Interdisciplinariedad en el diagnóstico del síndrome de clase III esquelético de Moyers / Interdisciplinarity in the diagnosis of Moyers skeletal class III syndrome

RESUMEN Fundamento: Dentro de las anomalías de la oclusión que provocan afectación estética y funcional en los pacientes, se destaca el síndrome de clase III esqueletal de Moyers, cuyo diagnóstico debe ser preciso y precoz. Objetivo: Cuantificar la concordancia entre los criterios diagnósticos ortodóncicos y médicos en los portadores del síndrome de clase III esquelético de Moyers. Metodología: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba desde enero de 2018 hasta enero de 2020. Se estudiaron, por Ortodoncia y diferentes especialidades médicas seleccionadas, 15 pacientes de 8 a 18 años de edad diagnosticados clínica y cefalométricamente con clase III esqueletal de Moyers. Resultados: El nivel de acuerdo entre ortodoncia y las diferentes especialidades médicas fue leve con Oftalmología (Kappa=0.10), casi perfecta con Ortopedia (Kappa=1.00), pobre por Gastroenterología y por Otorrinolaringología (Kappa de 0.09 y 0.10 respectivamente), resultados estadísticamente significativos solo con Ortopedia. Conclusiones: Es evidente la marcada concordancia entre los diagnósticos ortodóncicos y ortopédicos en el síndrome de clase III esquelético, a diferencia del resto de las especialidades médicas; probablemente asociado a la no estandarización de las evaluaciones clínicas.

ABSTRACT Background: Among the occlusion anomalies that cause esthetic and functional affectation in patients, Moyers skeletal class III syndrome stands out, its diagnosis should be accurate and early. Objective: To quantify the concordance between orthodontic and medical diagnostic criteria in patients with Moyers skeletal class III syndrome. Methodology: An observational, descriptive and cross-sectional study was conducted at the "Mártires del Moncada" Provincial Teaching Dental Care Clinic of Santiago de Cuba from January 2018 to January 2020. 15 patients aged 8 to 18 years clinically and cephalometrically diagnosed with Moyers skeletal class III were studied by Orthodontics and different selected medical specialties. Results: The level of agreement between Orthodontics and the different medical specialties was slight for Ophthalmology (Kappa=0.10), almost perfect for Orthopedics (Kappa=1.00), poor for Gastroenterology and Otolaryngology (Kappa of 0.09 and 0.10 respectively), statistically significant results only for Orthopedics. Conclusions: The manifest concordance between orthodontic and orthopedic diagnoses in skeletal class III syndrome is evident, unlike the rest of the medical specialties; probably associated with non-standard clinical evaluations.

Survey of dental diseases in Crioulo breed horses reared in an extensive farming system / Levantamento de afecções dentárias em equinos da raça Crioula mantidos em sistema de criação extensivo

The present study aimed to identify and quantify dental diseases in Crioulo horses reared exclusively under extensive farming conditions. In total, 254 Crioulo horses were evaluated, that were reared exclusively in native pastures with predominantly Eragrostis plana (Annoni grass). The animals were divided into three groups according to age: three to five years (G1), six to 12 years (G2), and 13 to 26 years (G3). In total, 46.1% of the animals in G1, 63.8% in G2, and 82.3% in G3 had two or more incisor disorders; 37.5% in G1, 52.5% in G2 and 45.5% in G3 had two or more disease findings in the canines; and 28.9% in G1, 35.4% in G2, and 64.7% in G3 had four or more disease findings in the second, third, and fourth premolars and molars. However, dental calculus was observed in 90.5% of G2 animals, whereas in G3, the occurrence rate of excessive enamel points and calculus was 82.4%. Although all of the horses studied were reared in an extensive farming system, dental changes were very common in the Crioulo breed reared under these management conditions.(AU)

O presente estudo teve por objetivo identificar e quantificar as afecções odontológicas de equinos da raça Crioula criados exclusivamente em regime extensivo. No total, foram avaliados 254 cavalos Crioulos, criados em pastagens nativas com predominância de Eragrostis plana (capim-annoni). Os animais foram divididos em três grupos, de acordo com a idade: de três a cinco anos (G1), seis a 12 anos (G2 ) e 13 a 26 anos (G3). No total, 46,1% dos animais do G1, 63,8% do G2 e 82,3% do G3 apresentaram dois ou mais transtornos incisivos; 37,5% do G1, 52,5% do G2 e 45,5% do G3 tiveram duas ou mais alterações nos caninos; 28,9% do G1, 35,4% do G2 e 64,7% do G3 mostraram quatro ou mais distúrbios no segundo, terceiro e quarto pré-molares e molares. Contudo, cálculo dentário foi observado em 90,5% dos animais do G2, enquanto no G3, a taxa de ocorrência de pontas excessivas de esmalte dentário e cálculo foi de 82,4%. Concluiu-se que, apesar de todos os equinos estudados serem mantidos em sistema extensivo, as afecções dentárias mostraram-se muito comuns na raça Crioula sob estas condições de manejo.(AU)

Relation of Dental Anomalies with Occlusal Alterations in the Pediatric Patients

Objective: To identify the dental anomalies that can modify the occlusal characteristics and their distribution in these occlusal alterations in the skeletal patterns of children. Material and Methods: We analyzed charts, panoramic and periapical radiographs of children aged 5 to 12 years from 2009 to 2012. The facial pattern was evaluated through subjective face analysis and cephalometric data, as well as the occlusion of patients with and without (control) dental anomalies. The relationship between the presence of dental anomalies and malocclusion was analyzed by the Chi-square test with significance level of 5%. Results: 73 children (27.8%) presented dental anomalies, being 49.3% in girls and 50.7% in boys in a total of 88 teeth involved. Anomalies observed in decreasing order were: enamel hypoplasias, eruptive ectopias, agenesis, supernumerary teeth, corono-radicular dilaceration, microdontia, transposition and imperfect amelogenesis. Of these, 22.2% presented associated dental anomalies, whose ectopic eruption with enamel hypoplasia were the most frequently encountered. When comparing the control group with children with dental abnormalities it was observed a significant relationship between the presence of dental anomalies and malocclusion (p<0.05). The most frequent alteration among patients with dental anomalies was deep overbite (24.6%), followed by crowding (23.3%), posterior crossbite (14.2%), anterior open bite (12.9%) and anterior crossbite (0.3%). Conclusion: Dental dysgenesis interferes with the development of occlusion and the resulting occlusal problems are distributed differently, taking into account the skeletal facial pattern in patients with and without dental anomalies.

Evaluation of Microleakage by Gas Permeability and Marginal Adaptation of MTA and BiodentineTM Apical Plugs: In Vitro Study / Evaluación de la microfiltración por permeabilidad de gas y adaptación marginal de tapones apicales de MTA y BiodentineTM: Estudio in vitro

Abstract The endodontic treatment of teeth with incomplete development is always a complex task. Nowadays, biomaterials such as bioceramics offers promising clinical evidence that supports its use. However, the standardization of its use for apexification purpose still needs a deeper understanding of the materials' behavior. The aim of this investigation was to evaluate the marginal adaptability and microleakage by gas permeability of MTA and Biodentine™ apical plugs in an in vitro model. Materials and methods: Twenty- four single rooted human teeth were selected according to previously stablished inclusion criteria. All samples were prepared obtaining standard cylindrical internal canals with a diameter of 1.3 mm. Root canals were gently rinsed using 5.25% sodium hypochlorite and EDTA 17%. The apical 3mm and remaining coronal dental structure were sectioned to obtain 10mm roots. Roots were randomly assigned to 3 different groups as follows: GROUP A: MTA (n=10), GROUP B: Biodentine™ (n=10) and Group C: Control (positive n=1, negative n=3). MTA and Biodentine™ were prepared according to manufacturer's indications, and apical plugs of 4mm were passively placed in the correspondent teeth. All samples were stored in saline solution for 7 days at 37°C before evaluation. Samples were mounted in cylindrical sample-holders using epoxy resin. Microleakage was evaluated with an automatic permeability detector that calculates nitrogen diffusion between the material-root interphase. After microleakage evaluation, the samples were recovered and analyzed by scanning electron microscopy (SEM). Microleakage results were analyzed using Chi-square and adaptation was evaluated with a descriptive analysis. Results: None of the evaluated materials completely avoided the nitrogen microleakage (positive leakage of 10% and 20% of samples for MTA and Biodentine™ respectively); with no statistical significant difference between groups (p=0.527). All apical plugs showed good adaptation under SEM, at 30x, 200x, 1000x and 2500x; with microscopical structures similar to previous reports. Conclusions: Both bioceramics behave similar when used as apical barriers to avoid permeability, with acceptable marginal adaptation. Further in vivo studies are needed to validate these results.

Resumen El tratamiento endodóntico de dientes con desarrollo incompleto es siempre una tarea compleja. Hoy en día, biomateriales como las biocerámicas ofrecen una evidencia clínica prometedora que apoya su uso. Sin embargo, la estandarización de su uso para fines de apexificación todavía necesita una comprensión más profunda del comportamiento de los materiales. El objetivo de esta investigación fue evaluar la adaptabilidad marginal y microfiltración por permeabilidad de gas de los tapones apicales de MTA y Biodentine™ en un modelo in vitro. Materiales y métodos: Veiticuatro dientes humanos uniradiculares fueron seleccionados meticulosamente según criterios de inclusión previamente establecidos. Todas las muestras fueron preparadas con canales cilíndricos internos estandarizados de 1,3 mm de diámetro. Los conductos radiculares fueron gentilmente lavados con hipoclorito de sodio al 5,25% y EDTA al 17%. La estructura dental apical de 3 mm y la coronal restante se seccionó para obtener raíces de 10 mm de longitud. Las raíces se asignaron aleatoriamente a 3 grupos diferentes de la siguiente manera: GRUPO A: MTA (n = 10), GRUPO B: Biodentine™ (n = 10) y Grupo C: Control (n = 1 positivo, n = 3 negativos). El MTA y Biodentine™ se prepararon de acuerdo con las indicaciones de los fabricantes, y se colocaron pasivamente los tapones apicales de 4 mm en los dientes correspondientes. Todas las muestras se almacenaron en solución salina durante 7 días a 37ºC antes de la evaluación. Las muestras se montaron en porta-muestras cilíndricos utilizando resina epóxica. La microfiltración se evaluó con un detector de permeabilidad automática que calcula la difusión de nitrógeno entre la interfase material-raíz. Después de la evaluación de microfiltración, las muestras fueron recuperadas y analizadas por microscopía electrónica de barrido (SEM). Los resultados de microfiltración se analizaron utilizando una prueba estadística de Chi-cuadrado y la adaptación se evaluó con un análisis descriptivo. Resultados: Ninguno de los materiales evaluados evitó completamente la microfiltración de nitrógeno (fuga positiva de 10% y 20% de muestras para MTA y Biodentine™, respectivamente); sin diferencias estadísticamente significativas entre los grupos (p = 0,527). Todos los tapones apicales mostraron una buena adaptación bajo SEM, a 30x, 200x, 1000x y 2500x; con morfologías similares a las previamente reportadas. Conclusiones: ambas biocerámicas se comportan de forma similar cuando se usan como barreras apicales para evitar la permeabilidad de gas, con adaptación marginal aceptable. Se necesitan más estudios in vivo para validar estos resultados.

Prevalence of Dental Developmental Anomalies in Patients Attending a Faculty of Dentistry in Ajman, United Arab Emirates

Objective: To determine the prevalence of dental developmental anomalies among patients visiting the dental clinics at Ajman University, United Arab Emirates. Material and Methods: This retrospective study consisted of 425 digital panoramic radiographs. The study sample included people in the United Arab Emirates who have visited the outpatient dental clinics at the Faculty of Dentistry, at Ajman University. These OPGs have been evaluated for the presence of dental anomalies such as: Macrodontia, Microdontia, Talon cusp, Taurodontism, Dilaceration, Ectopic Eruption, Supernumerary teeth or roots, Fusion, Gemination, and Concrescense. Results: 80.7% had at least 1 anomaly, with the maximum of 5 anomalies presented in 1.2% of the sample. Dilacerations were the most commonly identified anomaly (61.4%), followed by missing third molars (22.8%), and Ectopic Eruption (15.5%) where (12.9%) of this anomaly has affected the maxillary canines. Hypercementosis (10.2%) followed by Microdontia (4.6%), which was mostly seen in the Upper laterals. Taurodontism accounted for (4.1%), Macrodontia (2.3%) and Talon cusp (2.3%). Gemination, Dens Invaginatus, and Concrescence were separately present in 1.1%, each one, of the cases observed. Conclusion: Variations in data and results among different studies suggest the impact of racial, genetic and environmental factors. The high frequency of dental anomalies emphasize the need of early detection and diagnosis which can be achieved through radiographic imaging, this would aid in further awareness to minimize any means of complexity in dental problems.

Reabilitação do incisivo central decíduo fusionado ao supranumerário: relato de caso clínico / Primary maxillary right central incisor fused to supernumerary: case report

diagnosticadas precocemente. Este trabalho teve como finalidade relatar o caso clínico de uma paciente de três anos, gênero feminino, cuja queixa principal era a estética dos dentes anteriores superiores,devido ao tamanho desproporcional de um elemento dentário, que se apresentava também com coloração alterada. Ao exame clínico e radiográfico diagnosticou-se uma anomalia denominada fusão dentária, união de dois dentes adjacentes, na região anteros superior. O tratamento consistiu na secção dos dois dentes e exodontia do supranumerário, seguida do tratamento restaurador do incisivo central direito que apresentava lesão de cárie. Concluiu-se que, por meio de adequado diagnóstico e planejamento, o tratamento proposto foi efetivo na reabilitação da função e da estética,assim como na prevenção de complicações clínicas e ortodônticas que poderiam advir da anomalia dentária descrita, caso não tratada. A autoestima da criança foi restabelecida.

Dental anomalies can cause serious disorders in the development of teeth if not diagnose dearly. This study aimed to report a case of a three-year-old patient, female, who together with her responsible, whose main complaint was the aesthetics of the upper front teeth due to disproportionatesize and altered staining. During the clinical and radiographic examinations, ananomaly called teeth merger, which is the union of two adjacent teeth, was diagnosed in the upper anterior region. The treatment included the sectioning of the two teeth and extraction of the super numerary, followed by restorative treatment of the right central incisor that had caries lesions. It was concluded that, through proper diagnosis and planning, the proposed treatment was effective in the rehabilitation of function and aesthetics, as well as in the prevention of clinical and orthodontic complications that could result from the dental anomaly described, ifuntreated. The child’s self-esteem was re-established.

Peg Shaped Mandibular Lateral Incisor in a Hypodontia Patient: A Case Report.

Congenitally missing teeth are not rare. However, their association with other dental anomalies has always been a topic of interest in the profession. Occurrence of peg-shaped incisors in the mandibular arch is a rare finding. Strong association has been suggested between hypodontia and microdontia. Treatment approach has to be case specific and depends on the condition of primary predecessor, number of missing teeth, status of occlusion/occlusal condition and patient/parent’s preferences. This paper reports an unusual case of bilateral agenesis of permanent mandibular canines and unilateral agenesis of mandibular incisors, in association with a rare finding of peg-shaped mandibular lateral incisor in a 7-year-old Indian female.

Resolución interdisciplinaria de un caso clínico de retención y transposición dentaria / Interdisciplinary resolution of a clinical case of tooth transposition

El propósito de esta presentación es motivar a los odontólogos generales a realizar un seguimiento temprano, clínico y radiológico, de sus pacientes en crecimiento, para valorar el desarrollo de la oclusión y poder diagnosticar precozmente la posibilidad de retenciones dentarias y derivar a especialistas, con la finalidad de guiar la secuencia eruptiva. Se presenta el caso clínico de una paciente que efectuó consultas a varios odontólogos durante muchos años, quienes le solicitaron estudios radiológicos y como único tratamiento, le colocaron una placa removible, reponiendo los dientes que no habían erupcionado. El diagnóstico y tratamiento interdisciplinario permitió rehabiliar la función gnatológica con sus propios dientes, recuperar la estética dental y la sonrisa de la paciente

A de novo Microdeletion of ANKRD11 Gene in a Korean Patient with KBG Syndrome

KBG syndrome is a very rare genetic disorder characterized by macrodontia of upper central incisors, global developmental delay, distinctive craniofacial features, short stature, and skeletal anomalies. Ankyrin repeat domain 11 gene (ANKRD11) has recently been identified as a causal factor of this syndrome. We describe a 6-yr-old Korean boy with features of KBG syndrome. The patient had a short stature, macrodontia, dysmorphic facial features, speech and motor delay with intellectual disability, and partial seizures as indicated by the electroencephalogram, but he was neither autistic nor had autism spectrum disorders. Using high-resolution oligonucleotide array comparative genomic hybridization, we identified a heterozygous 240-kb deletion at 16q24.3 corresponding to ANKRD11. This patient provided additional evidence on the influence of ANKRD11 in KBG syndrome and suggested that deletion limited to ANKRD11 is unlikely to cause autism.

Incisivo lateral superior con dos raíces y dos conductos: caso clínico / Upper lateral incisor with two roots and two canals: a clinical case

Las anomalías en la morfología del incisivo lateral superior son de muy baja frecuencia. Las anomalías de desarrollo radicular pueden presentarse como alteraciones tanto en el número de conductos, como en el número de raíces, así como en ambas regiones a la vez. En el presente trabajo, se reporta el caso de un paciente que se presenta a la consulta con malestar en el incisivo lateral superior izquierdo. En laradiografía preoperatoria se detectó la presencia de dos conductos y dos raíces, sin anomalía morfológica de su corona clínica, con requerimiento de tratamiento endodóntico. Concluimos que una correcta interpretación de las imágenes radiográficas preoperatorias es esencial, para poder detectar estas variantes y tomar las consideraciones necesarias para el adecuado tratamiento endodóntico

Abnormalities in the morphology of the maxillary lateral incisor are very low frequency. Root development abnormalities can occur as alterations in the number of ducts and the number of roots, as well as two regions at once. In this paper, we report the case of a patient presenting with discomfort in the upper left lateral incisor. In preoperative radiography, we detected the presence of two channels and two roots, without morphological abnormality in clinical crown, with endodontic treatment requirement. We conclude that a correct interpretation of preoperative radiographic imaging is essential in order to detect these variants and take the necessary considerations for proper endodontic treatment.

Bolton ratio in subjects with normal occlusion and malocclusion

AIM: To verify the presence of Bolton anterior and total discrepancy in Brazilian individuals with natural normal occlusion and Angle's Class I and Class II, division 1 malocclusions. METHODS: The sample was divided in three groups (n=35 each): natural normal occlusion; Class I malocclusion; Class II, division 1 malocclusion. Of the 105 Caucasian Brazilian individuals, 24 were boys and 81 were girls aged from 13 to 17 years and 4 months. The mesiodistal width of the maxillary and mandibular teeth, from the left first molar to the right first molar, was measured on each pre-treatment dental plaster cast using a digital caliper accurate to 0.01 mm resolution. Values were tabulated and the Bolton ratio was applied. The Kolmogorov-Smirnov test was used to verify if data were normally distributed (p>0.2). For comparison between the values obtained and those from the Bolton standard, Student's t test was used and one-way ANOVA was used for comparisons among the 3 groups, with a significance level of 5% (p<0.05). RESULTS: For groups 1, 2 and 3, respectively, the total ratio found was 90.36% (SD 1.70), 91.17% (SD±2.58) and 90.76% (SD±2.45); and the anterior ratio was 77.73% (SD 2.39), 78.01% (SD 2.66) and 77.30% (SD 2.65). CONCLUSIONS: There was no significant difference among the groups regarding the values indicated in the Bolton ratio.

Double root anatomical variations in a single patient: endodontic treatment and rehabilitation of a three-rooted first premolar: case report / Variaciones anatómicas de raíces dobles en un solo paciente: tratamiento endodóntico y rehabilitación de un primer premolar trirradicular: reporte de caso

Abnormal interaction between oral epithelium and underlying mesenchematic tissue during odontogenesis could result in teeth with an anatomical variation. First maxilar premolar has such variable root canal morphology. However, (0.2-6% of cases) a three-rooted premolar is particularly uncommon. First mandibular premolar frequently has one root and one single canal (75% of cases), however, a tooth with two canals and two separate roots could be found (19.5-22.5%). Execution of an accurate diagnosis of root canal system is essential to perform a successful endodontic treatment and tooth rehabilitation. This article describes diagnosis, endodontic treatment and rehabilitation (means single crown) of a maxillary three-rooted and three-canal first premolar, and a non-endodontically treated mandibular first premolar with two canals and two independent roots in a single patient.

La interacción anormal entre el epitelio oral y el tejido mesenquimático subyacente durante la odontogénesis puede resultar en la formación de un diente con una variación anatómica. El primer premolar maxilar posee una anatomía relativamente variable, sin embargo, es especialmente poco frecuente (0,2% a 6% de los casos) la presencia de este diente con tres raíces y tres canales radiculares. El primer premolar mandibular posee frecuentemente una raíz y un canal radicular (75% de los casos) y es bastante más infrecuente encontrar este diente con dos raíces y dos canales radiculares (19.5 a 22.5%). Un diagnóstico acabado y preciso de es fundamental para lograr un exitoso tratamiento de endodoncia y posterior rehabilitación. Este artículo describe el diagnóstico, tratamiento de endodoncia y rehabilitación (mediante prótesis fija singular) de un primer premolar maxilar con tres raíces y tres canales radiculares, además el reporte de un caso de un primer premolar mandibular biradicular con dos canales radiculares. Ambos se presentan en un mismo paciente.

Oculo-facio-cardio-dental syndrome in three succeeding generations: genotypic data and phenotypic features

Oculo-facio-cardio-dental (OFCD) syndrome is a rare X-linked disorder mainly manifesting in females. Patients show ocular, facial, cardiac, and dental abnormalities. OFCD syndrome is caused by heterozygous mutations in the BCOR gene, located in Xp11.4, encoding the BCL6 co-repressor. We report a Croatian family with four female members (grandmother, mother and monozygotic female twins) diagnosed with OFCD syndrome who carry the novel BCOR mutation c.4438C>T (p.R1480*). They present high intrafamilial phenotypic variability with special regard to cardiac defect and cataract that showed more severe disease expression in successive generations. Clinical and radiographic examination of the mother of the twins revealed a talon cusp involving the permanent maxillary right central incisor. This is the first known report of a talon cusp in OFCD syndrome with a novel mutation in the BCOR gene.

Rotation of 180 degrees of a lower incisor: case report

The tooth rotation consists of a dental anomaly of position, in which there is a displacement of the tooth within the alveolar bone around its longitudinal axis. This study proposes to describe a rare condition of rotation of 180° in a lower right central incisor, no history of trauma or any other dental dental anomaly in the oral cavity. Thus, we sought to gain a deeper understanding of this anatomical variation, which can cause occlusal problems in patients, to alert the dental surgeons, so they are prepared to carry out a careful planning of the teeth involved.

Evaluation of facial asymmetry using soft-tissue thickness for forensic purposes / Evaluación de la asimetría facial mediante el grosor de tejidos blandos para propósitos forenses

Facial reconstruction for forensic sculpture aims to reproduce the face of an individual for identification. This technique is based on the knowledge of the facial soft-tissue thickness, which differs in terms of sexual dimorphism. However, in terms of asymmetry, the real significance of the soft-tissue thickness on both sides of the face is not considered to make an approximation of the morphofacial characteristics of an individual. This study analyzed the facial tissue thickness of 32 adult Spanish corpses of both sexes in six bilateral cephalometric landmarks through the needle puncture technique, comparing the measurements of right and left sides. No significant differences were found when comparing the soft-tissue thickness on the right and left sides in the total sample (p <0.05), or when comparing the values in men and women (p<0.05). The facial morphology is created by internal and external forces exerted on the soft tissue and influenced by their evolutionary development in vivo, where asymmetry parameters have a genetic and muscular determination, which in normal individuals do not represent a significant difference in the process of reconstruction of forensic sculpture, and can reliably standardize the entire information of facial thickness to the right or left side of the face.

La reconstrucción facial por escultura forense tiene por finalidad reproducir el rostro de un individuo para su identificación. Esta técnica se sustenta en el conocimiento del grosor del tejido blando facial; el cual presenta diferencias en términos de dimorfismo sexual. Sin embargo, en términos de asimetría, no se ha considerado la real significancia del espesor de tejido blando a ambos lados del rostro al realizar una aproximación de las características morfofaciales de un individuo. En este estudio se analizaron los grosores tisulares faciales de 32 cadáveres españoles adultos de ambos sexos en 6 puntos cefalométricos paramedianos bilateralmente mediante el método de punción por agujas, comparando las mediciones del lado derecho e izquierdo. No se encontraron diferencias significativas al comparar el espesor del tejido facial en el lado derecho e izquierdo en el total de la muestra (p<0,05), así como al comparar los valores en hombres y mujeres (p<0,05). La morfología facial es creada in vivo por fuerzas internas y externas ejercidas sobre el tejido blando e influenciada por su desarrollo evolutivo, donde parámetros de asimetría tienen una determinación genética y muscular, que en individuos normales no representan una diferencia significativa para el proceso de reconstrucción por escultura forense, pudiendo homologar de manera confiable la totalidad de la información del grosor facial del lado derecho o izquierdo del rostro.