Digital Lateral Cephalograms Research Articles

Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation

ObjectiveThis study aims to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult hemifacial microsomia (HFM) patients. MethodsSix adult HFM patients (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial CT scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry. ResultsAt T1, no significant differences were observed in skeletal movements compared to planned surgical movements (p > 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (p > 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (p < 0.05), along with notable improvements in chin deviation and occlusal cant (p < 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (p > 0.05), indicating substantial postoperative stability. Following personalized implantation (T3), further significant improvements were observed in skeletal symmetry. ConclusionCombining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult HFM patients, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.

Predictors of Curve of Spee Leveling in Class II Division 1 Malocclusion Treated With Reverse Curve of Spee Archwires: An Observational Study.

Introduction Aligning and leveling is the initial stage of comprehensive fixed orthodontic treatment aimed at minimizing the depth of the curve of Spee (COS). Various techniques exist to decrease the magnitude of the curve. This study investigates the skeletal and dental factors that reduce COS in individuals with minor class II malocclusions receiving nitinol (NiTi) wires with a reverse curve of Spee (RCS). Materials and methods The data for this observational study was collected from a sample of 84 patients who had class II molar relations and were sequentially treated with RCS NiTi wires throughout the initial leveling and aligning phase. All patients with class II molar relationships underwent non-extraction procedures during the leveling phase. The COS was determined using digitalized dental models. Skeletal and dental characteristics that could impact COS were identified and quantified using digital lateral cephalograms and orthopantomograms recorded during the pre-treatment (T1) and post-leveling (T2) stages. After calibrating the radiographs and models, we acquired angular and linear data. The data was categorized based on gender, growth pattern, and initial alignment of the teeth. We analyzed the differences between the groups using an independent t-test and an ANOVA. A paired t-test was used to compare the difference in the dimensional values between (T1) and (T2) points. Following the correlation coefficient tests, the study used stepwise multiple linear regression analysis to assess the predictive value of independent factors on the COS. The results were considered statistically significant at p < 0.05. Results The COS decreased by -1.43 ± 0.68 mm, which is statistically significant (<0.001*). There is no significant difference in COS reduction between the categorical variables. Despite statistically significant differences in the parameters between pre- and post-treatment, the linear correlation between most of the variables and COS reduction ranged from very weak (<0.20) to weak (0.20-0.39). Conclusions The vertical extrusion of lower premolars and molars combined with the intrusion of lower incisors contributed to the reduction of the COS by RCS wires. There is a change in the orientation of the occlusal plane with the flattening of the COS.

Single Nucleotide Polymorphisms in RUNX2 and BMP2 contributes to different vertical facial profile.

The vertical facial profile is a crucial factor for facial harmony with significant implications for both aesthetic satisfaction and orthodontic treatment planning. However, the role of single nucleotide polymorphisms (SNPs) in the development of vertical facial proportions is still poorly understood. This study aimed to investigate the potential impact of some SNPs in genes associated with craniofacial bone development on the establishment of different vertical facial profiles. Vertical facial profiles were assessed by two senior orthodontists through pre-treatment digital lateral cephalograms. The vertical facial profile type was determined by recommended measurement according to the American Board of Orthodontics. Healthy orthodontic patients were divided into the following groups: "Normodivergent" (control group), "Hyperdivergent" and "Hypodivergent". Patients with a history of orthodontic or facial surgical intervention were excluded. Genomic DNA extracted from saliva samples was used for the genotyping of 7 SNPs in RUNX2, BMP2, BMP4 and SMAD6 genes using real-time polymerase chain reactions (PCR). The genotype distribution between groups was evaluated by uni- and multivariate analysis adjusted by age (alpha = 5%). A total of 272 patients were included, 158 (58.1%) were "Normodivergent", 68 (25.0%) were "Hyperdivergent", and 46 (16.9%) were "Hypodivergent". The SNPs rs1200425 (RUNX2) and rs1005464 (BMP2) were associated with a hyperdivergent vertical profile in uni- and multivariate analysis (p-value < 0.05). Synergistic effect was observed when evaluating both SNPs rs1200425- rs1005464 simultaneously (Prevalence Ratio = 4.0; 95% Confidence Interval = 1.2-13.4; p-value = 0.022). In conclusion, this study supports a link between genetic factors and the establishment of vertical facial profiles. SNPs in RUNX2 and BMP2 genes were identified as potential contributors to hyperdivergent facial profiles.

Age and Gender Determination using Maxillary Sinus and Sella Turcica on Lateral Cephalogram: A Retrospective Digital Radiographic Study

Background: Anthropometry is of immense importance in human identification and plays a major role in medico legal investigation of demise. Lateral cephalogram provides architectural, morphological details of skull and multiple points for comparison also presents various anatomical landmarks. The study aimed to evaluate morphometric analysis of Maxillary sinus&amp; Sella turcica parameters in gender determination&amp; age estimation.Methodology: The study included 300 digital Lateral cephalograms of age range 10-40 years divided in to 3 groups &amp;50 males and 50 females in each age group. Linear measurement was performed for Maxillary Sinus Height, Width and Index &amp; Sella turcica (ST) Length, Depth and Diameter. Results indicated that all the study parameters were found to be statistically significant in determination of age except Sella turcica depth. Maxillary sinus parameters &amp; Sella turcica diameter, length showed significant corelation between age group Group-1 and Group-II. Maxillary sinus width, height&amp; Sella turcica length was found to be statistically significant in determination of gender. Discriminant equation of MS width had highest accuracy of 63.7% in determination of gender.Conclusion: Lateral Cephalogram can be used to determine age and gender using linear measurements of maxillary sinus and Sella turcica.

Sex estimation using angular measurements of nasion, sella, and glabella on lateral cephalogram among Indonesian adults in Yogyakarta

BackgroundSex estimation gives the probability that someone is classified as a male or a female. Lateral cephalogram analysis can be used for sex estimation due to the resistance and dimorphism of the skull. Glabella has been known to have dimorphic characteristic in male and female, while nasion and sella have been widely used as a standard point in many craniometric measurements. This study aimed to develop an equation using nasion–sella–glabella (NSG), sella–glabella–nasion (SGN), and glabella–nasion–sella (GNS) angles on lateral cephalograms for sex estimation among Indonesian adults in Yogyakarta, Indonesia.ResultsA total of 138 adults (aged 20–40 years) digital lateral cephalograms were taken from the dental records at Universitas Gadjah Mada Dental Hospital (108 used to form the equation of sex estimation; 30 used to test the equation), and the parameters were measured with EzDent-i Vatech. An independent t-test was used to analyze the differences in the angles between male and female adults. The equation for sex estimation was determined using discriminant function analysis. The average measurements of the NSG angles in male and female adults were 9.64° ± 1.36° and 11.21° ± 1.57°, respectively, the SGN angles were 54.65° ± 4.19° and 60.83° ± 4.13°, respectively, whereas the GNS angles were 118.33° ± 4.61° and 109.84° ± 5.19°, respectively. The independent t-test revealed a significant difference (p < 0.05) between male and female adults. Discriminant function analysis yielded an equation for sex estimation using the NSG, SGN, and GNS angles with an accuracy of up to 75.9%, with the accuracy of sex estimation based on the testing sample being 70%.ConclusionBased on the findings of this study, male Indonesian adults have a smaller NSG and SGN angles but a bigger GNS angle than female adults. Related to the accuracy, the study’s findings indicate that the discriminant function of NSG, SGN, and GNS angles for sex estimation should not be generalized in wider population. More cephalogram parameters must be investigated in future studies on sex estimation.

Soft tissue and incisor position changes in class I bimaxillary subjects after retraction using friction and frictionless mechanics

Aim: Bimaxillary protrusion is a common condition observed irrespective of race and ethnicity and is a chief concern for patients who seek orthodontic treatment. The aim of this study was to compare and evaluate changes in soft tissue structures and incisor positions in class I bimaxillary protrusion subjects undergoing orthodontic therapy when friction and frictionless mechanics were used. Methods: Two groups with a total of 40 patients aged 18–30 years diagnosed with class I bimaxillary protrusion treated by extracting first premolars were considered for this study. Patients treated with friction mechanics were included in Group 1 and those treated with frictionless mechanics in Group 2. The digital lateral cephalograms were calibrated and analyzed using Nemoceph software. Selected landmarks were marked on pre- and post-treatment cephalograms and assessed for intra- and inter-group soft tissue and incisor position changes. Student’s t-test was used to analyze the collected data using SPSS 20 software. Result: Intragroup comparison revealed significant changes in both groups. Inter-group comparison of the selected parameters between groups 1 and 2 showed differences but without any statistical significance, except for the inter-incisal angle. Conclusion: Pre- and post-treatment comparison analysis revealed significant soft tissue changes in both groups. However, the comparison between friction and frictionless mechanics showed no statistically significant changes.

Ponticulus Posticus: An Important Diagnostic Finding Often Missed in Lateral Cephalograms.

The purpose of the current study was to investigate the presence of the ponticulus posticus (PP) frequently encountered in lateral cephalograms. About 500 patients of age 12-40 years were selected whose digital lateral cephalogram was recorded and traced to confirm the presence of the PP and categorize as: (A) Absent, as evidenced by lateral cephalograms. (B) Complete PP evidenced by the presence of circumferential bone bridge that connected the upper articular process to the atlas's posterior arch. (C) Partial PP: presented as a bone spike that protruded from the top articular process or the posterior arch of the atlas and extended above the vertebral artery sulcus. Symptoms of migraine, shoulder discomfort, orofacial pain, and headache were also evaluated on interaction with the patients. Using the Chi-square test, the relationship between the patient's gender and the presence of the PP was assessed. A p-value of 0.05 or less was regarded as statistically significant. About 10% of the patients reported with the presence of complete variant, 70% with partial variant and rest 20% of patients with neither a partial nor a complete form of PP. There was no statistically significant association between the PP and gender, as indicated by the Chi-square values (3.146; p = 0.526). On conclusion, according to the findings of the current study, patients with a complete form of PP experience more symptoms than those with a partial form of PP. In both groups, the PP frequency was higher in females. In lateral cephalograms, the cervical spine region is typically ignored and given little weight. A common variation of atlas vertebrae is the PP, which is located in the posterior arch of the atlas. The PP exacerbates symptoms, such as migraine, tension headaches, shoulder pain, double vision, vertigo, stroke, and pain in the neck and orofacial region. Therefore, orthodontic specialists serve as initial diagnosticians and direct the patients to qualified physicians so that they can experience symptom relief.

Assessment of Posterior Pharyngeal Airway Changes After Orthognathic Surgery Using Barium Sulfate.

Obstructive sleep apnea(OSA), caused by airway narrowing, is likely to occur if the mandibular plane to hyoid distance is greater than 15.4 mm and the posterior airway space (PAS) is less than 11 mm. OSA may be caused by mandibular deficit, bimaxillary retrusion, increased lower facial height, extended soft palate, a large tongue base, and a posteroinferiorly positioned hyoid bone. Snoring and drowsiness during exercise are symptoms of OSA, which is a risk factor for high blood pressure, heart disease, and stroke, and these can result in car crashes. However, orthognathic surgery can improve dental occlusion and aesthetics by adjusting facial bone position, shape, and size. When bones move, the position and tension of soft tissues change. These novel soft tissue interactions, especially when anteroposterior, change the face's appearance and PAS dimensions. This study uses barium sulfate paste to enhance lateral cephalograms before and after orthognathic surgery to assess posterior pharyngeal airway changes. Barium sulfate was mixed with water to make a paste for the tongue's dorsum. A preoperative digital lateral cephalogram was obtained, and a postoperative evaluation was conducted six weeks after the procedure. In the cephalostat, the Frankfort horizontal and median planes were aligned parallel to the floor, and a radiograph was taken after the breathing cycle to standardize the hyoid bone location. Preoperative lateral cephalogram analysis using Burstone's hard tissue landmarks confirmed skeletal class II or III deformities. First, the narrowest part of the posterior pharyngeal airway was measured. Second, the narrowest portion between the soft palate and posterior pharyngeal wall parallel to the Frankfort horizontal plane was measured preoperatively, and the procedure was repeated six weeks postop. Complexity characterizes the pharyngeal airway, which, along with the surrounding structures, facilitates the bodily functions of eating, talking, and breathing. The pharyngeal airway is located behind the nose, mouth, and larynx, and adjusting the jaws changes the size and structure of the pharyngeal airway and surrounding soft tissues, which may affect breathing.A statistically significant change is detected in the posterior palatal and posterior lingual airways after different orthognathic operations. After the mandible is moved forward, both the posterior palatal and posterior lingual airways enlarge. Furthermore, the soft palate exhibits slight decreases in length, thickness, and angle. Additionally, there is an anterosuperior displacement of the hyoid bone. Following maxillary superior impaction, mandibular autorotation is seen in a counterclockwise direction, which has the same result as that of mandibular advancement. It is essential to consider these soft tissue changes when planning orthognathic procedures, as alterations in the pharyngeal airway may impact the patient's postoperative breathing and overall health. Patients with OSA or those at risk of developing it should be closely evaluated and managed appropriately during the surgical planning process.

Assessment of Skeletal Maturity in a Sample of the Saudi Population Using Cervical Vertebrae and Frontal Sinus Index: A Cephalometric Study Using Artificial Intelligence.

Aim This study aims toinvestigate the relationship between the frontal sinus index and different stages of cervical vertebral maturation and to determine whether these measurements can be used as accurate markers for evaluating skeletal maturity. Materials and methods The sample size was 120 subjects, with ages that ranged from 8 to 25 years. Standardized pretreatment digital lateral cephalograms were analyzed. Six groups representing different phases of cervical vertebral maturation were created from the entire sample. Each group had 20 subjects and was split into male and female groups. On the same radiograph, the cervical stages were assessed and the frontal sinus index was calculated. Correlations between the frontal sinus index and cervical vertebral maturation were assessed using statistical analysis. Results Sinus index values, which assess the ratio of frontal sinus dimensions to cervical stages, were found to be comparable between the two adjacent cervical stages. However, the patterns of sinus index values differed between males and females, suggesting potential variations in sinus development between the sexes. Conclusion Frontal sinus height and width were significantly correlated with cervical vertebral maturationstagesin both sexes. The frontal sinus index, on the other hand, was not significant.

Radiographic Analysis of Morphological Variations of Sella Turcica in Different Skeletal Patterns Among Saudi Subpopulations.

Size and shape of the sella turcica is considered vital for many radiographic analyses. To assess and compare the linear dimensions and shape of sella turcica on digital lateral cephalograms in Saudi subpopulation with different skeletal patterns, age groups and genders. A total of 300 digital lateral cephalograms were retrieved from the hospital archive. The selected cephalograms were grouped based on the age, gender, and skeletal types. The linear dimensions and shape of sella turcica were measured on each radiograph. Data were analyzed using an independent t-test and a one-way ANOVA. To test the inter-relationship of age, gender, and skeletal type with the dimensions of sella turcica, regression analyses were used. Statistical significance was set at P ≤ 0.01. Significant differences in linear dimensions between the age groups (P < 0.001) and genders (P < 0.001) were noted. On comparing sella size with different skeletal types, a significant difference was found for all sella dimensions (P < 0.001). The mean length, depth and diameter among skeletal class III were significantly higher than that among classes I and II. On comparing age, gender, and skeletal type with size of sella, age and skeletal type were significantly related to the change of length, depth and diameter (P < 0.001), whereas gender was found to be significantly related only to a change in length of the sella (P < 0.01). For the sella shape, normal morphology was noted in 44.3% of patients. According to the findings of this study, the measurements of sella can be used as reference standards for future studies in Saudi subpopulation.

Evaluation of Upper and Lower Pharyngeal Airway and Hyoid Bone Position in Skeletal Class II Patients Treated with Forsus and Powerscope Appliance: A Prospective Study

Objectives: To assess and compare the change in pharyngeal airway dimensions and hyoid bone position also to evaluate the skeletal and dental effects of Forsus and Powerscope appliance in skeletal Class II malocclusion patients with obstructive sleep apnea subjected to 6 months fixed functional appliance therapy. Methods: 30 patients with skeletal class II malocclusion having day-time somnolence associated with snoring requiring fixed functional orthodontic treatment were selected and randomly divided into Forsus and Powerscope groups. Patients were treated with MBT 0.022-slot and aligned till 19x25 SS. Fixed functional appliance was installed. Digital Lateral cephalograms were traced for Skeletal, Dental, Airway Measurements and Hyoid bone position at pre-treatment (T1), before start of fixed functional therapy (T2) & at end of fixed functional therapy (T3) analysed using Dolphin software. Findings : Skeletal correction achieved was same for both Forsus and Powerscope. Forsus showed significant improvement in sagittal correction whereas Powerscope produced dentoalveolar changes. Airway dimensions showed significant increase Pre & Post treatment for both groups. Whereas Hyoid Bone moved more mesial and superior with fixed functional therapy. Change in airway dimensions was similar for both the groups. Fixed functional appliance produced significant increase in airway dimension however no difference seen between Forsus and Powerscope. Novelty: The study revealed that correction of mandibular retrusion using mandibular advancement appliances in skeletal class II malocclusion with obstructive sleep apnoea increased the airway dimensions and improved nasal breathing. The dimension of upper and lower airway increased significantly. Keywords: Fixed Functional Appliance; Forsus; Powerscope; Hyoid Bone; Airway

GROWTH INDICATORS AND THEIR RELATION IN INDIVIDUALS WITH DIFFERENT SKELETAL MALOCCLUSIONS

Objectives: The purpose of our study is to assess the correlation between chronological age, cervical vertebral maturation index and Demirjian index of the lower second molars and analyze if the correlation affected by intermaxillary sagittal malocclusion. Material and methods: 150 subjects were evaluated, with age range from 6-19 years. Skeletal maturation stages according to Baccetti method were determined in lateral cephalometric radiographs. Demirjian index for lower second molars were evaluated in panoramic x-ray. Digital lateral cephalograms and panoramic radiographs were performed by Vatech and they were analyzed and saved in DICOM format using dedicated software (Easydent version 4.1). Statistical analysis with IBM SPSS version 26 for Windows, Chicago, Illinois to assess the correlation between cervical vertebral maturation index and Demirjian index for lower second molars and intergroup comparison. Results: There is a strong positive correlation between chronological age, cervical vertebral maturation index and Demirjian index for lower second molars, with p &lt; 0.000, Pearson correlation coefficient was from r = .847 to r = .883. The duration of prepubertal stage for class II subject was significantly longer. Whereas the actual peak of pubertal growth in class II subject was short, 3, 5 months. The overall period of growth modification raging from stage 2-4 of cervical vertebral maturation index was significantly longer in class III subjects. Conclusions: There is a strong correlation bewteen cervical vertebral maturation index and Demirjian index for lower second molars. The correlation is not affected by intermaxillary sagittal relationship, however in class II patients we have a shorter pubertal peak period and in class III there is a longer period of pubertal peak.

Digital evaluation and correlation of facial growth patterns assessed on lateral CEPH and orthopantomogram through ONECEPH mobile application

This study aimed to investigate the correlation of gonial angle and three linear measurements on OPG and lateral cephalograms and their effects on the different facial patterns using the OneCeph android app.About 90 pre-treatment digital lateral cephalograms and OPGs of 90 patients were selected and divided into 3 categories, based on their growth patterns. The OPGs and lateral cephalograms were uploaded on the OneCeph android app. After calibrating using One linear measurement i.e. length of extracted premolar for OPG and ruler in radiograph for lateral cephalogram, Gonial angle (Ar- Go-Me), ANS-Me (LAFH), U1-NF, L1-MP were measured. The data were collected, tabulated, and subjected to statistical analysis using the SPSS software (version 20.0). The level of significance was kept at 5%.Values for parameters were highest in the vertical growth pattern followed by average and horizontal in both cephalogram and OPG. Upon comparison of lateral cephalogram and OPG, no significant difference was observed in gonial angle and a significant difference in LAFH and L1-MP in all three growth patterns with OPG scores greater than cephalometric tracing. The interclass coefficient test indicated almost perfect agreement for the gonial angle between the two methods. A substantial agreement was seen for U1-NF on lateral cephalogram and OPG in the vertical group. Also, a fair agreement in the vertical and horizontal group was observed in Lower anterior mandibular height.Vertical parameters such as gonial angle and maxillary anterior dental height can be accurately determined on an OPG by the OneCeph application.

Assessment of Velar Morphological Variants as Gender Determination Tool in Kanpur Population: A Digital Cephalometric Study

Background: The posterior fibromuscular part of the palate that attaches to the hard palate is what is often referred to as the soft palate. To distinguish between sexes, this research measured the velar for length, breadth, and morphological diversity. Materials and Methods: One hundred and fifty boys and girls, ages 15–25, had digital lateral cephalograms obtained. Using the taxonomy proposed by You et al., we categorized velar morphology into six different types and conducted an in-depth analysis of each. The resting length of the soft palate may be seen as a straight line stretching from the back of the nose to the tip of the uvula. It was also determined how wide the soft palate really is. IBM SPSS statistics 21 was used for the statistical analysis. The mean, the standard deviation, and the percentage distribution were used to describe the data. To ensure that the data were normally distributed, the Shapiro–Wilk test was run on them. Comparisons of clusters of discrete categories were made using the Chi-square test. To identify statistically significant differences between the sexes, we employed the independent Student's t-test. The mean length and width of different velar shapes of both genders were calculated using an analysis of variance test. Results: Type 2 was more common in males than in Types 1, 3, or 6. Form 6 was the rarest of the forms. Type 1 was more common among women than any of the other types, including Types 2, 3, and 6. The most frequent kind was Type 1. The veli of men are much longer and broader than those of females. Conclusion: In light of all the metric measurements from the current study, gender can be established from the length, width, and soft palate morphology.

Evaluation of Sagittal Inclination of Occlusal Plane and Horizontal Condylar Guidance Using Various Anterior Reference Points on Arcon and Nonarcon Articulators.

Aim:The aim of the study was to determine the effect of different anterior reference points during facebow transfer, on sagittal inclination of occlusal plane (SIOP) and horizontal condylar guidance (HCG) values obtained on arcon and nonarcon articulators.Materials and Methods:Facebow records of 25 participants were made and transferred to Hanau Wide-Vue (WV) and Hanau H2 (H2) articulators using conventional indirect transfer (CIT), superior annular groove (SAG), and inferior annular groove (IAG) as anterior reference points. Maxillary casts were mounted on each articulator followed by mandibular mountings. Protrusive interocclusal record was used to determine HCG, and SIOP was measured as an angle between the occlusal plane of mounted maxillary cast and upper member of the articulator. Both, HCG and SIOP were measured on a digital lateral cephalogram and the values obtained were compared with previously determined values from both the articulators. Intergroup comparison was done by analysis of variance and pair-wise comparison by Tukey post hoc test.Results:Values of SIOP significantly (P = 0.00) changed on both the articulators when CIT, SAG, and IAG were the anterior reference points. The ratio of SIOP and HCG on both articulators was comparable to that of the cephalogram for CIT, IAG, but it was substantially low for SAG.Conclusions:The variation of anterior reference point changes the value of SIOP recorded on Hanau WV and H2 articulators; however, it had no effect on HCG values recorded on both the articulators. The angle between SIOP and HCG changed with variations in superior-inferior position of the mountings on both articulators.

A soft tissue analysis for central India population

Based on surgical-orthodontic treatment planning and prediction system Tony G. McCollum(TOMAC), the present study aims to determine surgical norms for Central India population and to evaluate the variation between Central India males and females. Digital lateral cephalograms of hundred subjects (50 males and 50 females) of 15- 25 years of age were obtained. These radiographs were manually traced by single operator based on the parameterstaken from TOMAC soft tissue analysis. The data obtained was statistically analyzed using Mann-Whitney U test and One-sample Wilcoxon Signed Rank test. Statistically significant difference were observed between the Central India population and Caucasian population and also significant sexual dimorphism was noted among the population of Central India. There exist racial diversity between Central India population and the Caucasian population.Therefore, it becomes necessary to have separate norms for different ethnic groups and choose the norms carefully suited to the treatment needs of individual population.

Linear Cephalometric Analysis of Pharynx at the Level of Epiglottis among Snorers and Nonsnorers: A Cross-Sectional Study.

Aim Snoring, which falls within the spectrum of sleep-related breathing disorders, is considered to be one of the common symptoms of airway obstruction. Lateral cephalometric analysis is an effective way of diagnosing airway obstruction by evaluating skeletal and soft tissue abnormalities in patients with sleep-disordered breathing (SDB). The present study was planned to analyze the pharyngeal space among snorers and nonsnorers in the retroglossal region and in the region of hypopharynx at the level of epiglottis. Materials and Methods The present cross-sectional study included a total of 60 individuals who were grouped into snorers and nonsnorers based on their answers for the study questionnaire related to snoring. Digital lateral cephalograms were taken for all maintaining the exposure parameters while Digora software was used for measurements related to the soft tissue parameters. The two significant soft tissue parameters analyzed were the distance of epiglottis from the tip of the soft palate, the retroglossal length, and the distance of posterior pharynx from the tip of the epiglottis, the pharyngeal space. Statistical Analysis The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, Illinois, United States) while paired t -test was used for intergroup analysis. A p -value of < 0.05 was considered statistically significant. Results The mean retroglossal length was found to be 25.52 mm among the snorers and 23.70 mm among the nonsnorers. In case of pharyngeal space, a mean of 8.54 mm was recorded among the snorers whereas among the nonsnorers, the respective mean value of 10.16 mm was observed. Conclusion In the present study, pharyngeal space was found to be less at the level of the tip of epiglottis among the snorers compared with nonsnorers which can be attributed to be one of the significant reasons behind snoring and obstructive sleep apnea syndrome.

Prevalence of ponticulus posticus on the posterior arch of the atlas in symptomatic and asymptomatic patients.

To calculate the prevalence of ponticulus posticus and its association with headache. The presence and types of ponticulus posticus were investigated on 640 digital lateral cephalograms. Patients with complete or partial ponticulus posticus were further evaluated and questioned for a history of cervicogenic headache. Dissemination of attain values was analyzed using a Chi-Square test, and p values < 0.05 were considered statistically significant. The prevalence of ponticulus posticus in our study was 9.8%, with complete form in 45 (7%) patients of which 29 (64.5%) were male and 16 (35.5%) were female. Partial ponticulus posticus was found in 18 (2.8%) of patients, of which 12 (66.6%) patients were male and six (33.33%) were female. In patients with the complete form of ponticulus posticus, 37 (82.22%) were symptomatic. Among these 37 patients, 22 (59.45%) were male and 15 (40.54%) were female. In complete ponticulus posticus patients, symptoms were slightly worse in males than females. Whereas in partial ponticulus posticus, 13 (72.22%) patients were found to be symptomatic. Of these 13 patients, seven (53.84%) were male and six (46.15%) were female. Of the 72 patients with a history of cervical pain, 50 (69.44%) showed ponticulus posticus on a lateral cephalogram. Of the 568 patients with no history of cervical pain, only 13 (2.2%) showed ponticulus posticus on the lateral cephalogram. This study examination showed that ponticulus posticus is a common anatomic variation often associated with tension-type headaches.

Age estimation using panoramic radiography and lateral cephalogram-A comparative study.

Age estimation allows the identification of living individuals, dead victims and estimation of age in children using maxillofacial radiographs. To compare age estimation by mandibular third molar developmental stages using modified Demirjian's method on OPG with age estimation by mandibular linear dimensions on lateral cephalogram. A total of 200 randomly selected subjects (100 males and 100 females), with age range from 9 to 20 years, and 200 Digital Orthopantomograms and 200 Digital Lateral Cephalograms were utilized for the study. Radiographs were taken with Kodak 8000C Digital Panoramic and Cephalometric machine operating at 60-90 kvp, with exposure time of 8-18 s at 2-15 mA, with an inbuilt magnification factor. A flat screen Compaq TFT-LCD monitor was used to view the OPG images. Linear mandibular dimensional measurements were made on each Digital Lateral Cephalogram using Trophy Dicom Software. Regression analysis and regression coefficient for establishing gender-specific equation were observed. Evaluation of results and statistical analysis was carried by using Student's 't' test. For all test, 'P' value of 0.05 or less was utilized for measuring the degree of significance. Intra-observer variability was detected using reliability analysis. The accuracy of age estimation by OPG was 93.8% and by lateral cephalogram was 79.7%. The OPG analysis is more reliable than the cephalometric parameters.

Linear Cephalometric Analysis of Pharynx at the Level of Epiglottis among Snorers and Nonsnorers: A Cross-Sectional Study.

Background and Aim:Snoring, which falls within the spectrum of sleep-related breathing disorders, is considered to be one of the common symptoms of airway obstruction. Lateral cephalometric analysis is an effective way of diagnosing airway obstruction by evaluating skeletal and soft-tissue abnormalities in patients with sleep-disordered breathing. The present study was planned to analyze the pharyngeal space among snorers and nonsnorers in retroglossal region and in the region of the hypopharynx at the level of epiglottis.Materials and Methods:The present cross-sectional study included a total of 60 individuals who were grouped into snorers and nonsnorers based on their answers for the study questionnaire related to snoring. Digital lateral cephalograms were taken for all maintaining the exposure parameters, whereas Digora software was used for measurements related to the soft-tissue parameters. The two significant soft-tissue parameters analyzed were the distance of epiglottis from the tip of the soft palate, the retroglossal length and the distance of posterior pharynx from the tip of the epiglottis, the pharyngeal space.Statistical Analysis Used:The statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA), whereas paired t-test was used for inter-group analysis. P <0.05 was considered statistically significant.Results:The mean retroglossal length was found to be 25.52 mm among the snorers and 23.70 mm among the nonsnorers. In the case of pharyngeal space, a mean of 8.54 mm was recorded among the snorers, whereas among the nonsnorers, the respective mean value of 10.16 mm was observed.Conclusion:In the present study, pharyngeal space was found to be less at the level of the tip of epiglottis among the snorers compared to nonsnorers which can be attributed to be one of the significant reasons behind snoring and obstructive sleep apnea syndrome.