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Mathapun J, Charoemratrote C. Is Incisor Compensation Related to Skeletal Discrepancies in Skeletal Class III? A Retrospective Cephalometric Study. Diagnostics (Basel) 2024; 14:1021. [PMID: 38786319 PMCID: PMC11119506 DOI: 10.3390/diagnostics14101021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/20/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
This study investigated compensation in skeletal Class III subjects to compare various severities of abnormal jaws. A retrospective analysis of 137 skeletal Class III cephalograms (63 males and 74 females) was conducted, with cephalometric assessments determining skeletal and dental values. The results were compared with Class I cephalograms. Incisor compensation was examined by pairing normal jaws with varied abnormal jaws, classified by severity using one standard deviation (SD). Statistical analyses included Kruskal-Wallis tests, Bonferroni tests, Spearman's correlations, and multiple linear regression. Four skeletal Class III groups were identified: OMx+PMd, RMx+OMd, OMx+OMd, and PMx+PMd (P = prognathic; O = orthognathic; R = retrognathic; Mx = maxilla; Md = mandible.). The upper central incisor (U1) showed proclination, and the lower central incisor (L1) showed retroclination across all groups except for U1 in PMx+PMd and L1 in OMx+OMd, which exhibited normal inclination. U1 exhibited limited compensation even with progressive maxillary retrognathism, while L1 showed limited compensation after one SD of mandibular prognathism. Maxilla (SNA) and jaw discrepancy (ANB) were inversely related to the U1 degree, whereas only jaw discrepancy (ANB) was positively related to the L1 degree. U1 in PMx+PMd and L1 in OMx+OMd showed no incisor compensation. U1 had limited compensation even with progressive maxillary retrognathism while L1 showed limited compensation after one SD mandibular prognathism.
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Affiliation(s)
| | - Chairat Charoemratrote
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai 90110, Thailand;
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Faria-Teixeira MC, Tordera C, Salvado E Silva F, Vaz-Carneiro A, Iglesias-Linares A. Craniofacial syndromes and class III phenotype: common genotype fingerprints? A scoping review and meta-analysis. Pediatr Res 2024; 95:1455-1475. [PMID: 38347173 PMCID: PMC11126392 DOI: 10.1038/s41390-023-02907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 02/18/2024]
Abstract
Skeletal Class III (SCIII) is among the most challenging craniofacial dysmorphologies to treat. There is, however, a knowledge gap regarding which syndromes share this clinical phenotype. The aims of this study were to: (i) identify the syndromes affected by the SCIII phenotype; (ii) clarify the involvement of maxillary and/or mandibular structures; (iii) explore shared genetic/molecular mechanisms. A two-step strategy was designed: [Step#1] OMIM, MHDD, HPO, GeneReviews and MedGen databases were explored; [Step#2]: Syndromic conditions indexed in [Step#1] were explored in Medline, Pubmed, Scopus, Cochrane Library, WOS and OpenGrey. Eligibility criteria were defined. Individual studies were assessed for risk of bias using the New Ottawa Scale. For quantitative analysis, a meta-analysis was conducted. This scoping review is a hypothesis-generating research. Twenty-two studies met the eligibility criteria. Eight syndromes affected by the SCIII were targeted: Apert syndrome, Crouzon syndrome, achondroplasia, X-linked hypohidrotic ectodermal dysplasia (XLED), tricho-dento-osseous syndrome, cleidocranial dysplasia, Klinefelter and Down syndromes. Despite heterogeneity between studies [p < 0.05], overall effects showed that midface components were affected in Apert and Down Syndromes, lower face in Klinefelter Syndrome and midface and lower face components in XLED. Our review provides new evidence on the craniofacial characteristics of genetically confirmed syndromes exhibiting the SCIII phenotype. Four major regulatory pathways might have a modulatory effect on this phenotype. IMPACT: What does this review add to the existing literature? To date, there is no literature exploring which particular syndromes exhibit mandibular prognathism as a common trait. Through this research, it was possibly to identify the particular syndromes that share the skeletal Class III phenotype (mandibular prognathism) as a common trait highlighting the common genetic and molecular pathways between different syndromes acknowledging their impact in craniofacial development.
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Affiliation(s)
- Maria Cristina Faria-Teixeira
- Complutense University of Madrid, School of Dentistry, 28040, Madrid, Spain
- University of Lisbon, School of Medicine, University Clinic of Stomatology, 1200, Lisbon, Portugal
| | - Cristina Tordera
- Complutense University of Madrid, School of Dentistry, 28040, Madrid, Spain
| | | | | | - Alejandro Iglesias-Linares
- Complutense University of Madrid, School of Dentistry, 28040, Madrid, Spain.
- BIOCRAN (Craniofacial Biology) Research Group, Complutense University, 28040, Madrid, Spain.
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Dehesa-Santos A, Park JA, Lee SJ, Iglesias-Linares A. East Asian and Southern European craniofacial class III phenotype: two sides of the same coin? Clin Oral Investig 2024; 28:84. [PMID: 38195777 DOI: 10.1007/s00784-023-05386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES The skeletal class III phenotype is a heterogeneous condition in populations of different ethnicities. This study aimed to analyse the joint and ethnicity-specific clustering of morphological features in skeletal class III patients of Asian and European origins. MATERIALS AND METHODS This cross-sectional study involved South Korean and Spanish participants who fulfilled the cephalometric, clinical, and ethnic-related selection criteria. Radiographic records were standardised, calibrated, and measured. A total of 54 skeletal variables were selected for varimax factorial analysis (VFA). Subsequently, a cluster analysis (CA) was performed (mixed method: k-means and hierarchical clustering). Method error and precision were assessed using ICC, Student's t-test, and the Dahlberg formula. RESULTS A total of 285 Korean and Spanish participants with skeletal class III malocclusions were analysed. After performing VFA and CA, the joint sample revealed three global clusters, and ethnicity-specific analysis revealed four Korean and five Spanish clusters. Cluster_1_global was predominantly Spanish (79.2%) and male (83.01%) and was characterised by a predominantly mesobrachycephalic pattern and a larger cranial base, maxilla, and mandible. Cluster_2_global and Cluster_3_global were mainly South Korean (73.9% and 75.6%, respectively) and depicted opposite phenotypes of mandibular projection and craniofacial pattern. CONCLUSIONS A distinct distribution of Spanish and South Korean participants was observed in the global analysis. Interethnic and interethnic differences were observed, primarily in the cranial base and maxilla size, mandible projection, and craniofacial pattern. CLINICAL RELEVANCE Accurate phenotyping, reflecting the complexity of skeletal class III phenotype across diverse populations, is critical for improving diagnostic predictability and future personalised treatment protocols.
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Affiliation(s)
- Alexandra Dehesa-Santos
- School of Dentistry, Complutense University of Madrid, Pza. Ramón y Cajal, S/N. Ciudad Universitaria, 28040, Madrid, Spain
| | - Ji-Ae Park
- Department of Orthodontics, Seoul National University School of Dentistry, 101 Daehak-Ro, Jongno-Gu, 03080, Seoul, South Korea
| | - Shin-Jae Lee
- Department of Orthodontics, Seoul National University School of Dentistry, 101 Daehak-Ro, Jongno-Gu, 03080, Seoul, South Korea
| | - Alejandro Iglesias-Linares
- School of Dentistry, Complutense University of Madrid, Pza. Ramón y Cajal, S/N. Ciudad Universitaria, 28040, Madrid, Spain.
- Craniofacial Biology and Orthodontics Research Group, School of Dentistry, BIOCRAN, Complutense University of Madrid, Pza. Ramón y Cajal, S/N. Ciudad Universitaria, 28040, Madrid, Spain.
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Afzoon S, Ghorbani F, Hasani M. Evaluation of the mandibular condyles trabecular structure in patients with severe class III pattern: a computed tomography (CT) fractal analysis study. Sci Rep 2023; 13:18183. [PMID: 37875543 PMCID: PMC10598208 DOI: 10.1038/s41598-023-45407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
Class III malocclusion is a combination of dental and skeletal disorders that causes discrepancies in occlusion. Malocclusion can affect the structure of the Temporomandibular joint (TMJ) resulting in many problems, one of which is affecting the internal structure of the bone. This study aimed to examine the morphological features of class III patients' trabecular structure of the mandibular condyle in comparison with normal class I individuals using fractal analysis (FA). To study the internal structure of the mandibular condyle bone, Computed Tomography (CT) scans of 45 severe class III patients (age: 16-46) who were the candidates for orthognathic surgery were selected and matched by age and sex with 45 normal class I individuals. The trabecular bone structure of the left and right mandibular condyles in three CT planes of the study group and control group were evaluated employing the FA. The result of the present study indicated that the fractal dimensions (FD) values of class III patients were lower than those of the normal class I individuals in axial (class I: 1.31 ± 0.02, class III: 1.28 ± 0.02), sagittal (class I: 1.25 ± 0.03, class III: 1.19 ± 0.08), and coronal (class I: 1.5 ± 0.06, class III: 1.45 ± 0.07) planes (P < 0.001). There were no significant differences between the FD values of the males and females. The intra-group evaluation revealed that there was no correlation between age and FD values. No evidence of laterality was found regarding the FD values of the right and left condyles. Given the noticeable differences between the FD values, it can be implied that severe class III malocclusion may affect the trabecular pattern of the cancellous bone of the mandibular condyle compared to class I individuals. Therefore, due to the altered trabecular structure, clinicians should be cautious when planning treatments for these patients.
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Affiliation(s)
- Saeed Afzoon
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Ghorbani
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahvash Hasani
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Alshoaibi LH, Alareqi MM, Al-Somairi MAA, Al-Tayar B, Almashraqi AA, An X, Alhammadi MS. Three-dimensional phenotype characteristics of skeletal class III malocclusion in adult Chinese: a principal component analysis-based cluster analysis. Clin Oral Investig 2023; 27:4173-4189. [PMID: 37121943 DOI: 10.1007/s00784-023-05033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Skeletal class III malocclusion has a diverse and complicated aetiology involving environmental and genetic factors. It is critical to correctly classify and define this malocclusion to be diagnosed and treated on a clinically sound basis. Thus, this study aimed to provide reliable and detailed measurements in a large ethnically homogeneous sample of Chinese adults to generate an adequate phenotypic clustering model to identify and describe the skeletal variation present in skeletal class III malocclusion. MATERIALS AND METHODS This is a retrospective cross-sectional study in which 500 pre-treatments cone-beam computed tomography (CBCT) scans of patients with skeletal class III malocclusion (250 males and 250 females) were selected following specific selection criteria. Seventy-six linear, angular, and ratios measurements were three-dimensionally analysed using InVivo 6.0.3 software. These measurements were categorised into 47 skeletal, 18 dentoalveolar, and 11 soft tissue variables. Multivariate reduction methods: principal component analyses and cluster analyses were used to present the most common phenotypic groupings of skeletal class III malocclusion in Han ethnic group of Chinese adults. RESULTS The principal component analysis revealed eight principal components accounted for 72.9% of the overall variation of the data produced from the seventy-six variables. The first four principal components accounted for 53.37% of the total variations. They explained the most variation in data and consisted mainly of anteroposterior and vertical skeletal relationships. The cluster analysis identified four phenotypes of skeletal class III malocclusion: C1, 34%; C2, 11.4%; C3, 26.4%; and C4, 28.2%. CONCLUSION Based on three-dimensional analyses, four skeletal class III malocclusion distinct phenotypic variations were defined in a large sample of the adult Chinese population, showing the occurrence of phenotypic variation between identified clusters in the same ethnic group. These findings might serve as a foundation for accurate diagnosis and treatment planning of each cluster and future genetic studies to determine the causative gene(s) of each cluster.
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Affiliation(s)
- Lina Hassan Alshoaibi
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | - Mohammed Muneer Alareqi
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Majedh Abdo Ali Al-Somairi
- Department of Orthodontics, School & Hospital of Stomatology, China Medical University, Shenyang, China
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
| | - Barakat Al-Tayar
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | - Abeer A Almashraqi
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Xiaoli An
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China.
| | - Maged Sultan Alhammadi
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Zohud O, Lone IM, Midlej K, Obaida A, Masarwa S, Schröder A, Küchler EC, Nashef A, Kassem F, Reiser V, Chaushu G, Mott R, Krohn S, Kirschneck C, Proff P, Watted N, Iraqi FA. Towards Genetic Dissection of Skeletal Class III Malocclusion: A Review of Genetic Variations Underlying the Phenotype in Humans and Future Directions. J Clin Med 2023; 12:jcm12093212. [PMID: 37176653 PMCID: PMC10179046 DOI: 10.3390/jcm12093212] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Skeletal abnormalities and malocclusions have varied features that impact populations globally, impairing aesthetics and lowering life quality. The prevalence of the Skeletal Class III disease is the lowest among all angle malocclusions, with varied prevalence across nations. Environmental, genetic, and societal factors play a role in its numerous etiologies. In this study, we conducted a thorough search across the published data relating to quantitative trait loci (QTL) and the genes associated with Class III progression in humans, discussed these findings and their limitations, and proposed future directions and strategies for studying this phenotype. METHODS An inclusive search of published papers in the PubMed and Google Scholar search engines using the following terms: 1. Human skeletal Class III; 2. Genetics of Human skeletal Class III; 3. QTL mapping and gene associated with human skeletal Class III; 4. enriched skeletal Class-III-malocclusion-associated pathways. RESULTS Our search has found 53 genes linked with skeletal Class III malocclusion reported in humans, genes associated with epigenetics and phenomena, and the top 20 enriched pathways associated with skeletal Class III malocclusion. CONCLUSIONS The human investigations yielded some contentious conclusions. We conducted a genome-wide association study (GWAS), an epigenetics-wide association study (EWAS), RNA-seq analysis, integrating GWAS and expression quantitative trait loci (eQTL), micro- and small-RNA, and long non-coding RNA analysis in tissues connected to skeletal Class III malocclusion phenotype in tissues connected with the skeletal phenotype. Finally, we invite regional, national, and international orthodontists and surgeons to join this effort by contributing human samples with skeletal Class III malocclusion following the accepted Helsinki ethical protocol to challenge these phenomena jointly.
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Affiliation(s)
- Osayd Zohud
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Iqbal M Lone
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Kareem Midlej
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Awadi Obaida
- Center for Dentistry Research and Aesthetics, Jatt 4491800, Israel
| | - Samir Masarwa
- Center for Dentistry Research and Aesthetics, Jatt 4491800, Israel
| | - Agnes Schröder
- Department of Orthodontics, University Hospital of Regensburg, University of Regensburg, 93047 Regensburg, Germany
- Institute for Clinical Microbiology and Hygiene, 93053 Regensburg, Germany
| | - Erika C Küchler
- Department of Orthodontics, University Hospital of Regensburg, University of Regensburg, 93047 Regensburg, Germany
| | - Aysar Nashef
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya, Tabaria 1520800, Israel
| | - Firas Kassem
- Department of Otorhinolaryngology, Head and Neck Surgery, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Vadim Reiser
- Department of Oral & Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva 4941492, Israel
| | - Gavriel Chaushu
- Department of Oral & Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva 4941492, Israel
- School of Dental Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Richard Mott
- Department of Genetics, University College of London, London SE1 7EH, UK
| | - Sebastian Krohn
- Department of Orthodontics, University Hospital of Regensburg, University of Regensburg, 93047 Regensburg, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University Hospital of Regensburg, University of Regensburg, 93047 Regensburg, Germany
| | - Peter Proff
- Department of Orthodontics, University Hospital of Regensburg, University of Regensburg, 93047 Regensburg, Germany
| | - Nezar Watted
- Center for Dentistry Research and Aesthetics, Jatt 4491800, Israel
- Department of Orthodontics, Faculty of Dentistry, Arab America University, Jenin 34567, Palestine
- Gathering for Prosperity Initiative, Jatt 4491800, Israel
| | - Fuad A Iraqi
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Department of Orthodontics, University Hospital of Regensburg, University of Regensburg, 93047 Regensburg, Germany
- Gathering for Prosperity Initiative, Jatt 4491800, Israel
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ElNaghy R, Daabous AT, Hasanin M, Tanha N, Ancona N, Al-Qawasmi R. Genetics of three-dimensional tooth inclination and angulation in orthodontic patients with Class I Occlusion: A cross-sectional study. Int Orthod 2023; 21:100713. [PMID: 36495779 DOI: 10.1016/j.ortho.2022.100713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/23/2022] [Accepted: 10/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This cross-sectional study aimed to utilize quantitative polymerase chain reaction (qPCR) to investigate the influence of genetic variance over teeth inclination and angulation in orthodontic patients with Class I occlusion. MATERIALS AND METHODS DNA was extracted from adolescent patients seeking orthodontic treatment in a single institution (from July 2018 to April 2020), who had CBCTs taken as part of initial standardized records. Patients had permanent dentition, Class I skeletal and dental classifications, with normal vertical and transverse skeletal dimensions, normal incisors inclination, no to mild crowding or spacing. qPCR was performed using genetic markers for candidate genes EPB41, TGFβ3, GHR and PAX9. Three-dimensional teeth inclinations (TI) and angulations (TA) were evaluated using Invivo6 software and correlated with genotypes. Reliability of TI and TA was assessed using intraclass correlation coefficients (ICC). Mixed models and multiple linear regression analyses were used to assess the association between each single nucleotide polymorphisms (SNP) with tooth inclination (TI) and with tooth angulation (TA). The results were evaluated at the significance level of P<0.05. RESULTS Twenty four adolescent patients with mean age of 13.4±2.4 years were included in the study. ICC showed adequate intra-examiner reliability for TI and TA (0.806<r<0.988, P<0.001). Multiple linear regression analysis showed a significant association between TI and homozygous-T polymorphism for PAX9 (P=0.028) and homozygous-G polymorphism for GHR (P=0.028). Also, a significant association between TA and homozygous-A polymorphism for EPB41 (P=0.019) and homozygous-G polymorphism for GHR (P=0.001) was evident. CONCLUSIONS Autosomal recessive patterns of inheritance for PAX9 and GHR with TI and for EPB41 and GHR with TA were shown. This study offers insight toward the hierarchical nature of epigenetic interactions between heredity and the environment in determining the three-dimensional positions of teeth in orthodontic patients with Class I occlusion.
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Affiliation(s)
- Rahma ElNaghy
- School of Dentistry, University of Detroit Mercy, Department of Graduate Orthodontics, Detroit, Michigan, USA.
| | - Andrew Thomas Daabous
- School of Dentistry, University of Detroit Mercy, Department of Graduate Orthodontics, Detroit, Michigan, USA
| | - Majd Hasanin
- School of Dentistry, University of Detroit Mercy, Department of Graduate Orthodontics, Detroit, Michigan, USA
| | - Nazanin Tanha
- School of Dentistry, University of Detroit Mercy, Department of Graduate Orthodontics, Detroit, Michigan, USA
| | - Nicholas Ancona
- School of Dentistry, University of Detroit Mercy, Department of Graduate Orthodontics, Detroit, Michigan, USA
| | - Riyad Al-Qawasmi
- School of Dentistry, University of Detroit Mercy, Department of Graduate Orthodontics, Detroit, Michigan, USA
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Yamamoto S, Tanikawa C, Yamashiro T. Morphologic variations in the craniofacial structures in Japanese adults and their relationship with sex differences. Am J Orthod Dentofacial Orthop 2023; 163:e93-e105. [PMID: 36621352 DOI: 10.1016/j.ajodo.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The morphology of the human face varies broadly, with genetic and environmental factors determining these variations. Examining variations in the 3-dimensional (3D) craniomandibular morphology and identifying related factors (eg, sex differences) are important in orthodontic clinics. This study observed shape variations in the 3D facial morphology of Japanese adults showing skeletal Class 1 malocclusion and examined the association of sexual dimorphism with shape variations. METHODS Sixty cone-beam computed tomography images of Japanese adults (30 males and 30 females) with skeletal Class I malocclusion were employed. In each cone-beam computed tomography image, wire mesh fitting was conducted as previously described. A principal component (PC) analysis after Procrustes registration and the PC clustering method was conducted to observe the shape variations. A PC regression analysis was conducted to determine the sexual morphologic characteristics. RESULTS Nine PCs depicting 62% of the morphology were determined. Four typical phenotypes were found, mainly related to mandibular protrusion (PC1) and the vertical divergence of the face (PC2). PCs related to sex determination were PC3 (robustness of the mandibular angle in males), PC5 (greater size and shape of the coronoid and mastoid processes in males), and PC7 (greater maxillary width in males), accounting for 16% of total variations. CONCLUSIONS The major shape variations in skeletal Class 1 subjects were related to nonsexual dimorphic characteristics (ie, mandibular protrusion and facial divergence). Sexual dimorphic characteristics were evaluated in detail and accounted for 16% of total morphologic variations.
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Affiliation(s)
- Sayuri Yamamoto
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Chihiro Tanikawa
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan.
| | - Takashi Yamashiro
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
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Difference in Using Protrusion Face Mask before or after Rapid Palatal Expansion in Skeletal Class III Children: A Preliminary Study. CHILDREN 2022; 9:children9101535. [PMID: 36291471 PMCID: PMC9600127 DOI: 10.3390/children9101535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022]
Abstract
Treatment of third-class malocclusions often presents a challenge for orthodontists. Skeletal disharmony is often associated with dental malposition. There are several therapeutic choices, including the use in combination of transverse expansion of the maxilla with rapid palatal expander (RPE) and posterior-anterior traction with a Delaire face mask (FM). The purpose of the study is to verify whether there are significant differences in the treatment outcome in the case of use of a face mask followed by a palatal expander or with the sequence of these auxiliaries reversed. Subject and Methods: The two groups were both made up of 13 patients, subdivided into group A, i.e., those whose sequence involved the use of extraoral traction first and then the disjunctor, and those with an inverted sequence in group B. Some cephalometric parameters and dento-skeletal characteristics were evaluated pre-treatment (t0) and at the end of therapy (t1). Results: Considering the T1-T0 of group A (Delaire + rapid palatal expander), the evaluation of the results obtained in this work allows us to observe how within group A there is a significant improvement in the Witts and Nanda indices and facial convexity. Group B (treated with the palate disjunctor sequence followed by traction with Delaire's mask) showed a significant improvement in ANB, in AoBo, and AppBpp values and in convexity. The two groups were comparable, and no statistically significant difference was highlighted. Discussion: The early therapy of the third skeletal classes by means of a rapid palate expander and face mask is effective. There is no statistically significant difference in the two groups who performed the therapy in reverse mode. This suggests that the clinician should choose the treatment sequence based on the skeletal and occlusal conditions of their patients at the start of treatment. Conclusion: Early therapy of third skeletal classes with sagittal expansion using a rapid palate expander can be performed earlier or later than posterior-anterior traction with a Delaire mask.
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Yang IH, Choi JY, Baek SH. Characterization of phenotypes of skeletal Class III malocclusion in Korean adult patients treated with orthognathic surgery using cluster analysis. Angle Orthod 2022; 92:477625. [PMID: 35147668 PMCID: PMC9235389 DOI: 10.2319/081421-635.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To characterize the phenotypes of skeletal Class III malocclusion in adult patients who underwent orthognathic surgery (OGS). MATERIALS AND METHODS The sample consisted of 326 patients with Class III malocclusion treated with OGS (170 men and 156 women; mean age, 22.2 years). Using lateral cephalograms taken at initial visits, 13 angular variables and one ratio cephalometric variable were measured. Using three representative variables obtained from principal components analysis (SNA, SNB, and Björk sum), K-means cluster analysis was performed to classify the phenotypes. Statistical analysis was conducted to characterize the differences in the cephalometric variables among the clusters. RESULTS Class III phenotypes were classified into nine clusters from the following four major groups: (1) retrusive maxilla group, clusters 7 and 9 (7.1% and 5.5%; severely retrusive maxilla, normal mandible, severe and moderate hyperdivergent, respectively) and cluster 6 (9.2%; retrusive maxilla, normal mandible, normodivergent); (2) relatively protrusive mandible group, cluster 2 (20.9%; normal maxilla, normal mandible, hyperdivergent); (3) protrusive mandible group, clusters 3 and 1 (11.7% and 15.3%; normal maxilla, protrusive mandible, normodivergent and hyperdivergent, respectively) and clusters 8 and 4 (15.3% and 3.7%; normal maxilla, severe protrusive mandible, normodivergent and hypodivergent, respectively); and (4) protrusive maxilla and protrusive mandible group, cluster 5 (11.4%; protrusive maxilla, severely protrusive mandible, normodivergent). Considerations for presurgical orthodontic treatment and OGS planning were proposed based on the Class III phenotypes. CONCLUSIONS Because the anteroposterior position of the maxilla and rotation of the mandible by a patient's vertical pattern determine Class III phenotypes, these variables should be considered in diagnosis and treatment planning for patients who have skeletal Class III malocclusion.
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Khosravi-Kamrani P, Qiao X, Zanardi G, Wiesen CA, Slade G, Frazier-Bowers SA. A machine learning approach to determine the prognosis of patients with Class III malocclusion. Am J Orthod Dentofacial Orthop 2021; 161:e1-e11. [PMID: 34535348 DOI: 10.1016/j.ajodo.2021.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The conundrum of determining how to treat a patient with Class III malocclusion is significant, creating a burden on the patient and challenging the orthodontist. The objective of this study was to employ a statistical prediction model derived from our previous cephalometric data on 5 predominant subtypes of skeletal Class III malocclusion to test the hypothesis that Class III subtypes are associated with treatment modalities (eg, surgical vs nonsurgical) and treatment outcome. METHODS Pretreatment lateral cephalometric records of 148 patients were digitized for 67 cephalometric variables, and measurements were applied to a mathematical equation to assign a Class III subtype. Subjects were assigned to either a surgical or nonsurgical group depending on the treatment received. Treatment outcome was determined by facial profile and clinical photographs. Log binomial models were used for statistical analysis. RESULTS Subtype 1 (mandibular prognathic) patients were 3.5 × more likely to undergo orthognathic surgery than subtypes 2/3 (maxillary deficient) and 5.3 × more likely than 4/5 (combination). Subtype 1 patients were also 1.5 × more likely to experience treatment failure than subtypes 2/3 (maxillary deficient) and 4/5 (combination). CONCLUSIONS This assessment of a systematic method to characterize patients with Class III malocclusion into subtypes revealed that subtype 1 (mandibular prognathic) showed a likelihood to undergo orthognathic surgery while subtypes 2/3 experienced significantly lower treatment failure (in response to orthodontics alone). Further refinement of the equation may yield a reliable prediction model for earlier identification of surgical patients and also provide predictive power of Class III treatment outcomes.
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Affiliation(s)
- Pegah Khosravi-Kamrani
- Orthodontics, Adams School of Dentistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Xingye Qiao
- Department of Mathematical Sciences, Binghamton University, State University of New York, Binghamton, NY
| | - Gustavo Zanardi
- Department of Orthodontics, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Gary Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Sylvia A Frazier-Bowers
- Orthodontics, Adams School of Dentistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Tsuji K, Haruyama N, Nomura S, Murata N, Yoshizaki K, Mitsuyasu T, Nakano H, Nakamura S, Mori Y, Takahashi I. Characteristics of craniofacial morphology and factors affecting them in patients with isolated cleft palate. PeerJ 2021; 9:e11297. [PMID: 33976983 PMCID: PMC8063870 DOI: 10.7717/peerj.11297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background Myriad maxillo-mandibular occlusal relationships are observed in patients with isolated cleft palate (ICP), unlike in patients with other cleft types, such as cleft lip and palate. Objectives This study aimed to categorise the characteristics of craniofacial morphology in patients with ICP, and investigate the clinical factors affecting these categorised morphological characteristics. Methods Thirty-six girls with ICP (age (mean ± SD): 5.36 ± 0.36 years) underwent cephalometric measurement. Their craniofacial morphology was categorised using cluster analysis. Profilograms were created and superimposed onto the standard Japanese profilograms to visualise the morphological characteristics of each group (cluster). The mean values and variations in the linear and angular measurements of each group were compared with the Japanese standards and statistically analysed using Dunnett’s test after the analysis of variance. Fisher’s exact test was used to analyse the differences between the cleft types (cleft in the hard and/or soft palate) and skills of the operating surgeons in the groups. Results Cluster analysis of craniofacial morphologies in patients with ICP resulted in the formation of three categories: the first cluster exhibited a relatively harmonious anteroposterior relationship between the maxilla and the mandible (22.2%); the second cluster exhibited crossbite owing to a significantly smaller maxilla (33.3%); and the third cluster exhibited a smaller mandible with posterior rotation showing skeletal class II malocclusion (44.4%). Differences in cleft types and surgeons were not associated with the distribution of patients in each cluster. Conclusions Patients with ICP exhibited characteristic morphological patterns, such as bimaxillary retrusion or severe mandibular retrusion, besides the anterior crossbite frequently found in patients with cleft lip and palate . Understanding the typical morphological characteristics could enable better diagnostic categorisation of patients with ICP, which may eventually improve orthodontic treatment planning.
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Affiliation(s)
- Kyoko Tsuji
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Naoto Haruyama
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Shunsuke Nomura
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Naohisa Murata
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Keigo Yoshizaki
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Takeshi Mitsuyasu
- Section of Oral and Maxillofacial Oncology, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Hiroyuki Nakano
- Department of Dentistry and Oral Surgery, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Seiji Nakamura
- Section of Oral and Maxillofacial Oncology, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Yoshihide Mori
- Section of Oral and Maxillofacial Surgery, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Ichiro Takahashi
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan
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Kanavakis G, Silvola AS, Halazonetis D, Lähdesmäki R, Pirttiniemi P. Incisor Occlusion Affects Profile Shape Variation in Middle-Aged Adults. J Clin Med 2021; 10:800. [PMID: 33671163 PMCID: PMC7923002 DOI: 10.3390/jcm10040800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the effect of overjet and overbite on profile shape in middle-aged individuals. METHODS The study population comprised 1754 46-year-old individuals, members of the 1966 Northern Finland Birth Cohort. Their profile images were digitized using 48 landmarks and semi-landmarks. The subsequent landmark coordinates were then transformed to shape coordinates through Procrustes Superimposition, and final data were reduced into Principal Components (PCs) of shape. Overjet and overbite values were measured manually, during a clinical examination. A multivariate regression model was developed to evaluate the effect of overjet and overbite on profile shape. RESULTS The first nine PCs described more than 90% of profile shape variation in the sample and were used as the shape variables in all subsequent analyses. Overjet predicted 21.3% of profile shape in the entire sample (η2overjet = 0.213; p < 0.001), while the effect of overbite was weaker (η2overbite = 0.138; p < 0.001). In males, the equivalent effects were 22.6% for overjet and 14% for overbite, and in females, 25.5% and 13.5%, respectively. CONCLUSION Incisor occlusion has a noteworthy effect on profile shape in middle-aged adults. Its impact becomes more significant taking into consideration the large variety of genetic and environmental factors affecting soft tissue profile.
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Affiliation(s)
- Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, UZB-University Center for Dental Medicine, University of Basel, Mattenstrasse 40, CH-4058 Basel, Switzerland
- Department of Orthodontics and Dentofacial Orthopedics, Tufts University School of Dental Medicine, Boston, MA 02111, USA
- Oral Development and Orthodontics, Research Unit of Oral Health Sciences, Medical Faculty, University of Oulu, FI-90014 Oulu, Finland; (A.-S.S.); (R.L.); (P.P.)
| | - Anna-Sofia Silvola
- Oral Development and Orthodontics, Research Unit of Oral Health Sciences, Medical Faculty, University of Oulu, FI-90014 Oulu, Finland; (A.-S.S.); (R.L.); (P.P.)
- Oral and Maxillofacial Department, Oulu University Hospital, Medical Research Center Oulu (MRC Oulu), FI-90014 Oulu, Finland
| | - Demetrios Halazonetis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, GR-11527 Athens, Greece;
| | - Raija Lähdesmäki
- Oral Development and Orthodontics, Research Unit of Oral Health Sciences, Medical Faculty, University of Oulu, FI-90014 Oulu, Finland; (A.-S.S.); (R.L.); (P.P.)
- Oral and Maxillofacial Department, Oulu University Hospital, Medical Research Center Oulu (MRC Oulu), FI-90014 Oulu, Finland
| | - Pertti Pirttiniemi
- Oral Development and Orthodontics, Research Unit of Oral Health Sciences, Medical Faculty, University of Oulu, FI-90014 Oulu, Finland; (A.-S.S.); (R.L.); (P.P.)
- Oral and Maxillofacial Department, Oulu University Hospital, Medical Research Center Oulu (MRC Oulu), FI-90014 Oulu, Finland
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Genetic factors contributing to skeletal class III malocclusion: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:1587-1612. [PMID: 33550467 DOI: 10.1007/s00784-020-03731-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present systematic review aims to report and critically assess the findings of the available scientific evidence from genetic association studies examining the genetic variants underlying skeletal class III malocclusion and its sub-phenotypes. MATERIAL AND METHODS A pre-piloted protocol was registered and followed. The PubMed, Scopus, WOS, Cochrane Library, Gray Open literature, and CADTH databases were explored for genetic association studies following PICOS-based selection criteria. The research was reported in accordance with PRISMA statement and HuGE guidelines. The Q-genie tool was applied to assess the quality of genetic studies. Meta-analysis of genetic association studies was done by means of Meta-Genyo tool. RESULTS A total of 8258 articles were retrieved, of which 22 were selected for in-depth analysis. Most of the studies did not differentiate between sub-phenotypes, and the cohorts were heterogeneous regarding ethnicity. Four to five principal components of class III malocclusion explained the phenotypic variation, and gene variants at MYO1H(rs10850110), BMP3(rs1390319), GHR (rs2973015,rs6184, rs2973015), FGF7(rs372127537), FGF10(rs593307), and SNAI3(rs4287555) (p < .05) explained most of the variation across the studies, associated to vertical, horizontal, or combined skeletal discrepancies. Meta-analysis results identified a statistically significant association between risk of class III malocclusion of A allele of the FBN3 rs7351083 [OR 2.13; 95% CI 1.1-4.1; p 0.02; recessive model]. CONCLUSION Skeletal class III is a polygenic trait substantially modulated by ethnicity. A multicentric approach should be considered in future studies to increase sample sizes, applying multivariate analysis such as PCA and cluster analysis to characterize existing sub-phenotypes warranting a deeper analysis of genetic variants contributing to skeletal class III craniofacial disharmony. CLINICAL RELEVANCE Grasping the underlying mechanisms of this pathology is critical for a fuller understanding of its etiology, allowing generation of preventive strategies, new individualized therapeutic approaches and more accurate treatment planification strategies.
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de Frutos-Valle L, Martin C, Alarcón JA, Palma-Fernández JC, Ortega R, Iglesias-Linares A. Sub-clustering in skeletal class III malocclusion phenotypes via principal component analysis in a southern European population. Sci Rep 2020; 10:17882. [PMID: 33087764 PMCID: PMC7578100 DOI: 10.1038/s41598-020-74488-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 09/28/2020] [Indexed: 02/08/2023] Open
Abstract
The main aim of this study was to generate an adequate sub-phenotypic clustering model of class III skeletal malocclusion in an adult population of southern European origin. The study design was conducted in two phases, a preliminary cross-sectional study and a subsequent discriminatory evaluation by main component and cluster analysis to identify differentiated skeletal sub-groups with differentiated phenotypic characteristics. Radiometric data from 699 adult patients of southern European origin were analyzed in 212 selected subjects affected by class III skeletal malocclusion. The varimax rotation was used with Kaiser normalization, to prevent variables with more explanatory capacity from affecting the rotation. A total of 21,624 radiographic measurements were obtained as part of the cluster model generation, using a total set of 55 skeletal variables for the subsequent analysis of the major component and cluster analyses. Ten main axes were generated representing 92.7% of the total variation. Three main components represented 58.5%, with particular sagittal and vertical variables acting as major descriptors. Post hoc phenotypic clustering retrieved six clusters: C1:9.9%, C2:18.9%, C3:33%, C4:3.77%, C5:16%, and C6:16%. In conclusion, phenotypic variation was found in the southern European skeletal class III population, demonstrating the existence of phenotypic variations between identified clusters in different ethnic groups.
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Affiliation(s)
- L de Frutos-Valle
- Section of Orthodontics, Faculty of Odontology, Complutense University, Madrid, Spain
| | - C Martin
- Section of Orthodontics, Faculty of Odontology, Complutense University, Madrid, Spain.,Craniofacial Biology Research Group, BIOCRAN, Complutense University, Plaza Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - J A Alarcón
- Section of Orthodontics, Faculty of Odontology, University of Granada, Campus Universitario de Cartuja, Granada, Spain
| | - J C Palma-Fernández
- Section of Orthodontics, Faculty of Odontology, Complutense University, Madrid, Spain
| | - R Ortega
- Faculty of Odontology, Complutense University, Madrid, Spain
| | - A Iglesias-Linares
- Section of Orthodontics, Faculty of Odontology, Complutense University, Madrid, Spain. .,Craniofacial Biology Research Group, BIOCRAN, Complutense University, Plaza Ramón y Cajal, s/n, 28040, Madrid, Spain.
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16
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de Frutos-Valle L, Martín C, Alarcón JA, Palma-Fernández JC, Ortega R, Iglesias-Linares A. Novel Sub-Clustering of Class III Skeletal Malocclusion Phenotypes in a Southern European Population Based on Proportional Measurements. J Clin Med 2020; 9:E3048. [PMID: 32971753 PMCID: PMC7565379 DOI: 10.3390/jcm9093048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/05/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023] Open
Abstract
Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using principal component analysis and cluster analysis. Radiometric data from 212 adult subjects (115 women and 96 men) of southern European origin affected by Class III skeletal malocclusion were analyzed. A total of 120 measurements were made, 26 were proportional skeletal measurements, which were used to perform principal component analysis and subsequent cluster analysis. The remaining 94 supplementary measurements were used for a greater description of the identified clusters. Principal component analysis established eight principal components that explained 85.1% of the total variance. The first three principal components explained 51.4% of the variance and described mandibular proportions, anterior facial height proportions, and posterior-anterior cranial proportions. Cluster analysis established four phenotypic subgroups, representing 18.4% (C1), 20.75% (C2), 38.68% (C3), and 22.17% (C4) of the sample. A new sub-clustering of skeletal Class III malocclusions that avoids gender influence is provided. Our results improve clinicians' resources for Class III malocclusion and could improve the diagnostic and treatment approaches for this malocclusion.
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Affiliation(s)
- Leixuri de Frutos-Valle
- Section of Orthodontics, Faculty of Odontology, Complutense University, 28040 Madrid, Spain; (L.d.F.V.); or
| | - Conchita Martín
- Section of Orthodontics, Faculty of Odontology, Complutense University, 28040 Madrid, Spain; (L.d.F.V.); or
- BIOCRAN (Craniofacial Biology) Research Group, Complutense University, 28040 Madrid, Spain
| | - José Antonio Alarcón
- Section of Orthodontics, Faculty of Odontology, University of Granada, 18071 Granada, Spain;
- BIOCRAN (Craniofacial Biology) Research Group, Complutense University, 28040 Madrid, Spain
| | | | - Ricardo Ortega
- Section of Radiology, Faculty of Odontology, Complutense University, 28040 Madrid, Spain;
| | - Alejandro Iglesias-Linares
- Section of Orthodontics, Faculty of Odontology, Complutense University, 28040 Madrid, Spain; (L.d.F.V.); or
- BIOCRAN (Craniofacial Biology) Research Group, Complutense University, 28040 Madrid, Spain
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Jiang N, Wang M, Bi R, Wu G, Zhu S, Liu Y. Risk factors for bad splits during sagittal split ramus osteotomy: a retrospective study of 964 cases. Br J Oral Maxillofac Surg 2020; 59:678-682. [PMID: 33952406 DOI: 10.1016/j.bjoms.2020.08.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/20/2020] [Indexed: 02/05/2023]
Abstract
To identify the potential risk factors for bad splits, we calculated the incidence of bad splits from 484 patients with 964 cases of sagittal split ramus osteotomy (SSRO) and investigated the association between the occurrence of bad splits and risk factors such as gender, patients' age, class of occlusion, unimaxillary or bimaxillary surgery, presence of the lower third molar, thickness of the ascending ramus, and the distance from the mandibular canal to the buccal cortical bone. The results showed that 40 sides (4.149%) with bad splits occurred in 36 patients (7.438%). The mean (SD) gap width from the canal to the buccal cortex for the bad split group, at 4.02 (1.20)mm, was narrower (p=0.003; OR=0.689; 95% CI=0.538 to 0.882) than the normal split group 4.80 (1.72)mm. On the contrary, no statistical significance (p>0.05) was detected between the patients with bad splits and those with normal splits for the other factors. In conclusion, SSRO patients with narrower distances from the mandibular canal to the buccal cortex were more prone to bad splits. More attention should be paid to patients with this risk factor during future surgeries.
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Affiliation(s)
- N Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - M Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - R Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - G Wu
- Department of Plastic and Aesthetic Surgery, Hospital of Stomatology, Jilin University, Changchun 130000, China.
| | - S Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Y Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Woon CK, Jamal NAA, Noor MNIM, Abdullah SM, Mohamed Ibrahim N, Norman NH, Alias A. Geometric morphometric analysis of malocclusion on lateral cephalograms in Malaysian population. Anat Cell Biol 2020; 52:397-405. [PMID: 31949978 PMCID: PMC6952698 DOI: 10.5115/acb.19.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 11/27/2022] Open
Abstract
Geometric morphometrics is a new approach for shape identification in diagnosis of malocclusion. Lateral cephalogram is an X-ray that taken for diagnosing malocclusion in dental setting. The aim of this study was to determine the differences of craniofacial shape in malocclusion by application of two-dimensional geometric morphometrics and to compile the database of malocclusion in adult Malaysian population. Lateral cephalogram radiographs of 381 adults Malaysia (age 18-45) were retrieved retrospectively and assigned to three groups according to their occlusion: class I, class II, and class III. The geometric morphometric shape study incorporated nine landmarks and was analyzed in details using tpsUtil p software. Geometric morphometric analysis such was done using MorphoJ software. The results of the principal component's analysis (PCA) yielded 14 main components responsible for 100% of the variation exhibited by the malocclusion with three highly significant PCA. The highest Mahalanobis distances were exhibited by the malocclusion class II and III population. The Procrustes ANOVA showed that the shape effect was highly significant (P<0.01). The discriminant function analysis showed the high percentage of 80% discriminate among the malocclusions after cross-validation. There are significant differences for ANB angle (A point-Nasion-B point) in all malocclusion groups. Class II has the widest ANB angle while class III has the most acute ANB angle. Skeletal shape was clearly associated with dental malocclusion and showed considerable variation. Geometric morphometrics is an alternative research tool and can be used for diagnosing individual classification of malocclusion.
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Affiliation(s)
- Choy Ker Woon
- Department of Anatomy, Faculty of Medicine & Biomedical Sciences, MAHSA University, Selangor, Malaysia
| | - Nurul Aiman Abu Jamal
- Department of Basic Sciences and Oral Biology, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Muhamad Nasim Ilmi Mohd Noor
- Department of Basic Sciences and Oral Biology, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Syiral Mastura Abdullah
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Nurjehan Mohamed Ibrahim
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Noraina Hafizan Norman
- Centre of Paediatric Dentistry and Orthodontics Studies, Faculty of Dentistry, Universiti Terkonologi MARA, Shah Alam, Malaysia
| | - Aspalilah Alias
- Department of Basic Sciences and Oral Biology, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
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Influence of overjet and overbite on soft tissue profile in mature adults: A cross-sectional population study. Am J Orthod Dentofacial Orthop 2019; 155:57-63.e3. [DOI: 10.1016/j.ajodo.2018.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 11/19/2022]
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Thomaz EBAF, Alves CMC, Gomes E Silva LF, Ribeiro de Almeida CCC, Soares de Britto E Alves MTS, Hilgert JB, Wendland EM. Breastfeeding Versus Bottle Feeding on Malocclusion in Children: A Meta-Analysis Study. J Hum Lact 2018; 34:768-788. [PMID: 29596751 DOI: 10.1177/0890334418755689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breastfeeding plays an important role in child health. However, there are doubts about its influence on malocclusions. Systematic reviews have yielded contradictory results. Research aim: This study aimed to investigate whether the type and duration of breastfeeding are associated with malocclusions in primary teething. METHODS The review strategy included several electronic databases, lists of references, reviews, dissertation and thesis websites, experts, and other relevant documents. Published and unpublished observational studies ( N = 42) were reviewed using the Participants (children), Interventions (breastfeeding), Comparisons (bottle feeding), Outcomes (malocclusion), and Study design (observational) strategy, without restrictions on language or locale. Information about the authors, publication year, country of study, setting, study design, sample size, age, type and duration of exclusive and mixed breastfeeding, and malocclusions was recorded by two blinded evaluators. Quantitative meta-analysis ( N = 30) of the studies with available data was performed. RESULTS Breastfeeding was a protective factor against malocclusions. The odds of association increased with breastfeeding duration. Irrespective of duration, breastfeeding had a protective association with open bite. For those who were breastfed for up to 6 months, breastfeeding protected against overjet, open bite, posterior crossbite, and crowding. Breastfeeding for 12 months or longer was associated with lower odds of overjet, open bite, and posterior crossbite. Breastfeeding exclusively for 6 months was also a protective factor against malocclusions. However, studies on this subject presented low quality, statistical heterogeneity, and only unadjusted measures of association in most of the cases. CONCLUSION Breastfeeding beneficially affects primary occlusion when practiced for at least 6 months.
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Affiliation(s)
- Erika Barbara Abreu Fonseca Thomaz
- 1 Department of Public Health, Graduate Program in Collective Health, Graduate Program in Dentistry, Federal University of Maranhão, São Luis, Maranhão, Brazil
| | - Cláudia Maria Coelho Alves
- 2 Department of Dentistry II, Graduate Program in Collective Health, Graduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | - Juliana Balbinot Hilgert
- 4 Department of Social and Preventive Dentistry, Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eliana M Wendland
- 5 Department of Collective Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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de Frutos-Valle L, Martin C, Alarcon JA, Palma-Fernandez JC, Iglesias-Linares A. Subclustering in Skeletal Class III Phenotypes of Different Ethnic Origins: A Systematic Review. J Evid Based Dent Pract 2018; 19:34-52. [PMID: 30926101 DOI: 10.1016/j.jebdp.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to systematically review articles investigating the efficiency of the clustering of skeletal class III malocclusion phenotypic subtypes of different ethnic origins as a diagnostic tool. METHODS The review protocol was structured in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in Prospero (CRD42016053865). A survey of articles published up to March 2018 investigating the identification of different subgroups of skeletal class III malocclusion via cluster analysis was performed using 11 electronic databases. Any type of study design that addressed the classification of subclusters of class III malocclusion was considered. The Newcastle-Ottawa scale for cohort and cross-sectional (modified) studies was used for quality assessment. RESULTS The final selection included 7 studies that met all the criteria for eligibility (% overall agreement 0.889, free marginal kappa 0.778). All studies identified at least 3 different types of class III clusters (ranging from 3 to 14 clusters; the total variation of the prevalence of each cluster ranged from 0.2% to 36.0%). The main shared variables used to describe the more prevalent clusters in the studies included were vertical measurements (Ar-Go-Me: 117.51°-135.8°); sagittal measurements: maxilla (SNA: 75.3°-82.95°), mandible (SNB: 77.03°-85.0°). With regard to ethnicity, a mean number of 8.5 and 3.5 clusters of class III were retrieved for Asian and Caucasian population, respectively. CONCLUSIONS The total number of clusters identified varied from 3 to 14 to explain all the variability in the phenotype class III malocclusions. Although each extreme may be too simple or complex to facilitate an exhaustive but useful classification for clinical use, a classification system including 4 to 7 clusters may prove to be efficient for clinical use in conjunction with complete and meticulous subgrouping. CLINICAL SIGNIFICANCE The identification and description of a subclustering classification system may constitute an additional step toward more precise orthodontic/orthopedic diagnosis and treatment of skeletal class III malocclusion.
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Affiliation(s)
| | - Conchita Martin
- Section of Orthodontics, Faculty of Odontology, Complutense University, Madrid, Spain; BIOCRAN (Craniofacial Biology) Research Group, Complutense University, Madrid, Spain.
| | - Jose Antonio Alarcon
- BIOCRAN (Craniofacial Biology) Research Group, Complutense University, Madrid, Spain; Faculty of Odontology, University of Granada, Campus Universitario de Cartuja, Granada, Spain
| | | | - Alejandro Iglesias-Linares
- Section of Orthodontics, Faculty of Odontology, Complutense University, Madrid, Spain; BIOCRAN (Craniofacial Biology) Research Group, Complutense University, Madrid, Spain
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22
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Mendoza LV, Bellot-Arcís C, Montiel-Company JM, García-Sanz V, Almerich-Silla JM, Paredes-Gallardo V. Linear and Volumetric Mandibular Asymmetries in Adult Patients With Different Skeletal Classes and Vertical Patterns: A Cone-Beam Computed Tomography Study. Sci Rep 2018; 8:12319. [PMID: 30120301 PMCID: PMC6098024 DOI: 10.1038/s41598-018-30270-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022] Open
Abstract
This study aimed to quantify the height of the mandibular condyle and ramus, condylar volume, and the asymmetry index in adult patients of different sex, skeletal class and vertical pattern using Cone-Beam Computed Tomography (CBCT), and to determine whether there were differences between these groups. The study used CBCT scans of 159 patients with a mean age of 32.32 ± 8.31 years. InVivoDental® software was used to perform both linear (condylar, ramal, and total height) and condylar volume measurements. Linear and volumetric asymmetries were calculated. There were not significant differences between right and left sides. The mean value obtained for condyle height was 7.27 mm, ramus height 42.3 mm, total height 49.6 mm and condyle volume 1907.1 mm3, with significant differences between men and women. Significantly higher values were found for condylar volume in hypodivergent patterns (p = 0.001) and for the asymmetry index of the condylar volume in Class II patients (p < 0.05). The prevalence of relevant asymmetry was high for condyle height and volume (73.1% y 75.6% respectively). Higher height and volume values were found among men, Class III, and hypodivergent patients. Linear and volumetric asymmetries were more prevalent among men, Class III and hyperdivergent patterns.
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Affiliation(s)
- Luz Victoria Mendoza
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Carlos Bellot-Arcís
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José María Montiel-Company
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
| | - Verónica García-Sanz
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José Manuel Almerich-Silla
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Hartsfield JK, Jacob GJ, Morford LA. Heredity, Genetics and Orthodontics - How Much Has This Research Really Helped? Semin Orthod 2017; 23:336-347. [PMID: 29290679 DOI: 10.1053/j.sodo.2017.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uncovering the genetic factors that correlate with a clinical deviation of previously unknown etiology helps to diminish the unknown variation influencing the phenotype. Clinical studies, particularly those that consider the effects of an appliance or treatment regimen on growth, need to be a part of these types of genetic investigations in the future. While the day-to-day utilization of "testing" for genetic factors is not ready for practice yet, genetic testing for monogenic traits such as Primary Failure of Eruption (PFE) and Class III malocclusion is showing more promise as knowledge and technology advances. Although the heterogeneous complexity of such things as facial and dental development, the physiology of tooth movement, and the occurrence of External Apical Root Resorption (EARR) make their precise prediction untenable, investigations into the genetic factors that influence different phenotypes, and how these factors may relate to or impact environmental factors (including orthodontic treatment) are becoming better understood. The most important "genetic test" the practitioner can do today is to gather the patient's individual and family history. This would greatly benefit the patient, and augment the usefulness of these families in future clinical research in which clinical findings, environmental, and genetic factors can be studied.
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Affiliation(s)
- James K Hartsfield
- E. Preston Hicks Professor of Orthodontics and Oral Health Research, University of Kentucky Center for the Biologic Basis of Oral/Systemic Diseases, Hereditary Genetics/Genomics Core
| | - George Jeryn Jacob
- Craniofacial Genetics Fellow, University of Kentucky Center for the Biologic Basis of Oral/Systemic Diseases, Hereditary Genetics/Genomics Core
| | - Lorri Ann Morford
- Research Assistant Professor, University of Kentucky Center for the Biologic Basis of Oral/Systemic Diseases, Hereditary Genetics/Genomics CoreThe University of Kentucky College of Dentistry, 800 Rose Street, Lexington, Kentucky USA 40536-0297
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24
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Craniofacial characteristics of children with mild hypodontia. Am J Orthod Dentofacial Orthop 2017; 150:611-619. [PMID: 27692418 DOI: 10.1016/j.ajodo.2016.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of our study was to evaluate the craniofacial characteristics of children with mild hypodontia using conventional and principal component (PC) analysis. METHODS We used radiographic images of 124 children (8-12 years old) with up to 4 missing teeth (55 boys, 69 girls) and of 676 reference children (365 boys, 311 girls) from the Rotterdam Generation R Study and the Nijmegen Growth Study in The Netherlands. Fifteen cephalometric measurements of children with hypodontia were compared with those of the reference children. Moreover, cephalometric parameters were combined into standardized PC scores using PC analysis, and the components were compared between the 2 groups. RESULTS PC analysis showed common dental characteristics for all types of hypodontia: a significant increase of the interincisal angle, and decreases of the maxillary and mandibular incisor angles. Other findings were consistent when both methods were applied: (1) anterior hypodontia was significantly associated with the high-angle (hyperdivergent) craniofacial pattern, (2) the tendency toward a Class III malocclusion was identified in maxillary hypodontia, and (3) we observed a significant reduction of lower posterior facial height in children with posterior and mandibular hypodontia. CONCLUSIONS Our findings suggest that children with mild hypodontia have distinctive skeletal and dental features.
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Weaver CA, Miller SF, da Fontoura CSG, Wehby GL, Amendt BA, Holton NE, Allareddy V, Southard TE, Moreno Uribe LM. Candidate gene analyses of 3-dimensional dentoalveolar phenotypes in subjects with malocclusion. Am J Orthod Dentofacial Orthop 2017; 151:539-558. [PMID: 28257739 DOI: 10.1016/j.ajodo.2016.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Genetic studies of malocclusion etiology have identified 4 deleterious mutations in genes DUSP6,ARHGAP21, FGF23, and ADAMTS1 in familial Class III cases. Although these variants may have large impacts on Class III phenotypic expression, their low frequency (<1%) makes them unlikely to explain most malocclusions. Thus, much of the genetic variation underlying the dentofacial phenotypic variation associated with malocclusion remains unknown. In this study, we evaluated associations between common genetic variations in craniofacial candidate genes and 3-dimensional dentoalveolar phenotypes in patients with malocclusion. METHODS Pretreatment dental casts or cone-beam computed tomographic images from 300 healthy subjects were digitized with 48 landmarks. The 3-dimensional coordinate data were submitted to a geometric morphometric approach along with principal component analysis to generate continuous phenotypes including symmetric and asymmetric components of dentoalveolar shape variation, fluctuating asymmetry, and size. The subjects were genotyped for 222 single-nucleotide polymorphisms in 82 genes/loci, and phenotpye-genotype associations were tested via multivariate linear regression. RESULTS Principal component analysis of symmetric variation identified 4 components that explained 68% of the total variance and depicted anteroposterior, vertical, and transverse dentoalveolar discrepancies. Suggestive associations (P < 0.05) were identified with PITX2, SNAI3, 11q22.2-q22.3, 4p16.1, ISL1, and FGF8. Principal component analysis for asymmetric variations identified 4 components that explained 51% of the total variations and captured left-to-right discrepancies resulting in midline deviations, unilateral crossbites, and ectopic eruptions. Suggestive associations were found with TBX1AJUBA, SNAI3SATB2, TP63, and 1p22.1. Fluctuating asymmetry was associated with BMP3 and LATS1. Associations for SATB2 and BMP3 with asymmetric variations remained significant after the Bonferroni correction (P <0.00022). Suggestive associations were found for centroid size, a proxy for dentoalveolar size variation with 4p16.1 and SNAI1. CONCLUSIONS Specific genetic pathways associated with 3-dimensional dentoalveolar phenotypic variation in malocclusions were identified.
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Affiliation(s)
| | - Steven F Miller
- Department of Anatomy, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Ill; Department of Dental Medicine, College of Dental Medicine-Illinois, Midwestern University, Downers Grove, Ill
| | - Clarissa S G da Fontoura
- The Iowa Institute for Oral and Craniofacial Research, College of Dentistry, University of Iowa, Iowa City, Iowa
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Brad A Amendt
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Nathan E Holton
- Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, Iowa
| | - Veeratrishul Allareddy
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa
| | - Thomas E Southard
- Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, Iowa
| | - Lina M Moreno Uribe
- The Iowa Institute for Oral and Craniofacial Research, College of Dentistry, University of Iowa, Iowa City, Iowa; Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, Iowa.
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Classification and characterization of class III malocclusion in Chinese individuals. Head Face Med 2016; 12:31. [PMID: 27821165 PMCID: PMC5100215 DOI: 10.1186/s13005-016-0127-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Class III malocclusion is a maxillofacial disorder that is characterised by a concave profile and can be attributed to both genetic inheritance and environmental factors. It is a clinical challenge due to our limited understanding of its aetiology. Revealing its prototypical diversity will contribute to our sequential exploration of the underlying aetiological information. The objective of this study was to characterize phenotypic variations of Class III malocclusion via a lateral cephalometric analysis in a community of Chinese individuals. METHOD One-hundred-and-forty-four individuals (58 males ≥18 and 86 females ≥16) with Class III malocclusion ranging from mild to severe were enrolled in this study. Principal component analysis and cluster analysis were performed using 61 lateral cephalometric measurements. RESULTS Six principal components were discovered in the examined population and were responsible for 73.7 % of the variability. Four subtypes were revealed by cluster analysis. Subtype 1 included subjects with mild mandibular prognathism with a steep mandibular plane. Subjects in subtype 2 showed a combination of prognathic mandibular and retrusive maxillary with a flat or normal mandibular plane. Subtype 3 included individuals with purely severe mandibular prognathism and a normal mandibular plane. Individuals in subtype 4 had a mild maxillary deficiency and severe mandibular prognathism with the lowest mandibular plane angle. CONCLUSION The six principal components extracted among the 61 variables improve our knowledge of lateral cephalometric analysis for diagnoses. We successfully identified four Class III malocclusion subtypes, indicating that cluster analysis could supplement the classification of Class III malocclusion among a Chinese population and may assist in our on-going genetic study.
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27
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Freudenthaler J, Čelar A, Ritt C, Mitteröcker P. Geometric morphometrics of different malocclusions in lateral skull radiographs. J Orofac Orthop 2016; 78:11-20. [PMID: 27796401 PMCID: PMC5247554 DOI: 10.1007/s00056-016-0057-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/22/2016] [Indexed: 12/01/2022]
Abstract
Background To evaluate the role of craniofacial shape in malocclusion by application of geometric morphometrics to a set of two-dimensional landmarks and semilandmarks obtained from lateral skull radiographs. Methods Cephalometric radiograph tracings of 88 untreated Caucasians (age range 7–39 years) were assigned to four groups according to their occlusion: neutrocclusion, distocclusion, mesiocclusion, and anterior open bite. The geometric morphometric shape analysis incorporated 66 landmarks and semilandmarks, which underwent generalized Procrustes analysis, between-groups principal component analysis, thin-plate spline deformation grid visualization, permutation tests, and receiver operating characteristic curves. Results The position and shape of the mandible contributed to differences between the distocclusion and mesiocclusion groups, whereas the maxillary shape showed less variation. The growth-related shape alteration during adolescence was most pronounced in the mesiocclusion group and least pronounced in the neutrocclusion group. The open bite group was associated with an altered orientation of the mandibular body and the maxilla, showed the most hyperdivergent maxillomandibular pattern but was not an own skeletal entity. Despite clear differences in mean shape across the four groups, the individual distribution of craniofacial shape overlapped between the groups without discrete clusters. Conclusions Craniofacial shape was clearly associated with dental malocclusion and showed considerable variation. Geometric morphometrics was a powerful research tool but for diagnosing individual malocclusion standard cephalometric measurements including overjet and overbite were equally or more efficient than geometric morphometric descriptors.
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Affiliation(s)
- Josef Freudenthaler
- Medical University of Vienna, Vienna, Austria.,School of Dentistry, Orthodontics, Sensengasse 2a, 1090, Vienna, Austria
| | - Aleš Čelar
- Medical University of Vienna, Vienna, Austria. .,School of Dentistry, Orthodontics, Sensengasse 2a, 1090, Vienna, Austria.
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28
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Moreno Uribe LM, Miller SF. Genetics of the dentofacial variation in human malocclusion. Orthod Craniofac Res 2016; 18 Suppl 1:91-9. [PMID: 25865537 DOI: 10.1111/ocr.12083] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/12/2023]
Abstract
Malocclusions affect individuals worldwide, resulting in compromised function and esthetics. Understanding the etiological factors contributing to the variation in dentofacial morphology associated with malocclusions is the key to develop novel treatment approaches. Advances in dentofacial phenotyping, which is the comprehensive characterization of hard and soft tissue variation in the craniofacial complex, together with the acquisition of large-scale genomic data have started to unravel genetic mechanisms underlying facial variation. Knowledge on the genetics of human malocclusion is limited even though results attained thus far are encouraging, with promising opportunities for future research. This review summarizes the most common dentofacial variations associated with malocclusions and reviews the current knowledge of the roles of genes in the development of malocclusions. Lastly, this review will describe ways to advance malocclusion research, following examples from the expanding fields of phenomics and genomic medicine, which aim to better patient outcomes.
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Affiliation(s)
- L M Moreno Uribe
- Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA; Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City, IA, USA
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29
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Miller SF, Vela KC, Levy SM, Southard TE, Gratton DG, Moreno Uribe LM. Patterns of morphological integration in the dental arches of individuals with malocclusion. Am J Hum Biol 2016; 28:879-889. [PMID: 27292446 DOI: 10.1002/ajhb.22880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 02/04/2016] [Accepted: 05/10/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES In humans, there is a large range of variation in the form of the maxillary and mandibular dental arches. This variation can manifest as either prognathism or retrognathism in either or both arches, which can cause malocclusion and lead to abnormal masticatory function. This study aims to identify aspects of variation and morphological integration existing in the dental arches of individuals with different types of malocclusion. METHODS Coordinate landmark data were collected along the gingival margins of 397 scanned dental casts and then analyzed using geometric morphometric techniques to explore arch form variation and patterns of morphological integration within each malocclusion type. RESULTS Significant differences were identified between Class II forms (increased projection of upper arch relative to the lower arch) and Class III forms (lower arch projection beyond the upper arch) in symmetrical shape variation, including anteroposterior arch discrepancies and abnormal anterior arch divergence or convergence. Partial least squares analysis demonstrated that Class III dental arches have higher levels of covariance between upper and lower arches (RV = 0.91) compared to the dental arches of Class II (RV = 0.78) and Class I (RV = 0.73). These high levels of covariance, however, are on the lower end of the overall range of possible masticatory blocks, indicating weaker than expected levels of integration. CONCLUSIONS This study provides evidence for patterns of variation in dental arch shape found in individuals with Class II and Class III malocclusions. Moreover, differences in integration found between malocclusion types have ramifications for how such conditions should be studied and treated. Am. J. Hum. Biol. 28:879-889, 2016. © 2016Wiley Periodicals, Inc.
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Affiliation(s)
- Steven F Miller
- Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City, Iowa, 52242
| | - Kaci C Vela
- Orthodontics Private Practice, Iowa City, Iowa, 52242
| | - Steven M Levy
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa, 52242.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, 52242
| | - Thomas E Southard
- Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, 52242
| | - David G Gratton
- Department of Prosthodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, 52242
| | - Lina M Moreno Uribe
- Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City, Iowa, 52242.,Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, 52242
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Borzabadi-Farahani A, Eslamipour F, Shahmoradi M. Functional needs of subjects with dentofacial deformities: A study using the index of orthognathic functional treatment need (IOFTN). J Plast Reconstr Aesthet Surg 2016; 69:796-801. [DOI: 10.1016/j.bjps.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
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Wellens HLL, Kuijpers-Jagtman AM. Connecting the new with the old: modifying the combined application of Procrustes superimposition and principal component analysis, to allow for comparison with traditional lateral cephalometric variables. Eur J Orthod 2016; 38:569-576. [PMID: 26739558 DOI: 10.1093/ejo/cjv096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The combination of generalized Procrustes superimposition (GPS) and principal component analysis (PCA) has been hypothesized to solve some of the problems plaguing traditional cephalometry. This study demonstrates how to establish the currently unclear relationship between the shape space defined by the first two principal components to the ANB angle, Wits appraisal, and GoGnSN angle, and to elucidate possible clinical applications thereof. METHODS Digitized landmarks of 200 lateral cephalograms were subjected to GPS and PCA, after which the sample mean shape was deformed along/parallel to principal components (PC) 1 and 2, recording the ANB, Wits, and GoGnSN value at each location. Trajectories were then calculated through the PC1-PC2 space connecting locations with the same values. These were finally utilized to renormalize the PC1-PC2 space. RESULTS The trajectories for the Wits appraisal were almost straight and parallel to PC1.Those for the ANB angle were angled approximately 20degrees downward relative to PC1, with a more accentuated curvature. The GoGnSN curves were mildly angled relative to the PC2 axis, their curvature increasing slightly with increasing PC1 scores. By combining the aforementioned trajectories, it was possible to delineate the region of the PC1-PC2 shape space which would be regarded as normodivergent and skeletal Class I in traditional cephalometry. Geometric distortion could be avoided by assigning patients the ANB, Wits, or GoGnSN value of the sample mean shape, deformed to the patient's position within the PC1-PC2 plot. CONCLUSION The methodology successfully relates the shape space resulting from the GPS-PCA results with traditional cephalometric variables.
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Affiliation(s)
- Hans L L Wellens
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Anne M Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, The Netherlands
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Harrington C, Gallagher JR, Borzabadi-Farahani A. A retrospective analysis of dentofacial deformities and orthognathic surgeries using the index of orthognathic functional treatment need (IOFTN). Int J Pediatr Otorhinolaryngol 2015; 79:1063-6. [PMID: 25957779 DOI: 10.1016/j.ijporl.2015.04.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/13/2015] [Accepted: 04/17/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the functional needs of orthognathic cases treated in Northampton General Hospital using the index of orthognathic functional treatment need (IOFTN). MATERIALS AND METHODS A retrospective study was conducted on 78 subjects (54 female and 24 males, 10-54 years, mean (SD) age=21.88 (6.98) years) who had orthognatic surgery in Northampton General Hospital or were in preparation for it (5 case). The sample represents a period between February 1997 and December 2014. The components of IOFTN and Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) as well as Malocclusion type were recorded. RESULTS Class III malocclusion/skeletal pattern was the most prevalent type (approximately 49%). There were 1, 36, 3, and 38 subjects with Class I, Class II Division I, Class II Division II, and Class III malocclusions, respectively. In terms of sagittal skeletal relationship, there were 2, 37, and 39 subjects with Class I, Class II, and Class III skeletal bases, respectively. The most prevalent IOFTN score in our sample was the 5.2 (29.5%), followed by 5.3 (15.5%), 4.2 (13%), 4.3 (11.5%). Overall, 92.3% were classified as in great and very great functional needs according to the IOFTN. Similarly, 84.6% scored as grade 4 or 5, according to the IOTN (DHC). The bimaxillary type osteotomy was the most prevalent type (61.5%). CONCLUSIONS Using IOFTN, 92.3% of our sample were classified as having great and very great functional needs. IOFTN is a simple and reliable tool to identify patients in need of orthognathic surgery and can be used in resource allocation for patients with highest functional needs.
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Affiliation(s)
- Claire Harrington
- Maxillofacial Unit and Orthodontics, Northampton General Hospital, Clifontville, Northampton, United Kingdom
| | - James R Gallagher
- Maxillofacial Unit and Orthodontics, Northampton General Hospital, Clifontville, Northampton, United Kingdom
| | - Ali Borzabadi-Farahani
- Maxillofacial Unit and Orthodontics, Northampton General Hospital, Clifontville, Northampton, United Kingdom; Warwick Dentistry, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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da Fontoura CSG, Miller SF, Wehby GL, Amendt BA, Holton NE, Southard TE, Allareddy V, Moreno Uribe LM. Candidate Gene Analyses of Skeletal Variation in Malocclusion. J Dent Res 2015; 94:913-20. [PMID: 25910506 DOI: 10.1177/0022034515581643] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluated associations between craniofacial candidate genes and skeletal variation in patients with malocclusion. Lateral cephalometric radiographs of 269 untreated adults with skeletal classes I, II, and III malocclusion were digitized with 14 landmarks. Two-dimensional coordinates were analyzed using Procrustes fit and principal component (PC) analysis to generate continuous malocclusion phenotypes. Skeletal class classifications (I, II, or III) were used as a categorical phenotype. Individuals were genotyped for 198 single-nucleotide polymorphisms (SNPs) in 71 craniofacial genes and loci. Phenotype-genotype associations were tested via multivariate linear regression for continuous phenotypes and multinomial logistic regression for skeletal malocclusion class. PC analysis resulted in 4 principal components (PCs) explaining 69% of the total skeletal facial variation. PC1 explained 32.7% of the variation and depicted vertical discrepancies ranging from skeletal deep to open bites. PC1 was associated with a SNP near PAX5 (P = 0.01). PC2 explained 21.7% and captured horizontal maxillomandibular discrepancies. PC2 was associated with SNPs upstream of SNAI3 (P = 0.0002) and MYO1H (P = 0.006). PC3 explained 8.2% and captured variation in ramus height, body length, and anterior cranial base orientation. PC3 was associated with TWIST1 (P = 0.000076). Finally, PC4 explained 6.6% and detected variation in condylar inclination as well as symphysis projection. PC4 was associated with PAX7 (P = 0.007). Furthermore, skeletal class II risk increased relative to class I with the minor alleles of SNPs in FGFR2 (odds ratio [OR] = 2.1, P = 0.004) and declined with SNPs in EDN1 (OR = 0.5, P = 0.007). Conversely, skeletal class III risk increased versus class I with SNPs in FGFR2 (OR 2.2, P = 0.005) and COL1A1 (OR = 2.1, P = 0.008) and declined with SNPs in TBX5 (OR = 0.5, P = 0.014). PAX5, SNAI3, MYO1H, TWIST1, and PAX7 are associated with craniofacial skeletal variation among patients with malocclusion, while FGFR2, EDN1, TBX5, and COL1A1 are associated with type of skeletal malocclusion.
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Affiliation(s)
- C S G da Fontoura
- Dows Institute for Research, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - S F Miller
- Dows Institute for Research, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - G L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - B A Amendt
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - N E Holton
- Dows Institute for Research, College of Dentistry, University of Iowa, Iowa City, IA, USA Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - T E Southard
- Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - V Allareddy
- Department of Oral Pathology-Radiology and Medicine, University of Iowa, Iowa City, IA, USA
| | - L M Moreno Uribe
- Dows Institute for Research, College of Dentistry, University of Iowa, Iowa City, IA, USA Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
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Sanggarnjanavanich S, Sekiya T, Nomura Y, Nakayama T, Hanada N, Nakamura Y. Cranial-base morphology in adults with skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop 2014; 146:82-91. [PMID: 24975002 DOI: 10.1016/j.ajodo.2014.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The objectives of this study were to clarify the characteristics of cranial-base morphology in adults with skeletal Class III malocclusion and investigate factors relating to the establishment of a skeletal Class III malocclusion. METHODS Initial lateral cephalograms of women were examined. Subjects with an ANB angle of 0° to 4°, normal overjet and overbite, and a Class I molar relationship were classified as Class I (n = 86). Those with an ANB angle less than -1°, a Wits appraisal less than 2 mm, a negative overjet, and a Class III molar relationship were the Class III group (n = 86) in this study. Angular, linear, and coordinate measurements were made. Multivariate analysis of variance and the Student t test were used to analyze significant differences between the 2 groups. Discriminant analysis, logistic regression analysis, and decision analysis were used to identify which cranial-base and maxillomandibular variables influenced the establishment of a skeletal Class III malocclusion. RESULTS The Class III group had smaller values for NSBa, SeSBa, FH-SSe, and FH-SBa. Sphenoidale and basion were more inferior and anterior than those of the Class I group. There was no difference in the anterior and posterior cranial-base lengths between the groups. Greater mandibular length was the first major characteristic in the Class III group, followed by smaller values for SeSBa and NSBa. CONCLUSIONS Cranial-base morphology in adults with a skeletal Class III malocclusion is different from that in a skeletal Class I malocclusion. Smaller cranial-base angles, steeper posterior cranial bases, more inferiorly positioned sphenoidale, and more anteriorly positioned basion are major characteristics of skeletal Class III malocclusions. These characteristics play important roles in the establishment of a skeletal Class III malocclusion.
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Affiliation(s)
- Seetala Sanggarnjanavanich
- Postgraduate student, Departments of Orthodontics and Translational Research, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Toshiko Sekiya
- Assistant professor, Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Yoshiaki Nomura
- Associate professor, Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Takahiro Nakayama
- Postgraduate student, Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Nobuhiro Hanada
- Professor and chairman, Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Yoshiki Nakamura
- Professor and chairman, Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
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Phenotypic diversity in white adults with moderate to severe Class II malocclusion. Am J Orthod Dentofacial Orthop 2014; 145:305-16. [PMID: 24582022 DOI: 10.1016/j.ajodo.2013.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Class II malocclusion affects about 15% of the population in the United States and is characterized by a convex profile and occlusal disharmonies. The specific etiologic mechanisms resulting in the range of Class II dentoskeletal combinations observed are not yet understood. Most studies describing Class II phenotypic diversity have used moderate sample sizes or focused on younger patients who later in life might outgrow their Class II discrepancies; such a focus might also preclude the visualization of adult Class II features. The majority have used simple correlation methods resulting in phenotypes that might not be generalizable to different samples and thus might not be suitable for studies of malocclusion etiology. The purpose of this study was to address these knowledge gaps by capturing the maximum phenotypic variations in a large sample of white Class II subjects selected with strict eligibility criteria and rigorously standardized multivariate reduction analyses. METHODS Sixty-three lateral cephalometric variables were measured from the pretreatment records of 309 white Class II adults (82 male, 227 female; ages, 16-60 years). Principal component analysis and cluster analysis were used to generate comprehensive phenotypes to identify the most homogeneous groups of subjects, reducing heterogeneity and improving the power of future malocclusion etiology studies. RESULTS Principal component analysis resulted in 7 principal components that accounted for 81% of the variation. The first 3 components represented variation on mandibular rotation, maxillary incisor angulation, and mandibular length. The cluster analysis identified 5 distinct Class II phenotypes. CONCLUSIONS A comprehensive spectrum of Class II phenotypic definitions was obtained that can be generalized to other samples to advance our efforts for identifying the etiologic factors underlying Class II malocclusion.
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