Photographic assessment of nasal morphology following rapid maxillary expansion in children

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64 percent of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92 percent of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56 percent of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Análise da correlação entre a angulação (mesiodistal) dos caninos e a inclinação (vestibulolingual) dos incisivos / Analysis of the correlation between mesiodistal angulation of canines and labiolingual inclination of incisors

OBJETIVO: avaliar o nível de correlação entre a angulação dos caninos e a inclinação dos incisivos. MÉTODOS: a angulação mesiodistal dos caninos e a inclinação vestibulolingual dos incisivos foram obtidas em um programa digital gráfico (Imagetool®), a partir de fotografias padronizadas dos modelos de 60 pacientes. A inclinação dos incisivos foi, ainda, avaliada pela cefalometria lateral. RESULTADOS: o erro casual mostrou uma variação em torno de 2° nas medidas feitas nos modelos (1,8-2,5º), enquanto o erro sistemático, avaliado pela teste de correlação intraclasse, revelou uma excelente reprodutibilidade para ambos os métodos empregados (p<0,001, r=0,84-0,96). Testes de correlação linear revelaram uma correlação positiva significativa entre a angulação dos caninos e a inclinação dos incisivos para a arcada superior (r=0,3, p<0,05), e mais significativa para a arcada inferior (r=0,46-0,51, p<0,001), quando ambas foram mensuradas nos modelos. Entretanto, quando a inclinação dos incisivos foi examinada pela cefalometria, o nível de correlação foi estatisticamente insignificante para os incisivos superiores (r=-0,06-0,21, p>0,05) e variou bastante na arcada inferior (r=0,14-0,50), dependendo da grandeza correlacionada. CONCLUSÃO: ratifica-se a introdução de mudanças na angulação dos caninos com o intuito de acompanhar as compensações observadas na inclinação dos incisivos, principalmente na arcada inferior.

OBJECTIVE: To assess the degree of correlation between canine angulation and incisor inclination. METHODS: Mesiodistal angulation of canines and labiolingual inclination of incisors were obtained by means of digital graphics software (ImageTool®) from standardized photographs of the casts of 60 patients. Incisor inclination was also assessed by lateral cephalometric radiographs. RESULTS: Random error showed a variation of around 2° in measurements made on the casts (1.8-2.5), while systematic error, measured by the intraclass correlation test, displayed excellent reproducibility for both methods used in this study (p<0.001, r=0.84 to 0.96). Linear correlation tests revealed a significant positive correlation between canine inclination and incisor inclination in the maxillary arch (r=0.3, p<0.05) and even more significantly in the mandibular arch (r=0.46 to 0:51, p<0.001), when both were measured on the casts. When incisor inclination was examined by cephalometrics, correlation level was statistically insignificant for maxillary incisors (r=0.06 to 0:21, p>0.05) and varied widely in the mandibular arch (r=0.14 to 0.50). CONCLUSIONS: The introduction of changes in the angulation of canines with the aim of monitoring compensations observed in incisor inclination is warranted, especially in the lower arch.