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Franke A, Sequenc AF, Sembdner P, Seidler A, Matschke JB, Leonhardt H. Three-dimensional measurements of symmetry for the mandibular ramus. Ann Anat 2024; 253:152229. [PMID: 38367950 DOI: 10.1016/j.aanat.2024.152229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The study examines a sample of patients presenting for viscerocranial computer tomography that does not display any apparent signs of asymmetry, assesses the three-dimensional congruency of the mandibular ramus, and focuses on differences in age and gender. METHODS This cross-sectional cohort study screened viscerocranial CT data of patients without deformation or developmental anomalies. Segmentations were obtained from the left and right sides and superimposed according to the best-fit alignment. Comparisons were made to evaluate three-dimensional congruency and compared between subgroups according to age and gender. RESULTS Two hundred and sixty-eight patients were screened, and one hundred patients met the inclusion criteria. There were no statistical differences between the left and right sides of the mandibular ramus. Also, there were no differences between the subgroups. The overall root mean square was 0.75 ± 0.15 mm, and the mean absolute distance from the mean was 0.54 ± 0.10 mm. CONCLUSION The mean difference was less than one millimetre, far below the two-millimetre distance described in the literature that defines relative symmetry. Our study population displays a high degree of three-dimensional congruency. Our findings help to understand that there is sufficient three-dimensional congruency of the mandibular ramus, thus contributing to facilitating CAD-CAM-based procedures based on symmetry for this specific anatomic structure.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany.
| | | | - Philipp Sembdner
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Alexander Seidler
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
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Olbrisch C, Santander P, Moser N, Klenke D, Meyer-Marcotty P, Quast A. Three-dimensional mandibular characteristics in skeletal malocclusion : A cross-sectional study. J Orofac Orthop 2024; 85:134-145. [PMID: 36018344 PMCID: PMC10879264 DOI: 10.1007/s00056-022-00419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to comprehensively analyse a possible correlation between skeletal malocclusions, gender and mandibular characteristics in all three dimensions in adults and to identify mandibular characteristics that are typical for extreme skeletal patterns. METHODS A 3D model of the skull was calculated in 111 adult patients (mean age = 27.0 ± 10.2 years; 49 women, 62 men) from available computed tomography or cone beam computed tomography scans of their heads. Based on the 3D models, the skeletal patterns were examined in (a) the transversal dimension regarding asymmetry according to menton deviation, (b) the sagittal dimension according to the Wits appraisal and (c) the vertical dimension according to the maxillomandibular plane angle. The mandibular characteristics assessed were linear (ramus height and width, body length), angular (ramus, gonial and body angle) and volumetric (ramus/mandibular volume, body/mandibular volume) parameters. RESULTS No correlation between transversal skeletal asymmetry and mandibular characteristics were found, while sagittal (F(16, 174) = 3.32, p < 0.001, η2 = 0.23) and vertical (F(16, 174) = 3.18, p < 0.001, η2 = 0.23) skeletal patterns were shown to have a significant effect on the mandible. Gender correlated with mandibular characteristics independently from the skeletal pattern. Discriminant analysis revealed that class II and III patients differed in ramus and body angle with class II patients showing higher angles (ramus angle: class II = 89.8 ± 3.9° vs. class III = 84.4 ± 4.8°; body angle: class II = 87.7 ± 4.8° vs. class III = 82.1 ± 5.2°). Hypo- and hyperdivergent patients were discriminated by gonial angle, body angle and body/mandibular volume with hyperdivergent patients having a greater gonial and body angle and body/mandibular volume (gonial angle: hypodivergent = 114 ± 9.3° vs. hyperdivergent = 126.4 ± 8.6°; body angle: hypodivergent = 82.9 ± 4.4° vs. hyperdivergent = 87.7 ± 6.5°; body/mandibular volume: hypodivergent = 72.4 ± 2.7% vs. hyperdivergent = 76.2 ± 2.6%). CONCLUSION When analysing 3D data for treatment planning of adult patients, the orthodontist should pay attention to angular and volumetric characteristics of the mandible to identify extreme skeletal sagittal or vertical malocclusions.
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Affiliation(s)
- Carolin Olbrisch
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
- Department of Orthodontics, University of Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany.
| | - Petra Santander
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Norman Moser
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Daniela Klenke
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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Li J, Wu S, Mei L, Wen J, Marra J, Lei L, Li H. Facial asymmetry of the hard and soft tissues in skeletal Class I, II, and III patients. Sci Rep 2024; 14:4966. [PMID: 38424179 PMCID: PMC10904784 DOI: 10.1038/s41598-024-55107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
To investigate and compare the facial asymmetry (hard and soft tissues) among skeletal Class I, II, and III patients. A total of 221 subjects, including skeletal Class I (n = 80), skeletal Class II (n = 75), and skeletal Class III (n = 66), were included in the study. CBCT, 22 skeletal landmarks, and 10 soft tissue landmarks were used for the measurements and the asymmetry index was calculated to assess the facial asymmetry. Statistical analyses included one-way ANOVA, Kruskal-Wallis test, and Spearman correlation analysis. The skeletal Class III patients presented greater asymmetry than Class II patients for 10 hard tissue landmarks and 3 soft tissue landmarks (p < 0.05). High correlation of asymmetry was found between four soft tissue landmarks and their corresponding skeletal landmarks (rs ≥ 0.71), as well as Me and ANS (r > 0.86). The ANS and Me in 21.3% patients deviated to contralateral sides. The skeletal Class III patients had more facial asymmetry than the Class II patients. Soft tissues showed similar asymmetry as the underlying hard tissues rather than a compensation of the hard tissue asymmetry. The inconsistency in the deviation of Me and ANS may exacerbate facial asymmetry.
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Affiliation(s)
- Jialing Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China
| | - Sujuan Wu
- Department of Orthodontics, Nanjing Lishui Stomatological Hospital, Nanjing, People's Republic of China
| | - Li Mei
- Discipline of Orthodontics, Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Juan Wen
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China
| | - Jamie Marra
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Lang Lei
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China.
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China.
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Vespasiano V, Mulder CS, Klop C, Koolstra JH, Nolte JW, Lobé NHJ, Beenen LFM, Becking AG. Mineralization and thickness of the condylar cortex in skeletal remains of children's mandibles: A preliminary study. Arch Oral Biol 2024; 157:105850. [PMID: 38007946 DOI: 10.1016/j.archoralbio.2023.105850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/05/2023] [Accepted: 11/14/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To explore the relationship between the volumetric bone mineral density (vBMD), the thickness of the condylar cortex (Tcortex) and the hemimandibular volumes (Vhemimandible) of symmetrical and asymmetrical mandibles of children. DESIGN The data collection consisted of 92 archeological skeletal remains of children's mandibles between 1 and 12 years old. The mandibles were digitalized with a computed tomography (CT) scan, and three dimensional models were obtained. Vhemimandible was calculated using the optimal symmetry plane. The volumes were used to calculate the asymmetry index (AI). Mandibles with an AI of ≥ 3% (N = 9) and a sample of the most symmetrical mandibles (N = 9) were selected for this research. Three groups were created: a symmetrical, an asymmetrical and a pooled group. Micro-CT was used to measure the vBMD and Tcortex in four volumes of interest. The AI was calculated for these parameters as well. RESULTS Significant correlations were found between the vBMD and the Tcortex in the pooled group (P < .01) and between the AI of the vBMD and the AI of the Tcortex in the pooled (P < .01) and symmetrical group (P < .05). No significant correlations were found between the vBMD and the Vhemimandible and between the respective AIs. Between the Tcortex and the Vhemimandible a significant correlation was found in the pooled and asymmetrical group. CONCLUSION There is a relationship between the vBMD and the Tcortex. The correlations between the Tcortex and the Vhemimandible are insufficient to draw firm conclusions. A relationship between the vBMD and Vhemimandible was not confirmed in this study.
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Affiliation(s)
- V Vespasiano
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers (location AMC) and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - C S Mulder
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers (location AMC) and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - C Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers (location AMC) and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - J H Koolstra
- Department of Oral Cell Biology and Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
| | - J W Nolte
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers (location AMC) and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - N H J Lobé
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers (location AMC) and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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España-Pamplona P, Zamora-Martinez N, Tarazona-Álvarez B, Pangrazio-Kulbersh V, Paredes-Gallardo V. Three-dimensional quantification of mandibular asymmetries in Caucasian adult patients with different sagittal and vertical skeletal patterns. A cone beam study using 3D segmentation and mirroring procedures. Head Face Med 2023; 19:54. [PMID: 38098053 PMCID: PMC10720065 DOI: 10.1186/s13005-023-00400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION An accurate identification of mandibular asymmetries is required by modern orthodontics and orthognathic surgery to improve diagnosis and treatment planning of such deformities. Although craniofacial deformities are very frequent pathologies, some types of asymmetries can be very difficult to assess without the proper diagnostic tools. The purpose of this study was to implement the usage of three-dimensional (3D) segmentation procedures to identify asymmetries at the mandibular level in adult patients with different vertical and sagittal patterns where the asymmetries could go unnoticed at the observational level. METHODS The study sample comprised 60 adult patients (33 women and 27 men, aged between 18 and 60 years). Subjects were divided into 3 sagittal and vertical skeletal groups. CBCT images were segmented, mirrored and voxel-based registered with reference landmarks using ITK-SNAP® and 3DSlicer® software's. 3D surface models were constructed to evaluate the degree of asymmetry at different anatomical levels. RESULTS There was a degree of asymmetry, with the left hemimandible tending to contain the right one (0.123 ± 0.270 mm (CI95% 0.036-0.222; p < 0.001). Although the subjects under study did not present significant differences between mandibular asymmetries and their sagittal or vertical skeletal pattern (p = 0.809 and p = 0.453, respectively), a statistically significant difference has been found depending on the anatomical region (p < 0.001; CI95%=1.020-1.021), being higher in the condyle, followed by the ramus and the corpus. CONCLUSIONS Although mandibular asymmetries cannot be correlated with vertical and sagittal skeletal patterns in symmetric patients, knowledge about 3D segmentation procedures and color maps can provide valuable information to identify mandibular asymmetries.
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Affiliation(s)
- Pilar España-Pamplona
- Faculty of Medicine and Dentistry, School of Dentistry, University of Valencia, C/ Gasco Oliag, 1, Valencia, 46010, Spain.
| | - Natalia Zamora-Martinez
- Faculty of Medicine and Dentistry, School of Dentistry, University of Valencia, C/ Gasco Oliag, 1, Valencia, 46010, Spain
| | - Beatriz Tarazona-Álvarez
- Faculty of Medicine and Dentistry, School of Dentistry, University of Valencia, C/ Gasco Oliag, 1, Valencia, 46010, Spain
| | | | - Vanessa Paredes-Gallardo
- Faculty of Medicine and Dentistry, School of Dentistry, University of Valencia, C/ Gasco Oliag, 1, Valencia, 46010, Spain
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Wang Y, Wang Y, Wang C, Cao Y, Zhang B, Chen Y, Liu C. Mandibular asymmetry in patients with skeletal class I and skeletal class II Malocclusions: A cone-beam computed tomography study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101441. [PMID: 36933658 DOI: 10.1016/j.jormas.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To study the difference in mandibular asymmetry between patients with skeletal Class I and skeletal Class II malocclusions and analyze the correlation between mandibular asymmetry and different facial skeletal sagittal patterns based on CBCT measurements. METHODS One hundred and twenty patients were selected according to the inclusion and exclusion criteria. Patients were divided into two groups (60 in the skeletal Class I group and 60 in the skeletal Class II group) based on ANB angles and Wits values. Patients' CBCT data were collected. Dolphin Imaging 11.0 was used to determine the mandibular anatomic landmarks and calculate the linear distance in patients in the two groups. RESULTS Intragroup comparison: in skeletal Class I group, measurements of the most posterior point of the condyle (Cdpost), the outer lateral point of the condyle (Cdlat), sigmoid notch point (Sn)), coronoid process point (Cop), gonion point (GO) and antimony notch point (Ag), right>left (P<0.05); in skeletal Class II group, measurements of Cdpost and Cop, right>left (P<0.05). Intergroup comparison: for measurements of GO and Ag, skeletal Class I group>skeletal Class II group (P<0.05). The asymmetry of the Ag and GO points was negatively correlated with the ANB angle (p<0.05). CONCLUSION Mandibular asymmetry was significantly different between patients with skeletal Class I and skeletal Class II malocclusions. The asymmetry of the mandible angle region in the former group was greater than that in the latter group, and the asymmetry of the mandibular angle was negatively correlated with the ANB angle.
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Affiliation(s)
- Yu Wang
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou, Guangdong 510120, China
| | - Chunhui Wang
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Yuming Cao
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Bing Zhang
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Yitian Chen
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China
| | - Chang Liu
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong 510120, China.
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Franke A, Hofmann EC, Steinberg A, Lauer G, Kitzler H, Leonhardt H. Probing real-world Central European population midfacial skeleton symmetry for maxillofacial surgery. Clin Oral Investig 2023; 27:5637-5647. [PMID: 37535197 PMCID: PMC10492674 DOI: 10.1007/s00784-023-05185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Symmetry is essential for computer-aided surgical (CAS) procedures in oral and maxillofacial surgery (OMFS). A critical step for successful CAS is mirroring the unaffected side to create a template for the virtual reconstruction of the injured anatomical structure. The aim was to identify specific anatomical landmarks of the midfacial skeleton, to evaluate the symmetry in a group of the real-world Central European population, and to use these landmarks to assess midfacial symmetry in CT scans. MATERIAL AND METHODS The retrospective cross-sectional study defined landmarks of the midface's bony contour using viscerocranial CT data. The distances of the skeletal landmarks (e.g., the frontozygomatic suture and temporozygomatic suture) of the left and right sides from the midline were measured and statistically compared. Midfacial symmetry for reference points was defined as a difference within 0 mm and their mean difference plus one standard deviation. RESULTS We examined a total of 101 CT scans. 75% of our population shows symmetrical proportions of the midface. The means of the differences for the left and right sides ranged from 0.8 to 1.3 mm, averaging 1.1 ± 0.2 mm for all skeletal landmarks. The standard deviations ranged from 0.6 to 1.4 mm, with a computed mean of 0.9 ± 0.3 mm. CONCLUSION We established a methodology to assess the symmetry of the bony midface. If the determined differences were equal to or lower than 2.5 mm in the mentioned midfacial skeletal landmarks, then the symmetry of the bony midface was considered present, and symmetry-based methods for CAS procedures are applicable. CLINICAL RELEVANCE Many CAS procedures require facial symmetry. We provide an easy-to-apply method to probe for symmetry of the midface. The method may be used for population-based research, to check for proper reduction of fractures after reposition or to screen for symmetry prior to CAS planning.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany.
| | - Elisabeth Claudia Hofmann
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Anna Steinberg
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Hagen Kitzler
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
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Zhao J, Xu Y, Wang J, Lu Z, Qi K. 3-dimensional analysis of hard- and soft-tissue symmetry in a Chinese population. BMC Oral Health 2023; 23:432. [PMID: 37386472 PMCID: PMC10308641 DOI: 10.1186/s12903-023-03163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Facial symmetry severely affects appearance and function. Large numbers of patients seek orthodontic treatment to improve facial symmetry. However, the correlation between hard- and soft-tissue symmetry is still unclear. Our aim was to investigate the hard- and soft-tissue symmetry in subjects with different levels of menton deviation and sagittal skeletal classes with 3D digital analysis and to investigate the relationship between the entire and individual hard- and soft-tissues. METHODS A total of 270 adults (135 males and 135 females) consisting of 45 subjects of each sex in each sagittal skeletal classification group. All subjects were further classified into relative symmetry (RS), moderate asymmetry (MA) and severe asymmetry (SA) groups based on the degree of menton deviation from the mid-sagittal plane (MSP). The 3D images were segmented into anatomical structures and mirrored across the MSP after establishing a coordinate system. Original and mirrored images were registered by a best-fit algorithm, and the corresponding root mean square (RMS) values and colormap were obtained. The Mann‒Whitney U test and Spearman correlation were conducted for statistical analysis. RESULTS The RMS increased with greater deviations with regard to the deviation of the menton in most of anatomical structures. Asymmetry was represented in the same way regardless of sagittal skeletal pattern. The soft-tissue asymmetry had a significant correlation with dentition in the RS group (0.409), while in the SA group, it was related to the ramus (0.526) and corpus (0.417) in males and was related to the ramus in the MA (0.332) and SA (0.359) groups in females. CONCLUSIONS The mirroring method combining CBCT and 3dMD provides a new approach for symmetry analysis. Asymmetry might not be influenced by sagittal skeletal patterns. Soft-tissue asymmetry might be reduced by improving the dentition in individuals with RS group, while among those with MA or SA, whose menton deviation was larger than 2 mm, orthognathic treatment should be considered.
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Affiliation(s)
- Jiamin Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China
| | - Yifei Xu
- Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Jinxiu Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China
| | - Zhen Lu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China
| | - Kun Qi
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China.
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, 710004, Xi'an, Shaanxi, P.R. China.
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Sritara S, Matsumoto Y, Lou Y, Qi J, Aida J, Ono T. Association between the Temporomandibular Joint Morphology and Chewing Pattern. Diagnostics (Basel) 2023; 13:2177. [PMID: 37443573 DOI: 10.3390/diagnostics13132177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to investigate whether the morphology of the temporomandibular joint (TMJ) is associated with chewing patterns while considering skeletal morphology, sex, age, and symptoms of temporomandibular disorder (TMD). A cross-sectional observational study of 102 TMJs of 80 patients (age 16-40 years) was performed using pretreatment records of cone-beam computed tomography imaging of the TMJ, mandibular kinesiographic records of gum chewing, lateral and posteroanterior cephalometric radiographs, patient history, and pretreatment questionnaires. To select appropriate TMJ measurements, linear regression analyses were performed using TMJ measurements as dependent variables and chewing patterns as the independent variable with adjustment for other covariates, including Nasion-B plane (SNB) angle, Frankfort-mandibular plane angle (FMA), amount of lateral mandibular shift, sex, age, and symptoms of TMD. In multiple linear regression models adjusted for other covariates, the length of the horizontal short axis of the condyle and radius of the condyle at 135° from the medial pole were significantly (p < 0.05) associated with the chewing patterns in the frontal plane on the working side. "Non-bilateral grinding" displayed a more rounded shape of the mandibular condyle. Conversely, "bilateral grinding" exhibited a flatter shape in the anteroposterior aspect. These findings suggest that the mandibular condyle morphology might be related to skeletal and masticatory function, including chewing patterns.
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Affiliation(s)
- Sasin Sritara
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Yoshiro Matsumoto
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Yixin Lou
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Jia Qi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
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Miranda-Viana M, Moreira GM, de Souza LM, Nejaim Y, Haiter-Neto F, Freitas DQ. Tridimensional assessment of the mandibular angle in patients with different skeletal patterns by cone-beam computed tomography scans: a retrospective study. BMC Oral Health 2023; 23:361. [PMID: 37271800 DOI: 10.1186/s12903-023-03074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/24/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Since the muscles of chewing are involved in the region of the mandibular angle, important structures in surgical and orthodontic procedures, to study its morphological aspects and the possible influence of different patterns of skeletal development would be of interest. Thus, this study aimed to assess the influence of patient characteristics - such as sex, skeletal malocclusion (Class I, Class II, and Class III) and facial type (brachycephalic, mesocephalic, and dolichocephalic) - on the width, height, thickness, and volume of the mandibular angle, using cone-beam computed tomography (CBCT) scans. METHODS CBCT scans were assessed - 144 men and 154 women, total of 298 - and classified according to skeletal patterns (skeletal malocclusions and facial types). Width, height, and thickness of the mandibular angle were measured using OnDemand 3D software. The volumetric measures of the mandibular angle were obtained using the ITK-SNAP software. Analysis of Variance (multiway ANOVA) with Tukey's post-hoc test compared the data, with a 5% significance level. RESULTS Among the factors studied, sex significantly influenced all the analyzed variables (height, width, thickness, and volume of the mandibular angle) (p < 0.05); in general, male individuals presented higher values than females. In some cases, the skeletal malocclusion and facial type factors influenced only the width and height variables (p < 0.05); in general, the Class III and dolichocephalic individuals presented higher values in relation to the other types of skeletal malocclusions and facial types. CONCLUSIONS Variations in the craniofacial growth pattern, considering the different skeletal malocclusions and facial types, had some influence in the width and height dimensions of the mandibular angle. Furthermore, sex influenced all the studied variables.
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Affiliation(s)
- Murilo Miranda-Viana
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil.
| | - Gabriel Mosso Moreira
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
| | - Larissa Moreira de Souza
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
| | - Yuri Nejaim
- Oral Radiology Area, Dental School, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
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Morgan N, Shujaat S, Jazil O, Jacobs R. Three-dimensional quantification of skeletal midfacial complex symmetry. Int J Comput Assist Radiol Surg 2023; 18:611-619. [PMID: 36272017 DOI: 10.1007/s11548-022-02775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Quantification of skeletal symmetry in a healthy population could have a strong impact on the reconstructive surgical procedures where mirroring of the contralateral healthy side acts as a clinical reference for the restoration of unilateral defects. Hence, the aim of this study was to three-dimensionally assess the symmetry of skeletal midfacial complex in skeletal class I patients. METHODS A sample of 100 cone beam computed tomography (CBCT) scans (50 males, 50 females; age range: 19-40 years) were recruited. Automated segmentation of the skeletal midfacial complex was performed to create a three-dimensional (3D) virtual model using a convolutional neural network (CNN)-based segmentation tool. Thereafter, the segmented model was mirrored and registered to quantify skeletal symmetry using a color-coded conformance mapping based on a surface part comparison analysis. RESULTS Overall, the mean and root-mean-square (RMS) differences between complete true and mirrored models were 0.14 ± 0.12 and 0.87 ± 0.21 mm, respectively. Female patients had a significantly more symmetrical midfacial complex (mean difference: 0.11 ± 0.1 mm, RMS: 0.81 ± 0.17 mm) compared to male patients (mean difference: 0.16 ± 0.13 mm, RMS: 0.94 ± 0.23 mm). No significant difference existed between left and right sides irrespective of the patient's gender. CONCLUSION The comparison between true and mirrored complete and left/right split midfacial complex showed symmetry within a clinically acceptable range of 1 mm, which justifies the applicability of using the mirroring technique. The presented data could act as a reference guide for surgeons during planning of reconstructive surgical procedures and outcome assessment at follow-up.
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Affiliation(s)
- Nermin Morgan
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium.
- Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omid Jazil
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Vespasiano V, Klop C, Mulder CS, Koolstra JH, Lobé NHJ, Beenen LFM, Nolte JW, Becking AG, Schreurs R, Maal TJJ, de Bakker BS. Normal variation of mandibular asymmetry in children. Orthod Craniofac Res 2023. [PMID: 36760175 DOI: 10.1111/ocr.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To explore the normal variation of asymmetry in mandibles of children in the age group of 1 to 12 years. MATERIALS AND METHODS The study group consisted of 92 cadaveric mandibles of children with a dental age of 1 to 12 years old in possession of ACTA (Academic Centre for Dentistry Amsterdam), Faculty of Dentistry, the Netherlands. 3D models of the mandibles were obtained from CT-scans and hemimandibular volumes of all mandibles were calculated. The condylar height, ramus height, mandibular body length and the gonial angle were bilaterally determined using a novel landmark-based method, and the degree of asymmetry was calculated. RESULTS No relationship was found between dental age and asymmetry of the studied parameters (P < .05). The highest degree of asymmetry was found in the ramus height, whereas the gonial angle presented the lowest degree of asymmetry. A positive correlation was found between the asymmetry of the hemimandibular volume vs the height of the ramus (P < .05) and the length of the mandibular body (P < .05). An inverse correlation was found between the asymmetry of the ramus height vs the condylar height (P < .05), mandibular body length (P < .05) and gonial angle (P < .05). CONCLUSIONS Mandibular asymmetries in children did occur (9.8% of the included mandibles presented with a relevant overall asymmetry of ≥3%) and were unrelated to age. The different segments of the mandible seem to compensate for each other, in order to maintain a functional equilibrium.
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Affiliation(s)
- Valeria Vespasiano
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Catharina S Mulder
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Jan H Koolstra
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H J Lobé
- Department of Radiology and Nuclear Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Jitske W Nolte
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Alfred G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), AZ, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery 3D Lab, Radboud University Medical Centre Nijmegen, GA, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), AZ, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery 3D Lab, Radboud University Medical Centre Nijmegen, GA, Nijmegen, The Netherlands
| | - Bernadette S de Bakker
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC (location AMC), University of Amsterdam, AZ, Amsterdam, The Netherlands
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Diwakar R, Bucci R, Kaushik A, Bansal A, Bucci P, Kochhar AS, Spagnuolo G. Three-Dimensional Assessment of Temporomandibular Joint Morphology and Facial Asymmetry in Individuals with Different Vertical Skeletal Growth Patterns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1437. [PMID: 36674193 PMCID: PMC9859447 DOI: 10.3390/ijerph20021437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
The aim of the current study was to investigate, by means of Cone-Beam Computed Tomography (CBCT), condyle−fossa relationship, temporomandibular joint (TMJ) morphology and facial asymmetry in subjects with different vertical skeletal growth patterns. CBCT of 56 patients (112 TMJs) were categorized into three groups according to the mandibular plane angle (MP): Hypodivergent (MP ≤ 23°), Normodivergent (23° < MP < 30°), and Hyperdivergent (MP ≥ 30°). TMJ spaces, width and depth of the condyle and thickness of the fossa were measured. Horizontal and vertical measurements were used to assess facial asymmetry. One-way Analysis of Variance (ANOVA) and post-hoc Turkey tests were computed for the between-groups comparison. Statistical significance was set at p < 0.05. Larger anterior joint space and smaller condylar dimensions (medio-lateral diameter and medio-lateral thickness) were observed in the hyperdivergent group compared to the normodivergent and hypodivergent groups. Right condylar distances to midsagittal plane were significantly larger than left distances in all the three groups. A vertical pattern of growth in healthy individuals seems to be associated with condylar position and dimension, while facial asymmetry values do not differ among different vertical groups.
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Affiliation(s)
- Rohan Diwakar
- Department of Orthodontics, PDM Dental College, Bahadurgarh 124507, India
| | - Rosaria Bucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Ankur Kaushik
- Department of Orthodontics, PDM Dental College, Bahadurgarh 124507, India
| | - Anubhav Bansal
- Department of Orthodontics, PDM Dental College, Bahadurgarh 124507, India
| | - Paolo Bucci
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | | | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, 80131 Naples, Italy
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia
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14
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Chou ST, Tsai PL, Chen SC, Lin SH, Chen CM, Tseng YC. Condylar and ramus volume in asymmetric and symmetric skeletal class III malocclusion: A cone-beam computed tomography study. J Dent Sci 2023; 18:175-183. [PMID: 36643236 PMCID: PMC9831784 DOI: 10.1016/j.jds.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/19/2022] [Indexed: 01/18/2023] Open
Abstract
Background/purpose Among the craniofacial structures, the mandible is the only bony structure with movable joints. Each part (including condyle process, coronoid process, and ramus) of mandible would interaction with the muscles and proceed different osteogenesis progress. The objective of this study was to evaluate the mandibles with symmetric and asymmetric skeletal Class III jaw relations by quantifying differences in the condyle process, coronoid process and ramus on CBCT (Cone-beam computer tomography) images. Our hypothesis was that CBCT would reveal no voluminal differences between deviated and non-deviated mandibular segments in asymmetric skeletal Class III. Materials and methods CBCT imagines were collected from dental department, KMUH and then divided into symmetric Class III group (Menton deviation < 4mm) and asymmetric Class III group (Menton deviation≧4mm). The mandibular structure would be segmented to ramus, condylar and coronoid process. Each volume was measured. Independent t test was used for comparison between groups, and paired t test was applied for comparison between both segmented parts within each group. Results Significant differences between deviation and non-deviation sides in the asymmetric group were found in condylar and ramus segments for volumetric quantitative measurements. There has no significant difference in ramus parts between groups. Significant greater condylar volume was found in non-deviation side of asymmetric group. Conclusion The results demonstrated that in the side with greater mandible growth potential, the condylar and the ramus volume would be greater as well. CBCT is a useful and accurate modality for quantification and evaluation of mandibular asymmetry.
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Affiliation(s)
- Szu-Ting Chou
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Lun Tsai
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Chieh Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Hsuan Lin
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Ming Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Chuan Tseng
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Corresponding author. School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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15
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Türker G, Öztürk Yaşar M. Evaluation of associations between condylar morphology, ramus height, and mandibular plane angle in various vertical skeletal patterns: a digital radiographic study. BMC Oral Health 2022; 22:330. [PMID: 35941596 PMCID: PMC9361641 DOI: 10.1186/s12903-022-02365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate condylar morphology, ramus height, and asymmetry indexes in patients with different vertical skeletal patterns and to determine the association between condylar and ramal measurements with the mandibular plane angle. Methods Dental panoramic radiographs of 60 patients with different skeletal patterns were evaluated. According to the cranial base (Sella-Nasion)-mandibular plane (SN-MP) angle, the patients were divided into three groups: normal angle (NA), low angle (LA), and high angle (HA). The condylar area, condylar perimeter, condylar heights, and ramus height were measured, and the asymmetry index value of each measurement was calculated. A one-way analysis of variance as well as a post hoc Tukey and Kruskall-Wallis tests were used to determine intergroup differences. Pearson’s correlation coefficient was used to determine the relationship between all measurements and SN-MP. Results The intergroup comparison of condylar area, condylar perimeter, condylar heights, and ramus height measurements showed that the patients in the LA group have statistically significantly greater values compared to those in the HA group. A statistically significant difference was detected between the NA and LA groups only in the condylar area measurements. There was no statistical difference only in the ramus height measurements between the NA and HA groups. Asymmetry index values of the groups were similar. The negative correlations were found between all measurements and the SN-MP angle. Conclusion HA individuals have lower ramus heights and smaller condylar morphologies than NA and LA individuals. In addition, as the SN-MP angle increases, the condyle dimensions and ramus height decrease, and this is a clinically important finding.
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Affiliation(s)
- Gökhan Türker
- Department of Orthodontics, Faculty of Dentistry, Mersin University, Mersin, Turkey.
| | - Meriç Öztürk Yaşar
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Analysis of the Volumetric Asymmetry of the Mandibular Condyles Using CBCT. Int Dent J 2022; 72:797-804. [PMID: 35931561 PMCID: PMC9676531 DOI: 10.1016/j.identj.2022.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives The aim of this study was to analyse volumetric asymmetries between the right and left condyles in relation to age, gender, and dental status. Materials and methods A retrospective analysis of 150 cone beam computed tomography (CBCT) scans was conducted. A single investigator performed the volumetric analysis of the CBCT scans using Vesalius 3D software. The volumetric data were analysed in relation to the gender, age, and dental status. Results The mean right condylar volume was significantly higher (P < .01) than the left condylar volume. Right and left condylar volumes were significantly higher (P < .01) in male study participants when compared to female study participants. There was no significant difference (P = .47) in the volumetric asymmetry between the male and female study participants. The volumetric asymmetry was significantly higher (P < .01) in the older age groups when compared to the younger age groups. The volumetric asymmetry was significantly higher (P < .01) in the partially and completely edentulous patients when compared to the dentate study participants. The condylar volume on the side having a partially edentulous area was significantly lower than the condylar volume of the contralateral dentate side (P < .001). Conclusions The volumetric asymmetry between the right and left condyle significantly increases with age and edentulousness. The result of the study encourages the clinicians to perform volumetric evaluation of the condyles in cases of radiographically evident condylar asymmetries to obtain a more accurate diagnosis.
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Evangelista K, Teodoro AB, Bianchi J, Cevidanes LHS, de Oliveira Ruellas AC, Silva MAG, Valladares-Neto J. Prevalence of mandibular asymmetry in different skeletal sagittal patterns. Angle Orthod 2022; 92:118-126. [PMID: 34546287 PMCID: PMC8691477 DOI: 10.2319/040921-292.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To analyze the prevalence of mandibular asymmetry in skeletal sagittal malocclusions. MATERIALS AND METHODS PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Two independent investigators selected the eligible studies, and assessed risk of bias and certainty of evidence (GRADE). One reviewer independently extracted the data and the second reviewer checked this information. Any disagreement between the reviewers in each phase was resolved by discussion between them and/or involved a third reviewer for final decision. RESULTS Electronic search identified 5,132 studies, and 5 observational studies were included. Risk of bias was low in two studies, moderate in one, and high in two. The studies showed high heterogeneity. Mandibular asymmetry ranged from 17.43% to 72.95% in overall samples. Horizontal chin deviation showed a prevalence of 17.66% to 55.6% asymmetry in Class I malocclusions, and 68.98% in vertical asymmetry index. In Class II patients, prevalence of mandibular asymmetry varied from 10% to 25.5% in horizontal chin deviation, and 71.7% in vertical asymmetry index. The Class III sample showed a prevalence of mandibular asymmetry ranging from 22.93% to 78% in horizontal chin deviation and 80.4% in vertical asymmetry index. Patients seeking orthodontic or orthognathic surgery treatment showed greater prevalence of mandibular asymmetry. CONCLUSIONS Skeletal Class III malocclusion showed the greatest prevalence of mandibular asymmetry. Mandibular vertical asymmetry showed a marked prevalence in all malocclusions. However, conclusions should be interpreted with caution due to use of convenience samples and low-quality study outcomes.
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Rojas Reyna BR, Ramírez Prado MI, Orozco Orozco NI, Rodríguez Pérez LR, Simg Alor AA, Quirarte Echavarría VM. [Diagnostic and treatment alternatives for the correction of facial asymmetries: a literature review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2022; 10:e098. [PMID: 38389908 PMCID: PMC10880717 DOI: 10.21142/2523-2754-1001-2022-098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/22/2022] [Indexed: 02/24/2024] Open
Abstract
Facial symmetry refers to a complete coincidence of each facial component on the sagittal plane, while asymmetry refers to the bilateral difference between these components. The presence of perfect bilateral symmetry is almost never present in human, so it is more common for individuals to predominate facial asymmetry. However, this condition can result from functional and esthetic problems. This research seeks to determine the alternatives, diagnosis and ideal treatment plan for the correction of each type of facial asymmetry through orthognathic surgery. For this purpose, a review of articles published between 2015 to date was carried out. Selecting those that were focused on describing or evaluating facial and dentofacial symmetry and asymmetry, type of diagnosis or treatment plan, including clinical cases. The Google search engine, SciELO and databases of medical interest, such as PubMed, PMC and Medigraphic were used. According to the research and treatments carried out during the last few years in the dental clinic, it has been proven that orthognathic treatment accompanied by previous planning is the best option for the management of skeletal facial asymmetries.
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Affiliation(s)
- Braulio Rafael Rojas Reyna
- Facultad de Odontologia de la Universidad Veracruzana Campus Minatitlan. Veracruz, Mexico. , , , , , Universidad Veracruzana Facultad de Odontologia Universidad Veracruzana Campus Minatitlan Veracruz Mexico
| | - María Isabel Ramírez Prado
- Facultad de Odontologia de la Universidad Veracruzana Campus Minatitlan. Veracruz, Mexico. , , , , , Universidad Veracruzana Facultad de Odontologia Universidad Veracruzana Campus Minatitlan Veracruz Mexico
| | - Norma Idalia Orozco Orozco
- Facultad de Odontologia de la Universidad Veracruzana Campus Minatitlan. Veracruz, Mexico. , , , , , Universidad Veracruzana Facultad de Odontologia Universidad Veracruzana Campus Minatitlan Veracruz Mexico
| | - Luis Renán Rodríguez Pérez
- Facultad de Odontologia de la Universidad Veracruzana Campus Minatitlan. Veracruz, Mexico. , , , , , Universidad Veracruzana Facultad de Odontologia Universidad Veracruzana Campus Minatitlan Veracruz Mexico
| | - Ana Alicia Simg Alor
- Facultad de Odontologia de la Universidad Veracruzana Campus Minatitlan. Veracruz, Mexico. , , , , , Universidad Veracruzana Facultad de Odontologia Universidad Veracruzana Campus Minatitlan Veracruz Mexico
| | - Víctor Manuel Quirarte Echavarría
- Facultad de Odontologia de la Universidad Veracruzana Campus Minatitlan. Veracruz, Mexico. , , , , , Universidad Veracruzana Facultad de Odontologia Universidad Veracruzana Campus Minatitlan Veracruz Mexico
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Morgan N, Suryani I, Shujaat S, Jacobs R. Three-dimensional facial hard tissue symmetry in a healthy Caucasian population group: a systematic review. Clin Oral Investig 2021; 25:6081-6092. [PMID: 34386858 DOI: 10.1007/s00784-021-04126-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the symmetry of the facial hard tissue structures using three-dimensional radiographic imaging modalities in a normal Caucasian population group. MATERIALS AND METHODS Electronic literature search was conducted in the following databases: PubMed, Embase, Web of Science, and Cochrane Library up to February 2021. The studies assessing symmetry of facial bones using computed tomography (CT) and cone beam CT were included. RESULTS The initial search revealed 8811 studies. Full-text analysis was performed on 33 studies. Only 10 studies were found eligible based on the inclusion criteria. The qualitative analysis revealed that a significant variability existed in relation to the methodologies applied for symmetry quantification. CONCLUSION The current review suggested that the overall relative symmetry of the normal Caucasian population group varied depending on the skeletal structure being assessed; however, majority of the observations showed a symmetry within the range of 1 mm without any significant difference between left and right sides. CLINICAL RELEVANCE The quantification of facial hard tissue structure symmetry is vital for the diagnosis and treatment planning of orthodontic and/or maxillofacial surgical procedures. Prospero registration number CRD42020169908.
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Affiliation(s)
- Nermin Morgan
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.
- Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
| | - Isti Suryani
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Comprehensive 3D analysis of condylar morphology in adults with different skeletal patterns - a cross-sectional study. Head Face Med 2020; 16:33. [PMID: 33256789 PMCID: PMC7708118 DOI: 10.1186/s13005-020-00245-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022] Open
Abstract
Background The correlation between individuals’ condylar morphology and their skeletal pattern is of great interest for treatment strategies ranging from orthodontic orthopaedics to orthognathic surgery. The objective of the present study was to investigate this relationship three-dimensionally. Methods A total of 111 adult patients (mean age = 27.0 ± 10.2 years) who underwent head computed tomography or cone beam computed tomography scans were included. Based on these data, 3D models of the skull and the condyles were calculated. The craniofacial skeleton was evaluated (1) transversally regarding skeletal symmetry (menton deviation), (2) sagittally regarding skeletal classes (Wits appraisal) and vertically regarding the inclination of the jaws (maxillomandibular plane angle). The condylar morphology was assessed (a) linearly by the condylar width, height and depth; (b) angularly by the antero-posterior and medio-lateral condylar inclination; and (c) volumetrically by the ratio of the condylar volume/mandibular volume (C/Mand). Results (1) Transversal: Asymmetric patients showed significantly higher discrepancies in the volumetric ratio C/Mand on the deviation and non-deviation side compared to symmetric patients. (2) Sagittal: Class III subjects demonstrated longer, more voluminous condyles with higher antero-posterior and medio-lateral inclination angles compared to Class II participants. (3) Vertical: Hyperdivergent subjects had smaller condyles with higher antero-posterior inclination angles than those of hypodivergent subjects. No interactions of skeletal class and vertical relationships regarding condylar morphology were observed. Conclusions This study demonstrates a clear correlation between pronounced skeletal patterns and condylar morphology in an adult population. The description of radiographic condyle characteristics in relation to the craniofacial morphology improves orthodontic treatment planning and could be helpful in the diagnosis of temporomandibular joint pathologies.
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Lemes CR, Tozzi CF, Gribel S, Gribel BF, Venezian GC, do Carmo Menezes C, Custodio W. Mandibular ramus height and condyle distance asymmetries in individuals with different facial growth patterns: a cone-beam computed tomography study. Surg Radiol Anat 2020; 43:267-274. [PMID: 32965519 DOI: 10.1007/s00276-020-02577-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to quantify mandibular ramus height and condylar distances asymmetry indexes in adult patients with different vertical facial growth pattern using Cone Beam computed tomography (CBCT). METHODS An observational cross-sectional study was conducted by using CBCT of 159 patients (mean age 26.36 ± 5.32 years). Vistadent 3D® software was used to determine the facial pattern in 3 groups (N = 53): hypodivergent, normodivergent and hyperdivergent-by Ricketts VERT index. Mandibular ramus height and the condylar linear distance in relation to the median sagittal plane were evaluated. The asymmetry index was calculated considering the right and left sides. Data were analyzed by generalized linear models and Tukey post-hoc test (α = 0.05). RESULTS Significantly lower values were found for the left and right mandibular ramus height in the hyperdivergent skeletal pattern (P < 0.05). There was no statistically significant difference for condylar and intercondylar distances among the facial groups (P > 0.05). Asymmetry indexes (mandibular ramus height and condylar distance) were similar, and no statistically significant differences were found among the skeletal patterns. In most subjects, the severity of mandibular ramus height asymmetry varied from light to not clinically significant independently of the facial type. CONCLUSION The findings suggest that vertical facial growth pattern not affected the asymmetry index of mandibular ramus height and the intercondylar distance. The results also demonstrated significantly shorter mandibular ramus height for the hyperdivergent skeletal pattern individuals.
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Affiliation(s)
- Christian Reis Lemes
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation, FHO, Av. Dr. Maximiliano Baruto, 500, Jd. Universitário, Araras, SP, 13607-339, Brazil
| | - Carolina Fernandes Tozzi
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation, FHO, Av. Dr. Maximiliano Baruto, 500, Jd. Universitário, Araras, SP, 13607-339, Brazil
| | - Saulo Gribel
- Department of Dentistry, Faculdade Modal, Belo Horizonte, Brazil
| | - Bruno Frazão Gribel
- Department of Digital Dentistry, Faculdade de Ciências Médicas, Escola de Pós Graudação em Odontologia, SCEO, Belo Horizonte, Brazil
| | - Giovana Cherubini Venezian
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation, FHO, Av. Dr. Maximiliano Baruto, 500, Jd. Universitário, Araras, SP, 13607-339, Brazil
| | - Caroline do Carmo Menezes
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation, FHO, Av. Dr. Maximiliano Baruto, 500, Jd. Universitário, Araras, SP, 13607-339, Brazil
| | - William Custodio
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation, FHO, Av. Dr. Maximiliano Baruto, 500, Jd. Universitário, Araras, SP, 13607-339, Brazil.
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