Digital Lateral Cephalometric Radiographs Research Articles

Deep convolutional neural network-the evaluation of cervical vertebrae maturation.

This study aimed to automatically determine the cervical vertebral maturation (CVM) processes on lateral cephalometric radiograph images using a proposed deep learning-based convolutional neural network (CNN) model and to test the success rate of this CNN model in detecting CVM stages using precision, recall, and F1-score. A total of 588 digital lateral cephalometric radiographs of patients with a chronological age between 8 and 22years were included in this study. CVM evaluation was carried out by two dentomaxillofacial radiologists. CVM stages in the images were divided into 6 subgroups according to the growth process. A convolutional neural network (CNN) model was developed in this study. Experimental studies for the developed model were carried out in the Jupyter Notebook environment using the Python programming language, the Keras, and TensorFlow libraries. As a result of the training that lasted 40 epochs, 58% training and 57% test accuracy were obtained. The model obtained results that were very close to the training on the test data. On the other hand, it was determined that the model showed the highest success in terms of precision and F1-score in the CVM Stage 1 and the highest success in the recall value in the CVM Stage 2. The experimental results have shown that the developed model achieved moderate success and it reached a classification accuracy of 58.66% in CVM stage classification.

Application of a Multi-Layer Perceptron in Preoperative Screening for Orthognathic Surgery.

Orthognathic surgery is used to treat moderate to severe occlusal discrepancies. Examinations and measurements for preoperative screening are essential procedures. A careful analysis is needed to decide whether cases require orthognathic surgery. This study developed screening software using a multi-layer perceptron to determine whether orthognathic surgery is required. In total, 538 digital lateral cephalometric radiographs were retrospectively collected from a hospital data system. The input data consisted of seven cephalometric variables. All cephalograms were analyzed by the Detectron2 detection and segmentation algorithms. A keypoint region-based convolutional neural network (R-CNN) was used for object detection, and an artificial neural network (ANN) was used for classification. This novel neural network decision support system was created and validated using Keras software. The output data are shown as a number from 0 to 1, with cases requiring orthognathic surgery being indicated by a number approaching 1. The screening software demonstrated a diagnostic agreement of 96.3% with specialists regarding the requirement for orthognathic surgery. A confusion matrix showed that only 2 out of 54 cases were misdiagnosed (accuracy = 0.963, sensitivity = 1, precision = 0.93, F-value = 0.963, area under the curve = 0.96). Orthognathic surgery screening with a keypoint R-CNN for object detection and an ANN for classification showed 96.3% diagnostic agreement in this study.

Verification of Convolutional Neural Network Cephalometric Landmark Identification

Introduction: The mass-harvesting of digitized medical data has prompted their use as a clinical and research tool. The purpose of this study was to compare the accuracy and reliability of artificial intelligence derived cephalometric landmark identification with that of human observers. Methods: Ten pre-treatment digital lateral cephalometric radiographs were randomly selected from a university post-graduate clinic. The x- and y-coordinates of 21 (i.e., 42 points) hard and soft tissue landmarks were identified by 6 specialists, 19 residents, 4 imaging technicians, and a commercially available convolutional neural network artificial intelligence platform (CephX, Orca Dental, Hertzylia, Israel). Wilcoxon, Spearman and Bartlett tests were performed to compare agreement of human and AI landmark identification. Results: Six x- or y-coordinates (14.28%) were found to be statistically different, with only one being outside the 2 mm range of acceptable error, and with 97.6% of coordinates found to be within this range. Conclusions: The use of convolutional neural network artificial intelligence as a tool for cephalometric landmark identification was found to be highly accurate and can serve as an aid in orthodontic diagnosis.

Cephalometric Analysis for Gender Determination Using Maxillary Sinus Index in Population of Gujrat, India

Introduction: Humans are sexually dimorphic. Identification of remnants of skeletal and decomposing parts of humans is one of the most difficult skills in forensic medicine. Forensic anthropologists can receive whole or fragmented skeletal remains. But the unique thing is that the maxillary sinus is intact within the skull, so maxillary sinus radiography is being used to identify remains and determine gender. Materials and Method: A total of 51 adult digital lateral cephalometric radiographs (20 males and 31 females) were included in the study. The maxillary sinus analysis was performed by measuring the height and width of these digital lateral cephalometric radiographs using measurement tools of Sidexis4 software. Maxillary sinus index was calculated, discriminant function analysis performed, and discriminant equation derived for determination of gender. Results: Comparison of maxillary sinus parameters (height and width) between male and female groups showed statistically insignificant differences in this study. Regression analysis is done and an equation is derived, which will aid in the prediction of gender by substituting the values of specific measurements in the equation.

Evaluating Soft Tissue Thickness in Different Anterior-Posterior Skeletal Classifications Informative

Background: The soft tissue thickness is affected by anterior posterior skeletal relationship. This study has been designed to evaluate the soft tissue thickness among different anterior posterior skeletal classifications. Material and Methods: In this cross-sectional study, 206 digital lateral cephalometric radiographs from patients undergoing treatment at several orthodontic clinics were evaluated. The skeletal group was determined by the ANB angle. The planned points were determined on digital radiographs using the Digimizer.V4.1.1.0 and then the measurements were done. Data were analyzed by Kruskal-Wallis, Mann-Whitney, Pearson Correlation and Spearman tests. Results: Significant difference showed between soft tissue thickness at Subnasale between class I and II, at Subnasale, Labrale Superius, Stomion Superius, Stomion Inferius between class I and III and at Subnasale, Labrale Superius, Stomion Superius, Stomion Inferius, between class II and III. Among the women, soft tissue thickness at subnasale were higher in class I group compared to class II, Subnasale, Labrale Superius, Stomion Superius, Stomion Inferius were higher in class III compared to class I and at Labrale Inferius was higher in class II compared to class III. Among the men, soft tissue thickness at Stomion Superius, Stomion Inferius and Labrale Superius were higher in class III group compared to class I and II. Conclusion: We established that soft tissue thickness in some landmarks were significantly different between skeletal groups and gender. There is a correlation in soft tissue thickness and skeletal relationship at Stomion Inferius, Subnasale, Labrale Superius, Stomion Superius. Keywords: Soft Tissue, Skeletal Classification, Cephalometry

LE FORT I OSTEOTOMİSİNDE İKİ PLAK İLE MAKSİLLER FİKSASYON YÖNTEMİ :TEKNİK RAPOR VE VAKA SUNUMU

Restoring facial esthetics and occlusion while maintaining long term stability are the goals of orthognathic surgery. Le Fort I osteotomy is frequently used for the correction of dentofacial deformities and is accepted as a relatively stable procedure. Many factors affecting the stability of the mobilized maxilla have been reported. Among these, the use of a stable internal fixation method is of primary importance to postoperative stability. Most oral and maxillofacial surgeons prefer bilaterally applying titanium miniplates in both the anterior apertura piriformis region and the posterior zygomaticomaxillary buttress region to achieve the rigid fixation of the maxillary segment following Le Fort I osteotomy. In the literature, there is currently a lack of agreement on the number of plates required to adequately secure the mobilized maxilla to prevent postoperative relapse. Reducing the number of miniplates allows surgeons to reduce any potential complications, operation time, and costs. In this case report, a patient with maxillary retrognathia and mandibular prognathia, manifesting dental Class III characteristics who underwent one piece Le Fort I osteotomy at Baskent University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery was presented. Under general anesthesia one piece Le Fort I osteotomy was performed. Following down fracture, mobilization of the maxillary segment was completed and 10 mm horizontal advancement movement was achieved. Surgical rigid fixation was performed under intermaxillary fixation with surgical splints. Maxillary fixation was completed with two pre-bent titanium Le Fort I plate placed bilaterally at the piriform apertura with no zygomaticomaxillary buttress fixation. Prior to extubation, intermaxillary fixation and surgical splints were released. Intermaxillary elastics were used six to eight weeks following surgery in addition to a soft, no-chew diet. The patient received both preoperative and postoperative orthodontic treatment. Digital lateral cephalometric radiographs, which were taken one week before orthognatic surgery (T1), one week postoperatively (T2), and nine months postoperatively (T3), were used to analyze skeletal movement and stability of the maxilla. Lateral cephalometric measurements were performed digitally using a computer-assisted software program. Linear and angular measurements of sagittal and vertical maxillary positions was calculated. A horizontal reference plane (HR) +7° to the SN plane at the S point and a vertical reference plane (VR) 90° to the horizontal plane at the Sella point were used in the analyses. After completion of growth and development, the SN plane remains in the same position, giving us the opportunity to measure skeletal movement with these horizontal and vertical reference planes. The difference in the A point-HR distances between the pre and postoperative radiographs indicates the horizontal movement of the maxilla, whereas the difference in the A point-VR distances indicates the vertical movement of the maxilla. The major criteria for maxillary skeletal relapse was the change in the distance from the A point to the horizontal and vertical reference planes. Significant immediate postsurgical changes were found in early postoperative lateral cephalometric radiography (T2). In 9 month follow-up lateral cephalometric measurements (T3) all landmarks in the horizontal and vertical plane showed skeletal stability. The relapse amount in maxillary movement was less than 1 mm in both horizontal and vertical planes. According to the postoperative lateral cephalometric measurements, the two plate anterior fixation method in the one piece Le Fort I ostetomy showed satisfactory results in terms of skeletal stability.

Effects of scanning parameters reduction in dental radiographs on image quality and diagnostic performance: A randomised controlled trial.

To investigate the effect of reducing scanning parameters of digital dental panoramic tomogram (DPT) and lateral cephalometric (LC) radiographs on quality and diagnostic performance of the images. Single-centre prospective two-arm parallel randomised controlled trial. Orthodontic Clinic, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia. Adult orthodontic patients aged 18-35 years, indicated for DPT and LC, who were fit and healthy with a body mass index of 18.5-25.0, not contraindicated to radiographic examination, not pregnant, and did not have a history of facial or skeletal abnormalities or bone diseases were included. Thirty-eight adult orthodontic patients were randomised into control and intervention groups. DPT and LC radiographs in the control group were obtained using standard scanning parameters as prescribed by the manufacturer using Orthopantomograph® OP300 by Instrumentarium. Scanning parameters in the intervention group were reduced by 60% for DPT (60 kV, 3.2 mA) and 30% for LC (85 kV, 8 mA). A five-point rating scale was used for the assessment of image quality. Images were evaluated for diagnostic performance by detection of anatomical landmarks. Mann-Whitney test was performed to compare the quality and diagnostic performance of the images and the observer agreement was assessed using the intraclass correlation coefficient (ICC). For image quality, the control group produced slightly lower median scores (DPT 2.0, LC 2.0) compared to the intervention group (DPT 2.0, LC 3.0). For diagnostic performance, both groups showed similar median scores (DPT 21.0, LC 32.0). The differences between control and intervention groups for both modalities were not statistically significant. The average scores for intra-observer agreement were excellent (ICC 0.917) and inter-observer agreement was good (ICC 0.822). Minimising radiation exposure by reducing scanning parameters on digital DPT by 60% and LC by 30% on Intsrumentarium 300 OP did not affect the quality and diagnostic performance of the images. Thus, scanning parameters on digital DPT and LC should be reduced when taking radiographs.

A Comparative Study on Use of Manual Versus Digital Method using Mobile Application for Cephalometric Measurements

Introduction: Various computer software and smartphone applications have been developed for digital cephalometric analysis with ease and in short time. The objective of this study was to compare linear and angular cephalometric measurements obtained, and cephalometric tracing duration between smartphone application tracing (app method) and conventional tracing (manual method) methods.
 Materials & Method: 35 digital Lateral cephalometric radiographs of patient who came for orthodontic treatment were collected. Measurements of cephalometric parameters of composite analysis were obtained with manual and smartphone application (OneCeph) method and compared statistically. Cephalometric tracing duration was also compared between two methods.
 Result: Cephalometric tracing duration using manual method was found to be significantly higher (p<.001) than that of the app method. There was no significant difference in values of SNA, SNB, ANB, Nasion perpendicular to point A, Nasion perpendicular to pogonion (pog), Angle of convexity, Go-GN/SN, FMA, U1–NA (degree), U1-NA (linear), L1–NB (degree), Cant of Occlusion, Interincisal angle, Nasolabial angle, Upper lip to Steiner’s S line, Lower lip to Steiner’s S line obtained with the manual and application method. The values of linear measurement between Lower incisor to NB line showed significant difference (p<0.05).
 Conclusion: Although there was no significant difference in cephalometric measurement, cephalometric tracing duration of cephalometric analysis using Smartphone application was significantly faster than that of conventional method.

Thickness of Facial Soft Tissue in Adult Patients with Class I, II and III Skeletal Patterns in Digital lateral Cephalometery

Introduction: Understanding the variations in the thickness of facial soft tissue is important in forensic medicine, dentistry, and plastic surgery. This study aimed to evaluate the thickness of the facial soft tissue in adolescents with different maxillary skeletal patterns and compare them between both sexes, by using digital lateral cephalometric radiographs. Methods: 97 patients over 18 years of age referring to a private radiology center for digital lateral cephalometric radiographs participated in this study. Standard digital lateral cephalometric radiographs of patients were categorized based on the ANB angle to three Skeletal jaw classes ( I, II, and III). Then, in each of the lateral cephalometric radiographs, the Soft tissue landmarks including glabella, nasion, subnasale, labrale superius, stomion, labrale inferius, labiomental, pogonion, menton, and the vertical distance of each landmark to the bone surface were determined. Soft tissue thickness landmarks at each site were measured separately in males and females and in three different skeletal class groups. Statistical analysis of multivariate multiplicative variance was used to compare the data. Results: The results of the study showed that soft tissue thickness in Glabella and Labiomental points were not significantly different between men and women (P-value >0.05). Other landmarks in men were significantly higher than women(P-value<0.05). As for the relationship between soft tissue thickness and skeletal classes, subnasale, labrale superius, stomion, labrale inferius had significant association with skeletal classification (P-value<0.05). Conclusion: These findings point to the importance of sex and cranial morphology in soft facial tissues for accurate facial reconstruction

Torque expression by active and passive self-ligating brackets in patients with four premolar extractions: A retrospective study.

Appropriate torque expression contributes to ideal treatment outcomes both clinically and aesthetically. Whether active and passive self-ligating brackets (SLBs) have different torque-control capability in vivo has never been reported. The purpose of present study was to explore whether there was difference in torque expression in active and passive SLBs. In this retrospective study, 225 patients with four first premolar extractions were enrolled. For each patient, the digital lateral cephalometric radiographs were taken before and after treatment. The study consisted of 2 groups: 111 subjects were treated with passive SLBs (Damon Q, Ormco) and 114 subjects with active SLBs (Empower 2, American Orthodontics). Measurements to determine skeletal changes and incisor inclination were obtained from cephalometric tracings using Dolphin software (version 11.8, USA). Comparisons in both groups and intergroups were compared using t tests and chi-square test. Significant differences in the variation of U1-SN(°), U1-NA(°), L1-NB(°) and L1-FH(°) were found between two groups. More labially inclined maxillary incisors were found in active SLB group, while more labially inclined mandibular incisors were observed in passive SLB group. With the present prescription set in the two brackets, active SLBs achieved more proclined maxillary incisors and retroclined mandibular incisors. Clinicians should take torque expression of brackets into consideration during orthodontic treatment.

Cervical vertebral maturation assessment on lateral cephalometric radiographs using artificial intelligence: comparison of machine learning classifier models.

This study aimed to develop five different supervised machine learning (ML) classifier models using artificial intelligence (AI) techniques and to compare their performance for cervical vertebral maturation (CVM) analysis. A clinical decision support system (CDSS) was developed for more objective results. A total of 647 digital lateral cephalometric radiographs with visible C2, C3, C4 and C5 vertebrae were chosen. Newly developed software was used for manually labelling the samples, with the integrated CDSS developed by evaluation of 100 radiographs. On each radiograph, 26 points were marked, and the CDSS generated a suggestion according to the points and CVM analysis performed by the human observer. For each sample, 54 features were saved in text format and classified using logistic regression (LR), support vector machine, random forest, artificial neural network (ANN) and decision tree (DT) models. The weighted κ coefficient was used to evaluate the concordance of classification and expert visual evaluation results. Among the CVM stage classifier models, the best result was achieved using the ANN model (κ = 0.926). Among cervical vertebrae morphology classifier models, the best result was achieved using the LR model (κ = 0.968) for the presence of concavity, and the DT model (κ = 0.949) for vertebral body shapes. This study has proposed ML models for CVM assessment on lateral cephalometric radiographs, which can be used for the prediction of cervical vertebrae morphology. Further studies should be done especially of forensic applications of AI models through CVM evaluations.

Palatally displaced maxillary lateral incisors maybe a causative factor of mandibular deficiency

Introduction: Several factors play a role in the etiology of skeletal Class II malocclusion. Displaced maxillary incisors might have a hindering effect on mandibular growth potential. Aim of the study: The aim of this cross-sectional study was to evaluate the influence of palatally displaced maxillary incisors on mandibular growth in a group of Egyptian patients. Subjects and Methods: The sample consisted of the digital lateral cephalometric radiographs of untreated 24 patients (12 females and 12 males) with age range of 15-30 years and a mean age of 22.4 years during the permanent dentition stage. The radiographs were selected from the patient database of private practice in Cairo. The sample was divided into 2 groups each consisting of 12 patients. Group A had palatally displaced maxillary lateral incisors without crossbite. Group B had palatally displaced maxillary lateral incisors with crossbite. Linear and angular cephalometric measurements (ANB & Witts appraisal) were used to assess the anteroposterior skeletal malocclusion and the position of the apical bases of the jaws in both groups. Independent samples t-test was performed to compare the results between the two groups. Results: Cephalometric measurements revealed statistically significant differences between groups A and B showing a mild skeletal Class II malocclusion with a retrognathic mandible in Group A (mean ANB = 4.4˚ ± 1.85), (mean Witts= 1.85 mm ± 3.22) while Group B had skeletal Class I pattern with mild skeletal Class III tendency (mean ANB= 0.8˚± 1.88), (mean Witts=-2.5mm ± 2.33). Conclusions: Palatally displaced maxillary lateral incisors without crossbite cause restraining effect on normal mandibular growth which results in mild skeletal Class II with mandibular deficiency. However, palatally displaced maxillary lateral incisors that are in crossbite have no restraining effect on mandibular growth which results in normal to slightly excessive mandibular growth. This can be used as a tool for early prediction of mandibular growth pattern that necessitates immediate intervention.

Is Preoperative Maintenance of the Curve of Spee Associated With an Increase of Facial Height in Class II Short Face Orthognathic Patients? A Never Answered Dogmatic Question

To determine the association of maintaining the curve of Spee (COS) before surgery with post-treatment facial height in patients with Class II short face syndrome undergoing combined orthodontic and orthognathic treatment. In this retrospective cohort study, the clinical and radiologic data of all patients with Class II short face syndrome who underwent combined orthodontic and orthognathic treatment were reviewed. The primary outcome variables were 1) preoperative COS and 2) post-treatment facial height. Depth of the COS and skeletal and soft tissue relations were measured on digital lateral cephalometric radiographs. Descriptive and bivariate statistics were performed. The sample was composed of 20 patients. Statistical analysis showed a significant increase of soft tissue facial height after treatment (P<.02). Preoperative depth of the COS was significantly associated with changes in sagittal skeletal relations (angle formed by the sella, nasion, and B point [SNB], correlation [cor]=-0.54, P<.02; angle formed by the A point, nasion, and B point [ANB], cor=0.43, P<.06). These changes and changes in overjet were associated with the post-treatment increase of lower facial height (SNB, cor=0.70, P<.001; ANB, cor=-0.69, P<.001; overjet, cor=-0.55, P<.049). The ratios of upper to lower soft tissue facial height and upper to lower lip height were improved to near normal values (1.0 and 0.5, respectively) for most patients. In patients with Class II short face orthognathism, the present study found that maintaining the COS before surgery was associated with 1) an increase of soft tissue facial height and 2) an improvement of the ratio of upper to lower facial height and the ratio of upper to lower lip height to near normal values. Moreover, the depth of the COS was correlated with the post-treatment increase of facial height through changes in skeletal relations and was related to the degree of severity of the mandibular deficiency.

Size and Morphology of Sella Turcica in Iraqi Adults

To measure the size and describe the morphology of sella turcica on true lateralcephalometric radiographs; and to determine if there is any statistical significantdifference in the size of sella turcica regarding the genders and skeletal classes.The sample included 130 pretreatment digital lateral cephalometric radiographs(67 female and 63 males) with an age range between 17-25 years, collected from theOrthodontic Department in the College of Dentistry, University of Baghdad. Thesample was divided according to ANB angle into 3 skeletal classes. The size of sellaturcica (length, depth, and diameter) was measured and its morphology wasdetermined. Frequency distribution and percentage described the morphology,independent samples t-test was used to test genders difference, while ANOVA testwas performed to show if there is any statistical significant difference in the size ofsella turcica among the skeletal patterns.Males had slightly higher sella turcica measurements than females with a nonsignificantdifference between genders; on the other hand, class III sample had highersella turcica measurements with a non-significant difference among the skeletalclasses. In addition to the normal morphology, six distinct variations of sella turcicawere identified with the highest percentage to the normal morpholgy.All the linear measurements of the sella turcica were within standard range.Neither gender nor skeletal patterns showed significant differences in sella turcicalinear measurements. Normal morphology of the sella turcica was found in themajority of subjects.

Sexual Dimorphism of Calvarial Thickness Parameter in Different Skeletal Patterns

The purpose of the current study was to evaluate the calvarial thickness parameterin both genders, and in different skeletal patterns. The sample included 120pretreatment digital lateral cephalometric radiographs of Iraqi subjects (60 males and60 females) aged between 17 to 30 years, attending Orthodontic Clinic in the Collegeof Dentistry; Baghdad University, and private clinics in Baghdad city. The 120radiographs were divided into 3 groups (40 radiographs for each group) according tothe ANB angles: ANB angle smaller than one degree (Class III), between two andfour degrees (Class I), and larger than four degrees (Class II), each group was furthersubdivided into two subgroups according to gender (20 radiographs for each gender).Four linear measurements were used exclusively in the assessment of calvarialthickness parameter in both genders.The mean calvarial thickness values changed from highest to lowest in sphenoid,parietal, occipital, and frontal bones respectively. In the skeletal class II malocclusionthe frontal and occipital bones' thickness showed highly significant gender differences(P&lt;0.01) using Student's t- test, with females had thicker frontal bone than males, andmales had thicker occipital bone than females, in addition the skeletal glass II groupshowed no significant gender difference (P&gt;0.05) regarding sphenoid and parietalbones' thickness. The most vital outcomes of the present study were the frontal andoccipital bones can be used as important key bones for understanding the calvarialphenotypic description and sexual dimorphism in different skeletal patterns, while thesphenoid and parietal bones can be used as reference bones for standardization ofcephalometric analysis.

Malocclusion and Craniofacial Characteristics in Saudi Adolescents with Sickle Cell Disease.

Background:Sickle cell disease can result in dentofacial abnormalities. However, in Saudi Arabia, there are limited data with respect to orthodontic manifestations in patients with sickle cell disease.Objective:To determine the malocclusion and craniofacial characteristics in sickle cell disease adolescents and compare them with that of controls from the Eastern Province of Saudi Arabia.Methods:This comparative cross-sectional study included 112 Saudi patients with sickle cell disease, aged 12–18 years, and 124 age-matched Saudi controls from three major hospitals in Al Khobar and Dammam, Saudi Arabia. The Dental Aesthetic Index was used to assess malocclusion and orthodontic treatment needs. Digital lateral cephalometric radiographs were recorded for each patient and control, and its analysis included linear and angular measurements.Results:The prevalence of malocclusion was 87.5% in sickle cell disease patients and 54% in controls (P = 0.0001). The percentage of sickle cell disease patients with severe malocclusion that required orthodontic treatment was higher than that of controls (37.5% vs. 26.6%). In the sickle cell disease cohort, incisal segment crowding (72.4%), overjet (67.3%) and maxillary misalignment in the anterior segment (56%) were the most prevalent types of malocclusions and were significantly higher than that of controls (P < 0.05). About 38% and 67% of the sickle cell disease patients had openbite and posterior crossbite, respectively, compared with 19.3% (P = 0.001) and 37.1% (P = 0.0001) of controls, respectively. Cephalometric analysis showed that SNA (86.7°) and ANB (9.9°) angles were significantly higher in sickle cell disease patients than in controls (81.5° and 2°, respectively). In addition, lower central incisor-to-Frankfort horizontal plane (55°) and interincisal angles (121.5°) were significantly lower in sickle cell disease patients than in controls.Conclusion:Adolescents with sickle cell disease had a higher prevalence of malocclusion and greater orthodontic treatment needs than controls. Similarly, they had greater incisal crowding, overjet, openbite and posterior crossbite and demonstrated higher SNA, ANB and lower interincisal angles than controls. The findings of this study suggest that adolescents with sickle cell disease should be provided frequent dental examinations and early orthodontic treatment to improve their oral health, and thus quality of life.

Comparison of craniofacial linear measurements of 20–40 year-old males and females using digital lateral cephalometric radiography in Indonesia

Craniofacial characteristics are one of the sex determination parameters of age after puberty. The aim of this study is to obtain linear measurements using lateral cephalometric radiography of adults aged 20–40 years based on sex in Indonesia. Ten linear craniofacial parameters on 100 digital lateral cephalometric radiographs were measured. Inter-intra observer reliability was tested using Technical Error Measurement. The independent t-test and the Mann–Whitney U test were used to evaluate the significance of the findings. There are significant differences between males and females on 10 of the linear measurements using lateral cephalometric radiography. Lateral cephalometric radiography showed that the linear measurements of 10 cephalometic parameters were higher in males than females, so it can be used to determine sex.

Cephalometric Analysis for Gender Determination Using Maxillary Sinus Index: A Novel Dimension in Personal Identification.

Purpose. Radiography is important in forensic odontology for the identification of humans. The maxillary sinus is the largest of the paranasal sinuses and first to develop. Sinus radiography has been used for identification of skeletal remains and determination of gender. Hence, the aim and objectives of the present study were to establish a new method for gender determination using maxillary sinus index from lateral cephalometric radiographs and to establish the reliability of maxillary sinus for gender determination. Methods. A total of 50 adult digital lateral cephalometric radiographs (25 males and 25 females) were included in the study. The maxillary sinus analysis was performed on these radiographs using the height and width measurement tools of Sidexis XG software. Maxillary sinus index was calculated, discriminant function analysis performed, and discriminant equation derived for determination of gender. Results. The mean maxillary sinus height and width were found to be higher in males, whereas the maxillary sinus index was greater in females. The discriminant function analysis derived in the study was able to differentiate the sex groups with sensitivity of 68% and specificity of 76%. Conclusions. From the results of the present study, it may be concluded that morphometric analysis of maxillary sinus can be used as a reliable tool in gender determination.

Diagnostic concordance between skeletal cephalometrics, radiograph-based soft-tissue cephalometrics, and photograph-based soft-tissue cephalometrics.

This study aims to investigate the diagnostic concordance between skeletal cephalometrics and soft-tissue cephalometrics in identifying facial lower third characteristics. We compared a skeletal cephalometric analysis (SCA) to a soft-tissue analysis performed on cephalometric radiographs (rSTCA) and to one performed on profile photograph (pSTCA). Ninety-six pre-treatment digital lateral cephalometric radiographs and 96 digital profile photographs were randomly selected for this study (patients' mean age: 18.33, SD: 3.38, age range: 14-29). Inclusion criteria were as follows: no skeletal asymmetry, well-aligned upper and lower dental arches, no history of orthodontic treatment, prosthodontic treatment, facial surgery and trauma, patient's age between 14 and 30 years, high-resolution images, exams taken with natural head position. Kruskas-Wallis and post hoc pairwise comparisons tests were used to find differences among the considered cephalometric methods. The diagnostic performance of the three methods was also assessed using the receiver-operating characteristic (ROC) curve analysis. Significant differences were found between SCA and rSTCA and between SCA and pSTCA in defining sagittal and vertical facial lower third characteristics (P < 0.05). No differences were found between rSTCA and pSTCA (P > 0.05) for the same facial characteristics. For each parameters investigated, pSTCA showed an area under the curve much closer to the perfect value of 1.00. Poor diagnostic concordance was found between SCA and rSTCA and between SCA and pSTCA. pSTCA is a reliable method for evaluating the soft-tissue profile characteristics compared to that performed on cephalograms.

Sella landmark variability and its effect on the Angles SNA and SNB: a comparative study

ABSTRACT Objective: To determine intra- and inter-observer precision in Sella (S), Nasion (N), point A and B identification. Additionally, to determine how it can interfere with angular measurements of SNA and SNB by orthodontists and dentomaxillofacial radiologists. Methods: Twenty digital lateral cephalometric radiographs were evaluated by five orthodontists and five dentomaxillofacial radiologists. Results: Differences in linear and angular measuremts were assessed. Intra- and inter-observer agreement was evaluated. Intra- and inter-observer reproducibility of the horizontal and vertical components of the S landmark identification (ICC: 0.75/0.90). Orthodontists tended to produce larger SNA (-0.18º), while SNB angle had a tendency to be smaller (0.55º). In general, SNA angle was smaller (DMFRs: -0.308º and orthodontists: -0.092º), and SNB presented with larger values (DMFR: 0.078º and orthodontists: -0.074º). Conclusion: Identification of the Sella landmark revealed a better agreement amongst dentomaxillofacial radiologists. Orthodontists, however, showed a larger variability in S identification and, consequently, the SNA and SNB angles drifted significantly.