Cephalometric Values Research Articles

Presurgical Maxillary Orthopedics and Primary Alveolar Closure: Protocol and Long-term Effects on Midfacial Growth in Patients With Complete Unilateral and Bilateral Clefts

BACKGROUND: In a complete cleft lip and palate, a defect exists in the alveolar segment of the maxilla. In order to achieve successful restoration of the maxillary arch, several techniques have been employed with the ultimate goal of achieving continuity and adequate bone stock across the alveolus. Passive orthodontic appliances (POA) and gingivoperiosteoplasty (GPP) are adjuncts utilized by some surgeons with primary cleft lip repair. POA aligns the alveolar segments prior to cleft lip repair, and GPP is utilized to achieve bony union across the cleft at the time of primary lip repair. The use of these treatments remains controversial. Along with the surgical technique of the cleft lip and palate repair, they have the possibility of impacting midface growth. Here, we present our protocol for cleft lip and palate repair utilizing GPP and POA for complete unilateral and bilateral cleft lip and palate patients. We also report preliminary treatment results in complete unilateral and bilateral cleft patients, evaluating midface growth at mixed dentition. METHODS: Ten consecutive complete unilateral and 10 consecutive complete bilateral cleft lip and palate patients were recruited. All presurgical molding was performed by a single individual, and all surgical treatments were performed by the senior author. Patients underwent POA treatment (initiated at 7 days) for 35 weeks. The nasal component was incorporated after 6 weeks. GPP was performed by elevating flaps in the subperiosteal or supraperiosteal plane and closing the alveolar defect. Unilateral cleft patients underwent rotation advancement repair at approximately 6 months, whereas bilateral cleft patients underwent staged repair with a similar technique at approximately 6 and 9 months of age. Cephalometric analysis of lateral radiographs of patients at mixed dentition was performed to evaluate maxillary and mandibular growth (SNA, SNB, ANB) and facial growth relative to the facial axis (facial axis angle). RESULTS: Twenty patients underwent POA, cleft lip closure with GPP and cephalometric analysis. Mean age at time of surgery for all patients was 6.8 months ± 2.6 months of GE with a range of 5–14 months of age. Mean cephalometric values were within age-specific normal values for SNA (80° ± 3.7°), SNB (74° ± 3.4°), ANB (4° ± 1.4°), and the facial axis angle (90° ± 3.5°). One unilateral patient and zero bilateral patients exhibited skeletal Class III malocclusion. CONCLUSION: Although controversy exists regarding the impact of GPP and POA on midface growth in cleft patients, our results demonstrate that GPP and POA do not interfere with maxillary grow or cause a Class III malocclusion at mixed dentition in most patients. POA, combined with GPP at the time of cleft lip repair, leads to normal maxillary development in unilateral and bilateral cleft lip and palate patients at mixed dentition. We feel that the normal maxillary growth justifies continuing the use of GPP and POA, especially when considering the potential advantageous that they can afford at the time of primary cleft lip repair, such as allowing for closure of the alveolus and anterior palate and achieving bony union across the cleft.

Cephalometric standard values of Iraqi Arab population - A cross sectional study

Is to find the accurate stranded cephalometric norms among the most significant sample of Iraqi adult's population and to see the racial variability between the Iraqi population cephalometric normative values and their counterparts of Caucasians population. A cephalometric analytic studies of Iraqi adults for period confined between 1988 to 2017 was conducted—twenty-seven studies from ninety-two. Collected studies were met the inclusion criteria. The selected studies have involved the published master theses, all of them exhibit numerical data for both genders of the Iraqi Arab population who have class I skeletal pattern with normal occlusion. Selection of 35 parameters took place, included most used skeletodental cephalometric measurements to be evaluated and compared. Statistical tests were applied to describe the means and SD, also to find out the statistical ethnic difference between the Iraqis Arab and Caucasians population. Study show standard norms of many cephalometric parameters exhibited a significant gender difference in Iraqi adults' individuals, with higher linear hard tissue measurements in males, while non-significant gender differences appeared in facial soft tissue profile. On the other hands, most of the elected cephalometric parameters showed statistically significant differences between the Iraqi Araband Caucasians compares.Generally, the Iraqis had smaller craniofacial dimensions, maxillary and mandibular skeletal retrusion, and more convex profile. Apparent sexual dimorphism in addition to significant ethnic difference requires the adoption of gender as well as ethnic specified standard norms during the cephalometric analysis of Iraqi Arab adult patients seeking orthodontic treatment, to reach an accurate diagnosis and treatment objectives.

Computer-aided heuristics in orthodontics

During the decision-making process, physicians rely on heuristics that consist of simple, useful procedures for solving problems, intuitive shortcuts that produce reliable decisions based on limited information. In clinical situations characterized by a high degree of uncertainty such as thoseencountered in orthodontics, cognitive biases and judgment errors related to heuristics are not uncommon. This study aimed at promoting trust in the effective interface between the intuitive reasoning of the orthodontic practitioner and the computational heuristics emerging from simple statistical models. We propose an integrative model based on the interaction between clinical reasoning and 2 computational tools, cluster analysis and fast-and-frugal trees, to extract a structured craniofacial representation of untreated subjects with Class III malocclusion and to forecast the worsening of the malocclusion over time. Cluster analysis of cephalometric values from 144 growing subjects with Class III malocclusion followed longitudinally (T1: mean age, 10.2±1.9years; T2: mean age, 13.8±2.7years) produced 3 morphologic subgroups with predominant sagittal, vertical, and slight maxillomandibular imbalances. Fast-and-frugal trees applied to different subgroups extracted heuristics that improved the prediction of key features associated with adverse craniofacial growth. Provided that cephalometric values are placed in the appropriate framework, the matching between simple and fast computational approaches and clinical reasoning could help the intuitive logic, perception, and cognitive inferences of orthodontic practitioners on the outcome of patients affected by Class III disharmony, decreasing errors associated with flawed judgments and improving the accuracy of decision making.

One-piece Lefort osteotomy versus segmental procedure for maxillary skeletal deformities - A retrospective study

Maxillary skeletal deformities can occur in all three planes and are corrected by orthognathic surgery. Osteotomies form the basis for orthognathic surgeries. One of the most commonly used osteotomy techniques for maxillary skeletal deformities is the LeFort osteotomy. The aim of this study was to compare the application of One Piece LeFort Osteotomy and Segmental Osteotomy procedures in the treatment of maxillary skeletal deformities. The institutional study involved analysis of case sheets of patients who underwent surgical correction of maxillary skeletal deformities in the stipulated time frame and assessment based on the parameters: Demographic data, type of cephalometric analysis, cephalometric values, type of skeletal deformity, and technique of Osteotomy. Statistical analysis was calculated by chi-square test. A p-value<0.05 was considered significant. Maxillary skeletal deformities were more prevalent among females (60%) than males (40%). Anterior maxillary segmental osteotomies were more commonly performed (60%), followed by LeFort 1 osteotomy (26.7%). The prevalence of posterior osteotomy technique was 13.3%. A statistically significant association was revealed between the type of skeletal malocclusion and technique of Osteotomy used, with a p-value of 0.008<0.05. The type of malocclusion dictates the technique of Osteotomy is used. In a skeletal Class II, segmental malocclusion procedure was more preferred for maxillary deformities.

Class II Division 1 malocclusion treatment with extraction of maxillary first molars: Evaluation of treatment and post-treatment changes by the PAR Index.

ObjectiveTo investigate occlusal result and post‐treatment changes after orthodontic extraction of maxillary first permanent molars in patients with a Class II division 1 malocclusion.Setting and SampleRetrospective longitudinal study in a private practice, with outcome evaluation by an independent academic hospital. Ninety‐six patients (53 males, 43 females) consecutively treated by one orthodontist with maxillary first permanent molar extraction were studied, divided into three facial types, based on pre‐treatment cephalometric values: hypodivergent (n = 18), normodivergent (n = 21) and hyperdivergent (n = 57).MethodsOcclusal outcome was scored on dental casts at T1 (pre‐treatment), T2 (post‐treatment) and T3 (mean follow‐up 2.5 ± 0.9 years) using the weighted Peer Assessment Rating (PAR) Index. The paired sample t test and one‐way ANOVA followed by Tukey's post hoc test were used for statistical analysis.ResultsPAR was reduced by 95.7% and 89.9% at T2 and T3, respectively, compared with the start of treatment. The largest post‐treatment changes were found for overjet and buccal occlusion. Linear regression analysis did not reveal a clear effect (R‐Square 0.074) of age, sex, PAR score at T1, incremental PAR score T2‐T1, overjet and overbite at T1, and facial type on the changes after treatment (incremental PAR score T3‐T2).ConclusionsThe occlusal outcome achieved after Class II division 1 treatment with maxillary first permanent molar extractions was maintained to a large extent over a mean post‐treatment follow‐up of 2.5 years. Limited changes after treatment were found, for which no risk factors could be discerned.

Gambaran Hasil Analisis Sefalometri Pada Pasien Ras Deutro Melayu Usia 8-12 Tahun Menggunakan Analisis Ricketts

Background: Cephalometric analysis is one of the supporting tools in establishing a correct diagnosis. From the various methods of cephalometric analysis, one that used is the analysis of Ricketts. This Ricketts analysis has a method for determining the position of facial convexity, dental position and face profile. This study was thus carried out to describe the value of cephalometric measurements in patients with Deutro Melayu race aged 8-12 years using Ricketts analysis. Method: This type of research is a descriptive observational cross sectional design. Samples were taken in the form of secondary data, namely cephalograms from orthodontic patients at RSGM FKG Usakti in January 2018 to December 2018. The analysis was carried out by measuring 8 Ricketts analysis parameters, namely: facial axis, facial depth, mandibular plane, convexity of point A, lower incisor to A-Pog, upper molar to PtV, lower incisor to A-Pog, lower lip to aesthetic lines. Result: Based on Ricketts analysis, the cephalometric mean value of RSGM FKG Usakti orthodontic patients was facial axis of 87,8°; facial depth of 85,6°; mandibular plane of 31°; convexity of point A 3,5 mm; the lower incisor distance to A-Pog of 3,0 mm; upper molar to PtV of 7,8 mm; the lower incisor angle to A-Pog of 23,5°; lower lip to aesthetic lines of 1,9 mm. Conclusions: Deutro Malay Race has a skeletal class 1 with a tendency towards lower incisor proclination and mild protusive lower lips.

Cephalometric evaluation of patients with unilateral and bilateral complete cleft lip and palate

This study aimed to evaluate craniofacial cephalometric morphology in patients with unilateral clefts (UCLP) and in those with bilateral clefts (BLCP). The lateral radiographs of 129 patients with UCLP or BCLP referred to San Bortolo Hospital in Vicenza between January 2010 and January 2019 were retrospectively evaluated. Fourteen cephalometric hard tissue landmarks per radiographs were digitized and fifteen measurements (eight angle measurements, six linear measurements, and one ratio measurement) were calculated. Statistical analyses were carried using Chi-squared test (P<0.05). The analysis included 33 patients (25%) with BCLP, 41 (32%) with right UCLP and 55 (43%) with left UCLP. Adjusting for age and sex, left UCLP was associated with lower gonial angle (mean difference [MD] -2.7, 95% CI 5.2 to -0.0), lower upper gonial angle (MD -2.2, 95% CI -3.9 to -0.6) but higher posterior facial height (MD 2.4, 95% CI 0.3 to 4.4) with respect to right UCLP. Adjusting for age and sex, BCLP was associated with lower articular angle (MD -2.8, 95% CI -5.5 to -0.2) but higher SNA (MD 2.6, 95% CI 0.6 to 4.6) and higher ANB (MD 3.2, 95% CI 1.3 to 5.0) with respect to UCLP. Differences between the two groups were found in relation to three cephalometric values: articular angle, that is bigger in UCLP patients; SNA, that is bigger in BCLP patients; ANB, that is bigger in BCLP patients. This different craniofacial morphology can influence the treatment plan in cleft lip and palate patients.

Cephalometric Characteristics of Cameroonian Adults: Dimensional Analysis of 80 Cases

Introduction and Objectives: The reference values used in Cephalometry to determine the orthodontic treatment to be realized are mostly of Caucasian origin. In Cameroon, the need for care is growing; but little information is available in Cephalometry. Should we treat with imported cephalometric standards? To answer this question, we conducted this study in order to determine the craniofacial morphological characteristics of a sample of Cameroonian subjects in the Yaounde Central hospital having high health standard in Cameroon. Methodology: We carried out an analytical study at the Yaounde Central Hospital from January to March 2016, on scout view scanographic images of patients, aged 20 to 50 years. 15 cephalometric variables were measured and their mean values and standard deviation calculated. To determine the reference values, we used indicator means with their 95% confidence interval as the best estimator of our population measures. Results: We included 80 subjects with an average age was 32.3years. Cameroonian subjects have sex differences only for SNB and SND measures that were higher in men. Compared with Caucasian values according to Steiner, the Cameroonian population had a protrusive dento-alveolar structure with higher average values except for inter-incisal angles 119.3o and SND 78.8o which showed a lower value against 1310 and 790 for Steiner. Conclusion: Differences between Cameroonian men and women were in SNB and SND measurements that were higher in men. The averages of the Cameroonian sample are significantly different from the Caucasian averages in most measurements. Considering these differences, this work enabled us to propose a charter of cephalometric values, thus providing clear indications as to the type of Cameroonian.

Craniofacial morphology of HIV-infected adolescents undergoing highly active antiretroviral therapy (HAART): An original research.

OBJECTIVES:To analyze the craniofacial morphology in child patients and adolescents by evaluating the skeletal cephalometric profile of the HIV infected patients in this age group and comparing them with the HIV-negative controls.MATERIALS AND METHODS:The present study was a planned case-control study which included 25 HIV-positive adolescent patients aged between 10 and 18 years (the study group) who were compared with 25 age- and sex-matched HIV-negative adolescent controls (the control group). All the patients had been HIV infected via a vertical transmission with positive serology confirmed in two different tests and had been kept on HAART since they were born. The diagnostic aids used for orthodontic documentation included facial photographs, digital orthopantomographs, lateral teleradiographs, and study models.RESULTS:With reference to the methodologies used for taking the cephalometric values, all the methods used were in strong agreement with each other for almost all the variables studied and had high intra-class correlation coefficient values except Co-A, SN.ANSPNS, and SNB which, too, had a good agreement of 60%. Nevertheless, the agreement was positive for these variables, too, since the P values obtained were found to be statistically significant (P < 0.05).CONCLUSION:Most of the measurements in the HIV-infected adolescents were found to be similar to the ones obtained for the HIV-negative controls, although, the study results highlighted the significance of further studies to be conducted in this regard, especially, the longitudinal study designs wherein the said variables can be studied on a follow-up basis in longitudinal studies to have an idea of the exact changes observed and their pattern in the included groups.

Evaluation of the Oropharyngeal Airway Space in Class II Malocclusion Treated with Mandibular Activator: A Retrospective Study

The development of a class II malocclusion is usually related to a reduced oropharyngeal airway space. In order to prevent airway obstruction, functional appliances are commonly used for orthodontic therapy. The aim of the article is to verify if these appliances could positively influence oropharyngeal diameters preventing the onset of future respiratory disorders. A group of 10 patients treated at the Dental Clinic of San Gerardo Hospital in Monza with mandibular activator was selected. Ten similar untreated class II subjects with retrognathic mandible were used as control group. The cephalometric tracings were made on lateral teleradiographs of the skull before and after the active therapy with functional devices for the treated group and before and after growth peak for the control one. Descriptive statistical analysis was calculated for all the cephalometric values in both study cases and control group using Excel worksheet. The data distribution was evaluated with Shapiro-Wilk test and the in-between group discrepancies were evaluated with Mann-Whitney U test. At T1 period, both case and control groups showed a class II pattern. At T2 period, the study group shows an improvement in bones relationship with reduced ANB angles and OVJ measurements. The control group otherwise did not show any important changes in maxillo-mandibular discrepancies. The airway size increased in either group in most cases. No significant differences between the treated and control groups were detected for airway size neither in the upper, middle, nor lower level at the T1-T2 interval. The upper airway values did not show any significant discrepancies between the two groups during the observation period. Functional devices were effective in solving class II relationships, but there is no evidence of successful breathing disorders prevention by using mandibular activators, probably due to the stability of airway tissues reached in pubertal age in both groups.

Study for Cephalometrics of Facial Bone by Computerized Tomography Images.

Authors tried to investigate the maxillomandibular morphology of Korean nationality with computerized tomography images and establish a series of cephalometric values which should be considered in orthognathic plastic surgery in Korea.The computerized tomography images of 200 patients were retrospectively reviewed with the computer workstation in Sanggye Paik Hospital, Inje University College of Medicine from 2016 to 2017.The mean distance between nasion to point A (NA) line and the maxillary central incisor was 5.07 cm. The mean distance from nasion to point B (NB) line to the mandibular central incisor was 7.11 cm. The mean angle between NA line and the long axis of the maxillary central incisor was 20.58 degree. The mean angle between NB line and the long axis of the mandibular central incisor was 26.47 degree. The mean angle between SN (sella to nasion) line and NA line was 83.18 degree. The mean angle between SN line and NB line was 78.83 degree. The mean angle between NA line and NB line was 4.35 degree. There were no any statistically significant differences between age groups. But there were statistically significant difference in the mean of angle between NB line and the long axis of the mandibular central incisor (P = 0.025, between sex groups) and in the mean of angle between NA line and the long axis of the maxillary central incisor between sex groups in the 51 to 60 age group (P = 0.045).The maxillomandibular profile of Korean adults was established which can be applied for orthognathic surgery of Korean patients.

A prospective 10-year cephalometric follow-up study of patients with obstructive sleep apnea and snoring who used a mandibular protruding device

This 10-year prospective cephalometric study evaluates the influence of a mandibular protruding device (MPD) in people with obstructive sleep apnea and snoring. A baseline study population of 77 people was followed biennially. After 10years, 65 people (45 MPD users and 20 stopped-MPD users) were reexamined. At baseline and after 10years, a lateral cephalogram was taken in the upright position. MPD users showed significant changes in all cephalometric variables except for maxillary protrusion. The maxillary incisors were retroclined by a mean -4.2° (standard deviation [SD] 3.95; P<0.001), mandibular incisors were proclined by a mean 3.2° (SD, 5.02; P<0.001), and SNB was reduced by a mean -0.6° (SD 1.41; P=0.01). In those who had stopped MPD use, these initial cephalometric values were retained. Significant changes in decreased overjet and overbite were seen in the MPD group but not in the MPD-stopped group. The length of the mandible (Cd-Pg) increased by a mean of 5.1mm (SD 6.78; P<0.001) and 6.1mm (SD 5.99; P<0.001) in MPD and MPD-stopped groups, respectively. The hyoid bone-mandibular plane distance (hy-ML) increased by a mean of 3.3mm (SD, 2.90; P<0.001) and 3.8mm (SD 3.67; P=0.001) in MPD and MPD-stopped groups, respectively. Long-term nocturnal MPD use causes retroclination of the maxillary incisors and proclination of the mandibular incisors with consequent decreased overjet and overbite. Both MPD and MPD-stopped users obtained increased mandibular length and lower position of the hyoid bone, which can be a normal physiological change with age.

Rapid Maxillary Expander and Eruption Guidance Appliance therapy in skeletal Class II: cephalometric considerations.

The use of rapid maxillary expander (RME) combined with eruption guidance appliances (EGA) represents a valid method in the treatment of skeletal Class II deep bite patients. In this paper a retrospective cephalometric study of the effects of RME and EGA therapy in Class II deep bite patients is described and compared with the treatment effects of patients with the same malocclusion treated only by RME. Pre and post treatment cephalometric radiographs of 47 Class II division 1 deep bite growing patients treated with RME followed by EGA (mean age 9.65 years) (Group 1) were compared with those obtained from a control group (Group 2) of 44 patients (mean age 9.34 years) treated with RME only. The following cephalometric values were analized: SNA; SNB; ANB; SN-PNS.ANS; SN-Go.GN; N-Me; S-Go. Improvement in maxillo-mandibular relationship was observed in both groups with significantly higher decrease of SNA and ANB in group 1. The cranio-maxillary relation shows a tendency to grow downward and backward in both groups. Both anterior and posterior total facial heights showed a significant increase in group 1. RME followed by EGA therapy in Class II skeletal deep bite patients has shown better results compared with RME therapy without functional appliance.

Comparison of a tridimensional cephalometric analysis performed on 3T-MRI compared with CBCT: a pilot study in adults

ObjectiveSince the introduction of cone-beam computed tomography (CBCT) in dentistry, this technology has enabled distortion-free three-dimensional cephalometric analysis for orthodontic and orthognathic surgery diagnosis. However, CBCT is associated with significantly higher radiation exposure than traditional routine bidimensional examinations for orthodontic diagnosis, although low-dose protocols have markedly reduced radiation exposure over time.The objective of this preliminary feasibility study is to compare the accuracy and diagnostic capabilities of an already-validated three-dimensional cephalometric analysis on CBCT to those of an analysis on 3-T magnetic resonance imaging (3T-MRI) to assess whether the latter can deliver a comparable quality of information while avoiding radiation exposure.Materials and methodsIn order to test the feasibility of three-dimensional cephalometry on 3T-MRI, 18 subjects (4 male; 14 female) with mean age 37.8 ± SD 10.2, who had undergone both maxillofacial CBCT and maxillofacial 3T-MRI for various purposes within 1 month, were selected from the archive of the Department of Dentistry and Maxillofacial Surgery of Fondazione Ospedale Policlinico Maggiore, IRCCS, Milano, Italy.A three-dimensional cephalometric analysis composed of ten midsagittal and four bilateral landmarks and 24 measurements (11 angular, 13 linear) was performed on both scans using Mimics Research® v. 17.0 (NV, Technologielaan 15, 3001 Leuven, Belgium). Cephalometric analysis was performed twice by two independent orthodontists for each scan, and each orthodontist repeated the measurements 3 weeks later. Statistical analysis was performed with SPSS® 20.00 for Windows (IBM® Corporation, Sommers, NY, USA). A Bland-Altman test for each cephalometric value was performed to assess the agreement between the procedures. The intraclass correlation coefficient (ICC) was used to assess interobserver and intraobserver reliability. The coefficient of variation was used to evaluate precision.ResultsBoth procedures showed good reliability, with mean intraobserver ICCs of 0.977/0.971 for CBCT and 0.881/0.912 for MRI. The average interobserver ICCs were 0.965 for CBCT and 0.833 for MRI. A Bland-Altman analysis for the cephalometric tracing revealed a similar range of agreement between the two modalities; the bias range (mean ± SD) was − 0.25–0.66 mm (0.174 ± 0.31) for distances and − 0.41–0.54° (0.12 ± 0.33) for angles.ConclusionsWithin the main limitation of this pilot study, that is, the small sample, it is possible to state that cephalometric measurements on 3T-MRI seem to possess adequate reliability and repeatability and that they show satisfying agreement with values measured on CBCTs. An MRI examination does not expose patients to ionizing radiation and could provide an alternative to CBCT for three-dimensional cephalometrics in the future.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: maxillary growth at eight years of age.

To assess differences in craniofacial growth at 8 years of age according to the different protocols for primary cleft surgery in the Scandcleft project. Prospective, randomized, controlled clinical trial (RCT) involving 10 centres, including non-syndromic Caucasians with unilateral cleft lip and palate (UCLP). In Trial 1, a common surgical method (1a) with soft palate closure at 3-4 months of age and hard palate closure at 12 months of age was tested against similar surgery but with hard palate repair at 36 months (delayed hard palate closure) (1b). In Trial 2, the common method (2a) was tested against simultaneous closure of both hard and soft palate at 1 year (2c). In Trial 3, the common method (3a) was tested against hard palate closure together with lip closure at 3 months of age and soft palate closure at 1 year of age (3d). Participants were randomly allocated by use of a dice. Operator blinding was not possible but all raters of all outcomes were blinded. The total number of participating patients at 8 years of age was 429. Lateral cephalograms (n = 408) were analysed. The cephalometric angles SNA and ANB were chosen for assessing maxillary growth for this part of the presentation. Within each trial (Trial 1a/1b, Trial 2a/2c, and Trial 3a/3d), there was no difference in cephalometric values between the common and the local arm. There were no statistically significant differences in the SNA and ANB angles between the common arm in Trial 1a (mean SNA 77.8, mean ANB 2.6) and Trial 2a (mean SNA 79.8, mean ANB 3.6) and no difference between Trial 1a and Trial 3a, but a statistical difference could be seen between Trial 2a and Trial 3a (mean SNA 76.9, mean ANB 1.7). However, the confidence interval was rather large. Intra- and inter-rater reliability were within acceptable range. The timing and the surgical method is not of major importance as far as growth outcomes (SNA and ANB) in UCLP are concerned. ISRCTN29932826. The protocol was not published before trial commencement.

Gambaran Nilai Pengukuran Parameter Sefalometrik Pasien Ras Deutro Melayu Usia 6-12 Tahun Menggunakan Analisis Steiner

Background: Cephalometric analysis is an important tool in the field of orthodontics. It is used to examine the growth and development of facial bones in treatment planning, and changes between before and after treatment in evaluation stage. Steiner's analysis uses angle dan distance measurements to determine the patient's skeletal position. Steiner's analysis includes the position and inclination of the incisors to the jaw and the position of the jaw to the cranial base. This study was thus carried out to describe the value of cephalometric parameter measurements of Deutro-Malay race patients aged 6-12 years using Steiner's analysis. Materials and Methods: This study is a descriptive observational method with a cross-sectional study design. Samples were taken from secondary data of cephalogram orthodontic patients RSGM FKG Usakti in 2017-2018. The analysis was carried out by measuring 11 Steiner's analysis parameters, namely: SNA, SNB, SND, ANB, Go-Gn to SN, U1-NA, L1-NB, U1-L1, Occl-SN. Results: Based on Steiner's analysis, the cephalometric mean value of RSGM FKG Usakti orthodontic patients was SNA of 80.80; SNB of 76.60; SND of 72.990; ANB of 4,240; Go-Gn to SN is 36.80; U1-NA is 26,920 and 3,93 mm; L1-NB of 32.10 and 5.98 mm; U1-L1 of 116,890; Occl-SN is 20,680. Conclusions: Malay Deutro Race has a tendency for class II, skeletal class II malocclusion, retrusive symphysis, less developed horizontal growth patterns, and incisive proclination.

Thoracic-lumbar-sacral spine sagittal alignment and cranio-mandibular morphology in adolescents

PurposeThe relationship between thoracic-lumbar-sacral spine sagittal alignment and craniofacial morphology is still controversial. Evidence-based results are difficult to obtain and scientific studies are inhomogeneous. The aim of this study was to investigate the difference of thoracic-lumbar-sacral spine posture and cephalometric values comparing two groups of subjects with different cranial structure in the sagittal plane. MethodsEighty-one subjects were consecutively selected and divided into two groups, according to the orientation of the condyle-orbital plane (CoOr) with respect to the superior maxilla (SpP): Group1: 49 subjects 11.6 (2.1) years showing posterior-rotation of CoOr: SpP^CoOr ≤ −2°, −4.1°(2.1°); Group2: 32 subjects 12.9 (2.3)years showing anterior-rotation of CoOr: SpP^CoOr ≥ 2°, 3.7°(1.9°). Each patient underwent in blinding, Spinal Mouse recording and cephalometry of the skull. ResultsGroup1 showed a significant forward tilting of the spine 4.4°(1.8°) with respect to Group2 2.4°(1.3°) (p < 0.0001) and higher values related to the vertical dimension of the skull: higher maxillary divergency (p < 0.0001), steep occlusal plane (p < 0.0007), higher gonial angle (p < 0.001). DiscussionThe results of this study showed a difference in the thoracic-lumbar-sacral spine inclination between groups with different craniofacial morphology. The achievement of this outcome is important to improve our multidisciplinary evaluation and treatment planning.

Evaluation of vertical facial height reduction and severity of temporomandibular joint disorders using Shimbashi number and cephalometric analysis

ABSTRACT Objective: This study was designed to evaluate the correlation between vertical dimension at occlusion (VDO) and various grades of temporomandibular disorders (TMDs) versus controls. Methods: Clinically measured Shimbashi number and radiographic cemento-enamel junction (CEJ-CEJ) measurements on 120 TMD patients and 40 controls were evaluated. Radiographic lateral cephalometric skull images of the patients were subjected to cephalometric analysis. The relationship between Shimbashi number, the cephalometric values, and its correlation with the degree of TMD were evaluated and statistically analyzed. Results: Shimbashi number and radiographic CEJ-CEJ values in the TMD patients were significantly lower than those in the controls. TMD severity appeared to increase with the increase in interincisal angle and the decrease in both Shimbashi number and radiographic CEJ-CEJ value. Conclusion: These findings indicate that radiographic evaluation of cephalograms is a reliable indicator of presence and degree of TMD, and the severity of TMD increases with the degree of reduction in VDO.

Adding Depth to Cephalometric Analysis: Comparing Two- and Three-Dimensional Angular Cephalometric Measurements.

Lateral cephalometric radiographs (LCR) have been the standard tool used for cephalometric analysis in craniofacial surgery. Over the past decade, a three-dimensional (3D) revolution in cephalometric analysis and surgical planning has been underway. To date, research has not validated whether cephalometric measurements taken from two-dimensional (2D) and 3D data sources are equivalent and interchangeable. The authors sought to compare angular cephalometric measurements taken with 2D and 3D modalities. Sixty-two head CT scans (36 females, 26 males) with an average age of 63 ± 20 years were studied. Twelve cephalometric angular measurements were taken from 3D reconstructed skulls using the software package Mimics 19.0 (Materialize; Leuven, Belgium). These same facial angles were measured from 2D lateral cephalograms reconstructed from the original CT scans using Dolphin 11.9. Measurements taken with both techniques were compared for agreement using a paired t test. Intra-class correlation coefficient assessment was used to determine inter-rater reliability. Statistical significance was set at P < 0.05. Five of the 12 angular measurements (SNA, SNB, MP-FH, U1-SN, and U1-L1) demonstrated statistically significant differences (P < 0.05) between the 2D and 3D analyses. All of these differences were less than the standard deviations for the respective measure. The differences between angular cephalometric values obtained from 2D LCRs and 3D CT reconstructions are small. This supports the practices of using 2D and 3D cephalometric data interchangeably in most applications. Clinicians must be selective in which measures they employ to maximize accuracy and care must be taken when measuring dental inclination with lateral cephalograms.

Cephalometric outcomes of a new orthopaedic appliance for Class III malocclusion treatment.

To evaluate dental and skeletal effects of a new orthopaedic appliance for the treatment of Class III malocclusion in growing patients. This retrospective cephalometric study was performed on a sample of 18 patients with a skeletal Class III malocclusion (4 males; 14 females; mean age 8.8 ± 1.5 years) treated with the Pushing Splints 3 (PS3) protocol. The control group consisted of 18 subjects (5 males; 13 females; mean age 9.1 ± 1.8 years) selected from a database of subjects with untreated Class III malocclusion. The cephalometric analysis was performed at the beginning (T0) and the end of the orthopaedic therapy (T1). Significant differences between the treated and control groups were assessed with independent samples t-test (P < 0.05). In the PS3 group, the post-treatment cephalometric values showed a forward displacement of the maxilla, resulting in a statistically significant increase of the SNA angle. ANPg and Wits appraisal improved significantly compared with the control group. Lingual inclination of mandibular incisors and buccal inclination of the upper incisors were significantly increased in comparison with the control group. No significant differences were recorded for backward mandibular rotation. This study presents a short-term evaluation of the treatment and the use of a historical control group. The PS3 was effective for the treatment of Class III malocclusion in growing patients, with favourable maxillary advancement and control of the vertical skeletal relationships.