Vertical Facial Types Research Articles

Three-dimensional morphological features of temporomandibular joint in skeletal malocclusion Class III patients with different vertical skeletal facial types

To investigate three-dimensional morphological features of temporomandibular joint in skeletal malocclusion Class III with different vertical skeletal facial types. Methods: A total of 46 adults with skeletal malocclusion Class III were enrolled and allocated into a normal-angle, a high-angle and a low-angle groups. All patients were undergone cone beam computed tomography (CBCT). Images of temporomandibular joint were reconstructed and analyzed by Invivo 5. Nine measurements relevant to the positions and forms of condyle as well as joint spaces were performed. Results: Significant differences were not observed between the 2 sides of each group among skeletal malocclusion Class III (P>0.05). Compared with the high-angle and normal-angle patients, the low-angle patients had larger superior spaces, bigger gradients of the articular tublecle, longer condyle, and larger internal spaces between the condyle and the fossa. Compared with the low-angle and normal-angle patients, the high-angle patients had smaller condylar antero-posterior diameters. Conclusion: Class III malocclusion patients with different vertical skeletal patterns have different positions and forms of condyles, which should be paid attention to in clinic.

Evaluation of buccolingual molar inclinations among different vertical facial types.

ObjectiveThe aim of this study was to compare the buccolingual inclination of maxillary and mandibular molars in adults with different vertical facial types.MethodsCone-beam computed tomography images of 135 adult patients (age, 20–45 years) with skeletal Class I maxillomandibular relationships were assigned to normodivergent (n = 46), hypodivergent (n = 49), and hyperdivergent groups (n = 40) according to linear and angular sella-nasion/gonion-menton measurements. The normodivergent group consisted of 24 females and 22 males, hypodivergent group of 26 females and 23 males, and hyperdivergent group of 24 females and 16 males. Buccolingual inclination of the maxillary and mandibular first and second molars was measured relative to the occlusal plane. One-way analysis of variance was used for intergroup comparison. Gender differences were evaluated using independent t-tests.ResultsBuccolingual molar inclinations did not differ significantly between females and males (p > 0.05). There were no statistically significant differences among the buccolingual inclinations of the first and second maxillary and mandibular molars of the groups (p > 0.05).ConclusionsBuccolingual inclinations of maxillary and mandibular molars are similar in normodivergent, hyperdivergent, and hypodivergent adults with Class I sagittal relationships.

Three-dimensional evaluation of alveolar bone thickness of mandibular anterior teeth in different dentofacial types.

The aim of this randomized study was to compare the alveolar bone thickness (ABT) of the mandibular incisor teeth of dental and skeletal Class I, II, and III adult patients at labial and lingual aspects of the bone and develop recommendations for the associated movements of teeth in this region, taking vertical facial type into consideration. : Sixty-two Class I, 74 Class II, and 63 Class III patients - aged between 20 and 45 - were assigned to three subgroups - high (H), low (L), and normal (N) growth patterns. On the axial slices of computerized tomographies, the measurements for the ABT on labial and lingual sides of the mandibular incisors were carried out at three levels. In Class I group, at apex region, ABT of subgroups N and L were greater than H, at labial side. In Class II, ABT of subgroups N and L were greater than H, at apex at both sides and cervical lingual region. Similarly, ABT of subgroup L of Class III group was greater than H, at labial and lingual apex, mid-root regions. In Class II, the ABT of subgroup H was greater than L, at lingual cementoenamel junction. ABT of mandibular incisors of Class I patients is not affected from vertical pattern except for apical region. There is not a thick bone on the lingual side of the Class II, high-angle patients. The ABT of the Class III, high-angle patients is thin as a risk factor for proclination.

Study of the canalis mandibulae morphology in different vertical facial types

The precise knowledge of the position of canalis mandibulae and foramen mandibulae is important for surgical and endodontic interventions on the mandible. The aim of the study is to examine the position of these anatomical landmarks in different vertical facial types. In the panorama radiograph of 26 normodivergent, 26 hypodivergent and 28 hyperdivergent arthritis (total of 1360 measurements) we measured the distance between the canalis mandibulae and interdental septums, the apex of the lateral teeth, the mandibular base, the goniac angle, and the steepness of the canal and the distance the foramen mandibulae to the anterior and posterior margin of the ramus. ANOVA and t-test statistical analysis showed that the foramen mandibulae is farer from the posterior margin of the ramus in hipodivergent facial types, in hyperdivergent facial types the canalis mandibulae was closer to the root apex of posterior teeth and in hypodivergent types to the base of the mandible. In normal and hyperdivergent individuals, the canalis mandibulae runs steeper and in the course of running it is increasingly distanced from the tangent to the base of the mandible. The position of the canalis mandibulae and the foramen mandibulae showed significant differences in the different vertical facial types. Orv Hetil. 2017; 158(46): 1841-1847.

Characteristics of mandible and mandibular dentition in patients with near-normal occlusion and different vertical facial skeletal types

Objective The aim of our work is to characterize individual normal occlusions to establish appropriate treatment standards for different vertical facial types. Methods A total of 30 patients with near-normal occlusion were grouped into high-angle group (eight cases), medium-angle group (12 cases), and low-angle group (10 cases) according to vertical facial skeletal type. Invivo5 software was used and digital imaging and communications in medicine data were rebuilt to measure the ∠L1/MP, ∠L6/MP, axis corner of L6, cant of occlusion plane, Balkwill angle, and Bonwill triangle of each group. Results Among the groups, the low-angle group had the smallest ∠L6/MP (P<0.05) and largest cant of occlusion. No significant difference was observed among the three groups with regard to the other parameters (P>0.05). Conclusion Patients with low-angle vertical facial skeletal type requires a modified treatment standard. In this group, the treatment standard must ensure that the cant of occlusion plane is more parallel to the Frankfurt horizontal plane compared with those of the other groups, and the axis of L6 is tilted distally relative to the mandibular plane.

The nasopalatine canal, a limiting factor for temporary anchorage devices: a cone beam computed tomography data study.

There is only little knowledge on topographical predispositions of the nasopalatine canal as a limiting factor for insertion of mid-palatal temporary anchorage devices (TAD). The purpose of the study was to assess the course of the nasopalatine canal, the adjacent vertical bone quantity, and whether it might differ among vertical facial types, using pre-existing cone beam computed tomography (CBCT) scans. Out of a consecutive sample collected from April 2008 to August 2012, only patient data depicting both upper and lower jaw completely were evaluated retrospectively. The linear measurements were taken on the respective midsagittal view perpendicular to the palate at the level of 1st molar/2nd premolar (5/6), 2nd premolar/1st premolar (4/5), and 1st premolar/canine (3/4). Screen-prints were used to measure the inclination of the nasopalatine canal in relation to the maxillary jaw base. Maxillary and mandibular divergence was assessed on rendered lateral cephalograms. Out of 3869 pre-existing consecutive CBCT scans, data from 398 patients met the inclusion criteria and could be extracted. The mean vertical bone was 4.09 mm at the 5/6 level, 5.22 mm at the 4/5 level, and 3.14 mm at the 3/4 level, respectively. A statistically significant negative correlation exists between jaw divergence and the canal angulation with regard to the maxillary base. A statistically significant negative correlation exists between the canal angulation and vertical bone measurements at the 4/5 and 3/4 levels. Vertical bone volume is sufficient at 4/5 level for TAD placement, and bares only a small risk for neuro-sensory impairment. Therefore, only in rare cases a CBCT is justified for palatal implant placement. The course of the nasopalatine canal is negatively correlated with the vertical skeletal facial pattern pointing to the fact that in hypodivergent patients a TAD might be placed in a more distal or paramedian region.

Leveling the curve of Spee with continuous archwire appliances in different vertical skeletal patterns: A retrospective study.

The aim of this study was to determine the effects of the leveling of the curve of Spee in subjects treated with preadjusted appliances in different skeletal vertical patterns. The study sample consisted of 90 white patients (39 male, 51 female; age, 19years 4months±1year 9months), with a curve of Spee of 2mm or greater before treatment. They were categorized into 3 groups: low-angle group (30 subjects; 12 male, 18 female; age, 19years 1month±1year 4months), normal-angle group (30 subjects; 14 male, 16 female; age, 19years 6months±2years 1month), and high-angle group (30 subjects; 13 male, 17 female; age, 19years 7months±1year 5months) by their vertical facial types. Cephalometric parameters were used to evaluate the different dental movements after treatment. The curve of Spee was measured on digital dental casts. Analysis of variance was used to determine any differences between the changes in the groups with time. For the skeletal variables, no significant modifications were found in the 3 groups. For the dentoalveolar variables, the low-angle group showed significant buccal movements and intrusion of the mandibular incisors. The high-angle group had greater extrusion of the posterior teeth associated with uprighting of the first and secondmolars. In low-angle subjects, leveling of the curve of Spee occurs through buccal movement and intrusion of the mandibular incisors; in high-angle subjects, it occurs through extrusion and uprighting of the posterior teeth.

Is There a Difference in Stability After Intraoral Vertical Ramus Osteotomy Between Vertically High-Angle and Normal-Angle Patients?

Few studies have evaluated the relapse pattern of intraoral vertical ramus osteotomy (IVRO) for the correction of mandibular prognathism with a high angle. The aim of this study was to measure the association between vertical facial types (high and normal mandibular plane angle) and relapse after IVRO for the management of mandibular prognathism. The retrospective cohort study sample (skeletal Class III patients) was divided into 2 groups according to the angle of the sella-nasion plane relative to the mandibular plane (SN-MP) at the initial examination. Lateral cephalograms were analyzed for the predictor (facial type) and outcome (cephalometric changes over time) variables before surgery, 7days after surgery, and 12months after surgery. The 2 groups were matched for sample size (n= 20 in each). Data were analyzed using repeated-measures analysis of variance with Bonferroni correction. The normal-angle group (group N, SN-MP from 27° to 37°) and high-angle group (group H, SN-MP >37°) were not significantly different in terms of gender and age at the initial examination. Seven days after surgery, the mandibles in group H moved 2.5mm more superiorly than those in group N(P=.013); consequently, the amount of overbite correction in group H was approximately 2mm greater than that in group N (P= .002). Nevertheless, 12months after surgery, there was no statistically significant difference in relapse of the maxilla and mandible between the 2 groups. In the 2 groups, the mandible moved approximately 0.7mm superiorly during retention. These findings suggest that IVRO is a clinically acceptable and stable treatment modality for mandibular prognathism with a high angle.

Comparison of the Stability After Mandibular Setback With Minimal Orthodontics of Class III Patients With Different Facial Types

Most studies on the surgery-first approach focused on skeletal relapse compared with conventional surgery. The objective of this study was to compare the stability of skeletal Class III patients with 2 different vertical facial types after mandibular setback surgery (MS) with minimal orthodontic preparation (MO). In this retrospective study, the patients were recruited from a population that had undergone MS. Consecutive patients were selected based on the following inclusion criteria: skeletal Class III malocclusion with mandibular prognathism, MO without extraction for less than 6months, and sagittal split ramus osteotomy. The vertical facial types of the patients were classified based on the Frankfort mandibular-plane angle (FMA). Lateral cephalograms were taken at the presurgical stage, at 1month after surgery (T1), and at the debonding stage (T2). To evaluate surgical changes (T1 - presurgical stage) and relapse (T2 - T1), the linear, angular, and dental measurements were analyzed using a paired t test and an independent t test. The 26 patients were divided into 2 groups: normal-angle group (n= 14; mean FMA, 23.58°) and high-angle (HA) group (n= 12; mean FMA, 30.26°). From T1 to T2, the normal-angle and HA groups showed significant forward and counterclockwise rotation of the mandible (distance between pogonion and perpendicular line to Frankfort horizontal plane from sella, 1.71mm and 1.51mm, respectively; distance between menton and perpendicular line to Frankfort horizontal plane from sella, 1.91mm and 1.60mm, respectively; angle between articulare-menton line and Frankfort horizontal plane, -0.55° and -0.89°, respectively). The HA group showed a significant upward movement of the mandible (distancefrom Frankfort horizontal plane to pogonion, -1.13mm; distance from Frankfort horizontal plane to menton, -0.78mm). However, there was no significant difference in the skeletal-dental changes between the 2 groups from T1 to T2. The vertical facial types of Class III patients with similar prognathic mandible and dental patterns may not cause any differences in the relapse pattern after MS-MO.

Determination of vertical characteristics with different cephalometric measurements.

Objective:To analyze a possible correlation between different measures in the definition of vertical facial types.Materials and Methods:This is an analytical observational study about 95 lateral teleradiographs of Caucasian individuals with normal occlusion, of which 54 were male (56.84%) and 41 female (43.16%), aged between 15 years and 2 months old and 21 years and 4 months old. Facial types were divided into dolichofacial, mesofacial, and brachyfacial, according to the standards established by different authors. A relationship between these measurements was verified using total agreement analysis and the Kappa method, with the interpretation suggested by Landis and Koch.Results:Kappa was considered fair for Jarabak X VERT (0.22 and 60%) and slight for Jarabak X SN. GoGn (0.06 and 36.8%).Conclusions:Cephalometric studies often present different interpretations on the description of vertical facial types. In this study, the lowest agreement was between Jarabak and SN.GoGn. Such difference in interpretation may lead to distinct therapeutic approaches and thus different results.

Antero-posterior and vertical facial type variations influence the aesthetic preference of the antero-posterior lip positions.

SummaryObjectives: The purposes of this study were to investigate whether the antero-posterior and vertical facial type variations influenced the favoured lip positions and to elucidate whether the favoured lip positions differed between orthodontists and laypersons. An average profile was constructed from a Japanese female with Class I occlusion and a well-balanced profile, as assessed by several cephalometric analyses. Nine facial types were composed by morphing the chin antero-posteriorly and/or vertically. Thirteen morphed lip profiles were constructed by moving the lips antero-posteriorly in the nine facial types, respectively. Seventy-seven Japanese laypersons and 30 orthodontists were asked to choose the top three most-favoured lip positions for each facial type. The protruded lip positions were significantly favoured for all the mandibular protrusive facial types. The retruded lip positions were significantly favoured for the short facial type of the antero-posteriorly average and mandibular retrusive-short facial types. Among the mandibular protrusive facial types, the protruded lip positions were significantly favoured for the long facial type. The retruded lip positions were statistically more attractive for orthodontists than laypersons on the antero-posteriorly average-short, mandibular protrusive-short, mandibular retrusive-vertically average, antero-posteriorly average-vertically average, and mandibular retrusive-long facial types. Our data were limited by the specific ethnic groups and variety of facial types. The favoured antero-posterior lip position was affected by not only the antero-posterior facial disproportion but also by the vertical dimensions. The favoured lip positions differed between orthodontists and laypersons. These results might be helpful in deciding between extraction and non-extraction treatment in borderline cases.

Differences in the mandibular premolar positions in Angle Class I subjects with different vertical facial types: A cone-beam computed tomography study.

ObjectiveTo compare the positions of the mandibular premolars in Angle Class I subjects according to vertical facial type. The results will provide a theoretical basis for predicting effective tooth movement in orthodontic treatment.MethodsCephalometric parameters were determined using cone-beam computed tomography in 120 Angle Class I subjects. Subjects were categorized as short, normal, and long face types according to the Frankfort mandibular angle. Parameters indicating the position of the mandibular right premolars and the mandible were also measured.ResultsThe angle between the mandibular first premolar axis and buccal cortex, the distance between the root apex and buccal cortex, angle of vestibularization, arc of vestibularization, and root apex maximum movable distance were significantly greater in the short face type than in the long and norm face types. The angle between the mandibular second premolar axis and buccal cortex, the distance from root apex to buccal cortex, and the arc of vestibularization were significantly greater in the short face type than in the normal face type.ConclusionsThere are significant differences in the mandibular premolar positions in Class I subjects according to vertical facial type.

Treating Class II malocclusion in children. Vertical skeletal effects of high‐pull or low‐pull headgear during comprehensive orthodontic treatment and retention

To evaluate, in Class II malocclusion children, vertical skeletal changes occurring with high- and low-pull headgear during non-extraction comprehensive orthodontic treatment, and retention. Two groups of thirty Class II malocclusion children (mean age 10.8 years) who had undergone non-extraction comprehensive orthodontic treatment with either high- or low-pull headgear and fixed appliances. Retrospective longitudinal study, where pre-treatment, post-treatment and at least 2 year post-retention lateral cephalometric radiographs were analyzed. Comparisons were made concerning changes during treatment and retention in high- or low-pull headgear-treated children. Correlation analyses were carried out investigating changes in vertical cephalometric parameters and pre-treatment vertical facial pattern or type of headgear used. During treatment, sagittal relationships improved in all children and remained stable during retention. Vertically, in both high- and low-pull headgear groups, the intermaxillary angle as well as the maxillary and mandibular plane angles did not show statistically significant changes during treatment or retention, and large variation was seen between patients. When pooling the whole patient sample, change in the vertical facial pattern was independent of the pre-treatment vertical facial pattern or type of headgear used. When treating Class II malocclusion children non-extraction with high- or low-pull headgear and fixed appliances, changes in vertical skeletal relationships demonstrate wide variation, both during treatment and retention. Dentoalveolar changes brought about by these appliances may not be able to make a predictable difference in vertical skeletal patterns of growing patients.

Maxillary buccal cortical plate inclination at mini-screw insertion sites.

To evaluate whether buccal cortical bone inclination varies for the maxillary alveolar processes of adult patients with decreased, normal, and increased facial heights. Cone-beam computed tomography images of 135 adult patients, including 49 hypodivergent subjects (26 women, 23 men), 40 hyperdivergent subjects (24 women, 16 men), and 46 normodivergent (25 women, 21 men) were analyzed. Cortical bone inclination measurements were made relative to the occlusal plane. Cross-sectional slices of the maxilla were taken at interdental sites from the distal aspect of maxillary canine to the mesial aspect of maxillary second molar. Analysis of variance indicated significant differences (P < .05) between the angles formed by the line tangent to the cortical bone and the occlusal plane among the vertical facial types for the regions between canine and first premolar and between second premolar and first molar at miniscrew insertion sites. The results of this study indicate that vertical facial pattern should be taken into consideration when adjusting the insertion angle of miniscrews at the maxillary buccal region.

Changes in the location of the human mandibular foramen as a function of growth and vertical facial type

Objective. A previous cross-sectional investigation showed that the mandibular foramen location depends on the age and the vertical facial pattern of growing individuals. The aim of the present longitudinal study was to explain how these factors influence the distance between the foramen and the occlusal plane. It is known that a certain distance is necessary for a successful inferior alveolar nerve block in clinical dentistry. Materials and methods. This distance, as well as another four cephalometric variables, were measured on both pre-treatment and 10-year post-treatment lateral cephalometric radiographs collected from 50 patients who underwent orthodontic treatment. The changes between these two sets of measurements were also calculated. Results. A multiple regression analysis was performed using the pre-treatment age, the pre-treatment inter-maxillary angle, the rotation of the occlusal plane and the change in mandibular ramus height as independent variables and the change of foramen-occlusal plane distance as a dependent variable. The independent variables under investigation were found to account for more than half of the variability of the foramen-occlusal plane distance (r = 0.732; p < 0.001). Conclusion. In very young individuals the mandibular foramen is located approximately at the level of the occlusal plane. With age it moves upwards relative to the occlusal plane and more so for those individuals with a low anterior facial height (short-face vertical facial type). These observations are, at least, partially explained by the differential growth of the various elements of the maxillo-mandibular complex and the change of the inclination of the occlusal plane.

Quantitative evaluation of alveolar cortical bone density in adults with different vertical facial types using cone-beam computed tomography

ObjectiveThe purpose of this study was to quantitatively evaluate the cortical bone densities of the maxillary and mandibular alveolar processes in adults with different vertical facial types using cone-beam computed tomography (CBCT) images.MethodsCBCT images (n = 142) of adult patients (20-45 years) were classified into hypodivergent, normodivergent, and hyperdivergent groups on the basis of linear and angular S-N/Go-Me measurements. The cortical bone densities (in Hounsfield units) at maxillary and mandibular interdental sites from the distal aspect of the canine to the mesial aspect of the second molar were measured on the images.ResultsOn the maxillary buccal side, female subjects in the hyperdivergent group showed significantly decreased bone density, while in the posterior region, male subjects in the hyperdivergent group displayed significantly decreased bone density when compared with corresponding subjects in the other groups (p<0.001). Furthermore, the subjects in the hyperdivergent group had significantly lower bone densities on the mandibular buccal side than hypodivergent subjects. The maxillary palatal bone density did not differ significantly among groups, but female subjects showed significantly denser palatal cortical bone. No significant difference in bone density was found between the palatal and buccal sides in the maxillary premolar region. Overall, the palatal cortical bone was denser anteriorly and buccal cortical bone was denser posteriorly.ConclusionAdults with the hyperdivergent facial type tend to have less-dense buccal cortical bone in the maxillary and mandibular alveolar processes. Clinicians should be aware of the variability of cortical bone densities at mini-implant placement sites.

Morphological Characteristics of the Cranial Base in Different Vertical Facial Types

Morphological Characteristics of the Cranial Base in Different Vertical Facial Types

Comparison of Maxillary and Mandibular Incisor Inclination in Class II Division 1 Malocclusion among Chinese Children

Objective: To determine maxillary and mandibular incisor inclination in Class II Division 1 malocclusion among different vertical skeletal type Chinese children.&#x0D; Materials &amp; Method: Lateral cephalograms of Class II Division I malocclusion cases of 120 Chinese children (male-55, female-65) of the age range 12-14 years were divided into three vertical skeletal types (low angle, average angle, high angle) based on Sella-Nasion to Mandibular plane angle. To determine incisor inclination, lateral cephalometric radiographs were measured and analyzed using factorial analysis. All angular parameters were processed using ANOVA and t-test. Maxillary and mandibular incisor inclinations were discussed in detail among three vertical facial skeletal types.&#x0D; Result: The maxillary and mandibular incisors of low angle individuals were found to be proclined more than those with high and average angle individuals.&#x0D; Conclusion: Different vertical facial types of Class II Division I malocclusion in early permanent dentition accord to establish discriminate values to set up the cephalometric standards for diagnosis and treatment planning for the clinicians.&#x0D;

Vertical facial height and its correlation with facial width and depth

IntroductionThe aim of the present study was to evaluate how vertical facial height correlates with mandibular plane angle, facial width and depth from a three dimensional (3D) viewing angle.MethodsIn this study 3D cephalometric landmarks were identified and measurements from 43 randomly selected cone beam computed tomography (CBCT) images of dry skulls from the Weisbach collection of Vienna Natural History Museum were analyzed. Pearson correlation coefficients of facial height measurements and mandibular plane angle and the correlation coefficients of height-width and height-depth were calculated, respectively.ResultsThe mandibular plane angle (MP-SN) significantly correlated with ramus height (Co-Go) and posterior facial height (PFH) but not with anterior lower face height (ALFH) or anterior total face height (ATFH). The ALFH and ATFH showed significant correlation with anterior cranial base length (S-N), whereas PFH showed significant correlation with the mandible (S-B) and maxilla (S-A) anteroposterior position.ConclusionsHigh or low mandibular plane angle might not necessarily be accompanied by long or short anterior face height, respectively. The PFH rather than AFH is assumed to play a key role in the vertical facial type whereas AFH seems to undergo relatively intrinsic growth.

Evaluation of arch width variations among different skeletal patterns in South Indian population

Background:Anterior cranial base can be taken as a reference line (SN) to determine the steepness of mandibular plane. Subjects with high mandibular plane angle tend to have a long face and one with low MP-SN angle has a shorter face.Objective:This study was done to investigate if dental arch widths correlated with vertical facial types and if there are any differences in arch widths between untreated male and female adults in South Indian population.Materials and Methods:Lateral cephalogram and dental casts were obtained from 180 untreated South Indian adults (90 males and 90 females) above 18 year old with no cross bite, minimal crowding and spacing. The angle between the anterior cranial base and the mandibular plane was measured on lateral cephalogram of each patient. Dental casts were used to obtain comprehensive dental measurements including maxillary and mandibular inter canine, inter premolar and inter molar widths, as well as amount of crowding or spacing.Results:The results showed that male arch widths were significantly larger than those of females (P < 0.05) and there was a significant decrease in inter arch width as the MP-SN angle increased in untreated adult South Indian population. The results obtained in our study when compared with studies done in other population groups showed that there is difference in inter arch widths according to ethnicity and race.Conclusion:It was concluded that the dental arch width is associated with gender, race and vertical facial morphology. Thus using individualized arch wires according to each patient's pre treatment arch form and width is suggested during orthodontic treatment.