Population affinity and variation of sexual dimorphism in three-dimensional facial forms: comparisons between Turkish and Japanese populations.

Examining the extent to which sex differences in three-dimensional (3D) facial soft tissue configurations are similar across diverse populations could suggest the source of the indirect evolutionary benefits of facial sexual dimorphism traits. To explore this idea, we selected two geographically distinct populations. Three-dimensional model faces were derived from 272 Turkish and Japanese men and women; their facial morphologies were evaluated using landmark and surface-based analyses. We found four common facial features related to sexual dimorphism. Both Turkish and Japanese females had a shorter lower face height, a flatter forehead, greater sagittal cheek protrusion in the infraorbital region but less prominence of the cheek in the parotid-masseteric region, and an antero-posteriorly smaller nose when compared with their male counterparts. The results indicated the possible phylogenetic contribution of the masticatory organ function and morphogenesis on sexual dimorphism of the human face in addition to previously reported biological and psychological characteristics, including sexual maturity, reproductive potential, mating success, general health, immune response, age, and personality.

NAM Therapy-Evidence-Based Results.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Quantifying faces three-dimensionally in orthodontic practice.

PURPOSE: The purpose of this study was to formulate and demonstrate a method for quantifying and visualizing the three-dimensional (3-D) configuration of the soft tissues of the face at rest to facilitate a quantitative and instantaneous understanding of a patient's static facial form characteristics. MATERIALS AND METHODS: 3-D facial images of 200 Japanese adult volunteers at rest were recorded using a 3-D photogrammetric system. For each participant, a wire mesh fitting was conducted based on the assignment of landmarks to each 3-D facial image. This method generated 6,017 points on the wire mesh (i.e., the nodes of the fitted mesh). For each point, the mean and standard deviation were calculated and used for patient evaluation. The system performance was exemplified with three orthodontic patients with skeletal Class II and III malocclusions and laterotrusion. RESULTS: Three patients with severe skeletal Class II and III deformities and laterotrusion were evaluated with the proposed method. CONCLUSION: A clinical method for practitioners to quantify and visualize the soft tissues of a patient's face in 3 dimensions has been presented with clinical applications and considerations. This method allows practitioners to evaluate how patients' facial characteristics differ from normative faces.

Three-dimensional tooth crown size symmetry in cleft lip and cleft palate.

OBJECTIVE: To evaluate and compare three-dimensional tooth size symmetry in the right and left sides of upper and lower dental arches in cleft lip and palate (CLP) patients and to compare it with an Angle Class I normal occlusion control group. MATERIALS AND METHODS: Dental casts of 72 individuals with CLP (20 bilateral [BCLP], 34 unilateral left [ULCLP], and 18 unilateral right [URCLP]) and 53 individuals with Class I occlusion, all with permanent dentition, were randomly selected. Mesiodistal (MD), labiolingual (LL), and occlusogingival (OG) measurements of upper and lower teeth were recorded with a digital caliper. Descriptive statistics and paired t-test were used for statistical analysis. RESULTS: Significant asymmetries were found between the right and left sides of the dental arches in CLP as follows: MD dimension: mandibular first premolar (ULCLP, P < .01); LL dimension: mandibular first premolar (URCLP, P < .05); OG dimension: maxillary central incisor and first premolar (ULCLP, P < .05 and P < .01, respectively), central incisor (BLCLP, P < .01), mandibular canine and first premolar (ULCLP, P < .01), and first molar (ULCLP, P < .05). Tooth crown size asymmetries were also recorded in the Class I group. CONCLUSIONS: Significant three-dimensional tooth size asymmetries were found in CLP subjects; however, such asymmetries were also present on the Class I control group.

Dental anomalies in individuals with cleft lip and/or palate.

Significant heterogeneity has previously been reported but with no consensus on the prevalence of dental anomalies in subjects with a cleft lip and palate (CLP), thus, the purpose of this study was to investigate the frequency of various dental anomalies in the upper dental arch in different cleft groups. Diagnostic records, i.e., panoramic, occlusal and periapical films, dental casts, and intra-oral photographs, of 122 subjects (mean age: 14 +/- 5 years; 67 males and 55 females) were grouped as either unilateral left cleft lip and palate (ULCLP), unilateral right cleft lip and palate (URCLP), bilateral cleft lip and palate (BCLP), or cleft palate (CP). Prevalence rates of 15 different dental anomalies were calculated for each group. Wilcoxon's test was used to determine if there was a statistically significant difference in the number of missing teeth between the right and left sides, in each cleft group. Overall, 96.7 percent of patients were found to have at least one dental anomaly. The most prevalent was agenesis in the anterior region on the cleft side (70.8-97.1 percent). There was a statistically significant difference in the prevalence of agenesis by cleft and non-cleft sides but only in the ULCLP group (P < 0.001). Significantly higher rates of impaction were observed in the anterior and premolar regions in the CLP groups (2.9-29.2 percent), with the highest rates in the anterior region on the cleft sides. A very high proportion of subjects were found to have at least one dental anomaly. Thus, the management of dental anomalies should be central to the treatment planning process of individuals with a cleft.

Prevalence of dental anomalies in various malocclusions.

INTRODUCTION: The purpose of this study was to evaluate the prevalence of dental anomalies in different orthodontic malocclusions. METHODS: Based on pretreatment diagnostic records, 900 orthodontic patients were classified as Class I (n = 358), Class II (n = 325), Class II Division 2 (n = 51), or Class III (n = 166). The occurrence rates of each dental anomaly were calculated as percentages of the total sample. Differences in incidence rates of each dental anomaly by sex and malocclusion were analyzed by using chi-square, Fisher exact, and z tests. The Mann-Whitney U test was used to determine whether there were significant differences in the occurrence of dental anomalies by age. RESULTS: It was found that 40.3% of patients (n = 363) had at least 1 dental anomaly. Agenesis was the most common (21.6%), followed by dens evaginatus (6.2%), invaginatus (5.0%), pulp stones (4.2%), and impaction (2.9%). No statistically significant correlations were found between dental anomaly and type of malocclusion, with the exception of impaction and short or blunt roots (P <0.01 and P <0.05, respectively). The Mann-Whitney U test indicated no significant difference in dental anomalies by age. CONCLUSIONS: A remarkably high rate of dental anomalies was recorded in orthodontic patients; therefore, orthodontists should carefully examine pretreatment records for dental anomalies to include their management in the treatment planning.

Long-term follow-up of patients with a skeletal Angle Class III relationship treated with chin caps.

AIM: To evaluate the long-term result of chin-cap treatment in patients with a skeletal Angle Class III relationship due to mandibular prognathism. MATERIAL AND METHODS: Records of nine patients (five girls and four boys) with a mean age of 10.8 ± 1.6 years at the start of treatment were retrieved from the archives. The records comprised lateral cephalograms, intra- and extraoral photographs, and dental casts. The subjects were recalled at 6.1 ± 1.5 years after the completion of active orthodontic treatment. Cephalometric measurements from the treatment's beginning (T1), end (T2), and follow-up (T3) were calculated by using PorDios software. Subjects with a positive overjet at T3 were grouped as stable, and those with a negative overjet were grouped as relapse. Differences between the two groups were analyzed by repeated measures analysis of variance (ANOVA) and the Duncan test. RESULTS: Five individuals maintained a positive overjet at T3, while four relapsed as indicated by a negative overjet. SNA increased in the stable group between T2 and T3 but not in the relapse group. CONCLUSION: About half of the young individuals with a mandibular prognathism treated with a chin cap relapsed over time. The relapse seemed to originate from skeletal rather than dentoalveolar changes.

Evaluation of 3-dimensional tooth crown size in cleft lip and palate patients.

INTRODUCTION: The aims of this study were to evaluate 3-dimensional (3D) tooth crown sizes in patients with cleft lip and palate (CLP) and to compare them with those of a Class I control group. METHODS: Orthodontic dental casts were used of 72 subjects with CLP (20 bilateral [BCLP], 34 unilateral left [ULCLP], 18 unilateral right [URCLP]) and 53 adolescents in the permanent dentition stage with Class I occlusion. Mesiodistal (MD), labiolingual (LL), and occlusogingival (OG) measurements were recorded by the same examiner using a digital caliper. Statistical analyses were conducted, including repeatability, analysis of variance (ANOVA), and the Duncan tests. RESULTS: Maxillary and mandibular premolar MD dimensions were larger in the CLP groups than in the control group. The smallest MD dimensions were those of the maxillary right lateral incisors in the BCLP group (P <0.05). The maxillary left lateral incisor MD dimensions in the ULCLP group were smaller when compared with other CLP groups (P <0.001). In general, all LL and OG measurements were smaller in the CLP groups than in the Class I group in both dental arches. CONCLUSIONS: In general, MD, LL, and OG dimensions of CLP patients were smaller than those of the Class I subjects, not only in the affected maxillary dental arch, but also in the mandibular dental arch. Variations in 3D tooth dimensions were found among all CLP types. The lateral incisor in the cleft region was the smallest. A 3D tooth-size evaluation should be included in the diagnostic records to determine precise treatment planning and final occlusion in CLP patients.

Evaluation of long-term satisfaction with orthodontic treatment for skeletal class III individuals.

The aim of this study was to investigate the long-term satisfaction rate among skeletal class III patients following orthodontic treatment. Questionnaires were sent to 315 post-retention (between 5 to 22.5 years) patients who had received orthodontic treatment without any type of surgery for the correction of skeletal class III malocclusion. The questionnaire contained 28 questions: 10 regarding orthodontic treatment, 13 regarding satisfaction with orthodontic treatment outcomes, and five regarding psychosocial benefits of orthodontic treatment. The frequency of each variable was calculated and chi-squared test was used to determine gender correlations. The survey response rate was 15.8% (n = 40). Most patients were satisfied with their facial appearance (92.5%) and final esthetic profile (95%). Of the 5% who were dissatisfied with their final profiles, prognathic mandible was given as the reason. Most patients (90%) were satisfied with the overall treatment results. Moreover, patient perceptions of psychosocial benefits of treatment were mainly positive, with the majority (72.5%) stating their social communication had improved following orthodontic treatment. Chi-squared test indicated almost no variations in response by gender. In conclusion, the majority of skeletal class III patients in the long-term post-retention period who had received orthodontic treatment were satisfied with the overall treatment outcome.

A cephalometric evaluation of lower lip in patients with unilateral cleft lip and palate.

OBJECTIVE: The aim of this study was to evaluate cephalometrically the lower lip position and area of patients with unilateral cleft lip and palate (UCLP) comparatively with Class I skeletodental normal subjects. PATIENTS: Lateral cephalometric and hand-wrist radiographs obtained from 24 patients with UCLP (mean age 12.86 years), along with 20 normal individuals (mean age 12.33 years) used as a control group, were examined. DESIGN: In addition to standard cephalometric dentofacial variables, lower lip area (superior, middle, inferior) was also measured using a digital planimeter on the lateral cephalograms. RESULTS: The superior and middle part of the lower lip areas were significantly smaller (p < .05) in the UCLP group, compared to the control group. The inferior and total lower lip areas of patients with UCLP were found to be significantly smaller than controls. The labiomental angle was also smaller (38.79 degrees). CONCLUSIONS: The results suggest that the lower lip of patients with UCLP is smaller, retruded, and curved, with a deep labiomental sulcus, compared with normal individuals during puberty. Therefore, practitioners should focus not only on the upper lip of patients with UCLP but also should consider the lower lip as it was found distinct from normal individuals during puberty.

Long-term effects of chin-cap therapy on the temporomandibular joints.

It is commonly believed that upward/backward forces applied to the condyle by a chin-cap cause temporomandibular dysfunction (TMD). In the current study the long-term follow-up (2-11 years) of patients treated with a chin-cap was investigated regarding signs and symptoms of TMD. The treatment group consisted of 32 individuals who had a skeletal Class III malocclusion treated using chin-cap therapy (mean age 18.4 years). The two control groups contained 39 untreated subjects with skeletal Class III malocclusions (mean age 15.5 years) and 53 dental students (mean age 19.2 years) with acceptable normal occlusions. Functional examination of the subjects was carried out and those with at least one sign/symptom (clicking, pain, or deviation) were identified as the 'symptomatic' subgroup. The distribution of symptomatic individuals was 25 per cent in the treatment group, 23 per cent in the Class III malocclusion group, and 41.5 per cent in the normal group (dental students). In addition, the frequency of signs and symptoms of TMD in the symptomatic individuals was also investigated. There were no signs of crepitus in any subject, clicking was found in 50 per cent of the treatment group and pain in 54.5 per cent of the normal group. The results of this long-term follow-up indicate that chin-cap treatment is neither a risk factor nor a prevention for TMD. Age and stress factors should always be considered in the evaluation of TMD.

Panoramic radiographs: a tool for investigating skeletal pattern.

The objective of this study was to investigate the possibility of enhancing the clinical versatility of the panoramic radiograph, which is an indispensable tool for dental diagnosis. The material of this study consisted of lateral cephalograms and panoramic radiographs obtained from 30 patients. A correlation test was performed between the parametric measurements, and the predictability level of the cephalometric measurements from panoramic radiograms was determined by using regression equations. The equations showed that the Go-Gn/S-N, ANS-PNS/Go-Me (palatal plane/mandibular plane), and Co-Go/Go-Me parameters could be predicted from panoramic radiographs within statistically significant levels, and their predictability levels were 20.6%, 15.6%, and 11.2%, respectively. Statistically significant correlations and predictability levels were also determined for the cephalometric and corresponding panoramic parameters in which Frankfort horizontal plane was used. It can be concluded that even though panoramic radiographs provide information on the vertical dimensions of craniofacial structures, clinicians should be vigilant when predicting skeletal cephalometric parameters from panoramic radiographs, because of their lower predictability percentages.

Fuzzy modelling for selecting headgear types.

The purpose of this study was to develop a computer-assisted inference model for selecting appropriate types of headgear appliance for orthodontic patients and to investigate its clinical versatility as a decision-making aid for inexperienced clinicians. Fuzzy rule bases were created for degrees of overjet, overbite, and mandibular plane angle variables, respectively, according to subjective criteria based on the clinical experience and knowledge of the authors. The rules were then transformed into membership functions and the geometric mean aggregation was performed to develop the inference model. The resultant fuzzy logic was then tested on 85 cases in which the patients had been diagnosed as requiring headgear appliances. Eight experienced orthodontists judged each of the cases, and decided if they 'agreed', 'accepted', or 'disagreed' with the recommendations of the computer system. Intra-examiner agreements were investigated using repeated judgements of a set of 30 orthodontic cases and the kappa statistic. All of the examiners exceeded a kappa score of 0.7, allowing them to participate in the test run of the validity of the proposed inference model. The examiners' agreement with the system's recommendations was evaluated statistically. The average satisfaction rate of the examiners was 95.6 per cent and, for 83 out of the 85 cases, 97.6 per cent. The majority of the examiners (i.e. six or more out of the eight) were satisfied with the recommendations of the system. Thus, the usefulness of the proposed inference logic was confirmed.

Functional analysis of cleft lip and palate patients with modified Rakosi method.

OBJECTIVE: The aim of this study was to investigate the mandibular functions of patients with cleft lip and palate (CLP) by means of modified Rakosi Functional Analysis and to test whether there was a risk of tendency to temporomandibular joint disorder when compared with Angle Class I non-CLP patients. DESIGN: Fifteen patients with unilateral CLP with a mean age of 12.2 +/- 1.91 years and randomly selected 15 Angle Class I orthodontic patients with a mean age of 10.5 +/- 2.01 years as a control group. None of the subjects had complaint of symptoms of temporomandibular joint disorder in their histories. All subjects were evaluated using modified Rakosi Functional Analysis method in accordance with a scoring system of the findings. MAIN OUTCOME MEASURES: Intra- and extracapsular clinical functional surveys were taken. A Mann-Whitney U test was used to evaluate the differences between the CLP and non-CLP groups. RESULTS AND CONCLUSION: There was a significant difference (p <.01) between the distributions of the total scores of the two groups. A significant difference (p <.05) in right lateral movement was also observed between the two groups. However, there were no significant but borderline differences in clicking, crepitus, and maximum mouth opening findings between the two groups. Because these results do not explain the reason for the aforementioned differences, further studies seem essential.

Longitudinal investigation of soft palate and nasopharyngeal airway relations in different rotation types.

The relationship between the soft palate and the nasopharyngeal airway in different mandibular growth rotation models was investigated. A total of 72 lateral cephalograms were obtained three years longitudinally from 24 individuals. The subjects had a mean age of 10.7 +/- 1.2 years and showed a normal (n = 8), posterior (n = 8), and anterior (n = 8) mandibular rotation pattern. Linear and angular measurements of the soft palate and nasopharyngeal airway were recorded by using PORDIOS computer program and were examined by means of descriptive statistics and paired t-tests. A linear increase in the soft palate length (SPL) was observed in all groups, with the posterior mandibular rotation group showing the largest increase within the observation period (28.56 +/- 4.83 to 34.98 +/- 2.87; P < .01). According to the paired t-test, palatal plane (ANS-PNS)/soft palate tip (SPT) angle showed a statistically significant decrease in the posterior rotation group (P < .01). The ratio between SPL and superior nasopharyngeal space (SPS) did not show a statistically significant difference among the groups. Although various amounts of soft palate and nasopharyngeal airway growth occurred in the different mandibular rotation types, the ratio between SPL and SPS (SPL/SPS), which plays an indispensable role in velopharyngeal functions, did not show a statistically significant difference in the groups. This assured velopharyngeal closure throughout the active growth period.