Digital Lateral Cephalograms Research Articles

Are orthodontic landmarks and variables in digital cephalometric radiography taken in fixed and natural head positions reliable?

The purpose of the study was to evaluate the reliability of the most common landmarks and variables in digital lateral cephalometric radiographies in fixed and natural head positions. Twenty-one patients with anterior or distal displacement of the mandible treated in the Postgraduate Orthodontic Clinic of the Aristotle University of Thessaloniki had a digital lateral cephalometric radiography in fixed and in natural head position. The images where digitized. The main investigator and 6 examiners, digitized 61 landmarks and analysed 34 variables. We examined the intra-observer and inter-observer variability. There was a significant difference in X-axis in the distribution (hence the mean results) according to the reliability of the landmarks and in only 2 variables in digital lateral cephalograms between fixed and natural head position. Cephalometric landmarks and variables showed reliability in digital lateral cephalometric radiography in fixed and natural head position. In lateral cephalograms taken in fixed head position an anterior inclination of the head was noticed compared to those in natural head position.

Morphometric Evaluation of Soft Palate in OSMF Patients Using Cephalometrics.

Oral submucous fibrosis (OSF) is a chronic disease and a well-recognized potentially malignant condition of the oral cavity characterized by inflammation and a progressive fibrosis of the lamina propria and deeper connective tissues. To study the morphology of soft palate in different stages of OSF on digital lateral cephalogram. To compare the changes in morphology of soft palate in OSF patients with control. The study was conducted from 2017 to 2018 on 217 patients with their age ranging from 17 to 60years. All patients detailed clinical examination and history was taken and cephalometric evaluation was done. Type I (51.14%) was found to be the most common in OSF group followed by type II (21.86%) and type VI (13.64%). The present study highlighted the variable radiographic appearances of the soft palate on lateral cephalograms with type I as most common morphology. Cephalometric analysis is one of the most commonly accepted techniques for evaluating the soft palate in both normal individuals and in those with cleft lip and palate.

Pharyngeal airway changes following symohyseal distraction osteogenesis

Introduction: The aim of this study was to analyze the effects of mandibular symphyseal distraction osteogenesis (MSDO) on the pharyngeal airway dimensions in a group of adult patients.Subjects and Methods: The sample consisted of digital lateral cephalograms of 10 patients (7 females and 3 males)with a mean age of 21.0 ± 2.5 years. Radiographs were taken before start of distraction (T1) and following distraction(T2) (12.5 days ± 2.3 days after surgery). Symphyseal distraction was done using a bone-borne distractor. The mean value of mandibular symphyseal distraction was 8.4 ± 1.7 mm. Digital lateral cephalometric tracing was done to evaluate airway changes following symphyseal distraction.Results: Digital lateral cephalometric analysis revealed no statistically significant changes in nasopharyngeal airway(0.3 ± 0.1 mm) (P > 0.05). There were statistically significant changes in oropharyngeal and hypopharyngeal airway widths (1.2 ± 0.3 mm) and (0.7 ± 0.4 mm) respectively (P 0.05) while statistically significant decrease were evident for the vertical measurement H-C3RGN (- 1.2 ± 0.2 mm) (P < 0.01).Conclusion: The results propose that MSDO significantly affects the lower pharyngeal airway dimensions but has no effect on the upper pharyngeal airway measurements. No significant effects on hyoid bone position were observed except mild decrease of its vertical measurement to reference planes. The normal reflex mechanisms that conserve the patency of the airway may have negated any potential changes in the hyoid bone position.

A simplified method for measurement of palatal bone thickness to select the optimum length of orthodontic mini-implant

Introduction The palatal bone is a suitable site for mini-implant placement due to it being a “rootless area” with dense bone. This application has increased with mini-implant-assisted rapid palatal expansion becoming the preferred method of expansion. It is necessary to measure the vertical bone height with a reasonable accuracy, at the implant insertion site, to utilize the maximum available bone support, and to avoid the risk of perforations. As an accepted method, full-volume cone-beam computed tomography (CBCT) scan is advised for the same. This requires an additional procedure, further, radiation exposure, and cost to the patient. The aim of the study was to establish the utility of lateral cephalogram as a simple and reliable method to measure palatal bone thickness for placement of mini-implants in the 1st premolar and 1st molar region, which are the most common sites of mini-implant placement. Materials and Methods A total of 30 CBCT scans and digital lateral cephalograms of patients were selected and analyzed at the 1st premolar and molar region and were statistically evaluated using Student’s t-test and Wilcoxon rank-sum test. Results The results obtained indicated a highly significant correlation between the measurements obtained on lateral cephalograms at both the 1st premolar and 1st molar areas, P &lt; 0.001. Conclusion The data presented show that lateral cephalometry provides a reliable assessment of the quantity of vertical bone for paramedian insertion of a palatal implant.

The Prevalence of Skeletotopy Variation of the Atlas and Vertebral Arteries Among Lithuanians and Its Significance for Physical Medicine Procedures and Rehabilitation

Research background. Vertebral artery relation with atlas anatomical variations can lead to sensomotor disorders of head and neck, and vertebrobasilar insuffciency. Kimmerle’s anomaly, a bony ring around vertebral artery, is also known as a risk factor for physical medicine procedures. To the best of our knowledge, this is the frst study of Ponticulus posticus prevalence in Lithuania. Aim. The research aim was to investigate the prevalence of skeletotopy variations of the posterior arch and vertebral artery among Lithuanian orthodontic patients of various ages and both genders. Research methods. We randomly selected 870 digital lateral cephalograms of Lithuanian orthodontic patients of various ages and both genders. 706 images with good visualization of VA bony socket shadow on the superior surface of the atlas posterior arch were chosen for the investigation. According to the degree of depth of the bony socket we categorized them into three variations: sulcus, groove and bony ring. If contours around VA of bony arch were equal or greater than 180°, we included those cases into the group of bony groove. Research results. We estimated predominance of sulcus (67.6%) of bony socket variations. A bony groove of various depths was found in 24.0% and a bony ring was found in 7.5% of the subjects studied. Vertebral artery groove was found to be more prevalent in females than in males and bony ring was more common in males than in females, but there was no signifcant difference (p &gt; 0.05). Statistically signifcant predominace of bony ring in the age group of 17–20 years (13.2%) was observed and it was higher than in the age group of 8–16 years (5.1%) (p &lt; 0.05). Conclusions. 1. Variations of bony socket including sulcus, groove, and bony ring (Kimmerle’s anomaly) develop in adolescence when ossifcation is most active. 2. The bony ring and semi open groove, which limit mobility of distal part of the vertebral artery, can be a risk factor of physical medicine procedures, especially in the elderly, whose artery walls are less elastic.Keywords: Ponticulus posticus, Kimmerle’s anomaly, atlas, vertebral artery, manual therapy of neck.

Morphological evaluation of soft palate in various stages of oral submucous fibrosis and normal individuals: A digital cephalometric study

Aim of Study: The aim of the study was to evaluate the morphology of soft palate in different stages of oral submucous fibrosis (OSMF) patients using digital lateral cephalogram. Materials and Methods: Total 100 participants were enrolled for the study. They were divided into two groups, Group 1 consisted of first 50 patients diagnosed with OSMF and Group 2 consisted of first 50 non-OSMF patients. Results: Morphology of soft palate was divided into eight types and was compared. Leaf shape (Type 1) was found to be most common and bifid shape least common. It was observed that as the grade of OSMF increases, the size of soft palate also shortens and becomes bulkier as compared to initial stages or non-OSMF group, and results were highly significant with a P value of > 0.05. Conclusion: The soft palate has variable radiographic appearances on lateral cephalometry. The classification system and statistical findings here may help the research of velopharyngeal closure in cleft palate individuals and etiological study of obstructive sleep apnea syndrome and other conditions.

Comparative Evaluation of Nemoceph and Foxit PDF Reader for Steiner\'s Cephalometric Analysis

The aim of this study was to evaluate and compare the values of Steiner's cephalometric analysis using Nemoceph and Foxit PDF Reader. No significant difference between the two methods will result in that Foxit PDF Reader can be used as a cost-effective alternative. This study was conducted on 100 digital lateral cephalograms taken from the same machine. The samples were collected by nonprobability convenience sampling procedures. These images were analyzed for Steiner's cephalometric analysis using two software packages. The skeletal and dental values showed no statistically significant difference in the majority, except for the L1-NA (linear) and L1-NB (linear). Results showed that there is a high agreement between the two methods. This article provides a simple and cost-effective method of onscreen cephalometric analysis. This technique uses the inbuilt measurement tools in the tool bar of our daily use software. The method can be used independently anywhere without any internet connection and software subscription.

Study of patterns of sella turcica with different malocclusions

Background: In the field of orthodontics and dentofacial orthopedics, for treatment of malocclusion, diagnosis of facial skeletal type is one of the important aspects. Sometimes, cephalograms are not enough to determine the facial skeletal pattern. Hence, the relationship between sella turcica and other facial skeletal patterns can guide us to determine the proper facial skeletal type and can also help in treatment planning. Aims: The aim of the study was to investigate the normalcy of the dimensions of sella turcica and comparison of the relationship of sella turcica with different skeletal malocclusions. Materials and Methods: A total of 90 pretreatment digital lateral cephalograms were selected according to the criteria and grouped into 3 groups: Group 1: Class I (n = 30), Group 2: Class II (n = 30), and Group 3: Class III (n = 30). Lateral cephalograms were traced and studied on the basis of sella turcica. The following linear measurements were recorded: length, depth, and diameter of the sella. Statistical Analysis Used: Data were subjected to descriptive analysis for mean and standard deviation of all variables and ranges. ANOVA and a post hoc test (Bonferroni and Sidak) were used for multiple comparisons. P Results: The linear measurements of length and diameter showed statistically significant differences in Class I, Class II, and Class III (P = 0.005). However, depth showed no statistically significant difference in the groups. Conclusions: The importance of sella turcica is established and normalcy is set by statistical analysis, and the standard values are given for the dimensions of the sella turcica. This can be used for further analysis and reference standards for the Indian population. The length and diameter were statistically significant with different groups. The largest value was given in Class III.

Assessment and correlation of the position and orientation of the hyoid bone in Class I, Class II, and Class III Malocclusions

Objective: This study aims to examine and correlate the position and orientation of the hyoid bone in Class I, Class II and Class III malocclusions. Materials and Methods: A total of 90 pretreatment digital lateral cephalograms were chosen in accordance with the established criteria and categorized into three groups, namely: Class I (n = 30), Class II (n = 37), and Class III (n = 23) malocclusions. The lateral cephalograms were traced and various linear and angular parameters such as MPH, H-NL, H-Go, H-Me, H-FH, H-C3, NSH, and H-NL were measured. The standard deviation and arithmetic mean values were computed for every measurement, after which independent t-test was conducted to study the variations between the skeletal classes of malocclusions. Results: The linear measurements of H-Me and H-C3 were found to be statistically significant. The angular measurements of SNA and ANB were also statistically significant and indicated the dissimilarities in the different classes of malocclusions. The anteroposterior position of hyoid bone was established, but the superoinferior positioning was found to be statistically insignificant. Conclusion: A significant difference occurs in the position and orientation of Hyoid Bone in relation to its surrounding structures in Class I, II, and III malocclusions. The hyoid bone is more anteriorly placed in Class III malocclusions than Class II which is more posteriorly placed. The superoinferior positioning of hyoid bone was found to be statistically insignificant in this study.

Determination of the occlusal vertical dimension in edentulous patients using lateral cephalograms.

The determination of the occlusal vertical dimension (OVD) in edentulous patients is based on clinical assessment with high variability. This study tested the hypothesis: The average OVD in edentulous patients with conventional dentures is too low compared to orthodontic norms, when only clinical parameters are used for the determination of the OVD. Edentulous patients with conventional full dentures were enrolled. Clinical parameters were judged by two senior prosthodontists. Digital lateral cephalograms were taken and served to calculate the OVD according to the lower face height angle (ANS-Xi-D) taking tooth-independent facial growth patterns into account. The ANS-Xi-D angle was compared with reference values by applying one-sample mean comparison tests. Thirty-six participants (17 female, 19 male; mean age 65.3±10.6years) were enrolled in this study. Clinically, the OVD of four dentures was judged too low, in one case too high, and in the other 31 cases as correct. The mean ANS-Xi-D angle was 48.28°±4.86 and statistically not different to the norm value of 49°±4 (n.s.). There was a tendency that the ANS-Xi-D angle was different between participants with different tooth-independent facial growth patterns (ANOVA, P=.0548). Predominantly, clinically sufficient prostheses show adequate ANS-Xi-D angles. Short-face type denture patients are often restored to comply with mesiofacial norms. The determination of the OVD based on lateral cephalography is not recommendable to be a standard diagnostic parameter. Orthodontic norms are derived from dentate cohorts and might not take the continuing facial growth and other confounding factors of edentulous subjects into account.

Cephalometric association of mandibular size/length to the surface area and dimensions of the frontal and maxillary sinuses.

Objective:This study aimed to determine the cephalometric association of mandibular size/length to the surface area and dimensions of the frontal and maxillary sinuses.Materials and Methods:This descriptive study was conducted on 116 digital lateral cephalograms of 38 patients with skeletal Class I malocclusion (normal), 40 patients with skeletal Class II malocclusion with mandibular deficiency, and 38 patients with skeletal Class III malocclusion with mandibular excess. Both male and female patients were included. Using AutoCAD 2016 software, the anteroposterior dimension, height and surface area of the frontal and maxillary sinuses, mandibular body length and cephalometric indices including anterior and posterior cranial bases, and growth pattern indices were measured on lateral cephalograms.Results:Dimensions and surface area of the frontal and maxillary sinuses in skeletal Class III malocclusion were greater than those in other groups. These variables were significantly correlated with the mandibular body length. The coefficient for the correlation of height, width, and surface area of the frontal sinus with mandibular body length was 0.253, 0.284, and 0.490, respectively. The coefficient for the correlation of height, length, and surface area of the maxillary sinus with mandibular body length was 0.346, 0.657, and 0.661, respectively. These variables (except for the frontal sinus width) had a significant correlation with the anterior and posterior cranial bases. The frontal sinus width had a significant correlation with the anterior cranial base. These variables in males were greater than those in females.Conclusion:The dimensions and surface area of the frontal and maxillary sinuses in skeletal Class III malocclusion were greater than those in other groups. These variables (except for the frontal sinus width) had a significant correlation with the anterior and posterior cranial bases and mandibular body length.

Long-Term Effects of Distraction Osteogenesis of the Mandible

1) To assess the fate of the permanent teeth in and adjacent to the regenerate in pediatric patients who underwent mandibular distraction osteogenesis (DO) and 2) to compare the postoperative growth of the distracted mandible with age- and gender-matched controls. This was a retrospective cohort study of children who underwent mandibular DO during the primary or mixed dentition period and before completion of somatic growth (boys aged ≤14years and girls aged ≤12years) at Massachusetts General Hospital from 1996 to 2014. From the DO registry, patients were selected who had complete clinical and radiographic records and at least 1year of follow-up. Patients with disorders of dental development (eg, ectodermal dysplasia) were excluded. Panoramic radiographs were used to assess changes in morphology, eruption, and orientation of the dentition. Standardized digital lateral cephalograms were used to assess the mandible (sella-nasion-B point, mandibular unit length, ramus height, body length) preoperatively, at the end of distraction, at 1year after device removal, and at longest follow-up. A total of 118 patients of all ages in the registry underwent some form of DO during the study period. For assessment of the effects on dentition, 26 subjects, who had 36 osteotomies and distraction wounds, met the inclusion criteria. In this sample, 22 of 26 subjects (85%) had 52 adverse effects in 38 of 90 permanent teeth (42.2%) assessed. Cephalometric measurements indicated that there was net mandibular growth at longest follow-up, after a period of skeletal relapse from the end of distraction to 1year after device removal; however, only 2 of 25 subjects (8%) regained a growth rate in the vector of DO that matched or exceeded normal age- and gender-matched controls. DO commonly results in adverse effects on the dentition within and adjacent to the DO gap, with only a minority resolving over time. Net growth of the mandible occurs after DO but at a slower rate and lesser magnitude than that of age- and gender-matched controls.

The application of frontal sinus index and frontal sinus area in sex estimation based on lateral cephalograms among Han nationality adults in Xinjiang

The frontal sinus, due to its unique anatomical features, has become an important element in research for individual identification. Previous studies have demonstrated the use of frontal sinus as an indicator for sex discrimination; however, the sex discrimination rate using frontal sinus was lower compared to that using the traditional morphological methods. In order to improve the sex discrimination percentage, we developed a new method involving the measurement of the frontal sinus index and frontal sinus area from lateral cephalogram radiographs. In this study, 475 digital lateral cephalograms of adult Han citizens from Xinjiang were included. The maximum height, depth, and area of the frontal sinus were calculated using the NemoCeph NX software. The frontal sinus index (ratio of the maximum height to the depth of frontal sinus) was also computed. Statistical analysis results showed significant differences in the frontal sinus index and area between males and females. Discriminant function equation derived from this study differentiated between sexes with 76.6% accuracy. The results demonstrated that the use of frontal sinus index and area for sex discrimination was more accurate than using the frontal sinus index alone.

Assessment of Relation of Orofacial Structures with Pharynx among Males and Females: A Lateral Cephalometric Study.

Aim:This study aimed to determine the correlation between orofacial structure and oropharyngeal airway space.Materials and Methods:It comprised of 160 individuals aged 14–24 years (males: 80 and females: 80), in which digital lateral cephalograms were taken. Linear and cephalometric analyses were performed in all cases.Results:Ba–PNS, apw2–ppw2, hy–apw2, distance between tongue and posterior pharyngeal wall (t–ppw), and Hormion perpendicular and anterior nasal spine-posterior nasal spine (ANS-PNS) showed significant difference between males and females (P < 0.05). Other distances such as Ba–ad1, Ba–ad2, Ptm–ad1, Ptm–ad2, PNS–ppw1, and apw4–ppw4 were statistically nonsignificant (P > 0.05).Conclusion:Linear and cephalometric measurements showed that Ba–PNS, t–ppw, Hy–ppw2, distance between Ho perpendicular and ANS-PNS plane, and apw2–ppw2 were higher in males as compared to females. Lateral cephalograms are useful in orthodontics in performing tracings in individuals with a potential risk of malocclusion.

Accuracy of Automatic Cephalometric Software on Landmark Identification

This study was to assess the accuracy of an automatic cephalometric analysis software in the identification of cephalometric landmarks. Thirty randomly selected digital lateral cephalograms of patients undergoing orthodontic treatment were used in this study. Thirteen landmarks (S, N, Or, A-point, U1T, U1A, B-point, Gn, Pog, Me, Go, L1T, and L1A) were identified on the digital image by an automatic cephalometric software and on cephalometric tracing by manual method. Superimposition of printed image and manual tracing was done by registration at the soft tissue profiles. The accuracy of landmarks located by the automatic method was compared with that of the manually identified landmarks by measuring the mean differences of distances of each landmark on the Cartesian plane where X and Y coordination axes passed through the center of ear rod. One-Sample T test was used to evaluate the mean differences. Statistically significant mean differences (p<0.05) were found in 5 landmarks (Or, A-point, Me, L1T, and L1A) in horizontal direction and 7 landmarks (Or, A-point, U1T, U1A, B-point, Me, and L1A) in vertical direction. Four landmarks (Or, A-point, Me, and L1A) showed significant (p<0.05) mean differences in both horizontal and vertical directions. Small mean differences (<0.5mm) were found for S, N, B-point, Gn, and Pog in horizontal direction and N, Gn, Me, and L1T in vertical direction. Large mean differences were found for A-point (3.0 < 3.5mm) in horizontal direction and L1A (>4mm) in vertical direction. Only 5 of 13 landmarks (38.46%; S, N, Gn, Pog, and Go) showed no significant mean difference between the automatic and manual landmarking methods. It is concluded that if this automatic cephalometric analysis software is used for orthodontic diagnosis, the orthodontist must correct or modify the position of landmarks in order to increase the accuracy of cephalometric analysis.

How common is ponticulus posticus on lateral cephalograms?

BackgroundPonticulus posticus is an anomaly of first cervical vertebra visible on lateral cephalogram and has some serious medical and surgical implications. Unfortunately, it is often overlooked or undetected by orthodontists. The general objective of this study is to sensitize orthodontists about this anomaly by depicting its prevalence among a group of Nepalese orthodontic patients.MethodsFour hundred and fourteen digital lateral cephalograms of orthodontic patients were retrieved from the archives of the department. The lateral cephalograms were carefully assessed for the presence of ponticulus posticus in the posterior spine of atlas vertebra by two investigators independently and the findings were recorded.ResultsPonticulus posticus was observed in 35.7% of the cases, of which 30.9% had partial ponticulus posticus and 4.8% had complete ponticulus posticus. Even though there was some female predilection, no statistically significant association was found between gender of the patient and presence of ponticulus posticus.ConclusionPonticulus posticus is a fairly common anomaly with more than one-third (35.7%) of a group of Nepalese orthodontic patients affected and is independent of gender. Since, this anomaly is associated with numerous medical conditions and has surgical implications, orthodontists should use lateral cephalogram as screening radiograph for this anomaly.

Prevalence of Ponticulus Posticus on Lateral Cephalometric Radiographs, its Association with Cervicogenic Headache and a Review of Literature.

The aim of this study was to calculate the prevalence of ponticulus posticus (a small bony bridge on the dorsal aspect of the atlas on lateral digital cephalometric radiographs) and classify it into a complete ring or an incomplete ring. The study also investigated its association with the presence or absence of cervicogenic headache in the examined population; a literature review of ponticulus posticus is also presented. The presence and types of ponticuli posticus were investigated on 500 digital lateral cephalograms and the same patients were questioned for a history of cervicogenic headache. In 500 patients, 79 ponticulus posticus (34 complete and 45 incomplete) were identified on the lateral cephalograms; therefore, the prevalence was 15.8%. The distribution of the type of ponticulus posticus was 13.1% in males and 17.9% in females in the studied sample. The overall prevalence of cervicogenic headache was 6% in the studied sample with a significant association between cervicogenic headache and type of ponticulus posticus. The study shows that ponticulus posticus is not a rare finding and its association with unexplainable headache, neck pain, and other symptoms as well as its importance and implications during management of cervical spine surgical procedures, especially those requiring lateral mass screw placements in the atlas, imply that radiologists and dentists in general should closely inspect the vertebral region on a lateral cephalogram.

Determination of Specific Anatomic Locations by SIFT Algorithm for Locating Cephalometric Points with the Use of an Automatic Technique

Background: Lateral cephalometry is very important for the evaluation of growth, diagnosis, treatment planning and therapeutic evaluations. Considering the advantages of lateral cephalometric analyses with the automatic technique and given the existing problems, the present study was undertaken to use a new automatic technique for determination of cephalometric landmarks. Aim: The aim of the present study was to determine the specific anatomic area by SIFT algorithm for locating cephalometric points using an automatic technique. Methods: In this study, 110 digital lateral cephalograms were randomly selected and pre-processing was carried out on the images. Three orthodontics used these cephalograms to manually select 11 cephalometric landmarks (point A, point B, PNS, ANS, Po, Or, N, Ar, Me, Gn and Pog) on a software program which had been designed to this end. The coordinates of the selected points were saved in the database for the corresponding process of the images. After completing the software program with these data, 30 new radiographs were submitted to the software program for anatomic determination of the points. SIFT algorithm was used in the software program for the anatomic identification of the landmarks. To make a comparison, these 30 cephalograms were manually analyzed by three orthodontists in order to evaluate the accuracy of the software program at various points. Paired t-teat was used to compare the manual and computerized techniques. Statistical significance was set at P 0.05). Conclusions: It was concluded that the designed algorithm had good performance for easy and relatively difficult points. In relation to very difficult points, too, it exhibited rather acceptable performance and located the points better than other algorithms.

Cephalometric study of the position of ala-tragus line in relation to Frankfort horizontal plane and occlusal plane among Ludhiana population

Introduction: The inclination of occlusal plane (OP) is determined by paralleling the OP to ala-tragus line. Inspite of its wide acceptability, the exact location of tragal point on ala-tragus line is unclear. In addition, morphologic features vary among various ethnic groups. Therefore, it is important to evaluate the exact reference point on tragus among Ludhiana population. Aim: The aim of this study is to determine the posterior reference point of the ala-tragus line that forms the most parallel line with the natural OP among Ludhiana population. Methodology: Digital lateral cephalograms were taken in 100 dentulous Angle's Class I subjects of 18–30 age group. Stainless steel balls were attached to ala of the nose (A) and three points that corresponded to superior (S), middle (M), and inferior (I) points on the tragus of ear. The angle formed by each line (SA, MA, and IA planes) with Frankfort horizontal (FH) plane and OP were measured on all tracings of cephalograms. Results: The mean angular value of IFH (angle between IA-FH planes) was the closest to the Cant of OP, and the mean angular value of IOP (angle between IA plane and OP plane) was the least compared to angles MOP (angle between MA-OP planes) and SOP (angle between SA-OP planes). Conclusion: The inferior point marked on tragus is the most appropriate point for marking ala-tragus line among Angle's Class I subjects of Ludhiana.

Skeletal maturity assessment using calcification stages of mandibular canine

Aim: The aim of this study was to correlate the growth phase of skeletal tissues with the calcification stages of mandibular canine. Materials and Methods: It was a cross-sectional observational study. Anonymized digital orthopantomogram and lateral cephalogram records of 300 pretreatment orthodontic patients aged 8–15 years were collected and analyzed. The calcification stages of right mandibular canine were scored on panoramic radiographs in accordance to the Gleiser and Hunt modified method of assessing tooth mineralization. The growth phase of skeletal maturation was scored on lateral cephalogram in accordance to the cervical vertebral maturation (CVM) method proposed by Baccetti et al. Results: A positive significant correlation was attained relating CVM Stages 1, 2, and 3 with mandibular canine calcification Stages 2, 3, and 4, respectively. Conclusion: The calcification stages of mandibular canine can be implemented for assessing the skeletal maturity clinically.