Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity

"Skeletal surgical approach in Down Syndrome with Obstructive Sleep Apnea."

Failing to address Obstructive Sleep Apnea (OSA) in Down Syndrome (DS) patients can have serious consequences, leading to increased mortality. Moreover, a notable portion of individuals find it challenging to tolerate Continuous Positive Airway Pressure (CPAP). Therefore, this study aims to share our experiences in treating adult DS patients with moderate to severe OSA who don't tolerate CPAP using various surgical approaches. A retrospective analytical study including 20 DS with moderate to severe/very severe OSA who had no tolerance to Continuous Positive Airway Pressure (CPAP) was conducted. Regarding the individual skeletal characteristics of each patient various orthognathic surgery techniques were performed. Two in-hospital polysomnographies (PSG) were undertaken for every patient; one before the surgical procedure, while another was performed between 6 and 60 months of the follow-up post-surgery period. Polysomnographic variables were analyzed in this study such as AHI, ODI, and T90, which all showed statistically significant improvement after surgery with a p value in the Wilcoxon test <0,01. These results have remained stable over time, with no recurrences of OSA observed over the five years of follow-up. Thus, orthognathic surgery may be the only viable option for individuals with DS who are unable to tolerate CPAP.

Evaluation of Incisor Position in a Sample of Orthodontic Patients

BACKGROUND

To achieve a successful result, the orthodontist must use a systematic approach to plan the orthodontic treatment. Defining the correct position of the upper and lower incisors and evaluating their relationship with intermaxillary discrepancy and facial divergence have been recognized as the starting point for the diagnostic decision regarding extractions and anchorage requirements. The aim of our study was to analyze the relationship between intermaxillary discrepancy (ANPg^), mandibular inclination (SN^GoGn), lip incompetence, and the positioning of the upper and lower incisors (UIPs and LIPs) in a group of orthodontic patients. This retrospective study included 290 lateral cephalograms in 122 males (42.1%) and 168 females (57.9%) aged 8 to 53 years (median 14; interquartile range IQR 12-17). Data were analyzed by means of one-way Analysis of Variance (ANOVA) and linear regression analysis.

RESULTS

This study showed a statistically significant increase in LIP values in patients with lip incompetence (p < 0.001). Moreover, the distribution of LIPs in groups with various SN^GoGn and ANPg^ angles was significantly different (p < 0.001). The regression analysis also showed a positive association between the LIP and SN^GoGn and between the LIP and ANPg^.

CONCLUSION

The LIP presented a statistically significant difference in patients with and without lip incompetence, which varied significantly in subjects with different sagittal malocclusions and vertical face patterns.

Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial

OBJECTIVE

To determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea-hypopnea index (AHI) and minimum oxygen saturation (MinSaO2) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship.

STUDY DESIGN/METHODS

Thirty-two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross-over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T0), 6 months after the first (T1) and the second (T2) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO2 severity, and intervention sequence were evaluated using linear regression analysis. Intra- and intergroup comparisons for AHI and MinSaO2 were performed using ANOVA and Tukey's test.

RESULTS

The initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO2 severity accounted for 83.1% of MinSaO2 improvement changes. Most AHI reductions and MinSaO2 improvements were due to AT.

CONCLUSIONS

Initial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO2 severity alone accounted for the most changes in MinSaO2 increase. In most cases, RPE had a marginal effect on AHI and MinSaO2 when adjusted for confounders.

Orofacial assessment as digital path for forensic and legal evidence record

In forensic scenarios, such as armed conflicts or mass disasters, the oral cavity can be a valuable source of identification information relevant to legal issues. In many European Union countries, it is mandatory to register dental records for identification purposes. A pilot and quasi-experimental study was performed. The study aims to analyze two methodologies, photography and wireless intraoral (IO) laser scanner, in the scope of the orofacial record in forensic pathology, highlighting their impact on human identification. The IO scanner i700 (Medit, Lusobionic, Portugal) and Canon 5D-Full Frame equipment were used to record the individual status, living patients (n = 5), and forensic cases (n = 5). IO and extraoral anatomical structures were recorded following six parameters: time, mineralized and soft detail, communication, extra devices, and distortion. The statistical analysis was performed in accordance with a scoring system and Mann-Whitney (P < 0.05) analysis. The photography method recorded extraoral data for all samples (score range between 15 and 23). The time elapsed to complete an IO scan in forensic cases was shorter than with photography, without requiring additional sources of light or mirror devices. Living patients and corpses identified statistically significant differences. It can be concluded that laser scanners are a valuable tool in the field of forensic pathology and can be used to record and analyze anatomic-morphological data for identification purposes accurately.

Key points

Human identification engages in orofacial details records.Photographic and laser scans record intraoral and extraoral anatomic structures.Forensic cases assessed by intraoral scanner technology are accurate and less time-consuming, optimizing the orofacial data for identification.

Mapping the evolving trend of research on Class III malocclusion: a bibliometric analysis

OBJECTIVES

This study aimed to provide visualized knowledge maps to show the evolving trends and key focal points of Class III malocclusion research through a comprehensive bibliometric analysis.

MATERIALS AND METHODS

Class III malocclusion research published between 2000 and 2023 was retrieved from the Web of Science Core Collection. VOSviewer was utilized to count the citation and publication number of authors, institutions, countries and journals. Co-occurrence, co-citation, and cluster analyses and burst detection were conducted using CiteSpace.

RESULTS

A total of 3,682 publications on Class III malocclusion were included in the bibliometric analysis. During 2000-2023, both the annual publication count and citation frequency exhibited a gradual upward trajectory, with a noticeable surge in recent years. In terms of production and citation counts of Class III malocclusion research, the core journal is the American Journal of Orthodontics and Dentofacial Orthopedics. Furthermore, apart from the primary keyword 'Class III malocclusion', 'orthognathic surgery' was identified as keyword with the most frequency. The cluster analysis of cited references reveals that the research focal points have shifted to 'skeletal anchorage' and 'surgery-first approach'. Furthermore, the burst detection identified 'quality of life' as a potential research hotspot since it has recently gained increasing scholarly attention.

CONCLUSIONS

The current study provides scholars with the knowledge maps of evolving trends and prominent topics of Class III malocclusion research and a summary of research progress on various priorities during different periods. These findings are expected to provide a valuable guidance to facilitate the future research on Class III malocclusion.

Evaluation of the soft tissue facial profile in different skeletal malocclusions in relation to age

BACKGROUND

The aim of the study was to assess the thickness of the soft tissue facial profile (STFP) in relation to the skeletal malocclusion, age and gender.

METHODS

All patients, aged 7-35 years, who were seeking orthodontic treatment at the Department of Orthodontics, Medical University of Warsaw between 2019 and 22 were included in the study. All patients had lateral head radiographs taken before the treatment. The cephalometric analysis was performed including the STFP analysis. The patients were allocated to one of six groups based on age and skeletal relations (ANB angle). The minimum number of patients in each group was 60 with equal gender distribution. The STFP analysis included ten linear measurements.

RESULTS

A total of 300 patients were included in the study and allocated to five groups. Group 6 (growing patients with skeletal Class III malocclusion) was not included in the study as it failed to achieve the assumed group size. There were significant differences in the thickness of the STFP in relation to the skeletal malocclusions. Adults with skeletal Class III malocclusion had significantly thicker subnasal soft tissues compared to patients with skeletal Class I and Class II malocclusions. The thickness of the lower lip in patients with Class II skeletal malocclusion was significantly bigger compared to the other groups. Children and adolescents with Class II malocclusions had thicker lower lip in comparison to the group with Class I malocclusion. The majority of the STFP measurements were significantly smaller in children and adolescents compared to adults. The thickness of the STFP in males was significantly bigger in all age groups compared to females.

CONCLUSIONS

The thickness of facial soft tissues depends on the patient's age and gender. The degree of compensation of the skeletal malocclusion in the STFP may be a decisive factor during orthodontic treatment planning regarding a surgical approach or a camouflage treatment of skeletal defects.

Facial, dental, periodontal, and tomographic characteristics of the etiology of excessive gingival display: a cross-sectional clinical study

PURPOSE

In this study, we examined the facial, dental, periodontal, and tomographic features associated with excessive gingival display (EGD) when smiling in young adults self-reporting a "gummy smile," categorized by potential etiology.

METHODS

The study included 25 healthy adults (18-42 years old; 23 women and 2 men) who self-reported EGD. Participants completed a health questionnaire and underwent a periodontal examination assessing probing depth, clinical attachment level, keratinized gingival width, and gingival thickness (GT). Extraoral and intraoral photographs were taken for smile analysis and to determine facial and dental characteristics. Cone-beam computed tomography (CBCT), performed with a lip retractor in place, was used to measure the distance from the gingival margin (GM) to the cementoenamel junction (CEJ), the distance from the CEJ to the alveolar crest, buccal bone thickness, and GT. The extent of EGD when smiling was quantified as the distance from the GM at the upper central incisor to the upper lip edge when smiling fully. The smile was categorized into 4 types based on gingival exposure characteristics observed during full smile.

RESULTS

Most participants were female (92%), with a mean age of 28.77±6.56 years. The average EGD was 4.2±2.44 mm, extending bilaterally from the anterior to the posterior maxilla. Two primary etiological factors were identified, alone or in combination: vertical maxillary excess (VME), predominantly indicated by an anterior maxillary height greater than 29 mm and a large interlabial gap; and altered passive/active eruption (APE), primarily characterized by square teeth (64%), upper central incisor width-to-height ratio (CIW:CIH) exceeding 87.5%, and GM-CEJ distance on CBCT exceeding 2 mm.

CONCLUSIONS

These findings suggest a multifactorial etiology of EGD, primarily associated with VME and APE. Clinical periodontal examination, CBCT conducted with a lip retractor, CIW:CIH, and soft tissue facial cephalometric analysis may aid in identifying the etiological factors of EGD.

Novel Parameter in Pre-Surgical Orthodontic Preparation: A Retrospective Study on the Role of the Upper Incisor Position and a Morphological Evaluation of the Anterior Nasal Spine

The position and inclination of the incisors play a crucial role in achieving optimal outcomes in orthodontic and orthognathic surgical treatment, given their impact on facial aesthetics. Background/objectives: Due to numerous distorting factors that affect the reliability of the ANB angle, the aim of the present work is to evaluate a more constant parameter over time, the anterior nasal spine (ANS), and explore whether aligning the incisal margin of the upper incisors with the anterior nasal spine could be a reliable indicator for achieving appropriate labial support in pre-surgical orthodontic preparation. Methods: From a pool of 500 cone beam computed tomography (CBCT) scans, 50 CBCT examinations displaying a Class 1 skeletal pattern (ANB = 2° ± 2°) with an intermediate (3.2-4 mm) or mixed (4-6 mm) sagittal maxillary position (MX), as determined by the 3D multiplanar total face approach (TFA), were selected and compared with CBCT examinations randomly chosen from the initial pool. Moreover, 12 landmarks were identified, and measurements were automatically obtained, using software, and recorded. Mean and standard deviation values were calculated for each sample. A comparison was made between the two samples, aligning the results with the morphological analysis of the anterior nasal spine and the sagittal position of the upper maxilla. Results: In Class 1 subjects, the distance between the incisal margin and the plane passed in relation to the anterior nasal spine should range between -1 mm and 1 mm, aligned with or slightly ahead of the anterior nasal spine or slightly ahead of this limit. Conclusions: The anterior nasal spine can serve as a reliable reference point for planning the position of the upper incisors, with excessive proclination or retroclination from this reference point deemed unacceptable.

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.

Which Skeletal Factors Can Affect Lip Canting in Facial Asymmetry?: Statistical Analysis

Lip canting, which is a noticeable factor in patients with facial asymmetry, can be influenced by the dentofacial skeleton. During orthognathic surgery, postoperative changes in facial soft tissue occur along the newly positioned hard tissue. Therefore, the evaluation of soft tissue before surgery is important. The purpose of this study was to investigate the skeletal factors that can affect lip canting by statistically comparing 2 facial horizontal planes using a three-dimensional reconstruction model. The findings of the present study showed a statistical correlation between lip canting and 3 skeletal factors: menton deviation, maxillary canting, and ramal length differences. Furthermore, a statistical correlation was identified between the Frankfort Horizontal plane and the intercanthal plane compared with the lip canting line. This result suggests that the intercanthal plane could be a standard horizontal plane in three-dimensional reconstruction model analysis.

Soft tissue changes with skeletal anchorage in comparison to conventional anchorage protocols in the treatment of bimaxillary proclination patients treated with premolar extraction : A systematic review

PURPOSE

This review systematically evaluates the evidence related to comparisons between skeletal and conventional anchorage protocols in the treatment of bimaxillary proclination patients who underwent premolars extraction with respect to soft tissue profile changes, treatment duration and three-dimensional (3D) soft tissue changes.

METHODS

Electronic database search and hand search with no language limitations were conducted in the Cochrane Library, PubMed, Ovid, Web of Science, Scopus and ClinicalTrials.gov. The selection criteria were set to include studies with patients aged 13 years and above requiring extractions of upper and lower first premolars to treat bimaxillary proclination with high anchorage demand. Risk of bias assessment was undertaken with Cochrane's Risk Of Bias tool 2.0 (ROB 2.0) for randomised controlled trials (RCTs) and ROBINS‑I tool for nonrandomised prospective studies. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for quality assessment. Results were summarised qualitatively; no meta-analysis was conducted.

RESULTS

Two RCTs and two nonrandomised prospective studies were included. According to the GRADE approach, there is low to very low quality of evidence that treatment using mini-implant anchorage may significantly change nasolabial angle, upper and lower lip procumbence, and facial convexity angle compared to treatment with conventional anchorage. Similarly, very low quality evidence exists showing no differences in treatment duration between treatments with skeletal or conventional anchorage.

CONCLUSIONS

The overall existing evidence regarding the effect of anchorage protocols on soft tissue changes in patients with bimaxillary protrusion and premolar extraction treatment plans is of low quality.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42020216684.

Using a structured light scanner to evaluate 3-dimensional soft-tissue changes after extracting 4 premolars in young adult female patients

INTRODUCTION

Facial esthetics have always received much attention in orthodontic treatment, especially in young adult female patients. Three-dimensional (3D) soft-tissue changes after orthodontic extraction have not been fully explained. This study evaluated the 3D morphologic changes after orthodontic extraction in young female patients using a structured light scanner.

METHODS

Forty-five adult female patients aged 20-25 years were enrolled in our study. The treatment group consisted of patients who received orthodontic treatment with 4 premolar extractions, and the control group was composed of young female volunteers who had not undergone any orthodontic treatment. To monitor the soft-tissue changes, 9 morphologic regions and 12 landmarks were identified for the 3D deviation analyses. The spatial deviations of landmarks and regions in the x, y, and z directions were constructed for quantitative analysis. Color map images were constructed to visualize soft-tissue displacement as a qualitative evaluation. The paired sample test was used to compare differences at the beginning of the experiment (T0) and after 24 months (T1) in both groups. An independent t test with Bonferroni correction was performed to compare differences between the treatment and control groups. A linear regression test was performed between incisor retraction and changes in the perioral tissues.

RESULTS

Subtracting the effect of aging from the lip changes in the control group, the treatment group showed a statistically significant difference in the displacement of labrale superius (-1.37 mm), labrale inferius (-1.89 mm), the upper lip region (-0.98 mm), and the lower lip region (-1.36 mm) along the z-axis. No significant differences were found between the treatment and control groups in the temporal, parotideomasseteric, and buccal regions. Pearson correlation tests indicated a positive correlation between incisor tip retraction and changes in soft tissues (two-dimensional cephalometric analysis, 3D landmark measurements, and 3D regional measurements). The correlation coefficient ranged between 0.45 and 0.55.

CONCLUSIONS

Three-dimensional soft-tissue changes were mainly concentrated in the upper and lower lip regions in adult female patients after the 4 premolars were extracted. For female patients aged 20-25 years with 4 extracted premolars, soft-tissue changes in the temporal, parotideomasseteric, and buccal regions were not clinically significant.

Oral health professional intervention and child physical abuse-European legal approach

Physical violence against children and adolescents is an issue of Global Public Health. This study aims to identify traumatic injuries and the medicolegal temporary framework of the victim's profile in the European legal approach. Participants and setting include the following: the clinical reports of a Portuguese European Clinical Academic Center database were analysed. An observational and prospective cohort study was performed. A descriptive analysis of the variables was conducted, considering gender, bimodal age groups, place of residence, offender data, place of occurrence, aetiology, localization, type of injuries, personal injury assessment by Quantum doloris, and injury time. The statistical analysis was performed by Spearman's rho and Kendall's tau-b correlation tests, Pearson's chi-square test of independence (χ2), and Mann-Whitney and Kruskal-Wallis nonparametric tests (P < 0.05). The relationship between age groups and the place of occurrence was statistically significant (P = 0.001). Orofacial and nonorofacial injuries were related (P = 0.035). The General Data Protection Regulation is not a barrier to the treatment and sharing of justified data but a framework for safeguarding individuals' fundamental rights, including the Right to Health. Meticulous reporting of the clinical situation involves the victim, the occurrence, and the potential offender.

Key points

An oral health professional's notification of the event is a fundamental step of the judicial process.The timeline is the core of traumatic injury assessment in a child physical abuse scenario.Medicolegal evaluation impacts disability prevention, imputability, and notification of the crime.

Occlusal plane rotation and orthodontic decompensation: influence on the outcome of surgical correction of class III malocclusion

PURPOSE

The aim of this retrospective multicenter study is to evaluate the influence of surgical manipulation of the upper occlusal plane (UOP) and orthodontic decompensation on the outcome of class III orthognathic surgery.

METHODS

Incisor inclinations, occlusal plane inclination as well as skeletal and soft tissue changes were assessed in lateral cephalograms of 85 class III patients who had previously undergone orthognathic surgery. Fourteen linear and eight angular measurements were performed on each radiograph at the beginning of treatment (T0), before surgery (T1) and at the end of treatment (T2) using imaging software. After measurement of variables, Mann-Whitney U‑test, repeated-measures analysis of variance (ANOVA) with Bonferroni multiple comparison test, and Spearman's correlation analysis were performed.

RESULTS

A statistically significant improvement was observed in both sagittal skeletal and soft tissue measurements (p < 0.05). Surgical change in UOP was significantly correlated with changes in overbite, upper lip strain and soft tissue B‑point change in the sagittal direction (p < 0.05). Overjet change was significantly correlated with changes in the soft tissue and all sagittal skeletal parameters except for SNA. Changes in the incisor inclinations was significantly correlated with changes in the sagittal skeletal parameters and lower facial height. Significant differences were also observed between the groups with induced clockwise or counterclockwise rotation of the mandible in terms of IMPA (long axis of LI to mandibular plane), overbite, upper lip strain and position of soft tissue B‑point (p < 0.05).

CONCLUSION

Sufficient dental decompensation is crucial for controlling the sagittal as well as the vertical relationship during surgery. Counterclockwise rotation provides an increase in sagittal projection of the mandibular body at the soft tissue B‑point.

[Aesthetic preferences of individuals when evaluating photographs of facial profiles with different sagittal and vertical growth patterns. A cross-sectional study]

Objective

To evaluate the aesthetic preferences of individuals by observing photographs of different facial profiles with different sagittal and vertical growth patterns.

Materials and Methods

Cross-sectional study that evaluated 300 students from a private university. Edited photographs of a man and a woman were used. The maxilla being moved in a vertical direction while the mandible was moved in a sagittal direction, various combinations of the photographic profile of the two individuals were created. These movements created 9 photographic profiles for the woman and the man; for intra-observer reliability, two photo profiles of both sexes were duplicated. Chi square tests and binary logistic regression were used. P<0.05.

Results

In general, the evaluated individuals mostly preferred the type 6 profile (65.7%), followed by the type 5 profile (21.7%) (slightly convex). It was found that for every year of age that an individual increases, there is a 31% greater chance of choosing one of these profiles.

Conclusions

Both sexes prefer a straight or slightly convex profile, and as age increases, individuals prefer a straight profile.

Evaluation of optimal anterior-posterior position of upper incisors through ANS point: a retrospective study on a Chinese sample

OBJECTIVES

This study was designed to determine the optimal anterior-posterior (AP) position of upper incisors through Anterior Nasal Spine (ANS) point.

MATERIALS AND METHODS

Lateral cephalometric radiographic images of 690 patients were collected and divided into a derivation group and a validation group, and the former were subdivided into a proper AP position (PAP) group and an improper AP position (iPAP) group. The distance from facia-axis (FA) point of upper incisors to the line perpendicular to Frankfort horizontal (FH) plane through ANS (FA-ANS) was measured, and the relationship between FA-ANS and several cephalometric indices were studied through Pearson correlation analysis. Receiver operating characteristic (ROC) curves for different clinical indices were analyzed to evaluate the diagnostic efficiency of optimal AP position of upper incisors.

RESULTS

The average value of FA-ANS in PAP group was 0.57±1.99, which was significantly different from FA-ANS in iPAP group. Cephalometric indices such as U1-NA, U1-SN, AB-NPo, UL-TVL, Wits, and ANB were found to be correlated with FA-ANS. The receiver operating characteristic (ROC) curves represented a greater diagnostic efficiency of FA-ANS compared with other clinical indices.

CONCLUSIONS

ANS point, as a stable skeletal landmark, could be used to access an optimal AP position of upper incisors, providing aids to clinical diagnosis and treatment goal determination for clinical practice.

CLINICAL RELEVANCE

A new index FA-ANS, together with other traditional indices, could help determine the optimal position of upper incisors and provide a personalized therapeutic plan.

Prevalence of Malocclusions in Down Syndrome Population: A Cross-Sectional Study

Background and Objectives: A higher prevalence of dental malocclusion has been suggested among individuals with Down Syndrome (DS) compared to controls, although no studies to date have investigated such a difference according to age group. Therefore, the aim of this study was to compare the prevalence of dental malocclusion and other orthodontic measures between DS and non-syndromic (non-DS) individuals across three age groups of children, adolescents, and adults. Materials and Methods: This cross-sectional study was conducted on a total of 147 patients. Of those, 72 were diagnosed with DS and were divided into N = 15 children (<10 years), N = 23 adolescents (10-18 years) and N = 34 adults (>18 years). The remaining 75 patients were sex- and age-matched controls. The two groups were compared according to age group in terms of the prevalence of dental malocclusion, measures of sagittal, vertical, and transverse discrepancy, facial profile, and probable sleep bruxism with chi-square tests for proportion. Results: The DS patients consistently exhibited a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to the non-DS patients, regardless of age group. The non-DS adolescents presented with a significantly higher prevalence of convex profile than the DS adolescents. The adolescent and adult DS patients most commonly presented with a maxillary transverse discrepancy and posterior crossbite compared to the non-DS controls. The DS adults had a higher prevalence of probable sleep bruxism. Conclusions: Patients with DS showed a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to non-DS controls, regardless of age group. Other orthodontic measures showed a fluctuation according to the age group considered.

The Correlation of a Novel Photographic Parameter for Facial Profile Assessment in Subjects With Different Sagittal Malocclusions: A Prospective Study

Aim The soft tissue paradigm shift is the current trend in orthodontic diagnosis and treatment planning. This study's aim was to assess the correlation of newly derived photographic Frankfort horizontal plane-subnasale to soft tissue pogonion (FSA) angle with other established soft tissue cephalometric angles, such as the Z angle and the Holdaway (H) angle, for estimating facial profile convexity in subjects with all classes of sagittal malocclusions. Materials and methods This prospective study included a sample of 60 Dravidian population subjects consisting of 30 males and 30 females with different skeletal sagittal malocclusions (Class I, Class II, and Class III) based on the radiographic criteria (ANB angle). The Z and Holdaway angles on lateral cephalograms were compared with the FSA angles in cephalograms and digital profile photographs. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) software version 23.0 (IBM SPSS Statistics, Armonk, NY). Pearson's correlation was done to assess the correlation between soft tissue FSA angle on digital photographs and cephalometric angle (Z angle and Holdaway angle). Results The overall Pearson's correlation was significant (p < 0.05) between the Z and FSA angles in Class I, II, and III malocclusions, which had a high positive correlation. There was a significant positive correlation (p < 0.05) between the Holdaway and FSA angles in subjects with Class I and Class II malocclusions. A moderate positive correlation was noted between the Holdaway and FSA angles in Class III. Conclusion Photographic FSA angle can be used to evaluate the facial profile of subjects with different sagittal malocclusions. This angle has a good correlation with other cephalometric profile measures, such as the Z and Holdaway angles used to assess facial profile convexity.

Influence of social media on the esthetic perception of the lip profile of orthodontic patients

Objective

To identify the use of social media as an influencing factor of the orthodontic patient's preferences regarding the lip profile protrusion.

Methods

A two-part cross-sectional questionnaire was distributed to orthodontic patients in Spain and The Netherlands. The first part collected general data and frequency of use of different social media. The second part consisted of a series of modified female and male silhouettes presenting different lip profile positions. Each participant was required to choose both the (male and female) most attractive silhouette and the least attractive one.Student t-test, one-way ANOVA and Chi-square test were performed. Effect sizes were calculated to express the magnitude of differences between samples.

Results

The Spanish sample resulted in a moderate higher tendency (R² = 0.060) to choose protrusive lips as the most attractive lip profile for females, on subjects with more frequent use of social media. A medium tendency (R²⁼0,26) was observed as result of low users of social media choosing and ideal lip profile for men.The Dutch sample showed that high users of social media tended to choose as attractive a more protrusive female lip profile versus low users (p < .01). This was also observed (p < .05) on male attractive lip profiles.

Conclusions

Results suggest that frequent users of social media platforms tend to prefer more protruded lips than their less frequent counterparts. This information is valuable to be considered when formulating a treatment plan to satisfy the patient's expectations.

Managing Predicted Post-Orthognathic Surgical Defects Using Combined Digital Software: A Case Report

For facial abnormalities, recent developments in virtual surgical planning (VSP) and the virtual design of surgical splints are accessible. Software companies have worked closely with surgical teams for accurate outcomes, but they are only as reliable as the data provided to them. The current case's aim was to show a fully digitized workflow using a combination of three digital software to correct predicted post-upward sliding genioplasty defects. To reach our goal, we presented a 28-year-old man with long-face syndrome for orthodontic treatment. Before orthognathic surgery, a clinical and paraclinical examination was performed. For a virtual surgical plan, we used the dedicated surgical planning software NemoFab (Nemotec, Madrid, Spain) and Autodesk MeshMixer (Autodesk Inc., San Rafael, CA, USA). To create the design of the digital guides, DentalCAD 3.0 Galway (exocad GmbH, Darmstadt, Germany) and Autodesk MeshMixer (Autodesk Inc., San Rafael, CA, USA) were used. The patient had undergone bilateral sagittal split osteotomy in addition to Le Fort 1 osteotomy and genioplasty, followed by mandible base recontouring ostectomy. Stable fixation was used for each osteotomy. Based on our case, the current orthognathic surgery planning software was not able to perform all the necessary operations autonomously; therefore, future updates are eagerly awaited.

Buccal Fat Pad Flap in Orthognathic Surgery: Facial Soft Tissue Volume's Redistribution Strategy to Improve the Esthetic Outcomes

Traditional osteotomic procedures can fail to restore the natural appearance of the face and can sometimes highlight the intrinsic decrease in the volume of soft tissues; in these cases, soft-tissue-improving procedures should be considered. The authors describe a new strategy that can help redistribute facial soft tissues and enhance facial esthetics in orthognathic surgery using a pedicled buccal fat flap to increase the volume of the malar soft tissue envelope. Between January 2017 and January 2021, 47 patients with dentoskeletal deformity who needed to increase the projection of the cheekbone contour underwent orthognathic surgery with simultaneous pedicled buccal fat pad flap for malar augmentation. Preoperative and postoperative facial appearance was evaluated by clinical examination and analysis of photographs to assess the occlusal and esthetic outcomes. A patient questionnaire was used to assess self-evaluation satisfaction scores. A good projection of the cheekbone contour was obtained, and noticeable postoperative facial esthetic improvement was observed in all patients. The overall esthetic improvement was considered "excellent" by 89.36% of patients, and facial esthetic improvement was assessed as "very much improved" or "much improved" by the clinicians in 95.7% of cases. The buccal fat pad flap is a promising and easy technique in orthognathic surgery that helps harmonize the malar region; improve esthetic outcomes with predictable and lasting long-term stability; and ensure very low morbidity and great esthetic satisfaction.

Systematic Review and Meta-analysis of Facial Anthropometric Variations Among Cisgender Females of Different Ethnicities: Implications for Feminizing Facial Gender Affirming Surgery

BACKGROUND

Feminizing Facial Gender-Affirming Surgery (FFGAS) is gaining popularity among the diverse population of patients impacted by gender incongruence. However, most studies examining facial femininity are based on Caucasians. Thus, it is unclear if ethnic differences exist in anthropometric measures relevant to FFGAS procedures. This study aims to analyze ethnic anthropometric variations in the cisgender female face to identify differences that are potentially relevant to FFGAS.

METHODS

A systematic review and meta-analysis of the PubMed, EMBASE, and Cochrane databases was performed following PRISMA guidelines on June 25, 2021. Original studies reporting facial anthropometry in cisgender women were included. Anthropometric measures of interest included mandibular and zygomatic width, facial and forehead height, and nasolabial angle. A meta-analysis was performed using a linear mixed-effects model for each anthropometric measure.

RESULTS

A total of 1246 abstracts were screened, yielding 21 articles that met the inclusion criteria. Facial anthropometric data of 4792 cisgender females of 16 different ethnicities were analyzed. This meta-analysis demonstrated that compared with Caucasian cisgender women, Japanese, Chinese, and Korean cisgender women had a wider mandible (Japanese +20.13 mm [SE 4.43, P<0.001, P value adjusted for multiple comparisons (p-adj)=0.002], Chinese +16.22 mm [SE 4.39, P=0.002, p-adj=0.013]; and Korean +14.46 mm [SE 3.97, P=0.002, p-adj=0.014]). Further, when compared with Caucasian cisgender women, Chinese cisgender women demonstrated a larger zygomatic width, African American cisgender women tended to have smaller nasolabial angles, and Indian and Japanese cisgender women tended to have a smaller and larger facial height, respectively. However, following P value adjustment for multiple comparisons, these differences were not found to be statistically significant.

CONCLUSIONS

We found that mandibular width tends to be greater for Japanese and Chinese cisgender women relative to Caucasian cisgender women. This data may be useful in counseling patients during preoperative evaluations ahead of mandibular reduction. No other anthropometric features were found to be significantly different among the ethnic groups studied. This portends that current approaches to FFGAS, which emphasize patient-specific needs and maintenance of a harmonious appearance, may require minimal or no adjustment to account for ethnic facial anthropometric differences.

Barcelona line. A multicentre validation study of a facial projection reference in orthognathic surgery

The purpose of this study was to validate an already published facial anteroposterior reference: upper incisor (UI) to soft tissue plane or so-called Barcelona line (BL) to trace the most aesthetic sagittal position of the maxilla. A cross-sectional multicentre evaluation of Caucasian patients from Spain and Brazil with different anteroposterior maxillary positions was designed. Sagittal images in natural head orientation of grouped patients according to the horizontal distance from the UI to BL were ranked by healthcare professionals and non-professional Caucasian raters according to the aesthetic perception of each profile, using a digital survey. Seventy-four raters (50 laypeople, 12 orthodontists, and 12 maxillofacial surgeons) rated 40 profiles. The best-rated profile corresponded to group 3 (0-4 mm UI-BL) with 61.8% of positive evaluations, followed by group 4 (≥ 4 mm UI-BL): with 61.1%. On the other hand, group 1 (≤-4 mm UI-BL) was the worst-ranked profile with 71.8% of negative evaluations, followed by group 2 (-4-0 mm UI-BL): with 59.6% of negative evaluations. The correlation between the mean assessment score and UI-BL showed a moderately-strong association (r = 0.68, p < 0.001). The inter-rater reliability of assessment (74 evaluators) was moderate (k = 0.49, 95% CI: 0.39 to 0.59). The results suggest that protrusive middle-third facial profiles are preferable. The BL is proposed as a simple, individualised, and reproducible tool to trace an aesthetic sagittal position of the maxilla in orthognathic surgery.

Impact of facial components on the attractiveness of face: A perception-based study

INTRODUCTION

Magazines and television displays are not merely crammed with faces-they are filled with appealing faces, and both men and women are interested in a suitable partner's appearance. This study investigated what makes a face attractive and whether perception-related differences exist between facial attractiveness and facial components.

METHODS

In this descriptive-analytical study, frontal and lateral view photographs of 18 young adults (9 male and 9 female) in Class I, II, and III malocclusions were assessed by 90 orthodontists, dentists, models, and laypeople using a 7-point Likert scale in terms of attractiveness. Based on scores, attractive and unattractive groups were formed. Using image analysis software, a range of defined length, angles, perimeter, and area for lips, nose, and chin were measured for the attractive group. For statistical analysis, each group was compared using a 1-way analysis of variance. Logistic regression was performed to analyze the factors of different parameters to the attractiveness of facial components.

RESULTS

Overall full-face width, upper lip angle, lip area, and mentolabial angle was significantly different in all the 3 classes (P ≤0.05). In Class I malocclusion, nasolabial angle among orthodontists, nasofrontal angle among dentists, lower lip among models, and full-face width among laypeople were responsible for facial attractiveness variation. In Class II malocclusion, nose to upper lip among orthodontists, Cupid's bow among dentists, wider face among models, and upper lip among layperson were responsible for variation in facial attractiveness. In Class III malocclusion, lower lip angle among orthodontists and dentists, Cupid's bows among models and layperson was responsible for variation in facial attractiveness.

CONCLUSIONS

In Class I faces, lips (Cupid's bows, lower lips, lip areas), nose (nasolabial, nasofrontal, and nasomental angles), and chin (lower lip to chin) contributed to the overall attractiveness of the face, while in Class II faces, lips (upper lip length, interbow distance, lower lip angle), nose (full facial convexity), and chin (mentolabial sulcus), as well as a greater full-face width contributed to the overall attractiveness of the face. In Class III faces, lips (lower lip angle, upper lip length), nose (nose tip angle, full facial convexity), and chin (mentolabial sulcus depth) contributed to the overall attractiveness of the face.

A Full Computerized Workflow for Planning Surgically Assisted Rapid Palatal Expansion and Orthognathic Surgery in a Skeletal Class III Patient

In the present case report, we present and discuss the digital workflow involved in the orthodontic/orthognathic combined treatment of a skeletal malocclusion correction in a 17-year-old male patient affected by a skeletal class III, facial asymmetry, sagittal and transversal deficiency of the medium third of the skull, dental crowding, and bilateral cross-bite. The first stage of the treatment involved surgically assisted rapid palatal expansion and occlusal decompensation, using fixed self-ligating appliance. An orthodontic software package (i.e., Dolphin 3D Surgery module) was used to perform virtual treatment objective evaluation by integrating data from cone beam computer tomography acquisition, intraoral scan, and extraoral photographs. The software allowed a comprehensive evaluation of skeletal, dento-alveolar, and soft-tissue disharmonies, qualitative and quantitative simulation of surgical procedure according to skeletal and aesthetic objectives, and, consequently, the treatment of the malocclusion. Using a specific function of the software, the surgical splint was designed according to the pre-programmed skeletal movements, and subsequently, the physical splint was generated with a three-dimensional (3D) printing technology. Once a proper occlusal decompensation was reached, a Le Fort I osteotomy of the maxilla and a bilateral sagittal surgical osteotomy of the mandible were executed to restore proper skeletal relations. The whole treatment time was 8 months. The orthodontic/orthognathic combined treatment allowed to correct the skeletal and the dental imbalance, as well as the improvement of facial aesthetics. Accordingly, the treatment objectives planned in the virtual environment were achieved. Virtual planning offers new possibilities for visualizing the relationship between dental arches and surrounding bone and soft structures in a single virtual 3D model, allowing the specialists to simulate different surgical and orthodontic procedures to achieve the best possible result for the patient and providing an accurate and predictable outcome in the treatment of challenging malocclusions.

The untold history of planning in orthognathic surgery: a narrative review from the beginning to virtual surgical simulation

We aimed to produce a narrative review of planning orthognathic surgery, chronologically. Also, to present flaws of methods and the future of orthognathic surgery planning. The search was carried out mainly in PubMed, SCOPUS, Embase, and Cochrane databases. Also was complemented by manual search in reference lists from identified studies and in grey literature. The first orthognathic surgery was reported in 1849, and it took more than a century for the development of the traditional orthognathic 2D planning. Besides the advances, surgeons observed failures and lacks on 2D method in representing with reliability the facial and maxillary tridimensional structure (3D). With technological developments in 90s and 2000s, methodological improvements were granted, and the 3D protocol was created. The CASS and Charlotte protocols were the earliest 3D planning protocols conceived. Since then, some steps were simplified, and new technologies are being developed and added to create a more reliable and precise way of planning orthognathic surgery.

A soft tissue analysis for central India population

Based on surgical-orthodontic treatment planning and prediction system Tony G. McCollum(TOMAC), the present study aims to determine surgical norms for Central India population and to evaluate the variation between Central India males and females. Digital lateral cephalograms of hundred subjects (50 males and 50 females) of 15- 25 years of age were obtained. These radiographs were manually traced by single operator based on the parameterstaken from TOMAC soft tissue analysis. The data obtained was statistically analyzed using Mann-Whitney U test and One-sample Wilcoxon Signed Rank test. Statistically significant difference were observed between the Central India population and Caucasian population and also significant sexual dimorphism was noted among the population of Central India. There exist racial diversity between Central India population and the Caucasian population.Therefore, it becomes necessary to have separate norms for different ethnic groups and choose the norms carefully suited to the treatment needs of individual population.

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.

Combined orthodontic and surgical open bite correction

OBJECTIVES

To present a clinical description of the team's treatment techniques.

MATERIALS AND METHODS

In Part 1, 30 patients underwent segmental maxillary orthodontics, multisegment Le Fort I, and bilateral sagittal osteotomies of the mandible. Part 1 reported excellent occlusal stability at a mean follow-up of 49.43 months (range, 36-92 months). Cases presented in Part 2 were selected based on availability of excellent technique photographs. The same techniques described in Part 2 cases were used on all Part 1 patients.

RESULTS

The coordination of arch widths and forms, overbite, overjet, and maxillary curve of Spee corrections were stable using the team protocols for orthodontic and surgical treatment.

CONCLUSIONS

In the study group, long-term three-dimensionally stable occlusal results were achieved. To duplicate these results, specific orthodontic preparation, intraoperative surgical steps, and postsurgical steps must be carefully planned and executed. These steps are described in this article, Part 2.

Combined orthodontic and surgical open bite correction

OBJECTIVES

To examine the stability of combined surgical and orthodontic bite correction with emphasis on open-bite closure. All study patients were treated with strict and consistent orthodontic and surgical protocols.

MATERIALS AND METHODS

Study inclusion required all patients to have anterior open bites, maxillary accentuated curve of Spee, 36-month minimum follow-up, and no temporomandibular joint pathology. Thirty patients met the inclusion/exclusion criteria. Importantly, segmental upper arch orthodontic preparation (performed by EG) was used. Surgery consisted of a multisegment Le Fort I (MSLFI) combined with a bilateral sagittal osteotomies (BSSO). Surgery was performed (by ADA and LT) at the Department of Dentistry and Maxillofacial Surgery of the University of Verona, Italy.

RESULTS

The long-term open bite and overjet relapse were not statistically significant. The mean transverse relapse of the upper and lower molars was statistically significant. Of great importance, the upper and lower arch widths narrowed together, maintaining intercuspation of the posterior dentition which prevented anterior open bites from developing.

CONCLUSIONS

This study revealed stability of three-dimensional occlusal correction including anterior open bite. Stable open bite closure was achieved by using rigid protocols for orthodontic preparation, surgical techniques, surgical follow-up, and orthodontic finishing.

Teleorthodontics: Where Are We Going? From Skepticism to the Clinical Applications of a New Medical Communication and Management System

Teleorthodontics represents the orthodontic care system involving remote management of orthodontic treatment. Despite skepticism, there are several advantages of including teleorthodontics in the clinical orthodontic practice. In the present review, we discuss the lights and shadows of this new communication healthcare system and its applications in the field of orthodontics that is destined to change the future of our clinical practice. For this purpose, we have provided a point-to-point analysis based on data from the most valuable scientific evidence on this topic. The information and data discussed in the present paper were obtained from the most relevant studies evaluating the performance of teleorthodontics and remote monitoring systems in clinical practice.

Proposed parameters of optimal central incisor positioning in orthodontic treatment planning: A systematic review

OBJECTIVE

Planning of incisal position is crucial for optimal orthodontic treatment outcomes due to its consequences on facial esthetics and occlusion. A systematic summary of the proposed parameters is presented.

METHODS

Studies on Google Scholar©, PubMed©, and Cochrane Library, providing quantitative information on optimal central incisor position were included.

RESULTS

Upper incisors supero-inferior position (4-5 mm to upper lip, 67-73 mm to axial plane through pupils), antero-posterior position (3-4 mm to Nasion-A, 3-6 mm to A-Pogonion, 9-12 mm to true vertical line, 5 mm to A-projection, 9-10 mm to coronal plane through pupils), bucco-lingual angulation (4-7° to occlusal plane perpendicular on models, 20-22° to Nasion-A, 57-58° to upper occlusal plane, 16-20° to coronal plane through pupils, 108-110° to anterior-posterior nasal spine), mesio-distal angulation (5° to occlusal plane perpendicular on models). Lower incisors supero-inferior position (41-48 mm to soft-tissue mandibular plane), antero-posterior position (3-4 mm to Nasion-B, 1-3 mm to A-Pogonion, 12-15 mm to true vertical line, 6-8 mm to coronal plane through pupils), bucco-lingual angulation (1-4° to occlusal plane perpendicular on models, 87-94° to mandibular plane, 68° to Frankfurt plane, 22-25° to Nasion-B, 105° to occlusal plane, 64° to lower occlusal plane, 21° to A-Pogonion), mesio-distal angulation (2° to occlusal plane perpendicular on models).

CONCLUSIONS

Although these findings can provide clinical guideline, they derive from heterogeneous studies in terms of subject characteristics and reference methods. Therefore, the optimal incisal position remains debatable.

Factors that affect lip changes following incisor retraction in Vietnamese adults with a convex facial profiles

OBJECTIVE:

This study aimed to evaluate the factors that influence lip change through the results of tooth anterior retraction by fixed orthodontic treatment in Vietnamese adult patients with a convex facial profile.

MATERIALS AND METHODS:

This prospective study included 32 Vietnamese adults who have convex facial profiles. Digital software measurements according to Arnett's analysis and the superimposition method were performed to evaluate the changes in dentoskeletal structures, and soft tissue variables included lip change. A multiple logistic regression model was applied with various explanatory variables to analyze the correlation.

RESULTS:

The study revealed a strong correlation of lip change at the site of the cervical point and incisal edge of the upper incisors, and the cervical position demonstrated a stronger correlation. The ratio between lip change and incisor retraction in patients is approximately 1:2.3 at the incisal edge and 1:1.3 at the cervical point.

CONCLUSION:

Lip change was associated with incisor retraction at the cervical and incisal edge, but it did not correlate with the rotation axis of the upper incisors.

Assessment of chin morphology in different skeletal dysplasia – A cross-sectional study

Objective:

The objective of the study is to evaluate the morphology of the symphyseal region of adult skeletal Class II and Class III malocclusion as compared with Skeletal Class I subjects.

Materials and Methods:

The symphyseal width and height were evaluated using data from 80 lateral cephalograms of the age range of 18 years to 25 years. Average growing Skeletal Class II (n = 30) and Class III (n = 20) subjects were used as a comparison group. Average growing normal occlusion samples (n = 30) were used as controls.

Results:

Alveolar height was similar in all groups. The width of the symphyseal region including basal width, the width of the cervical region of the lower central incisor at the cementoenamel junction, and symphysis width were found to be similar in all groups. There is no significant difference in gonial angle in both Class II and III groups as compared to control. Articular angle showed no significant difference. Mandibular incisor dentoalveolar height (L1-AH) was found to be significantly higher in the Class II group (P < 0.05).

Conclusions:

There are no definite morphological differences in the symphyseal region between average grower Class I, Class II, and Class III skeletal malocclusions except mandibular incisor dentoalveolar height (L1-AH) and incisor mandibular plane angle which is higher whereas ramus length and body length which is lesser in Class II group as compared with controls. Width of the cervical region of the lower central incisor at the cementoenamel junction (Id-Id’) and incisor mandibular plane angle was lower than control in Class III subjects.

Perception of facial esthetics in young North Indian population

INTRODUCTION:

A person's ability to recognize a beautiful face is innate, but translating this into defined treatment goals is a challenge for clinicians.

AIM:

To determine if faces considered esthetic and pleasing in the young North Indian population (both males and females) exhibit similar cephalometric measurements as used for ideal treatment and successful results.

MATERIALS AND METHOD:

A panel of five judges evaluated a set of one frontal, one frontal during smiling, and one profile extra-oral photograph of 160 students (80 females and 80 males) on a five-point attractiveness scale. For each photographic set, the mean and final scores were calculated. Once the sample was assessed, 60 subjects (30 females and 30 males) with the highest final facial aesthetic score were selected and cephalometric analysis was performed. The obtained data were subjected to statistical analysis using SPSS 20 software.

RESULTS:

Both males and females with class I skeletal jaw bases were found to be attractive. The females with short faces; mild facial convexity and lower lip closer to the esthetic line were found to be attractive. The males with a prominent chin, straight profile, prominent nose, increased upper lip thickness, upper lip length, and lower lip length were found to be attractive.

CONCLUSION:

The faces considered attractive in this study fulfilled most of the cephalometric norms commonly used for the diagnosis and treatment planning except for a few inconsistencies which may be attributed to the gender and demographic origin.

Neuroradiology in Transgender Care: Facial Feminization, Laryngeal Surgery, and Beyond

Transgender individuals experience incongruence between their gender identity and the sex assigned to them at birth. This incongruence can cause many transgender individuals to experience distressing physical and mental discord, a diagnosis known as gender dysphoria. Craniofacial structures have distinct anthropometric characteristics that affect perceived masculinity and femininity. The face, neck, and voice are highly exposed anatomic areas that have recognizable gender-specific characteristics that may hinder a transgender individual's successful social integration and public acceptance. Reconstructive facial and laryngeal procedures are among the surgical options transgender persons may elect to undergo to better align their physical appearance with their gender identity. These include feminization surgeries such as facial feminization and reduction chondrolaryngoplasty, as well as masculinizing facial and laryngeal surgeries. Maxillofacial CT is frequently used in the preoperative evaluation of patients before facial feminization surgery (FFS). Several CT measurements guide surgeons to the optimal correction required in FFS to achieve appropriate aesthetic planes. Mapping important craniofacial landmarks to avoid untoward surgical complications is crucial. Transgender patients may encounter other neurologic complications that require neuroimaging evaluation. For example, gender-affirming hormone therapy (eg, estrogen and testosterone) may increase the risk of stroke or may influence growth of various hormone-sensitive tumors such as pituitary adenomas. Radiologists may interpret imaging examinations in transgender patients for routine care or for evaluation before and after facial and laryngeal surgeries and must be aware of the role of neuroimaging in the care of this population. An invited commentary by Callen is available online. The online slide presentation from the RSNA Annual Meeting is available for this article. ^©RSNA, 2022.

Changes in health-related quality of life after orthognathic surgery: a multicenter study

Objective

To evaluate changes in general and oral health-related quality of life (HRQoL) in patients with dentofacial deformity undergoing orthognathic surgery, and whether these changes vary according to type of deformity.

Material and methods

This is a prospective longitudinal multicenter study of patients with dentofacial deformities (n = 90). The Orthognathic Quality of Life Questionnaire (OQLQ), Oral Health Impact Profile (OHIP-14), and Short-Form Health Survey version2 (SF-36v2) were self-completed by patients before surgery, 3 and 6 months after orthognathic surgery. Change was tested using paired t-test, and compared between Class II and Class III of dentofacial deformity by unpaired t-test. The magnitude of change was examined estimating the standardized response mean (SRM).

Results

The OQLQ and OHIP-14 showed statistically significant improvements 6 months after surgery, compared with the pre-surgical evaluation, but the SF-36v2 only in the physical component summary. The SRM was large in OQLQ oral function (-1.11) and dentofacial facial aesthetics (-0.76) dimensions, and moderate in most of OHIP-14 dimensions. Differences in mean change between Class II and III were statistically significant for global scores of OQLQ (-10.08 vs -20.30, p = 0.0271) and OHIP-14 (-3.79 vs -10.56, p = 0.0144).

Conclusions

A significant improvement was observed in oral HRQoL and in the physical component of general health in patients with dentofacial deformities Class II and III after orthognathic surgery. Improvement was greater among Class III than in Class II patients.

Clinical relevance

These results provide patients, oral health care professionals, and planners with valuable information to make evidence-based decisions and facilitate shared clinical decision-making, taking into account the patients’ perspective.

Three-dimensional pharyngeal airway space changes after bimaxillary advancement

INTRODUCTION

The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient.

OBJECTIVE

The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA).

METHODS

A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level.

RESULTS

There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively.

CONCLUSION

MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.

Correlation between objective evaluation and subjective evaluation of facial profile in skeletal Type II females

Objectives:

The objective of this study was to find the cephalometric measurements that correlate with the visual perception.

Materials and Methods:

A total of 250 lateral cephalograms of patients from the year 2016 to 2018 were hand traced and analyzed. Thirty-six hard- and soft-tissue measurements were obtained from the lateral cephalometric analysis. Silhouettes obtained from cephalometric films were rated by 10 orthodontists based on their level of convexity. For each sample, the rating of visual perception was correlated with all the cephalometric (hard and soft) measurements.

Results:

ANB, AF-BF, L1-NB (mm), overjet, anterior maxillary alveolar height, posterior maxillary alveolar height, lower lip to E plane, and H angle were positively correlated with the visual perception. On the contrary, Pg. to N perpendicular and Pg. to NB (mm) were negatively correlated with the visual perception. However, the measurements in the vertical dimensions did not have any significant correlations with visual perception. H angle showed a higher correlation with visual perception than the nasolabial angle, facial contour angle, and lower lip to E plane.

Conclusion:

The agreement between objective cephalometric measurements and subjective visual perception was less than expected. In general, only 27% of the cephalometric measurements had a significant correlation with visual perception. Therefore, orthodontic treatment planning based solely on cephalometric analysis can result in unsatisfactory treatment outcomes. An inclusion of subjective measures such as visual perception in orthodontic diagnosis and treatment planning is necessary.

Recent Trends in Orthognathic Surgery in Asia

Anatomy and standards of beauty are different between Asians and Westerners. Unlike Westerners, Asians have a wide and prominent jaw shape but prefer a slim and soft face shape. To achieve this goal, maxillary setback and/or posterior impaction surgeries are popular among upper jaw surgery, and various adjuvant surgeries are performed simultaneously on the mandible to obtain the so-called oval shape or V-line face. In addition, according to the development of virtual surgery software and orthodontic treatment techniques, the surgery-first approach is now accepted as a reliable option for orthognathic surgery if it is indicated.

Biomechanical properties of the lips in a pre-orthodontic sample of adolescents and young adults

OBJECTIVES

To assess biomechanical properties of the lip muscles and to investigate their relationship with sex, age, body mass index (BMI), and cephalometric variables.

MATERIALS AND METHODS

Demographic information and BMI were collected from 83 study participants seeking orthodontic treatment at the University of Otago. Tone, stiffness, and elasticity of the lip muscles were measured thrice at four different anatomical sites using a digital palpation device. To estimate method error, a duplicate set of measurements in a subsample of 20 participants was taken a week later. Sagittal and vertical cephalometric classifications were based on ANB and FMPA angles, respectively. Data were analysed using mixed models.

RESULTS

Biomechanical properties of lip muscles were remarkably consistent both within and between different recording sessions. The lower lip had higher tone and stiffness than the upper lip. Both the upper and lower lip stiffness and tone were higher in females than in males, whereas upper lip elasticity was higher in males. Thinner upper lips had higher tone and were stiffer than thicker upper lips, whereas thinner lower lips were less elastic than thicker lower lips. Muscle tone and stiffness of both the upper and lower lips were lower in Class III than in Class I and Class II individuals. The upper lip of hyperdivergent individuals was less elastic than that of normodivergent and hypodivergent individuals, and stiffer than that of hypodivergent individuals.

CONCLUSIONS

The biomechanical properties of perioral soft tissues can be reliably measured and vary with anatomical site, sex, and cephalometric measurements.

Methods of mandibular condyle position and rotation center used for orthognathic surgery planning: a systematic review

We aimed to evaluate whether there is a consensus among bi- (2D) and three-dimensional (3D) evaluations of mandible condyle position and its rotation center. Also, if this data can be replicated in orthognathic surgery planning. The survey was carried out on the major databases (PubMed, SCOPUS, Embase, Cochrane). Human or human bio models evaluations in 2D or 3D of mandibular condylar position concerning its fossa and rotational axis for orthognathic surgery planning were eligible. The heterogeneity of the studies and uncertainties in methodological biases did not allow us to identify the superiority of 2D or 3D methodology in determination of the condylar rotational axis. There is a lot of divergences in the definition of occlusal relationships among dental specialties. Although there was no consensus regarding condylar position in relation to the fossa, the most reported axis of rotation was positioned posterior-inferior. Weak scientific evidence and divergences in dental vocabulary shows the need for clinical studies with more accurate and transparent methodological design to standardize concepts. Despite we cannot affirm, we can suggest that the centric relation (CR) is not the condylar position when clinically manipulated in the posterior superior direction. This condylar position is the retruded contact position (RCt) while CR is the functional position of the condyle. In this way, the orthognathic surgery has two occlusal relationships during planning and execution. The ideal axis of rotation for orthognathic surgery planning must be fixed, permit individualization for each condyle and be reproducible. The 2D planning is obsolete as cannot provide all the necessary tools for an accurate planning.