Referencias argentinas de perímetro cefálico desde el nacimiento hasta los 19 años / Argentine reference charts for head circumference from birth to 19 years of age

Introducción. El perímetro cefálico (PC) es un indicador del crecimiento cerebral y es necesario contar con referencias de crecimiento que permitan determinar variaciones normales o patológicas. Objetivos. Presentar las primeras referencias argentinas de perímetro cefálico entre el nacimiento y los 19 años, y compararlas con las referencias de Nellhaus, utilizadas en nuestro país hasta la actualidad. Población y métodos. Para la construcción de estas referencias, se combinaron datos de la Encuesta Nacional de Nutrición y Salud 2018 y estudios transversales realizados entre 2004 y 2007 en las provincias de Buenos Aires y La Pampa, que incluyeron 8326 niños, niñas y adolescentes sanos. Las curvas de crecimiento fueron ajustadas con el método LMS. Para evaluar la magnitud de las diferencias entre estas referencias y las de Nellhaus, a diferentes edades, se graficaron los centilos 2, 50 y 98. Resultados. El PC mostró un incremento de tamaño variable con la edad, de mayor magnitud en los primeros años de vida, y un ligero incremento en la pubertad. Los valores del centilo 98 de las referencias argentinas fueron mayores que los de Nellhaus en todas las edades. Los valores del centilo 2 de la referencia nacional fueron menores que los de Nellhaus durante los primeros 2 años de vida, similares entre los 3 y 7 años, y mayores a partir de esta edad. Conclusiones. Las curvas argentinas describen adecuadamente el patrón de crecimiento del PC. Las diferencias halladas con la referencia de Nellhaus pueden atribuirse a cambios seculares.

Introduction. Head circumference (HC) is an indicator of brain growth; growth charts are necessary to determine normal or pathological variations. Objectives. To present the first Argentine HC reference charts between birth and 19 years of age and to compare them with the Nellhaus charts, which have been used in our country to date. Population and methods. These references were developed based on combined data from the National Survey on Nutrition and Health of 2018 and cross-sectional studies conducted between 2004 and 2007 in the provinces of Buenos Aires and La Pampa, which included 8326 healthy children and adolescents. Growth curves were adjusted using the LMS method. To assess the differences between these reference charts and the Nellhaus charts, at different ages, the 2nd, 50th, and 98th percentiles were plotted. Results. HC showed a variable increase in size with age, which was greater in the first years of life, and a slight increase at puberty. The values for the 98th percentile of the Argentine reference charts were higher than those of the Nellhaus charts at all ages. The values for the 2 nd percentile of the national reference were lower than those of the Nellhaus charts during the first 2 years of life, similar between 3 and 7 years of age, and higher after this age. Conclusions. The Argentine curves adequately describe the growth pattern of HC. The differences found with the Nellhaus charts may be attributed to secular changes.

Automatic Landmark Annotation and Measurement of 3D Mandibular Morphology Using Non-Rigid Registration: A Preliminary Exploration and Accuracy Assessment.

This study aimed to develop an automatic methodology for mandibular landmarking and measurement using non-rigid registration as well as analyze the accuracy of automatic landmarking and measurements.Statistical analysis.Digital technology center, tertiary hospital.130 healthy Chinese adults with equal gender distribution, average age 28.2 ± 5.6 years.Four mean shape mesh templates were generated from 100 head CT scans. Following manual indication of landmarks, these templates were applied for automatic landmark annotation and measurements on mandibles from another 30 head CT scans, using non-rigid iterative closest point registration.Differences of landmark coordinates and measurements between automatic and manual annotation were analyzed using mean difference, centroid size, Euclidean distances and intraclass correlation coefficient (ICC), assessing the accuracy and validity of automatic landmark annotation.The majority of automatic landmarks (16/22) did not exhibit consistent displacement to specific direction. ICCs of all landmark coordinates exceed 0.950, with 87.9% larger than 0.990. The average Euclidean distance between manual and automatic landmarks was 2.038 ± 0.947 mm. Most ICCs of linear and angular measurements between manual and automatic annotation (20/26) exceeded 0.900, with the average errors being 1.425 ± 0.973 mm and 2.257 ± 0.649 °, respectively.A novel and efficient method for automatic landmark annotation was established based on non-rigid registration. Its credibility and accuracy in mandibular annotation and measurements were demonstrated.

Impaired head circumference growth and behavioural problems in childhood: Longitudinal findings from the MINA-Brazil birth cohort.

BACKGROUND: Previous evidence on the relation between early head circumference (HC) growth and behavioural outcomes in preschoolers has been inconsistent. OBJECTIVE: We aimed to investigate whether HC growth from birth to 5 years of age was related to internalising or externalising behavioural problems at 5 years of age in a sex-specific manner. METHODS: Among 303 girls and 318 boys from the MINA-Brazil birth cohort, we examined the associations between changes in HC from birth to 5 years of age and internalising and externalising behaviour problem scores at 5 years according to the Strengths and Difficulties Questionnaire for parents. HC values were transformed into sex- and age-specific z-scores (HCZ) using World Health Organisation standards, and the differences between values at 5 years of age and birth were classified into quintiles. We estimated adjusted mean differences with 95% confidence intervals in behavioural problem scores between HCZ change quintiles using multivariable linear regression by sex. To examine nonlinear associations, we included cubic spline terms. RESULTS: Head circumference growth from birth to 5 years of age was inversely and nonlinearly associated with internalising problems in girls. Compared with girls at the lowest quintile of HC growth, those above had an adjusted 1.27 (95% confidence interval 0.28, 2.27) points lower mean internalising problems score. This association was mostly driven by HC growth during the first 2 years. We found no association between HC growth and externalising behaviour in either sex. CONCLUSIONS: Impaired HC growth was related to higher mean internalising problem scores at 5 years of age in girls but not in boys. HC growth was not associated with externalising problems.

Assessment of Upper and Lower Airway Dimensions in Skeletal Class I and Class II Subjects Having Different Growth Patterns - A Cross-Sectional Cephalometric Study.

Objectives: To compare the airway dimensions among subjects having skeletal class I and class II patterns considering their hypodivergent, normodivergent, and hyperdivergent growth patterns and to determine any variations between them. Methods and Materials: The study consisted of 156 pre-treatment lateral cephalograms of subjects aged above 18 years. The sagittal skeletal pattern was used to separate the sample into two groups. Each group was further subdivided into hypodivergent, normodivergent, and hyperdivergent growth patterns. The upper and lower airway dimensions were measured in all the subgroups. The intragroup comparison of class I and class II was performed with 1-way ANOVA and post-hoc test. Using the independent t-test, the upper and lower airways were compared between groups. Results: Comparison of subjects according to the growth pattern showed that vertical growth patterns have statically significantly reduced upper and lower airway dimensions as compared to the average and horizontal growth patterns in both skeletal class I and class II subjects. However, the subjects with skeletal class II hyperdivergent growth patterns have significantly reduced lower airway dimensions than those with skeletal class I having hyperdivergent growth patterns. Conclusion: Individuals with skeletal class I and class II patterns characterized by hyperdivergent growth exhibit reduced upper and lower pharyngeal airways. The sagittal skeletal type also plays a role in influencing the dimensions of the upper and lower airways.

Profile Photograph Classification Performance of Deep Learning Algorithms Trained Using Cephalometric Measurements: A Preliminary Study.

Extraoral profile photographs are crucial for orthodontic diagnosis, documentation, and treatment planning. The purpose of this study was to evaluate classifications made on extraoral patient photographs by deep learning algorithms trained using grouped patient pictures based on cephalometric measurements. Cephalometric radiographs and profile photographs of 990 patients from the archives of Kocaeli University Faculty of Dentistry Department of Orthodontics were used for the study. FH-NA, FH-NPog, FMA and N-A-Pog measurements on patient cephalometric radiographs were carried out utilizing Webceph. 3 groups for every parameter were formed according to cephalometric values. Deep learning algorithms were trained using extraoral photographs of the patients which were grouped according to respective cephalometric measurements. 14 deep learning models were trained and tested for accuracy of prediction in classifying patient images. Accuracy rates of up to 96.67% for FH-NA groups, 97.33% for FH-NPog groups, 97.67% for FMA groups and 97.00% for N-A-Pog groups were obtained. This is a pioneering study where an attempt was made to classify clinical photographs using artificial intelligence architectures that were trained according to actual cephalometric values, thus eliminating or reducing the need for cephalometric X-rays in future applications for orthodontic diagnosis.

A Pilot Study on the Relationship between Obstructive Sleep Apnoea-Hypopnea Syndrome, Neurodevelopment, and Ricketts' Cephalometry.

Background: The aim of this research is to achieve the early detection of facial characteristics in patients diagnosed with neurodevelopmental deficits and obstructive sleep apnoea-hypopnea syndrome (OSAHS) through the analysis of the VERT index and Ricketts' cephalometry to minimise the neurocognitive morbidity associated with these disorders. Methods: This clinical study was conducted on 44 patients aged 4 to 15 years. Participants completed an initial questionnaire about sleep disturbances, followed by a polysomnography, a radiographic study, and an oral examination. Results: The maximum variability in the data was obtained in the mandibular plane angle, where we observed that the measurement was higher in patients diagnosed with OSAHS. The relative and normalised indices of facial depth and the mandibular plane showed variations between patients with a clinical picture compatible with OSAHS and the control group without pathology. Conclusions: Our findings indicate that Ricketts' VERT index by itself is unable to provide evidence of a diagnosis compatible with OSAHS in patients with early neurodevelopmental deficits, but, after analysing the results obtained, we observed that for the cephalometric measurements of the mandibular plane angle and facial depth relative to the patient's age, there are sufficiently strong variations for creating a solid method of differential diagnosis, thus preventing complications at the neurocognitive level.

Association of LSMx and LIMd Angles With Cephalometric Dental and Soft Tissue Parameters of Incisor Proclination and Lip Protrusion.

BACKGROUND: Soft tissue analysis can be used to assess anatomical features but may or may not accurately correlate with underlying hard tissue morphology, leading to an incorrect perception of malocclusion. OBJECTIVE: This study aimed to assess the reliability of different soft tissue reference lines used to evaluate anteroposterior lip position and the position of incisors and malocclusion and compare it with those assessed via hard tissue angles (LSMx and LIMd) and determine if they are true indicators of underlying protrusion of incisors and malocclusion. METHOD: A total of 120 pre-treatment lateral cephalometric radiographs were selected where patients were 18-30 years old, diagnosed as Skeletal Class I, II (Division 1 and 2), and III malocclusion. The measurements taken were SN to point A angle (SNA), SN to point B angle (SNB), angle between point A and point B (ANB), upper incisor to SN plane angle (UI-SN), upper incisor to palatal plane angle (UI-PP), incisor mandibular plane angle (IMPA), Ricketts' E line, Sushner's S2 line, nasolabial (NL) angle, mentolabial (ML) angle, LSMx angle, and LIMd angle. RESULTS: In the Class I malocclusion group, when the upper lip was assessed, the distribution of UI-SN, UI-PP, E line to UL, S line to UL, NL angle, and LMax was significantly different statistically (p=0.000), though the assessment of lower variables in Class I malocclusion showed the distribution of IMPA, E line to UL, S line to UL, ML angle, and LMand angle has a statistically significant difference (p=0.007). In Class II Division 2 malocclusion, a significant difference was observed for the upper variables (p=0.000), whereas the distribution of lower values was the same across all the variables (p=0.0724). In the sample of Class III malocclusion, a significant correlation was found in the upper variables, while the distribution among lower variables did not show any significant difference (p=0.211). CONCLUSION: This study indicates that the upper and lower soft tissue correlation with hard tissue variables is reliable for some variables but not throughout for all. Soft tissue analysis (under study) can be used to assess disproportion, but it fails to correlate to the underlying hard tissue morphology and does not explain the correct malocclusion. Further studies based on 3D diagnosis to formulate a close relationship are encouraged that can help assess soft and hard tissue patterns consistent with one another.

Variabilidad en la medición del ángulo ANB de Steiner entre estudiantes de odontología y ortodoncia. Medición del Angulo ANB de Steiner

Introducción: El ángulo ANB de Steiner entrega la relación entre el maxilar y la mandíbula en sentido anteroposterior y es una de las medidas cefalométricas más aplicadas en ortodoncia. Su identificación precisa podría presentar dificultades, influyendo directamente en el posterior estudio cefalométrico, diagnóstico y plan de tratamiento. El objetivo de esta investigación fue comparar la medición del ángulo ANB de Steiner entre estudiantes de pregrado de odontología y postítulo de ortodoncia de la Facultad de Odontología de la Universidad de Chile 2020. Materiales y Métodos: Por medio del programa Adobe Photoshop CS6 (Adobe System ®), se solicitó a los estudiantes la identificación de los puntos Nasion, A y B en 5 telerradiografías laterales de cráneo. Al aplicar los criterios de inclusión y exclusión se reclutaron 15 estudiantes de cada grupo. Luego se unieron los puntos mediante trazados, se midió el ángulo ANB de Steiner y se utilizó el coeficiente de correlación intraclase (ICC) para determinar el grado de acuerdo. Resultados: Se encontró un coeficiente de correlación intraclase ICC promedio de 0.97 entre ambos grupos de estudiantes. Conclusión: No hay diferencia estadística en la determinación del ángulo ANB de Steiner entre estudiantes de pregrado de odontología y postítulo de ortodoncia.

Background: The Steiner ANB angle measures the relationship between the maxilla and mandible in the anteroposterior direction and is one of the most applied cephalometric measurements in orthodontics. Its precise identification could pose difficulties, directly influencing the subsequent cephalometric study, diagnosis and treatment plan. The aim of this research was to compare the measurement of the Steiner ANB angle between dental student and postgraduate students in orthodontics from the Faculty of Dentistry of the University of Chile 2020. Materials and Methods: Using the Adobe Photoshop CS6 program (Adobe System ®), the students were asked to identify the Nasion, A and B points in 5 lateral cephalogram of the skull. By applying the inclusion and exclusion criteria, 15 students were recruited from each group. The points were then joined by tracing, the Steiner ANB angle was measured, and the intraclass correlation coefficient (ICC) was used to determine the degree of agreement. Results: An average ICC intraclass correlation coefficient of 0.97 was found between both groups of students. Conclusion: T here is no statistical difference in the determination of the Steiner ANB angle between undergraduate students of dentistry and postgraduate students of orthodontics.

Fractal analysis of mandibular trabecular pattern following protraction facemask therapy : A pilot study.

OBJECTIVE: To assess the remodeling effects of protraction facemask therapy on the trabecular pattern of the mandible and identify quantitatively the regions of the mandible undergoing maximum changes in the trabecular pattern. MATERIALS AND METHODS: The retrospective study was conducted in 30 subjects divided into two groups. The treatment group (group 1) consisted of 15 subjects with skeletal class III malocclusion treated with a facemask (mean age: 9.1 ± 2.1 years). Digital panoramic radiographs (OPG) were obtained before treatment (T0) and at the end of active facemask therapy (T1) with a mean duration of 16.1 ± 2.5 months. In all, 15 skeletal class I subjects who did not undergo any orthodontic treatment (mean age 9.1 ± 2.2 years) comprised the control group (group 2) who had two OPGs at a mean interval of 13.6 ± 2.2 months. The fractal dimensional (FD) value was calculated in three regions: angular, condylar, and corpus region. RESULTS: Intragroup comparisons revealed a significant increase in the FD values in the right condylar (T0 = 1.2 ± 0.2; T1 = 1.4 ± 0.1) and left condylar (T0 = 1.2 ± 0.1; T1 = 1.4 ± 0.1) region (p < 0.05) and in the corpus region (FD values: right T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; left T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; p < 0.05). The intergroup comparison demonstrated that the treatment group showed greater changes compared with the controls in the condylar process (mean difference: right = 0.19, left = 0.20; p < 0.05) and the corpus region (0.172; p < 0.05). CONCLUSION: FD analysis demonstrated that the condylar process and the corpus region underwent the most significant change in the trabecular pattern in subjects treated with protraction facemask therapy.

The Effect of Barrel-Stave Osteotomy Length in Sagittal Strip Craniectomy.

OBJECTIVE: In managing sagittal craniosynostosis, strip craniectomy of the affected suture is commonly paired with barrel-stave osteotomies to allow for additional cranial remodeling. However, the effect of these osteotomies is not well-established. This study aimed to evaluate the effect of the length of barrel-stave osteotomies on outcomes in patients with sagittal craniosynostosis. DESIGN: A retrospective review of operative records and pre-operative and one-year post-operative three-dimensional images. SETTING: Tertiary care pediatric institution. PATIENTS: Forty-five patients with sagittal craniosynostosis. INTERVENTIONS: Sagittal strip craniectomy and either long, medium, or short barrel-stave osteotomy lengths followed by helmet therapy. MAIN OUTCOME MEASURES: Operative and three-dimensional craniometric outcomes. RESULTS: Operative time, estimated blood loss, and hospital length of stay were significantly decreased in the short group (P = .003; 0.002; 0.027). The cranial index was normalized in all groups, but the long group was significantly lower (P = .007; 0.025). Head circumference was similar between groups. All indexes were within the normal percentiles in all groups. The medium group had a significantly decreased scaphocephalic index (P = .031; .035). The short group had significantly greater occipital bulleting than the medium group (P = .001). The long group had significantly greater narrowing than the short group (P = .036). CONCLUSIONS: Strip craniectomy with the addition of long, medium, or short barrel staves all resulted in clinically successful outcomes. Our findings suggest that increased barrel-stave osteotomy length may not be necessary for a successful outcome while avoiding more extensive dissection, potential risk, increased operative time, and hospital length of stay.