Morfología ósea facial en cirugía ortognática. ¿existe tendencia hacia el avance facial? / Facial morphology in orthognathic surgery: is there a facial advance trend?

RESUMEN: El objetivo de esta investigación fue determinar los movimientos preferidos en maxila y mandíbula para obtener normalidad en morfología facial utilizando técnicas de superimposición en análisis 3D. Se realizó un estudio descriptivo para evaluar el desplazamiento óseo bimaxilar y del hueso hioides en sujetos clase facial tipo II y clase facial tipo III sometidos a cirugía ortognática. Para la superimposición se utilizó como puntos fijos Nasion - Silla - Porion y la sutura cigomática-maxilar. Estos puntos se superpusieron en CBCT pre quirúrgico y postquirúrgico y se evaluó el desplazamiento de la espina nasal anterior, Punto A, Punto B, mentón y del hueso hioides. Para la evaluación y comparación de las variables continuas antes y después de la cirugía ortognática se utilizó la prueba T de Student. Para la correlación entre las variables, se utilizó el Test de Spearman considerando un valor p<0,05 como diferencia significativa. 44 sujetos de entre 18 y 40 años de ambos sexos, fueron incluidos en esta investigación. En el 90 % de los sujetos se realizó un movimiento sagital de avance de la maxila. El movimiento sagital de avance mandibular se realizó en el 100 % de los sujetos con clase facial tipo II, mientras que el 100 % de los sujetos con clase facial tipo III se realizó se le retroceso mandibular. El hueso hioides presentó un avance en 26 de los 27 sujetos con clase facial tipo III. Es posible concluir que existe una tendencia al avance maxilar independiente de la deformidad facial.

ABSTRACT: The objective of this research was to determine the preferred movements in the maxilla and mandible to obtain normality in facial morphology using superimposition techniques in 3D analysis. A descriptive study was carried out to evaluate bimaxillary bone displacement and hyoid bone in subjects facial class II and facial class III undergoing orthognathic surgery. were used as fixed points for superimposition: Nasion (N) - Silla (S) - Porion (Po) and the zygomatic-maxillary suture (Z). These points were superimposed in pre-surgical and post- surgical CBCT and was evaluated to displacement of the anterior nasal spine, Point A, Point B, Chin and the hyoid bone. For the evaluation and comparison of continuous variables before and after orthognathic surgery, was used the Student's t test. For the correlation between the variables, the Spearman test is used, considering a p value <0.05 as a significant difference. 44 subjects between 18 and 40 years old of both sexes were included in this research. A 90% of subjects a was performed a maxillay sagittal movement. The sagittal movement of mandibular advancement was performed in 100% with facial class type II, while 100 % of the subjects with with facial class type III had a mandibular recession. The hyoid bone advanced in 26 of the 27 subjects with facial class type II. It is possible to conclude that there is a tendency for maxillary advancement, independent of facial deformity.

3D CT Soft Tissue Craniofacial Analysis and Lip Morphology

ABSTRACT Objctive: To assess the soft tissue characteristics of Bangladeshi adults to formulate soft tissue 3D CT standards using Holdaway's (HA) and lip morphology (LM) analyses. Another aim of this study was to assess the gender dimorphism of Bangladeshi population. Material and Methods: One hundred and seventeen (Eighty-five men and Thirty-two women) Bangladeshi adults have obtained their computed tomography (CT) scan at the Radiology Department for normal diagnosis. Craniofacial deformities were undetected in all cases. The CT images were prepared by a 3D imaging programming software (Mimics 11.02 Materialise). Parameters from the identified landmark points were measured in 3D through this software. Results: Upper lip thickness (ULT) (vermillion UL-A point) measurement was significant in HA and in LM analyses, upper lip protrusion (ULP) (Ls to Sn-SPog) measurement has demonstrated significant difference among both genders, where p-value was less than 0.05. Mean measurements of Bangladeshi adults were relatively comparable except the face convexity (FC) when compared with the HA cephalometric soft tissue values. Conclusion: By using HA and LM analyses, 3D CT soft tissue standards were established for Bangladeshi adults. Measurements for all parameters have remained equivalent with the HA standard data apart from the FC measurement. This consequently may demonstrate that the Bangladeshi population retains a convex shape with a slight protrusive lip or retruded chin.

Influence of skeletal class and facial type on nose dimensions in a Brazilian subpopulation: a CBCT study

Abstract: Evaluating factors that may influence the nose dimensions and, therefore, contribute to the singularity of a person, is important for obtaining a precise facial reconstruction (FR) in forensic anthropology. Thus, the aim in this study was to evaluate the influence of sex, skeletal class, and facial type on nose dimensions of Brazilian individuals using cone-beam computed tomography (CBCT) scans. CBCT images of 54 males and 67 females were classified according to skeletal class (class I, II, or III) and facial type (brachycephalic, dolichocephalic and mesocephalic). Linear and angular measurements of the nose were performed using the CS 3D Imaging software. The measurements obtained for males and females were compared by one-way ANOVA. Two-way ANOVA was used to compare the measurements in the different skeletal classes and facial types. Significance level was set at 5%. All linear measurements were greater in males (p < 0.05); the angular measurements, however, did not differ between sexes (p > 0.05). Linear and angular measurements of class III males were significantly different from the other classes; the same was observed for the angular measurements in females (p < 0.05). Regarding facial types, some linear measurements were significantly greater in dolichocephalics males (p < 0.05). For females, there was no influence of facial type (p > 0.05), except for the nasal convexity angle. Nose dimensions differed in specific points among different skeletal classes and facial types, and there was sexual dimorphism in all linear nose dimensions. This information may be applicable for nose reconstructions, allowing more reliable FR.

Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation

ABSTRACT The Herbst appliance can be very effective in treatment of Class II patients with mandibular retrognathism. Because of the continuous action in a full-time basis, treatment time using it normally takes from six to ten months, and is usually followed by a second phase of full fixed appliances, in order to obtain both occlusal refinement and long term stability. Despite Herbst appliance's effectiveness in the occlusal and dentoalveolar perspectives, its facial results may differ among patients with different growth patterns, as well as in distinct stages of skeletal maturation. In the current paper, two patients with different facial patterns are presented, who were treated under the same protocol, using Herbst and full fixed appliances in different skeletal maturation stages, and both dentoalveolar and facial results are compared and discussed.

RESUMO Um número significativo de pacientes que procuram o tratamento ortodôntico apresenta má oclusão de Classe II acompanhada pelo retrognatismo mandibular. Abordagens ortopédicas para avanço mandibular são comumente utilizadas enquanto houver crescimento facial remanescente e, nesses casos, o estágio de maturação esquelética deve ser avaliado para definir a melhor época de intervenção terapêutica. Após concluída a fase ortopédica, normalmente é realizada uma segunda fase ortodôntica para refinamento oclusal, com o intuito de oferecer maior estabilidade das correções em longo prazo. No presente artigo, serão discutidos os resultados do avanço mandibular ortopédico considerando-se diferentes estágios de crescimento.

Morphometric analysis of 3D soft-tissue for sexual dimorphism in human face / Análisis morfométrico de tejidos blandos 3D de dimorfismo sexual en rostro humano

Sexual dimorphism in Homo-sapiens is a phenomenon of a direct product of evolution by natural selection where evolutionary forces acted separately on the sexes which brought about the differences in appearance between male and female such as in shape and size. Advances in morphometrics have skyrocketed the rate of research on sex differences in human and other species. However, the current challenges facing 3D in the acquisition of facial data such as lack of homology, insufficient landmarks to characterize the facial shape and complex computational process for facial point digitization require further study in the domain of sex dimorphism. This study investigates sexual dimorphism in the human face with the application of Automatic Homologous Multi-points Warping (AHMW) for 3D facial landmark by building a template mesh as a reference object which is thereby applied to each of the target mesh on Stirling/ESRC dataset containing 101 subjects (male = 47, female = 54). The semi-landmarks are subjected to sliding along tangents to the curves and surfaces until the bending energy between a template and a target form is minimal. Principal Component Analysis (PCA) is used for feature selection and the features are classified using Linear Discriminant Analysis (LDA) with an accuracy of 99.01 % which demonstrates that the method is robust.

El dimorfismo sexual en el Homo-sapiens es un fenómeno directo de la evolución por selección natural, donde las fuerzas evolutivas actuaron por separado en los sexos, lo que provocó las diferencias en la apariencia entre hombres y mujeres, tal como la forma y tamaño. Los avances en el área de la morfometría, han generado un aumento significativo de las investigaciones en las diferencias de sexo en humanos y otras especies. Sin embargo, los desafíos actuales que enfrenta el 3D en el análisis de datos faciales, como la falta de homología, puntos de referencia insuficientes para caracterizar la forma facial y la complejidad del proceso computacional para la digitalización de puntos faciales, requiere un estudio adicional en el área del dimorfismo sexual. Este estudio investiga el dimorfismo sexual en el rostro humano con la aplicación de la deformación automática de múltiples puntos homólogos para el hito facial 3D, mediante la elaboración de una malla de plantilla como objeto de referencia, y se aplica en cada una de las mallas objetivas en el conjunto de datos Stirling / ESRC que contiene 101 sujetos (hombre = 47, mujer = 54). Los semi-puntos de referencia se deslizan a lo largo de las tangentes a las curvas y superficies hasta que la energía de flexión entre una plantilla y una forma objetivo es mínima. El análisis de componentes principales (PCA) se utiliza para la selección de características y las características se clasifican mediante el análisis discriminante lineal (ADL) con una precisión del 99,01 %, lo que demuestra la validez del método.

Avaliação do volume das vias aéreas superiores conforme o padrão facial / Upperairway volume assessment accordingto facial pattern

Objetivo: analisar o volume da via aérea superior (VAS) em pacientes adultos saudáveis, a partir de exames de tomografia computadorizada de feixe cônico, comparando os padrões faciais esqueléticos I, II e III, considerando a idade e o sexo. Método: um estudo retrospectivo de análise do banco de dados de uma clínica radiológica, com uma amostra de 129 exames de face total em formato DICOM, datados de 2015 a 2018. Após a divisão da amostra em três grupos, conforme o padrão esquelético, as medidas volumétricas foram obtidas através do aplicativo ITK-SNAP versão 3.6.0, um processador gratuito de segmentação anatômica 3D. Resultados: a amostra foi separada em padrão I com 60 exames, padrão II com 48 exames e padrão III com 21 exames. O sexo feminino foi o mais frequente, com 69,8% (n = 90), e a média de idade foi definida em 35 anos. O volume médio geral foi de 22.774,2 mm³ e a média entre os padrões esqueléticos não apresentou diferença significante (p = 0,251), segundo o teste não paramétrico de Kruskal-Wallis (p < 0,05). Na análise do dimorfismo sexual, os homens apresentaram maior volume, com diferença estatística (p = 0,033) através do teste de Mann-Whitney. Conclusão: o volume médio da VAS entre indivíduos saudáveis com padrões faciais I, II e III não apresentou diferença significativa, apenas uma discreta variação, sendo o padrão III maior em 14,8% do que o padrão I. O sexo masculino se destacou com maior volume, e a variação da idade não teve correlação com o volume do espaço aéreo faríngeo.(AU)

Aims: Analyze upper airway volume in healthy adult patients from CBCT examinations, comparing skeletal facial patterns I, II and III, considering age and gender. Methods: A retrospective study of a radiological clinic database analysis, with a sample of 129 full-face DICOM exams, dated between 2015 and 2018. After dividing the sample into three groups, according to skeletal pattern, volumetric measurements were obtained through the application ITK-SNAP version 3.6.0, a free 3D anatomical segmentation process. Results: The sample was separated into pattern I with 60 exams, pattern II with 48 and pattern III with 21 exams. Females were the most frequent with 69.8% (n = 90) and the mean age was defined as 35 years. The overall mean volume was 22,774.2 mm³ and the mean between skeletal patterns showed no significant difference (p = 0,251), according to the nonparametric Kruskal-Wallis test (p < 0,05). In the analysis of sexual dimorphism, men presented higher volume, with statistical difference (p = 0,033) through the Mann-Whitney test. Conclusion: The mean upper airway volume among healthy individuals with facial patterns I, II and III showed no significant difference, only a slight variation, pattern III being 14.8% higher than pattern I. The male gender stood out with greater volume and the age variation had no correlation with the pharyngeal space volume.(AU)

Evaluation of the reproducibility of non-verbal facial expressions in normal persons using dynamic stereophotogrammetric system / 北京大学学报(医学版)

OBJECTIVE@#To assess the reproducibility of non-verbal facial expressions (smile lips closed, smile lips open, lip purse, cheek puff) in normal persons using dynamic three-dimensional (3D) imaging and provide reference data for future research.@*METHODS@#In this study, 15 adults (7 males and 8 females) without facial asymmetry and facial nerve dysfunction were recruited. Each participant was seated upright in front of the 3D imaging system in natural head position. The whole face could be captured in all six cameras. The dynamic 3D system captured 60 3D images per second. Four facial expressions were included: smile lips closed, smile lips open, lip purse, and cheek puff. Before starting, we instructed the subjects to make facial expressions to develop muscle memory. During recording, each facial expression took about 3 to 4 seconds. At least 1 week later, the procedure was repeated. The rest position (T0) was considered as the base frame. The first quartile of expressions (T1), just after reaching the maximum state of expressions (T2), just before the end of maximum state of expressions (T3), the third quartile of expressions (T4), and the end of motion (T5) were selected as key frames. Using the stable part of face such as forehead, each key frame (T1-T5) of the different expressions was aligned on the corresponding frame at rest (T0). The root mean square (RMS) between each key frame and its corresponding frame at rest were calculated. The Wilcoxon signed ranks test was applied to assess statistical differences between the corresponding frames of the different facial expressions.@*RESULTS@#Facial expressions like smile lips closed, smile lips open, and cheek puff were reproducible. Lip purse was not reproducible. The statistically significant differences were found on the T2 frame of the repeated lip purse movement.@*CONCLUSION@#The dynamic 3D imaging can be used to evaluate the reproducibility of facial expressions. Compared with the qualitative analysis and two-dimensions analysis, dynamic 3D images can be able to more truly represent the facial expressions which make the research more reliable.

Accuracy evaluation of tridimensional images performed by portable stereophotogrammetric system / Avaliação da acurácia de imagens tridimensionais realizadas em sistema de estereofotogrametria portátil

Abstract Introduction Human facial characteristics vary according to individual dental occlusion, facial harmony, orofacial musculature and the format and configuration of craniofacial structures. Traditionally, anthropometric measurements have been acquired through direct evaluation of subjects in a clinical environment using calipers and metric tapes to measure distances between arches and landmarks. Scientific breakthroughs have enabled the digitization of data and introduced the possibility of quick, precise, radiation-free acquisitions; details can be archived for future analysis and easily shared with patients and colleagues. Among new facial analysis methods, the stereophotogrammetry technique has emerged, which uses a group of cameras to take many photographs of a subject in rapid succession from multiple angles. Nowadays, portable stereophotogrammetric systems are being proposed, as they are more practical and easier to use. Objective The aim of this work was to analyze the accuracy and reproducibility of a portable 3D stereophotogrammetric system (Vectra H1, Canfield, Fairfield, NJ, USA) in measuring soft facial tissues of 30 participants, defining measures of a cube and comparing these measurements with those obtained by a set 3D stereophotogrammetric system (Vectra M3, Canfield, Fairfield, NJ, USA) with previously validated accuracy and reproducibility through quantitative analysis of possible errors. Material and method Thirty temporary landmarks were used to measure (in mm) 34 distances in 30 participants (n = 30). Regarding the cube, 12 angles and 9 linear distances were evaluated. Result The results obtained by the established methodology indicated that the Vectra H1 portable system has shown accuracy and reproducibility equal to that of the Vectra M3 set system. Conclusion Data analysis and correlation to literature findings show Vectra H1's capability to reliably capture tridimensional images, which makes it practical for use in diverse clinical applications.

Resumo Introdução A configuração e o formato das estruturas craniofaciais, a oclusão dentária, a musculatura orofacial bem como a harmonia facial são determinantes para as características próprias da face humana. Instrumentos manuais como paquímetro e fitas métricas têm sido tradicionalmente utilizados para realizar as medidas antropométricas, diretamente de um sujeito em ambiente clínico. O avanço tecnológico possibilitou transformar a aquisição destas medidas analógicas em medições digitais, tornando possível aquisições rápidas, precisas e sem radiação. Tais informações podem, ainda, ser arquivadas para futuras análises e compartilhamento de informações com colegas e pacientes. A estereofotogrametria tem se destacado dentre as novas técnicas de captação de imagens tridimensionais, onde um grupo de câmeras de rápida captura fotografam a imagem do indivíduo a partir de variadas angulações. Atualmente, sistemas portáteis de estereofotogrametria vêm sendo propostos no mercado por apresentarem maior praticidade e simplicidade no manuseio. Objetivo A proposta do presente estudo foi avaliar a precisão e a reprodutibilidade de um sistema de estereofotogrametria 3D portátil (Vectra H1, Canfield Scientific, Fairfield, NJ, EUA) em medições dos tecidos moles faciais de 30 participantes e de um cubo de medidas definidas, comparando tais medidas com as obtidas por um sistema de estereofotogrametria 3D fixo (Vectra M3, Canfield Scientific, Fairfield, NJ, EUA), de precisão e reprodutibilidade estabelecidas e validadas, através de análise quantitativa dos possíveis erros. Material e método Foram realizadas marcações craniométricas transitórias em tecido mole da face nos 30 participantes do estudo (n=30), sendo estes submetidos à aquisição de imagens pela técnica da estereofotogrametria, tanto pelo sistema fixo Vectra M3, quanto pelo sistema portátil Vectra H1. Trinta pontos de referência (landmarks) foram utilizados para realizar as medidas (em mm) de 34 distâncias. Quanto ao cubo, foram avaliados, no total, 20 ângulos, 20 áreas e 9 distâncias lineares. Resultado Os resultados obtidos pela metodologia estabelecida mostraram que o sistema portátil Vectra H1 apresentou precisão e repetibilidade comparáveis com o sistema fixo Vectra M3. Conclusão A análise dos dados, juntamente com a correlação aos achados da literatura, evidenciam a capacidade do Vectra H1 de capturar imagens tridimensionais de modo eficaz, o que torna viável seu uso nas mais diversas aplicações clínicas.

PHACE syndrome: clinical manifestations, diagnostic criteria, and management

Abstract: Infantile hemangioma can be linked to other organ malformations. In 1996, PHACE syndrome was first defined as the association of large and segmental infantile hemangioma, usually on the face, head, or cervical region, with malformations of the posterior fossa of the brain, arterial anomalies of the central nervous system, coarctation of the aorta, cardiac defects, and ocular abnormalities. Over 300 cases of PHACE syndrome have been reported, and it is cconsidered one of the most common neurocutaneous vascular disorders in childhood. Knowledge of the features and locations of lesions that imply a greater risk of systemic involvement is crucial for the diagnosis and proper management of PHACE syndrome patients. This review highlights the diagnostic criteria for PHACE syndrome, the imaging workup for extracutaneous involvement, the treatment of infantile hemangioma, and the importance of a multidisciplinary approach in the management of these patients.

Termografia infravermelha na odontologia / Infrared thermography in dentistry

A termografia infravermelha consiste em um exame de imagem complementar aplicada na avaliação da temperatura corporal com base na emissão de radiação infravermelha através da pele, podendo auxiliar no diagnóstico ou monitoramento das intervenções terapêuticas. Trata-se de uma técnica não ionizante e não invasiva que capta e registra a distribuição térmica da superfície cutânea avaliada por meio das alterações na microcirculação dos pacientes frente a diferentes condições patológicas. Dentre as aplicações na Odontologia, a termografia pode complementar o exame físico anatômico, visto que apresenta em tempo real condições fisiológicas, de acordo com a temperatura. Esta técnica pode auxiliar no diagnóstico e planejamento do tratamento de alterações orofaciais, como processos inflamatórios e infecciosos na região orofacial, acompanhamento pós-cirúrgico e na avaliação de pacientes com desordens temporomandibulares (DTM). A termografia ainda é pouco utilizada na Odontologia, e protocolos para avaliação de alterações na região de cabeça e pescoço ainda devem ser testados e estabelecidos. Porém, já mostra ser um exame complementar de boa performance na detecção de pontos gatilho da dor, acompanhamento de pacientes de forma não invasiva e como documentação médico-legal.

Infrared thermography consists of a complementary imaging test applied to the assessment of body temperature based on the emission of infrared radiation through the skin, which may aid in the diagnosis or monitoring of therapeutic interventions. It is a non-ionizing and non-invasive technique that captures and records the thermal distribution of the cutaneous surface evaluated by means of the changes in the patients' microcirculation in face of different pathological conditions. Among the applications in Dentistry, thermography can complement the anatomical physical examination, since it presents in real time physiological conditions according to temperature. This technique can help in the diagnosis and planning of the treatment of orofacial alterations, such as inflammatory and infectious processes in the orofacial region, post-surgical follow-up and in the routine evaluation of patients with temporomandibular disorders (TMD). Thermography is still poorly used in Dentistry and protocols for the evaluation of head and neck disorders have yet to be tested and established. However, it already shows up as a good complementary examination for the detection of pain trigger points, follow-up of patients in a non-invasive way, and as medical-legal documentation.

The effect of hard tissue surgical changes on soft tissue displacement: a pilot CBCT study

ABSTRACT Introduction: This pilot study had as main objective to test the reliability of a new method to evaluate orthognathic surgery outcomes and also, to understand the effect of hard tissue changes on soft tissue displacement. Methods: The sample consisted of eight patients that underwent bimaxillary advancement and had CBCT at two time points (before surgery and 6-8 months follow-up). Voxel-based cranial base superimposition was used to register the scans. A different technique of iterative closest point (ICP) was used to measure and correlate the changes. The average displacement of 15 areas (4 hard tissue and 11 soft tissue) were measured twice. Results: ICC was > 0.99 for all areas. Changes in the tip of the nose did not correlate with changes in any maxillary area, whereas soft tissue A point, A point and upper lips had correlation with several areas. The highest correlation for the maxilla was between the upper lip and the left/right supra cheilion (p< 0.001, r= 0.91 and p< 0.001, r= 0.93, respectively). In the mandible, the majority of the correlations involved soft tissue pogonion, pogonion and lower incisors, with the strongest one between pogonion and lower incisors (p< 0.001, r= 0.98). Conclusion: With the proper case selection, ICP is a reliable method that can be used to assess three-dimensional changes.

RESUMO Objetivo: o objetivo deste estudo piloto foi testar a confiabilidade de um novo método para avaliar os resultados da cirurgia ortognática e entender o efeito das alterações dos tecidos duros no deslocamento dos tecidos moles. Métodos: a amostra selecionada consistiu de oito pacientes submetidos a avanço bimaxilar que possuíam TCFC em dois períodos de tempo (antes da cirurgia e de 6 a 8 meses após a cirurgia). A sobreposição da base do crânio pelo método voxel-based foi utilizada para registrar as varreduras, enquanto uma técnica diferente, de ponto iterativo mais próximo (ICP), foi usada para medir e correlacionar as mudanças. O deslocamento médio de 15 áreas (4 em tecidos duros e 11 em tecidos moles) foi mensurado duas vezes. Resultados: o ICC foi > 0,99 para todas as áreas. As alterações da ponta do nariz não se correlacionaram com alterações em qualquer área da maxila, enquanto o ponto A em tecido mole, o ponto A e os lábios superiores apresentaram correlação com várias áreas. A maior correlação para a maxila foi entre o lábio superior e a supracomissura esquerda/direita (p< 0,001, r = 0,91 e p< 0,001, r = 0,93, respectivamente). Na mandíbula, a maioria das correlações envolveu o pogônio em tecido mole, pogônio e incisivos inferiores, sendo a maior entre pogônio e incisivos inferiores (p< 0,001, r= 0,98). Conclusão: com a seleção adequada do caso, o ICP é um método confiável que pode ser utilizado para avaliar mudanças tridimensionais.

Subjective facial analysis and its correlation with dental relationships

ABSTRACT INTRODUCTION: Subjective facial analysis is a diagnostic method that provides morphological analysis of the face. Thus, the aim of the present study was to compare the facial and dental diagnoses and investigate their relationship. METHODS: This sample consisted of 151 children (7 to 13 years old), without previous orthodontic treatment, analyzed by an orthodontist. Standardized extraoral and intraoral photographs were taken for the subjective facial classification according to Facial Pattern classification and occlusal analyses. It has been researched the occurrence of different Facial Patterns, the relationship between Facial Pattern classification in frontal and profile views, the relationship between Facial Patterns and Angle classification, and between anterior open bite and Long Face Pattern. RESULTS: Facial Pattern I was verified in 64.24% of the children, Pattern II in 21.29%, Pattern III in 6.62%, Long Face Pattern in 5.96% and Short Face Pattern in 1.99%. A substantial strength of agreement of approximately 84% between frontal and profile classification of Facial Pattern was observed (Kappa = 0.69). Agreement between the Angle classification and the Facial Pattern was seen in approximately 63% of the cases (Kappa = 0.27). Long Face Pattern did not present more open bite prevalence. CONCLUSION: Facial Patterns I and II were the most prevalent in children and the less prevalent was the Short Face Pattern. A significant concordance was observed between profile and frontal subjective facial analysis. There was slight concordance between the Facial Pattern and the sagittal dental relationships. The anterior open bite (AOB) was not significantly prevalent in any Facial Pattern.

RESUMO INTRODUÇÃO: a análise facial subjetiva é um método diagnóstico que privilegia a avaliação morfológica da face; assim, o principal objetivo do presente trabalho foi comparar os diagnósticos faciais e dentários e investigar a correlação entre eles. MÉTODOS: a amostra consistiu de 151 crianças (7 a 13 anos de idade), sem nenhum tratamento ortodôntico prévio, analisadas por um ortodontista. Foram realizadas fotografias padronizadas extrabucais e intrabucais, para a classificação subjetiva dos Padrões Faciais e das relações dentárias segundo a classificação de Angle. Investigou-se a ocorrência de diferentes tipos de Padrões Faciais, em vistas frontal e de perfil; a relação entre os Padrões Faciais e as relações dentárias de Classe e, também, entre a má oclusão de mordida aberta anterior e o Padrão Face Longa. RESULTADOS: o Padrão Facial I (PF I) esteve presente em 64,24% das crianças; o PF II, em 21,29%; o PF III, em 6,62%; o PF Face Longa, em 5,96% e o PF Face Curta, em 1,99%. Observou-se concordância substancial entre a avaliação do PF na vista frontal e na de perfil, igual a 84% (Kappa = 0,69). Houve concordância entre a avaliação da relação dentária de Classe e do PF em 63% da amostra (Kappa = 0,27). O PF Face Longa não demonstrou maior prevalência da má oclusão de mordida aberta. CONCLUSÃO: os Padrões Faciais I e II foram os mais prevalentes em crianças, enquanto o menos prevalente foi o Padrão Face Curta. Verificou-se concordância significativa entre as análises faciais frontal e de perfil. Existe uma ligeira concordância entre o Padrão Facial e a relação sagital dentária. A mordida aberta anterior não se apresentou mais prevalente em nenhum tipo de Padrão Facial.

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.

Effect of Head Position on Maxillofacial Transverse Measurements Made on the Skull and Cone Beam Computed Tomography Scans

Article Incorrect patient positioning and the resultant image distortion occur in many radiographic examinations. This study aimed to assess the effect of tilting, rotation and tipping of the head on the accuracy of maxillofacial transverse measurements made on cone beam computed tomography (CBCT) scans. The CBCT scans were obtained in central position of 10 dry human skulls. Using three-dimensional (3D) Dolphin software, six positions namely 10° and 20° tilts, rotations and tips were reconstructed of central position. Transverse distances between landmarks were measured on 3D scans and the skulls. The intraclass correlation coefficient (ICC) and the Bland-Altman plot were used to compare the mean values measured by the two observers. For most landmarks, no significant differences were noted between the mean transverse distances measured in the six positions and those measured in central position on 3D scans (p>0.005). In conclusion, all measurements of transverse distances made on 3D scans in different positions were underestimated compared to the actual values measured on the skull.