Craniofacial morphology in patients with obstructive sleep apnea: cephalometric evaluation / Morfologia craniofacial em pacientes com apneia obstrutiva do sono: avaliação cefalométrica

Abstract Introduction: Obstructive sleep apnea is characterized by a reduced airflow through the upper airways during sleep. Two forms of obstructive sleep apnea are described: the central form and the obstructive form. The obstructive form is related to many factors, such as the craniofacial morphology. Objective: To evaluate the correlation between the morphology of the cranial base, of the mandible and the maxilla, and obstructive sleep apnea severity. Methods: Eighty-four patients, mean age of 50.4 years old; 73 males and 11 females with obstructive sleep apnea were enrolled in the present study. Patients with high body mass index and comorbidities were excluded. Lateral cephalograms and polysomnography were collected for each patient to evaluate the correlation between craniofacial morphology and obstructive sleep apnea severity. A Spearman's rho correlation test between cephalometric measurements and obstructive sleep apnea indexes was computed. Statistical significance was set at p < 0.05. Results: Patients with a severe obstructive sleep apnea presented a reduction of sagittal growth of both effective mandibular length and cranio-basal length. The mandibular length was the only variable with a statistical correlation with apnea-hypopnea index. Vertical dimension showed a weak correlation with the severity of obstructive sleep apnea. No correlation with maxillary sagittal dimension was shown. Conclusion: Obstructive sleep apnea severity may be correlated to mandibular and cranial base growth. Facial vertical dimension had no correlation with obstructive sleep apnea severity.

Resumo Introdução: A apneia obstrutiva do sono é caracterizada por um fluxo de ar reduzido nas vias aéreas superiores durante o sono. Duas formas de apneia são descritas: a forma central e a forma obstrutiva. A forma obstrutiva tem sido relacionada a vários fatores, como a morfologia craniofacial. Objetivo: Avaliar a correlação entre a morfologia da base do crânio, da mandíbula e da maxila e a gravidade da apneia obstrutiva do sono. Método: Foram incluídos no presente estudo 84 pacientes com apneia obstrutiva do sono, com média de 50,4 anos; 73 homens e 11 mulheres. Pacientes com alto índice de massa corpórea e comorbidades foram excluídos. Foram coletados cefalogramas laterais e polissonografia para cada paciente para avaliar a correlação entre a morfologia craniofacial e a gravidade da apneia. Foi computado o coeficiente de correlação de postos de Spearman (rho) entre medidas cefalométricas e índices de apneia obstrutiva do sono. A significância estatística foi estabelecida em p < 0,05. Resultados: Pacientes com apneia obstrutiva do sono grave apresentaram redução do crescimento sagital do comprimento mandibular efetivo e do comprimento crânio-basal. O comprimento mandibular foi a única variável que apresentou correlação estatística com o índice de apneia-hipopneia. A dimensão vertical mostrou uma fraca correlação com a gravidade da apneia. Não foi demonstrada correlação com a dimensão maxilar sagital. Conclusão: A gravidade da apneia obstrutiva do sono pode estar correlacionada ao crescimento da base mandibular e craniana. A dimensão facial vertical não apresentou correlação com a gravidade da apneia.

Estudio dimensional de los puntos craneométricos mediosagitales en cráneos de población chilena / Dimensional study of midsagital craneometric points in skulls of Chilean population

RESUMEN: La utilidad de los puntos craneométricos en neurocirugía radica en la estudiada relación que poseen con las estructuras encefálicas y vasculares que subyacen, siendo relevantes al momento de planificar y realizar diversos abordajes y disminuir la morbilidad asociada. A pesar de esto, hasta el momento no se disponen de datos publicados de las distancias de estos puntos craneométricos en población chilena. Se utilizaron 45 cráneos secos de cadáveres adultos. Se realizaron mediciones de las distancias superficiales entre diversos puntos craneométricos mediosagitales. La distancia superficial promedio entre nasion y bregma fue de 12,71 cm; entre bregma y lambda, 12,34 cm; entre lambda e inion, 6,64 cm; entre inion y opistocranio, 5,16 cm; entre lambda y opistocráneo, 3,88 cm y entre inion y opistion, 5,16 cm. Se encontraron diferencias estadísticamente significativas (p<0,05) entre el grupo estudiado con datos obtenidos de la literatura en las distancias nasion-bregma, bregma-lambda, lambda-opistocranio. Las distancias entre los distintos puntos craneométricos en cráneos de población chilena fueron caracterizadas en el presente estudio existiendo algunas diferencias con los datos de la literatura que deben ser considerados en el contexto de la práctica quirúrgica relacionada.

Preliminary study on the method of automatically determining facial landmarks based on three-dimensional face template / 中华口腔医学杂志

Objective: To explore the establishment of an efficient and automatic method to determine anatomical landmarks in three-dimensional (3D) facial data, and to evaluate the effectiveness of this method in determining landmarks. Methods: A total of 30 male patients with tooth defect or dentition defect (with good facial symmetry) who visited the Department of Prosthodontics, Peking University School and Hospital of Stomatology from June to August 2021 were selected, and these participants' age was between 18-45 years. 3D facial data of patients was collected and the size normalization and overlap alignment were performed based on the Procrustes analysis algorithm. A 3D face average model was built in Geomagic Studio 2013 software, and a 3D face template was built through parametric processing. MeshLab 2020 software was used to determine the serial number information of 32 facial anatomical landmarks (10 midline landmarks and 22 bilateral landmarks). Five male patients with no mandibular deviation and 5 with mild mandibular deviation were selected from the Department of Orthodontics or Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June to August 2021. 3D facial data of patients was collected as test data. Based on the 3D face template and the serial number information of the facial anatomical landmarks, the coordinates of 32 facial anatomical landmarks on the test data were automatically determined with the help of the MeshMonk non-rigid registration algorithm program, as the data for the template method to determine the landmarks. The positions of 32 facial anatomical landmarks on the test data were manually determined by the same attending physician, and the coordinates of the landmarks were recorded as the data for determining landmarks by the expert method. Calculated the distance value of the coordinates of facial anatomical landmarks between the template method and the expert method, as the landmark localization error, and evaluated the effect of the template method in determining the landmarks. Results: For 5 patients with no mandibular deviation, the landmark localization error of all facial anatomical landmarks by template method was (1.65±1.19) mm, the landmark localization error of the midline facial anatomical landmarks was (1.19±0.45) mm, the landmark localization error of bilateral facial anatomical landmarks was (1.85±1.33) mm. For 5 patients with mild mandibular deviation, the landmark localization error of all facial anatomical landmarks by template method was (2.55±2.22) mm, the landmark localization error of the midline facial anatomical landmarks was (1.85±1.13) mm, the landmark localization error of bilateral facial anatomical landmarks was (2.87±2.45) mm. Conclusions: The automatic determination method of facial anatomical landmarks proposed in this study has certain feasibility, and the determination effect of midline facial anatomical landmarks is better than that of bilateral facial anatomical landmarks. The effect of determining facial anatomical landmarks in patients without mandibular deviation is better than that in patients with mild mandibular deviation.

Percentage of tonsil hypertrophy in orthodontic patients with different sagittal skeletal relationship / 中华口腔医学杂志

Objective: To investigate the prevalence of tonsil hypertrophy in patients with different sagittal skeletal craniofacial patterns, as well as the correlation between tonsil hypertrophy and the type of skeletal pattern. Methods: Lateral cephalograms of patients who visited the Department of Orthodontics Division 1, School of Stomatology, Wuhan University during January to August, 2019 were retrospectively collected. Patients (children: age≥6 and ≤12 year; adults: age≥18 year) were divided into three groups according to the ANB (subspinale-nasion-supramental) angle: the skeletal class Ⅰ group (0°≤ANB≤4°), skeletal class Ⅱ group (ANB>4°) and skeletal class Ⅲ group (ANB<0°). Tonsil hypertrophy was diagnosed with lateral cephalogram by two specifically trained orthodontists independently, according to the Baroni's method. The between-group differences in tonsil hypertrophy prevalence were analyzed using chi-square tests with Bonferroni correction (α=0.017). Results: A total of 1 776 patients (593 children and 1 183 adults) were included, among which 672 (37.8%) were with class Ⅰ, 849 (47.8%) with class Ⅱ, and 255 (14.4%) with class Ⅲ skeletal pattern. The prevalence of tonsil hypertrophy in children was 66.3% (393/593). The proportion of children with tonsil hypertrophy in class Ⅲ group [87.0% (60/69)] were significantly higher than that in class Ⅰ [65.6% (145/221), χ²=11.56, P<0.017] and class Ⅱ [62.0% (188/303), χ²=15.69, P<0.017] groups. The prevalence of tonsil hypertrophy in adults was 23.2% (275/1 183). The proportion of adults with tonsil hypertrophy in class Ⅲ group [42.5% (79/186)] was significantly higher than that in class Ⅰ [19.1% (86/451), χ²=36.50, P<0.017] and class Ⅱ [20.2% (110/546), χ²=35.00, P<0.017] groups. However, there was no significant difference in the prevalence of tonsil hypertrophy between class Ⅰ and class Ⅱ groups for both children (χ²=0.70, P>0.017) and adults (χ²=0.18, P>0.017). Conclusions: The prevalence of tonsil hypertrophy in skeletal class Ⅲ patients was significantly higher than that in patients with skeletal class Ⅰ and Ⅱmalocclusion. Tonsil hypertrophy could be an important risk factor for skeletal class Ⅲ patients.

Efficacy of vertical control by using mini-implant anchorage in maxillary posterior buccal area for Angle class Ⅱ extraction patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the efficacy of vertical control by using conventional mini-implant anchorage in maxillary posterior buccal area for Angle class Ⅱ extraction patients.@*METHODS@#Twenty-eight Angle class Ⅱ patients [9 males, 19 females, and age (22.6±2.8) years] were selected in this study. All of these patients were treated by using straight wire appliance with 4 premolars extraction and 2 mini-implant anchorage in maxillary posterior buccal area. In this study, the self-control method was used to measure and analyze the lateral radiographs taken before and after orthodontic treatment in each case, the main cephalometric analysis items were related to vertical changes. The digitized lateral radiographs were imported into Dolphin Imaging Software (version 11.5: Dolphin Imaging and Management Solutions, Chatsworth, California, USA), and marked points were traced. Each marked point was confirmed by two orthodontists. The same orthodontist performed measurement on the lateral radiographs over a period of time. All measurement items were required to be measured 3 times, and the average value was taken as the final measurement result.@*RESULTS@#Analysis of the cephalometric radiographs showed that, for vertical measurements after treatment, the differences of the following measurements were highly statistically significant (P < 0.001): SN-MP decreased by (1.40±1.45) degrees on average, FMA decreased by (1.58±1.32) degrees on average, the back-to-front height ratio (S-Go/N-Me) decreased by 1.42%±1.43% on average, Y-axis angle decreased by (1.03±0.99) degrees on average, face angle increases by (1.37±1.05) degree on average; The following measurements were statistically significant (P < 0.05): the average depression of the upper molars was (0.68±1.40) mm, and the average depression of the upper anterior teeth was (1.07±1.55) mm. The outcomes indicated that there was a certain degree of upper molar depression after the treatment, which produced a certain degree of counterclockwise rotation of the mandibular plane, resulting in a positive effect on the improvement of the profile.@*CONCLUSION@#The conventional micro-implant anchorage in maxillary posterior buccal area has a certain vertical control ability, and can give rise to a certain counterclockwise rotation of the mandible, which would improve the profile of Angle Class Ⅱ patients.

Discrepancia negativa transversal del maxilar y diferencias cefalométricas laterales según el ancho de la arcada superior / Negative maxillary transverse discrepancy and cephalometric lateral differences according to the width of upper arch

Introduction: Negative maxillary transverse discrepancy is not exclusive to narrow upper arch. The transverse discrepancy due to maxillary deficiency is well described, but this is not the case when the maxilla displays adequate dimensions and the origin of the problem is an excess of mandibular width. Objective: To describe the cephalometric characteristics of negative maxillary transverse discrepancy present in narrow upper arches with those of normal or increased width. Methods: An observational and cross-sectional study was carried out in records of patients with negative maxillary transverse discrepancy. The cases referred to the maxillofacial surgery department at Hospital Clínico Quirúrgico "Hermanos Ameijeiras" between January 2016 and January 2020 were selected. The initial study models were measured and two groups were formed: those with a distance between central fossae of 16 to 26, less than 47 mm and the other with equal or greater values. Lateral cephalometric analysis of Ricketts, McNamara, Björk & Jarabak, Burstone and soft profile were performed on the initial teleradiographs. Using the Mann Whitney U test of independent samples, measurements with statistically significant differences between both groups were selected. (p <0.05). Results: Significant differences were found regarding the cranial-mandibular relationship, mandibular anatomy, maxillo-mandibular relationship and occlusal relationship. The most important differences observed in each group were respectively: S-Ar / Ar-Go ratio (p = 0.033), mandibular body length (p = 0.01), mandibular-maxillary difference (p = 0.003) and overjet (p = 0.043). Conclusions: In the studied patients, negative maxillary transverse discrepancy has the same probability of presenting a wide or in norm upper arch, as well as a narrow arch. In the first case, it is more likely to find jaws with increased body length, a skeletal class III pattern and a concave profile; in the second case, the tendency is to present small jaws with increased articular angle and dental overjet(AU)

Introducción: La discrepancia negativa transversal del maxilar no es exclusiva de una arcada superior angosta. La discrepancia transversal por deficiencia maxilar está bien descrita, pero no ocurre así cuando el maxilar se presenta con dimensiones adecuadas y el origen del problema es un exceso del ancho mandibular. Objetivo: Describir las diferencias cefalométricas de la discrepancia negativa transversal del maxilar que presentan arcadas superiores estrechas con aquellas de ancho normal o incrementado. Métodos: Se realizó un estudio observacional, de corte transversal, en expedientes de pacientes con discrepancia negativa transversal del maxilar. Se seleccionaron los casos que acudieron entre enero del 2016 y enero del 2020 a la consulta de cirugía maxilofacial del Hospital Clínico Quirúrgico "Hermanos Ameijeiras". Se midieron los modelos de estudio iniciales y se conformaron dos grupos: aquellos con distancia entre fosas centrales de 16-26, menor de 47 mm y el otro con valores iguales o superiores. Se realizaron análisis cefalométricos laterales en las telerradiografías iniciales de Ricketts, McNamara, Björk & Jarabak, Burstone y perfil blando. Por medio de la prueba U de Mann Whitney de muestras independientes, se seleccionaron las mediciones con diferencias estadísticas significativas entre ambos grupos (p < 0.05). Resultados: Se encontraron diferencias significativas concernientes a la relación cráneo mandibular, anatomía mandibular, relación máxilo mandibular y relación oclusal. Las diferencias observadas más importantes de cada grupo fueron respectivamente: relación S-Ar/Ar-Go (p = 0,033), longitud del cuerpo mandibular (p = 0,01), diferencia mandibular-maxilar (p = 0,003) y resalte (p = 0,043). Conclusiones: En los pacientes estudiados, las discrepancias negativas transversales tienen la misma probabilidad de presentarse con la arcada superior ancha o en norma, que angosta. En los primeros es más probable encontrar mandíbulas con longitud del cuerpo incrementada, patrón de clase III esquelética y perfil cóncavo; en los segundos, la tendencia es a presentar mandíbulas pequeñas con ángulo articular y resalte dentario aumentados(AU)

Validación de un modelo cefalométrico de predicción para el brote de los terceros molares / Validation of a cephalometric prediction model for third molar eruption

Introducción: La intervención temprana en el brote anormal de los terceros molares podría reducir la proporción de pacientes con las molestias asociadas y la aparición de alteraciones producto a la retención dentaria. Objetivo: Validar el modelo cefalométrico predictivo para el brote de los terceros molares desarrollado González Espangler. Métodos: Se realizó un estudio longitudinal, descriptivo, de corte transversal, en adolescentes del Instituto Preuniversitario "Rafael María de Mendive" de Santiago de Cuba durante el periodo comprendido entre enero del 2017 y marzo del 2020. Fueron empleadas dos muestras aleatorias de 21 estudiantes de 15-18 años y 29 profesionales de las ciencias de la salud. Se estudiaron variables como el sexo, color de la piel, localización, etapa de formación, espacio óseo posterior, angulación, diámetro mesiodistal, factores predictivos y tipo de brote de los terceros molares. Resultados: Predominó el tipo de brote anormal: 19,0 por ciento para la localización 1.8; 17,9 por ciento para la 2.8; 21,4 por ciento en la 3.8 y 20,2 por ciento en la posición 4.8. No existieron diferencias significativas entre las medidas promedios del espacio óseo posterior, angulación y diámetro mesiodistal con el estudio de referencia. La validación de modelo por criterio de expertos obtuvo una calificación global de concordancia entre ellos del 100 por ciento. Conclusiones: El modelo cefalométrico predictivo validado es viable en el proceso de predicción del brote de los terceros molares en la población(AU)

Introduction: Early intervention in the abnormal eruption of third molars could reduce the number of patients with associated discomfort and the appearance of alterations caused by dental retention. Objective: Validate the cephalometric prediction model for third molar eruption developed by González Espangler. Methods: A cross-sectional longitudinal descriptive study was conducted of adolescents from Rafael María de Mendive Senior High School in Santiago de Cuba from January 2017 to March 2020. The two random samples examined consisted of 21 students aged 15-18 years and 29 health sciences professionals. The variables considered were sex, skin color, location, training stage, posterior bony space, angulation, mesiodistal diameter, predictive factors and type of third molar eruption. Results: Abnormal eruption prevailed: 19.0 percent in location 1.8; 17.9 percent in 2.8; 21.4 percent in 3.8 and 20.2 percent in 4.8. Significant differences were not observed between average values for posterior bony space, angulation and mesiodistal diameter, and the study reference. Validation of the model by expert criteria obtained a global agreement score of 100 percent. Conclusions: The cephalometric prediction model validated in the study is viable for the prediction of third molar eruptions in the population(AU)

Estabilidad: Análisis de la inclinación del incisivo inferior luego del tratamiento ortodóncico / Stability: Analysis of the inclination of the lower incisor after orthodontic treatment

Este trabajo de investigación tiene como finalidad comparar la inclinación del incisivo inferior pre y post-tratamiento en pacientes tratados ortodóncicamente con técnicas Roth y técnica Damon a los cuales no se les realizó exodoncias. El grupo de estudio estuvo conformado por 150 pacientes adultos con dentición permanente completa que han sido atendidos en el Círculo Argentino de Odontología. Para medir la inclinación se utilizó la fórmula de Tweed: ángulo IMPA, eje axial del incisivo inferior con el plano mandibular. Los valores tomados de los trazados pre y post-tratamiento fueron sometidos a un test de Student apareado utilizando el programa Infostat v 2010. Se encontró una diferencia significativa en la inclinación axial del incisivo inferior post tratamiento cualquiera sea la técnica utilizada, aumenta en ambos casos. No se realizó discriminación de torques (Roth ­ 1°, Damon torque estándar ­ 3°, Damon bajo torque - 11°) (AU)

This research work aims to compare the inclination of the lower incisor before and after treatment in patients treated orthodontically with Roth techniques and Damon technique to which no exodontics were performed. The study group consisted of 150 adult patients with complete permanent dentition who have been treated in Circulo Argentino de Odontología. To measure the inclination the Tweed formula was used: IMPA angle, axial axis of the lower incisor with the mandibular plane. The values taken from the pre and post-treatment plots were subjected to a Student test paired using the Infostat v 2010 program. A significant difference was found in the axial inclination of the lower incisor post treatment whatever the technique used, it increases in both cases. No torques discrimination was performed (Roth - 1 °, Damon standard torque - 3 °, Damon under torque - 11 °) (AU)

Cephalometric Evaluation of Nasopharyngeal Airway and Hyoid Bone Position in Subgroups of Class II Malocclusions / Evaluación cefalométrica de la vía área nasofaríngea y posición del hueso hioides en subgrupos de maloclusión clase II

Abstract The aim of the study is to evaluate pharyngeal airway dimensions and hyoid bone position according to different Class II malocclusion types in Turkish population. Materials and Methods: The retrospective clinical study consisted of patients divided into 3 subgroups with skeletal Class II malocclusion. A total of 221 individuals (131 females and 90 males) were included in the study. Individuals with skeletal Class II malocclusion were divided into three subgroups as maxillary prognathia, mandibular retrognathia and combined. In the cephalometric analysis; 8 nasopharyngeal, 7 oropharyngeal, 2 hypopharyngeal, 9 hyoid measurements and 4 area measurements were used. The distribution of sex and growth-development stages of the patients were compared with the Pearson chi-square test. One-way ANOVA was used to evaluate patients. Tukey Post-Hoc tests were used for bilateral comparisons for significant parameters. SPSS package program was used for data analysis. Results were considered statistically significant at p0.05). When the position of the hyoid bone was evaluated, a statistically significant difference was found between the three groups in the measurements of Hy-Pg (mm) (p<0.05). Conclusion: Linear and areal nasopharyngeal airway dimensions are similar in subgroups of Class II malocclusions, while the distance of the hyoid bone from the pogonion is less in the mandibular retrognathia group.

Resumen El objetivo del estudio es evaluar las dimensiones de las vías respiratorias faríngeas y la posición del hueso hioides según los diferentes tipos de maloclusión de clase II en la población turca. Materiales y métodos: El estudio clínico retrospectivo consistió en pacientes divididos en 3 subgrupos con maloclusión esquelética de Clase II. Un total de 221 individuos (131 mujeres y 90 hombres) fueron incluidos en el estudio. Los individuos con maloclusión esquelética de Clase II fueron divididos en tres subgrupos como prognatismo maxilar, retrognatismo mandibular y combinados. En el análisis cefalométrico se utilizaron 8 medidas nasofaríngeas, 7 orofaríngeas, 2 hipofaríngeas, 9 medidas hioides y 4 medidas de área. La distribución del sexo y las etapas de desarrollo del crecimiento de los pacientes se compararon con la prueba de chi cuadrado de Pearson. Se utilizó un ANOVA unidireccional para evaluar a los pacientes. Las pruebas Tukey Post-Hoc se usaron para comparaciones bilaterales de parámetros significativos. El programa del paquete SPSS se usó para el análisis de datos. Los resultados se consideraron estadísticamente significativos a un nivel de significación p0.05). Cuando se evaluó la posición del hueso hioides, se encontró una diferencia estadísticamente significativa entre los tres grupos en las mediciones de Hy-Pg (mm) (p<0.05). Conclusión: Las dimensiones de las vías respiratorias nasofaríngeas lineales y areales son similares en los subgrupos de maloclusiones de Clase II, mientras que la distancia del hueso hioides al pogonion es menor en el grupo de retrognacia mandibular.

Gonial Angle Characteristics of Class III Malocclusion in Javanese Ethnic

ABSTRACT Objective: To describe the gonial angle characteristics in class III skeletal malocclusion in Javanese ethnic. Material and Methods: Pretreatment lateral cephalometric radiographs of 43 Javanese ethnic patients were measured: upper (Go1) and lower gonial angle (Go2), anterior (AFH) and posterior face height ratio (PFH), maxilla-mandibular length difference, mandibular plane angle (FMA), Y axis, ramus position, ANB angle, posterior cranial base/ramus height and mandibular body length/anterior cranial base. The relation between Go1, Go2 and other variables were analysed using correlation and regression analysis. Results: The total gonial angle is within normal range, but Go1 is below normal and Go2 is above normal. There is no difference between male and female gonial angle measurements (p=0.939 and p=0.861, respectively). Ramus position is positively correlated to Go1 (p=0.003), while AFH (p=0.000), maxilla-mandibular length difference (p=0.000), FMA (p=0.000), Y axis (p=0.000), and posterior cranial base/ramus height (p=0.018) are positively correlated to Go2. PFH is negatively correlated to Go2 (p=0.018). Conclusion: The upper gonial angle is influenced by the position of mandibular ramus, while the lower gonial angle is affected by the posterior and anterior lower facial height and mandibular size and rotation. Javanese with class III malocclusion tends to have hypodivergent facial type, with more posteriorly located mandibular ramus and excess mandibular length.

Análisis de diferentes protocolos cefalométricos laterales. Parte II: consideraciones sobre diferentes aplicaciones / Analysis of different lateral cephalometric protocols. Part II: consideratios on different applications

El objetivo de esta segunda parte es relacionar el protocolo utilizado en el Ateneo Argentino de Odontología (A.A.O.) expuesto en la Parte I, con los cefalogramas laterales diseñados por los Dres. Arne Björk, Joseph Jarabak, James McNamara y Robert Ricketts y proponer las visiones complementarias en la búsqueda de un diagnóstico y un plan de tratamiento de mayor precisión. La aplicación de una secuencia lógica en el diagnóstico de una maloclusión permite establecer una categoría de análisis jerarquizada en función de los condicionantes y de las posibilidades de intervención terapéutica (AU)

The objective of this second part is to relate the protocol used in the Ateneo Argentino de Odontología (A.A.O.) exposed in Part I, with the lateral cephalograms designed by the Drs. Arne Bjork, Joseph Jarabak, James McNamara and Robert Ricketts and propose complementary visions in the search for a more accurate diagnosis and treatment plan. The application of a logical sequence in the diagnosis of malocclusion, allows to establish a category of hierarchical analysis according to the conditions and the possibilities of therapeutic intervention (AU)

Relación Transversal, Vertical y Sagital en Sujetos con Deformidad Facial Candidatos a Cirugía Ortognática / Transverse, Vertical and Sagittal Relationship in Subjects with Facial Deformity Candidates for Orthognathic Surgery

RESUMEN: El objetivo de este estudio fue evaluar la relación entre la clase esqueletal sagital y las condiciones transversales o verticales en sujetos con deformidad facial sin presencia de asimetría facial; Se realizó un análisis cefalomét rico de la clase esqueletal sagital, transversal y vertical en 115 sujetos con indicaciones de cirugía ortognática. Se consideró algunos datos del análisis cefalométrico de Steiner y el análisis cefalométrico de Ricketts en sentido sagital para determinar la clase esqueletal facial. A nivel transversal se determinó la dimensión transversal facial, dimensión transversal maxilar y dimensión transversal mandibular. A nivel vertical se determinó la dimensión vertical oclusal y dimensión vertical total. Al comparar las mediciones transversales y verticales entre sujetos de sexo femenino y masculino, se observó que los hom- bres presentaban mayores dimensiones que las mujeres (p=0,0001) en todos los análisis realizados. Los sujetos clase III presentaron mayor dimensión transversal facial (p=0,0002) y transversal mandibular (p=0,001) que los sujetos clase II. Además, se observó que los sujetos clase III presentaban mayor dimensión vertical total (p=0,002) que los sujetos clase II; Es posible concluir que existe características faciales transversales y verticales que se pueden relacionar con la posición sagital de las estructuras maxilo-mandibulares.

ABSTRACT: The aim of this study is to evaluate the relationship between sagittal skeletal class and transverse or vertical conditions in subjects with facial deformity without presence of facial asymmetry; A comparative study was conducted between the results of the cephalometric analysis of the sagittal, transverse and vertical skeletal class in 115 subjects with indications for orthognathic surgery. The Steiner cephalometric analysis in the sagittal direction was used to determine the facial skeletal class and the Ricketts cephalometric analysis in the sagittal analysis. At the transverse level it was determined the facial transverse dimension, maxillary transverse dimension and mandibular transverse dimension. At a vertical level it is determined the occlusal vertical dimension and total vertical dimension. When comparing cross-sectional and vertical measurements between female and male subjects, it was observed that male subjects presented greater dimensions than female subjects (p=0.0001). Class III subjects present greater facial transverse dimension (p=0.0002) and mandibular transverse dimension (p=0.001) than class II subjects. Also, it was observed that class III subjects had a greater total vertical dimension (p=0.002) than class II subjects; It is possible to conclude that there are facial characteristics transverse and vertical that can be related with the sagittal position of the maxillo-mandibular structures.

Análisis de concordancia entre trazado cefalométrico manual y cefalométrico digital con programa Nemoceph / Analysis of concordance between manual cephalometric and digital cephalometric tracing with Nemoceph program

La importancia del análisis cefalométrico dentro del diagnóstico en ortodoncia ha ido incrementando a través de los años, por ello, el interés de comparar la confiabilidad de los sistemas digitales con el trazado manual convencional. Objetivo: Definir el grado de concordancia entre los resultados de trazado cefalométrico manual y con Nemoceph. Material y métodos: Se utilizaron ocho medidas lineales y angulares del análisis cefalométrico de Steiner. Se realizó un estudio transversal, correlacional, en el cual se analizaron 70 radiografías laterales de cráneo digitales. Los resultados se dividieron en dos grupos, trazado manual y trazado cefalométrico con Nemoceph, los cuales fueron evaluados con un índice de correlación intraclase. Conclusión: Se reportó un grado de correlación intraclase mayor a 0.75, estableciendo que el sistema digital exhibe la misma precisión del manual, con algunas ventajas convenientes a la época (AU)

The importance taken by the cephalometric analysis within the orthodontic diagnosis has been increasing over the years, for that reason the interest of comparing the reliability of the digital systems with the conventional manual tracing. Objective: To define the degree of concordance between the results of manual cephalometric tracing and with Nemoceph. Material and methods: Eight linear and angular measurements of Steiner's cephalometric analysis were used. A crosssectional, correlational study was conducted in which 70 digital skull lateral radiographs were analyzed. The results were divided into two groups; manual tracing and cephalometric tracing with Nemoceph, which were evaluated with an intraclass correlation index. Conclusion: a correlation degree greater than 0.75 was reported. Establishing that the digital system exhibits the same precision of the manual, with some advantages suited to the age (AU)

Evaluation of diagnostic agreement among cephalometric measurements for determining incisor position and inclination / Evaluación de la concordancia diagnóstica entre mediciones cefalométricas para la determinación de la posición e inclinación de los incisivos

SUMMARY: The incisors are a key factor in dental occlusion and dentofacial aesthetics; therefore, the sagittal position and inclination of the incisors is a key parameter in diagnosis and orthodontic treatment planning. In some cases, the orthodontist will use more than one cephalometric analysis, and thus different results can be obtained. The aim of this study was to establish the diagnostic agreement among the different cephalometric measurements used to determine the anteroposterior position and the inclination of the incisors. Lateral cephalometric radiograms of patients between 18 and 59 years old were measured (n=260). Digital cephalometric measurements were made with Dolphin Imaging software, by a single calibrated operator. Here, a specific cephalometric analysis was designed in the software analysis editor. The results for each variable and each measurement were registered and compared. Fleiss's Kappa statistical tests, Cohen's Kappa, and Kendall's coefficient were used to determine the strength of agreement using the Minitab software. The results showed diagnostic strength agreement between slight and moderate among measurements of the same variable. This indicates that same diagnosis might not be obtained when using different approaches to measure the anteroposterior position and inclination of the incisors. It was concluded that there is a difference in the diagnosis between one measurement and another because the results showed slight or moderate strength of agreement. However, in some cases, better agreement was found when the measurements were compared as a function of the diagnostic response.

RESUMEN: Los incisivos son un factor clave en la oclusión dental y la estética dentofacial; por lo tanto, la posición sagital y la inclinación de los incisivos es un parámetro clave en el diagnóstico y la planificación del tratamiento de ortodoncia. En algunos casos, el ortodoncista utilizará más de un análisis cefalométrico y, por lo tanto, se pueden obtener resultados diferentes. El objetivo de este estudio fue establecer el acuerdo de diagnóstico entre las diferentes mediciones cefalométricas utilizadas para determinar la posición anteroposterior y la inclinación de los incisivos. Se midieron radiografías cefalométricas laterales de pacientes entre 18 y 59 años (n = 260). Las mediciones cefalométricas digitales se realizaron con el software Dolphin Imaging, por un solo operador calibrado. Aquí, se diseñó un análisis cefalométrico específico en el editor de análisis de software. Los resultados para cada variable y cada medición se registraron y compararon. Las pruebas estadísticas Kappa de Fleiss, Kappa de Cohen y el coeficiente de Kendall se usaron para determinar la fuerza del acuerdo utilizando el software Minitab. Los resultados mostraron un acuerdo de fuerza diagnóstica entre leve y moderado entre las mediciones de la misma variable. Esto indica que no se puede obtener el mismo diagnóstico cuando se utilizan diferentes enfoques para medir la posición anteroposterior y la inclinación de los incisivos. Se concluyó que existe una diferencia en el diagnóstico entre una medición y otra porque los resultados mostraron una fuerza de acuerdo leve o moderada. Sin embargo, en algunos casos, se encontró un mejor acuerdo cuando se compararon las mediciones en función de la respuesta de diagnóstico.

The changeability of some cephalofacial variables and stature during a timeline of over 80 years / La capacidad de cambio de algunas variables cefalofaciales y estatura durante un periodo de más de 80 años

Cephalofacial variables and the body height have priority importance in anthropological researches for a chronological study of the anthropological status of peoples. The main aim of this study was to evaluate the changeability of the cephalofacial variables and stature under the influence of exogenous factors during the over 80 years period-time. The realisation of the goal was done by comparing of some anthropometrical data (stature, 5 cephalofacial measurements and 2 cephalofacial indexes) done on the Albanian male population in three different time-line studies (Coon, 1950; Dhima, 1974-84; Rexhepi et al. 2018; cephalofacial measurements, 1997-2008, and stature, 2007-2017). Regarding the cephalofacial variables, some minor systematic differences were found between three different timeline studies, but without contradictions regarding the group's classification according to the corresponding scale. The major and meaningful differences between the three studies are noted in body height (Coon = 169.71 cm, Dhima=171.61cm; Rexhepi et al.=178.23 cm). The results of this study suggested that the timeline difference over 80 years, with all exogenous factor changes (environment, socioeconomic conditions, health, etc.) has a meaningful impact on body height, while not on the substantial changes on cephalofacial variables.

Las variables cefalofaciales y la altura del cuerpo tienen una importancia mayor en las investigaciones antropológicas para un estudio cronológico del estado antropológico de la población. El objetivo principal de esta investigación fue evaluar la capacidad de cambio de las variables cefalofaciales y la estatura de acuerdo a la influencia de factores exógenos durante un período de más de 80 años. El objetivo se llevó a cabo mediante la comparación de algunos datos antropométricos (estatura, 5 mediciones cefalofaciales y 2 índices cefalofaciales) realizados en la población masculina albanesa en tres estudios de línea de tiempo diferentes (Coon, 1929-30; Dhima, 1974-84; Mediciones cefalofaciales de Rexhepi et al., 1997-2008, y estatura, 2007-2017). Con respecto a las variables cefalofaciales, se encontraron algunas diferencias sistemáticas menores entre tres estudios de línea de tiempo diferentes, pero sin contradicciones con respecto a la clasificación del grupo, según la escala correspondiente. Las diferencias principales y significativas entre los tres estudios se observaron en la altura del cuerpo (Coon = 169,71 cm, Dhima = 171,61 cm; Rexhepi et al. = 178,23 cm). Los resultados de esta investigación sugieren que la diferencia en la línea de tiempo en un periodo de 80 años, junto a todos los cambios de factores exógenos (ambiente, condiciones socioeconómicas, salud, etc.) tienen un impacto significativo en la altura corporal, mientras que esto no ocurre en los cambios de las variables cefalofaciales.

Los tipos craneométricos caninos aparecen bien expresados a nivel de conformación del arco cigomático / Craneometric canine types are well expressed at the level of the zygomatic arch conformation

Dentro del espectro de conformación del cráneo, se reconocen generalmente tres amplias categorías que se corresponden con el concepto de biotipo cefálico, determinado por el Índice Cefálico. El Estos tres biotipos cefálicos son: el braquiocefálico, mesaticefálico y dolicocefálico, pero están basados en medidas lineales. A fin de revisar esta clasificación en base a su geometría, se estudiaron 53 cráneos de perros adultos, correspondientes a los tres grupos craneométricos descritos: 16 braquicéfalos, 20 mesaticéfalos y 17 dolicocéfalos. Para ello se obtuvieron fotografías en el plano ventral, en las que posteriormente se ubicaron 17 hitos anatómicos que se analizaron mediante técnicas de morfometría geométrica. De estos hitos, 5 correspondían a la zona neurocraneal y el resto al esplacnocráneo. Los tres grupos craneométricos mostraron diferencias estadísticamente significativas entre ellos tanto por el tamaño como por la forma. Las variables que contribuyeron más a explicar la diferenciación fueron las ubicadas en el margen más lateral de los arcos cigomáticos y en la base de este mismo arco. Las variables esplacnocraneales presentaban una alometría mucho más marcada que las neurocráneos. Puesto que el arco cigomático debe ser considerado como parte del esplacnocráneo, sugerimos que es tan importante el índice cefálico (que tiene en cuenta la máxima anchura de la cabeza) como el facial (que tiene en cuenta la máxima anchura de la cara). La conformación neurocraneal sería mucho más conservativa y por ende el índice craneal, de mucho menor poder discriminatorio entre grupos. El cambio entre tipos se debería a los músculos masetero y temporal, que tienen su inserción en el arco.

Within the wide conformation of skull spectrum, there are generally three recognized broad categories that correspond to the concept of cephalic biotype, determined by the cephalic index. The three cephalic biotypes are: brachiocephalic, mesaticephalic and dolichocephalic, which are based on linear measures. In order to revise this classification based on its geometry, we studied 53 skulls of adult dogs, corresponding to the three craneometric groups previously described: 16 brachycephalic, 20 mesaticephalic and 17 dolichocephalic. Images on ventral plane were obtained and 17 anatomical landmarks were subsequently located and analyzed by means of geometric morphometric techniques. Five of those landmarks corresponded to the neurocraneal area and the rest of the splanchnocranium. The three craneometric groups showed statistically significant differences between them for both size and shape. The variables that contributed to the differentiation between them were located along the edge of the zygomatic arches and on the basis of this arch. Splanchnocranial variables also presented a much more marked allometry than the neurocraneal variables. Since the zygomatic arch should be considered as part of the splanchnocranium, we suggest that the cephalic index (which takes into account the maximum width of the head) is as important as the facial index (which takes into account the maximum width of the face). The neurocraneal index would be much more conservative, and therefore less discriminatory between the groups.

Análise bi e tridimensional das vias aéreas superiores em pacientes submetidos à cirurgia ortognática bimaxilar / Two- and three-dimensional analysis of the upper airways in patients undergoing bimaxillary orthognathic surgery

O propósito deste trabalho foi analisar as mudanças bi e tridimensionais na via área superior após procedimentos de cirurgia ortognática. Tomografias pré (T1) e pós-operatórias (T2) foram utilizadas, padronizando pontos craniométricos que serviram de referência para analisar mudanças lineares e volumétricas de diferentes áreas na via aérea superior. Vinte e dois pacientes foram incluídos no estudo, tendo sido submetidos a cirurgia bimaxilar com alteração do plano oclusal. Todos os casos foram planejados virtualmente, e o software Dolphin Imaging (versão 11.9) foi utilizado para análise das medidas lineares, bem como, o cálculo da área da via área superior total, e de suas 3 subdivisões e da região de maior constrição. A via aérea posterior e superior total, foi beneficiada com os movimentos de avanço das cirurgias bimaxilares. Houve correlação positiva entre o valor da constrição pré e pós e o valor total 3D da via aérea pré e pós. Observou-se diferença significativa quando se avalia a média Pré e Pós do seguimento de via aérea total (ST) bi e tridimensionalmente. Encontrou-se uma correlação positiva entre o giro anti-horário do plano oclusal e a ampliação da via aérea. Não foi possível determinar com precisão como cada ponto craniométrico individualmente influenciou e/ou contribui para as mudanças em cada segmento da via aérea analisada. Com bases nos dados da pesquisa a cirurgia ortognática bimaxilar demonstrou aumento das dimensões da via aérea superior, apresentando comportamentos diferentes a depender do segmento da via aérea superior avaliado, e da sua relação com os movimentos dos pontos craniométricos (AU).

The purpose of this work aimed to analyze the bi and three-dimensional changes in the upper airway after orthognathic surgery procedures. Pre (T1) and postoperative (T2) CT scans were used, standardizing craniometric points that served as a reference to analyze linear and volumetric changes in different areas in the upper airway. Twenty-two patients were included in the study, having undergone bimaxillary surgery with alteration of the occlusal plane. All cases were planned virtually, and the Dolphin Imaging software (version 11.9) was used to analyze the linear measurements, as well as the calculation of the area of the total upper area, and its 3 subdivisions and the region most significant. The posterior and upper total airways benefited from the advancing movements of bimaxillary surgeries. There was a positive correlation between the pre and post constriction value and the total 3D value of the pre and post airway. A significant difference was observed when evaluating the pre and post average of the total airway (ST) bi and three-dimensional follow-up. A positive correlation was found between the counterclockwise rotation of the occlusal plane airway's enlargement of the airway. It was not possible to accurately determine how each craniometric point individually influenced and / or contributed to the changes in each segment of the analyzed airway. Based on the research data, bimaxillary orthognathic surgery demonstrated an increase in the dimensions of the upper airway, showing different behaviors depending on the segment of the upper airway evaluated, and its relationship with the movements of the craniometric points (AU).

La vertical verdadera al punto A´(blando), al Pg´(blando), al Labrale superior y al Labrale inferior en posición ideal asistida de la cabeza (PIAC) / The true vertical from point A´(soft), to Pg´ (soft), to superior Labrale and inferior Labrale in Ideal Assisted Head Position (PIAC)

El 81,3% de una encuesta realizada a 96 ortodoncistas y ortopedistas calificados y técnicos radiólogos consultados informan que ubican la cabeza del paciente en una posición ideal, subjetiva del profesional instruido que lo asiste, ya que muchas de sus fotografías y telerradiografías no son posiciones naturales de la cabeza genuinas. Se ha utilizado la vertical verdadera como parámetro para mediciones, todas angulares, para definir la disposición ánteroposterior del punto A´ (de construcción) para el cuerpo del labio superior, el punto Pg´para el mentón, el Labrale superior y el Labrale inferior para el bermellón de cada labio, con la finalidad de planificar correcciones ortopédicas, ortodóncicas u ortodóncicas-quirúrgicas de acuerdo a la anomalía detectada (AU)

Variación del ángulo SN-Frankfort en los diferentes biotipos faciales / Variation of the SN-Frankfort angle in the different facial biotypes

RESUMEN Introducción: La determinación del ángulo SN-Frankfort ha sido una constante utilizada por muchas décadas con un valor de 7°, sin embargo, son diversas las investigaciones que han refutado esta afirmación, debido a que los factores sociodemográficos influyen en la variación de este ángulo. Asimismo, la importancia de determinarlo es pieza clave para establecer un diagnóstico certero. Objetivo: Evaluar la variación del ángulo SN-Frankfort según el biotipo facial en pacientes. Métodos: Estudio descriptivo, transversal, retrospectivo y observacional. La muestra estuvo conformada por 225 radiografías cefalométricas laterales de pacientes entre 12 a 35 años que acudieron al Servicio de Ortodoncia del Hospital Hipólito Unanue durante los años 2014-2017. Se cumplieron los criterios de inclusión y la selección se realizó de forma probabilística por el método aleatorio simple. Para la evaluación de las radiografías cefalométricas se realizó el trazado manual. El biotipo facial se determinó mediante el índice de VERT y luego se obtuvo el ángulo SN-Frankfort. Se emplearon dos métodos estadísticos para la evaluación de la concordancia y reproducibilidad: El índice de Kappa para la evaluación del biotipo facial y el coeficiente de correlación interclase para la determinación del ángulo. Resultados: El promedio del ángulo SN-Frankfort en los pacientes con biotipo dolicofacial fue de 10,46 ± 3,02°, con biotipo mesofacial 10,12 ± 3,03° y con biotipo braquifacial 10,39 ± 3,48°. Los pacientes del sexo femenino presentaron una mayor angulación SN-Frankfort (10,69 ± 3,04) en comparación con los pacientes del sexo masculino (9,73 ± 3,23); p= 0,026. Conclusiones: Existe una variación en el ángulo SN-Frankfort según el tipo de biotipo facial, sin embargo, estas diferencias no fueron significativas. De modo contrario, se encontró que existe una significativa mayor angulación de ángulo SN-Frankfort en los pacientes del sexo femenino(AU)

ABSTRACT Introduction: Determination of the SN-Frankfort angle has been a constant used for many decades with a value of 7°. However, several studies have refuted that statement, based on the influence of sociodemographic factors on the variation of this angle. On the other hand, the importance of its determination is crucial to achieve an accurate diagnosis. Objective: Evaluate the variation of the SN-Frankfort angle according to the facial biotype of patients. Methods: A descriptive cross-sectional observational retrospective study was conducted. The sample was 225 lateral cephalometric radiographs of patients aged 12-35 years attending the Orthodontics Service of Hipólito Unanue Hospital in the period 2014-2017. Inclusion criteria were complied with, and selection was made by simple random probability sampling. Manual tracing was performed to evaluate the cephalometric radiographs. Facial biotype was determined by the VERT index, and the SN-Frankfort angle was then obtained. Two statistical methods were used for agreement and reproducibility evaluation: the Kappa index for evaluation of the facial biotype and the interclass correlation coefficient for determination of the angle. Results: Average SN-Frankfort angle was 10.46 ± 3.02° for the dolichofacial biotype, 10.12 ± 3.03° for the mesofacial biotype and 10.39 ± 3.48° for the brachifacial biotype. Female patients had greater SN-Frankfort angulation (10.69 ± 3.04) than male patients (9.73 ± 3.23); p= 0.026. Conclusions: Variation was found in the SN-Frankfort angle according to the facial biotype, but those differences were not significant. Significantly greater SN-Frankfort angulation was found among female patients(AU)

Cuantificación de la distorsión presente en la radiografía posteroanterior de cráneo / Quantification of the distortion present in the postero-anterior cephalogram

RESUMEN Introducción: Universalmente se acepta que la radiografía postero-anterior de cráneo presenta menor grado de distorsión que otras imágenes radiográficas, por lo que las mediciones en ella son consideradas confiables. Objetivo: Determinar el porcentaje de distorsión que se presenta en las diferentes regiones faciales de la radiografía posteroanterior de cráneo. Métodos: Treinta cráneos humanos con sus mandíbulas fueron divididos por tres planos horizontales y cuatro verticales en quince cuadrantes; resultaron diez en el cráneo y cinco en la mandíbula. En cada uno de ellos se colocó un alambre de acero en posiciones vertical y horizontal y se midió su longitud (medida real). A cada conjunto se le tomó una radiografía en proyección postero-anterior y se midió la longitud de los alambres en la imagen (medida radiográfica). Resultados: No fue posible medir en los cuadrantes laterales del cráneo. La medida horizontal en los cuadrantes intermedios inferiores derecho e izquierdo del cráneo y en los cuadrantes intermedio y lateral de ambos lados de la mandíbula no es confiable; en el cuadrante mediano de la mandíbula se minimiza; en los cuadrantes medianos superior e inferior e intermedios superiores derecho e izquierdo del cráneo se magnifica. Las medidas verticales en todos los cuadrantes son confiables; en los cuadrantes intermedios superiores derecho e izquierdo del cráneo y en los intermedios y laterales derechos e izquierdos de la mandíbula se magnifica; en los cuadrantes intermedios inferiores y medianos superior e inferior del cráneo y mediano de la mandíbula se minimiza. La menor distorsión para ambas medidas se presenta en el cuadrante mediano superior del cráneo. Se reportan los porcentajes de distorsión para cada cuadrante. Conclusiones: Se presenta distorsión en la radiografía postero-anterior de cráneo y esta varía de una región a otra de la cara(AU)

ABSTRACT Introduction: Universally, it has been accepted that the postero-anterior cephalogram presents less distortion than any other x-ray radiograph; for this reason, the measurements taken on it are considered reliable. Objective: To determine for a postero-anterior cephalogram, what percentage of distortion is present in different regions of the skull and mandible. Methods: Thirty human skulls with their mandibles were divided by three horizontal and four vertical planes in fifteen quadrants, resulting ten in the skull and five in the mandible. In each quadrant, one vertical and one horizontal steel wire were fixed and their lengths were measured (real value). To each set, a postero-anterior cephalogram was taken and the wire images were measured (radiograph value). Results: No measurement could be taken in the lateral quadrants of the skull. The horizontal measurement in the right and left intermediate inferior quadrants of the skull and in the right and left intermediate and lateral quadrants of the mandible is not reliable; in the median quadrant of the mandible it is minimized; in the median superior and inferior and intermediate superior right and left quadrants of the skull it is magnified. The vertical measurement in all the quadrants is reliable; in the right and left intermediate superior quadrants of the skull and right and left intermediate and lateral quadrants of the mandible it is magnified; in the right and left intermediate inferior and median superior and inferior quadrants of the skull and median quadrant of the mandible it is minimized. The minimum distortion for both measurements is present in the median superior quadrant of the skull. The percentage of distortion in each quadrant for both measurements is reported. Conclusions: Distortion is present in the postero-anterior cephalogram and it varies from one region to another of the face(AU)