Skeletal Relationships Research Articles

Effects of thalassaemia major on components of the craniofacial complex- a cephalometric study in Andhra Pradesh population

Introduction: The cephalometric study was conducted to evaluate the craniofacial effects of thalassaemia major on the Andhra Pradesh population. Methods: A total of 32 thalassaemic patients (23 male, 9 female) were selected from the Thalassaemia and Sickle Cell Society and 32 controls (19 male, 13 female) from schools of Hyderabad city to eliminate any bias on the ethnic background. All 64 lateral cephalograms were taken under standard conditions with teeth in occlusion and lips in a relaxed position. Forty - two linear and angular cephalometric parameters defining craniofacial morphology (22 skeletal, 13 dentoalveolarand 7 softtissue) were selected. Results: Everypatient with thalassaemia exhibited a skeletal base relationship of class II, accompanied by an average ANB angle of 4°. There was a significant increase in the length of the anterior cranial base. The length of the maxillary and mandibular base was significantly reduced, and the mandible appeared to be retruded in the face. Pronounced vertical growth was evident from linear and angular measurements. The dental deviations seen in thalassaemic patients were proclination, significant over-eruption of the maxillary anterior teeth and increased overjet. A marked increase in the convexity of the lower face, prominent upper lip, reduced nasolabial angle and increased inter-labial angle were evident from soft tissue measurements. Conclusions: The reduced length of the maxillary and mandibular base could be due to chronic anaemia which causes retardation of growth in thalassaemic patients. An increase in the anterior cranial base length resulted in the posterior positioning of the mandible and an increase in anterior facial height led to a skeletal class II pattern.Keywords: Anaemia; craniofacial growth; cephalometry; thalassaemia major.

The use of straightwire technique and myofunctional therapy to treat anterior open bite due to tongue thrusting (case report)

Background : In contrast to the posterior teeth, which are still in occlusion, No incisal contact in the anterior part of the maxilla and mandibula between the vertical dimension is referred to as anterior open. Skeletal irregularity during the expansion of the intermaxillary gap and poor habits can both contribute to openbite. Tongue thrusting is one of the undesirable practices that might result in anterior openbite. Objective : This treatment's objective is to break negative habits by employing myofunctional therapy to develop a healthy swallowing pattern and train the posture of the tongue and lips while at rest. Case Report : A 19-year-old woman who protruded her tongue visited a dental office with the main complaint of an unattractive anterior open bite. She had an open bite of 12 12 21 22 dan 31 32 41 42, a Class II Division I subdivision Angle, a Class II skeletal relationship (protruding maxilla, retrusive mandibula, and bidental protrusive), an overjet of 6.87 mm, an overbite of 0.43 mm, and a Class II skeletal relationship. Case Management : myofunctional therapy combined with straightwire orthodontic treatment. Result : The anterior open bite is rectified, the overjet is reduced to 2,2 mm, and the overbite is increased to 2 mm after 16 months of therapy. The patient's poor swallowing pattern has improved, and their terrible tongue-trusting behavior has decreased. Conclusion : Straightwire method and myofunctional therapy are both effective treatments for anterior openbite repair brought on by tongue thrusting.

The Relationship of Facial Soft Tissue A’N’B Angle and Facial Hard Tissue ANB Angle in Determination of Skeletal Relations

Background: Cephalometric analysis used in orthodontics to informs the diagnosis, treatment planning, quantifies changes during treatment, and provides data for clinical research. It has been used for determination of Skeletal Relations using facial hard tissue ANB Angle. Points A and B on the facial hard tissue correlate closely with the positions of the corresponding points on the soft tissue. This study aims to determine the relationship between the A'N’B angle of soft tissue and the ANB angle of hard tissue in determining the class of skeletal relations
 Method: The sample used in this study was 75 cephalograms, which had been selected according to the criteria. Cephalometric tracing is done manually. Inter-observer and intra-observer measurements were carried out to increase the validity and reliability of the research instrument. The Bland-Altman method is used as a statistical fit test. The results of the research data were then tested for normality with the Kolmogorov-Smirnov test. For further testing to test the significance of the correlation coefficient obtained in the Pearson test, the significance test of the t-test is used.
 Result: The results of t-count > t-table, which means that there is a strong linear relationship between hard tissue ANB and soft tissue A'N’B with a correlation coefficient (r) > 0.05.
 Conclusion: The soft tissue A'N'B' angle can be used as an alternative in determining the class of skeletal relationships in addition to the hard tissue ANB angle

Cephalometric profile analysis between genders. A study protocol

Background: According to current American Association of Orthodontists guidelines, two-dimensional lateral and posteroanterior cephalometric radiographs are recognized as essential components of diagnostic imaging records in orthodontics. Cephalometry is defined as the discipline that analyzes the craniofacial complex in a segmented way, to study the interrelationships between its structures and understand how the growth or alteration of one of these structures can compromise the whole. Through cephalometry, it is possible to indicate the clinical approach for patients, involving dental therapy with intraoral appliances and physical therapy with continuous positive pressure in the upper airway. Objectives: Investigate possible differences in cephalometric anatomical patterns between genders. Methods: This study protocol follows the STROBE - Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A convenience sample will be used, consisting of teleradiography (cephalograms) of adult patients of both genders, carried out in a private Dental Clinic, located in the city of São José dos Campos (SP), Brazil, by the established inclusion and exclusion criteria. Six angular and nine linear measurements will be used in the analysis of cephalometric measures according to the study protocol. The exams will be distributed into three groups and paired according to the value of the angle formed between point A nasion and point B nasion (ANB). Groups will be formed by exams with class 1 skeletal relationship (0o < ANB angle ≤ 4º), group 2 with class 2 exams (ANB angle > 4°), and group 3 formed by class 3 exams (ANB angle ≤ 0°). Considerations: In some cases, craniofacial changes may predict the risk of sleep-disordered breathing, such as obstructive sleep apnea (OSA). Increased length and thickness of the soft palate and hyoid bone in the mandibular plane and retrognathia are associated with the pathogenesis of OSA. Therefore, the etiology of sleep-disordered breathing may vary in patients according to gender, according to cephalometric analysis.

Correlation between Cranial Base, Mandible, and Hyoid Bone Position in Different Anteroposterior Skeletal Malocclusions: A Cephalometric Study

Abstract Background Development of malocclusion can be promptly recognized through an understanding of the optimal position of the bone structures in the orofacial system and their relationship to the cranial base and jaw base. The aim of this study was to assess the relationship between the cranial base, mandible, and hyoid bone in different anteroposterior skeletal malocclusions. Materials and Methods This retrospective study evaluated 120 lateral cephalometric radiographs of individuals aged between 15 and 30 years. The subjects were classified using Burstone's analysis into three groups based on the N perpendicular to point A and N perpendicular to point B. The collected lateral cephalograms of the selected individuals were analyzed using Nemoceph v.12 software (Nemotec, Spain). The nasion-sella-articulare (NSAr), hyoidale angle (C3HyD), sella-articulare-hyoid angle (SArHy), and nasion-sella-hyoid (NSHy) angles were measured and compared among all the three groups. Results In the present study, considering the various angles among the three study groups, a statistically significant difference was observed for the SArHy angle (p < 0.05). However, the saddle angle (NSAr) and hyoidale angle (C3HyD) showed no statistically significant difference between the three study groups. Post hoc Bonferroni test was applied to compare the differences between two groups. A statistically significant difference (p < 0.05) was observed between class I and class II and between class II and class III groups. Conclusion Though the findings of the present study concluded that there is no variation in saddle angle among the three groups, the significant association of SArHy angle among class I, class II, and class III skeletal relationships, suggests an adaptation of the hyoid bone position in various skeletal patterns. We also suggest that the posterior positioning of the hyoid bone is related to skeletal class II malocclusion, whereas a forward positioning of the hyoid bone is related to skeletal class III malocclusion.

Comparison of accuracy of panoramic radiograph and lateral cephalogram in determining linear mandibular measurements among orthodontic patients in tertiary dental care center of Kathmandu

Mandibular dimensions are one of the key parameters for planning the treatment by an Orthodontist. Lateral cephalograms are usually used to evaluate the skeletal relationship. However, due to the superimposition of both the sides, lateral cephalogram may not be reliable in measuring the right and left sides of the cranial landmarks. Panoramic radiography delivers a wide-ranging view of maxillofacial structures with comparatively lesser radiation exposure than other tools and superimposition of structures is less compared to lateral cephalogram image. OPG and lateral cephalograms of all the patients of age group 16-35 years attending Department of Orthodontics in Nepal Medical College from September 2022 to February 2023, having Angle’s Class I Molar relationship with minimum crowding was taken. Linear measurements (ramus height, total mandibular length and mandibular body length) were measured on OPG and Lateral cephalogram. The data was processed in SPSS version 17 for further analysis. There was no statistically significant difference in mean linear measurements between right and left sides on OPG (p-value 0.77, 0.49 and 0.59 respectively). But there was a statistically significant difference in mean linear measurements between both sides on OPG and lateral cephalograms (p-value <0.001). OPG can be used reliably to measure the mandibular length and ramus height of right and left side but comparison of mandibular length and ramus height between lateral cephalogram and OPG may not be reliable.

Cotton on to the problems: a visual aid for mimicking maxillary advancement surgery chairside

When planning orthognathic surgery for patients with a mild Class III skeletal relationship, it may be challenging for orthodontists to predict soft tissue changes in a way that is meaningful to patients. A simple tip is to place two damp cotton wool rolls under the patient's upper lip to mimic anterior repositioning of the maxilla. While dermal fillers are becoming increasingly popular, they can complicate facial assessment as a result of the altered soft tissue profile. Patients should be encouraged not to use dermal fillers at any point along the orthognathic pathway, or delay facial assessment in multidisciplinary clinics until these fillers have dissolved. CPD/Clinical relevance: This article describes a quick and easy chairside aid to help patients and clinicians visualise the facial changes with maxillary advancement surgery by placing two damp cotton wool rolls under the upper lip to mimic anterior repositioning of the maxilla.

The saddle angle and its relationship with different sagittal skeletal patterns for Iraqi population

Abstract Background: The cranial base has a substantial role in determining how the maxilla and mandible are related to each other and its growth influences the maxillo-mandibular growth. Aim: The main aim of this study was to evaluate and assess the relationship of the saddle angle (NSAr) with different patterns of the sagittal interarch skeletal relationship for the Iraqi population and detect the effect of gender on it. Materials and Methods: The samples included 125 true lateral cephalometric radiographs for Iraqi patients of both genders (male and female) between the age of 18–25 years obtained from the clinic’s archives of the Orthodontic Department at the Dentistry Teaching Hospital of the Faculty of Dentistry, Baghdad University, Iraq, who was looking for orthodontic therapy. The samples were divided according to the value of ANB angle into skeletal Cl I (33 females and 14 males), skeletal Cl II (27 females, 14 males), and skeletal Cl III (17 females and 20 males) groups, then the saddle angle were digitized and recorded using AutoCAD 2012 computer program, the data then analyzed by SPSS version 24 (2016) computerized statistical analysis. Results: The results clarified that the mean value of saddle angle was smaller in the skeletal Cl III group for both genders, with females showed the smallest value with no significant difference, and the larger value of saddle angle was in the skeletal Cl II group for both genders with females showed the largest value with no significant difference. Conclusion: The sagittal skeletal relationship tends to alter from skeletal Cl III to Cl II with progressive flattening of the cranial base and vice-versa. The effect of gender on saddle angle was more than that of sagittal skeletal classes.

Treatment Options for Oral Rehabilitation of the Atrophic Maxilla: A Literature Review

Background: The aim of this narrative literature review was clinical indications as well as common complications of the most common treatment options for oral rehabilitation of the upper jaw. The paper also introduced a novel decision-making tool for guiding the selection of the most appropriate treatment for oral rehabilitation based on patients’ residual bone height, width, and quality. Methods: This study is a review article based on PubMed and Scopus that was done by reviewing articles from 2000 to 2022. Treatment choices for edentulous maxillae with the insufficient bone for implant placement comprise two broad classifications: bone defect compensation by bone augmentation techniques and modified implant designs for specific situations to utilize the remaining bone. The following factors have to be taken into consideration: the residual bony anatomy, remaining bone volume and quality, skeletal maxillomandibular relationship, scientific evidence, the experience of the clinicians, and, the patients’ increasing demands and expectations. Results: Grafting techniques are often demanding for both patients and surgeons. Likewise, they are associated with a prolonged treatment time, increased financial cost, and higher complication risks, especially in medically compromised patients. Several non-grafting alternative options have been reported such as zygomatic implants (ZIs), short implants, tilted implants, and the like. Conclusion: Oral rehabilitation in the upper jaw should follow a comprehensive assessment and examination of the patient’s quality and dimensions of residual bone. The clinical decision between grafting versus non-grafting options is associated with several factors.

Relationship between vertical facial morphology and dental arch measurements in class II malocclusion: a retrospective study.

To evaluate the relationship between dental arch measurements and the vertical facial pattern determined in skeletal Class II untreated patients. Lateral cephalograms and plaster models were obtained from 124 untreated female adults (average age: 17.6 ± 3.8 years). Class I (CI), Class II Division 1 (CII/1) and Class II Division 2 (CII/2) malocclusions were divided into three subgroups according to their vertical morphology as hypodivergent, normodivergent and hyperdivergent. The multivariate variance analysis (MANOVA) method was used in the comparison of measurement values according to vertical and sagittal morphology. The relationship between both A point-Nasion-B point (ANB) and Frankfurt-mandibular plane (FMA) angles and dental arch measurements was examined by Pearson correlation analysis. The significance level was received as p < 0.05. While vertical morphology has a statistically significant effect on mandibular arch length, sagittal morphology affects maxillary arch depth. The parameters influenced by both morphologies are maxillary and mandibular arch length, as well as maxillary intermolar width. The mandibular arch length was significantly shorter in hyperdivergent-CII-2 malocclusion (50.5 ± 7.4 mm). Larger values were obtained in both mandibular arch length and maxillary arch depth measurements in CII-1 malocclusion compared to CII-2 malocclusion. The maxillary intermolar width was significantly shorter in hypodivergent-CII-1 malocclusion (46.8 ± 3.4 mm), while it was higher in hypodivergent-CI malocclusion (51.1 ± 3.4 mm). The maxillary arch length was the lowest in hyperdivergent-CI malocclusion (63.1 ± 13.3 mm) and the highest in hypodivergent-CI malocclusion (72.8 ± 7.6 mm). Additionally, a positive but weak correlation was found between ANB and FMA angles. Dental arch measurements have been found to be affected by both vertical facial morphology and skeletal sagittal relationship. A positive correlation was found between ANB and FMA angles.

Association between the occurrence of buccally displaced canine and palatal and craniofacial morphology in adolescents.

The main objective of the present research study is to evaluate the association between the occurrence of buccally displaced canine (BDC) and the palatal as well as the craniofacial morphology in adolescents in accordance at the early permanent dentition. As the experimental group, 100 adolescents of Chinese ethnicity (mean age 13.05 years) with crowding and buccally displaced canine (BDC-c) were selected in comparison with the same number of candidates (mean age 12.59 years) without BDC and crowding as control group. Digital dental casts and cephalograms were collected for three dimensional (3D) and cephalometric measurements. An independent sample T-test was used to compare the cephalometric values between the two groups. Logistic regression as commonly statistical methods used in empirical study including categorical dependent variables was used to identify the joint effects of the dental variables' 3D measurements. When comparing the groups with above analysis, patients with BDC showed a statistically significant narrower and higher palatal vault. For the cephalometric variables, the anterior cranial base length, sagittal position of the maxilla (SNA), sagittal position of the mandible (SNB), and skeletal relationship between maxilla and mandible (ANB) appeared to be smaller, whilst palatal plane angle (SN-PP), Frankfort-mandibular plane angle (FMA), anterior facial height, and lower facial height were larger in BDC-c control group (p < 0.05). A smaller inter-first premolar width was significant in the prediction model (p = 0.002). This study highlights that BDC-c participants in early permanent dentition exhibited a narrower dental arch and higher palatal vault, of which a smaller inter-first premolar width would significantly increase the occurrence of BDC.

Full single arch distalization in Class II malocclusion using subzygomatic temporary anchorage devices: A case report

Abstract Distalization of the maxillary molars is among the most commonly employed nonextraction treatment strategies for angle Class II malocclusion. This approach is primarily recommended for subjects with dentoalveolar maxillary protrusion or minor skeletal abnormalities. A case of a 17-year-old Hispanic male patient with Class II skeletal base with Class II end on canines and molars, upper anterior crowding, severe overjet, and moderate overbite is hereby reported. He refused extraction; therefore, he was offered full single upper arch distalization using subzygomatic temporary anchorage devices (TADs). After 11 months of retraction, the TADs were removed and it was observed that the overjet and overbite were now within normal values and midline shift was also corrected. Satisfactory leveling and alignment, alleviation of crowding, and Class I molar and canine relationship were achieved. The aim of this case report was to describe full single arch distalization using subzygomatic TADs in a patient with Class II skeletal, molar, and canine relationships.

An Update in Non-Nutritive Sucking Habit Cessation

Statement of the problem Non-nutritive sucking habits (NNSH) encompass a variety of comforting behaviours in children. While considered normal in early childhood, the persistence of these habits has the potential to cause adverse effects on dental and skeletal relationships in the permanent dentition. Several interceptive techniques to promote habit cessation have been recommended. Purpose of the review To update the dental practitioner on techniques recommended for cessation of NNSH in children and evidence of their efficacy. Discussion There are various interventions for NNSH cessation, including pacifier substitution, behavioural modification, orthodontic appliances, or aversive therapy. Psychological interventions were more likely to stop NNSH versus no treatment in the short and long term. Appliances were shown to be effective in stopping NNSH and demonstrated favourable effects on occlusion. There was no difference between alternative behavioural techniques. While there is insufficient evidence in support of a single intervention, these techniques demonstrate success when used alone or in combination to promote the cessation of NNSH. Conclusions Creating awareness of the treatment options available for managing NNSH may allow practitioners to work with families to establish early habit intervention, with options individualised to the patient. Further high-quality studies are needed to strengthen the evidence base surrounding techniques available for NNSH cessation in general practice.

Comparison of the transverse cranial base dimension in different craniofacial skeletal relationships: A cone-beam computed tomography study

Background/purposeIn comparing the cranial base's size, most cephalometric studies focused on the length and angle in the anteroposterior direction. However, investigating the anterior, middle, and posterior cranial base's transverse dimensions is challenging. This study aimed to investigate the transverse dimensions of the cranial base in different craniofacial skeletal patterns and sexes using cone-beam computed tomography (CBCT). Materials and methodsA total of 210 adults (105 males and 105 females), including three different skeletal relationships, were included in the study. The cranial base dimensions were measured on a three-dimensional image structure rendered by CBCT. Statistical methods included the Kappa statistic for analysis of consistency and reproducibility and the independent t-test for differences in cranial base dimensions between sexes. A general linear model (GLM) was used to compare the transverse size of the cranial base among skeletal Class I, II, and III groups. The Pearson correlation coefficient explored the correlation among the cranial base dimensions. ResultsThe cranial base dimensions did not differ significantly between skeletal Class I, II, and III. The more prominent cranial base size was found in males than females, except for the crista galli length (CGL) and cribriform ethmoid plate width (CEPW). The cranial base dimensions did not differ significantly between different skeletal relationships. Most dimensions have significant correlations in the middle and the posterior cranial base. ConclusionThe cranial base's transverse dimensions in Taiwanese adults show no significant differences between craniofacial skeletal relationships. In the middle and posterior cranial base, transverse measurements reveal significant sexual dimorphism.

Comparative Study of Soft Tissue and Hard Tissue Variables Correlation between Two Different Racial groups: A Canonical study

Aims: The purpose of this study was to investigate the correlation between dental, skeletal, and soft tissue variables and compare the results with Saudi study and other previous studies. Material and Method: The sample size consisted of 29 adult Sudanese patients (ages 18 to 25) seeking orthodontic treatment, and 19 variables were examined. The error of the method was assessed using Student's t-test, and canonical correlation analysis was used to analyze the correlation between soft and hard tissues. Results: The study found that the Sudanese population had higher mean values in dental and soft tissue variables compared to the Saudi population, while similar mean values were found in the skeletal sagittal relationship, except for the vertical relationship, where the Saudi population had a higher tendency for an open basal configuration. The canonical analysis revealed that the upper and lower incisors' inclinations had a strong negative loading, while the nasolabial angle and lower lip thickness and position had moderate loading. Conclusion: These findings show the impact of these variables which can help the clinician in diagnosis, prediction and assessment of post treatment changes. Additionally, the multivariate statistical analysis extracted a clinically significant association between soft tissue and hard tissue.

Predictability of Wits appraisal, ANB, Beta, Yen, W, µ and Pi angle as indicators of anteroposterior dysplasia in Jharkhand population

: The measurements for assessing the antero-posterior discrepancy between the apical bases are many with their individual benefits and shortcomings. So, it is very important to categorize the reliability of the major diagnostic criteria for successful planning of treatment and to fore see the outcome. The present study assesses the predictability of Wits appraisal, ANB, Beta, Yen, W, µ and Pi angles as an indicators of anteroposterior dysplasia. A total of 120 lateral cephalograms of skeletal Class I, II and III patients were selected based on Down’s facial angle and then tracing was carried out manually to measure Wits appraisal, ANB, Beta, Yen, W, µ and Pi angles. Analysis of variance and correlation coefficient analysis were done to assess the significance of association between these variables. Yen angle is highly predictable and a homogenously distributed angular parameter used to assess sagittal discrepancy. The most desirable differentiation results among the three skeletal relationship were represented by Beta angle followed by Yen angle. Statistically significant correlation among the seven parameters for skeletal Class I relationship were shown by Yen and W angle, for skeletal Class II relationship by Beta angle and µ angle and for skeletal Class III relationship by Beta angle and W angle. No statistically significant correlation existed between Yen Angle and Beta Angle in all the three groups. Yen angle was found to have the most homogenous and predictable parameter. A statistically significant correlation for skeletal Class I relationship were observed between Yen and W angle, for skeletal Class II relationship between Beta and µ angle and for skeletal Class III relationship between Beta angle and W angle and they can be used interchangeably in assessing skeletal jaw relationship.

A skillful combination of invisalign aligners followed with veneers: A case report

Dental aesthetics have become highly important nowadays. Treating aesthetic needs with non-invasive and with minimal techniques can preserve tissues. Invisalign aligners are an aesthetic and comfortable option too for orthodontic treatment. The increased demand for orthodontic treatment in adults has increased and widened the upper age limit for orthodontic intervention. The antero-posterior skeletal relationship of the maxilla and mandible is determined by the ANB angle. Veneers can be one of the techniques which show excellent aesthetic results and longevity of the treatment. This report highlights the relevant aspects of Invisalign aligners and veneers in a 54-year-old female with the minimal invasive method where the aesthetics of patient was highly improved.

Lateral Cephalometric Analysis of Nasal Morphology in Patients Visiting Nishtar Institute of Dentistry

Nasal morphology is the keystone of facial aesthetics. Being the most prominent part of the face, the shape and position of the nose greatly influence the facial profile and nasal soft tissue thickness also plays a vital role in orthodontic diagnosis and treatment planning. Objective: To evaluate the soft tissue nasal morphology in individuals presenting with different skeletal patterns such as skeletal class 1 and skeletal class 2 jaw relationship. Methods: It was Comparative Cross-sectional study conducted in Orthodontics Department of Nishtar Institute of Dentistry for the period of six months (5th Mar 2020 to 6th Jun 2021). Study sample consisted of Lateral cephalometric radiographs of 65 subjects. Age range of sampled subjects was 19-26 years (mean age 20.93). The sample was divided into two groups on basis of the Skeletal jaw relationship as class-1 and class-2. An Independent t-test was applied for evaluation of the difference in lateral nasal morphology between both groups. Results: Notable differences were found between skeletal class 1 and skeletal class 2 groups for the prominence of the mandible and Linear distance between soft tissue Pogonion and Pronasale. Considerable differences in measurements of nasal depth, nasofrontal angle, nasal tip projection angle, nasofacial angle and nasomental angle were found. Conclusions: It is concluded that nasal morphology was greatly influenced by not only the underlying skeletal jaw relationship yet other factors e.g., dentition along with soft tissue thickness were also responsible for nasal morphology differences among various skeletal patterns. Gender dimorphism also exists for various nasal features.

Maxillary sinus and alveolar bone levels in subjects with skeletal anterior open bite: Is there room for mini-implant supported molar intrusion?

Objective: To compare the maxillary sinus (MS) and alveolar bone (AB) heights in adult subjects with normal occlusion and those with skeletal anterior open bite (AOB). Study Design: Cross-sectional. Setting: Aga Khan University Hospital, Karachi. Period: December 2020 to June 2021. Material &amp; Methods: The study was conducted on the pretreatment orthodontic records of sixty adult subjects (30 males, 30 females). Skeletal high angle cases with AOB &gt;1 mm were included in skeletal AOB while a matched sample with normal dental and skeletal relationships was included in normal occlusion group. The MS and AB heights were measured on lateral cephalograms and orthopantomograms at interdental regions from maxillary 1st premolar to 2nd molar. The MS and AB heights were compared between males and females and between skeletal AOB group and normal occlusion groups using independent sample t-test. Results: The mean age of the subjects with skeletal AOB (22.68±4.04 years) and those with normal occlusion (23.19±4.68 years) were comparable (p=0.653). In general, MS height and AB heights were greater in males than females. There was no significant difference in the MS height between the skeletal AOB and normal occlusion groups for both genders (p&gt;0.05). However, both males and females with skeletal AOB had greater AB heights between 2nd premolar and 1st molar and between 1st molar and 2nd molar than those with normal occlusion (p&lt;0.05). Conclusion: The MS height in skeletal AOB and normal occlusion groups were comparable. Subjects with skeletal AOB had maximum AB height mesially and distally to maxillary 1st molar that was significantly greater than those with the normal occlusion.

The accuracy of photographic soft-tissue profile analysis to determine Class II and vertical skeletal relationships in children.

Lateral cephalometric analysis (LCA) is the reference standard for identifying common skeletal relationships in orthodontics, such as Cl II and hyperdivergent skeletal discrepancies, but it entails radiation exposure. Therefore, photographic soft-tissue profile analysis (PSPA) could be a useful alternative for these diagnoses, particularly for paediatric patients. This study aims to estimate the accuracy of PSPA for determining common skeletal discrepancies in children. Cephalometric radiographs and profile photographs of a consecutive series of 100 children (8.0-17.6 years old) made on the same day were included. The validity of PSPA was verified against comparable LCA. First, by assessing the Pearson correlation and then estimating the sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the curve (AUC) in sample A (n = 50). After external validation in a new sample B (n = 50), the ROC-AUC, diagnostic odds ratio, best cut-off points and discriminative validity were assessed in the total sample. Interrater reliability was estimated using the intraclass correlation coefficient, the standard error of measurement and Bland-Altman plots. The measurement properties of the PSPA angles A'N'B', Gl'-Sn-Pog, N'-Sn-Pog', and N'-Tra-Me' were valid (ROC-AUC > 0.7) and reliable (ICCs > 0.92). The angles A'N'B', Gl'-Sn-Pog', and N'-Sn-Pog', with the respective cut-off points ≥7.7', ≥12.8', and ≤163.5', were accurate values for determining Cl II discrepancy. The N'-Tra-Me'-angle (≥63') was an accurate estimate for a hyperdivergent discrepancy. These validated PSPA angles could be used in clinical settings as a minimally invasive diagnostic tool to screen children suspected of having skeletal Cl II and hyperdivergent discrepancies.