Subjective facial analysis and its correlation with dental relationships

Relationship between Skeletal Malocclusion and Radiomorphometric Indices of the Mandible in Long Face Patients

This study aimed to assess the relationship between skeletal malocclusion and radiomorphometric indices of the mandible in long face patients. This cross-sectional study evaluated 174 lateral cephalograms and panoramic radiographs of long face patients between the ages of 17 and 30 presenting at the Orthodontics Department of Qazvin Dental School. The gonial angle, antegonial angle, type of antegonial notch, and depth of antegonial notch were measured bilaterally on panoramic radiographs. The correlation between the radiomorphometric parameters and the type of occlusion was analyzed using one-way ANOVA, independent t-test, Chi-square test, and Fisher's exact test (alpha = 0.05). The mean size of gonial angle was significantly different among the three classes of occlusion (p = 0.046), while the difference was not significant regarding the antegonial angle size and antegonial notch depth (p > 0.05). An independent t-test showed that the mean sizes of gonial angle (p = 0.026) and antegonial angle (p = 0.036), and the antegonial notch depth (p = 0.046) in males, were significantly greater than the values in females. According to the Chi-square and Fisher's exact test, the right antegonial notch type was significantly different among the three classes of malocclusion (p = 0.006), while this difference was not significant in the left side (p = 0.318). The right antegonial notch type II was more common in males, while the right antegonial notch type I was more common in females (p = 0.014). According to the results, the indices of gonial angle and type of antegonial notch can be clinically useful for predicting the growth rate of the mandible and designing the appropriate treatment in long face patients.

Concordance of the facial biotype between Bjork-Jarabak cephalometrics and photographic analysis of the facial opening angle

Background

Analysis of the facial biotype can provide useful information for orthodontic diagnosis and can determine the type of growth of a patient to guide orthodontic treatment. The objective of this study was to determine the concordance of the facial biotype according to Bjork-Jarabak cephalometric analysis and photographic analysis of the angle of facial opening in Peruvian individuals.

Material and Methods

This retrospective study included 244 cephalometric radiographs and frontal photographs of the same patients obtained from a database. The facial biotype (mesofacial, brachyfacial, or dolichofacial) was determined with the Björk-Jarabak polygon (cephalometric) and the angle of facial opening (photographic). Two trained investigators performed all the measurements. The concordance of the facial diagnosis was determined using correlations of the interclass coefficient and the kappa test. p<0.05.

Results

In cases with a mesofacial biotype, both analyses coincided in 60 individuals (68.2%), while in those diagnosed with a dolichofacial biotype, the analyses only coincided in 17 individuals (10.4%). There was no concordance between the two methods regarding the brachyfacial biotype since according to the angle of facial opening none of the individuals presented a brachyfacial biotype (kappa weighted test= 0.020, p=0.586).

Conclusions

Cephalometric and photographic analyses should be complementary and one should not substitute the other. Attention should be focused on dolichofacial and brachyfacial biotypes, which showed less concordance between evaluations. So, more studies are needed to follow this line of research. Key words:Facial biotype, cephalometry, photography, facial type, radiography.

Association between Eruption Sequence of Posterior Teeth, Dental Crowding, Arch Dimensions, Incisor Inclination, and Skeletal Growth Pattern

Background: We conducted research to investigate the effects of the eruption sequence of posterior teeth, arch dimensions, and incisor inclination on dental crowding. Material and Methods: A cross-sectional analytic study was performed on 100 patients (54 boys and 46 girls; mean ages: 11.69 and 11.16 years, respectively). Seq1 (canine-3-/second premolar-5-) or Seq2 (5/3) eruption sequences were recorded in maxilla, and Seq3 (canine-3-/first premolar-4-) or Seq4 (4/3) eruption sequences in mandible; tooth size, available space, tooth size-arch length discrepancy (TS-ALD), arch lengths, incisor inclination and distance, and skeletal relationship were noted. Results: The most common eruption sequences in the maxilla and mandible were Seq1 (50.6%), and Seq3 (52.1%), respectively. In the maxilla, posterior tooth sizes were larger in crowded cases. In the mandible, anterior and posterior tooth sizes were larger in crowded patients. No relationship between incisor variables and the maxillo-mandibular relationship and dental crowding was found. A negative correlation between inferior TS-ALD and the mandibular plane was found. Conclusions: Seq1 and Seq 2 in the maxilla and Seq 3 and Seq 4 in the mandible were equally prevalent. An eruption sequence of 3–5 in the maxilla and 3–4 in the mandible is more likely to cause crowding.

Evaluation of palatal dimensions in different facial patterns by using digital dental casts

OBJECTIVE

To analyze the variations of hard palate volume in adults with normal occlusion and different facial types and patterns, by using a three-dimensional analysis on digital casts.

METHODS

The dental casts of 70 Caucasian adults (28 men, 42 women), mean age of 16.4 years (SD 1.3 years), were scanned by using a tridimensional scanner (Delcam PowerSHAPE™, 2010, Birmingham, UK). Close points were selected in the gingival and cervical regions on the lingual surface of the maxillary teeth, to analyze palatal morphology. The facial patterns and types, and the measurements (width, length, height, volume) of the space on the hard palate were compared using analysis of covariance (ANCOVA), with age as the covariate, and sex as the independent variable. The significance level of 5% (p < 0.05) was adopted.

RESULTS

This study showed that the measurements of the width and length were similar among the mesofacial, dolichofacial and brachyfacial facial types, although the height and volume of the space on the hard palate were slightly smaller in dolichofacial individuals, and both Pattern I and Pattern II individuals showed no significant changes for the four measurements. The mean values among facial patterns were: Pattern I - width 38.31±2.59 mm; length 37.44±2.42 mm; height 17.03±2.42 mm and volume 10.52±1.72 mm3; Pattern II - width 37.48±2.44 mm; length 37.48±2.44 mm; height 16.79±2.42 mm and volume 10.41±1.65 mm3 (p>0.05 for all variables).

CONCLUSION

There were no significant differences for the facial patterns and facial types of the individuals compared in the analyzed sample.

Prevalence of dental anomalies in different facial patterns and malocclusions in an Iranian population

Objective

This study aimed to evaluate the prevalence and association of dental anomalies with different types of malocclusions and facial patterns.

Methods

In this cross-sectional study, the records of patients referred to the Orthodontics Department at 12-20 years of age were collected. The patients were classified into four types of malocclusion: Cl I, Cl II div 1, Cl II div 2, and Cl III, and three types of facial patterns: normal, long, and short. Fifteen dental anomalies were searched within the documents. The statistical analysis of data was performed with chi-squared and Fisher's exact test.

Results

Among 602 patients evaluated in this study, 28.6% were males, and 71.4% were females. The prevalence of Cl I, Cl II div1, Cl II div 2, and Cl III was 58.3%, 28.7%, 5.5%, and 7.5%, respectively. The normal facial pattern was most prevalent (47.2%), followed by the long facial pattern (41.4%) and short facial pattern (11.5%); 60.7% of the study population had at least one dental anomaly. Dilaceration was the most common anomaly (27.7%), followed by impaction (21.8%) and hypodontia (18.9%). Most dental anomalies were found in females, Cl II malocclusion, and long face samples. A statistically significant association was found between transposition and male gender (P = 0.006) and between short roots and Cl II malocclusion (P = 0.047). No significant association was found between dental anomalies and facial patterns.

Conclusion

Significant associations were reported between transposition and male gender and between short roots and Cl II malocclusion. In our population, dilaceration was the most common dental anomaly.

The use of sel-ligating appliance can reduce inflammatory response to orthodontic force and keep periodontal health in orthodontic treatment

OBJECTIVE

Orthodontics, as a common way of orthodontic treatment, is usually to maintain oral health and protect periodontal tissue. The self-ligating appliance technique, since its advent in the 1930s, have been rather popular ammong the majority of orthodontists. This study was to determine that self-ligating appliance can reduce inflammation in gingival crevicular fluid (GCF) of patients receiving orthodontic treatment and keep periodontal health.

METHODS

The clinical data of 97 orthodontic patients admitted to the Department of Stomatology of Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University from March 2019 to March 2020 were analyzed retrospectively. Among them, 42 patients receiving orthodontic treatment with traditional MBT straight-wire appliance (SWA) were included in the control group (CG) and 55 patients treated with self-ligating appliance were collected as the observation group (OG). The two cohorts were compared with respect to the following aspects: curative effect, pain degree on the 1st, 2nd, 3rd, 5th and 7th day after wearing the appliance, oral related quality of life (QoL) before and after orthodontic treatment, satisfaction with the orthodontic treatment, periodontal condition, and GCF and inflammatory factor contents before, 3 months and 6 months after orthodontic treatment.

RESULTS

OG had significantly higher therapeutic efficacy of orthodontic treatment than CG (P<0.05). At the initial stage of treatment, the pain degree in OG was obviously lower than that in CG (P<0.05). Compared with CG, the plaque index (PLI), sulcus bleeding index (SBI), gingival recession (GR), periodontal probing depth (PPD) and clinical attachment loss (CAL) were better in OG after orthodontic treatment, and the differences were statistically significant (P<0.05). The contents of GCF, prostaglandin E2 (PGE₂), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in OG were lower than those in CG after orthodontic treatment, with significant differences between the two groups (P<0.05). Oral related QoL and orthodontic satisfaction were higher in OG, and the differences were statistically significant (P<0.05).

CONCLUSIONS

Compared with traditional SWA, the self-ligating appliance in orthodontic treatment contributes to higher efficacy and satisfaction, less local inflammatory reaction, and significantly improved periodontal condition and oral health of patients.

Personalized Orthodontics: From the Sagittal Position of Lower Incisors to the Facial Profile Esthetics

Background: One of the goals of orthodontic treatment is to obtain maximum facial harmony. The sagittal position of the lower incisors plays a significant role in the planning of orthodontic treatment. The aim of the study was to evaluate the relationship between the sagittal position of lower incisors and facial profile esthetics with reference to the skeletal vertical dimension. Methods: There were 200 patients included in the study. Patients were allocated into three groups, depending on the vertical growth pattern: normal-angle, low-angle, and high-angle cases. Tweed–Merrifield cephalometric analysis was used to assess the sagittal and vertical position of the mandible, as well as to assess the sagittal position of the lower incisors. Results: Z-angle and Frankfort mandibular incisor plane angle (FMIA) decreased significantly (p < 0.001) with the increase of the skeletal vertical dimension. Incisor mandibular plane angle (IMPA) was significantly higher (p < 0.001) in low-angle patients compared to the high-angle ones. Z-angle appeared to be the most accurate parameter (area under curve, AUC = 0.957) describing patients with a convex profile. The cutoff value of Z-angle 68.0° was characterized by the sensitivity of 94.1% and the specificity of 84.3%. Conclusions: The sagittal position of the lower incisors significantly affects the facial profile convexity. The Z-angle is the parameter which most accurately describes the patients with a convex profile.

Artificial intelligence in orthodontics

This article aims to discuss how AI with its powerful pattern finding and prediction algorithms are helping orthodontics. Much remains to be done to help patients and clinicians make better treatment decisions. AI is an excellent tool to help orthodontists to choose the best way to move teeth with aligners to preset positions. On the other hand, AI today completely ignores the existence of oral diseases, does not fully integrate facial analysis in its algorithms, and is unable to consider the impact of functional problems in treatments. AI do increase sensitivity and specificity in imaging diagnosis in several conditions, from syndrome diagnosis to caries detection. AI with its set of tools for problem-solving is starting to assist orthodontists with extra powerful applied resources to provide better standards of care.

Validation of the Vertical Facial Growth Screening Test

Background. Vertical facial growth has a high prevalence. Nonspecialized professionals have shown low sensitivity to identify patients at risk. In the face of this difficulty, we designed and validated a screening checklist for vertical facial growth. Methods. A multidisciplinary team of 5 members developed the Vertical Facial Growth Screening Test. A sample of 160 evaluations was obtained. We consider as the gold standard the evaluation of 2 specialists in dentofacial orthopedics. Results. Consistency measured with Cronbach α was .675 for 10 items. Test-retest reliability was .956. The interobserver concordance was .886. The receiver operating characteristic curve has .987 area under the curve. Conclusion. This is the first study to design and validate a screening checklist for vertical facial growth for nonexpert evaluators. We think that given its good performance, ease of use, inexpensiveness, and availability, the test could be useful for nontrained professionals dealing with children.

Are pediatricians and otolaryngologists well prepared to identify early signs of vertical facial growth?

BACKGROUND

The prevalence of vertical facial growth is very high in the developed world. Most authors agree that mouth breathing is its main cause. Even though care is mainly conducted by odontologists, the professionals who first see these patients are pediatricians and otolaryngologists. The objective of this study is to analyze the ability of pediatricians and otolaryngologists to identify early signs of vertical facial growth among children.

METHODS

60 participant aged 4.1-13.7 years were analyzed subjectively by 9 otolaryngologists, 9 pediatricians and two specialists in dentofacial orthopedics. They were also assessed objectively with cephalometric analysis.

RESULTS

Otolaryngologists showed 34.78% sensitivity, 92.86% specificity and 48.33% efficiency. Pediatricians showed 13.04% sensitivity, 100% specificity and 33.33% efficiency. Using a linear regression model compared against the objective measurements we found a weak positive correlation both for otolaryngologists and pediatricians.

CONCLUSION

The sensitivity was very low for both groups. We believe it is of paramount importance to increase the awareness and the ability of otolaryngologists and pediatricians to recognize signs of disrupt facial growth.