A longitudinal cephalometric study of the soft tissue profile of short- and long-face syndromes from 7 to 17 years

3D face reconstruction for maxillofacial surgery based on morphable models and neural networks: A preliminary assessment for anthropometry accuracy

OBJECTIVES

This study aimed to evaluate the anthropometric accuracy of 3D face reconstruction based on neural networks (3DFRBN) using 2D images, including the assessment of global errors and landmarks, as well as linear and angular measurements.

METHODS

Thirty healthy volunteers were recruited in this study. For each volunteer, five standard photos were taken, capturing anterior, 45° to left and right, and 90° to left and right views. These 2D images were then imported into the 3DFRBN program for generating 3D facial models. Accuracy of landmarks on these models was analyzed in comparison with 3dMD-captured models, as well as global error, and linear and angular measurements.

RESULTS

The average root mean square error of the 3DFRBN-generated models was 1.52 ± 0.23 mm. Euclidean distance for landmark deviation on 3DFRBN-generated models was 1.87 ± 0.13 mm, ranging from 1.21 mm to 2.17 mm. 13 out of 16 measurements had ICCs over 0.90. The average errors for linear and angular measurements were 0.67 mm and 3.25°, respectively.

CONCLUSIONS

This study introduced a novel, convenient, and accurate approach for both prospective and retrospective 3D facial data acquirement. Its great potential for retrospective 3D facial data acquisition can greatly benefit trauma and oncological reconstruction, as well as retrospective studies.

Comparisons of facial soft tissue characteristics in adult patients with various mandibular divergence patterns

BACKGROUND

The alignment of craniofacial structures in three dimensions-transverse, vertical, and sagittal-determines facial esthetics. While skeletal and dental factors influence these outcomes, soft tissue characteristics, especially facial soft tissue (FST) thickness, are increasingly recognized as important. However, few studies have examined the impact of vertical facial divergence on soft tissue variation, particularly in the middle and lower thirds of the face.

OBJECTIVE

This study aimed to evaluate the association between vertical facial divergence and facial soft tissue characteristics of lower and upper thirds in adult patients.

METHODS

A total of 120 non-growing individuals (60 men, 60 women) with an average age of 27.87 years (range: 18-56) seeking orthodontic treatment were included. Participants were stratified into four groups based on mandibular plane inclination to anterior cranial base (MP/SN): Group 1: MP-SN ≤ 27°, group 2: 27°< MP-SN ≤ 32º, group 3: 32°< MP-SN < 37°, and group 4: MP-SN ≥ 37°. Lateral cephalometric radiographs were used to measure FST thickness in the horizontal plane at specific anatomical landmarks, including the base of the forehead, nose, lips, and chin. Additionally, lip length, chin projection, and angular inclinations were assessed. Group comparisons were performed using one-way ANOVA followed by the post-hoc Benferroni test. The strength of the linear relationship between variables was investigated using the Pearson correlation test. Statistical significance was set at p = 0.05.

RESULTS

Significant differences in facial soft tissue characteristics were observed across groups. Hyperdivergent individuals (Group 4) exhibited significantly (p < 0.001) increased total facial height (TFH), lower facial height (LFH), and longer upper and lower lips compared to hypodivergent individuals (Group 1). Group 4 also had thinner soft tissue (p < 0.001) at the chin (Gn-Gn' and Me-Me'). Shallower mental sulcus and more obtuse chin angle existed in Group 4. Gender differences were noted in chin extension and throat angle. Positive correlations were found between MP/SN and various soft tissue measurements, including lip length and chin projection. No statistically significant differences were observed among the four groups in the upper face neither in linear nor in angular measurements.

CONCLUSIONS

Vertical facial divergence significantly influences soft tissue characteristics, particularly in the lower third of the face. Hyperdivergent individuals exhibit increased lip length and reduced chin thickness. Nose length and projection did not differ between the different divergent groups. These findings have clinical implications for orthodontic treatment planning, highlighting the need for individualized approaches based on vertical facial patterns.

Three-dimensional facial soft-tissue changes after surgical orthodontics in different vertical facial types of skeletal Class III malocclusion: A retrospective study

The study compared the soft-tissue response to hard-tissue movement among different Class III vertical facial types after orthognathic surgery (OGS). The study included 90 consecutive adult patients with skeletal Class III malocclusion who underwent two-jaw OGS. Patients were divided into three groups (high, medium, and low angle) based on the presurgical Frankfort-mandibular plane angle. Cone-beam computerized tomographs were taken before surgery and after debonding. Soft- and hard-tissue linear and angular measurements were performed using three-dimensional reconstruction images. One-way analysis of variance was used for intergroup comparisons. Soft tissue tended to respond more to hard-tissue movement in the lower lip area in patients with low angle (mean = 0.089, SD = 0.047, p = 0.023), whereas no significant difference was observed for other sites. Consistently, L1/Li thickness increased most significantly in the high-angle group (mean = 1.98, SD = 2.14, p = 0.0001), and B/Si thickness decreased most significantly after surgery (mean = 2.16, SD = 2.68, p = 0.016). The findings suggest that the high-angle group had a higher chance of undergoing genioplasty to enhance chin contour. Different OGS plans should be considered for different Class III vertical facial types.

3D analysis of maxillomandibular morphology in hyperdivergent and hypodivergent individuals: A cross-sectional study

INTRODUCTION

The aim of this cross-sectional study was to investigate maxillomandibular morphology in hyperdivergent and hypodivergent individuals, using 3D surface models generated by cone-beam computed tomography (CBCT).

METHODS

The sample consisted of 60 CBCTs (30 males, 30 females) patients aged 12-30 years, divided into two groups comprising hyperdivergent (≥35°) and hypodivergent (≤30°) individuals, according to the mandibular plane (MP) angle. Multiplanar reconstructions were used to mark the landmarks, and 3D surface models were created to evaluate structures of the maxillomandibular complex, including condyle, ramus, symphysis and palatal height. Intergroup comparisons were performed by independent t-test. Pearson's correlation test was used (P < .05) to evaluate the correlation of the MP angle with the angles and linear measurements of other structures.

RESULTS

Significant differences were found between the groups regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. No differences (P > .05) were found for the condylar height, symphysis inclination angle or palatal height. Correlations (P < .05) were found between the MP angle and structures of the maxillomandibular complex.

CONCLUSIONS

Hyperdivergent (MP ≥ 35°) and hypodivergent (MP ≤ 30°) individuals present different skeletal morphology regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. There is a significant correlation between MP angle and morphological structures such as condyle, ramus, symphysis, palatal plane angle and palatal-mandibular angle.

Analysis of Nasal Morphology in Skeletal Class I and Skeletal Class II Malocclusion: An Observational Study

Background and objectives

The nose is one of the major focuses of face attractiveness. Through careful evaluation of the soft tissue drape, a treatment plan can be designed to enhance a patient's facial attractiveness. The aim of this study was to evaluate and assess the variations in nasal morphology among class I malocclusion and class II horizontal and class II vertical malocclusion.

Material and method

Lateral cephalograms of 27 patients were taken and consisted of three groups: skeletal class I malocclusion, class II horizontal malocclusion, and class II vertical malocclusion. The various linear and angular measurements specific to nose were assessed.

Results and conclusion

In class II and class I malocclusion, the nose is observed to be straight and convex, respectively. Additionally, compared to class II horizontal malocclusion, it is more convex in class II vertical malocclusion. Vertical growers or high-angle cases are more likely to have a nose with an increased inclination toward nasal dorsum convexity than horizontal growers or low-angle instances.

Analyzing the effects of tooth extraction on the lip in orthodontic treatment

INTRODUCTION

The aim of this study was to analyze changes occurring in the lip and facial soft-tissue profile after fixed orthodontic treatment, with or without tooth extraction, in patients with dental class II malocclusion.

MATERIALS AND METHODS

Measurements were made on cephalometric films of 75 individuals with dental class II malocclusion before and after fixed orthodontic treatment. The patients were divided into three groups: no extraction, extraction of upper two premolars, or extraction of four premolars. The parameters measured were: basic upper lip thickness (BULT), vermilion upper lip thickness (VULT), upper lip inclination (ULI), basic lower lip thickness (BLLT), vermilion lower lip thickness (VLLT), lower lip inclination (LLI), face axis angle (Ba-N/PtmGn), labiomental angle, facial convexity angle, and total face convexity angle. The results were analyzed statistically using the Wilcoxon, Kruskal-Wallis, and Mann-Whitney U tests.

RESULTS

It was found that the VULT value in the group with no extraction was lower than the four-extraction group (P = 0.001; P < 0.05). The VULT value in the upper-two extraction group was significantly lower than that in the four-extraction group, and the Ba-N/PtmGn in the no-extraction group was lower than that in the four-extraction group (P = 0.001; P < 0.05).

CONCLUSIONS

These findings suggest that tooth extraction in orthodontic treatment may affect the vermilion upper lip thickness and facial axis, but that this does not have any negative effects on the soft-tissue facial profile. Premolar tooth extraction can be performed by establishing an accurate diagnosis and treatment plan to avoid undesirable and negative effects on the facial soft-tissue profile.

Customized maxillary incisor position relative to dentoskeletal and soft tissue patterns in Chinese women: A retrospective study

Objective

To provide reliable prediction models based on dentoskeletal and soft tissue variables for customizing maxillary incisor positions and to optimize digitalized orthodontic treatment planning.

Methods

This study included 244 Chinese women (age, 18–40 years old) with esthetic profiles after orthodontic treatment with fixed appliances (133 in group I 1° ≤ The angle between the nasion [N]-A point [A] plane and the N-B point [B] plane [ANB] ≤ 4°; 111 in group II 4° < ANB ≤ 7°). Dental, skeletal, and soft tissue measurements were performed on lateral cephalograms of the participants. Correlation and multiple linear regression analyses were used to determine the influence of dentoskeletal and soft tissue variables on maxillary incisor position.

Results

The ideal anteroposterior position of the maxillary incisor varied between sagittal skeletal patterns. The position of the maxillary incisor correlated with the sagittal discrepancy between the maxilla and the mandible (ANB), protrusion of the midface, nasal tip projection, development of the chin, and inclination of both the maxillary and mandibular incisors. Distance from the maxillary central incisor to nasion-pogonion plane predicted using multiple linear regression analysis was accurate and could be a practical measurement in orthodontic treatment planning.

Conclusions

Instead of using an average value or norm, orthodontists should customize a patient’s ideal maxillary incisor position using dentoskeletal and soft tissue evaluations.

Assessment and evaluation of soft tissue measurements between various mandibular divergences in the South Indian population: A cephalometric study

Aim:

The aim of this study is to evaluate the association between the mandibular divergent patterns and soft tissue chin (STC) thickness measured at different chin levels in nongrowing patients.

Methodology:

Pretreatment lateral cephalograms of 400 adult patients were segregated into four groups based on mandibular divergence pattern defined by the mandibular plane to cranial base angle (average 32° ± 5°), Group I with low angle (below 27°), Group II with medium low angle (28°–32°), Group III with medium high angle (33°–36°), and Group IV with high angle (above 37°). STC thickness was measured between Pog-Pog' (pogonion), Gn-Gn' (gnathion), and Me-Me' (menton), thickness and height of the upper and lower lips were also measured. Statistical analysis was done using one-way analysis of variance followed by post hoc Tukey analysis.

Results:

A significant difference in the STC thickness at Pog, Gn, and Me was observed among all four groups with hyperdivergent patterns, showing decreased STC thickness than the hypodivergent mandibular pattern. Thickness of the upper and lower lips was greater in hypodivergent mandible, whereas height of the lips was greater in hyperdivergent mandible.

Rapid maxillary expansion treatment increases mid-facial depth in early mixed dentition

OBJECTIVE

To evaluate the effects of rapid maxillary expansion (RME) on mid-facial depth in early mixed dentition and to investigate the relationship between change in mid-facial depth and maxillary sinus and nasal cavity.

METHODS

A total of 35 patients with mixed dentition treated with a Haas expander were included in this retrospective study. All patients underwent a cone-beam computed tomography scan before and after rapid maxillary expansion. The Wilcoxon signed-rank test was performed to evaluate the changes in maxillary width, facial depth, maxillary sinus, and nasal cavity volume before and after expansion. Multiple linear regression analysis was applied to evaluate the correlations among them.

RESULTS

The hard and soft tissue facial depth in the middle third increased significantly (P < 0.001). The gain on the outer sagittal plane (1.04-1.52 mm) was slightly bigger than that on the inner sagittal plane (0.91-1.30 mm). Maxillary width and nasal cavity width increased 3.42 ± 0.93 mm (P < 0.001) and 2.25 ± 0.77 mm (P < 0.001), respectively, after treatment. A gain was also achieved in both nasal cavity volume (2,236.15 mm³, P < 0.001) and maxillary sinus volume (1,227.33 mm³, P < 0.001). Multiple linear regression analysis showed that with the increase in maxillary sinus volume, the facial depth increased as well (B = 0.455-0.683, P < 0.05). Also, statistically significant correlations were found between nasal width and nasal cavity volume (B = 0.384, P < 0.05).

CONCLUSION

The depth of the middle third face increased significantly. The facial depth increase was related to the enlargement of maxillary sinus volume, while the nasal cavity volume gain was related to the nasal width increase. This indicated that RME might enhance the fullness of the mid-face and facilitate the patency of nose breathing.

Exploring the midline soft tissue surface changes from 12 to 15 years of age in three distinct country population cohorts

INTRODUCTION

Several studies have highlighted differences in the facial features in a White European population. Genetics appear to have a major influence on normal facial variation, and environmental factors are likely to have minor influences on face shape directly or through epigenetic mechanisms.

AIM

The aim of this longitudinal cohort study is to determine the rate of change in midline facial landmarks in three distinct homogenous population groups (Finnish, Latvian, and Welsh) from 12.8 to 15.3 years of age. This age range covers the pubertal growth period for the majority of boys and girls.

METHODS

A cohort of children aged 12 were monitored for facial growth in three countries [Finland (n = 60), Latvia (n = 107), and Wales (n = 96)]. Three-dimensional facial surface images were acquired (using either laser or photogrammetric methods) at regular intervals (6-12 months) for 4 years. Ethical approval was granted in each country. Nine midline landmarks were identified and the relative spatial positions of these surface landmarks were measured relative to the mid-endocanthion (men) over a 4-year period.

RESULTS

This study reports the children who attended 95 per cent of all scanning sessions (Finland 48 out of 60; Latvia 104 out of 107; Wales 50 out of 96). Considerable facial variation is seen for all countries and sexes. There are clear patterns of growth that show different magnitudes at different age groups for the different country groups, sexes, and facial parameters. The greatest single yearly growth rate (5.4 mm) was seen for Welsh males for men-pogonion distance at 13.6 years of age. Males exhibit greater rates of growth compared to females. These variations in magnitude and timings are likely to be influenced by genetic ancestry as a result of population migration.

CONCLUSION

The midline points are a simple and valid method to assess the relative spatial positions of facial surface landmarks. This study confirms previous reports on the subtle differences in facial shapes and sizes of male and female children in different populations and also highlights the magnitudes and timings of growth for various midline landmark distances to the men point.

Lip profile changes in patients with Class II Division 1 malocclusion of varied growth patterns treated with maxillary premolar extractions: A pilot study

INTRODUCTION

This retrospective pilot study assessed the pre- and posttreatment lip profile changes among adult patients with Class II Division 1 malocclusion of varied growth patterns and compared these changes with patients with a skeletal Class I relationship, to identify the dental, skeletal, and soft tissue cephalometric variables that altered the posttreatment lip profile.

METHODS

A total of 33 digital cephalograms were divided into 4 study groups based on the mandibular plane (Mp-SN) angle: group 1 (control, skeletal Class I; mean angle = 21.5°) (n = 8), group 2 (Class II Division 1 malocclusion; low angle = <26°) (n = 8), group 3 (Class II Division 1 malocclusion; intermediate angle = 26°-38°) (n = 9), and group 4 (Class II Division 1 malocclusion; high angle = >38°) (n = 8).

RESULTS

We observed a significant decrease in SNA, ANB, maxillary incisor to NA (degrees and millimeters), and soft tissue parameters, especially lip strain and lower lip to E line and upper lip to E line. Posttreatment intergroup comparison showed a significant increase of Mp-SN, and this increase was greater in group 3, followed by group 4 as compared with group 1. In addition, statistically significant differences in SNA, ANB, mandibular incisor to NB (degrees) and IMPA, and H angle in groups 2-4 were observed.

CONCLUSIONS

Patients with Class II Division 1 malocclusion showed a significant decrease in SNA, ANB, maxillary incisor to NA, and all soft tissue parameters in posttreatment compared with group 1. Thus, the soft tissue changes resulted in a similar profile to patients in group 1, who are considered to have an aesthetically pleasing posttreatment profile.

Mesiodistal angulation of posterior teeth in orthodontic patients with different facial growth patterns

Background. Mesiodistal and buccolingual angulations of teeth are variable in different malocclusion classes. This study aimed to assess the mesiodistal angulation of posterior teeth in orthodontic patients with vertical, normal, and horizontal facial growth patterns. Methods. This descriptive, cross-sectional study evaluated 150 lateral cephalograms of orthodontic patients. According to cephalometric analysis, facial growth patterns were divided into three groups of normal, horizontal, and vertical (n=50). The angulation of maxillary and mandibular posterior teeth was then measured. Data were analyzed using SPSS 22. Results. The results showed an increase in the mean angle of maxillary and mandibular posterior teeth relative to palatal and mandibular planes in patients with a vertical facial growth pattern. Conversely, their angulation decreased relative to the bisected occlusal plane (BOP). The angulation of posterior teeth decreased relative to palatal and mandibular planes and increased relative to the occlusal plane with an increase in overbite. The mean angle of all maxillary teeth relative to the palatal plane was significantly greater in open bite patients compared to normal and deep bite patients. This value in patients with normal bite was significantly greater than that in deep bite patients (P<0.05). Conclusion. The current results revealed that in patients with a vertical growth pattern, all the posterior teeth had a forward inclination. Conversely, in patients with a horizontal growth pattern, the teeth had a backward inclination.

A guided manual method for juvenile age progression using digital images

Predicting the possible age-related changes to a child's face, age progression methods modify the shape, colour and texture of a facial image while retaining the identity of the individual. However, the techniques vary between different practitioners. This study combines different age progression techniques for juvenile subjects, various researches based on longitudinal radiographic data; physical anthropometric measurements of the head and face; and digital image measurements in pixels. Utilising 12 anthropometric measurements of the face, this study documents a new workflow for digital manual age progression. An inter-observer error study (n = 5) included the comparison of two age progressions of the same individual at different ages. The proposed age progression method recorded satisfactory levels of repeatability based on the 12 anthropometric measurements. Seven measurements achieved an error below 8.60%. Facial anthropometric measurements involving the nasion (n) and trichion (tr) showed the most inconsistency (14-34% difference between the practitioners). Overall, the horizontal measurements were more accurate than the vertical measurements. The age progression images were compared using a manual morphological method and machine-based face recognition. The confidence scores generated by the three different facial recognition APIs suggested the performance of any age progression not only varies between practitioners, but also between the Facial recognition systems. The suggested new workflow was able to guide the positioning of the facial features, but the process of age progression remains dependant on artistic interpretation.

Short Face Dentofacial Deformities: Changes in Social Perceptions, Facial Esthetics, and Occlusion After Bimaxillary and Chin Orthognathic Correction

The purpose of this study was to document changes in social perceptions and facial esthetics, and document occlusion outcomes in a series of short face (SF) dentofacial deformity (DFD) subjects. The investigators hypothesized that subjects would achieve positive change in social perceptions and facial esthetics, and maintain a long-term corrected occlusion after undergoing bimaxillary and chin osteotomies.A retrospective cohort study was implemented. Photographic records and occlusion parameters were studied preoperatively and >2 years after surgery. The first outcome variable was social perceptions of SF subjects, judged by laypersons. The second outcome variable was facial esthetics, judged by professionals. The third outcome variable was occlusion maintained long-term.Fifteen subjects met inclusion criteria. Mean age at operation was 33 years. Consistent facial contour deformities at presentation included deficient maxillary dental show and downturned oral commissures. As a group, there was improvement (P < 0.05) in 11 of 12 social perceptions, judged by laypersons, all subjects achieved correction of the facial esthetic parameters studied by professionals, and all subjects maintained a favorable occlusion long-term.In SF DFD subjects, bimaxillary and chin surgery proved effective to improve social perceptions, to correct facial contour deformities, and in achieving a long-term corrected occlusion.

[Does gender make a difference in orthodontics? A literature review]

OBJECTIVES

The objective of this literature review is to investigate whether the gender of patients and practitioners makes any difference to orthodontic treatment.

MATERIALS AND METHODS

Sixty-nine articles were selected, the vast majority of which studied patient gender.

RESULTS

Young females are the category of patients which most often apply for orthodontic treatment, probably because of their higher aesthetic demands, despite their objective needs being no greater. Aesthetic, skeletal and dental analyses reveal an obvious dimorphism with larger dimensions in males, especially for the nose, cheekbones, mouth and mandibular canines. Nevertheless, cephalometric angular values do not vary significantly between male and female individuals. Growth is quantitatively greater in males. It also occurs later, as does eruption and maturation of their teeth. Response to the different orthodontic / orthopedic therapies would appear not to differ according to the sex of the patient.

DISCUSSION

These results, however, need to be qualified according to the country concerned, the patients' life style and mind frames, as these can modify or influence the studied parameters.

Growth Patterns and Individual Variation in Mid-sagittal Facial Soft Tissue Depth from Childhood to Adulthood

Previous studies have used longitudinal samples to investigate growth of the skeletal aspects of the face, although far less has been done on facial soft tissue. This study uses a larger sample than previous studies on the same data (Denver and Fels growth series) to explore covariation of bony and soft facial dimensions comprehensively from childhood to adulthood. A total of 1036 lateral cephalometric radiographs were digitized from 60 individuals, and distances between facial landmarks were measured using ImageJ. Multivariate analysis of variance (MANOVA) showed all bony facial landmark distances were significantly different (p > 0.05) between age groups; however, only half were significantly different between sexes. Further analysis showed the effect of age (calculated as eta-squared) explained a greater percentage of total variation (20%) than sex (15%). Overall, soft tissue changes between 0 and 19 years of age were small (<3 mm) and only some were correlated to underlying facial skeleton dimensions.

Long-Face Dentofacial Deformities: Occlusion and Facial Esthetic Surgical Outcomes

PURPOSE

The purpose of this study was to document malocclusion and facial dysmorphology in a series of patients with long face (LF) and chronic obstructive nasal breathing before treatment and the outcomes after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery.

MATERIALS AND METHODS

A retrospective cohort study of patients with LF undergoing bimaxillary, chin, and intranasal (septoplasty and inferior turbinate reduction) surgery was implemented. Predictor variables were grouped into demographic, anatomic, operative, and longitudinal follow-up categories. Primary outcome variables were the initial postoperative occlusion achieved (T₂; 5 weeks after surgery) and the occulsion maintained long-term (>2 years after surgery). Six key occlusion parameters were assessed: overjet, overbite, coincidence of dental midlines, canine Angle classification, and molar vertical and transverse positions. The second outcome variable was the facial esthetic results. Photographs in 6 views were analyzed to document 7 facial contour characteristics.

RESULTS

Seventy-eight patients met the inclusion criteria. Average age at surgery was 24 years (range, 13 to 54 yr). The study included 53 female patients (68%). Findings confirmed that occlusion after initial surgical healing (T₂) met the objectives for all parameters in 97% of patients (76 of 78). Most (68 of 78; 87%) maintained a favorable anterior and posterior occlusion for each parameter studied long-term (mean, 5 years 5 months). Facial contour deformities at presentation included prominent nose (63%), flat cheekbones (96%), flat midface (96%), weak chin (91%), obtuse neck-to-chin angle (56%), wide lip separation (95%), and excess maxillary dental show (99%). Correction of all pretreatment facial contour deformities was confirmed in 92% of patients after surgery. Long face patients with higher preoperative body mass index levels were more likely to have residual facial dysmorphology after surgery (P = .0009).

CONCLUSION

Using orthognathic surgery techniques, patients with LF dentofacial deformity achieved the planned occlusion and most maintained the corrected occlusion long-term. In unoperated patients with LF, a "facial esthetic type" was identified. Orthognathic surgery proved effective in correcting associated facial dysmorphology in most patients.

Cross-sectional human study of soft tissue chin (STC) thickness in adult patients in relation to sex, facial pattern and skeletal class

PURPOSE

The aim of this study was to study the relations between the soft tissue chin (STC) and sex, skeletal class, and facial pattern; and to describe the shape and behavior of the STC.

METHODS

385 non-growing patients were selected, 206 women and 179 men, with a mean age of 28.8 years (SD 4.2). Patients were divided into groups by skeletal class (class I, II or III) and facial pattern (brachyfacial, mesofacial or dolichofacial). STC thicknesses were measured at pogonion (Pg), soft pogonion (Pg'), gnathion (Gn), soft gnathion (Gn'), menton (Me) and soft menton (Me') in the CBCTs.

RESULTS

Sexual dimorphism was observed at Pg-Pg' and Me-Me'. STC thickness was not related to skeletal class but related to facial pattern. Pg-Pg' and Me-Me' measurements showed significant differences to the combination of skeletal class/facial pattern. STC thickness was not homogenous in terms of shape and behavior.

CONCLUSIONS

The results provide evidence of a strong but complex relationship between sex, facial pattern, skeletal class and STC thickness; for this reason, each patient must be evaluated individually before undergoing orthodontics or orthognathic surgery involving the mandible and the mandibular symphysis.

Prevalence of the Short Face Pattern in Individuals of Bauru-Brazil

Aim:

This study aimed at assessing the prevalence and severity of short face pattern in ethnically different individuals.

Material and Methods:

The sample comprised 4,409 Brazilians (2,192 females and 2,217 males), with a mean age of 13 years, enrolled in secondary schools in the municipality of Bauru. The sample inclusion criteria involved subjects with vertically impaired facial relationship based on excessive lip compression, when standing at natural head position, with the lips at rest. Once short face syndrome had been identified, the individuals were classified into three severity subtypes: mild, moderate, and severe. The sample was then stratified by ethnic background as White (Caucasoid), Black (African descent), Brown (mixed Caucasian–African descent), Yellow (Asian descent), and Brazilian Indian (Native Brazilian descent), using the Brazilian Institute of Geography and Statistics classification. The chi-square test at the 5% significance level was used to compare frequency ratios of individuals with vertically impaired facial relationships and across different ethnicities, according to severity.

Results:

The prevalence of short face pattern was 3.15%, as 1.11%, 1.99%, and 0.02% considered mild, moderate and severe subtypes, respectively. The severe subtype was rare (0.02%) and found only in one White individual. The White group had the highest relative frequency (45.53%) of the moderate subtype, followed by Brown individuals (43.40%). In the mild subtype, Yellow (68.08%) and White (62.21%) individuals showed similar and higher relative frequency values.

Conclusion:

The prevalence of short face pattern was 3.15%, and White individuals had the highest prevalence.

Comparison of the effect of labiolingual inclination and anteroposterior position of maxillary incisors on esthetic profile in three different facial patterns

Objective:

To test the null hypothesis that there is no effect of esthetic perception of smiling profile in three different facial types by a change in the maxillary incisor inclination and position.

Materials and Methods:

A smiling profile photograph with Class I skeletal and dental pattern, normal profile were taken in each of the three facial types dolichofacial, mesofacial, and brachyfacial. Based on the original digital image, 15 smiling profiles in each of the facial types were created using the FACAD software by altering the labiolingual inclination and anteroposterior position of the maxillary incisors. These photographs were rated on a visual analog scale by three panels of examiners consisting of orthodontists, dentists, and nonprofessionals with twenty members in each group. The responses were assessed by analysis of variance (ANOVA) test followed by post hoc Scheffe.

Results:

Significant differences (P < 0.001) were detected when ratings of each photograph in each of the individual facial type was compared. In dolichofacial and mesofacial pattern, the position of the maxillary incisor must be limited to 2 mm from the goal anterior limit line. In brachyfacial pattern, any movement of facial axis point of maxillary incisors away from GALL is worsens the facial esthetics. The result of the ANOVA showed differences among the three groups for certain facial profiles.

Conclusion:

The hypothesis was rejected. The esthetic perception of labiolingual inclination and anteroposterior of maxillary incisors differ in different facial types, and this may effect in formulating treatment plans for different facial types.

Phenotype-genotype correlations of facial width and height proportions in patients with Class II malocclusion

OBJECTIVES

To characterize soft-tissue facial height and width variation in Class II malocclusion and test for correlations with genes HMGA2, AJUBA, and ADK.

SETTING AND SAMPLE POPULATION

Nine facial proportions were estimated from 2D frontal repose photographs of 330 Caucasian adults with Class II malocclusion.

MATERIAL AND METHODS

After adjustments for age and gender, the facial proportions were submitted to a principal component analyses (PCA). The most meaningful phenotypic variations were correlated with SNPs rs7924176 (ADK), rs17101923 (HMGA2), and rs997154 (AJUBA) genotyped in 106 individuals.

RESULTS

Principal component analyses resulted in four principal components (PCs), which explained 75% of total variation. PC1 captured variation in the intercanthus distance and explained 28% of total variation. PC2 explained 21% of the variations in facial taper and facial index. PC3 explained 14% and reflected variations in the vertical dimension of the lower face. PC4 explained 12% and captured variations in distance between the eyes, width of the commissures, and the length of the superior aspect of the lower face height corresponding to the vertical dimension of the philtrum of the upper lip. A suggestive association (p<0.05) was observed between PC4 and rs997154 corroborating the role of AJUBA in variation of facial dimensions.

CONCLUSION

2D frontal photographs can be used to derive quantitative measures of soft-tissue phenotypes that are of clinical relevance. The methods described are suitable for discovery and replication of associations between genotypes and malocclusion phenotypes.

Surgical treatment of class II dento-facial deformity during adolescence: Long-term follow-up

PURPOSE

The purpose of this study is to evaluate the long-term stability of patients operated during adolescence on the base of clinical measurements and cephalometric analysis. Although, the potential benefits of early orthognathic surgery are known to be a reduction in treatment times and a greater healing potential leading to a better adaptation and stability of the occlusion, muscles, bones and joints, no consensus can be found in literature on the minimum age for surgical correction.

MATERIALS AND METHODS

In this study, thirty patients (age ≤ 15) with a class II dento-skeletal malocclusion were selected, of which 11 having a hyperdivergent (II,1) and 19 a hypodivergent (II,2) growth pattern, representing 2 distinct groups with a different treatment plan and long-term behavior.

RESULTS AND CONCLUSION

Observing the performance of all parameters over-time, it is seen that subjects belonging to division II,2 have a modification of the growth vectors maintaining the harmonious development between the jaws and the facial aesthetics. Less predictable is the trend in hyperdivergent patients, which are more prone to relapse in the long-term. Early surgery in these patients should be considered in the light of the degree of deformity and its influence felt by the patient on his development of self-image and interpersonal relationship.

Dynamic smile evaluation in different skeletal patterns

Objective:

To evaluate dynamic smile in different skeletal patterns and to correlate vertical smile parameters with the underlying causative factors.

Materials and Methods:

A total of 150 participants ranging in age from 16–25 years were selected and divided into one of three groups—horizontal, average, and vertical skeletal pattern—using the following three cephalometric parameters: SN-MP, FMA, and Jarabak ratio. Videographic records of smile were obtained, and measurements were recorded and analyzed at rest, including upper lip length, and during smile, including maxillary incisal display, interlabial gap, intercommisural width, change in upper lip length, and smile arc. Differences among the three groups were subjected to two-way analysis of variance and post hoc and chi-square tests for smile arc. Correlations between vertical smile variables and vertical skeletal (N-ANS, N-Me) and dental cephalometric measurements (U1 to palatal plane) were also investigated.

Results:

Vertical parameters were significantly increased in the vertical pattern when compared with the horizontal pattern, ie, upper lip length (P &lt; .01), maxillary incisal display (P &lt; .001), interlabial gap (P &lt; .001), and change in upper lip length (P &lt; .001), whereas intercommisural width was significantly decreased in vertical pattern when compared with the horizontal pattern (P &lt; .001). Flat smile arc was seen more frequently in the horizontal pattern. Positive correlations were found between the N-Me, U1-PP, and change in upper lip length with vertical smile parameters.

Conclusions:

Different skeletal patterns exhibit their characteristic smile features. Upper lip length is not responsible for increased incisal display during smile. Increased incisal display during smile is more closely associated with upper lip elevation than vertical skeletal and dental factors.

Perioral soft tissue evaluation of skeletal Class II Division 1: A lateral cephalometric study

INTRODUCTION

To obtain the balance and harmony of the soft tissue facial profile in orthodontic treatment, it is necessary to identify the characteristics of overlying soft tissues according to the horizontal and vertical skeletal patterns. The aim of this study was to evaluate the perioral soft tissue characteristics of skeletal Class II Division 1 subjects (group II) with various vertical patterns compared with skeletal Class I subjects (group I).

METHODS

Lateral cephalograms of 99 Korean adults (44 women, 45 men; mean age, 23.4 years) were divided into 4 groups based on horizontal and vertical skeletal pattern (SN-MP angle): group I, 22 subjects; group II-low angle (<27°), 14 subjects; group II-normal angle (27°-36°), 33 subjects; and group II-high angle (>37°), 30 subjects. The correlations and multiple linear regression tests were used to determine the skeletal and dental variables influencing soft tissue characteristics.

RESULTS

Group II-high angle showed significantly greater values than did group II-low angle for basic lower lip thickness and lower lip length. The perioral soft tissue measurements of group II were correlated with the inclination and anteroposterior position of the maxillary and mandibular incisors along with facial depth (N-Go) and facial length (S-Gn). Upper lip strain of group II was not influenced by any skeletal variables but only by the inclination and anteroposterior position of the maxillary incisors.

CONCLUSIONS

Clinicians need to evaluate lip strain and lip thickness based on the skeletal pattern as well as dental inclination to obtain balance in the perioral muscle activity.

Changes on facial profile in the mixed dentition, from natural growth and induced by Balters' bionator appliance

OBJECTIVE

The purpose of this study was to evaluate the facial profile changes induced by Balters' bionator appliance in Class II division 1 patients, at mixed dentition stage.

METHODS

The sample consisted of 28 pre-pubertal individuals at stages 1 and 2 of skeletal maturation (CVM), which were divided into two groups. The experimental group consisted of 14 individuals (7 boys and 7 girls, initial mean age of 8y12m) which were treated with Balters' bionator appliance for 14.7 months. The effects of treatment were compared to a control group of 14 subjects (7 boys and 7 girls, initial mean age of 8y5m) with Class II malocclusion, division 1, not orthodontically treated, which were followed up for 15.4 months. The statistical analysis was performed using Student's t test, at a significance level of 5%.

RESULTS

The results showed that the Balters' bionator appliance promoted a significant increase on the mentolabial angle, in addition to demonstrating a tendency to reduce the facial skeletal convexity, to restrict the maxillary growth and to increase the nasolabial angle and the lower anterior facial height.

CONCLUSIONS

It can be concluded that the Balters' bionator appliance improved the facial profile of children treated at mixed dentition stage.

Comparisons of soft tissue chin thickness in adult patients with various mandibular divergence patterns

OBJECTIVE

To evaluate the association between soft tissue at the chin (STC) thickness and mandibular divergence.

MATERIALS AND METHODS

Nongrowing patients seeking orthodontic treatment (n  =  190; 113 women and 77 men), who had an average age of 26.94 years (range  =  18.10-53.50 years), were stratified in four subgroups based on cephalometric mandibular plane inclination to anterior cranial base (MP/SN): low  =  MP/SN ≤ 27° (n  =  48); medium-low  =  27° < MP/SN ≤ 32° (n  =  60); medium-high  =  32° < MP/SN < 37° (n  =  37); and high  =  MP/SN ≥ 37° (n  =  45). The STC thicknesses were measured at pogonion (Pog), gnathion (Gn), and menton (Me). Group differences were evaluated with two-way analysis of variance and Student's t-test. The Pearson product moment correlation gauged associations between parameters.

RESULTS

The STC values were greater in men than women (P < .02) and were smaller in the high group (7.47 ± 2.42 mm) than in all other groups at Gn (mean values  =  9.00 mm < STC < 9.58 mm; P < .001) and at Me (high group  =  6.30 ± 1.89 mm; other groups  =  7.15 mm < STC< 7.57 mm; P  =  .011).

CONCLUSION

The STC is thinner at Gn and Me in hyperdivergent facial patterns, apparently in contrast to Pog. This differential thickness warrants focused research as it implies that it is possible (1) to vertically grow hard tissues impinging on the inferior soft tissue envelope in patients with severe hyperdivergence and (2) to plan for genioplasty in such patients when more advancement of the chin might be needed to compensate for the increased vertical height.

Objective classification of nose-lip-chin profiles and their relation to dentoskeletal traits

OBJECTIVES

To objectively classify the nose-lip-chin profiles of adult women and identify any associations between the nose-lip-chin profile patterns and dentoskeletal patterns.

SETTING AND SAMPLE POPULATION

Lateral facial photographs and lateral cephalograms were obtained for 229 Japanese women who were being assessed for orthodontic treatment.

METHODS

A feature vector that was effective in distinguishing differences in nose-lip-chin profiles was extracted for each photograph. To categorize the records into an optimum number of subclasses according to nose-lip-chin profile configurations, a vector quantization method was applied to the feature vectors of all samples. Dentoskeletal patterns that corresponded to the nose-lip-chin profile subclasses were compared.

RESULTS

Eight profile patterns were identified, and the differences among patterns were notably maximized by the nasolabial angle, configuration and vertical length of the subnasal region, vertical thickness of the lip vermilion borders, sagittal position of the upper- and lower-lip vermilion borders and their relation to each other, labiomental angle, depth of the labiomental sulcus, degree of prominence of the chin, and degree of protrusion of the mandible. The dentoskeletal patterns showed significant differences between the classified profile patterns (p < 0.01).

CONCLUSIONS

A method to objectively classify the nose-lip-chin profiles of adult women was established, and the nose-lip-chin profile patterns were found to be associated with the dentoskeletal patterns.

Patterns of vertical facial growth in Korean adolescents analyzed with mixed-effects regression analysis

INTRODUCTION

To understand the growth patterns of skeletal open bite and deepbite, we present observations from 9 years of pure longitudinal data based on lateral cephalometric radiographs using mixed-effects regression model analysis.

METHODS

In total, 51 children (14 years old) with extreme values for the ratio of lower anterior facial height to total anterior facial height were assigned to 1 of 2 groups: a skeletal open-bite group (11 boys, 14 girls) or a skeletal deepbite group (14 boys, 12 girls). Measurements of total anterior facial height, upper anterior facial height, lower anterior facial height, total posterior facial height, ramus height, and ratio of lower anterior facial height to total anterior facial height were obtained for all subjects. All data were analyzed and interpreted using a mixed-effects regression model analysis with random effects.

RESULTS

From these 4 groups at 14 years old, statistically significant differences were observed between the groups when subjects of the same sex were compared; however, statistical significance was not reached between subjects of opposite sexes in each group. Morphologic differences were clearly evident from the start and became more pronounced with age. There were statistical significances in the initial values and increases with age in all 6 variables except for increases with age in the ratio of lower anterior facial height to total anterior facial height. Statistical significance was also reached for morphologic differences between the annual increases in the ratio of lower anterior facial height to total anterior facial height and lower anterior facial height. In general, individual random variability was high in all variables when compared with the annual changes over time.

CONCLUSIONS

Divergent patterns were established early and became more pronounced with age, with anterior facial height dimensions primarily contributing to these differences. Individual variations were so pronounced that caution is recommended for all clinical decisions.

Longitudinal study of cephalometric soft tissue profile traits between the ages of 6 and 18 years

OBJECTIVE

To study the longitudinal changes in 19 soft tissue cephalometric traits (according to the Bergman cephalometric soft tissue facial analysis).

MATERIALS AND METHODS

Cephalograms and photographs of 40 subjects (20 male, 20 female, from the Burlington Growth Centre) that were obtained at ages 6, 9, 12, 14, 16, and 18 years were used. Subjects were orthodontically untreated whites and had Class I dentoskeletal relationships (ideal overjet and overbite). Images were obtained with the lips in a relaxed position or lightly touching.

RESULTS

Three groups of soft tissue traits were identified: (1) traits that increased in size with growth (nasal projection, lower face height, chin projection, chin-throat length, upper and lower lip thickness, upper lip length, and lower lip-chin length); (2) traits that decreased in size with growth (interlabial gap and mandibular sulcus contour [only in females]); and (3) traits that remained relatively constant during growth (facial profile angle, nasolabial angle, lower face percentage, chin-throat/lower face height percentage, lower face-throat angle, upper incisor exposure, maxillary sulcus contour, and upper and lower lip protrusion).

CONCLUSION

Current findings identify areas of growth and change in individuals with Class I skeletal and dental relationships with ideal overjet and overbite and should be considered during treatment planning of orthodontic and orthognathic patients.

Associations between orbicularis oris thickness and skeletal and dental variables in mixed dentition

AIM: To evaluate the association between orbicularis oris thickness and skeletal and dental variables in children with mixed dentition. MATERIAL AND METHOD: A convenience sample of 22 children, aged 7 to 12 years, with skeletal Class I and Class II malocclusion and subdivisions were selected. The upper and lower fascicles of the orbicularis oris thicknesses were measured using ultrasound (US) by one calibrated examiner, at rest and in the contracted state. Cephalometric radiograph measurements of the hard and soft tissues were calculated by one trained examiner. The results were analyzed by the Pearson and Spearman coefficients. RESULT: The upper and lower fascicles of the orbicularis oris in the contracted state showed a negative correlation with the distance between Ricketts' E-line and the labrale superius (E ┴ Ls). There were positive correlations between the lower face height and the distance between the AB plane and the labrale superius (AB-Ls) and between the ANB angle and the distance between E ┴ Ls and Ricketts' E-line and the labrale inferius (E ┴ Li). The lower-incisor distance from the N-Pg plane correlated positively with the distance between AB-Ls and the distance between the E ┴ Ls and E ┴ Li. Overbite and interincisal angle were negatively correlated with the distance between the pogonion and the soft tissue pogonion and the distance between E ┴ Li, respectively. CONCLUSION: Skeletal and dental variables were associated with upper and lower lip position and pogonion thickness, while the upper and lower fascicles of the orbicularis oris thicknesses in the contracted state were associated only with upper lip retrusion.

Comparação das dimensões de tecido mole entre padrões faciais distintos

OBJETIVO: o presente estudo destinou-se a comparar a morfologia tegumentar de indivíduos segundo a tipologia facial. MÉTODOS: foram utilizadas 90 telerradiografias de pacientes de ambos os sexos, de 12 a 16 anos de idade, divididas em três grupos distintos, referentes a cada padrão morfológico: mesofacial, dolicofacial e braquifacial. Os grupos foram comparados no que se refere às medidas de espessura e altura do lábio superior e inferior, além da espessura do mento mole. Ainda, foi apurada a presença de correlações entre as variáveis de tecido mole avaliadas e medidas cefalométricas de natureza dentária e esquelética. RESULTADOS E CONCLUSÕES: os lábios superiores e inferiores, assim como o mento mole, não apresentaram diferenças em relação às suas espessuras em todos os grupos morfológicos. Porém, as alturas do lábio superior e inferior foram significativamente maiores para os dolicofaciais quando esses foram comparados aos demais grupos. Braquifaciais apresentaram menor altura do lábio superior quando comparados aos mesofaciais, embora ambos não tenham se diferenciado significativamente no que se refere à altura do lábio inferior. A análise das correlações estabelecidas entre as variáveis dos tecidos moles e duros indicou evidências de um desenvolvimento vertical dos lábios superior e inferior em acompanhamento ao desenvolvimento vertical do esqueleto. O posicionamento vertical do incisivo superior se correlacionou significativamente aos mesmos parâmetros labiais, o que garantiu um nível de exposição semelhante desse elemento dentário em todos os grupos.

[Facial volumes and vertical facial type: a three dimensional comparative study]

INTRODUCTION

The purpose of this study was to compare the volume of facial cavities in untreated young subjects with long- and short-faces.

METHODS

Two groups of thirty subjects each, one with low (GoGn-SN < or = 28 degrees), and the other with high (GoGn-SN > or = 36 degrees) mandibular plane angles, ages between 18 to 30 years, were selected. For each subject, volumes of orbital, sinusal and buccal cavities were measured from CT scans with the AMIRA software. The statistical studies were performed using Kolmogorov-Smirnov, followed by Student "t" test (p < 0.05).

RESULTS

Results suggest that there is no statistically significant difference between the volume of facial cavities in long- and short-face subjects. Only the ratio of nasal cavity volume to the total volume is significantly smaller in the short-face group.

CONCLUSION

A compensatory phenomenon might exist between the three directions of growth to equilibrate an excess or deficit of the vertical dimension, thus maintaining constant the volume of facial cavities.

Longitudinal profile changes in an Anatolian Turkish population

The goal of this study was to assess longitudinal changes in the facial soft tissue profile in relation to age and gender in young Anatolian Turkish subjects. A total of 30 subjects (15 females and 15 males) with an Angle Class I occlusal relationship and normal antero-posterior (ANB, 2-4 degrees) skeletal relationships were selected from the archive of Dicle University. All subjects were of Anatolian Turkish heritage, and none had any apparent facial disharmony or had undergone orthodontic therapy. Lateral cephalometric radiographs taken at T1 (mean age 8.8 years), T2 (mean age 13.8 years), and T3 (mean age 17.8 years) were separately investigated. Non-gender-specific research was also carried out at the same time periods. In total, 24 measurements were analysed longitudinally. Differences between the genders were determined using independent t-tests. Repeated measures analysis of variance tests were used to evaluate repeated measurements, and paired sample t-tests to compare inside effects between the genders. Significant increases (P < 0.05) were found with age for both females and males. Generally, the increases were greater in males than in females. Nasal prominence increased more than chin prominence, resulting in a tendency to have convex profiles.

Morphometric correlation between facial soft-tissue profile shape and skeletal pattern in children and adolescents

INTRODUCTION

Prediction of soft-tissue outline shape from skeletal remains is useful in forensics and archaeology. The inverse problem, the assessment of underlying skeletal relationships from the external appearance, is pertinent in orthodontics. The purposes of this study were to assess the correlation between craniofacial shape and shape of the soft-tissue profile outline and to determine the extent to which it might be possible to predict the latter from the former.

METHODS

Lateral cephalograms from 170 consecutive orthodontic patients were used, and 17 skeletal, 2 dental, and 22 soft-tissue landmarks were digitized and processed by using Procrustes superimposition and principal component analysis. The principal components of the skeletal and soft-tissue shapes were entered into the correlation analysis.

RESULTS

Significant correlations were found between the skeletal and the soft-tissue components. The use of 7 anterior skeletal landmarks (not including the nasal bone) resulted in a predictive power (coefficient of determination) of 38% of the variability of soft-tissue shape. This increased to almost 50% by adding nasal and incisor points but showed only a slight further improvement by incorporating posterior skeletal landmarks.

CONCLUSIONS

Anterior skeletal and dental landmarks can be used to predict soft-tissue profile shape with a 50% power in children and adolescents.

Profile changes of patients treated with and without premolar extractions

INTRODUCTION

In this study, we evaluated and compared treatment effects and long-term soft-tissue profile changes in patients treated with extraction of 4 first premolars and with a nonextraction protocol.

METHODS

Cephalometric records of 98 patients were evaluated. For half (n = 49) of the patients, treatment included the extraction of 4 first premolars; the other 49 patients had no premolar extractions. The groups were evaluated before treatment (T1), at the end of treatment (T2), and at least 4 years postretention (T3).

RESULTS

At T1, the extraction group had more protrusive lower lips than the nonextraction group, as measured by the Z-angle. At T2, the Z-angles had improved in both groups and were not significantly different. During treatment, upper lip vermilion and superior thicknesses increased, whereas lower lip vermilion thickness decreased in both groups. Except for lower lip inferior thickness, which increased significantly in the nonextraction group, no other soft-tissue differences were significant. Significant growth of the nose occurred during from T1 to T2 in both groups, and there was a tendency for the incisors in both groups to return to pretreatment values. The nose also continued to grow during that period.

CONCLUSIONS

Overall, the soft-tissue facial profile measurements for both extraction and nonextraction samples were similar at T3, and there were no clinically significant correlations between hard- and soft-tissue variables at T1, T2, and T3.

Características cefalométricas do Padrão Face Longa: considerando o dimorfismo sexual

OBJETIVO: o presente estudo avaliou a hipótese de variação das características cefalométricas de acordo com o gênero para portadores de Padrão Face Longa. METODOLOGIA: foi analisado um total de 73 telerradiografias em norma lateral, sendo 34 Padrão Face Longa e 39 Padrão I (grupo controle), selecionadas com base na morfologia facial, sem considerar as relações oclusais. Foram avaliados: padrão de crescimento facial, alturas faciais anteriores e posterior, relação maxilomandibular, além das relações dentárias com suas bases apicais. RESULTADOS: o grupo controle (Padrão I) apresentou dimorfismo (p<0,001) no comprimento efetivo da maxila e da mandíbula, além das alturas faciais avaliadas. Foram significantes também (p<0,05) as proporções entre as alturas faciais e as distâncias entre os incisivos e molares em relação aos planos palatino e mandibular. Para os portadores de Padrão Face Longa, as mesmas variáveis cefalométricas não mostraram diferenças significantes entre os gêneros (p>0,05), exceto os comprimentos efetivos da maxila e da mandíbula, além da altura facial anterior inferior e posterior (p<0,05). CONCLUSÕES: concluiu-se que enquanto ocorreu dimorfismo nos indivíduos Padrão I, para as estruturas influenciadas pela diferença no tamanho esquelético entre os gêneros, isso não aconteceu nos portadores de Padrão Face Longa. Essa maior similaridade entre os gêneros provavelmente ocorreu porque a deformidade, mais grave no gênero feminino, foi suficiente para anular o menor tamanho esquelético esperado para estes indivíduos.

Long-term stability of orthodontic treatment and patient satisfaction. A systematic review

OBJECTIVE

To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment.

MATERIALS AND METHODS

Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies.

RESULTS

The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective.

CONCLUSIONS

This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.

Proposta para classificação, segundo a severidade, dos indivíduos portadores de más oclusões do Padrão Face Longa

OBJETIVO: o presente estudo teve como objetivo propor um método para classificação, segundo a severidade, dos indivíduos Padrão Face Longa, avaliando sua confiabilidade e reprodutibilidade. METODOLOGIA: foram utilizadas fotografias faciais (frontal, perfil e frontal sorrindo) de 125 crianças Padrão Face Longa (54 do gênero feminino e 71 do gênero masculino), selecionadas apenas considerando-se a morfologia facial, com idades entre 10 anos e 6 meses e 15 anos e 2 meses. As fotografias foram avaliadas, separadamente, por três examinadores, sendo reavaliadas após três semanas, em uma nova disposição aleatória. Os indivíduos foram graduados em três subtipos, de acordo com a severidade: moderado, médio e severo. Para avaliar as concordâncias intra e interexaminadores, foi utilizada a estatística Kappa (k). RESULTADOS: na avaliação intra-examinador, todos os examinadores obtiveram concordâncias substanciais, com o valor de Kappa variando de 0,64 a 0,66, havendo em todos os examinadores 80% ou mais de concordância. Quando comparadas as avaliações interexaminadores, as freqüências de concordância diminuíram, variando de 67,2% a 70,4%. A partir dos valores de Kappa, que variaram de 0,41 a 0,46, a interpretação foi considerada moderada. CONCLUSÕES: com base nesses resultados, o método foi considerado aplicável, com necessidade de complemento de informações provenientes de outros exames rotineiramente aplicados em Ortodontia. A aplicação clínica será demonstrada com intuito de evidenciar os níveis diferentes de severidade das más oclusões do Padrão Face Longa e as características do protocolo de tratamento recomendado.

Características cefalométricas do padrão face longa

Este estudo determinou as características cefalométricas dos indivíduos portadores de Padrão Face Longa em comparação com indivíduos Padrão I. Um total de 73 telerradiografias em norma lateral, sendo 34 Padrão Face Longa e 39 Padrão I, foram selecionadas com base na morfologia facial, não considerando as relações oclusais e sagitais. Foram avaliados: padrão de crescimento facial, alturas faciais anteriores e posterior, relação maxilo-mandibular, além das relações dentárias com suas bases apicais. De uma forma geral, os indivíduos Padrão Face Longa apresentaram grandes desvios em relação aos indivíduos Padrão I, sendo a doença decorrente de um desequilíbrio entre os componentes verticais. Pôde-se observar que os valores das grandezas AFAT, AFAI, AFATperp, AFAIperp, 1-PP, 6-PP, 1-PM, SNB, ANB, ângulo goníaco, ângulo plano mandibular, além das proporções AFAI/AFAT e AFAIperp/AFATperp, estavam significantemente alterados para os indivíduos Padrão Face Longa. Com base nos resultados obtidos neste estudo, verificou-se que esses indivíduos caracterizavam-se pelo padrão de crescimento vertical e por um aumento da altura facial anterior inferior - conseqüentemente, da altura facial anterior total - estando a deformidade localizada abaixo do plano palatino. Foram observados ainda um retrognatismo maxilar e mandibular, além da presença de extrusão dentária anterior (superior e inferior) e póstero-superior, com os incisivos superiores bem posicionados em suas bases e os inferiores lingualizados.

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

OBJECTIVE

The aim of this study was to evaluate cephalometrically the lower lip position and area of patients with unilateral cleft lip and palate (UCLP) comparatively with Class I skeletodental normal subjects.

PATIENTS

Lateral cephalometric and hand-wrist radiographs obtained from 24 patients with UCLP (mean age 12.86 years), along with 20 normal individuals (mean age 12.33 years) used as a control group, were examined.

DESIGN

In addition to standard cephalometric dentofacial variables, lower lip area (superior, middle, inferior) was also measured using a digital planimeter on the lateral cephalograms.

RESULTS

The superior and middle part of the lower lip areas were significantly smaller (p < .05) in the UCLP group, compared to the control group. The inferior and total lower lip areas of patients with UCLP were found to be significantly smaller than controls. The labiomental angle was also smaller (38.79 degrees).

CONCLUSIONS

The results suggest that the lower lip of patients with UCLP is smaller, retruded, and curved, with a deep labiomental sulcus, compared with normal individuals during puberty. Therefore, practitioners should focus not only on the upper lip of patients with UCLP but also should consider the lower lip as it was found distinct from normal individuals during puberty.

Buccolingual inclinations of posterior teeth in subjects with different facial patterns

This study compared the buccolingual inclination of the posterior teeth in subjects with a horizontal growth pattern (proportionally short lower anterior face height) with that of subjects with a vertical growth pattern (proportionally long lower anterior face height). Seventy subjects with permanent dentition were divided into 2 groups. Group I comprised 35 subjects (16 male, 19 female) with Class II Division 2 malocclusion with a horizontal growth pattern, and group II comprised 35 subjects (15 male, 20 female) with a vertical growth pattern. Buccolingual inclinations of the first molar and second premolar were indirectly assessed on photocopies of buccolingual sections of these teeth by measuring their occlusal surface (represented by an imaginary line connecting the lingual and buccal cusps) inclination. The groups were compared with t tests (P <.05). The maxillary posterior teeth of subjects with a vertical growth pattern had a significantly greater buccal inclination compared with those of subjects with a horizontal growth pattern. However, there were no statistically significant differences in the inclinations of the mandibular posterior teeth between the 2 groups.

Lateral facial soft-tissue prediction model: analysis using Fourier shape descriptors and traditional cephalometric methods

This study was designed to investigate the relationship between traditional skeletal cephalometric measurement and Fourier analysis of the lateral soft-tissue profile. A random sample of 121 untreated subjects of European descent, with wide ranges of malocclusions and underlying facial patterns, was selected in the Orthodontic Unit at the University of Melbourne. Lateral cephalograms were available for all subjects. Both traditional lateral cephalometric analysis and Fourier soft-tissue profile analysis were carried out. Multivariate statistical analysis among 11 hard-tissue cephalometric measurements and the first 50 Fourier harmonics was then performed. This analysis formed the basis for a subsequently proposed soft-tissue prediction model. From this model, 50 predicted x- and y-harmonics were generated for each subject in the total sample. Calculation of Pearson's correlation coefficients between the actual and predicted harmonics revealed strong relationships for many of the lower-order harmonics. To further test the model, the prediction-coefficients derived from all 121 subjects were then used to make predictions for the first 50 x- and y-harmonics for a subgroup of 10 independent test subjects. Once again, Pearson's correlations between the actual and predicted harmonics of the test model in the lower-order harmonics revealed strong associations. Superimposition of the actual and predicted soft-tissue outlines, however, revealed that much actual detail in the region between the nose and the chin was still lost using the predicted Fourier harmonics. This suggests that soft-tissue prediction based on this Fourier test model, while already useful in Forensic facial reconstruction, may not yet be appropriate for useful diagnosis and planning in clinical disciplines.

Effect of orthodontic therapy on the facial profile in long and short vertical facial patterns

The purpose of the present study was to evaluate the effects of orthodontic treatment on the soft tissue facial profile of patients with long and short facial types. Orthodontic treatment records of 99 white long-faced and short-faced patients were analyzed to determine the effects of edgewise orthodontic treatment over an average period of 2.16 +/- 0.32 years. The average ages at the initiation and conclusion of treatment were 13.40 +/- 0.40 years and 15.61 +/- 0.29 years, respectively. A significant finding in this study was the large variability in soft tissue response to tooth movement. This variability was due to a wide dispersion of individual results between upper and lower lip change to maxillary and mandibular incisor movement anteriorly or posteriorly. Because of this soft tissue variability among individuals, definite differences between the long-faced and short-faced types could not be identified, nor was it possible to establish definite ratios for change in lip response to incisor movements.