Cephalometric Characteristics in Chilean Latino Population with Normal Occlusion and Harmonic Profiles in Permanent Dentition. A Retrospective Study / Características Cefalométricas en Población Latina Chilena con Oclusión Normal y Perfiles Armónicos en Dentición Permanente. Un Estudio Retrospectivo

SUMMARY: Malocclusion is usually treated based on clinical decisions complemented with a cephalometric analysis, allowing the comparison of an individual with standard reference norms. Cephalometric standards have mostly been obtained from Caucasian population, but may not be appropriate for other ethnic groups, becoming a clinically relevant problem in multicultural and multiracial societies. The present study aimed to establish cephalometric norms for Chilean-Latino population, using a representative sample of class I individuals in permanent dentition. A sample of 72 cephalometric x-rays of class I growing individuals (47 women and 25 men) between 10 and 20 years of age with class I occlusion and harmonic profile was obtained from the records of the Universidad de los Andes taken between 2012 and 2019, including 1164 individuals. The radiographs were classified according to their cervical vertebral maturation status, and cephalometrically analyzed, obtaining vertical and sagittal parameters in soft and hard tissues, which were compared with Caucasian cephalometric norms. The statistical analysis was performed using descriptive and inferential statistics (T-test, ANOVA and Bonferroni tests). Cephalometric norms were obtained for hard and soft tissues. Upon comparison with Caucasian norms, the subjects included in the sample present a tendency towards a convex profile, significant incisal proclination, dental protrusion, labial biprotrusion and an acute nasolabial angle. There are cephalometric differences between the Caucasian cephalometric norms and those observed Chilean Latino population, displaying differences at a hard and soft tissue level that should be taken into account for clinical decision making in Orthodontics.

La maloclusión generalmente se trata con base en decisiones clínicas complementadas con un análisis cefalométrico, lo que permite la comparación de un individuo con normas de referencia estándar. Los estándares cefalométricos se han obtenido en su mayoría de población caucásica, pero pueden no ser apropiados para otros grupos étnicos, convirtiéndose en un problema clínicamente relevante en sociedades multiculturales y multirraciales. El presente estudio tuvo como objetivo establecer normas cefalométricas para población chileno-latina, utilizando una muestra representativa de individuos clase I en dentición permanente. Se obtuvo una muestra de 72 radiografías cefalométricas de individuos en crecimiento clase I (47 mujeres y 25 hombres) entre 10 y 20 años de edad con oclusión clase I y perfil armónico de los registros de la Universidad de los Andes tomados entre 2012 y 2019, incluidas 1164 personas. Las radiografías se clasificaron según su estado de maduración vertebral cervical, y se analizaron cefalométricamente, obteniendo parámetros verticales y sagitales en tejidos blandos y duros, que se compararon con normas cefalométricas caucásicas. El análisis estadístico se realizó mediante estadística descriptiva e inferencial (T-test, ANOVA y pruebas de Bonferroni). Se obtuvieron normas cefalométricas para tejidos duros y blandos. En comparación con las normas caucásicas, los sujetos incluidos en la muestra presentan una tendencia hacia un perfil convexo, proinclinación incisal significativa, protrusión dental, biprotrusión labial y un ángulo nasolabial agudo. Existen diferencias entre las normas cefalométricas caucásicas y las observadas en población latina chilena, mostrando diferencias a nivel de tejidos duros y blandos que se deben considerar para la toma de decisiones clínicas en Ortodoncia.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern

Abstract Introduction: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. Objective: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. Methods: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). Results: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). Conclusion: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Resumo Introdução: numerosas análises cefalométricas foram propostas para diagnosticar a discrepância sagital das estruturas craniofaciais. Objetivo: este estudo teve como objetivo avaliar a confiabilidade e validade de diferentes análises esqueléticas para a identificação do padrão esquelético sagital. Métodos: foram incluídos 146 indivíduos (homens = 77; mulheres = 69; idade média = 23,6 ± 4,6 anos). O ângulo ANB, a avaliação de Wits, o ângulo Beta, o ângulo do plano AB, o ângulo de convexidade de Downs e o ângulo W foram utilizados para avaliar o padrão esquelético anteroposterior em cefalogramas laterais. A amostra foi classificada nos grupos Classe I, II e III, conforme os resultados diagnósticos da maioria dos parâmetros. A validade e a confiabilidade das análises acima mencionadas foram determinadas usando estatísticas Kappa, sensibilidade e valor preditivo positivo (VPP). Resultados: foi encontrada uma concordância significativa entre o ângulo ANB e o diagnóstico feito pelo grupo final (k = 0,802). No grupo Classe I, o ângulo de convexidade de Downs mostrou a maior sensibilidade (0,968), enquanto o ANB apresentou o maior VPP (0,910). No grupo Classe II, o ângulo ANB mostrou a maior sensibilidade (0,928) e o maior VPP (0,951). No grupo Classe III, o ângulo ANB, a avaliação de Wits e o ângulo Beta apresentaram a maior sensibilidade (0,902), enquanto o ângulo de convexidade de Downs e o ângulo ANB apresentaram o maior VPP (1,00). Conclusão: o ângulo ANB foi considerado o indicador mais válido e confiável em todos os grupos sagitais. O ângulo de convexidade de Downs, a avaliação de Wits e o ângulo Beta podem ser usados como indicadores válidos para avaliar o padrão sagital de Classe III.

Intervalo de confianza para las normas del cefalograma resumido de Ricketts en niños de cubanos / Confidence interval for the standards of the Ricketts´summarized cephalogram in Cuban children

Introducción: en hallazgos cefalométricos de diferentes países en poblaciones con patrones de crecimientos y oclusión normal, se reportan diferencias estadísticamente significativas a los valores dados en los cefalogramas de Ricketts, Steiner, Downs, Jarabak y otros. En Cuba no existen estudios de estos patrones en niños con dentición mixta los que favorecerían un mejor diagnóstico de las anomalías dento-maxilofaciales. Objetivo: proponer el perfeccionamiento de las normas del cefalograma resumido de Ricketts para los niños. Materiales y Métodos: investigación observacional, descriptiva en cuatro poblaciones pertenecientes a las siguientes zonas del país: Matanzas, Cárdenas, Camagüey y Sancti Spíritus. El universo estuvo constituido por 1 657 niños de 9 años de edad. La muestra 163 niños, seleccionados por el método estratificado por conglomerados con oclusión dentaria normal. Se utilizó el análisis del cefalograma resumido de Ricketts y la prueba t de media para determinar los valores de las variables estudiadas y se hicieron estimaciones puntuales y por intervalos de confianza. Resultados: tres variables mostraron medias iguales a las normas de Ricketts: eje facial (90°), profundidad facial (87°) y profundidad maxilar (90°). En las restantes fueron comprobadas diferencias significativas. Se obtuvo un intervalo de confianza para cada una de las variables del cefalograma resumido de Ricketts. Conclusiones: solamente tres variables presentaron valores similares a los planteados por Ricketts, las restantes presentaron valores que difieren significativamente de los planteados por Ricketts. Se propone utilizar el intervalo de confianza obtenido en esta investigación en las variables del cefalograma resumido de Ricketts para diagnosticar las anomalías dento-maxilofaciales en niños cubanos (AU).

Introduction: in cephalometric findings from different countries in populations with normal growing and occlusion patterns, significant statistic differences are reported in relation to the values given in the cephalograms of Ricketts, Steiner, Downs, Jarabak, and others. In Cuba there are not studies of these patterns in children with mixed dentition that might allow a better diagnosis of dental, maxilla-facial anomalies. Objective: to propose the improvement of the standards of the Ricketts abridge cephalogram for children. Materials and methods: descriptive, observational research in four populations belonging to different regions of the country: Matanzas, Cárdenas, Camagüey and Sancti Spíritus. The universe was formed by 1675 children aged 9 years old; the sample, 163 children with normal dental occlusion, was chosen by the stratified method per conglomerate. The analysis of the Ricketts summarized cephalogram and the mean T test were used to determine the values of the studied variables; punctual estimates and estimates by confidence interval were carried out. Results: three variables showed equal means than Ricketts' standards: facial axis (90o), facial depth (87o) and maxillary depth (90o). In the remaining variables there were found significant differences. A confidence interval was obtained for every one of the Ricketts' summarized cephalogram variable. Conclusions: only three variables showed values similar to those given by Ricketts. The remaining ones presented values significantly differing from those established by Ricketts. The proposition is using the confidence interval obtained in this research in the variables of the Ricketts' summarized cephalogram to diagnose the dental-maxillafacial anomalies in Cuban children (AU).

Analysis of reliability, accuracy, sensitivity and predictive value of a subjective method to classify facial pattern in adults

ABSTRACT Introduction: Craniofacial pattern diagnosis is vital in Orthodontics, as it influences decision-making regarding treatment options and prognosis. Capelozza Filho proposed a subjective method for facial classification comprising five patterns: I, II, III, Long Face and Short Face. Objective: To investigate the accuracy of a subjective classification method of facial patterns applied to adults. Methods: A sample consisting of 52 adults was used for this study. Frontal and lateral view photographs were taken with subjects at rest position, including frontal smile. Lateral cephalometric radiographs were organized in a PowerPoint® presentation and submitted to 20 raters. Method performance was assessed by examining reproducibility with Kappa test and calculating accuracy, sensitivity and positive predictive values, for which 70% was set as critical value. The gold standard of the classification was personally set by the author of the method. Results: Reproducibility was considered moderate (Kappa = 0.501); while accuracy, sensitivity and positive predictive values yielded similar results, but below 70%. Conclusions: The subjective method of facial classification employed in the present study still needs to have its morphological criteria improved in order to be used to discriminate the five facial patterns.

RESUMO Introdução: o diagnóstico do padrão craniofacial é fundamental em Ortodontia, visto que influencia tanto a decisão terapêutica quanto seu prognóstico. Capelozza Filho propôs um método subjetivo de classificação facial em cinco padrões: Padrão I, Padrão II, Padrão III, Face Longa e Face Curta. Objetivo: investigar o desempenho do método subjetivo de classificação do padrão facial, quando aplicado em adultos. Métodos: a amostra foi composta por 52 adultos de ambos os sexos. Fotografias frontal e lateral em repouso, frontal em sorriso e telerradiografia em norma lateral foram montadas em apresentação do PowerPoint® e levadas pessoalmente aos vinte examinadores. Para se avaliar o desempenho do método, foi analisada a reprodutibilidade por meio do teste Kappa e calculados os valores de acurácia, sensibilidade e valor preditivo positivo, para os quais adotou-se 70% como valor crítico. O padrão-ouro foi constituído pela classificação realizada pelo autor do método. Resultados: a reprodutibilidade foi considerada regular (Kappa 0,501) enquanto a acurácia, sensibilidade e valor preditivo positivo obtiveram resultados próximos; porém, abaixo de 70%. Conclusão: o método subjetivo de classificação facial precisa de aprimoramentos nos critérios morfológicos utilizados para discriminar os cinco padrões faciais.

Comparative study of dental cephalometric patterns of Japanese-Brazilian, Caucasian and Mongoloid patients

INTRODUCTION: The objective of this study was to identify the patterns of dental variables of adolescent Japanese-Brazilian descents with normal occlusion, and also to compare them with a similar Caucasian and Mongoloid sample. METHODS: Lateral cephalometric radiographs were used to compare the groups: Caucasian (n = 40), Japanese-Brazilian (n = 32) and Mongoloid (n = 33). The statistical tests used were one-way ANOVA and ANCOVA. The cephalometric measurements used followed the analyses of Steiner, Tweed and McNamara Jr. RESULTS: Statistical differences (P < 0.05) indicated a smaller interincisal angle and overbite for the Japanese-Brazilian sample, when compared to the Caucasian sample, although with similar values to the Mongoloid group. CONCLUSION: The dental patterns found for the Japanese-Brazilian descents were, in general, more similar to those of the Mongoloid sample. .

OBJETIVO: as características cefalométricas dentárias variam consideravelmente entre as diferentes raças. No Brasil, em virtude da grande miscigenação populacional, é necessário conhecer, também, as variações apresentadas pelas misturas dessas raças. Por essa razão, o objetivo desse estudo foi identificar o padrão das variáveis dentárias de jovens mestiços nipo-brasileiros com oclusão normal e compará-los com amostras semelhantes de leucodermas e de xantodermas. MÉTODOS: foram utilizadas 40 telerradiografias de jovens leucodermas, 32 de nipo-brasileiros e 33 de xantodermas. As rês amostras apresentavam indivíduos com oclusão normal e face bem balanceada. Foram realizadas análises estatísticas de variância a um critério (ANOVA) e a de covariância (ANCOVA). Basicamente, as variáveis cefalométricas usadas seguiram as preconizadas por Steiner, Tweed e McNamara Jr. RESULTADOS: encontrou-se diferença estatística (p < 0,05) entre as raças em cinco das variáveis estudadas. Essas diferenças indicaram menor ângulo interincisivos e menor sobremordida para a amostra nipo-brasileira, com relação à amostra leucoderma, mas com valores semelhantes aos da amostra xantoderma. CONCLUSÃO: os valores dentários encontrados para os jovens nipo-brasileiros foram, em geral, mais similares àqueles da amostra de xantoderma. .

Normas del cefalograma de Ricketts en niños de Matanzas / Ricketts' cephalogram norms observed in children from Matanzas

El estudio de los procesos de crecimiento y desarrollo permite identificar y diagnosticar las anomalías existentes con el fin de determinar la conducta terapéutica adecuada lo más temprano posible, bajo el criterio de que las maloclusiones con características esqueletales no se agraven en esta etapa de la vida y se conviertan posteriormente en problemas severos de difícil solución y pronóstico. Objetivo: determinar los valores medios de las variables del cefalograma de Ricketts, en niños de 9 años de edad. Métodos: se realizó una investigación de desarrollo en niños de las ciudades de Matanzas y Cárdenas. El universo estuvo constituido por los 1 128 niños examinados. Se seleccionó una muestra por el método de muestreo estratificado por conglomerados en dos etapas de 103 niños con oclusión dentaria normal, en los cuales se realizó el análisis del Cefalograma de Ricketts. Se utilizó la prueba t de media para determinar los valores de las variables del estudio que presentaron diferencias significativas con respecto a los de las variables de Ricketts. Resultados: se obtuvo que cuatro variables mostraron medias iguales a las normas de Ricketts: eje facial (90°), profundidad facial (87°), ángulo plano mandibular (26°) y profundidad maxilar (90°). En las variables restantes fueron comprobadas diferencias significativas: altura facial inferior (43°), arco mandibular (32°), convexidad facial (3 mm), incisivo inferior a A-Po (5 mm), inclinación del incisivo inferior (26°), primer molar superior a PTV (14 mm), incisivo inferior al plano oclusal (2 mm), ángulo interincisivo (123°), y protrusión del labio inferior (3 mm). Conclusiones: este estudio determinó que solamente cuatro variables presentaron valores similares a los planteados por Ricketts, las nueve variables restantes presentaron valores que difieren significativamente de los planteados por Ricketts(AU)

The study of the growth and development processes allows identifying and making diagnosis of anomalies to determine as early as possible the most adequate treatment, with the criteria of preventing malocclusions with skeletal characteristics from turning into more serious problems of difficult solution and prognosis in the future. Objective: to determine the mean values of Rickett's cephalogram in nine years-old children. Method: a development research was conducted in children from Matanzas and Cardenas. The universe of study was 1128 children and the final sample of 103 children with normal occlusion was selected by the stratified cluster sampling; they were analyzed using Ricketts' cephalogram. Mean t Test was used to determine values of the study variables, which showed statistically significant differences in comparison with Ricketts's variables. Results: it was proved that just four variables showed means equal to the Ricketts's norms. Conclusions: Four variables showed values similar to those of Ricketts's variables. The other nine were significantly different from those of Rickett's cephalogram(AU)

Brachycephalic, dolichocephalic and mesocephalic: is it appropriate to describe the face using skull patterns?

The use of a standardized terminology in the medical sciences is essential for both clinical practice and scientific research. In addition to facilitating communication between professionals, it enhances the reliability of comparisons made between studies from different areas, thereby contributing to a higher level of scientific evidence. Examples of attempts made to standardize the terminology in other areas dedicated to the study of craniofacial morphology can be found in the literature. On the other hand, one can find in the orthodontic literature a variety of terms that render the consensus and communication between orthodontists and other researchers even more problematic. As an example, one could cite the use of the terms brachyfacial, mesofacial and dolichofacial, which form part of a cranial index terminology used to describe facial types. Thus, a reflection on the origin and differences of the terms used to describe the human facial phenotype may pave the way toward a consensus regarding the meaning that best represents the craniofacial patterns.

A padronização da nomenclatura utilizada nas ciências médicas é fundamental tanto para a prática clínica quanto para a pesquisa científica. Além de facilitar a comunicação entre os profissionais, aumenta a confiabilidade da comparação entre trabalhos de diferentes áreas, favorecendo um melhor nível de evidência científica. Exemplos de esforços, em áreas também voltadas ao estudo da morfologia craniofacial, no sentido de uniformização da terminologia podem ser encontrados na literatura médica. Por outro lado, observa-se na literatura ortodôntica uma diversidade de termos que torna mais difícil o consenso e a comunicação entre ortodontistas e demais pesquisadores. Como exemplo, pode-se citar o uso dos termos braquifacial, mesofacial e dolicofacial, terminologia relativa ao índice craniano utilizada para descrever o tipo facial. Sendo assim, a reflexão sobre a origem e diferenças dos termos utilizados para descrever o fenótipo facial humano pode ser útil ao consenso do significado que melhor representa o padrão craniofacial.

Evaluation of radiographic magnification in lateral cephalograms obtained with different X-ray devices: experimental study in human dry skull

OBJECTIVE: The purpose of this study was to evaluate the influence of the magnification factor of the radiographic image in angular, linear and proportional measurements. METHODS: From a dried human skull where metallic spheres with predetermined size were fixed (1.0 mm), 14 radiographs were obtained in devices of three different manufacturers: Panoura, Instrumentarium and Tomeceph. The Pearson correlation test was used to investigate the relationship between the rate of radiographic magnification and the cephalometric measurements assessed. RESULTS: According to the results, the linear measurements showed a high positive correlation, pointing out great influence of the magnification factor, while the angular and proportional measurements did not correlate. CONCLUSIONS: Comparisons between linear cephalometric measurements obtained with different devices from the same manufacturer showed maximum rates of expansion of 0.6%, 1.25% and 2.3%, respectively, for the devices from Instrumentarium (OP-100, Instrumentarium, Finland), Panoura (10CSU, Yoshida, Japan) and Satelec/Tomeceph (XMind, Satelec/Tomeceph Orion Corporation, Finland).

OBJETIVO: avaliar a influência do fator de magnificação da imagem radiográfica nas grandezas angulares, lineares e proporcionais. MÉTODOS: a partir de um crânio seco humano, no qual foram fixadas esferas metálicas de dimensões pré-definidas (1,0mm de diâmetro), 14 telerradiografias foram obtidas em diferentes aparelhos de três fabricantes: Panoura, Instrumentarium e Tomeceph. Foi realizada a análise estatística descritiva e utilizado o teste de correlação de Pearson para verificar a relação entre a taxa de magnificação radiográfica e as grandezas cefalométricas analisadas. RESULTADOS: as medidas lineares apresentaram alta correlação positiva, evidenciando grande influência do fator de magnificação sobre essas grandezas, ao passo que as angulares e proporcionais não apresentaram correlação. CONCLUSÃO: comparações entre medidas cefalométricas lineares obtidas com diferentes aparelhos do mesmo fabricante demonstraram taxas de ampliações máximas de 0,6%, 1,25% e 2,3%, respectivamente, para os aparelhos Instrumentium (OP-100 Instrumentarium), Panoura (10CSU Yoshida) e Satelec/Tomeceph (XMind Satelec/Tomeceph Orion Corp).

Assessing the predictability of ANB, 1-NB, P-NB and 1-NA measurements on Steiner cephalometric analysis

OBJECTIVE: To evaluate, in the initial and final stages of corrective orthodontic treatment, the predictability of the ANB, 1-NB, PNB and 1-NA during case individualization, which considers the characteristics of the patient, professional experience and the mechanics to be used. METHODS: Ninety patients were selected at the State University of Londrina (UEL, Brazil), presenting Angle Class I and II malocclusions, treated with and without extraction of four premolars and divided into three groups: Horizontal, balanced and vertical. The cephalometric variables were evaluated in the initial, prognosis and final stages of treatment in order to observe the behavior of the estimates, or how they were higher or lower than the values obtained. RESULTS: It was noticed the influence of the facial pattern on the behavior of the measures examined, the values proposed for the ANB were statistically different from values obtained at the end of the treatment; in the vertical group the final value was the one that most approached the proposed value; regarding 1-NB the values proposed with the Steiner analysis for the balanced and vertical groups were not achieved. For P-NB, there was no difference between genders. For 1-NA it was observed that the values obtained at the end of treatment differ from estimates in the three groups. CONCLUSIONS: The limitations of the estimates of the measures do not invalidate its clinical or teaching use, if aware of its deficiencies, the analysis can be used with restrictions.

OBJETIVO: avaliar, nas fases inicial e final de tratamento ortodôntico corretivo, a previsibilidade das medidas ANB, 1-NB, P-NB, e 1-NA durante a individualização dos casos, onde se consideram as características inerentes do paciente, bem como a experiência do profissional e a mecânica a ser utilizada. MÉTODOS: foram selecionados 90 pacientes, tratados na UEL, apresentando Classes I e II de Angle, tratados com e sem extrações de quatro pré-molares e divididos em três grupos: horizontal, equilibrado e vertical. As grandezas cefalométricas foram avaliadas nas fases inicial, proposta e final de tratamento, com o intuito de observar o comportamento das estimativas, ou seja, o quanto elas foram maiores ou menores que os valores obtidos. RESULTADOS: constatou-se influência do padrão facial no comportamento das medidas analisadas; os valores propostos para o ANB foram estatisticamente diferentes dos valores obtidos ao final do tratamento; no grupo vertical, o valor final foi o que mais se aproximou do valor proposto; em relação à medida 1-NB, os valores propostos durante a elaboração da análise de Steiner para os grupos equilibrado e vertical não foram alcançados. Para medida PNB, não se observou diferença entre os sexos. Na medida 1-NA, foi observado que os valores obtidos ao final do tratamento diferem das estimativas nos três grupos analisados. CONCLUSÃO: as limitações das estimativas das medidas não invalidam seu emprego clínico ou didático, desde que, conscientes de suas deficiências, sejam utilizadas com restrições.

Soft-tissue cephalometric norms for the Lambada population in Telangana Region of Andhra Pradesh.

Introduction: Facial contours were traditionally considered to be the result of positioning of underlying hard tissue followed by the soft tissue. However, current trend shows a paradigm shift from the conventional hard tissue analysis to also include both hard- and soft-tissue analysis. The objective of our study was to determine the soft-tissue cephalometric norms for the Lambada population, to define gender differences and to correlate the variables, skeletal convexity (SC), and H angle (HA). Materials and Methods: Fifty subjects of Lambada ethnic group between 18 and 26 years old, grouped into 25 males and 25 females were taken. Their lateral cephalograms were obtained and analyzed using Holdaway's analysis. Descriptive statistics and the student's t-test were used. Results: Soft-tissue facial angle (SFA), superior sulcus depth (SSD), lower lip to H line (LL-H), and soft-tissue subnasale to H line (S-H) were well within the range given by Holdaway. The variable, lip strain showed that the upper denture is protrusive (P<0.001). Skeletal convexity and HA were significantly correlated in the female sample. HA revealed that a slightly more protrusive profile was acceptable for this ethnic group. Conclusion: Although established Caucasian norms are applicable to the Lambada ethnic tribe, few parameters like basic upper lip thickness (ULT) and upper lip strain (ULS), skeletal convexity, inferior sulcus to H line (LS-H) were significantly different. The male group exhibited straighter profile, thicker lips, prominent nose, deep mentolabial sulcus, and a prominent chin than females. The differences could be considered in diagnosis and treatment planning for orthodontic practice and for orthognathic surgery.

Determination of craniofacial relation among the subethnic Indian population: A modified approach - (Sagittal relation).

Aim : To measure the linear cephalometric dimensions of anterior and posterior segments of the craniofacial complex sagittally, to establish ratios between different linear dimensions of sagittal segments and check for dimensional balance among the various segments in subjects with normal occlusion, pleasing profile and facial harmony. Setting and Sample Population : Department of Orthodontics, Saveetha University. Lateral cephalograms of 120 subjects of both sexes in the age group of 17-28 years with normal occlusion belonging to Chennai, India Materials and Methods : Linear dimensions of anterior and posterior segments of the craniofacial complex were measured sagittally with the posterior maxillary plane as a key reference plane. Ratios were established between the various parameters in the anterior and posterior region. Results : A ratio of 1:1 was found to exist between the individual and aggregate sagittal segments of the craniofacial complex in both sexes. There was a statistically significant sexual dimorphism in the aggregate lengths(P=0.028,P=0.005).However, the ratio between the anterior cranial floor and effective maxillary length was 2:3 and 5:8 and that between anterior cranial floor to effective mandibular length was 5:8 and 3:5 in females and males respectively. The difference in the above values was not statistically significant. Conclusion : A dimensional balance was found to exist between the maxilla and mandible both at the dentoalveolar and skeletal level with a ratio of 1:1. There was also a dimensional balance between the posterior cranial floor and ramus width. However, there was no architectural balance between the anterior cranial floor and maxilla and mandible.

Impacto dos fatores perinatais nos déficits de crescimento de prematuros / Impact of perinatal factors on growth deficits of preterm infants

OBJETIVO: Analisar fatores perinatais associados a déficit de crescimento em prematuros com 1 ano de idade corrigida. MÉTODOS: Estudo de coorte de prematuros com peso ao nascer < 2.000 g. Calcularam-se os percentis e escores Z de peso (P/I), comprimento (C/I) e perímetro cefálico (PC/I) com 1 ano de idade corrigida, utilizando a curva do Centers for Disease Control and Prevention. RESULTADOS: Entre 303 prematuros, as frequências de medidas abaixo do percentil 10 (P10) e de -2 escores Z foram, respectivamente, 43,2 por cento e 24,4 por cento de P/I, 22,1 por cento e 8,6 por cento de C/I e 15,8 por cento e 4,6 por cento de PC/I. A análise de regressão logística mostrou que fatores associados à maior chance de P/I < P10 foram reanimação ao nascimento (1,8 vez) e pequeno para a idade gestacional (3,0 vezes). Nas crianças classificadas como pequenas na idade pós-conceptual de termo, a chance de P/I < P10 foi 4,0 vezes maior naquelas com peso ao nascer entre 1.000 g e 1.499 g e 3,5 vezes maior naquelas > 1.500 g. A chance de C/I < P10 aumentou com a diminuição do comprimento ao nascer, mas não associou ao peso ao nascer. A chance de PC/I < P10 foi 2,5 vezes maior nas crianças pequenas para a idade gestacional. Nas crianças com peso < 1.000 g, a chance de PC/I < P10 foi 4,4 vezes maior quando comparadas àquelas entre 1.000 g e 1.499 g e 5,3 vezes maior quando comparadas àquelas > 1.500 g. CONCLUSÃO: Com 1 ano de idade corrigida, prematuros nascidos com peso < 2.000 g apresentaram frequências elevadas de déficits de crescimento, e os fatores associados variaram com o déficit analisado, destacando-se a restrição de crescimento intrauterino e pós-natal.

OBJECTIVE: To review perinatal factors associated with a growth deficit in preterm infants at a corrected age of one year. METHODS: Cohort study of preterm infants with a birth weight < 2,000 g. Percentiles and Z scores of body weight (W/A), length (L/A) and head circumference (HC/A) at one year of corrected age were calculated by using the Centers for Disease Control and Prevention curves. RESULTS: Among 303 preterm infants, the frequencies of measures below the 10th percentile (P10) and Z scores -2 were 43.2 percent and 24.4 percent for W/A, 22.1 percent and 8.6 percent for L/A and 15.8 percent and 4.6 percent for HC/A, respectively. Logistic regression analyses showed factors associated with higher odds for W/A < P10 were resuscitation at birth (1.8 times) and small for gestational age infants (3.0 times). In infants rated as small at full-term postconceptual age, the odds for W/A < P10 were 4.0 times as high in those with a birth weight between 1,000 and 1,499 g and 3.5 times as high in those > 1,500 g. As birth length was reduced, the odds for L/A < P10 increased, but this was not associated with birth weight. The odds for HC/A < P10 were 2.5 times as high in small for gestational age infants. In infants with a body weight < 1,000 g, the odds for HC/A < P10 were 4.4 times higher, compared with those between 1,000 g and 1,499 g and 5.3 times higher if compared with those > 1,500 g. CONCLUSION: At a corrected age of one year, preterm infants with a birth weight < 2,000 g were found with high growth deficits frequencies, and associated factors were variable, depending on the analyzed deficit, with intrauterine and postnatal growth restriction being outstanding predictors.

Cephalometric norms for Central Indian population using Burstone and Legan analysis.

Background: Lateral cephalometric standards of normal Central Indian adults having class I occlusion and acceptable facial profile were studied using the Burstone and Legan comprehensive cephalometric analyses that are specific for orthognathic surgery. Aim: To study normal dentofacial patterns of adult population belonging to Central India. Materials and Methods: Cephalometric radiographs of 76 Central Indian adults (38 males and 38 females) having class I occlusion with acceptable facial profile were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of Caucasian adults as reported in the literature. Results: The Central Indian males demonstratedgreater anterior cranial base length and ramal length and a reduced chin depth. The inclination of the upper and lower incisors was also greater. The females demonstrated greater posterior cranial base length, increased upper anterior and posterior facial heights, and an increased maxillary length. Both mandibular body and ramal lengths were increased and there was greater mandibular protrusion and a reduced chin depth. The lower incisors were found to be proclinated. Conclusion: This study reveals that some of the cephalometric parameters in the Central Indian population are significantly different than that of the Caucasian population, especially in the females.

Accuracy of linear measurements before and after digitizing periapical and panoramic radiography images

The aim of this study was to evaluate the accuracy of linear measurements made on conventional and digitized periapical and panoramic radiographic images of dry human hemi-mandibles. Images from the posterior region of 22 dry human hemi-mandibles were obtained by conventional panoramic and periapical radiography technique. Using a digital caliper, 3 vertical measurements were marked directly on the dry hemi-mandibles (reference measurements) as well as on the tracing from the conventional radiographic images of the specimens made onto acetate paper sheet: Distance 1: between the upper limit of the alveolar ridge and the lower limit at the mandible base; Distance 2: between the upper limit of the alveolar ridge and the upper limit of the mandibular canal; Distance 3: between the lower limit of the mandibular canal and the lower limit of the mandible base. Next, the radiographs were digitized and the three measurements were made on the digital images using UTHSCSA Image Tool software. Data were analyzed statistically by one-way ANOVA (α=0.05). There was no statistically significant differences (p>0.05) between periapical and panoramic radiographs or between the measurements recorded using the digital caliper and UTHSCSA software compared with dry mandible specimens for Distances 1 (p=0.783), 2 (p=0.986) and 3 (p=0.129). In conclusion, the radiographic techniques evaluated in this study are reliable for vertical bone measurements on selected areas and the UTHSCA Image Tool software is an appropriate measurement method.

O objetivo deste estudo foi avaliar a acurácia de medidas lineares realizadas em radiografias panorâmicas e periapicais convencionais e digitalizadas de hemimandíbulas humanas secas. Imagens da região posterior de 22 hemimandíbulas humanas secas foram obtidas pelas técnicas panorâmica e periapical convencionais. Com o paquímetro eletrônico digital, foram realizadas três medições verticais diretamente sobre as hemimandíbulas (medidas referenciais), bem como sobre o decalque das imagens convencionais, em papel de acetato: Distância 1: Distância entre o limite superior do rebordo alveolar e o limite inferior da base da mandíbula; Distância 2: Distância entre o limite superior do rebordo alveolar e o limite superior do canal mandibular e Distância 3: Distância entre o limite inferior do canal mandibular e o limite inferior da base da mandíbula. Posteriormente, as radiografias foram digitalizadas e as três medidas foram realizadas nas imagens digitais utilizando o programa UTHSCSA Image Tool. Os dados foram analisados estatisticamente pelo teste ANOVA a um critério (α=0,05). Não houve diferenças estatisticamente significantes (p>0,05) entre as radiografias panorâmicas e periapicais, assim como para as medidas obtidas com o paquímetro e pelo programa UTHSCSA Image Tool, quando comparados aos espécimes mandibulares, avaliando as distâncias 1 (p=0,783), 2 (p=0,986) e 3 (p=0,129). Em conclusão, as técnicas radiográficas avaliadas neste estudo mostraram-se confiáveis para mensurações ósseas verticais na área selecionada e o programa de digitalização de imagens UTHSCSA Image Tool é um método adequado de aferição.

Head morphology and degree of variation in lacerta bilineata: podarcis muralis and podarcis sicula / Morfología de la cabeza y el grado de variación en lacerta bilineata: podarcis muralis y podarcis sicula

The morphology of cephalic scales in Lacertids is organised in well defined geometrical structures. The variation of these elements is related to the underlying bone growth and morphogenesis, but it is also associated with the muscular system and the sutural dynamics. In this paper, the patterns of variation of the cephalic scales have been compared between three common Mediterranean species: Podarcis muralis, Podarcis sicula and Lacerta bilineata. The morphospace generated by the morphological relationships within the cephalic system in these three species is investigated in order to consider their degree of variation and their anatomical peculiarities. Generally, Lacerta is 64 percent larger than Podarcis, shows a relative reduction of the frontal scale, enlarged fronto-parietal structures, and stretched occipital area. L. bilineata shows the smaller degree of variation within the shape space, while P. muralis shows the highest values. The morphology of the two genera is definitely different mostly because of allometric variation. Non-allometric distinctions between the three species are subtle but detectable. The degree and pattern of variation are interpreted in terms of possible environmental pressures and of functional cranial dynamics associated with the fronto-parietal suture, respectively. In this sense, the structural relationships between bones and scales are of particular interest to further investigate ontogeny and phylogeny in reptiles.

La morfología de las escamas cefálicas en Lacértidos se organiza en estructuras geométricas bien definidas. La variación de estos elementos está relacionada con el crecimiento y la morfogénesis del hueso subyacente, pero está también es asociada con el sistema muscular y sutural dinámico. En este trabajo, son comparados los patrones de variación de las escamas cefálicas de tres especies mediterráneas comunes: Podarcis muralis, Podarcis sicula y Lacerta bilineata. El morfoespacio generado por las relaciones morfológicas con el sistema cefálico en estas tres especies se investigó con el fin de examinar su grado de variación y sus peculiaridades anatómicas. En general, Lacerta es 64 por ciento más grande que Podarcis, muestra una reducción relativa de la escama frontal, alargamiento de la estructura fronto-parietal, y estrechamiento del área occipital. L. bilineata muestra el menor grado de variación en la forma del espacio, mientras que P. muralis muestra los valores más altos. La morfología de los dos géneros es diferente principalmente debido a variaciones alométricas. Diferencias no alométricas entre las tres especies son sutiles pero detectables. El grado y el patrón de variación son interpretados en términos de las posibles presiones del medio ambiente y la dinámica funcional craneal asociada a la sutura fronto-parietal, respectivamente. En este sentido, las relaciones estructurales entre los huesos y las escamas son de particular interés para seguir investigando ontogenia y filogenia de los reptiles.

Craniofacial anthropometric norms of Malaysian Indians.

Objective: This study was done to establish the craniofacial anthropometric norms of the young adult (18- 25 years) Malaysian Indian. Materials and Methods: The study group consisted of convenient samples of 100 healthy volunteers, with equal number of female and male subjects who had no history of mixed racial-parentage. Twenty-two linear measurements were taken twice from 28 landmarks over six craniofacial regions. The methodology and evaluation of indices of the craniofacial region was adapted from Hajnis et al. Results: The minimum measurements are always contributed by the female Indian except for the nose height (n-sn), (left) eye fissure length (ex-en), upper vermillion height (ls-sto), and lower vermillion height (sto-li). There is a gender difference in all the measurements except the (left) eye fissure height (independent t-test; P < 0.05). The Malaysian Indians exhibit some North American White Caucasian (NAWC) features in all regions. The cephalic index indicates a brachycephalic or relatively short wide head with a tendency towards mesocephaly. From the low nasal index, the Malaysian Indian female have a nose that is narrow or leptorrhin similar to the NAWCs. The lower value of the upper lip height to mouth width index in the Indian female indicates a relatively shorter upper lip height compared to the mouth width, also similar to the NAWC. Conclusion: This study establishes the craniofacial anthropometric norms of the Malaysian Indian over 22 parameters. Male in general has a significantly higher measurement than female. The Malaysian Indians do exhibit some NAWC features.

Cephalometric norms according to the Harvold´s analysis / Normas cefalométricas de acuerdo al análisis de Harvold

The purpose of this study was to establish cephalometric norms by age and gender of Harvold´s analysis for people living in the central region of Mexico and compare them with other populations to found morphologic craniofacial differences. One hundred sixteen males and 125 females were studied. The participants were divided into age groups. The parents and grandparents of the participants were born in Mexico. All participants had class I occlusion with normal growth, facial symmetry, no crowding and no previous orthodontic, orthopedic or maxillofacial surgery treatment. Lateral skull x-rays were obtained; each radiograph was analyzed on with a Harvold-like analysis. For statistical evaluation, the Student t´ test was used to compare the age groups between males and females. Significant gender differences were found in the following measurements: maxillary position, mandible position, and the anterior lower facial height in all age groups. Differences were found in the cranial and dental positions with other races respect to facial growth. Because every gender and race have their own characteristics, it is appropriate to use correct cephalometric norms in daily orthodontic practice. It is suggested to use the analysis of Harvold in a complementary way when in diagnosing a patient there is doubt on the alterations in the maxillae.

El propósito de este estudio fue establecer normas cefalométricas por edad y sexo de acuerdo al análisis de Harvold, para población de la región central de México y comparar estos patrones con otras poblaciones para encontrar diferencias en las características morfológicas craneofaciales. 116 hombres y 125 mujeres conformaron el estudio, divididos por grupos de edad. Los padres y abuelos de los participantes eran originarios de México. Todos los sujetos tenían clase I molar con un desarrollo normal, simetría facial, sin apiñamiento y sin previo tratamiento ortodóntico, ortopédico o cirugía maxilofacial. Se obtuvieron las radiografías laterales de cráneo; cada una se examinó de acuerdo al análisis cefalométrico de Harvold. Para el análisis estadístico, se aplicó la prueba t’ de Student para hacer la comparación entre grupos de edad y sexo. Se encontraron diferencias significativas entre hombres y mujeres en los siguientes parámetros: posición maxilar, posición mandibular y altura facial anteroinferior en todos los grupos de edad. Se demostraron diferencias en la posición dental y craneal con otras razas, respecto al crecimiento facial. Cada género y raza presenta sus características propias, por lo que es apropiado utilizar normas cefalométricas adecuadas en la práctica ortodóntica diaria. Se sugiere utilizar el análisis de Harvold como auxiliar o complemento cuando existe duda en el diagnóstico del paciente debido a alteraciones de los maxilares.

Desenvolvimento e teste de um modelo interativo para aprendizagem e calibragemm em cefalometria radiográfica / Development and testing of a learning and calibrating interactive model for radiographic cephalometrics

As análises cefalométricas computadorizadas baseiam-se na marcação de pontos anatômicos sobre imagens radiográficas digitalizadas. Estudos têm questionado o desempenho dos executores, tendo em vista a falta de reprodutibilidade dos exames. Tal fato, gera preocupação com a formação do profissional para a prática da cefalometria radiográfica. Desta forma, se faz necessária a criação de novas abordagens no ensino que permitam promover e consolidar conhecimentos e intervenções neste domínio. Dentro deste contexto, foram desenvolvidos um objeto virtual chamado Ceph-Learning para aprendizagem e um software intitulado Cyclops Cephalometry para treinamento e calibragem em cefalometria radiográfica. Especialistas em tecnologia educativa, ortodontia, alunos de graduação e pós-graduação testaram os produtos criados. Os resultados mostraram que estes apresentam-se como ferramentas úteis, eficientes e facilitadoras do processo de aprendizagem e calibragem, servindo de suporte para o aprendizado e prática da cefalometria. Conclui-se que a tecnologia virtual aplicada ao aprendizado assistido por computador é eficiente e melhora o desempenho acadêmico e profissional nos exames cefalométricos.

Computed cephalometric analysis is based on the identification of anatomical landmarks marked on digitized radiographic images. Some studies have been enquiring the performance of the examiner, considering the analysis lack of reproducibility. This outcome generates a concern regarding the academic training of the professionals responsible for the cephalometric analysis. Therefore, the creation of new educational approaches which could allow the promotion and consolidation of interventions within this domain is necessary. This context has lead to the development of a virtual object directed to teaching denominated Ceph-Lerning and a calibrating and training software named Cyclops Cephalometry. Technology education and orthodontics specialists, undergraduate and graduate students have tested the developed products. Results show that these tools have facilitated the teaching and calibrating process proven to be useful and efficient, therefore, standing as a cephalometric practice and learning support. As a conclusion, virtual technology applied to computer-aided learning is efficient and improves the professional and academic performance regarding cephalometric analysis.

Estudo antropométrico do crânio de recém-nascidos normais em Sergipe / Anthropometric cranial measurements of normal newborn in Sergipe - Northeast of Brazil

O estudo antropométrico do crânio é fundamental para a avaliação do recém-nascido. As medidas antropométricas usadas na atualidade são baseadas em resultados obtidos há mais de cinco décadas, os quais não são capazes de determinar um padrão nacional em decorrência de possíveis influências de algumas etnias. Realizamos estudo descritivo analítico em uma Maternidade em Aracaju-SE, com medidas de perímetro cefálico, distancia biauricular e anteroposterior, índice cefálico e medida da fontanela; foram examinadas 450 recém-nascidos com idade gestacional entre 37 e 42 semanas; 49,3 por cento era do gênero masculino e 50,6 por cento do feminino. O perímetro cefálico variou entre 30,0 cm e 39,8 cm com média de 34,14±2,48 com P50 34 cm. O índice cefálico variou entre 0,69 e 1,13 com média de 0,98±0,06 com P50 1. Foi feito uma comparação entre os estudos estrangeiros e brasileiros; o recém-nascido sergipano aproxima-se mais dos resultados obtidos nos estudos da região sudeste do que dos resultados da região nordeste, geograficamente semelhante. A possibilidade de influencias étnicas foi levantada, como também a necessidade de realizar um estudo multicêntrico para criar um perfil antropométrico do recém-nascido brasileiro.

The anthropometric mesureaments of the skull is essential for the evaluation of the newborn. The anthropometrics measureaments utilized at the present time are based in the results obtained for more than five decades, which are not able to determine a national pattern mostly likely due to some ethnic influences. We carried out an analytical descriptive study in a maternity hospital in Aracaju-Sergipe, Northeast of Brazil. Measurements of cephalic perimeter, biauricular and anteroposterior distances, cephalic index and fontanels were obtained from 450 newborns with gestacional age from 37 and 42 weeks; 49.3 percent were male and 50.6 percent female. The cephalic perimeter ranged from 30.0 cm to 39.8 cm with mean value of 34.14±2.48 P50 34 cm, and cephalic index ranged from 0.69 and 1.13 with mean value of 0.98±0.06 P50 1. A comparison was made between brazilian and foreign studies; the results of the newborn from Sergipe were closer to results obtained in the southeast region than the ones obtained in the northeast region itself. The possibility of ethnical influences was raised as well as the need to design a multicentric study in order to define an anthropometric profile of the brazilian newborn.

Relationship between dental size and normal occlusion in Brazilian patients

The present study was performed on dental casts and lateral cephalometric films of 30 Caucasian Brazilian individuals (15 males and 15 females) aged 18 to 27 years and 4 months, all presenting normal occlusion and satisfactory facial profile. The aims were to investigate the existence of dental discrepancies according to Bolton's criteria, to obtain mean values for overbite, overjet, curve of Spee and interincisal angle, and to demonstrate any correlation among these parameters. A single calibrated operator measured each variable characteristics and the process was recorded twice with an accurate modified digital caliper. It was observed that the sample of normal occlusion did not present any dental discrepancy among the 12 teeth of opposite arches. The overall ratio (91.46) and anterior ratio (77.83) were in accordance with those proposed by Bolton. The mean values for normal occlusion in this Brazilian sample were defined as: 2.45 mm for overbite; 1.92 mm for overjet; 1.01 mm for curve of Spee and 129.57° for interincisal angle. A statistically significant correlation was found between overjet and overbite.

O presente estudo foi realizado em modelos de gesso e radiografias cefalométricas laterais de 30 indivíduos brasileiros, leucodermas, sendo 15 do sexo feminino e 15 do sexo masculino, com idades variando de 18 anos a 27 anos e 4 meses, todos portadores de oclusão excelente e bom perfil facial. Os objetivos foram verificar a existência de discrepância dentária de Bolton, obter valores médios para a sobremordida (overbite), sobressaliência (overjet), curva de Spee e ângulo interincisivo e verificar a existência de correlação entre essas variáveis. As medições foram realizadas por um único avaliador e o procedimento realizado duas vezes com auxílio de um paquímetro digital modificado de alta precisão. Observou-se que a amostra de oclusão normal não apresentou discrepância dentária entre os doze dentes dos arcos opostos e as razões total (91,46) e anterior (77,83) foram próximos aos dos propostos por Bolton. Os valores médios encontrados como padrão para a amostra de oclusão normal de indivíduos brasileiros foram determinados em: 2,45 mm para a sobremordida; 1,92 mm para a sobressaliência; 1,01 mm para a curva de Spee e 129,57(0) para o ângulo interincisivo, havendo apenas correlação significativa entre sobressaliência e as classes de sobremordida.