ENPP1 and ESR1 genotypes associated with subclassifications of craniofacial asymmetry and severity of temporomandibular disorders.

INTRODUCTION: We investigated whether ACTN3, ENPP1, ESR1, PITX1, and PITX2 genes which contribute to sagittal and vertical malocclusions also contribute to facial asymmetries and temporomandibular disorders (TMD) before and after orthodontic and orthognathic surgery treatment. METHODS: One hundred seventy-four patients with a dentofacial deformity were diagnosed as symmetric or subdivided into 4 asymmetric groups according to posteroanterior cephalometric measurements. TMD examination diagnosis and jaw pain and function (JPF) questionnaires assessed the presence and severity of TMD. RESULTS: Fifty-two percent of the patients were symmetric, and 48% were asymmetric. The asymmetry classification demonstrated significant cephalometric differences between the symmetric and asymmetric groups, and across the 4 asymmetric subtypes: group 1, mandibular body asymmetry; group 2, ramus asymmetry; group 3, atypical asymmetry; and group 4, C-shaped asymmetry. ENPP1 SNP-rs6569759 was associated with group 1 (P = 0.004), and rs858339 was associated with group 3 (P = 0.002). ESR1 SNP-rs164321 was associated with group 4 (P = 0.019). These results were confirmed by principal component analysis that showed 3 principal components explaining almost 80% of the variations in the studied groups. Principal components 1 and 2 were associated with ESR1 SNP-rs3020318 (P <0.05). Diagnoses of disc displacement with reduction, masticatory muscle myalgia, and arthralgia were highly prevalent in the asymmetry groups, and all had strong statistical associations with ENPP1 rs858339. The average JPF scores for asymmetric subjects before surgery (JPF, 7) were significantly higher than for symmetric subjects (JPF, 2). Patients in group 3 had the highest preoperative JPF scores, and groups 2 and 3 were most likely to be cured of TMD 1 year after treatment. CONCLUSIONS: Posteroanterior cephalometrics can classify asymmetry into distinct groups and identify the probability of TMD and genotype associations. Orthodontic and orthognathic treatments of facial asymmetry are effective at eliminating TMD in most patients.

Evaluation of Nasal Obstruction in Various Sagittal Skeletal Deformity of Jaws.

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

Functional needs of subjects with dentofacial deformities: A study using the index of orthognathic functional treatment need (IOFTN).

OBJECTIVES: To assess the functional needs of orthognathic patients treated in Isfahan University of Medical Sciences affiliated hospitals using the index of orthognathic functional treatment need (IOFTN). MATERIALS AND METHODS: A retrospective study was conducted using 2011-2015 records of 103 patients [58 female, 45 males, 16-45 years, mean (SD) age = 23.47 (6.44) years] who had orthognathic surgery. Malocclusion type (incisor classification), sagittal skeletal pattern (ANB angle), IOFTN score, and Dental Health Component of the IOTN [IOTN (DHC)] were recorded. RESULT: Overall, 92.2% and 82.5% of subjects scored 4 or 5 for IOFTN and IOTN (DHC), respectively, and no gender differences detected for both indices (P > 0.05). Gender differences detected for malocclusions/skeletal patterns (P < 0.05). Class III malocclusions (45.6%) and Class II skeletal patterns (51.5%) were the most prevalent type. Subjects with Class I, Class II, and Class III sagittal skeletal bases formed 4.8%, 51.5%, and 43.7% of the sample, respectively. IOFTN score of 5.3 (reverse OJ ≥ 3 mm, 27.2%) was the most prevalent, followed by 4.2(19.4%), 4.3(13.6%), 4.10 (12.6%), and 5.2 (8.7%). Subjects with Class III sagittal skeletal patterns or malocclusions had higher percentages of grade 5 IOFTN scores (62.2% and 59.6%), compared to Class II sagittal skeletal patterns or malocclusions (18.9% and 21.2%) and the distribution of functional needs between malocclusions or sagittal skeletal patterns were different (p < 0.01). CONCLUSION: IOFTN identified 92.2% of orthognathic surgery patients as having great and very great functional needs and appeared to be reliable tool to identify patients in need of orthognathic surgery. Higher percentages of Class III subjects scored grade 5 of IOFTN, indicating higher functional need for orthognathic surgery in this group.

Dental informatics to characterize patients with dentofacial deformities.

Relevant statistical modeling and analysis of dental data can improve diagnostic and treatment procedures. The purpose of this study is to demonstrate the use of various data mining algorithms to characterize patients with dentofacial deformities. A total of 72 patients with skeletal malocclusions who had completed orthodontic and orthognathic surgical treatments were examined. Each patient was characterized by 22 measurements related to dentofacial deformities. Clustering analysis and visualization grouped the patients into three different patterns of dentofacial deformities. A feature selection approach based on a false discovery rate was used to identify a subset of 22 measurements important in categorizing these three clusters. Finally, classification was performed to evaluate the quality of the measurements selected by the feature selection approach. The results showed that feature selection improved classification accuracy while simultaneously determining which measurements were relevant.

Assessment of the epidemiological profile of patients with dentofacial deformities who underwent orthognathic surgery.

The present study aimed to establish the profile of patients who underwent orthognathic surgery in a private clinic by evaluating their demographic characteristics, their facial types, and aspects related to the surgical procedures that were performed. The sample consisted of 419 medical records from male and female patients aged 15 to 62 years who underwent orthognathic surgery between 2001 and 2011. A single examiner collected data by evaluating a database of information extracted from medical records, particularly radiographic and photographic analyses. The following criteria were evaluated: gender, age, skin color, type of orthognathic surgery, type of associated temporomandibular joint (TMJ) surgery, complications, and recurrences. Seventeen patients were rejected because they had incomplete records. The average age of the patients was 28.5 years old; most were females (255 patients) and faioderm (295 patients). The most prevalent facial pattern was Pattern III (n = 166, 41.3%). Orthognathic surgery that affected the maxilla, jaw, and chin was the most prevalent type (n = 199, 49.5% of cases). A genioplasty was performed concurrently with combined surgeries and single-jaw surgery in 76.86% of patients (n = 309). TMJ surgery was performed concomitantly with orthognathic surgery in 4% of cases (n = 16). The most common postoperative complication was infection/inflammation (n = 12). We concluded that there was a higher frequency of orthognathic surgery among women and young people, the brunette skin phenotype was prevalent, and most patients had a combination of maxillary and mandibular problems.

Effects of bimax and segmental surgeries for correction of bimaxillary dentoalveolar protrusion class I on soft tissue parameters: upper lip thickness and curvature, nasolabial angle and nasal prominence.

AIM: Results of this study can show if bimax surgery for posterior repositioning of maxilla and correction of BPCLI has priority to the currently used segmental orthognathic surgery or not. MATERIALS AND METHODS: This study was done on 40 white- skinned Iranian patients with bimaxillary dentoalveolar protrusion class I (BPCLI) who sought treatment for their deformity. In the first group, treatment includes segmental surgery for backward replacement of anterior segment of the upper and lower jaw. In the second group, treatment was bimax surgery, in which whole upper and lower jaw moved backward. Twenty patients were included in each group. For this purpose, we measured upper lip thickness (ULT, distance between LS and IA), nose prominence (NP, distance between nasal tip and the perpendicular line from upper lip vermilion on FHP), subsulcus depth (SSD, distance of SLS from this perpendicular line), SN to H line distance and finally, nasolabial angle (NLA) before and after surgery. RESULTS: In our study, 65% of patients were female and the mean of age was 27 (17-39) years old. The mean of SNA, SNB, ANB and INA in our patients were 81.7 ± 2.9, 78.8 ± 2.8, 4.50 ± 1.4 and 120 ± 8.7, respectively. All variables except SSD were analyzed with t-test to compare the results of two methods of surgery. Differences in the values of NP, NLA, SN to H line distance and ULT before and after segmental and bimax surgeries between before and after surgery were significant. After surgeries, ULT and the SN to H line distance reduced significantly, and NLA became corrected to its normal range (90-110). CONCLUSION: The results of this study showed that bimax and segmental surgeries can effectively correct BPCLI. Because of possible dental and periodontal complications of segmental surgery, we highly recommend bimax surgery for treatment of BPCLI.

Masticatory efficiency in class II and class III dentofacial deformities.

Masticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals with dentofacial deformities. 30 patients with class II (DG-II) and 35 patients with class III (DG-III) dentofacial deformity participated in the study, all had an indication for orthognathic surgery. 30 volunteers (CG) with no alterations of facial morphology or dental occlusion and with no signs or symptoms of temporomandibular joint dysfunction also participated. Masticatory efficiency was analysed using a bead system (colorimetric method). Each individual chewed 4 beads, one at a time, over 20s measured with a chronometer. The groups were compared in terms of masticatory efficiency using analysis of variance (ANOVA), with the level of significance set at P<0.05. Masticatory efficiency was significantly greater in CG (P<0.05) than in DG-II and DG-III in all chewing tasks tested, with no significant difference between DG-II and DG-III (P>0.05). It was observed that the presence of class II and class III dentofacial deformity affected masticatory efficiency compared to CG, although there was no difference between DG-II and DG-III.