Craniofacial development in obese adolescents

Craniofacial features of adult obese obstructive sleep apnoea patients in relation to the obesity onset - A pilot study

INTRODUCTION

Obesity and craniofacial structures are aetiologies of obstructive sleep apnoea (OSA). The effect of obesity onset on the craniofacial development and growth of obese OSA subjects has been suggested, but supporting data were lacking. This study aimed to assess the craniofacial features of adult obese OSA patients in relation to their obesity onset.

MATERIALS AND METHODS

A total of 62 adult OSA patients were included in the study, consisting of 12 early-onset (i.e. before puberty), 21 late-onset (i.e. after puberty) and 29 non-obese. All participants underwent a sleep study and cephalometric radiograph. Cephalometric analysis was conducted to measure the craniofacial features among the groups.

RESULTS

The early obesity onset group (n = 12) showed a more prognathic mandible, longer lower facial height, protrusive incisors, a more caudal position of the hyoid bone and a wider lower airway. The late-onset group (n = 21) had more proclined and protrusive upper incisors, a shallower overbite, a more inferiorly positioned hyoid bone and an obtuse craniocervical angle. The overall obese group showed a combination of the findings above, plus a shorter soft palate and shorter airway length. There was no significant difference between early and late obesity onset groups. However, the early group showed a tendency for a shallower or decreased mandibular plane angle and deeper overbite.

CONCLUSIONS

The current pilot study had many limitations but holds important information as a hypothesis generator. Craniofacial features of OSA patients with different obesity onset showed discrepancies and were distinguished from non-obese controls. Adult OSA patients with an early obesity onset showed a tendency for a more hypodivergent growth pattern than those with a late obesity onset.

The skeletal and dental age advancements of children and adolescents with overweight and obesity: A systematic review and meta-analysis

INTRODUCTION

Over the past decades, a trend of increasing obesity among children has emerged. This study aimed to evaluate and summarize the impacts of overweight and obesity on children's and adolescents' skeletal and dental developmental advancement that may influence orthodontic management.

METHODS

Registered with the Prospective Register of Systematic Reviews (registration no. CRD42022347488), this study complies with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Particularly, relevant original studies on skeletal or dental age evaluation were screened from accessible electronic databases and supplemented by hand-searching. Meta-analysis was recruited to calculate differences (and their 95% confidence interval [CI]) between subjects with overweight or obese and normal-weight counterparts.

RESULTS

After applying the inclusion and exclusion criteria, 17 articles were selected for the final review. Two of the 17 selected studies were found to have a high risk of bias and moderate the other 15. A meta-analysis detected no statistically significant difference in skeletal age between children and adolescents with overweight and normal-weight counterparts (P = 0.24). However, the dental age of children and adolescents with overweight was found to be 0.49 years (95% CI, 0.29-0.70) advanced in comparison with normal-weight counterparts (P <0.00001). In contrast, children and adolescents with obesity were found to have advanced skeletal age by 1.17 (95% CI, 0.48-1.86) years (P = 0.0009) and dental age by 0.56 (95% CI, 0.37-0.76) years (P <0.00001) compared with their normal-weight counterparts.

CONCLUSION

Because the orthopedic outcomes of the orthodontic intervention are closely tied to the skeletal age of the patients, these results suggest that the orthodontic evaluation and treatment of children and adolescents with obesity might occur earlier than that of the normal-weight population.

Impact of genetic variations in the WNT family members and RUNX2 on dental and skeletal maturation: a cross-sectional study

BACKGROUND

This study evaluated if genetic variations in the WNT family members and RUNX2 are associated with craniofacial maturation, investigating dental and skeletal maturity in children and teenagers.

METHODS

Radiographs from pre-orthodontic treatment of Brazilian patients (7 to 17 years-old) were used to assess dental (panoramic radiographs) and skeletal maturity (cephalometric radiographs). The chronological age (CA) was calculated based on the date of birth and the time the radiographs were performed. For the dental maturity analysis, the Demirjian (1973) method was used and a delta [dental age - chronological age (DA-CA)] was calculated. For the skeletal maturity analysis, the Baccetti et al. (2005) method was used and the patients were classified as "delayed skeletal maturation", "advanced skeletal maturation" or "normal skeletal maturation". DNA isolated from buccal cells was used for genotyping of two genetic variations in WNT family genes: rs708111 (G > A) in WNT3A and rs1533767 (G > A) in WNT11; and two genetic variations in RUNX2: rs1200425 (G > A) and rs59983488 (G > T). A statistical analysis was performed and values of p < 0.05 indicated a significant difference.

RESULTS

There were no associations between dental maturity and genotypes (p > 0.05). In the skeletal maturity analysis, the allele A in the rs708111 (WNT3A) was statistically more frequent in patients with delayed skeletal maturation (Prevalence Ratio = 1.6; 95% Confidence Interval = 1.00 to 2.54; p-value = 0.042).

CONCLUSIONS

The rs708111 in the WNT3A gene impacts on skeletal maturation.

Effects of obesity on the rat incisor enamel and dentine thickness, as well as on the hemimandible shape over generations

Obesity has several effects on the general body metabolism. However, little is known about the impact of obesity on the growth and shape of mineralized tissues like mandibles and teeth, as well as if it effects are passed down from generation to next. Therefore, in this study, we aimed to evaluate, over nine generations using the consanguineous mating (inbreeding), the effect of the obesity condition produced by the reduction in the number of rats per litter during the lactation period on the hemimandible shape, dentine, and enamel of the rat incisor. Litters were reduced to two males and two females after birth, and were consanguinity mated in adulthood for nine generations. For all evaluations performed in this investigation, only males were used. The control group was formed by a non-consanguineous litter containing eight males. The parameters evaluated were food consumption, body weight, Lee Index, and bone density of the hemimandible bone. Incisor enamel and dentine thickness were also evaluated. The hemimandible shape was evaluated using geometric morphometry. The results show a significant and progressive increase in food intake, Lee Index, body weight, hemimandible weight, and enamel thickness, and a decrease in dentine thickness. The linear measurements of the length of the ramus ascending hemimandibular segment were found to be shorter, while its height was increased. In contrast, the geometric morphometry shows that the general hemimandible shape changed over the consanguineous obesity generations. We conclude that over generations, obesity increases and maintains the parameters evaluated with significant changes in hemimandible shape as well as in the dimensions of enamel and dentine of incisors, suggesting that enamel and dentine could be used as phenotype biomarkers to detect changes in tooth and craniofacial development related to obesity effects.

Facial reconstruction using 3-D computerized method: A scoping review of Methods, current Status, and future developments

Facial reconstruction (otherwise known as facial approximation) is an alternative method that has been widely accepted in forensic anthropological and archaeological circumstances. This method is considered useful for creating the virtual face of a person based on skull remain. Three-dimensional (3-D) traditional facial reconstruction (known as sculpture or manual method) has been recognized for more than a century; however, it was declared to be subjective and required anthropological training. Until recently, with the progression of computational technologies, many studies attempted to develop a more appropriate method, so-called the 3-D computerized facial reconstruction. This method also relied on anatomical knowledge of the face-skull relationship, divided into semi- and automated based computational method. The 3-D computerized facial reconstruction makes it more rapid, more flexible, and more realistic to generate multiple representations of faces. Moreover, new tools and technology are continuously generating fascinating and sound research as well as encouraging multidisciplinary collaboration. This has led to a paradigm shift in the 3-D computerized facial reconstruction to a new finding and new technique based on artificial intelligence in academia. Based on the last 10-years scientific-published documents, this article aims to explain the overview of the 3-D computerized facial reconstruction and progression as well as an issue relating to future directions to encourage further improvement.

The Effect of Two-Generation Exposure to a High-Fat Diet on Craniofacial Morphology in Rats

This study aimed to examine the sexual dimorphism effect of two-generation exposure to a high-fat diet (HFD) on the craniofacial growth of rat offspring. Ten eleven-week-old pregnant Wistar rats were fed either a control or HFD from day 7 of pregnancy until the end of lactation. Twelve male and female offspring from the control-diet-fed mothers were assigned to the CM (control male, n = 6) and CF (control female, n = 6) groups. The other twelve from the HFD-fed mothers were assigned to the HFD male (HFDM, n = 6) and HFD female (HFDF, n = 6) groups. HFDM and HFDF rats continued with an HFD. The offspring's weight and fasting blood sugar levels were measured every two weeks. The craniofacial and dental morphologies were studied from lateral X-rays of the head at ten weeks old. The HFDM rats showed an increased body weight and larger neurocranial parameters compared with the CM group. Furthermore, there were slightly significant differences in body weight and viscerocranial parameters between the rats in the HFDF and CF groups. In conclusion, two-generational exposure to an HFD had a greater effect on the male offspring's body weight and craniofacial morphology.

Influence of the nutritional status on facial morphology in young Japanese women

Evidence regarding the possible influence of nutritional status on the facial morphology has thus far been insufficient. We examined whether or not the physical body compositions and dietary behaviors were correlated with any morphological characteristics of the face. One hundred and fifteen young Japanese women participated. Variables representing the dietary behaviors were extracted from self-reported survey data, and corresponding three-dimensional (3D) facial images and body compositions were examined. Multivariate analyses identified significant relationships between the nutritional status and facial topography (p < 0.05). The clustering method revealed the existence of three dietary condition patterns ("balanced diet", "high-calorie-diet" with obesity tendency, and "imbalanced low-calorie-diet" with sarcopenic obesity tendency). Among these three patterns, a round face (increased facial width; analysis of variance [ANOVA], p < 0.05) was observed in the high-calorie-diet pattern, while the imbalanced low-calorie-diet pattern showed a more masculine face (increased face height, decreased eye height, increased non-allometric sexual shape differences; ANOVA, p < 0.05), thus suggesting the possibility of sex-hormonal influences. In summary, the body composition and dietary behaviors were found to influence the facial morphology, and potential biological influences were discussed.

Craniofacial form differences between obese and nonobese children

INTRODUCTION

Current evidence suggests that obesity is correlated with differences in craniofacial form in children and adolescents. Here, we sought to test this hypothesis by evaluating the craniofacial form of obese and nonobese preorthodontic patients, using 2D cephalometric data combined with cephalometric and geometric morphometric approaches.

METHODS

Height, weight, age, and lateral cephalometric radiographs were gathered from patients aged 7-16 years before beginning orthodontic treatment at the University of British Columbia. Based on their body mass index, 24 obese patients were age, sex, and Angle classification of malocclusion matched with nonobese controls. Cephalometric radiographs were annotated, and coordinates of landmarks were used to obtain linear and angular cephalometric measurements. Geometric morphometric analyses were performed to determine overall craniofacial form differences between cohorts. Dental maturation index scores and cervical vertebral maturation scores were recorded as an indicator of skeletal maturation.

RESULTS

Cephalometric analysis revealed that the maxillary length and gonial angle are the only marginally larger metrics in obese subjects than in control subjects. However, principal component and discriminant analyses (geometric morphometrics) confirmed that the overall craniofacial form of obese patients differs statistically from that of control patients. Obese patients tend to be slightly mandibular prognathic and brachycephalic. Dental maturation index scores were statistically higher in the obese group than in the control group, with no statistical difference in cervical vertebral maturation scores.

CONCLUSIONS

Our data reveals a subtle but significant difference in cranial skeletal morphology between obese and nonobese children and adolescents, suggesting a correlation between craniofacial form and physiological/metabolic phenotypes of subjects. It is likely that with continued growth, these differences may increase. Recording body mass index as part of the orthodontic records for patients may help in supporting the assessment of craniofacial form.

Evaluation of facial soft-tissue values and craniofacial morphology in obese adolescent patients with different skeletal classes

Objectives:

The purpose of this study was to evaluate the facial soft tissue and craniofacial morphological structures in adolescent obese individuals with different skeletal patterns.

Materials and Methods:

The study was carried out on 292 adolescents examined under three groups based on their body mass indexes (BMIs) as obese, healthy, and overweight. The subjects were also categorized based on skeletal classes as Class I, Class II, and Class III.

Results:

The glabella, nasion, labiale inferius, labiomentale, and pogonion values of the female patients were significantly higher in obese group. In the obese and overweight groups, effective midfacial and mandibular length, anterior and posterior facial heights, and SN values of the females were higher than males. In the obese group, the mean effective midfacial and mandibular length (Co-A and Co-Gn), anterior and posterior facial heights (S-Go and N-Me), and anterior cranial base (SN) values were significantly higher than other groups.

Conclusion:

Soft-tissue thicknesses increase as BMI value increases. Craniofacial morphology reveals significant differences between BMI groups.

Influence of BMI percentile on craniofacial morphology and development in children and adolescents

BACKGROUND

The prevalence of childhood and adolescent obesity is increasing worldwide. Reports suggest that elevated body mass index (BMI) is associated with larger craniofacial dimensions and advanced dental and skeletal development. Such an association is important for timing orthodontic treatment relative to pubertal growth and dental eruption.

MATERIALS AND METHODS

To evaluate associations between BMI, craniofacial morphology, dental age, and cervical vertebrae maturation staging (CVMS), 400 participants were consecutively selected (8-15 years, n = 200 overweight and obese BMI >85%, 200 normal weight) from the University of North Carolina database. Records were analysed for cephalometric measures, Demirjian index values, and CVMS. Bivariate statistics and linear regression analysis evaluated whether CVMS, dental age, and cephalometric dimensions varied with BMI.

RESULTS

Overweight/obese children and adolescents had a proportionally larger bimaxillary prognathic skeletal pattern compared to those of normal weight. These cephalometric measurements [articulare-gnathion (Ar-Gn), condylion-anterior nasal spine (Co-ANS), sella-gonion (S-Go), nasion-menton (N-Me), anterior nasal spine-menton (ANS-Me), sella-nasion-A point (SNA), sella-nasion-B point (SNB), and sella-nasion-pogonion (SNPg)] were significantly different [statistically (P < 0.05) and clinically (>2 mm or >2 degrees)] between the two study groups, with a linear relationship between BMI percentile and craniofacial dimension. The overweight/obese BMI group had a mean dental age 1.4 years advanced relative to the normal weight group (P < 0.05), with an advancement of nearly one CVM stage between the ages of 12 and 14 (P < 0.05).

LIMITATIONS

The study is retrospective.

CONCLUSIONS

Obese/overweight children and adolescents have proportionally larger antero-posterior and vertical dimensions and are more likely to experience advanced dental and skeletal maturation. Obese/overweight subjects may enter their growth spurt at a younger age and have earlier eruption of teeth, affecting treatment timing. BMI percentile should be a consideration for orthodontic treatment in growing patients.

Craniofacial morphology of HIV-infected adolescents undergoing highly active antiretroviral therapy (HAART): An original research

OBJECTIVES:

To analyze the craniofacial morphology in child patients and adolescents by evaluating the skeletal cephalometric profile of the HIV infected patients in this age group and comparing them with the HIV-negative controls.

MATERIALS AND METHODS:

The present study was a planned case-control study which included 25 HIV-positive adolescent patients aged between 10 and 18 years (the study group) who were compared with 25 age- and sex-matched HIV-negative adolescent controls (the control group). All the patients had been HIV infected via a vertical transmission with positive serology confirmed in two different tests and had been kept on HAART since they were born. The diagnostic aids used for orthodontic documentation included facial photographs, digital orthopantomographs, lateral teleradiographs, and study models.

RESULTS:

With reference to the methodologies used for taking the cephalometric values, all the methods used were in strong agreement with each other for almost all the variables studied and had high intra-class correlation coefficient values except Co-A, SN.ANSPNS, and SNB which, too, had a good agreement of 60%. Nevertheless, the agreement was positive for these variables, too, since the P values obtained were found to be statistically significant (P < 0.05).

CONCLUSION:

Most of the measurements in the HIV-infected adolescents were found to be similar to the ones obtained for the HIV-negative controls, although, the study results highlighted the significance of further studies to be conducted in this regard, especially, the longitudinal study designs wherein the said variables can be studied on a follow-up basis in longitudinal studies to have an idea of the exact changes observed and their pattern in the included groups.

Childhood obesity may accelerate timing of human facial growth

OBJECTIVE

We hypothesize that childhood obesity influences both facial and mandibular size and form in children and adolescents.

DESIGN

Pre-treatment records of patients (n = 181; 86 males, 95 females) from the Department of Orthodontics at the University of Illinois at Chicago representing six different ancestry groups (Asian, African-American, Caucasian Non-Hispanic, Hispanic, Multiracial, Unknown) were reviewed retrospectively. Body mass index (BMI) scores and categories were calculated using the Center for Disease Control and Prevention (CDC) guidelines. Twenty-two landmarks were collected on lateral cephalometric radiographs. The landmark dataset was analyzed as a whole (facial shape) and a subset of landmarks was also used to study mandibular shape in isolation.

RESULTS

Evidence of allometry (size related shape differences) was detected. Principal Component Analyses (PCA) were performed on the allometric regression residuals. Overall facial shape did not correlate with BMI. A series of one-way ANOVA tests on PC1-6 on a mandible-only subset of the landmarks using BMI category (normal, overweight, obese) showed PC5 and PC6 were significant (p = 0.003; p = 0.027). Centroid size was positively correlated with BMI when controlling for age (facial: p = 0.011, r = 0.196; mandibular: p < 0.001, r = 0.256).

CONCLUSIONS

Our results mostly did not support a relationship between high BMI and facial shape. However, we found larger facial skeletal sizes in high BMI children, providing tentative evidence that childhood obesity may lead to accelerated timing of facial growth.

Clinical, laboratory and radiological assessment of skeletal maturation in children and adolescents with obesity

Background

Childhood obesity is related to multiple serious health problems and an enhanced risk of premature onset of diseases. The relation of skeletal maturation to obesity is undetermined. The study aims to evaluate skeletal maturation in children and adolescents with obesity, to correlate it with their anthropometric data, body fat content, BMI, fat mass and pubertal stage.

Results

Our study shows that obese children and adolescents have accelerated skeletal maturation compared to control normal-weight healthy subjects (mean skeletal age difference of 0.123 ± 0.67 years versus − 0.175 ± 0.32 years). Also, there were significant positive correlations between bone age and BMI (r = 0.435, P value 0.00).

Conclusion

The mean skeletal age difference was more in the obese group as compared to the control group and suggesting accelerated skeletal development in the obese group. It is important to assess skeletal maturity in growing patients to determine the best timing for orthopedic and orthodontic treatment around the growth spurt.

Correlation between Dental Maturity and Body Mass Index in Korean Children

Objective: The aim of this study was to determine relationships between dental maturity and body mass index (BMI) in Korean children. Study Design: 600 Korean children aged between 5 and 10 years for whom panoramic radiographs have been obtained between 2010 and 2017 were selected. Subjects were divided into four weight-status groups: underweight, normal weight, overweight, and obese. Five lower-left permanent teeth were observed and rated. The stage of each tooth was converted into a score using the table suggested by Demirjian, and the sum of these scores was designated as the 'maturity score'. Results: This study found statistically significant differences in dental maturity between the weight groups (analysis of variance, P=0.003), with the maturity score being higher in the obese group than in normal-weight subjects (Tukey's post-hoc test, P=0.004). The linear regression showed a positive association between BMI and the maturity score after adjusting for sex and age (β=0.34, P<0.001). The linear regression coefficient was higher in girls (β=0.61, P<0.001) than in boys (β=0.31, P=0.02). Conclusions: These data suggest that dental maturation is positively associated with BMI in Korean children. Since many treatment decisions are made in relation to dental maturity, these findings may have implications for pediatric dental care.

Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies

Objectives:

To assess the impact of increased body mass index (BMI) on orthodontic tooth movement (OTM) and related parameters in children and adolescents.

Search sources:

A search of six electronic databases and manual searching were performed up to June 2019 without language and time restrictions.

Data selection:

Eligibility criteria were as follows: (1) longitudinal controlled clinical studies; (2) children and adolescents undergoing orthodontic therapy (OT); (3) no systemic diseases; (4) experimental group: patients with increased BMI; and (5) control group: patients with normal BMI.

Data extraction:

Screening, study selection and data extraction were performed; bias within studies was assessed using the Risk of Bias In Non-randomised Studies (ROBINS-I) tool.

Results:

Seven studies were included. One study showed that an increased BMI is associated with less wear-time of removable orthodontic appliances and one study found no significant association. One study showed that an increased BMI is associated with less cooperation during OT; however, not with the treatment results. One study reported higher pain experience during OT in adolescents with than without increased BMI. Two studies showed that increased BMI in adolescents is related to OTM, one with increased and one with decreased rates of OTM, respectively. One study reported an association between increased BMI and incidence of white spot lesions and gingivitis during OT. The ROBINS-I tool showed low to moderate risk of bias within studies.

Conclusions:

The influence of BMI on OTM and related parameters in children and adolescents remains debatable.

Dental development and craniofacial morphology in school-age children

INTRODUCTION

The growth of the craniofacial complex is important for establishing a balanced relationship among the teeth, jaws, and other facial structures. However, there is still a lack of information about craniofacial parameters that are affected by the rate of dental development. The aim of this study was to investigate the association between dental development and craniofacial morphology in school-age children.

METHODS

This study was embedded in the Generation R Study, Rotterdam, The Netherlands. In 3,896 children aged 8 to 11 years, dental development was assessed from panoramic radiographs and craniofacial morphology was assessed by combining cephalometric parameters into 9 uncorrelated principal components, each representing a distinct skeletal or dental craniofacial pattern. The statistical analysis was performed using linear and nonlinear regression model.

RESULTS

Dental development was positively associated with the bimaxillary growth (β = 0.04; 95% CI 0.01 to 0.08). Children with above-average dental development had a tendency toward Class II jaw relationship (β = -0.08; 95% CI -0.13 to -0.04). Regarding dental parameters, the proclination increased for incisors and lips with advanced dental development (β = 0.15 [95% CI 0.10 to 0.19] and β = 0.13 [95% CI 0.09 to 0.17], respectively), but the incisor proclination remained more pronounced in children that had above-average dental development.

CONCLUSIONS

The findings of this large population-based study show that dental development is associated with specific dental and skeletal cephalometric characteristics in school-age children. Further longitudinal studies are necessary to confirm the observed effects over time.

Craniofacial morphology of HIV-positive children and adolescents undergoing antiretroviral therapy: A pilot study

INTRODUCTION

In this study, we aimed to analyze craniofacial morphology by assessing the skeletal cephalometric profiles of HIV-positive patients receiving antiretroviral therapy.

METHODS

For this study, 21 HIV-positive patients aged between 6 and 17 years (study group) were selected and compared with 21 normoreactive patients (control group), paired by sex and age. The patients were also divided into 3 age ranges (6-8, 9-12, and 13-17 years) considering the pubertal growth spurt as the central event. Eighteen (linear and angular) measurements were traced on teleradiographs by using 2 methodologies. The mean values of each measurement were compared between the study and control groups by age range.

RESULTS

The majority of the measurements checked in the HIV-positive children and adolescents for the 13-to-17 year age range were diminished, but not enough to generate a statistically significant difference in craniofacial growth. Statistically significant differences (P <0.05) were found only in the inclination of the palatal plane (6-8 years) and the position of the maxilla in the anteroposterior direction (13-17 years).

CONCLUSIONS

These results led us to conclude that some cephalometric measurements of HIV-positive children and adolescents may be similar to those of normoreactive subjects.

Analysis of facial soft tissue values and cranial skeletal widths in different body mass index percentile adolescent subjects

OBJECTIVE

The purpose of this study was to analyze facial soft tissue thickness and cranial skeletal transverse widths in adolescent subjects with different body mass index (BMI) percentiles.

METHODS

The 80 subjects were divided into three groups according to BMI percentile: normal-weight, overweight, and obese adolescent subjects. Facial soft tissue linear and cranial skeletal transversal width measurements were performed on lateral and postero-anterior cephalometric radiographs.

RESULTS

Glabella, nasion, pogonion, and gnathion soft tissue thicknesses were significantly different among normal-weight, overweight, and obese subjects (p < 0.05). However, other facial soft tissue thickness parameters were not statistically significantly different among the groups (p > 0.05). Moreover, there were no significant differences in cranial skeletal transversal widths among groups (p > 0.05).

CONCLUSION

Nasion soft tissue thickness was thicker in overweight subjects; whereas, glabella, pogonion and gnathion soft tissue thickness was thicker in obese subjects. All measured cranial skeletal widths were similar in normal-weight, overweight, and obese subjects.

Index of orthodontic treatment need in obese adolescents

Aim. This case-control retrospective study is aimed at assessing if obese adolescents need more orthodontic treatment in comparison with normal-weight patients of the same age. Methods. The test group included 100 obese subjects (50 males and 50 females; average age: 13.09 ± 1.19 years old) and the control group included 100 normal-weight patients matched for age and sex (50 males and 50 females; average age: 13.07 ± 1.26 years old). Clinical examinations were conducted on dental casts to assess the need of orthodontic treatment, by using the Index of Orthodontic Treatment Need (IOTN) (DHC, dental health component; AC, aesthetic components). Results. No statistically significant difference (P > 0.05) was observed between the two groups with regard to AC. Obese females showed a significant (P < 0.05) higher percentage of DHC 3 (32%) in comparison to the normal-weight girls (22%); for the other grades of DHC and for the single kind of malocclusion, no significant difference was found. Conclusions. Obese adolescents showed a similar need for orthodontic treatment compared to normal-weight patients of the same age. However, in obese females, a slightly greater need for orthodontic treatment was observed, compared to normal-weight patients.

Lateral facial profile may reveal the risk for sleep disordered breathing in children--the PANIC-study

OBJECTIVE

To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs.

MATERIALS AND METHODS

The present study sample consisted of 382 children 6-8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile.

RESULTS

The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000-0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951-0.992.

CONCLUSION

In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Predicting visceral obesity based on facial characteristics

Background

Visceral obesity is associated with facial characteristics and chronic disease, but no studies on the best predictor of visceral obesity based on facial characteristics have been reported. The aims of the present study were to investigate the association of visceral obesity with facial characteristics, to determine the best predictor of normal waist and visceral obesity among these characteristics, and to compare the predictive power of individual and combined characteristics.

Methods

Cross-sectional data were obtained from 11347 adult Korean men and women ranging from 18 to 80 years old. We examined 15 facial characteristics to identify the strongest predictor of normal and viscerally obese subjects and assessed the predictive power of the combined characteristics.

Results

FD_94_194 (the distance between both inferior ear lobes) was the best indicator of the normal and viscerally obese subjects in the following groups: Men-18-50 (p ≤ 0.0001, OR = 4.610, AUC = 0.821), Men-50-80 (p ≤ 0.0001, OR = 2.624, AUC = 0.735), and Women-18-50 (p ≤ 0.0001, OR = 2.979, AUC = 0.76). In contrast, FD_43_143 (mandibular width) was the strongest predictor in Women-50-80 (p ≤ 0.0001, OR = 2.099, AUC = 0.679). In a comparison of the combined characteristics, the area under the receiver operating characteristic curve (AUC) and the kappa values of the 4 groups ranged from 0.826 to 0.702 and from 0.483 to 0.279, respectively. The model for Men-18-50 showed the strongest predictive values and the model for Women-51-80 had the lowest predictive value for both the individual and combined characteristics.

Conclusions

In both men and women, the predictive power of the young and middle-age groups was better than that of the elderly groups for predicting normal waist and viscerally obese subjects for both the individual and combined characteristics. The predictive power appeared to increase slightly with the combined characteristics.

Association between malocclusion and headache among 12- to 15-year-old adolescents: a population-based study

OBJECTIVES

Headaches are a common problem among adolescents, and malocclusion is a possible risk factor. The purpose of this study was to investigate the association between malocclusion and headache among Japanese adolescents aged 12-15 years using a population-based sample.

METHODS

A total of 938 adolescents (94.7% of the target population in Koshu City) participated. A modified version of the Index of Orthodontic Treatment Need (IOTN) was used by orthodontists to evaluate occlusal characteristics, and the frequency of headaches (none, rarely, sometimes) was assessed via questionnaire (N = 938). Ordered logistic regression analyses were used to analyze the association between malocclusion and headache.

RESULTS

The prevalence of malocclusion diagnosed using the modified version of the IOTN was 44.9%. Multiple ordered logistic regression analyses showed that the odds ratio (OR) of having malocclusion for headache was 1.38 (95% confidence interval [CI]: 1.06-1.80), after adjustment for demographics, lifestyle, and dental status including orthodontic treatment history and tooth size. Moreover, among occlusal traits, lower crowding was independently associated with headache (OR: 1.64, 95% CI: 1.07-2.51).

CONCLUSIONS

We found that malocclusion, especially lower crowding, was associated with headache in a population-based sample of adolescents aged 12-15 years in Japan. Further study is needed to elucidate the mechanisms by which malocclusion affects headache.

Retinal vessel abnormalities as a possible biomarker of brain volume loss in obese adolescents

OBJECTIVE

Endothelial dysfunction in childhood obesity may precede cerebrovascular damage and cognitive impairment in adulthood. A noninvasive proxy of microvascular health is required to identify the risk for microvascular damage in obese children.

DESIGN AND METHODS

The associations of hippocampal volumes and global cerebral atrophy were assessed with retinal vessel caliber in 40 normal BMI controls and 62 obese age-matched nondiabetic adolescents and the contribution of inflammation, obesity, and insulin resistance to retinal vessel caliber was evaluated.

RESULTS

Compared to controls, obese adolescents had smaller retinal arterioles (8.3% decrease, P < 0.05) and wider venules (5.4% increase, P < 0.01). Larger retinal arteriole diameters were associated with less global cerebral atrophy (B = -0.24 [95% confidence interval, CI: -0.48, -0.002]) and larger hippocampal volumes (B = 0.01 [95% CI: 0, 0.02]). Venule diameters (B = 84.2 [95% CI: 30.3, 138.1]) were predicted by inflammation (fibrinogen). Arteriolar diameters were predicted by insulin resistance, indicated by logHOMA (homeostatic model assessment, HOMA) values (B = -17.03 [95% CI: -28.25, -5.81)] and body mass index (BMI) (B = -.67 [95% CI: -1.09, -0.24)]. All analyses were adjusted for mean arterial pressure, sleep apnea, and vessel diameter.

CONCLUSIONS

Measures of brain health, BMI, and insulin resistance are associated with retinal vessel caliber. If confirmed in larger studies, retinal arteriolar caliber may serve as a possible noninvasive proxy for brain atrophy in obese adolescents, and the identification of elevated risk for cerebral microvascular disease in adulthood.

A population-based cross-sectional study of the association between facial morphology and cardiometabolic risk factors in adolescence

OBJECTIVE

To determine whether facial morphology is associated with fasting insulin, glucose and lipids independent of body mass index (BMI) in adolescents.

DESIGN

Population-based cross-sectional study.

SETTING

Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England.

PARTICIPANTS

From the ALSPAC database of 4747 three-dimensional facial laser scans, collected during a follow-up clinic at the age of 15, 2348 white British adolescents (1127 males and 1221 females) were selected on the basis of complete data on cardiometabolic parameters, BMI and Tanner's pubertal stage.

MAIN OUTCOME MEASURES

Fasting insulin, glucose and lipids (triglycerides, high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc)).

RESULTS

On the basis of the collection of 63 x, y and z coordinates of 21 anthropometric landmarks, 14 facial principal components (PCs) were identified. These components explained 82% of the variation in facial morphology and were used as exposure variables. With adjustment for age, gender and pubertal stage, seven PCs were associated with fasting insulin, none with glucose, three with triglycerides, three with HDLc and four with LDLc. After additional adjustment for BMI, four PCs remained associated with fasting insulin, one with triglycerides and two with LDLc. None of these associations withstood adjustment for multiple comparisons.

CONCLUSIONS

These initial hypotheses generating analyses provide no evidence that facial morphology is importantly related to cardiometabolic outcomes. Further examination might be warranted. Facial morphology assessment may have value in identifying other areas of disease risk.

Morphometry of the soft tissues of the orbital region in Northern Sudanese persons

The orbital region plays a predominant role in the evaluation of the craniofacial complex. No current normative data exist for Northern Sudanese subjects. In the current study information about normal sex- and age-related dimensions of the orbital region was provided. The three-dimensional coordinates of ten landmarks on the orbital soft tissues were obtained using a hand-held laser scanner in 654 healthy Northern Sudanese subjects aged 4-30 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analysed linear soft-tissue orbital dimensions, except intercanthal width and left orbital height, were significantly larger in men than in women (p<0.01). A significant sexual dimorphism was found also for the height-to-width ratios (larger in women in most age groups), the orbital inclinations vs. the true horizontal and Frankfurt plane (both measurements were almost always larger in men than in women), and the right side inclination of the eye fissure vs. the true horizontal (larger in women than in men), while no sex-related differences were observed for the left side inclination of the eye fissure vs. the true horizontal. All measurements but the right side inclination of the eye fissure vs. the true horizontal underwent significant modifications as a function of age, with several significant age×sex interactions. Biocular and intercanthal widths, orbital height, length of the eye fissure, all increased from childhood to young adulthood; in the second decade of life all age-related increments were larger in men than in women. Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human orbital morphology during normal growth and development. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, ageing of living and dead people, personal identification) may also benefit from age- and sex-based data banks.

Leonardo da Vinci meets celiac disease

BACKGROUND AND AIM

Leonardo da Vinci's face symmetry derives from 3 equal craniofacial segments: trichion-nasion (tn), which represents the superior third of the face, nasion-subnasal (ns) that is the medium third of the face, and subnasal-gnathion (sg) that is the length of the lower third of the face. It has been reported that adult subjects with celiac disease (CD) can be identified on the basis of a greater extension of the forehead in comparison to the medium third of the face, with a high tn/ns ratio. The aim of the present study was to investigate the correlation between facial asymmetry and CD in childhood and adulthood.

METHODS

We studied 126 biopsy-proven patients with CD (76 children and 50 adults) and 102 healthy controls (43 children and 59 adults). Their faces were photographed; the pictures were edited using a software program to calculate the facial segments.

RESULTS

The tn length was significantly different between adult celiac and adult controls (7.43 ± 1.46 cm vs 6.38 ± 1.73 cm, P = 0.001). The cutoff of 6.5 cm tn, derived from receiver operating characteristic curve analysis, identified 43 of 50 patients (sensitivity 86%), but 34 of 59 controls were positive (specificity 54.2%). The positive predictive value was 56%; however, the tn/ns ratio was not significantly different between celiacs and controls. Neither the tn length nor the tn/ns ratio in celiacs correlated to the time of gluten exposure.

CONCLUSIONS

Adults, but not children, with celiac disease show a forehead extension significantly greater than controls, but this test's specificity appears too low to be used in the screening of CD.

Skeletal maturation in obese patients

INTRODUCTION

The objective of this study was to compare skeletal maturation in obese patients and in subjects of normal weight to evaluate the best timing for orthopedic and orthodontic treatment. The null hypothesis was that obese and normal-weight patients show similar degrees of skeletal maturation.

METHODS

The sample for this retrospective study consisted of 50 white patients (28 boys, 22 girls) whose x-rays (hand-wrist and lateral cephalometric radiographs) were already available. The test group included 25 obese patients (11 girls, 14 boys; average age, 9.8 ± 2.11 years), and the control group included 25 subjects of normal weight (11 girls, 14 boys; average age, 9.9 ± 2.5 years). Skeletal maturation was determined by using the carpal analysis method and the cervical vertebral maturation method.

RESULTS

According to the carpal analysis, there was a significant difference between skeletal and chronologic ages between the test group (11.8 ± 11.4 months) and the control group (-2.9 ± 3.1 months). Furthermore, the obese subjects exhibited a significantly higher mean cervical vertebral maturation score (2.8 ± 0.7) than did the control subjects (2 ± 0.6) (P <0.05).

CONCLUSIONS

Compared with the normal-weight subjects, the obese subjects showed a higher mean discrepancy between skeletal and chronologic ages according to the carpal analysis and had a significantly higher cervical vertebral maturation score. Thus, to account for the growth in obese patients with skeletal discrepancies, it might be necessary to perform examinations and dentofacial and orthopedic treatments earlier than in normal-weight subjects.

A classification method of normal and overweight females based on facial features for automated medical applications

Obesity and overweight have become serious public health problems worldwide. Obesity and abdominal obesity are associated with type 2 diabetes, cardiovascular diseases, and metabolic syndrome. In this paper, we first suggest a method of predicting normal and overweight females according to body mass index (BMI) based on facial features. A total of 688 subjects participated in this study. We obtained the area under the ROC curve (AUC) value of 0.861 and kappa value of 0.521 in Female: 21–40 (females aged 21–40 years) group, and AUC value of 0.76 and kappa value of 0.401 in Female: 41–60 (females aged 41–60 years) group. In two groups, we found many features showing statistical differences between normal and overweight subjects by using an independent two-sample t-test. We demonstrated that it is possible to predict BMI status using facial characteristics. Our results provide useful information for studies of obesity and facial characteristics, and may provide useful clues in the development of applications for alternative diagnosis of obesity in remote healthcare.

Testosterone-mediated sex differences in the face shape during adolescence: subjective impressions and objective features

Sex identification of a face is essential for social cognition. Still, perceptual cues indicating the sex of a face, and mechanisms underlying their development, remain poorly understood. Previously, our group described objective age- and sex-related differences in faces of healthy male and female adolescents (12-18 years of age), as derived from magnetic resonance images (MRIs) of the adolescents' heads. In this study, we presented these adolescent faces to 60 female raters to determine which facial features most reliably predicted subjective sex identification. Identification accuracy correlated highly with specific MRI-derived facial features (e.g. broader forehead, chin, jaw, and nose). Facial features that most reliably cued male identity were associated with plasma levels of testosterone (above and beyond age). Perceptible sex differences in face shape are thus associated with specific facial features whose emergence may be, in part, driven by testosterone.

Predicting adult health and mortality from adolescent facial characteristics in yearbook photographs

Several important longitudinal studies in the social sciences have omitted biomarkers that are routinely recorded today, including height and weight. To account for this shortcoming in the Wisconsin Longitudinal Study (WLS), an 11-point scale was developed to code high school senior class yearbook photographs of WLS participants for relative body mass (RBM). Our analyses show that although imperfect, the RBM scale is reliable (alpha = .91) and meets several criteria of validity as a measure of body mass. Measured at ages 17-18, the standardized relative body mass index (SRBMI) was moderately correlated (r = .31) with body mass index (BMI) at ages 53-54 and with maximum BMI reported between ages 16 and 30 (r = .48). Overweight adolescents (> or = 90th percentile of SRBMI) were about three times more likely than healthy-weight adolescents (10th-80th percentile of SRBMI) to be obese in adulthood and, as a likely consequence, significantly more likely to report health problems such as chest pain and diabetes. Overweight adolescents also suffered a twofold risk of premature death from all nonaccidental causes as well as a fourfold risk of heart disease mortality. The RBM scale has removed a serious obstacle to obesity research and lifelong analyses of health in the WLS. We suggest that other longitudinal studies may also be able to obtain photos of participants at younger ages and thus gain a prospectively useful substitute for direct measures of body mass.

The effect of Delaire cheilorhinoplasty on midfacial growth in patients with unilateral cleft lip and palate

The aim of this research was to evaluate the effect of the Delaire surgical technique on the midfacial morphology in a group of subjects with a congenital unilateral cleft of lip and palate (UCLP), prior to orthodontic treatment. Thirty-five UCLP (15 left and 20 right) patients (16 males and 19 females, mean age 7.03+/-0.9 years; age range 8.7-5.0 years), treated for the correction of congenital malformation, were retrospectively selected. Analysis of midfacial growth was undertaken on lateral cephalograms, and the data were compared with reference values (Ricketts analysis). A Mann-Whitney ranked sum test was used to detect significant differences between the findings and reference values. P <or= 0.05 was considered as significant. The results demonstrated a retropositioning of both the maxilla and mandible (SNA and SNB P<0.01) and increased mandibular development (Go-Me distance). Vertically, there was a trend to a posterior rotation of the mandible (P<0.01), resulting in a hyperdivergent profile. This trend was confirmed by the increase in SpA-SpP/Go-Me (P<0.05). In agreement with previous studies, the effects of surgical closure of a cleft lip might be responsible for excessive maxillary retropositioning with a downward rotation.

Obesity in adolescence: Implications in orthodontic treatment

The incidence of obesity is increasing in the United States and around the world, and it is likely that obese patients will present for orthodontic therapy in greater numbers in the future. The implications of obesity for psychosocial well-being, bone metabolism, craniofacial growth, and pubertal growth must be assessed in treating obese orthodontic patients. This review article focuses on the relevant issues concerning obesity in regard to orthodontic therapy.