Lateral Cephalograms Research Articles

Can artificial intelligence-driven cephalometric analysis replace manual tracing? A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to investigate the accuracy and efficiency of artificial intelligence (AI)-driven automated landmark detection for cephalometric analysis on two-dimensional (2D) lateral cephalograms and three-dimensional (3D) cone-beam computed tomographic (CBCT) images. An electronic search was conducted in the following databases: PubMed, Web of Science, Embase, and grey literature with search timeline extending up to January 2024. Studies that employed AI for 2D or 3D cephalometric landmark detection were included. The selection of studies, data extraction, and quality assessment of the included studies were performed independently by two reviewers. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A meta-analysis was conducted to evaluate the accuracy of the 2D landmarks identification based on both mean radial error and standard error. Following the removal of duplicates, title and abstract screening, and full-text reading, 34 publications were selected. Amongst these, 27 studies evaluated the accuracy of AI-driven automated landmarking on 2D lateral cephalograms, while 7 studies involved 3D-CBCT images. A meta-analysis, based on the success detection rate of landmark placement on 2D images, revealed that the error was below the clinically acceptable threshold of 2mm (1.39mm; 95% confidence interval: 0.85-1.92mm). For 3D images, meta-analysis could not be conducted due to significant heterogeneity amongst the study designs. However, qualitative synthesis indicated that the mean error of landmark detection on 3D images ranged from 1.0 to 5.8mm. Both automated 2D and 3D landmarking proved to be time-efficient, taking less than 1min. Most studies exhibited a high risk of bias in data selection (n = 27) and reference standard (n = 29). The performance of AI-driven cephalometric landmark detection on both 2D cephalograms and 3D-CBCT images showed potential in terms of accuracy and time efficiency. However, the generalizability and robustness of these AI systems could benefit from further improvement. PROSPERO: CRD42022328800.

Relationship between Cephalometric and Ultrasonic Airway Parameters in Adults with High Risk of Obstructive Sleep Apnea.

Background/Objectives: Polysomnography and cephalometry have been used for studying obstructive sleep apnea (OSA) etiology. The association between craniofacial skeleton and OSA severity remains controversial. To study OSA's etiology, cephalometry, fiberoptic pharyngoscopy, polysomnography, and sleep endoscopy have been used; however, airway obstructions cannot be located. Recent research suggested ultrasonography for OSA screening and upper airway obstruction localization. Thus, this study aims to investigate the relationship between specific craniofacial cephalometric and ultrasonic airway parameters in adults at high risk of OSA. Methods: To assess craniofacial structure, lateral cephalograms were taken from thirty-three adults over 18 with a STOP-Bang questionnaire score of three or higher and a waist-to-height ratio (WHtR) of 0.5 or higher. Airway parameters were assessed through submental ultrasound. Results: NSBA correlated with tongue base airspace width, while MP-H correlated with oropharynx, tongue base, and epiglottis airspace width. SNA, SNB, and NSBA correlated with tongue width at the oropharynx. At tongue base, ANB and MP-H correlated with tongue width. SNB and NSBA were associated with deep tissue thickness at the oropharynx, while MP-H correlated with superficial tissue thickness at velum and oropharynx. Conclusions: Cephalometric parameters (SNA, SNB, ANB, NSBA, and MP-H) were correlated with ultrasonic parameters in the velum, oropharynx, tongue base, and epiglottis.

Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners.

The purpose of this study was to evaluate the mandibular growth and/or projection following maxillary incisor proclination, overbite correction, and maxillary dentoalveolar expansion without the use of any class II mechanics, in growing class II division 2 patients treated with clear aligners. Before and after treatment cone-beam computed tomographic (CBCT) generated lateral and posteroanterior cephalograms of thirty-two patients with skeletal class II division 2, 16 in the treatment group and 16 in the untreated group, were reviewed to evaluate treatment-related changes. Upper incisors were proclined and protruded, as well as upper arch expansion and overbite correction were performed as part of their regular treatment. Cephalometric analysis was performed to evaluate skeletal and dental changes. Unpaired statistical t-tests were performed to determine if significant skeletal class II correction was achieved in the treatment group. In the treatment group, after treatment, the upper incisors became more proclined and protruded, and the inter-molar width increased while the overbite was reduced compared to the control group. An increase in skeletal mandibular growth and forward projection was also observed, thus contributing to an improvement of the sagittal skeletal relationship as evidenced by ANB and Wits values compared to the control group. A combination of upper incisor proclination, correction of deep overbite, and maxillary dentoalveolar expansion using clear aligners appears to contribute to an improvement of the skeletal class II relationship in growing patients with class II division 2. This study shows that unlocking the mandible by correcting a deep overbite, proclining upper incisors, and expanding the upper arch in growing class II division 2 patients can improve skeletal class II using clear aligners. How to cite this article: Mirzasoleiman P, El-Bialy T, Wiltshire WA, et al. Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners. J Contemp Dent Pract 2024;25(4):295-302.

Assessment of Nasal Aesthetic Parameters in Patients with Unilateral Cleft Lip and Palate – A Retrospective Study

Objectives To assess and compare the deviating nasal cephalometric parameters of patients with unilateral cleft lip and palate (UCLP) with a control group. The study also aims to correlate the deviating cephalometric parameters with two aesthetic scoring systems. Design A retrospective study. Setting Dental college and hospital. Participants Pre-treatment lateral cephalograms and extra oral photographs of 20 adult patients with repaired UCLP presenting for orthodontic treatment. 20 patients with age and type of malocclusion matched control were selected. Main Outcome The nasal cephalometric parameters of patients with UCLP and a control group were compared. The nasolabial region of patients with cleft lip and palate (CLP) was scored using Asher McDade Aesthetic Index (AMAI) and Cleft Aesthetic Rating Scale (CARS). The scoring was done by six different groups assessors to study their perception of the nasolabial region. Correlation between cephalometric parameters and the aesthetic scores was done. Results The study found significant differences in nasal length ( P = .003) and depth ( P < .001) between UCLP and the non-cleft control group. In the aesthetic assessment, orthodontist gave the least scores, while layman group scored the highest. The CARS nose aesthetic scores showed statistically significant high, negative correlation with the nasal length ( P = .01). Conclusion The cephalometric parameters and the aesthetic indices can be aid the orthodontists in the assessment of nasolabial aesthetics and additionally refer for further definitive rhinoplasty to improve the patient's overall facial aesthetics.

Hard to Soft Tissue Profile Changes in Skeletal Class III Dentofacial Deformities After Maxillary Advancement and Mandibular Setback Orthognathic Surgery

Objective To correlate the sagittal hard tissue movement and soft tissue changes among patients with skeletal class III malocclusion following bimaxillary orthognathic surgery. Material and Methods Fifty-nine subjects with skeletal class III malocclusion treated consecutively with maxillary advancement and mandibular setback were assessed for skeletal and soft tissue linear changes using presurgical (T1) and post-treatment (T2) lateral cephalograms. Pearson’s correlation coefficient test was used to correlate hard and soft tissue parameters. Results The sagittal hard tissue movement and soft tissue changes for all the parameters assessed in maxilla and mandible showed statistically significant correlations. The ratios of changes for the maxillary protrusion [N-A (HP)] to horizontal subnasale (Sn), superior labial sulcus (Sls), and labrale superioris (Ls) were 0.574:1, 0.703:1, and 0.721:1 respectively. The ratio of horizontal labrale inferioris (Li), mentolabial fold (Mlf), and soft tissue (Pg′) to mandibular protrusion [N-B (HP)] were 0.992:1, 0.970:1, and 0.590:1 respectively and to chin protrusion [N-Pg (HP)] were 1.293:1, 1.252:1, and 1.001:1, respectively. The ratios were different for males and females in maxilla and mandible. Conclusion Sagittal hard tissue movement and soft tissue changes are significantly correlated. The soft tissue movement in the mandible were more proportionate compared to the maxilla. The sagittal hard tissue to soft tissues movement ratios were greater in maxilla and lesser at pogonion and mentolabial sulcus in females compared to males. The ratios obtained can be used for predicting postsurgical soft tissue changes.

The effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group: A multicentre two-arm parallel randomised controlled trial.

To evaluate the effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group in terms of perceived need for orthognathic surgery, skeletal and dental change, and psychological impact. A multicentre two-armed parallel randomised controlled trial. Six UK hospital orthodontic units. A total of 57 patients were randomly allocated into either the BAMP group (BAMPG) (n = 28) or a no treatment control group (CG) (n = 29). Data collection occurred at registration (DC1),18 months (DC2) and 3 years (DC3), where skeletal and dental changes were measured from lateral cephalograms and study models. Oral Aesthetic Subjective Impact Score (OASIS) and Oral Quality of Life (OHQOL) questionnaires were used to assess the psychological impact of treatment. The mean age was 12.9 ± 0.7 years and 12.6 ± 0.9 years in the BAMPG and CG, respectively. At DC2, the BAMPG achieved a class III ANB improvement of +0.6° compared with -0.7° in the CG (P = 0.004). The overjet improvement was +1.4 mm for the BAMPG and -0.2 mm for the CG (P = 0.002). There was no evidence of any other group differences for the other skeletal or dental cephalometric outcomes (P > 0.05) or the questionnaire data (OASIS P = 0.10, OHQOL P = 0.75). At DC2, the 18-month follow-up, 22% of the BAMPG achieved a positive overjet. At the 3-year follow-up (DC3), fewer participants in the BAMPG were perceived to need orthognathic surgery (48%) compared with 75% of participants in the CG (P = 0.04), with an odds ratio of 0.31 (95% confidence interval = 0.10-0.95). The BAMP technique did not show any social or psychological benefits; however, the skeletal class III improvement in ANB and the overjet change were sufficient to reduce the perceived need for orthognathic surgery by 27% compared with the CG.

Comparison Between an Expert Operator an Inexperienced Operator, and Artificial Intelligence Software: A Brief Clinical Study of Cephalometric Diagnostic.

Artificial intelligence (AI) is constantly developing in several medical areas and has become useful to assist with treatment planning. Orthodontics and maxillofacial surgery use AI-based technology to identify and select cephalometric points for diagnostics. Although some studies have shown promising results from the use of AI, the evidence is still limited. Hence, additional investigation is justified. In this retrospective study, 2 human operators (1 expert and 1 inexperienced) and 1 software analyzed 30 lateral cephalograms of individuals with orthodontic treatment indications. They measured 10 cephalometric variables and then 2 weeks later, repeated measurements on 30% of the sample. We evaluated the reliability of the measurements between the 2-time points and the differences in the means between the expert operator and the AI software and between the expert and inexperienced operators. There was high reliability for the expert operator and AI measurements, and moderate reliability for the inexperienced operator measurements. There were some significant differences in the means produced by the AI software and the inexperienced operator compared with the expert operator. Although AI is useful for cephalometric analysis, it should be used with caution because there are differences compared with analysis by humans.

In-office distalizer as Motion Carriere versus Herbst appliance: a comparative study by superimpositions on 156 cases

Among the class II dental supported therapeutic devices, the Carriere Motion Appliance (Henri Schein) was introduced in 2004 followed by in-office adjustments. The objective of this study was to evaluate, by superimpositions, the dento-skeletal effects of the in-office distalizer (D) close to the Carriere Motion Appliance compared to the reference treatment: the Herbst appliance (B). A retrospective intention-to-treat study was conducted. Patients had to be in class II, 1 bilateral, have growth potential, two successive lateral cephalograms. The criteria evaluated were cephalometric, mainly from the Pancherz analysis. Statistical tests were performed with a threshold of 5%. Overall, 116 patients treated with D and multi-attachment appliance (MA) and 40 patients treated with B and MA were included. D and B slow maxillary advance, stimulate mandibular advance and correct the skeletal Class II. They normalize the molar class by distalizing the maxillary arch (palato-position of the maxillary incisors, retreat of the maxillary first molar) and by mesializing the mandibular arch (vestibulo-position and vestibulo-version of the mandibular incisors by 5 to 6°, advance of the mandibular first molar). They provide good control of facial divergence, but with a clockwise tilt of the occlusal plane. Randomized trials are needed to confirm our results. With similar adverse effects, the in-office distalizer may be an interesting alternative because of its smaller volume, comfort and easy manufacture.

Developmental Changes in Pharyngeal Airway in the Male Population From Adolescence to Adulthood.

During adolescence, there is a significant surge in height and total body mass of males. Consequently, they simultaneously experience enhancements in their circulatory and respiratory systems, which adapt to these physiological transformations. The purpose of present study was to investigate the developmental changes in male pharyngeal airway from adolescence to adulthood. Lateral cephalograms of 192 males were obtained and divided into 5 groups: early adolescence (age 10-13 years), middle adolescence (age 14-17 years), late adolescence (age 18-21 years), early adulthood (age 22-30 years), and middle adulthood (ages 31-50 years). The dimensions of pharyngeal airway spaces and the related anatomical structures were investigated. The one-way analysis of variance and Pearson correlation analysis were employed for statistical analysis. During middle adolescence, the pharyngeal airway seems to be nearly completed in males. A significant negative correlation was found between the ANB angle and SPS, TPS, and EPS values.

Clinical implications of amathematical-geometrical model to predict changes in the anterior arch dimension.

Anterior arch length (AL) and the alterations in its dimension following incisor movements were shown to be predictable for an individual patient using amathematical-geometrical model based on athird-degree parabola. Although the model has been validated previously, it is hard to apply in daily orthodontic routine. Thus, the aim of this study was to modify the model using different approaches to allow its establishment in daily routine. This retrospective study was based on astudy collective, which was described previously and consisted of 50randomly chosen dental casts and lateral cephalograms taken before (T0) and after (T1) orthodontic treatment with fixed appliances. AJAVA computer program (Oracle, Austin, TX, USA) was developed to predict AL changes following therapeutic changes of arch width, depth or incisor inclination/position, taking the type of tooth movement into account. Performing exemplary AL calculations with the computer program, general rules and nomograms were set up, followed by multiple linear regression analyses to establish easy-to-use regression equations. The JAVA computer program is available for download. Sagittal changes showed more effect on AL than transverse modifications. Protruding incisors increased AL, but also reduced overbite. The extent of alteration in AL depended on the initial depth, width, incisor inclination, tooth movement type and distance between the incisal edge and the centre of rotation. The computer program precisely predicts individual changes in AL but is time-consuming. The presented regression equations and nomograms, considering metric variables, are easier to apply clinically and the differences compared to the AL calculated by the computer program are negligible.

Comparison of transverse dimensional and incisor changes between wide and narrow orthodontic archwires: a randomized controlled trial.

To clinically compare the effects of broader archwires to standard archwires, using conventional brackets in both cases, on the transverse and incisor changes in maxillary and mandibular arches during leveling and alignment. Fifty-two patients presenting with crowding were allocated into two groups; one group received the broad Damon archwires while the other received standard 3M OrthoForm III Ovoid archwires. All participants were treated with conventional brackets using similar archwire sequences (0.014, 0.018, 0.016 × 0.022/0.016 × 0.025, 0.019 × 0.025 NiTi/CuNiTi archwires). Digital casts were obtained from alginate impressions before treatment (T0) and six weeks after inserting 0.019 × 0.025 NiTi archwires (T1). Pretreatment (T0) and post-alignment (T1) lateral cephalograms were obtained for each patient. The primary outcomes were the changes in the transverse arch dimensions and incisor inclination. The secondary outcomes were the horizontal and vertical linear changes in incisor position. Complete data were collected for 47 patients. There was a significant increase in arch width during treatment within each group, except for upper inter-molar width in 3M group (P = 0.071). Damon wire induced a statistically significant increase in maxillary inter-second premolar width (P = 0.042), and mandibular inter-first premolar (P = 0.043), inter-second premolar (P = 0.008) and inter-molar widths (P = 0.033) compared to 3M group. The increase in incisor proclination and the linear change in incisor position were significant within each group, with less mandibular incisor proclination (P = 0.004) and horizontal advancement (P = 0.038) in the Damon group. Damon archwires created a comparatively greater increase in the maxillary inter-second premolar width and the mandibular inter-first premolar, inter-second premolar, and inter-molar widths, and less proclination and horizontal advancement in mandibular incisors. The study provides invaluable evidence that using broad archwires with self-ligating brackets is the reason behind any greater expansion observed in this system rather than the unique mechanical and biological features exerted by the self-ligating system. Our results suggest that Damon archwire might be a better alternative compared to the narrower standard archwires that are usually used with conventional brackets, especially in the mandibular arch, in cases where mild to moderate crowding is planned to be resolved with a non-extraction approach. However, as arch expansion in the absence of posterior crossbites raises the question of long-term stability, the reported advantage of the use of wide wires should be interpreted with caution and should be considered in the retention phase, bearing in mind that achieving a good post-treatment occlusion is important for enhancing post-treatment stability.

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.

Three-dimensional assessment of condylar morphology, position, and joint spaces in different jaw base divergences: A cone-beam computed tomography study

Objectives: The mandibular condyle being part of the temporomandibular joint complex, its volume, and shape play a pivotal role in treatment stability and outcomes in orthodontic and orthognathic patients over the long term. Different loading patterns would result in different morphology of the TMJ. The association with different facial types and understanding of the relationship between condylar morphology and jaw base divergence is limited. The objective of this study was to assess the condylar morphology, which includes condylar height, length, width, axis angulation, joint spaces, height of the fossa, and volume in different jaw base divergences. Material and Methods: A cross-sectional study was conducted in which 90 patients undergoing orthodontic treatment were selected and allocated into three groups of 30 each, namely, hypodivergent, normodivergent, and hyperdivergent based on Frankfort mandibular plane angle. Patients satisfying the inclusion criteria were subjected to lateral cephalogram and cone-beam computed tomography under standard resolution and field of view of 8 × 8 cm2 with the teeth in maximum intercuspation. On the obtained digital imaging and communications in medicine image, ten anatomical landmarks were marked and analyzed using Carestream imaging software. The condylar volume was assessed using three-dimensional Slicer software. Results were statistically analysed using analysis of variance and post hoc Bonferroni test. Results: The average values of the condylar width and volume showed statistically significant values in the hypodivergent whereas axis angulation and superior joint spaces in the hyperdivergent groups, respectively. Conclusion: Hypodivergent individuals have condyles that are larger in size and volume, whereas hyperdivergent individuals have larger axis angulation and more superiorly positioned condyles.

Growth Patterns of the Maxillomandibular Complex in Preadolescent Patients With Pierre-Robin Sequence Using Cluster Analysis and Longitudinal Follow-Up Cephalometric Data.

To investigate the growth patterns of the maxillomandibular complex in preadolescent patients with Pierre-Robin sequence (PRS). The samples consisted of 20 preadolescent PRS patients who had cleft palate and did not undergo growth-modification therapy or surgical intervention [6 boys and 14 girls; mean age of lateral cephalograms taken, 8.8 y (T1) and 13.7y (T2)]. According to k-means cluster analysis, four clusters were defined over 3 major groups at T1: (1) Both very retrusive maxilla and mandible group: Cluster-4 [n=4, very large gonial angle, very low facial height ratio (FHR)] and Cluster-1 (n=5, small gonial angle, normal FHR); (2) Retrusive maxilla and very retrusive mandible group (Cluster-3, n=7, normal gonial angle, very low FHR); and (3) Both normal maxilla and mandible group (Cluster-2, n=4, very large gonial angle, low FHR). Seven angular and ratio variables [sella-nasion-A point (SNA), sella-nasion-B point (SNB), A point-nasion-B point (ANB), saddle angle, gonial angle, mandibular-body-length/anterior-cranial-base-length (MBL/ACBL), and FHR] at T1 and T2 and growth change from T1 to T2 were investigated. At T1, SNA, SNB, saddle angle, gonial angle (all P<0.05), and FHR (P<0.01) showed significant difference among 4 clusters. At T2, SNA, SNB and gonial angle (all P<0.05) still showed significant difference among 4 clusters. During T1 to T2, there was no significant change in variables at each cluster except an increase in MBL/ACBL in Cluster-1 and FHR in Cluster-3 (all P<0.05). Preadolescent PRS patients exhibited diverse skeletal phenotypes at T1, which did not change significantly from their original skeletal patterns by growth during T1 to T2.

Pilot study for three-dimensional cephalometric Enlow's counterpart analysis: Vertical track. Two-dimensional and three-dimensional comparison.

The introduction of cone beam computed tomography (CBCT) in dentistry has given orthodontists the possibility of studying craniofacial structures in three dimensions. Despite the possibility to obtain lateral cephalograms synthesized from CBCT, this approach still does not provide a fully three-dimensional evaluation of the patient's anatomy. While there has been some success in adapting traditional two-dimensional cephalometric analyses to three dimensions, the specific application of Enlow's cephalometric analysis using CBCT remains unexplored. This pilot study aims to introduce a novel approach for performing Enlow's vertical track analysis using CBCT images. Eighteen CBCT images of skeletal Class I (ANB = 2 ± 2) subjects (12 males and 6 females, aged from 9 to 19 years) with no history of previous orthodontic treatment were selected. For each subject, 2D Enlow's vertical track analysis was performed on lateral cephalograms extracted from the CBCT images, and separately, 3D vertical track analysis was directly performed on the CBCT images. To validate the proposed method, we compared the differences between the posterior vertical counterpart (PVC) and the middle vertical counterpart (MVC), as well as between the middle vertical counterpart (MVC) and the anterior vertical counterpart (AVC), as obtained from both the two-dimensional and three-dimensional analyses. The Kolmogorov-Smirnov normality test was applied for each variable to check whether data were normally distributed and a paired Student's t-test was performed. The level of statistical significance was .05. The comparison between three-dimensional PVC-MVC (-0.43 ± 0.37 cm) and two-dimensional PVC-MVC (-0.53 ± 0.36 cm) revealed no statistical difference (P = .27). Similarly, no significant difference (P = .28) was observed between two-dimensional MVC-AVC (-0.56 ± 0.34 cm) and three-dimensional MVC-AVC (-0.47 ± 0.37 cm). The method proposed by this study to realize the vertical track analysis on 3D images is valid and superimposable on that described by Enlow on lateral cephalograms.

Incisor and Soft Tissue Characteristics of Adult Bimaxillary Protrusion Patients among Different Skeletal Anteroposterior Classifications.

The objective of this study was to investigate the upper incisors (U1), lower incisors (L1), and soft tissue profiles of bimaxillary protrusion (BM) adult patients among skeletal Class I (BM1), II (BM2) and III (BM3). Understanding these characteristics would be useful for incisor and lip diagnostics in different skeletal classifications. Fourteen linear and twelve angular variables of the incisors and lips were evaluated in 214 lateral cephalograms (BM1 = 91, BM2 = 84, BM3 = 39). ANOVA and Bonferroni tests compared the measurements. BM1 and BM3 exhibited a greater U1 position and U1 inclination than the norms, while BM2 presented only a greater U1 position than the norms but normal U1 inclination. BM1 and BM3 had a significantly greater U1 position than BM2. BM1 and BM2 demonstrated a greater L1 position and L1 inclination than the norms, whereas BM3 displayed only a greater L1 position than the norms but normal L1 inclination. BM2 had the most anterior L1 position, whereas BM3 had the least anterior position. Only BM2 had a longer anterior dental height (ADH) than the norms, while BM1 and BM3 had a normal ADH and the significantly shortest ADH, respectively. Only BM1 had a normal upper incisor display at rest (U1R), while BM2 and BM3 displayed an increased and decreased U1R, respectively, with significant differences among the three groups. The most significantly protruded upper and lower lips were presented in BM2, but these were exhibited the least in BM3. The most significant acute nasolabial angle (NLA) was found in BM3, whereas BM2 presented the least acute NLA. A normal lip-chin-throat angle (LCTA) was observed in BM1 and BM3, while only BM2 had a greater LCTA than the norms. The most significant obtuse LCTA was found in BM2, while BM3 had the least obtuse LCTA. Therefore, both U1 and L1 in all groups presented protrusion and proclination, except for U1 in BM2, while L1 in BM3 exhibited normal inclination. The ADH and U1R were increased in BM2 but decreased in BM3. The most acute NLA was found in BM3, whereas the least acute was found in BM2. The most obtuse LCTA was in BM2, while the least was in BM3.

Impact of Overjet Severity and Skeletal Divergence on the Perioral Soft Tissue Area

Overjet (OJ) and skeletal divergence affect the perioral soft tissue. However, no previous study has investigated the combined effects on perioral soft tissue, which includes the upper lip (UL), lower lip (LL), and chin projection. We explored the impact of OJ severity and skeletal divergence on the perioral soft tissue. Lateral cephalograms of 133 untreated skeletal Class II adult patients were allocated into three categories according to the degree of skeletal divergence: hypodivergence (Hypo), normodivergence (Normo), and hyperdivergence (Hyper). Furthermore, OJ was classified as normal OJ (NOJ), moderately excessive OJ (MEOJ), and severely excessive OJ (SEOJ). A matrix of skeletal divergence and OJ variables produced the following groups: NOJ-Hypo, MEOJ-Hypo, SEOJ-Hypo, NOJ-Normo, MEOJ-Normo, SEOJ-Normo, NOJ-Hyper, MEOJ-Hyper, and SEOJ-Hyper. The skeletal, dental, and soft tissue parameters were measured. Statistical analyses showed that increased hyperdivergence and OJ severity corresponded with a more retruded mandibular perioral soft tissue (MPST), except for the Pog’ in the SEOJ-Hypo group, which was insignificantly more prominent than the MEOJ-Hypo group. Unlike the LL, the UL was similar among the groups. Multiple regression indicated that greater OJ and skeletal divergence significantly influenced MPST retrusion and increased vermilion lower lip thickness (VLLT) while independently affecting deeper mentolabial sulcus depth (MSD) and a more obtuse lip-chin-throat angle (P &lt; 0.05). The effect of OJ was most significant at the LL and gradually decreased down to the chin; conversely, divergence increased downwards. The SEOJ-Hyper group displayed the greatest retruded MPST, thickest VLLT, and deepest MSD, which highlighted the combined effect of OJ and divergence.

Diagnostic evaluation of skeletal cephalometric parameters and photograph-Based soft tissue parameters in Malwa Population

The primary goal of orthodontic diagnostic and treatment planning is to create a balanced and aesthetically attractive face. During the decades-long period of cephalometric dominance, the "aesthetic" of the face was predominantly used to describe the profile as observed on a lateral cephalogram However, the paradigm has now shifted to soft tissue-based diagnosis and treatment planning. This creates the need for soft tissue-based analysis especially on photographs considering its evaluation of myriad populations. To evaluate the skeletal cephalometric parameters and photograph-based soft tissue parameters in the Malwa population. The study was conducted using 50 lateral cephalometric radiographs and 50 profile photographs. Data were analyzed for probability distribution using the Shapiro-Wilk test. Descriptive statistics were performed and data were presented as median and inter-quartile range. Correlation between the variables was assessed using Spearman’s correlation coefficient. P value &amp;#60; .05 was considered statistically significant. Our reported values of both photographic and lateral cephalogram parameters are different not only from the international population, but also different values are observed from the not only Indian population, but also from various subsets of the Indian population. Therefore, the average value of lateral profile photographic parameters as well as cephalometric parameters in my study can be used as floating norms for the Malwa population.

Evaluation of different skeletal classes on basis of angles of convexity

The goal of this study was to determine whether it was possible to identify the underlying skeletal Class using a lateral (profile) photograph, as well as which reference points of the angle of convexity are most useful for doing so. Retrospective evaluation of 60 Orthodontic patients baseline profile photos and lateral cephalograms was performed. Based on the Wits values determined by radiographic analysis, the subjects were assigned to skeletal Classes. The Class I subjects were 20 patients (05 males, 15 females) with an average age of 13.3 ±1.42 years, the Class II subjects 20 patients (9 males, 11 females) with an average age of 13.85 ± 1.27 years, and the Class III subjects 20 patients (10 males, 10 females) with an average age of 13.60 ± 1.23 years. A'OrB '(=POrA '-POrA'), A'N'B ', and the angle of convexity with its variants (N'SnPog ', N'A'Pog', TrSnPog', TrA'Pog, Gl'SnPog', and Gl'A'Pog ') were measured. Highly Significant differences between Class II and Class III subjects were seen for all angles (P 0.001). Nearly all angles showed highly significant differences between Classes I and III (P 0.001), and A'N'B' showed significant differences (P 0.05). Only some angles showed significant (P &amp;#62; 0.05) differences between Class I and Class II. It was simpler to distinguish between skeletal Classes I and III than between Classes I and II. The lack of distinction between Division I and Division II subclasses within the Class II subjects could be one of the causes.

Evaluation of reliability of salivary alkaline phosphatase in comparison to other methods of assessing the skeletal maturation

Evaluation of skeletal maturation is crucial to growth determination which in turn influences orthodontic treatment planning. Various methods employed for assessment are chronological age, hand wrist maturation, cervical vertebral maturation, and dental calcification. Recently, salivary Bone specific alkaline phosphatase (BALP) have been introduced due to its role in the bone mineralization process. To test the alternate hypothesis that salivary alkaline phosphatase is a reliable indicator of skeletal maturity in comparison with other methods of assessment of skeletal maturation. Total 112 subjects were selected out of 150 subjects on the basis of inclusion and exclusion criteria, for participation in the study. For each subject, personal details including chronological age was noted. Height and weight measurements were done for calculation of body mass index (BMI). Further, Lateral Cephalogram and Orthopantomogram were obtained for assessment of cervical vertebrae maturation stages and Demirjian index. Then, an unstimulated salivary sample was collected for evaluation of alkaline phosphatase activity by colorimetric method. The data obtained was analyzed using SPSS software. The results of the present study showed that the highest correlation for skeletal maturation assessment was found with alkaline phosphatase activity. The hypothesis is accepted. Salivary Alkaline Phosphatase proved to be reliable biomarker for assessment of skeletal maturation.