18- 30 years of age group), comprising 18 with skeletal class II and 18 with skeletal class III were collected from a tertiary care hospital in Mangalore. Salivary DNA samples were collected and analyzed using Sanger sequencing. Digital tracing was performed on lateral cephalometric radiographs by using AutoCAD software for digitization to assess the anterio-posterior and vertical relationship of the maxillary and mandibular arch.When polymorphism of 36 samples comprised of 18 Class II and 18 Class III were assessed, 83.3% Class III malocclusion and 5.6% Class II showed RUNX2 gene polymorphism in the population. Chi Square test which indicated that the results are statistically significant in Class III malocclusion for RUNX2 single nucleotide polymorphism (p&amp;#60;0.001). RUNX2 gene polymorphism was statistically significant in skeletal Class III malocclusion when compared to skeletal Class II malocclusion. This is a preliminary study done on a smaller sample, we need a larger sample size to confirm our findings.

A RETROSPECTIVE LATERAL CEPHALOMETRIC STUDY ON FRONTAL SINUS HEIGHT AND WIDTH MEASUREMENT PROTOCOL FOR GENDER DETERMINATION

Aim: To develop and assess a protocol proposed for sex determination using frontal sinus height and width measured from two dimensional lateral cephalometric radiographs. Material and Methods: The frontal sinus index was measured on sixty-four cephalometric scans (32 males &amp; 32 females). The maximum height and width of the sinus were measured. The data was tabulated and independent t test was done to determine the correlation to gender. Results: There was a high statistically significant difference between the frontal sinus width measured between male and female groups. The p value for width was found to be 0.02 which is significant. Conclusion: Measuring the frontal sinus height and width by the proposed protocol is promising. Multicentric study is recommended to reach a solid evidence-based result. Also testing the reliability of the standardization protocol is recommended by applying it on multiple drawn sinus borders by multiple experienced radiologists.

A comparative study of the efficacy of customized titanium plates versus conventional maxillary protraction in the treatment of skeletal class Ⅲ patients

Objective: To compare the clinical efficacy of customized titanium plate and conventional maxillary protraction treatment in patients with skeletal class Ⅲ malocclusion during growth spurt. Methods: During growth spurt, skeletal class Ⅲ patients with maxillary hypoplasia who were treated in the Department of Orthodontics, Capital Medical University School of Stomatology from August 2018 to July 2021 were prospectively enrolled. They were treated with maxillary protraction using customized titanium plates (customized titanium plate group) and conventional methods (conventional protraction group), respectively. Lateral cephalometric radiographs were collected before and after treatment for conventional cephalometric analysis, including SNA angle (angle between Sella, Nasion and A point), ANB angle (angle between A point, Nasion, and B point), FH-MP angle (mandibular plane angle), Y-axis angle, U1-L1 angle (upper to lower central incisor angle), U1-SN angle (upper incisor to SN plane angle), anterior and lower height, maxillary length, etc. The stable basicranial line (SBL) was used as the reference line to measure the distance from each reference point (ANS point, A point, Prn point, Sn point, UL point etc.) to the stable basicranial vertical line (VerT, the perpendicular line of the skull base line at the intersection point of the anterior wall of the sella image and the inferior edge of the anterior bed process). Paired t-tests were performed on the cephalometric data before and after maxillary protraction treatment in the two groups, and two independent samples t-tests were performed to compare the differences in the efficacy of the two maxillary protraction methods. Results: A total of 20 patients (9 males and 11 females), aged (10.8±1.3) years, were included in the personalized titanium plate group. A total of 20 patients (8 males and 12 females), aged (10.5±1.1) years, were included in the conventional protraction group. The SNA angle, ANB angle, FH-MP angle, Y-axis angle, anterior lower height, maxillary length, ANS-VerT distance, A-VerT distance, Prn-VerT distance, Sn-VerT distance, and UL-VerT distance were significantly higher than those before treatment in the two groups (P<0.05). The changes of SNA angle, ANB angle and A-VerT before and after treatment in the personalized titanium plate group [3.15°±2.28°, 4.64°±1.40°, (4.41±3.43) mm, respectively] were significantly higher than those in the traditional group [2.13°±2.69°, 2.81°±1.10°, (3.13±4.76) mm, respectively](P<0.05), and the changes of U1-L1 angle and U1-SN angle before and after treatment (-0.76°±7.42° and 1.74°±6.38°, respectively) was significantly lower than that of the control group (-5.14°±6.62° and 4.57°±5.24°, respectively, P<0.05). Conclusions: Maxillary protraction can effectively improve skeletal class Ⅲ relationships in growing patients. The linear measurements using the SBL line as a reference plane visualize the sagittal improvement in sagittal relationship after maxillary protraction. The customized titanium plate maxillary protraction treatment has a clear therapeutic effect on patients with skeletal class Ⅲ deformities, and its dental effect is relatively small.

Determination of orthodontic anomaly patterns in patients in the Thrace region and assessment of the relationship between orthodontic anomalies and DMFT indices: a retrospective study

OBJECTIVE: The aim of this study was to investigate the prevalence of dental and skeletal anomalies that could be a cause of malocclusion and their relationship with caries distribution in the western region of Türkiye. MATERIALS AND METHOD: A retrospective study was conducted with 1815 digital panoramic and lateral cephalometric radiographs taken from patients, age ranging between 6 and 47 years, who applied for orthodontic treatment. The lateral cephalometric radiographs, panoramic radiographs, and dental records were reviewed according to skeletal anomaly, dental malocclusion (Angle classification), and decay-missing- filling teeth (DMFT) index. Kruskal Wallis test was used in intergroup comparisons of variables that did not show normal distribution, and Dunn’s multiple comparison test was used in subgroup comparisons. The chi-square test and Yates correction were used in comparisons of qualitative data. RESULTS: The mean DMFT of the dental Class I malocclusion group was statistically and significantly lower than Class II division 1 and Class III malocclusion groups (p &amp;lt; 0.05). The mean DMFT index of Class II subdivision malocclusion group was statistically and significantly lower than that of Class III malocclusion group (p &amp;lt; 0.05). The DMFT index was significantly lower in the skeletal Class I group compared to the skeletal Class II and Class III anomaly groups (p &amp;lt; 0.05). CONCLUSION: There is a correlation between DMFT indices and dental malocclusions as well as skeletal anomalies. By correcting dental malocclusions and skeletal anomalies with orthodontic treatment and providing ideal occlusion, it becomes easier for patients to maintain oral hygiene and DMFT indices might decrease.