Evaluating Diagnostic Performance of Three Cephalometric Vertical Parameters

Objectives: The goal of this research was to see how reliable and valid three selected parameters from different analysis were in detecting the vertical skeletal pattern. Methods: There were 94 cephalometric x?rays used in all. The vertical skeletal pattern was assessed using the mandibular plane angle by Steiner, Frankfort mandibular angle by Tweed, and facial axis angle by McNamara. According to the diagnostic results of the majority of the measures, the samples were classified as normo?divergent, hypodivergent, or hyperdivergent. Kappa statistics, positive predictive value, and sensitivity were employed to verify the validity and reliability of the analyses. Results: A statistically significant weak negative correlation was found between Frankfort mandibular angle and facial axis angle in female group (p value < 0.01). A good agreement was found between mandibular plane angle with final diagnosis (K = 0.726). The mandibular plane angle showed highest sensitivity and positive predictive value in hypodivergent group (0.939, 0.816) and normo?divergent group (0.795, 0.833), respectively. Conclusion: For determining the facial vertical growth pattern the most accurate indicators were identified to be mandibular plane angle (SN?GoGn) and Frankfort mandibular angle.

Association Of Impacted Third Molars With Facial Growth Patterns Among Adult Indian Patients - A Retrospective Study

Introduction: The third molar (3M) varies more than other molars in terms of shape, size, timing of eruption, and tendencytoward impaction. Hence, studies need to be carried out to clarify the association of the various patterns of facial growth withmandibular 3M impaction.Purpose: The purpose of this study is to relate the level of impaction of mandibular 3Ms and their inclinations to various patternsof facial growth among Indian patients.Materials and Methods: A total of 207 lateral cephalograms and optic pathway gliomas (OPGs) of patients were obtainedfrom NISSAN Radiological and Diagnostic Centre. The OPGs were analyzed by a single examiner as per: (1) Angulations(using Quek’s analysis - beta angle, 2003). (2) Depth of 3Ms. The lateral cephalograms were assessed by a single examinerusing: (1) Down’s analysis. (2) Beta angle. (3)Jarabak’s ratio. (4) Bjork’s analysis.The subjects were further classified into skeletal Class I, II, and III as well as into horizontal, vertical, and normal growth patterns.The final study data were subjected to a Pearson correlation test to check the association between the 3M impactions andvarious angles. The values found significant were coded into ordinate data and Kendall’s Tau-B Test was done.Results: Statistically, significant correlation was found between depth of impacted mandibular 3Ms and facial angle, Y-axis,cant of occlusion, angle of convexity, and gonial angle.Conclusion: Greater incidence of 3Ms was found to be at position B and C in Class II patients as compared to Class I and IIIpatients. Furthermore, patients showing vertical growth pattern were found to have increased percentage of mandibular 3Mimpactions.

Varying width ratio patterns of posterior hard palate cleft to posterior maxillary tuberosity plane in cleft palate / 华西口腔医学杂志

OBJECTIVE@#The varying width ratio patterns of posterior hard palate cleft to posterior maxillary tuberosity plane and their relationship with growth and development were studied in specific-age patients with simple cleft palate before surgery to provide a reference for evaluating operation difficulty and predetermining operative period.@*METHODS@#A total of 581 patients with simple cleft palate who received surgical treatment and are aged 8 months to 38 years participated in this study. All patients were categorized into seven groups based on age at preoperative measurement. The widths of posterior maxillary tuberosity plane and hard palate cleft were selected from the preoperative direct measurements. The relative width ratio of the hard palate to posterior maxillary tuberosity plane in each patient was used to objectively reflect the relative width of cleft palate.@*RESULTS@#For patients with simple cleft palate, the widths of posterior maxillary tuberosity plane and hard palate showed remarkably increasing trends.@*CONCLUSIONS@#The transverse proportion of cleft palate fissure in the upper mandible increases statistically with age, suggesting the need for complex operation.

Analysis of Treatment Period on the Intraoral Removable Appliance Utilizing Vertical Facial Growth on Class III Malocclusion / 대한소아치과학회지

Vertical facial growth triggers the rotation of mandible to move the chin point to the downward and backward direction, which showed remarkably effective result making the less prominent chin. Recently, the intraoral removable appliance utilizing class III elastic demonstrated the vertical growth trigger mechanism. The treatment change was very fast and wearing was quite easy, compared to extraoral appliances.The purpose of this study was to verify the duration of the treatment on class III malocclusion using intraoral removable appliances, which designed to accelerate vertical facial growth.56 patients were selected with the complaint of the protruded mandible and class III malocclusion (overjet : −3 – 0 mm, overbite : 0 – 4 mm). Information like; age at start, duration of the treatment events, type of the treatment, overjet, overbite etc. was collected and calculated.The average age of the patients delivering the initial brace was 8.75 ± 1.10 year. Most of the anterior crossbite was resolved within 6 months. The total treatment period was 21.79 ± 10.73 months with the additional procedures like the alignment of anterior teeth and torque control using additional removable and fixed orthodontic appliances. The correlation study showed that patient's cooperation (p = 0.000) and the use of fixed appliance (p = 0.032) were significantly influenced on treatment duration.

Facial pattern analysis: critic review and collection of facial proportions in a brazilian sample using cone-beam computed tomography / Análise de tipos faciais: revisão crítica e coleta de proporções faciais em amostra de brasileiros utilizando tomografia computadorizada de feixe cônico

The classification of facial vertical patterns is a common practice among dentists of different specialties. It influences treatment planning and expected outcomes, but is usually carried out qualitatively. The aim of this study is to better understand vertical facial proportions, combining a critic review of the literature with the collection of data from 100 Brazilian adult sample in search of 3D quantitative parameters with the use of Cone-Beam Computed Tomography (CBCT) measurements. In Pubmed database, the following quoted phrases were used: "Facial pattern" AND "Facial Index" AND "Facial height Index" AND "Facial height" AND "Dolichofacial" AND "Brachyfacial" AND "Longface syndrome" AND "Short-face syndrome" in a 25 years interval (1990-2015). Study selection was performed searching for crucial facial features, commonly used to determine the facial pattern of a patient. In CBCT exams, 100 patients had facial features measured and classified by the three most reliable methods. The literature on the field can be very confusing, as the methods, landmarks and averages differed considerably. Most of the facial features researched had different values when the literature was analyzed and compared to our data. This indicates that ethnic, age and gender variations play an important whole in facial pattern diagnostic and should be taken in account when using general cephalometric approaches on diagnosis. With a group sorting method, combining the ratios between the anterior Facial height and the width, the anterior vertical proportion and the gonial angle divergence, and with anatomical landmarks we successfully correlated the sample to the qualitative description, as shorter faced patients to larger bi-zygomatic distances and less divergent gonial angles and longer faced patients with narrower and more divergent faces.

A classificação de padrões faciais verticais é prática comum entre Cirurgiões Dentistas de diferentes especialidades. Esta influencia o planejamento de tratamento e resultados esperados, no entanto, essa tarefa é frequentemente realizada de forma qualitativa. O objetivo deste trabalho foi compreender melhor as proporções verticais da face, combinando uma análise crítica da literatura com a coleta de dados de 100 adultos brasileiros na procura por parâmetros quantitativos em 3D, usando tomografias computadorizada de feixe cônico (TCFC). Na base de dado pubmed, a seguinte frase foi utilizada: "Facial pattern" AND "Facial Index" AND "Facial height Index" AND "Facial height" AND "Dolichofacial" AND "Brachyfacial" AND "Long-face syndrome" AND "Short-face syndrome" em um intervalo de 25 anos (1990-2015). A seleção dos estudos foi realizada procurando características faciais cruciais e métodos comuns para a determinação do padrão facial do paciente. Em exames de TCFC de 100 pacientes adultos, foram medidas as dimensões faciais foram registradas e os três métodos mais confiáveis e encontrados na literatura foram testados. A literatura sobre o assunto pode ser muito confusa, ao ponto de que os métodos, pontos de referência e médias variaram consideravelmente. Muitas das características pesquisadas tinham valores diferentes quando analisada a literatura em comparação com os dados dessa pesquisa. Isso indica que variações de etnia, idade e gênero tem papel importante no diagnóstico do padrão facial e deve ser levada em consideração quando utilizados padrões cefalométricos para diagnóstico. Com a metodologia de agrupamento, utilizando o índice entre a altura facial anterior e a largura, a proporção anterior da face e a divergência do ângulo goníaco, assim como os pontos cefalométricos selecionados, nós correlacionamos com sucesso a amostra com as descrições qualitativas como: os pacientes de face curta e as distâncias bi-zigomáticas e ângulos faciais menos divergentes, assim como os pacientes de face longa com faces mais estreitas e menos divergentes.

Premaxilla: an independent bone that can base therapeutics for middle third growth!

ABSTRACT Premaxilla, in its early descriptions, had the participation of Goethe. In our face, in a certain period of growth and development processes, premaxilla is an independent and, then, a semi-independent bone to finally be totally integrated to the maxilla. Formation of the premaxilla acts as a stabilization element inside the facial skeleton comparable to the cornerstone of a Roman arch and is closely related to the development of human face and its abnormal growth with characteristic malformations. Until when the premaxillary-maxillary suture remains open and offers opportunities to orthopedically influence facial growth to exert influence over facial esthetics and function? Contact with preliminary results in 1183 skulls from anatomic museums at USP, Unicamp and Unifesp led us to question therapeutic perspectives and its clinical applicability.

RESUMO A descrição inicial da pré-maxila teve a participação de Goethe. Na face, em determinado período do crescimento e desenvolvimento, têm-se a pré-maxila como um osso independente e, depois, semi-independente para, finalmente, se integrar totalmente à maxila. A formação da pré-maxila atua como um elemento estabilizador dentro do esqueleto facial, comparável com a pedra angular de um arco romano, e está intimamente relacionada com o desenvolvimento da face humana e seu crescimento anormal, com malformações características. Até quando a sutura pré-maxilar-maxilar continua aberta e oferece oportunidades para se influenciar ortopedicamente o crescimento facial e modificar a estética e função da face? O contato com estudos preliminares em 1.183 crânios de museus anatômicos da USP, Unicamp e Unifesp nos induziu a questionar sobre as perspectivas terapêuticas e aplicabilidades clínicas.

Cephalometric deviations present in children and adolescents with temporomandibular joint disorders

INTRODUCTION: Temporomandibular disorders (TMD) have proved to be a risk factor for developing hyperdivergent facial growth patterns. OBJECTIVE: The aims of this study were: (1) Assess differences between the cephalometric measurements in children with articular TMD and a control group, before and after mandibular growth peak according to cervical vertebral maturation; and (2) Identify a predictive model capable of differentiating patients with TMD and control group patients based on early cephalometric characteristics. METHOD: The study included children and adolescents with maximum age of 17 years, divided into experimental group (n=30) diagnosed with articular TMD-according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for children and adolescents-subdivided according to growth stage, called pre-peak (n=17) and post-peak (n=13) and control group (n = 30), matched by gender, skeletal maturity stage of the cervical vertebrae and classification of malocclusion. Lateral cephalometric and craniofacial structures were traced and their relations divided into: Cranial base, maxilla, mandible, intermaxillary relations, vertical skeletal relations and dental relations. Differences between the means for each variable were evaluated by applying the statistical Student t test for independent samples. RESULTS: The means of the variables analyzed in the pre-peak showed no statistically significant differences. However, analysis of post-peak showed that the experimental group displayed decreased SNA and SNB and increased SN.Gn and 1.NB (p<0.05). CONCLUSION: It was possible to identify a predictive model able to differentiate patients with TMD and asymptomatic controls from early cephalometric characteristics.

Crecimiento facial vertical en 44 mestizos colombianos sin tratamiento desde los 6 hasta los 25 años Grupo CES-LPH / Vertical facial growth in 44 untreated colombian subjects from 6-to 25 years of age

Introducción y Objetivo: El crecimiento craneofacial posnatal es un proceso complejo que continúa aún después de los 20 años de edad. Cuantifi car por primera vez en una población mestiza latinoamericana y colombiana el desarrollo vertical facial anterior (AFA) y posterior (AFP). Materialesy Métodos: seguimiento cefalométrico bianual de 44 sujetos con apariencia facial normal y sin ningúntipo de tratamiento ortodóncico.Resultados: Hubo una disminución continua del ángulo del planomandibular (SN/PM) en ambos sexos. Se encontraron aumentos continuos de la AFA y AFP con diferencias signifi cativas por sexo a partir de los 16 años. El pico puberal para las mujeres de la AFA y AFP fue alrededor de los 13 años, para los hombres alrededor de los 15. Esta tendencia general mostró variaciones individuales importantes. Antes de los 11 años de edad el 63% de la muestra tuvo incrementos bianuales de más de 3 mm, después de los 16 años el 29,5% de los sujetos tuvo incrementos bianuales de más de 2 mm. Las mujeres después de los 18 años no tuvieron un patrón de rotación mandibular a favor de las manecillas del reloj, ni los hombres en contra. Conclusiones: se muestran diferencias importantes respecto a otros estudios reportados en poblaciones caucásicasen cuanto a la variabilidad individual, presencia de varias etapas de aceleración del crecimientovertical pre y pospuberalmente y rotación mandibular después de los 18 años. Estas diferencias no son debidas a características genéticas o nutricionales sino probablemente a cambios normalesdel crecimiento vertical facial.

Introduction and Objetive: The postnatal craniofacial growth is a complex process that continues even after 20 years of age. To quantify for the fi rst time, the anterior (AFA) and posterior vertical facial (AFP) developmental growth, in a mestizo Colombian and a latin-american population. Materials and Methods: Biannual cephalometric follow-up of 44 subjects with normal facial appearance and without any type of orthodontic treatment. Results: There was a continuous decrease of the mandibular plane angle SN / PM in both sexes. There were continuous increases in the AFA and AFP with signifi cant differences by sex after the age of 16. The pubertal peak for women in the AFA and AFP was about 13 years of age, and for men around the age of 15. This general trend showed signifi cant individual variations. Before the age of 11, 63% of the sample had biannual increments over 3 mm, after the age of 16, 29,5% of the subjects had biannual increases more than 2 mm. Women after the age of 18 had no clockwise mandibular rotation, neither did men had counterclockwise mandibular rotation. Conclusions: It is shown that there is an important difference between this study and other studies reported from Caucasian populations in terms of individual variability, presence of various growth spurt stages in the vertical facial height pre-and postpuberty. There was a non specifi c gender tendency of mandibular rotation after 18 years of age. These differences are not due to genetic or nutritional changes, but probably normal vertical facial growth changes.

The relationship between upper airway width and facial growth changes in orthodontic treatment of growing children / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate how airway changes influence facial growth during puberty in Korean children. METHODS: Thirty-six patients aged 9 to 11 (mean age: 10.7 years) were selected. Cephalograms and hand-wrist x-rays were taken at pre-treatment (T1) and post-treatment (T2). The sample was divided into narrow (5.2 - 8.6 mm, AW-Narrow), medium (8.9 - 11.5 mm, AW-Medium), and wide (11.7 - 16.0 mm, AW-Wide) groups according to the airway width at T1. Cephalometric measurements at T1, T2 and growth from T1 to T2 were compared between groups. RESULTS: The degree of increase in airway size in each group was 4.55 mm, 3.84 mm and 1.94 mm in the AW-Narrow, AW-Medium, and AW-Wide groups, respectively. Moreover, the differences were statistically significant. The significant smallest posterior facial height was found in the AW-Narrow group at T1. For the growth values from T1 to T2, the AW-Narrow group showed significantly larger values of PFH/AFH, facial axis, ANS (T1 - T2), and Gn (T1 - T2) than the AW-Medium group. CONCLUSIONS: The compensational changes in the airway width and facial growth were found in the narrow group. Surgical approach of the airway to prevent unfavorable facial growth in these years of age should be carried out, but with careful deliberation because these problems may be improved naturally.

Effects of activator treatment on different skeletal patterns in growing class II malocclusion patients / 대한치과교정학회지

OBJECTIVE: To establish proper diagnosis and treatment plan for skeletal Class II malocclusions, some important factors to consider are the patient's skeletal morphology, prognosis as well as the treatment effects. Therefore, the present study analyzed the effects of activator treatment on different skeletal patterns in growing Class II malocclusion patients. METHODS: A total of 116 patients (53 boys & 63 girls) in the experimental group were treated with the activator appliance. The experimental group was classified into either hyperdivergent or hypodivergent groups according to articular and gonial angles. RESULTS: Patients with hypodivergent growth patterns showed good effects of activator treatment. CONCLUSION: It seems conceivable that through classifying adolescent Class II malocclusion patients into different skeletal patterns, activator treatment effects may be predicted during the diagnosis and treatment planning stage.

Cephalometric study of the effect of cervical pull headgear based on facial growth patterns / 대한치과교정학회지

The purpose of this study is to investigate the negative effects of cervical pull headgear and to compare the differences between the two groups of growers-vertical grower and horizontal grower group-which are classified by the posterior-anterior facial height ratio. Initial and final lateral cephalograms were taken for 26 patients including 15 vertical growers and 11 horizontal growers ; also, 3 angular measurements and 4 linear measurements were evaluated. The following results were found. 1. The palatal plane was tipped anteroinferiorly in the vertical grower group. 2. The posterior facial height/anterior facial height ratio was increased in the horizontal grower group. 3. The Mandibular plane angle remained stable on both groups. 4. There was no significant difference between the two groups in the amount of maxillary molar extrusion.

Treatment effect of protraction head gear on skeletal Class III malocclusion / 대한치과교정학회지

Before 1970, mandibular overgrowth was known as main cause of skeletal Class III malocclusion in growing children ; however, recent study reports that many skeletal Class III malocclusion patients also show maxillary deficiency. Since 1972, when Delaire re-accommodated Protraction Head Gear (P.H.G.), many researchers have reported that skeletal Class III discrepancies could be corrected through use of P.H.G., which induces anterior movement of maxilla and change in mandibular growth pattern into infero-posterior direction ; nevertheless, it is very difficult to predict resultant changes of orofacial region. The purpose of this study was to find out what treatment effect P.H.G. has on different study samples. Author divided 51 skeletal Class III malocclusion patients with maxillary deficiency who were treated with P.H.G. into different study groups depending on sex, treatment beginning age, intraoral appliance, and facial growth pattern. By doing so, following results were obtained. 1. Treatment beginning age and Sex Four age groups (5.8 to 8 year-old, 8 to 10 year-old, 10 to 12 year-old, 12 to 14 year-old) were compared, and no significant difference was observed. (p<0.05) There was no significant difference between the sex groups, either. (p<0.05) 2. Intraoral appliance Treatment effects of study groups that used R.P.E.(mean age of 10.2) and Labio-Lingual appliance(mean age of 8.9) were compared. There was no significant difference depending on the type of intraoral appliance that was used. (p<0.05) 3. Facial growth pattern 1) Amounts of SNB and ANB corrections were smaller in clockwise growth pattern group than those in normal or counterclockwise growth pattern group. (p<0.05) 2) Amounts of increase in Wits appraisal and mandibular plane angle were greater in counterclockwise growth pattern group than those in normal or clockwise growth pattern group.(p<0.05) 3)Amounts of increase in articular angle were greater in counter lockwise growth pattern group than those in clockwise growth pattern group. (p<0.05)