SNA Angle Research Articles

Cephalometric Parameters as Predictive Factors for Orthognathic Surgery in Unilateral Cleft Lip and Palate Patients: A Systematic Review and Meta-Analysis.

To identify cephalometric parameters that could predict future need for orthognathic surgery (OGS) in patients with unilateral cleft lip and palate (UCLP). Final search was conducted on July 7, 2024, across PubMed, Scopus, Embase, Web of Science, Cochrane, Ovid Medline, EBSCO, and LILACS, without any language and publication time restriction. Studies comparing surgical versus nonsurgical UCLP patients were included. Two independent reviewers screened studies, and those included were evaluated using Quality in Prognostic Studies (QUIPS) tool. Random-effects meta-analysis of various sagittal and vertical cephalometric parameters (SNA, SNB, ANB, mandibular plane angle [MPA], and lower anterior face height [%LFH]) was performed. Ten studies were included in systematic review and 5 in meta-analysis. Quality in Prognostic Studies tool assessment indicated moderate risk in 6 studies, with 2 demonstrating high and low risks of bias. Meta-analysis revealed that in the 5- to 8-year age group, significant differences were observed in SNA and ANB angles between surgical and nonsurgical groups, with mean differences of 2.25° (95% confidence interval [CI] = 1.12, 3.39) and 3° (95% CI = 1.86, 4.15), respectively. In 9- to 14-year age group, significant differences were found in all 3 sagittal parameters: SNA angle difference of 2.65° (95% CI = 1.44, 3.86), SNB angle difference of 3.23° (95% CI = −4.69, −1.77), and ANB angle difference of 5.54° (95% CI = 3.66, 7.42). Vertical parameters (MPA and %LFH) were not statistically significant between groups in any age group. Cephalometric parameters could be a valuable predictive factor for determining the future need for OGS in patients with UCLP. ANB angle has been shown to be a significant predictor for distinguishing between surgical and nonsurgical patients.

Comment on "Near-Normalized Maxillomandibular Relationship and Upper Airway in Infants With Robin Sequence Treated With Stanford Orthodontic Airway Plate".

It's interesting to note that despite clinical improvements in upper airway dimensions, the maxillary, mandibular, and mandibular body lengths remained smaller than those of controls. This finding may represent an underlying neurocristopathy, which represents a deficiency in the population of neural crest cells available in the embryonic maxillary and mandibular processes de novo. Indeed, it is known that craniofacial dimensions in infants with malformations, such as cleft palate, are often smaller when compared to non-cleft counterparts. The post-treatment decrease in the SNA angle and increase in angle SNB, which resulted in a decreased ANB angle may be associated with a "headgear effect" whereby the maxilla is dragged postero-inferiorly by the mandible, aided by gravity. To avoid this effect, proactive maxillary development might be beneficial. In fact, the concept of "catch-up growth" is also noteworthy since a developmental mechanism would need to be invoked. The authors referred to the old Functional matrix hypothesis, but the treatment effect was primarily a change in jaw position, which evoked a positive functional outcome. Thus, according to the Spatial matrix hypothesis, clinical decompensation of a dysfunctional spatial matrix leads to a cascade of events since a change in mandibular position is associated with changes in gene expression. Recently, genetic expression of Sdf1 and Foxc1 associated with histologic changes following mandibular advancement in rats has been reported as well as the effects of the PINK1/Parkin pathway on the genioglossus muscle through mandibular advancement device use in rabbits with obstructive sleep apnea. Clinically, therapeutic epigenetic changes using an orthodontic mandibular advancement device have also been reported in children.

Anew harmony box supplemented with gonial angle and age based on agrowing Swiss population.

The scope of the present study was to create anew harmony box by adding two diagnostically and clinically important cephalometric variables, the gonial and interincisal angles, while also considering the effect of sex and age for agrowing Swiss population. Ahealthy sample with an overjet and overbite between 2and 4 mm, and 1.5and 4.5 mm, respectively, of the Zurich Craniofacial Growth Study was considered. Pairwise correlations between the cephalometric angles were evaluated with the Pearson correlation coefficient(r). Regression models were built for each cephalometric variable serving as the dependent one. The Akaike Information Criterion and the Bayesian Information Criterion were used to structure and select the final multivariable regression model. Bland-Altman plots and the Lin's concordance correlation coefficient were used to assess inter- and intraexaminer agreement. The sample consisted of 301 individuals with amean age of 13.4 years. Measurement concordance was confirmed both within and between examiners. The strongest correlations were observed between the angles SNB and SNA (r = 0.81), ArGoMe and SN-ML (r = 0.57), and SN-ML and SNB (r = 0.56). The SNB angle qualified as the dependent variable in the multivariable regression that framed the newly provided harmony box, with the predictor variables age (p < 0.001) and the angles SNA (p < 0.001), SN-ML (p < 0.001), SN-NL (p = 0.005), NSBa (p = 0.001), and ArGoMe (p < 0.001). The interincisal angle did not increase the robustness of the model and was excluded (p > 0.05). Contrary to the interincisal angle, gonial angle and age qualified for inclusion in the new harmony box for individualized cephalometrics in asample of healthy schoolchildren from Zurich, Switzerland.

A Cephalometric Evaluation of Anterior Cranial Base Slope in Patients with Different Skeletal Malocclusions

Objective: To assess the correlation in the anterior cranial base (SNA, SNB angles) and among the three different skeletal malocclusions. Study Design: Descriptive cross-sectional study. Study setting: Orthodontic Department KRL Hospital G-9, Islamabad, from March to August 2024. Methodology: The data included lateral cephalograms of people undergoing orthodontic treatment. By simple consecutive non-random sampling technique, a total sample size of 120 patients was selected. IBM SPSS version 23.0 was used for the data analysis. Quantitative data like age, SNA, SNB and ACB slope was expressed in mean (SD) as descriptive statistics. Pearson correlation coefficient was used to evaluate the relationship between the anterior cranial base and the skeletal malocclusions. A p-value ≤ 0.05 was considered statistically significant. Results: Out of 120 patients evaluated in this study, the distribution across the three skeletal malocclusions was as follows: 10% were classified as skeletal class I, 65% as skeletal class II, and 25% as skeletal class III. A significant correlation was observed between the anterior cranial base slope and the type of skeletal malocclusion (p &lt; 0.05). The patients with Class II malocclusion, the SNA angle was notably higher while in Class III malocclusion patients, the SNB angle was significantly increased. Additionally, the SN-FH angle demonstrated a steeper slope in Class III patients compared to those with Class I and Class II malocclusions. There was no significant difference in anterior cranial base length (BA-S) across the malocclusion groups. The correlation analysis between SNA, SNB, and the anterior cranial base slope indicated that the steepness of the cranial base plays a role in the manifestation of the skeletal malocclusions. Conclusion: This research study underscores the significance of the anterior cranial base in the development of skeletal malocclusions. The findings suggest that patients with Class II malocclusion exhibit a steeper anterior cranial base slope, whereas Class III patients tend to have a flatter cranial base slope. These variations in anterior cranial base morphology can serve as effective diagnostic tools in the assessment, evaluation, and treatment planning of skeletal malocclusions. The study also highlights the complex interplay between cranial base morphology and skeletal relationships, indicating the need for comprehensive analysis in orthodontic assessment and treatment strategies.

Evaluating Once a Week Maxillary Advancements Using a Distraction Device

Introduction: Maxillary distraction is often used to correct significant molar Class III malocclusion. We have introduced a modification of the traditional distraction schedule utilizing larger interval distractions once a week under sedation. We hypothesize that this new schedule still allows for successful advancement with limited relapse of the LeFort segment. The underlying principle is that the greatest benefit of maxillary advancement is utilizing the LeFort I segment to expand the soft tissues of the palate and midface. Methods: The modified advancement schedule consisted of the placement of internal distraction devices following a LeFort I osteotomy with an initial advancement of 5 to 8 mm. Thereafter, the patient underwent weekly “interval” advancements under sedation in the operating room. Cephalograms were taken preoperatively, perioperatively, and 6 months after distraction device removal. The cephalometric landmarks were analyzed including SNA and ANB angles as an indicator of maxillary positioning. Results: From June 2021 to September 2023, 13 consecutive patients underwent maxillary advancement with the new interval advancement schedule. Nine patients were found to have all 3 data points required for inclusion in this study. The total distance of advancement averaged 17.2 (±2.9) mm. Patients had an average of 2.7 (±0.7) advancement events. Advancement on the day of surgery averaged 6.7 (±0.8) mm and during each interval advancement event averaged 6.1 (±1.0), 5.2 (±1.6), and 0.5 (±0.5) mm. Conclusion: Modifying the schedule of maxillary distraction from twice daily advancements during the activation phase to weekly advancements with larger interval movements grants acceptable advancement with limited relapse. This new approach to maxillary advancement utilizes both the principles of distraction osteogenesis and soft tissue expansion.

Measurement of Steiner analysis conventionally and digitally at the age of 12-18 years at RSGM-P Universitas Airlangga

Background: Malocclusion is generally not a pathological process but a deviation process that occurs in the growth and development of the craniofacial system starting in childhood, affecting function and aesthetics, thereby impacting quality of life and social interactions. Lateral cephalometry is used to study individual growth changes within a population. Lateral cephalometric analysis measurements can be performed using conventional or digital methods. With technological advancements, several measurement methods using digital and computer applications for cephalometric analysis have been developed. Consequently, digital measurement methods are gradually replacing conventional methods. Purpose: To analyze the results of conventional and digital Steiner analysis measurements on cephalometric radiographs in individuals aged 12-18 years. Methods: A total of 50 lateral cephalometric samples (19 males; 31 females) were selected according to inclusion and exclusion criteria from patients in the Department of Pediatric Dentistry. Steiner analysis was used for each radiographic measurement. The SNA, SNB, and ANB angles were first measured conventionally, followed by digital methods using the Android-based OneCeph application. The results obtained from both methods were then compared. Results: The data used in this study are not normally distributed; therefore, the non-parametric Mann-Whitney test is used to analyze the data. There is no significant difference between the results of Steiner analysis measurements using conventional and digital methods (OneCeph app). Conclusion: The results of this study indicate that there is no difference between the Steiner analysis measurement results for individuals aged 12-18 years using the conventional method (hand-tracing) and the digital method (One-Ceph app).

Does Cranial Base Angle Make a Difference in the Effectiveness of Functional Orthopedic Treatment? A Retrospective Cohort Study.

Background/Objectives: The literature suggests that the cranial base angle is considered one of the contributing factors to sagittal jaw malpositions when its relationship with the viscerocranium is examined. Our study aims to compare and evaluate the outcomes of fixed functional orthopedic treatment in patients with mandibular retrognathia across different cranial base groups. Methods: Participants were treated at Erciyes University with fixed functional appliances and categorized by CBA into low (<130°), medium (130°-134°), and high (>134°) groups. A total of 39 patients were included: 13 in the low CBA group (7 males, 6 females; mean age 14.62 ± 1.12 years), 13 in the medium CBA group (3 males, 9 females; mean age 14.38 ± 0.96 years), and 13 in the high CBA group (4 males, 9 females; mean age 14.08 ± 1.04 years). Results: In the low CBA group, Ar-Go-N (p = 0.005) and SNA (p = 0.023) angles significantly decreased, while the ANB angle and Wits appraisal significantly decreased across all groups (p < 0.05). The high CBA group showed increases in ANS-Me, N-Me, N-ANS, and N-Gn lengths (p < 0.05). The medium and high CBA groups had significant increases in S-Go and ANS-Gn lengths, while Co-Gn length increased significantly in the low and high CBA groups (p < 0.05). Incisor measurements (IMPA, L1-APog, L1/NB, L1-NB) increased in all groups, with overjet and overbite reduced (p < 0.05). U1/PP (p = 0.039), U1/SN (p = 0.043), U1-NA (p = 0.030), and U1/NA (p = 0.025) parameters increased in the low CBA group, with the Upper Lip-E distance decreasing significantly in the low and high CBA groups (p < 0.05). A comparison between groups showed significant differences in U1/PP, U1-NA, and U1/NA parameters, which increased in the low and medium CBA groups but decreased in the high CBA group. Conclusions: CBA influences treatment outcomes. The low CBA group experienced decreases in Ar-Go-N and SNA angles, while the high CBA group showed increases in certain vertical facial dimensions. Incisor parameters rose in the low and medium CBA groups but decreased in the high CBA group, suggesting limited CBA effects on treatment results.

Maxillary sinus volume changes in individuals with different craniofacial skeletal patterns: CBCT study

BackgroundThe maxillary sinus, which is crucial for craniofacial growth, is the largest and earliest sinus to develop among the paranasal sinuses. Our study aimed to evaluate the maxillary sinus volume (MSV) in individuals with different sagittal skeletal patterns via cone beam computed tomography (CBCT).Materials and methodsIn this study, CBCT images of 106 retrospectively selected patients (62 females and 42 males) were included. The ANB and SNA angles were measured to determine the skeletal pattern and position of the maxilla in the sagittal direction. Patients were divided into three groups according to ANB angle: Class I (ANB 2°±2°), Class II (ANB˃4°), and Class III (ANB < 0°). The position of the maxilla in the sagittal direction was divided into three groups according to the SNA angle: normal (SNA 82°±2°), retrognathic (SNA < 80°) and prognathic (SNA˃84°). The MSV was measured by two observers and the data obtained were statistically analyzed.ResultsThe mean age of the participants was 22.5 ± 4.32. The mean MSV was 28.598 ± 7.9 cm3 in females and 34.231 ± 8.93 cm3 in males. The difference between the sexes was statistically significant in terms of MSV (p < 0.001). When the MSV was compared according to different skeletal patterns and positions of the maxilla, no statistically significant difference was detected between the SNA groups (p = 0.650) and the ANB groups (p = 0.905).ConclusionsDifferent skeletal patterns and positions of the maxilla in the sagittal direction do not significantly change the MSV, but compared with sex, the MSV is greater in males than in females. The outcomes of this study may be beneficial in the context of dental interventions such as orthodontics and maxillofacial surgery.Clinical trial numberNot applicable.

The Impact of Presurgical Nasoalveolar Molding on Midface Growth in Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis.

Nasoalveolar molding (NAM) can optimize aesthetic outcomes in patients with cleft lip and palate (CLP), particularly in those with wider clefts. However, its impact on long-term postoperative sequelae such as midface hypoplasia (MFH) remains unclear. This study analyzed cephalometric data to evaluate NAM's effect on MFH in patients with complete unilateral CLP (UCLP). Systematic Review and Meta Analysis. Included studies reported cephalometrics of patients ≥ 7 years old with repaired UCLP who underwent presurgical NAM versus no-NAM (control). Studies of bilateral cases or unoperated clefts were excluded. Main outcomes were cephalometric angles (sella-nasion-A point (SNA), sella-nasion-B point (SNB), and A point-nasion-B point (ANB)) of patients treated with NAM vs. no-NAM. Of 2063 articles, three met inclusion criteria. Cephalometrics were reported for 171 patients (89 NAM, 82 no-NAM) at an average age of 8.5 ± 0.9 years. On pooled analysis, compared to the no-NAM cohort, the NAM cohort had insignificantly smaller SNA (78.8°±1.5° vs. 76.7°±1.5°, p = 0.169), SNB (75.5°±1.0° vs. 75.5°±1.0°, p = 0.954), and ANB (3.6°±1.4° vs. 1.23°±1.2°, p = 0.089) angles. Upon meta-analysis, compared to the no-NAM cohort, the NAM cohort had significantly smaller SNA (Mean Difference (MD) -1.96 [-3.31 to -0.61], p = 0.005) and ANB angles (MD -2.22 [-3.20 to -1.24], p < 0.001). This meta-analysis revealed that patients with UCLP who underwent presurgical NAM had significantly smaller SNA and ANB angles, possibly indicating worse MFH. Before choosing NAM, clinicians should consider CLP severity, potential sagittal growth restrictions, and feasibility, particularly in low-resource settings.

Oral Rehabilitation After Maxillary Protraction With Skeletal Anchorage in a Patient With Oligodontia.

To evaluate the outcomes of skeletal anchorage-supported maxillary protraction and prostetic restoration in a patient with class III malocclusion and hypodontia. Anchorage plates were placed in the apertura piriformis region as skeletal anchorage support. Subsequently, 500g orthopedic force per side was applied for maxillary protraction. After protraction, fixed orthodontic treatment corrected the tooth spaces and occlusion. It was made ready for prosthetic restoration. The active treatment process lasted 23 months. After 3 years, long-term follow-up checks were performed and prosthetic restorations were completed. Following treatment, the SNA angle [Angle between cranial base (SN) and point A] increased by 2.96 degrees, and the SN/GoGn [Angle between cranial base (SN) and mandibular plane] angle increased by 0.18 degrees. The SNB [Angle between cranial base (SN) and point B] and FMA angles [Angle between Frankfurt horizontal plane and mandibular plane] decreased by 2.28 degrees and 0.79 degrees, respectively. The overjet increased by 6.35mm. As a result of long-term follow-up, the results were seen to be stable, and ideal smile aesthetics and occlusion were achieved with prosthetic restorations. Skeletal anchorage-supported protraction treatments in class III malocclusion with insufficient dental support lead to significant improvements in profile and facial appearance.

Skeletal and Dental Effects of Forsus Fatigue Resistance Device Versus Twin Block Appliance for Class II Malocclusion Treatment in Growing Patients: A Systematic Review.

This study systematically searched the literature and assessed the available evidence to compare the efficacy of Forsus Fatigue Resistance Device (FRD) versus Twin Block Appliance (TBA) in treating class II malocclusion. The search for published literature was published up to May 28, 2024. The databases were included in the search: MEDLINE, PubMed, EMBASE, Cochrane Oral Trials Register, Tripe, Web of Science, and Scopus. Additionally, unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and ProQuest Dissertations and Theses. All eligible studies were carefully reviewed and two reviewers independently extracted data. In cases of disagreement, an arbiter was consulted for resolution. Two randomized controlled trials (RCTs) and five non-RCTs were included in this review. The total number of patients included in the studies examining SNA, SNB, and ANB was 254. The studies also looked at the variables Go-Gn, L1-ML, and U1-SN, with 279, 205, and 277 patients included for each variable, respectively. According to the evidence reported, TBA showed greater skeletal effects in terms of mandibular length and advancement. The pooled estimate revealed a statistically significant 1.3° increase in the SNB, and a decrease of -1.34° in the ANB angles for patients treated with TBA compared with those treated with FRD, with no statistically significant differences in the SNA angle. Most studies had a moderate risk of bias, while only two studies had a high risk of bias. FRD has been proven to be an effective treatment device for correcting ANB and restricting SNA angle, similar to TBA. However, TBA appears to offer better mandibular length and SNB outcomes.

Efficacy of the maxillary anterior segmental distraction osteogenesis in patients with cleft lip and palate.

Cleft lip and palate (CLP) is one of the most common birth defects worldwide. It typically results in significant maxillary dysplasia, causing severe oral function problems and substantially affecting the patient's facial aesthetics. Maxillary anterior segmental distraction osteogenesis (MASDO) has gained popularity in recent years as an effective treatment for correcting maxillary dysplasia. However, the evaluation of its effectiveness in patients with CLP varies across different studies. Our research was aimed at providing evidence of the effects of MASDO among CLP patients. A meta-analysis covered Medline, Web of Science, Embase, Scopus, and Cochrane Library. Controlled clinical trial studies published before February 2024 and analyzed changes in maxillary cephalometric landmarks before and after MASDO among patients with maxillary hypoplasia and CLP were included. Our meta-analysis included 10 papers in total. One study was at low risk of bias, seven were at medium risk, and two were at serious risk. MASDO significantly increased the maxillary length. The mean SNA angle increased by 6.43° (95% CI, 4.11° to 8.74°) and A-McNamara rose by 7.29mm (95% CI, 6.21mm to 8.37mm). The maxilla also showed a slight counterclockwise rotation; however, this reached no statistical significance. The mandibular position did not vary remarkably. Moreover, a significant increase in upper anterior tooth tipping and overjet, a decrease in overbite, and an improvement in nasolabial soft tissue were observed. MASDO might be a valid therapy option for CLP patients. It causes a significant increase in the maxillary length, anterior tooth crossbite, and nasolabial soft tissue were also greatly improved.

Craniofacial Growth in Children With Unilateral Cleft Lip and Palate: Adopted From China Versus Born in Sweden.

In 2005, the number of internationally adopted children (IAC) with cleft lip and palate (CLP) from China increased globally, followed by an increase in the number of surgical complications. The aim was therefore to evaluate the craniofacial growth of children with unilateral CLP adopted from China and compare with non-adopted peers (NA). Cephalograms taken at 10 and 13 were analysed for the SNA, SNB, ANB, NAPg and NSBa angles. Surgical data were extracted from the medical records. The rate of secondary cleft-related surgery including secondary alveolar bone grafting (SABG) was higher in the IAC group than in the native groups. At age 10, the IAC exhibited higher SNB and NAPg and lower ANB values than the NA-Mod group and a similar pattern was observed at age 13. The IAC group demonstrated significantly lower SNA and ANB and higher NAPg values than the NA-Orig group at age 10. At age 13, lower SNA and ANB and higher SNB, NAPg, and NSBa values were observed in the IAC group compared with the NA-Orig group. Craniofacial growth is not finalized at age 13 years, why additional studies are needed to determine long-term outcomes. Results from this novel study present unfavorable craniofacial growth at age 10 and 13 years of age among IAC with UCLP and indicate an increased need for future orthognathic surgery compared with NA peers.

Dentofacial and skeletal effects of two orthodontic maxillary protraction protocols: bone anchors versus facemask

BackgroundMaxillary retrognathia and/or mandibular prognathia are resulting in class III malocclusion. Regarding orthodontic class III malocclusion treatment, the literature reports several treatment approaches. This comparative clinical study investigated two maxillary protraction protocols including bone anchors and Delaire type facemask.MethodsCephalometric radiographs of n = 31 patients were used for data acquisition. The patients were divided into two groups according to their treatment protocol: bone anchored protraction (n = 12, 8 female, 4 male; mean age 11.00 ± 1.76 years; average application: 13.50 ± 5.87 months) and facemask protraction (n = 19, 11 female, 8 male; mean age 6.74 ± 1.15 years; average application: 9.95 ± 4.17 months). The evaluation included established procedures for measurements of the maxilla, mandibula, incisor inclination and soft tissue. Statistics included Shapiro-Wilk- and T-Tests for the radiographs. The level of significance was set at p < 0.05.ResultsThe cephalometric analysis showed differences among the two groups. SNA angle showed significant improvements during protraction with bone anchors (2.30 ± 1.18°) with increase in the Wits appraisal of 2.01 ± 2.65 mm. SNA angle improved also during protraction with facemask (1.22 ± 2.28°) with increase in the Wits appraisal of 1.85 ± 4.09 mm. Proclination of maxillary incisors was larger in patients with facemask (3.35 ± 6.18°) and ML-SN angle increased more (1.05 ± 1.51°) than in patients with bone anchors. Loosening rate of bone anchors was 14.58%.ConclusionsBoth treatment protocols led to correction of a class III malocclusion. However, this study was obtained immediately after protraction treatment and longitudinal observations after growth spurt will be needed to verify the treatment effects over a longer period. The use of skeletal anchorage for maxillary protraction reduces unwanted side effects and increases skeletal effects needed for class III correction.

Morphometric Tomographic Analysis of the Head of the Tridactyl Humanoid Specimen from Nasca-Peru

Objective: To report the tomographic and morphometric analysis of the head of the tridactyl humanoid specimen from Nazca, Peru. Method: A qualitative case study approach. RadiAnt DICOM Viewer software version 4.2.1 was used to analyze lengths, diameters, and volume in tomographic images of the head. The morphological biometric analysis applied anthropometric methods using some craniometric points and cephalometric angles. Results and Discussion: As a result, it is reported that there are atypical, strange, and exceptional morphometric imaging features in the cephalic segment of specimen M01. The cephalometric analysis based on the ANB angle revealed a class II skeletal pattern, and according to the Bjorl-Jarabak analysis, it has a convex facial profile with hypodivergent growth (brachyfacial). The patient also has maxillary biprotrusion, severe protrusion of upper and lower incisors, loss of teeth, presence of root remnants, severe dental abrasion, non-assessable canine class, absence of three third molars and ocular protrusion. Based on craniometric points, the SNA angle (Sella, Nasion and Point A) and the SNB angle (Sella, Nasion and Point B) maxillary protrusion and mandibular protrusion were diagnosed. Implications of the research: It is concluded that the combination of uncommon morpho-anatomical features in the maxillofacial and cranial massif do not correspond to a human craniofacial biotype, but could be considered as suggestive findings of morpho-anatomical features typical of a hominid species similar to humans. Originality/Value: The expansion of biometric and morphoanatomical data of the head reinforces the hypothesis that morphologically it would be a non-human hybrid species.

The impact of spheno-occipital synchondrosis exposure via extended endoscopic endonasal surgery on midface growth in pediatric patients.

Pediatric extended endonasal procedures pose significant surgical challenges. Lesions from the suprasellar region to the lower clivus necessitate extensive exposure. This study examined whether drilling the spheno-occipital synchondrosis (SOS) to remove the posterior clinoid process and dorsum sellae (DS) for greater exposure affects pediatric midfacial growth. From 2014 to 2020, the authors performed endoscopic endonasal surgery (EES) in 14 patients aged 12 years or younger. The lesions consisted of 11 cases of craniopharyngioma, 1 pituitary neuroendocrine tumor, 1 Rathke's cleft cyst, and 1 Langerhans cell histiocytosis. In 8 of the 14 cases, an extended EES procedure was used by exposing the SOS to remove the posterior clinoid process and DS. Measurement of the central face was based on head MRI before and after surgery. Measuring points were the sellae-nasion (SN) plane, the foremost points of the anterior maxilla (point A), and the maximum concavity point of the mandibular symphysis (point B). The authors measured and evaluated the SNA angle (angle created by the SN plane and the NA [a line connecting point A and the nasion] plane), SNB angle (angle created by the SN plane and the NB [a line connecting point B and the nasion] plane), and the ANB angle (angle created by the NA plane and the NB plane). In addition, a comparison was made with 6 pediatric cases in which transcranial surgery was performed for craniopharyngiomas. In the extended EES group, the average preoperative age was 7 years, and the average postoperative age was 12 years. Mean preoperative angles in this group were 84° (SNA), 80.9° (SNB), and 3.1° (ANB); mean postoperative angles were 83.5° (SNA), 83.9° (SNB), and -0.4° (ANB). In the standard EES group, the average preoperative age was 9 years, and the average postoperative age was 14.5 years. Average preoperative angles in the standard EES group were 83° (SNA), 80.3° (SNB), and 2.7° (ANB); average postoperative angles were 82.7° (SNA), 81° (SNB), and 1.6° (ANB). In the transcranial surgery group, the average preoperative age was 4.5 years, and the average postoperative age was 9.8 years. Mean preoperative angles were 83.8° (SNA), 80.3° (SNB), and 3° (ANB); mean postoperative angles were 83.8° (SNA), 82.6° (SNB), and 1.2° (ANB). The only significant difference between groups was the postoperative ANB angle, which was negative in the extended EES group compared to the standard EES group, indicating the maxilla was positioned posteriorly compared to the mandible. The measurement values of the EES groups and the transcranial surgery group exhibited minimal differences, except for a significant decrease in the postoperative ANB angle in the extended EES group compared with the standard EES group. These results show that extended EES may impact midface growth. Further research is required to understand the long-term impact of SOS exposure.

Evaluation of Maxillary Protraction Using a Mini Screw-Retained Palatal C-Shaped Plate and Face Mask.

To evaluate a newly designed minimally invasive palatal-plate face mask combination for the management of developing Class III malocclusion due to maxillary deficiency. A sample of 16 Class III patients due to maxillary deficiency in the early mixed dentition (8 boys and 8 girls) aged between 7 and 9 years participated in this study and were treated with a combination of palatal plate face masks. Extra-oral elastics were attached between the intra-oral and extra-oral appliances; the elastics were set at 30° to the occlusal plane. The force magnitude was 250-300 g per quadrant. Cephalometric radiographs were taken before and immediately after maxillary protraction. In addition, skeletal measurements were measured, tabulated, and statistically analyzed. The pre- and post-protraction measurements were compared using the Student's t-test, and the significance level was set at a p-value <0.05. A statistically significant increase in SNA angle and maxillary length was observed by 3.13±1.52 degrees and 2.60±0.75 mm (p<0.05), respectively, indicating forward maxillary growth. The skeletal and soft tissue patterns were also improved, as evidenced by the statistically significant increase in the ANB angle, Wits appraisal, and H angle by 4.50±1.28 degrees, 5.30±1.86 mm, and 5.02±3.24 degrees (p<0.05), respectively. A favorable clockwise mandibular rotation was observed as evidenced by the increase in the SN/MP angle and the decrease in the SNB angle by 1.46±1.96 degrees and -1.38±1.86 degrees (p<0.05), respectively. The palatal-plate facemask combination is an effective treatment alternative for Class III malocclusion due to maxillary deficiency with minimal pain and discomfort.

A comparative study of the efficacy of customized titanium plates versus conventional maxillary protraction in the treatment of skeletal class Ⅲ patients

Objective: To compare the clinical efficacy of customized titanium plate and conventional maxillary protraction treatment in patients with skeletal class Ⅲ malocclusion during growth spurt. Methods: During growth spurt, skeletal class Ⅲ patients with maxillary hypoplasia who were treated in the Department of Orthodontics, Capital Medical University School of Stomatology from August 2018 to July 2021 were prospectively enrolled. They were treated with maxillary protraction using customized titanium plates (customized titanium plate group) and conventional methods (conventional protraction group), respectively. Lateral cephalometric radiographs were collected before and after treatment for conventional cephalometric analysis, including SNA angle (angle between Sella, Nasion and A point), ANB angle (angle between A point, Nasion, and B point), FH-MP angle (mandibular plane angle), Y-axis angle, U1-L1 angle (upper to lower central incisor angle), U1-SN angle (upper incisor to SN plane angle), anterior and lower height, maxillary length, etc. The stable basicranial line (SBL) was used as the reference line to measure the distance from each reference point (ANS point, A point, Prn point, Sn point, UL point etc.) to the stable basicranial vertical line (VerT, the perpendicular line of the skull base line at the intersection point of the anterior wall of the sella image and the inferior edge of the anterior bed process). Paired t-tests were performed on the cephalometric data before and after maxillary protraction treatment in the two groups, and two independent samples t-tests were performed to compare the differences in the efficacy of the two maxillary protraction methods. Results: A total of 20 patients (9 males and 11 females), aged (10.8±1.3) years, were included in the personalized titanium plate group. A total of 20 patients (8 males and 12 females), aged (10.5±1.1) years, were included in the conventional protraction group. The SNA angle, ANB angle, FH-MP angle, Y-axis angle, anterior lower height, maxillary length, ANS-VerT distance, A-VerT distance, Prn-VerT distance, Sn-VerT distance, and UL-VerT distance were significantly higher than those before treatment in the two groups (P<0.05). The changes of SNA angle, ANB angle and A-VerT before and after treatment in the personalized titanium plate group [3.15°±2.28°, 4.64°±1.40°, (4.41±3.43) mm, respectively] were significantly higher than those in the traditional group [2.13°±2.69°, 2.81°±1.10°, (3.13±4.76) mm, respectively](P<0.05), and the changes of U1-L1 angle and U1-SN angle before and after treatment (-0.76°±7.42° and 1.74°±6.38°, respectively) was significantly lower than that of the control group (-5.14°±6.62° and 4.57°±5.24°, respectively, P<0.05). Conclusions: Maxillary protraction can effectively improve skeletal class Ⅲ relationships in growing patients. The linear measurements using the SBL line as a reference plane visualize the sagittal improvement in sagittal relationship after maxillary protraction. The customized titanium plate maxillary protraction treatment has a clear therapeutic effect on patients with skeletal class Ⅲ deformities, and its dental effect is relatively small.

Lateral cephalometric parameters among Arab skeletal classes II and III patients and applying machine learning models

BackgroundThe World Health Organization considers malocclusion one of the most essential oral health problems. This disease influences various aspects of patients’ health and well-being. Therefore, making it easier and more accurate to understand and diagnose patients with skeletal malocclusions is necessary.ObjectivesThe main aim of this research was the establishment of machine learning models to correctly classify individual Arab patients, being citizens of Israel, as skeletal class II or III. Secondary outcomes of the study included comparing cephalometric parameters between patients with skeletal class II and III and between age and gender-specific subgroups, an analysis of the correlation of various cephalometric variables, and principal component analysis in skeletal class diagnosis.MethodsThis quantitative, observational study is based on data from the Orthodontic Center, Jatt, Israel. The experimental data consisted of the coded records of 502 Arab patients diagnosed as Class II or III according to the Calculated_ANB. This parameter was defined as the difference between the measured ANB angle and the individualized ANB of Panagiotidis and Witt. In this observational study, we focused on the primary aim, i.e., the establishment of machine learning models for the correct classification of skeletal class II and III in a group of Arab orthodontic patients. For this purpose, various ML models and input data was tested after identifying the most relevant parameters by conducting a principal component analysis. As secondary outcomes this study compared the cephalometric parameters and analyzed their correlations between skeletal class II and III as well as between gender and age specific subgroups.ResultsComparison of the two groups demonstrated significant differences between skeletal class II and class III patients. This was shown for the parameters NL-NSL angle, PFH/AFH ratio, SNA angle, SNB angle, SN-Ba angle. SN-Pg angle, and ML-NSL angle in skeletal class III patients, and for S-N (mm) in skeletal class II patients. In skeletal class II and skeletal class III patients, the results showed that the Calculated_ANB correlated well with many other cephalometric parameters. With the help of the Principal Component Analysis (PCA), it was possible to explain about 71% of the variation between the first two PCs. Finally, applying the stepwise forward Machine Learning models, it could be demonstrated that the model works only with the parameters Wits appraisal and SNB angle was able to predict the allocation of patients to either skeletal class II or III with an accuracy of 0.95, compared to a value of 0.99 when all parameters were used (“general model”).ConclusionThere is a significant relationship between many cephalometric parameters within the different groups of gender and age. This study highlights the high accuracy and power of Wits appraisal and the SNB angle in evaluating the classification of orthodontic malocclusion.

Stepwise surgical management of binder syndrome with skeletal class III malocclusion in adults

Our study aimed to evaluate a stepwise treatment of class III malocclusion accompanied with flat nasal deformity, using orthodontics, orthognathic surgery, and rhinoplasty, as well as stability during long-term follow-up.In total, 27 patients with nasomaxillary hypoplasia and skeletal class III malocclusion were enrolled in this study. All patients had accepted orthodontic and orthognathic surgery, followed by rhinoplasty with costal cartilage as the second surgical procedure. Clinical results were evaluated by radiography, medical photography, questionnaire, and cephalometric analysis.All patients were satisfied with the surgical results and no serious complications occurred. During the follow-up, the patients showed well-corrected midface contour and nasal projection, and stable occlusion. The costal cartilage grafts were well fixed, without obvious absorption deformation. Lateral cephalometric analysis and overlay results showed that the postoperative point A had advanced approximately 5.20 ± 1.43 mm and the SNA angle had increased by approximately 5.59 ± 2.86°. Soft-tissue measurements showed a 14.22 ± 6.56° decrease in the facial lobe, while the nasolabial angle had increased by 16.83 ± 6.65° postoperatively.The results suggested that stepwise orthodontic-orthognathic surgery and rhinoplasty produce a predictable and stable result in long-term follow-up.