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Murali S, Kannan A, Kailasam V. Cervical spine changes with functional appliance treatment: A systematic review and meta-analysis. J Oral Biol Craniofac Res 2024; 14:446-454. [PMID: 38855038 PMCID: PMC11157267 DOI: 10.1016/j.jobcr.2024.05.015] [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: 01/22/2024] [Revised: 04/24/2024] [Accepted: 05/18/2024] [Indexed: 06/11/2024] Open
Abstract
Objective Cervical spine posture is related to craniofacial morphology, airway, gait and body posture. This posture may be influenced by the changes in the mandibular position brought about by functional appliance therapy. Therefore, this systematic review aimed to assess the changes in the cervical spine posture with functional appliance treatment in Skeletal Class II subjects. Methods A search of studies in six electronic databases - Medline (via Pubmed), the Cochrane Library, OVID, LILACS, Scopus and Web of Science were performed until January 18, 2024 without any restriction in date or language of publication. Eligibility screening, study selection, and data extraction were performed by two reviewers independently. The risk of bias assessment of the included studies was performed with the Newcastle Ottawa scale and Cochrane RoB 2.0. Meta-analysis was performed using random effects model for assessment of changes in the cervical spine with removable and fixed functional appliances. Results Twelve articles that satisfied the eligibility criteria were included for systematic review and nine articles for meta-analysis. Five studies showed a low risk of bias, one as moderate and six as high risk of bias. GRADE assessment revealed a low quality evidence. Meta-analysis revealed a decrease of the upper cervical inclination by 1.16° (95 % CI of -2.68 to 0.35, I2 = 6 %), an increase of the middle cervical inclination by 2.20° (95 % CI of 0.46-3.94, I2 = 49 %), an increase in cervical curvature angle by 1.60° (95 % CI of 0.12-3.09, I2 = 89 %) and a decrease in cervical lordosis angle by 1.54° (95 % CI of -4.16 to 1.08, I2 = 0 %). Conclusions Minimal uprighting of the cervical spine was noted with functional appliances. Fixed functional appliances exerted a greater effect than removable functional appliances. Cervical hyperlordosis was reduced with removable functional appliance treatment. Though these changes are minimal, the clinical orthodontist should be aware that functional therapy also influences cervical spine posture. Due to the heterogeneity and low quality of evidence, the results are to be considered critically.
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Affiliation(s)
- Sandhya Murali
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College & Hospital, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 600116, India
| | - Annapurna Kannan
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College & Hospital, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 600116, India
| | - Vignesh Kailasam
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College & Hospital, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 600116, India
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Sfondrini MF, Gallo S, Pascadopoli M, Gandini P, Roncoroni C, Scribante A. Upper Airway Dimensions among Different Skeletal Malocclusions: A Retrospective Observational Study by Cephalometric Analysis. Dent J (Basel) 2024; 12:12. [PMID: 38248220 PMCID: PMC10813941 DOI: 10.3390/dj12010012] [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: 09/17/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
The aim of the present work was to investigate the upper airway dimensions in adult non-orthodontic patients, equally divided according to their skeletal class. METHODS In this retrospective cross-sectional study, lateral cephalometric radiographs of adult patients referred for orthodontic consultation were collected. Cephalometric tracing was performed with dedicated software. For each measure, descriptive statistics were calculated. Cephalometric measurements between the different skeletal classes were compared. Linear regressions were performed between upper airway diameters and cephalometric measurements, sex and age. Significance was predetermined for p < 0.05. RESULTS Lateral cephalometric radiographs of 120 patients were reviewed. Nasopharynx length (NL) and depth (PD) measurements were significantly shorter in skeletal class III patients (p < 0.05). The superior pharyngeal airway space (SPAS) was found to be significantly shorter in class III patients as compared to class II patients (p < 0.05), and the mean airway space (MAS) of class I patients was found to be significantly shorter compared to class II patients (p < 0.05). Palate length (PL) values were found to be significantly longer in class I (p < 0.05). Linear regressions showed that the sella-nasion-A point angle (SNA) and Riedel's angle between point A, the nasion and point B (ANB) significantly influenced NL and PD (p < 0.05). CONCLUSIONS Class III patients show significantly shorter nasopharynx measurements; clinicians should consider that this sagittal discrepancy could be related to an altered anatomy of the upper respiratory tract.
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Affiliation(s)
- Maria Francesca Sfondrini
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Simone Gallo
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Maurizio Pascadopoli
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paola Gandini
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Caterina Roncoroni
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Andrea Scribante
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Tse KL, Savoldi F, Li KY, McGrath CP, Yang Y, Gu M. Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study. Prog Orthod 2023; 24:31. [PMID: 37691059 PMCID: PMC10493207 DOI: 10.1186/s40510-023-00481-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Identifying the prevalence of adenoid hypertrophy (AH) and craniofacial factors associated with this condition requires studies with random sampling from the general population, and multiple criteria can be used for assessing AH on lateral cephalometric radiograph (LCR). The present analysis represents the first report performed according to these requirements in a large cross-sectional sample of children. METHODS LCRs of 517 12-year-old children (286 males, 231 females) randomly selected from the general population were retrospectively retrieved. AH was defined using three criteria (At/Nd, Ad-Ba/PNS-Ba, 1-Npaa/Npa), and twelve craniofacial variables were measured (SNA, SNB, ANB, Wits, Cd-Gn, MnP^SN, MxP^MnP, TPFH/TAFH, OPT^SN, C2ps-C4pi^SN, H-CV, H-FH). Skeletal characteristics were compared between children with and without AH using Mann-Whitney U test. Binary logistic regression (adjusted for sex and skeletal growth) was used to independently quantify the association between craniofacial factors and AH. RESULTS The prevalence of children with AH was 17.6% (according to At/Nd), 19.0% (according to Ad-Ba/PNS-Ba), and 13.9% (according to 1-Npaa/Npa). Children with AH presented greater antero-posterior jaw discrepancy (larger ANB, smaller SNB), greater mandibular divergence (larger MnP^SN), forward head posture (larger OPT^SN and C2ps-C4pi^SN), and anteriorly positioned hyoid bone (larger H-CV). Larger SNA (OR = 1.39-1.48), while smaller SNB (OR = 0.77-0.88) and Wits (OR = 0.85-0.87), were associated with greater likelihood of having AH, independently from the assessment method used. CONCLUSIONS The prevalence of children with AH ranged from 13.9 to 19.0% based on LCR. Greater antero-posterior maxillo-mandibular discrepancy and mandibular retrusion were independently associated with higher likelihood of having AH.
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Affiliation(s)
- Kwan Lok Tse
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Kar Yan Li
- Clinical Research Centre, Faculty of Dentistry, The University of Hong Kong, 5/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Colman P McGrath
- Dental Public Health, Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, 1/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China.
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Savoldi F, Fung KKF, Mak WS, Kan EYL, Yang Y, Kwok KL, Gu M. Are the severity of obstruction and the apnea-hypopnea index related to orofacial anatomy in children with obstructive sleep apnea? a kinetic MRI study. Dentomaxillofac Radiol 2023; 52:20220422. [PMID: 37192022 PMCID: PMC10304841 DOI: 10.1259/dmfr.20220422] [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: 12/13/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea-hypopnea index (AHI) or the amount of upper airway obstruction. METHODS MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level α = 0.05). RESULTS As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI(p = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI (β = -0.512, p = 0.007) and obstruction severity (β = 0.625, p = 0.002); and the retropalatal width was related to AHI (β = -0.384, p = 0.024) and obstruction severity (β = 0.519, p = 0.006). CONCLUSIONS In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
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Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Kevin KF Fung
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Elaine YL Kan
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Ka-Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
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Farronato M, Baselli G, Baldini B, Favia G, Tartaglia GM. 3D Cephalometric Normality Range: Auto Contractive Maps (ACM) Analysis in Selected Caucasian Skeletal Class I Age Groups. Bioengineering (Basel) 2022; 9:bioengineering9050216. [PMID: 35621494 PMCID: PMC9137702 DOI: 10.3390/bioengineering9050216] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this paper is to define normal values of a novel 3D cephalometric analysis and to define the links through an artificial neural network (ANN). Methods: One hundred and fifteen CBCTs of Class I young patients, distributed among gender-adjusted developmental groups, were selected. Three operators identified 18 cephalometric landmarks from which 36 measurements were obtained. The repeatability was assessed through the ICC. Two-dimensional values were extracted by an automatic function, and the mean value and standard deviation were compared by paired Student’s t-tests. Correlation coefficient gave the relationships between 2D and 3D measurements for each group. The values were computed with the ANN to evaluate the parameters normality link and displayed by Pajek software. Results: The ICC assessed an excellent (≥0.9) repeatability. Normal values were extracted, and compared with 2D measurements, they showed a high correlation on the mid-sagittal plane, reaching 1.00, with the lowest 0.71 on the lateral plane. The ANN showed strong links between the values with the centrality of the go-sagittal plane compared to the rest. Conclusions: The study provides a set of 3D cephalometric values obtained by the upper and lower 95% CI for the mean divided into the developmental stage subgroups. The two-dimensional measurements showed variable concordance, while the ANN showed a centrality between the parameters.
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Affiliation(s)
- Marco Farronato
- Department of Orthodontics, Faculty of Medicine, University of Milan, 20100 Milan, Italy; (B.B.); (G.M.T.)
- Correspondence:
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, 20133 Milan, Italy;
| | - Benedetta Baldini
- Department of Orthodontics, Faculty of Medicine, University of Milan, 20100 Milan, Italy; (B.B.); (G.M.T.)
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, Odontostomatology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Gianluca Martino Tartaglia
- Department of Orthodontics, Faculty of Medicine, University of Milan, 20100 Milan, Italy; (B.B.); (G.M.T.)
- Facial Surgery and Dentistry Fondazione IRCCS Cà Granda, UOC Maxillo, Ospedale Maggiore Policlinico, 20142 Milan, Italy
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Savoldi F, Svanetti L, Tsoi JK, Gu M, Paganelli C, Genna F, Lopomo NF. Experimental determination of the contact pressures produced by a nasal continuous positive airway pressure mask: A case study. J Mech Behav Biomed Mater 2022; 132:105272. [DOI: 10.1016/j.jmbbm.2022.105272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
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Gu M, Savoldi F, Chan EYL, Tse CSK, Lau MTW, Wey MC, Hägg U, Yang Y. Changes in the upper airway, hyoid bone and craniofacial morphology between patients treated with headgear activator and Herbst appliance: A retrospective study on lateral cephalometry. Orthod Craniofac Res 2020; 24:360-369. [PMID: 33217159 PMCID: PMC8411420 DOI: 10.1111/ocr.12442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/21/2020] [Accepted: 11/11/2020] [Indexed: 12/02/2022]
Abstract
Background The present study compared the treatment changes in the upper airway, hyoid bone position and craniofacial morphology between two groups of children with skeletal class II malocclusion treated with the headgear activator (HGA) and Herbst appliance (Herbst). Setting and sample population Orthodontic population from the Faculty of Dentistry of the University of Hong Kong. Methods Thirty‐four skeletal class II patients treated with the HGA (17 patients, mean age 10.6 ± 1.5 years) and the Herbst (17 patients, mean age 11.0 ± 1.4 years) were matched for sex, age, overjet, skeletal class and mandibular divergence. The patients received lateral cephalometric radiographs (LCRs) at the beginning of treatment (T1), after treatment (T2) and at follow‐up (T3). In the HGA group, patients underwent LCRs 7 months before the beginning of treatment (T0), which were used as growth reference for intra‐group comparison. Paired Student's t tests were used for intra‐ and inter‐group comparisons (α = .05). Results Treatment changes (T2‐T1) did not differ significantly between the groups. However, at follow‐up (T3‐T1) the Herbst group showed a smaller increase than the HGA group in the vertical position of the hyoid bone relative to the Frankfort plane (P = .013) and mandibular plane (P = .013). Conclusions There were no significant differences in the upper airway, hyoid bone position and craniofacial morphology between the groups at the end of treatment. However, the Herbst may provide better long‐term control of the vertical position of the hyoid bone than the HGA in children with skeletal class II malocclusion.
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Affiliation(s)
- Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China.,Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Eliza Y L Chan
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Christine S K Tse
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Michelle T W Lau
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Mang C Wey
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Urban Hägg
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
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