Perception of maxillary incisor inclination and its correlation with dental cephalometric measurements

OBJECTIVE

To correlate the clinical perception of maxillary incisor inclination from photographs of the smiling face with cephalometric measurements, using conventional incisor axis reference points and crown reference points.

DESIGN

Cross-sectional study.

SETTING

Department of Orthodontics, School of Dentistry, University of Lisbon (Portugal).

PARTICIPANTS

Eight orthodontists.

METHODS

The perception of maxillary incisor inclination of 47 female patients (mean age 23.4 ± 1.5 years) was evaluated by eight orthodontists. The participants' photographs (smiling frontal, smiling three-quarter and smiling profile) were shown to each assessor and a continuous visual analogue rating scale was used to assess the perception of maxillary incisor inclination. Pearson's correlation and linear regression were calculated between each cephalometric measurement and the perception of incisor inclination.

RESULTS

Anatomical crown inclination measurements U1ac-FH (r = 0.854; P < 0.01) and U1ac-SN (r = 0.845; P < 0.01) had the highest correlation values with the assessors' perception of maxillary incisor inclination. Conventional incisor axis measurements showed the lowest correlation values (r = 0.668-0.756).

CONCLUSION

Cephalometric measurements of the labial surface of the anatomical crown of the maxillary incisors showed the strongest correlations with the clinical perception of maxillary incisor inclination from photographs. For optimal aesthetics, the inclination of the labial surface of maxillary incisor crown should be evaluated.

Genetic and environmental impact on mandibular growth in mono- and dizygotic twins during adolescence: A retrospective cohort study

INTRODUCTION

This study aimed to discover the genetic and environmental factors that contribute to the mandibular development of untreated monozygotic and dizygotic twins.

MATERIAL AND METHODS

The sample, taken from the Forsyth Moorrees Twin Study, included 52 untreated monozygotic twins (36 male, 16 female) and 46 untreated dizygotic twins (23 male, 23 female). At the ages of 12 and 17, lateral cephalograms were collected and traced to assess total mandibular length, mandibular ramus length, mandibular corpus length, gonial angle, SNB, and bony chin prominence. The genetic and environmental components of variation were assessed using multilevel mixed-effects structural equation modelling.

RESULTS

At 12 years of age, high additive genetic influences were observed for total mandibular length (74%), gonial angle (76%), SNB (41%), and bony chin prominence (64%), whereas strong dominant genetic components were observed for corpus length (72%), and mandibular ramus length was under unique environment influence (54%). At 17 years of age, only total mandibular length (45%), ramus length (53%), gonial angle (76%), and bony chin prominence (68%) were under strong additive genetic control, while the remainder were under strong dominant genetic control.

CONCLUSIONS

Although monozygotic and dizygotic twins share at least a portion of their DNA, additive, dominant, or environmental components were discovered during adolescence. Nonetheless, by the age of 17, the majority of the mandibular traits are under either additive or dominant genetic impact.

Is There a Need for Greater Emphasis on Clinical Facial Analysis than Cephalometrics & 3D Software Solutions in the Diagnosis and Treatment Planning of Patients with Dentofacial Deformities?

Purpose

This study is designed to evaluate the need for a greater emphasis on clinical facial analysis over cephalometrics in the diagnosis and treatment planning of patients with dentofacial deformities.

Materials and Method

A predetermined questionnaire study was designed to get the thought process of surgeons and consultants involved in orthognathic surgery from various parts of southern India. Two hundred and twenty-eight maxillofacial consultants were involved in the survey. Demographic information, type of professional practice, preferred tool in the diagnosis & treatment planning: Cephalometrics or 3D software solutions and flaw in the available tools were evaluated.

Results

The results of this study revealed that only 36.8% of the consultants felt that cephalometrics is the prime tool and 73.3% of the consultants felt that 3D software solutions were superior to cephalometrics in the diagnosis and treatment planning of patients with dentofacial deformities. However, 46% of the consultants preferred facial analysis as the prime tool with cephalometrics as an adjunct. Pertaining to the clinical outcome of their treated cases of dentofacial deformities, 61.8% of the consultants felt the need to address additional cosmetic issues following an orthognathic procedure. It was observed that 92.1% of the participants felt the need for greater emphasis on clinical facial analysis than cephalometrics.

Conclusion

Human faces should always be evaluated taking into consideration the various esthetic units of the face. Performing corrective jaw surgery merely based on cephalometric values inevitably fails to address the various other innate imbalances of the face. Hence, cephalometric data should only be considered as an adjunct to clinical judgment in the diagnosis and treatment planning of dentofacial deformities.

Effect of SEC III protocol on upper airway dimensions in growing class III patients: a retrospective study

BACKGROUND

The primary objective of the study was to evaluate the effects of SEC III (Splints, Class III Elastics, and Chin cup) protocol on the upper airway dimensions using lateral cephalometric radiographs. The secondary objectives were to evaluate the skeletal and dental effects of the SEC III protocol using lateral cephalometric radiographs.

METHODS

The pre- and post-treatment lateral cephalometric radiographs of 24 patients treated using the SEC III protocol were used to address the aim of the study. Children in the pre-pubertal (CS-1 or CS-2) or circumpubertal (CS-3 or CS-4) skeletal maturation stage and having class III dentoskeletal malocclusion were included in the study. Patients with a history of previous orthodontic treatment, maxillofacial surgery or trauma, tonsillectomy, adenoidectomy, or craniofacial malformations were excluded. The pre-treatment and post-treatment lateral cephalometric radiographs were traced, then airway measurements, skeletal measurements, and dental measurements were performed. The results were analysed using paired samples t-test or Wilcoxon signed rank test according to the data normality.

RESULTS

Data of 6 males and 18 females were analysed (Mean age = 11.21 ± 1.02 years). Duration of active treatment was 5.75 ± 1.03 months. Treatment using SEC III protocol resulted in a significant increase in ANB angle (2.92 ± 1.50 degrees, p < 0.001) and Wits appraisal (3.31 ± 1.99 mm) (p < 0.001). The increase in the mandibular plane angle (0.75 ± 1.42 degrees, p = 0.02) and the maxillary length (2.29 ± 2.69 mm, p < 0.001) was statistically significant. Contrarily, the mandibular length did not change significantly (p = 0.10). The maxillary incisors were significantly proclined (4.38 ± 4.28 degrees; p < 0.001), while the mandibular incisors were significantly retroclined (-5.79 ± 6.21 degrees; p < 0.001) following treatment. The change in the nasopharyngeal airway and the retropalatal airway was not statistically significant. The middle and inferior pharyngeal space (retroglossal airway) significantly decreased by 1.33 ± 1.97 mm (p = 0.003) and 1.96 ± 2.48 mm (p = 0.001), respectively.

CONCLUSIONS

Early class III correction using SEC III protocol reduced the retroglossal airway dimensions but did not affect the nasopharyngeal and retropalatal airway dimensions. Correction of the class III dentoskeletal relationship was obtained through both skeletal and dental changes.

A Cephalometric Study of Sella Turcica: Correlation of Its Size with Different Skeletal Malocclusions

Introduction

The present study was done to determine the size of the sella turcica in different skeletal type subjects and to evaluate if any significant difference exists between them, which could be the basis for early diagnosis.

Materials and methods

A total of 60 lateral cephalograms of patients above 15 years of age were selected and distributed according to skeletal malocclusion into class I (n = 20), class II (n = 20), and 20 class III (n = 20). Syndromic patients (physically/mentally/both) or patients with major illnesses were not included. Two linear measurements of the sella turcica, that is, length and depth in mid-sagittal plane, were obtained in accordance with Silverman and Kisling method. Unpaired t-test and one-way analysis of variance (ANOVA) were performed.

Results

The mean length of sella turcica in class I, class II, and class III subjects was 3.81, 3.37, and 3.9, respectively. Similarly, the mean depth of sella turcica in class I, class II, and class III subjects was 7.6, 6.83, and 9.075, respectively.

Conclusion

No significant difference in length of the sella turcica could be found between different skeletal types. Maximum depth of sella turcica was found to be in subjects with class III and minimum with class II skeletal types.

Clinical significance

The linear dimensions of sella turcica can be used to approximate the pituitary gland size. The pedodontist should be familiar with different morphologies of the sella turcica to differentiate normal from abnormal appearance so that treatment can be diagnosed and treated early.

How to cite this article

Grover N, Khan DUZ, Bhagchandani J, et al. A Cephalometric Study of Sella Turcica: Correlation of Its Size with Different Skeletal Malocclusions. Int J Clin Pediatr Dent 2023;16(S-3):S229-S232.

Airway changes in patients with unilateral cleft lip/palate (UCL/P) after maxillary advancement

OBJECTIVES

To assess the effect on the retropalatal airway (RPA), retroglossal airway (RGA), and total airway (TA) volumes and cephalometrics (SNA, SNB, ANB, PP-SN, Occl-SN, N-A, A-TVL, B-TVL) after maxillary advancement orthognathic surgery in patients with unilateral cleft lip/palate (UCL/P) using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The CBCT scans of 30 patients (13 males and 17 females, 17-20 years old) with UCL/P were evaluated at two time points: preoperative (T1) and postoperative (T2). The interval between T1 and T2 ranged from 9-14 weeks, except for two patients in whom the interval was 24 weeks. Intraexaminer reliability was measured with an intraclass correlation coefficient test. A paired t-test was used to compare the airway and cephalometric measurements between T1 and T2, with a P value of .05 being considered significant.

RESULTS

From T1 to T2, significant increases were found in the volumes of RPA (from 9574 ± 4573 to 10,472 ± 4767, P = .019), RGA (from 9736 ± 5314 to 11,358 ± 6588, P = .019), and TA (from 19,121 ± 8480 to 21,750 ± 10,078, P = .002). In addition, the RGA (from 385 ± 134 to 427 ± 165, P = .020) and TA (from 730 ± 213 to 772 ± 238, P = .016) sagittal area increased significantly. For minimal cross-sectional area (MCA), only the RPA increased significantly (from 173 ± 115 to 272 ± 129, P = .002). All cephalometric changes were statistically significant between T1 and T2 except for SNB.

CONCLUSIONS

Maxillary advancement in patients with UCL/P produces statistically significant increases in the retropalatal (volumetric and MCA), retroglossal (volumetric and sagittal), and total (volumetric and sagittal) airways based on data from CBCT imaging.

Cephalometric evaluation of deep overbite correction using anterior bite turbos

OBJECTIVES

To evaluate the outcome of treating deep overbite (OB) using anterior bite elevators concurrently with a pre-adjusted edgewise appliance.

MATERIALS AND METHODS

The Case Western Reserve University (CWRU) cephalometric analysis was used to isolate tipping movement of upper (TUI) and lower incisors (TLI), bodily tooth movement of upper (BUI), and lower incisors (BLI), as well as vertical skeletal changes in the anterior region of the maxilla (MXSK) and mandible (MNSK). Thirty treated subjects were examined at pretreatment (T1) and posttreatment (T2) and compared to an untreated control group matched on age, sex, and Angle malocclusion from the Bolton Brush Growth Study Collection (CWRU, Cleveland, Ohio).

RESULTS

Overbite (OB) in the treated group was decreased significantly (P < .001) (-5.6 mm) compared to controls. Statistically significant (P < .001) changes were found for BUI (-0.7 mm), TUI (0.9 mm), TLI (-1.4 mm), BLI (-1.1 mm), and MNSK (-1.6 mm). Most of the overbite correction was in the lower arch and included tipping and intrusion of the lower incisors along with an increase in lower vertical facial height.

CONCLUSIONS

Deep OB correction was achieved efficiently using anterior bite elevators with pre-adjusted edgewise appliance. Correction using bite turbos would be a treatment option for individuals presenting with decreased lower facial height and deep bite.

Age Estimation using Cephalometrics-A Cross-Sectional Study among Teenagers of Salem District, Tamil Nadu

Background

Age estimation is important not only in identifying dead body of a person but also in living persons since there is an increasing rate of juvenile delinquencies recorded every year. To avoid foul play by age fabrication, legal age estimation becomes important. Facial growth alteration takes place in the jawbones as age advances which can be observed with lateral cephalometry. Thus, the aim of the study is to create a regression formula for age estimation using cephalometrics of teenagers in Salem population.

Materials and Methods

A cross-sectional study was done using 770 lateral cephalometrics of teenagers (13-19 yrs) in Salem population. Nine cephalometric points with two linear hard tissue measurements (condylion to mandibular plane (AFH) and palatal plane to menton (PFH)) and one angular soft tissue measurement (z angle) were recorded as predictor variables using a digital lateral cephalometric software (Carestream CS8100 SC) which were subjected to regression analysis using SPSS version 21.0 to develop a formula for age estimation.

Results

Significant association on age was obtained for the two linear measurements. The regression formula generated for estimating the age was Age = 7.146 + 0.044 (AFH) + 0.146 (PFH) with R2 value = 0.674.

Conclusion

Within the limitations of the present study, age estimation of teenagers in Salem population can be estimated. The predictability of the age can be increased by taking more cephalometric variables in generating the formula with increase in sample size.

Interobserver and Intraobserver Reliability of Cephalometric Measurements Performed on Smartphone-Based Application and Computer-Based Imaging Software: A Comparative Study

Objective

The aim was to compare the reliability of cephalometric analysis using a smartphone-based application with conventional computer-based imaging software.

Methods

Pre-treatment cephalometric radiographs of 50 subjects (26 males, 24 females; mean age, 19.2 years; ±4.2) were traced using the OneCeph® application and Dolphin imaging software®. Two independent observers identified seventeen landmarks and measured fourteen cephalometric measurements at an interval of. Interobserver and intraobserver reliability were evaluated using the intraclass correlation coefficient. Student's t-test was used to compare the means of two measurement methods for observer 1 and observer 2. Additionally, the time taken to complete the cephalometric measurements was also compared between the two methods.

Results

Good (ICC 0.75-0.90) to excellent (ICC 0.90-1.00) interobserver and intraobserver reliability was observed for all hard and soft tissue measurements with both methods. No significant differences were found between the two measurement methods for both observers (p<0.05). OneCeph application took significantly more time to complete the analysis than Dolphin imaging software (p<0.001).

Conclusion

Cephalometric measurements made through a smartphone-based application showed good to excellent interobserver and intraobserver reliability and are comparable with the computer-based software. Therefore, it can be recommended for clinical use. The time taken to complete the cephalometric measurements was more with a smartphone-based application (OneCeph application) compared to computer-based software (Dolphin imaging software).

Heritability of cephalometric variables of airway morphology in twins with completed active growth

BACKGROUND

The interplay between genetic and environmental impacts on dental and facial morphology has been widely analyzed, but little is known about their relative contributions to airway morphology. The aim of this study was to evaluate the genetic and environmental influences on the cephalometric variables of airway morphology in a group of postpubertal twins with completed craniofacial growth.

MATERIALS AND METHODS

The materials comprised lateral head cephalograms of 94 pairs of twins (50 monozygotic, 44 dizygotic) with completed craniofacial growth. Zygosity was determined using 15 specific DNA markers. The computerized cephalometric analysis included 22 craniofacial, hyoideal, pharyngeal structural linear and angular variables. Genetic analysis and heritability estimation were performed using maximum likelihood genetic structural equation modeling (GSEM). Principal component analysis (PCA) was used to assess the correlations between cephalometric measurement variables.

RESULTS

Upper airway dimensions showed moderate to high genetic determination (SPPW-SPP and U-MPW: a² = 0.64 and 0.5, respectively). Lower airway parameters showed only common and specific environmental determination (PPW-TPP a² = 0.24, e² = 0.38; LPW-V c² = 0.2, e² = 0.63; PCV-AH c² = 0.47, e² = 0.28). The relationship between the maxilla and the hyoid bone (for variables PNS-AH, ANS-AH d² = 0.9, 0.92, respectively) showed very strong additive genetic determination. The size of the soft palate was affected by additive and dominant genes. Its length (SPL) was strongly influenced by dominant genes, while its width (SPW) showed a moderate additive genetic influence. Owing to correlations in the behavior of variables, the data could be expressed in 5 principal components that jointly explained 36.8% of the total variance.

CONCLUSIONS

The dimensions of the upper airway are strongly determined by genes, while the parameters of the lower airway depend mainly on environmental factors.

TRIAL REGISTRATION

The protocol has been approved by the Kaunas Regional Ethical Committee (No. BE - 2-41., May 13, 2020).

Craniofacial growth and function in achondroplasia: a multimodal 3D study on 15 patients

BACKGROUND

Achondroplasia is the most frequent FGFR3-related chondrodysplasia, leading to rhizomelic dwarfism, craniofacial anomalies, stenosis of the foramen magnum, and sleep apnea. Craniofacial growth and its correlation with obstructive sleep apnea syndrome has not been assessed in achondroplasia. In this study, we provide a multimodal analysis of craniofacial growth and anatomo-functional correlations between craniofacial features and the severity of obstructive sleep apnea syndrome.

METHODS

A multimodal study was performed based on a paediatric cohort of 15 achondroplasia patients (mean age, 7.8 ± 3.3 years), including clinical and sleep study data, 2D cephalometrics, and 3D geometric morphometry analyses, based on CT-scans (mean age at CT-scan: patients, 4.9 ± 4.9 years; controls, 3.7 ± 4.2 years).

RESULTS

Craniofacial phenotype was characterized by maxillo-zygomatic retrusion, deep nasal root, and prominent forehead. 2D cephalometric studies showed constant maxillo-mandibular retrusion, with excessive vertical dimensions of the lower third of the face, and modifications of cranial base angles. All patients with available CT-scan had premature fusion of skull base synchondroses. 3D morphometric analyses showed more severe craniofacial phenotypes associated with increasing patient age, predominantly regarding the midface-with increased maxillary retrusion in older patients-and the skull base-with closure of the spheno-occipital angle. At the mandibular level, both the corpus and ramus showed shape modifications with age, with shortened anteroposterior mandibular length, as well as ramus and condylar region lengths. We report a significant correlation between the severity of maxillo-mandibular retrusion and obstructive sleep apnea syndrome (p < 0.01).

CONCLUSIONS

Our study shows more severe craniofacial phenotypes at older ages, with increased maxillomandibular retrusion, and demonstrates a significant anatomo-functional correlation between the severity of midface and mandible craniofacial features and obstructive sleep apnea syndrome.

Association between the severity of hypodontia and the characteristics of craniofacial morphology in a Chinese population: A cross-sectional study

Objective

To investigate craniofacial differences in individuals with hypodontia and explore the relationship between craniofacial features and the number of congenitally missing teeth.

Methods

A cross-sectional study was conducted among 261 Chinese patients (males, 124; females, 137; age, 7-24 years), divided into four groups (without hypodontia: no teeth missing, mild: one or two missing teeth, moderate: three to five missing teeth, severe: six or more missing teeth) according to the number of congenitally missing teeth. Differences in cephalometric measurements among the groups were analyzed. Further, multivariate linear regression and smooth curve fitting were performed to evaluate the relationship between the number of congenitally missing teeth and the cephalometric measurements.

Results

In patients with hypodontia, SNA, NA-AP, FH-NA, ANB, Wits, ANS-Me/N-Me, GoGn-SN, UL-EP, and LL-EP significantly decreased, while Pog-NB, AB-NP, N-ANS, and S-Go/N-Me significantly increased. In multivariate linear regression analysis, SNB, Pog-NB, and S-Go/N-Me were positively related to the number of congenitally missing teeth. In contrast, NA-AP, FH-NA, ANB, Wits, N-Me, ANS-Me, ANS-Me/N-Me, GoGn-SN, SGn-FH (Y-axis), UL-EP, and LL-EP were negatively related, with absolute values of regression coefficients ranging from 0.147 to 0.357. Further, NA-AP, Pog-NB, S-Go/N-Me, and GoGn-SN showed the same tendency in both sexes, whereas UL-EP and LL-EP were different.

Conclusions

Compared with controls, patients with hypodontia tend toward a Class III skeletal relationship, reduced lower anterior face height, flatter mandibular plane, and more retrusive lips. The number of congenitally missing teeth had a greater effect on certain characteristics of craniofacial morphology in males than in females.

A Novel Cephalometric Approach Aiming to Quantify a Normal Range of Bony Chin Protrusion

Introduction

Cephalometric analysis is an essential tool in the diagnostics and planning of orthognathic surgery. No objective criterion exists to facilitate decision making regarding genioplasties. Differing opinions amongst clinicians therefore leads to wide variability amongst treatment options offered to potentially suitable patients. This study has three aims. The first was to quantify the distribution of chin morphology amongst the average population using cephalometric analysis. Secondly, we sought to determine whether cephalometric parameters could be used to predict overlying soft tissue changes. Lastly, we consider the use of a new cephalometric angle, BNPg, for pre- and post-operative assessment of genioplasty patients.

Methods

This study retrospectively analysed 231 lateral cephalograms. The angle between the landmarks: B point, Nasion and Pogonion was measured to generate 'BNPg' a novel unit to quantify bony chin protrusion.

Results

The mean BNPg from all 231 samples was 1.12 degrees with a standard deviation of ± 1.35. Comparison between sexes showed no significant differences between male and females (P = 0.108). Furthermore, bony chin protrusion was found to strongly positively correlate with soft tissue chin appearance (r = 0.731), however, BNPg was found not to correlate with skeletal malocclusion (ANB, r = 0.085).

Conclusion

The novel unit BNPg may serve as a useful tool in contributing to the determination of treatment thresholds in osseous genioplasty for desirable aesthetic outcomes and may be used post-operatively to assess outcomes also. As this is a pilot study, further clinical studies would be required to validate this parameter in genioplasty patients, both pre- and post-operatively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-022-01784-5.

Cephalometric comparison of Eastman standards among caucasians and saudi population in the Najran region

Caucasian norms derived from the European-American population are often applied in the diagnosis and treatment planning of Saudi orthodontic patients. Minor differences in cephalometric values can be considered routine and normal, but significant differences indicate a structural deviation. The objective of this study was to establish the cephalometric norms of normal and pleasant soft tissue profiles of adult Saudi living in the Najran region of Saudi Arabia and compare them with the Eastman standards derived from the Caucasian population. A total of 60 lateral cephalometric radiographs (30 males and 30 females) of Najran adults aged between 18-30 years with pleasing, acceptable, harmonious and well-balanced soft tissue profile and Class I molar relationship with no history of previous orthodontic treatment, no crowding or spacing, normal overjet and overbite were selected for the study. Descriptive analysis and Student t-test were performed to evaluate the male and female gender differences and compare the Najran mean with Eastman standards. On evaluating the gender differences, Najran females tend to have more ANB angle and L1 to A-Pog linear distance than Najran males(p<0.05). On comparing with the Eastman Caucasian standards, the Najran population tends to have more SNA, ANB, UI to MxP and L1 to A-Pog (p<0.05). The U1 to L1 angle tends to be less in Najran population than the Caucasians (p<0.05). The Najran population has more protrusive skeletal bases, bimaxillary protrusion, more proclined upper and lower incisors and reduced interincisal angle than Caucasians. The Najran females have more protrusive skeletal bases and more proclined lower incisors compared to Najran males. The cephalometric findings of this study can be useful in the diagnosis and treatment planning of orthodontic patients belonging to the Najran region of Saudi Arabia.

Association of temporomandibular joint osteoarthrosis with dentoskeletal morphology in males: A cone-beam computed tomography and cephalometric analysis

OBJECTIVE

The objective of the study was to assess the differences in dentoskeletal morphology in males with and without temporomandibular joint osteoarthrosis (TMJOA).

METHODS

Three hundred seventy-one male participants seeking orthodontic treatment were enrolled in this cross-sectional study. Each participant's osseous status was evaluated using cone-beam computed tomography (CBCT) and classified into normal (N = 104), indeterminate for TMJOA (N = 110) and TMJOA (N = 157) groups. The dentoskeletal characteristics were evaluated using cephalograms. Stratified analysis was performed based on age and skeletal pattern. Descriptive statistics and one-way analysis of variance were performed to investigate dentoskeletal differences among groups. P < .05 was considered statistically significant.

RESULTS

The differences in posterior cranial base length, FMA, MP-OP, anterior facial height, articular angle, ramus height and L1-MP were statistically significant. After stratification by age, the differences in FMA, maxillomandibular angle, posterior facial height, facial height ratio, gonial angle and mandibular body length were statistically significant in adults. No statistical difference except for articular angle was observed in adolescents. After stratification by skeletal pattern, statistical differences were mainly apparent in skeletal Class II adults.

CONCLUSION

Males with TMJOA showed a posteriorly positioned and backward-rotated mandible, especially in skeletal Class II adults. Compared with women, the craniofacial morphology of men is less affected by TMJOA. The association between TMJOA and craniofacial morphology also varied across different age groups and skeletal patterns. Prospective studies are required to clarify the cause-effect relationship between TMJOA and craniofacial morphology in males.

Skeletal and dentoalveolar characteristics of maxillary lateral incisor agenesis patients: a comparative cross-sectional study

BACKGROUND

The aim of the study was to evaluate the cephalometric and dentoalveolar characteristics of maxillary lateral incisor agenesis patients, and to compare the findings to a matched control group without tooth agenesis, excluding third molars, from the same population.

METHODS

The pre-orthodontic records of 72 non-growing patients, who were treated at the Orthodontic Department, Faculty of Dentistry, Alexandria University, were used to address the aim of this retrospective study. Patients having unilateral or bilateral maxillary lateral incisor agenesis, with no history of previous orthodontic treatment, congenital craniofacial malformations, facial trauma, or surgeries were divided into two test groups based on the pattern of maxillary lateral incisors agenesis (group I: unilateral (UMLIA), group II: bilateral (BMLIA)). A control group (group III (CTRL)) having a complete set of permanent dentition (excluding third molars), and having no dental anomalies was age-matched with the test groups. Measurements were performed on the pre-orthodontic lateral cephalometric radiographs and the pre-orthodontic digital dental casts. The measured variables were compared between the groups using one-way ANOVA and Kruskal Wallis tests according to the normality of the variable. In case of significant results, both tests were followed by multiple pairwise comparisons using Bonferroni adjusted significance level. Significance level was set at P < 0.05.

RESULTS

BMLIA group showed a smaller SNA angle and maxillary length, a more negative ANB angle and Wits appraisal, and a larger Maxillo-mandibular differential than UMLIA and/or CTRL group. The dental and soft tissue cephalometric measurements did not show any significant differences between the groups. Dentoalveolar cast measurements showed that BMLIA patients presented with significantly smaller maxillary inter-canine width than UMLIA and CTRL patients.

CONCLUSIONS

Cephalometric analysis has shown that subjects with BMLIA have a statistically significant reduced ANB and maxillary length. Tooth eruption may play a role in the development of the maxillary arch.

Reliability of Frankfort Horizontal Plane with True Horizontal Plane in Cephalometric Measurements

INTRODUCTION

The purpose of the study is to determine reliability of true horizontal (TH) plane with Frankfort horizontal (FH) plane in cephalometric measurements.

MATERIALS AND METHODS

One hundred lateral cephalograms were collected and traced using FACAD software, all cephalometric measurements which included FH plane as reference planes were used in this study. Cephalometric tracing was done with FH plane as reference plane and another set of measurements with TH plane as reference plane was done. Statistical tests were done using independent sample t-test (p <0.05).

RESULTS

Results of an independent t-test revealed a statistically insignificant difference that was observed for all the parameters assessed (p <0.05). Both angular and linear measurements showed an insignificant difference between FH and TH.

CONCLUSION

Within the limitations of the study, the results show that the FH plane is closest and as reliable as the TH plane. The variation of FH was least for all the parameters assessed.

Validation of three-dimensional digital model superimpositions based on palatal structures in patients with maximum anterior tooth retraction following premolar extraction

Objective

This study aimed to evaluate the superimposition accuracy of digital modes for measuring tooth movement in patients requiring anterior retraction after premolar extraction based on the proposed reference regions.

Methods

Forty patients treated with bilateral maxillary first premolar extraction were divided into two groups: moderate retraction (< 7.0 mm) and maximum retraction (≥ 7.0 mm). Central incisor displacement was measured using cephalometric superimpositions and three-dimensional (3D) digital superimpositions with the 3rd or 4th ruga as the reference point. The Wilcoxon signed-rank test and linear regression analyses were performed to test the significance of the differences and relationships between the two measurement techniques.

Results

In the moderate retraction group, the central incisor anteroposterior displacement values did not differ significantly between 3D digital and cephalometric superimpositions. However, in the maximum-retraction group, significant differences were observed between the anteroposterior displacement evaluated by the 3rd ruga superimposition and cephalometric methods (p < 0.05).

Conclusions

This study demonstrated that 3D digital superimpositions were clinically as reliable as cephalometric superimpositions in assessing tooth movements in patients requiring moderate retraction. However, the reference point should be carefully examined in patients who require maximum retraction.

Long-term hard and soft tissue response following isolated genioplasty: a systematic review

PURPOSE

Genioplasty facilitates alteration of the chin position and contour which contributes to aesthetics and function. The response of the hard and soft tissues following genioplasty has not been assessed after a year or more of the surgery being performed. Hence, the aim of this systematic review was to assess the response of the hard and soft tissues occurring at least 1 year after the procedure.

MATERIAL AND METHODS

A literature search was conducted in the following electronic databases: PubMed, Ovid, LILACS, and Cochrane Library. Potential articles were identified wherein only studies with genioplasty performed as an isolated procedure and with data at least 12 months after the procedure were included.

RESULTS

Five studies were included in this systematic review. Two of the articles included were considered to be of good quality while three were considered to be of moderate quality using a modified Downs and Black tool. The ROBINS-I tool showed a moderate risk of bias for most domains. The study characteristics revealed varying degrees of relapse for the hard and soft tissues.

CONCLUSIONS

In the anteroposterior plane, the soft tissue relapsed more than the hard tissues 3 years post genioplasty. However, relapse in the vertical plane showed a wide variation for both the hard and soft tissues. In the anteroposterior plane, the hard tissue to soft tissue response 2 years or more following genioplasty ranged from 1:0.77 to 1:0.91 while in the vertical plane the hard tissue to soft tissue response ranged from 1:0.67 to 1:1.16.

Customized maxillary incisor position relative to dentoskeletal and soft tissue patterns in Chinese women: A retrospective study

Objective

To provide reliable prediction models based on dentoskeletal and soft tissue variables for customizing maxillary incisor positions and to optimize digitalized orthodontic treatment planning.

Methods

This study included 244 Chinese women (age, 18–40 years old) with esthetic profiles after orthodontic treatment with fixed appliances (133 in group I 1° ≤ The angle between the nasion [N]-A point [A] plane and the N-B point [B] plane [ANB] ≤ 4°; 111 in group II 4° < ANB ≤ 7°). Dental, skeletal, and soft tissue measurements were performed on lateral cephalograms of the participants. Correlation and multiple linear regression analyses were used to determine the influence of dentoskeletal and soft tissue variables on maxillary incisor position.

Results

The ideal anteroposterior position of the maxillary incisor varied between sagittal skeletal patterns. The position of the maxillary incisor correlated with the sagittal discrepancy between the maxilla and the mandible (ANB), protrusion of the midface, nasal tip projection, development of the chin, and inclination of both the maxillary and mandibular incisors. Distance from the maxillary central incisor to nasion-pogonion plane predicted using multiple linear regression analysis was accurate and could be a practical measurement in orthodontic treatment planning.

Conclusions

Instead of using an average value or norm, orthodontists should customize a patient’s ideal maxillary incisor position using dentoskeletal and soft tissue evaluations.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Comparison of patient satisfaction between complete dentures fabricated using "conventional" and "cephalometric angular reconstruction" vertical dimension procedures: A multicenter randomized clinical trial

Aim

In Prosthodontics, during complete denture fabrication, conventional methods employed to determine occlusal vertical dimension require patient co-operation. Hence, the aim of the present study is to evaluate the clinical effectiveness of the 'cephalometric angular reconstruction' procedure in the calculation of these lost dimensions.

Settings and Design

Multicentric randomised clinical trial conducted in four dental hospitals.

Materials and Methods

Fully edentulous people who came to the hospitals for complete denture treatment were recruited into the study. Those who fulfilled the inclusion criteria were randomly assigned to two groups; Group 1: Dentures fabricated using a 'conventional' procedure and Group 2: Dentures fabricated using 'cephalometric angular reconstruction'. The patient's level of satisfaction was assessed on a scale of 1 to 5; 1-dissatisfaction to 5-excellent. The confounding factors that can influence the satisfaction were also recorded.

Statistical Analysis Used

The distribution of patient's satisfaction was assessed using Chi-square test, whereas the difference between the two groups was evaluated using Mann-Whitney test.

Results

There was no significant difference either in the vertical dimension determined (P = 0.465) or the patient's level of satisfaction (P = 0.943) between the two groups. There was no influence of confounding factors considered in the present study on the satisfaction levels. There was no difference in the distribution of satisfaction levels based on the dentist's quality assessment (P = 0.243).

Conclusion

Complete dentures fabricated using cephalometric angular reconstruction procedure of vertical dimension determination were equivalent with respect to patient satisfaction, compared to those made using a conventional method. Hence, the new method can be clinically recommended during denture fabrication.

A Study of Dentofacial Morphology in Yemeni Adults with Normal Occlusions a cross sectional prospective study

OBJECTIVE

The purpose of this study was to describe the dentofacial morphology of Yemeni adults.

MATERIALS AND METHODS

The lateral cephalograms of 100 Yemeni adults (50 males, 50 females) were included in the study. All subjects were born to Yemeni parents and grandparents. They all had Class I occlusions with minor or no crowding, well-aligned upper and lower dental arches, good facial harmony, all teeth present except third molars, and no history of orthodontic therapy or maxillofacial surgery. Five angular and eighteen linear measurements were analyzed to determine the soft tissue, skeletal, and dental features. The differences for each measurement between Yemeni males and females were calculated using unpaired t-tests.

RESULTS

Significant sexual and racial differences were found for three linear parameters in the skeletal analysis, one angle, and four linear dental measurements, and for all soft tissue linear parameters. Yemeni adults showed a tendency to a facial pattern of Class II, convex profile, reduced prominence of chin, increased lower facial height, and a clockwise rotation of the mandibular plane angle.

CONCLUSION

Yemeni adults have different dentofacial parameters when compared to other racial standards, and these differences could aid in diagnosis and treatment planning.

Cephalometrics of Libyan adults

BACKGROUND

Cephalometric radiography enables a physician to identify specific areas of craniofacial disproportionality and decide on a treatment plan. Cephalometric analysis is a method for localizeing malocclusion with the facial skeleton and soft tissue structures. This study reports the results from the cephalometric analysis of Libyan adults, as a surrogate for the population of North Africa.

METHODS

Lateral cephalometric radiographs were taken of 100 non-growing Libyan adults: 74 males and 26 females, aged 17-45 years. All subjects had no previous orthodontic treatment. The mean values and standard deviations of 92 parameters were determined.

RESULTS

The hard tissue cephalometric analysis revealed lower variability in the length of vertical distances compared to those extending more horizontally. In adult Libyans, linear and angular midface measurements (hard tissue and soft tissue) exhibit less variability compared to other measurements taken. Libyans exhibit some of the structural deviations from Bolton's means that were previously found in Americans of African descent. Namely, they are characterized by the greater development of the maxillomandibular complex and by the presence of dentoalveolar protrusion, which must be taken into account when treating patients of this ethnic group.

CONCLUSION

The current study once again confirmed the need to develop cephalometric norms for different ethnic groups, the Arab population in North Africa in particular.

Estimation of occlusal vertical dimension using cephalometric angular reconstruction

Aim

To propose a new technique, based on cephalometrics for determining the vertical dimension of occlusion (VDO).

Methods and Material

Thirty-five participants in the age range of 20.

–

22 years who met the inclusion criteria were recruited. Lateral cephalograms were obtained and tracing done. Five reference landmarks, Nasion (N), Anterior Nasal Spine (ANS), Porion (P), Gonion (G) and Gnathion (Gn) were marked and joined to form four angles, N-ANS-Gn, N-ANS-G, P-G-Gn and P-G-ANS; distance between ANS and Gn was considered as VDO in cephalogram (VDO-Ceph). The angles N-ANS-Gn and N-ANS-G; P-G-Gn, and P-G-ANS were correlated; two simple linear regression models were developed to predict N-ANS-Gn and P-G-Gn, using N-ANS-G and P-G-ANS, as independent variables. Using the formulae, the predicted angles, N-ANS-Gn and P-G-Gn were drawn and intersection marked as 'reconstructed point Gn'. The predicted VDO-Ceph values (distance between ANS and reconstructed Gn) were measured and correlated with actual values.

Results

The angles N-ANS-Gn and P-G-Gn had a statistically significant positive correlation with N-ANS-G (r = 0.77, P < 0.001) and P-G-ANS (r = 0.83, P < 0.001), respectively. Using simple linear regression analysis, the following formulae were obtained: N-ANS-Gn (in degrees) = 1.271 N-ANS-G (in degrees) + 24.83 and P-G-Gn (in degrees) = 0.987 P-G-ANS (in degrees) + 35.93. The predicted and actual VDO-Ceph values showed no statistical significance difference (P = 0.92).

Conclusion

By tracing four cephalometric landmarks, N, ANS, P, G; and using the angular reconstruction, it is possible to predict the location of Gn. Hence, during prosthetic replacement of lost teeth, this can be employed for the estimation of lost dimensions.

Reliability of cephalometric landmark identification on three-dimensional computed tomographic images

Our aims were to evaluate the reliability of three-dimensional (3D) cephalometric landmark identification in 3D images, and to propose an improved protocol for determining these landmarks. Computed tomographic (CT) images of 13 landmarks were obtained. One that did not show any artifacts, asymmetry in maxillofacial structures, or bony defects, was selected. Two orthodontic practitioners identified 3D cephalometric landmarks 10 times at one-week intervals. The distances of 26 landmarks were measured on the basis of three reference planes (coronal, horizontal, and sagittal). Ten mean (SD) measurements from each examiner were calculated, and the maximum and minimum values and the difference from the 10 measurements of each one were measured at a 95% confidence interval. Interexaminer differences for the three planes were found in the upper right first molar, point A, both gonions, left orbitale, and both porions. The lower right first molar, foramen magnum, gnathion, nasion, and pogonion showed interexaminer differences in two planes. Menton, basion, posterior nasal spine, upper and lower left first molar, and right mental foramen showed interexaminer differences in only one plane. With reference to intraexaminer differences, poor repeatability was observed for gonion, orbitale, condylion, and porion. Reliable 3D landmarks are the meeting point of sutures, distinct structures at converging planes, landmarks positioned in the midline, distinct anatomical structures such as the mental foramen, and teeth using multiplanar views.

Effect of extraction treatment on upper airway dimensions in patients with bimaxillary skeletal protrusion relative to their vertical skeletal pattern

Objective

To investigate dimensional changes in regional pharyngeal airway spaces after premolar extraction in bimaxillary skeletal protrusion (BSP) patients according to vertical skeletal pattern, and to further identify dentoskeletal risk factors to predict posttreatment pharyngeal changes.

Methods

Fifty-five adults showing BSP treated with microimplant anchorage after four premolar extractions were included in this retrospective study. The subjects were divided into two groups according to the mandibular plane steepness hyperdivergent (Frankfort horizontal plane to mandibular plane [FH-MP] ≥ 30) and nonhyperdivergent groups (FH-MP < 30). The control group consisted of 20 untreated adults with skeletal Class I normodivergent pattern and favorable profile. Treatment changes in cephalometric variables were evaluated and compared. The association between posttreatment changes in the dentoskeletal and upper airway variables were analyzed using linear regression analysis.

Results

The BSP patients showed no significant decrease in the pharyngeal dimensions to the lower level in comparison with controls, except for middle airway space (MAS, p < 0.01). The upper airway variable representing greater decrease in the hyperdivergent group than in the nonhyperdivergent group was the MAS (p < 0.01). Posttreatment changes in FH-MP had negative correlation with changes in MAS (β = –0.42, p < 0.01) and inferior airway space (β = –0.52, p < 0.01) as a result of multivariable regression analysis adjusted for sagittal skeletal relationship.

Conclusions

Decreased pharyngeal dimensions after treatment in BSP patients showed no significant difference from the normal range of pharyngeal dimensions. However, the glossopharyngeal airway space may be susceptible to treatment when vertical dimension increased in hyperdivergent BSP patients.

Genetic and environmental components of vertical growth in mono- and dizygotic twins up to 15-18 years of age

OBJECTIVES

To determine the additive genetic and environmental contributions to the vertical growth of craniofacial structures.

MATERIALS AND METHODS

The sample consisted of 64 untreated monozygotic (44 male, 20 female) and 61 untreated dizygotic twins (32 male, 29 female). Lateral cephalograms taken at 15 and 18 years of age were traced to analyze the sella-nasion-nasal line angle (SN-NL), nasal line-mandibular line angle (ML-NL), sella-nasion-mandibular line angle (SN-ML), sella-nasion-sella-gnathion angle (Y-axis), posterior face height/anterior face height (PFH/AFH), and lower anterior face height/anterior face height (LAFH/AFH). The genetic and environmental components of variance were analyzed with structural equation modeling for multilevel mixed effects.

RESULTS

At 15 years of age, strong dominant genetic control was seen for NL-ML (81%), LAFH/AFH (73%), and Y-axis (57%), whereas strong additive genetic components were found for PFH/AFH (78%), SN-NL (58%), and SN-ML (57%). Unique environmental factors accounted for 18-42% of observed variance, with SN-NL being affected the most (42%). At 18 years of age, only LAFH/AFH (86%) was under strong dominant genetic control, whereas the remainder were under additive genetic influence. The sole exception was SN-NL, which changed from additive to unique environmental influence.

CONCLUSIONS

Either additive or dominant genetic components were found at 15 or 18 years of age for most vertical variables. Environmental factors accounted for about 10-40%, with SN-NL being mostly affected.

Predicting the mandibular growth spurt

OBJECTIVES

To develop a prediction model that combined information derived from chronological age, sex, and the cervical vertebral maturation (CVM) method to predict the pubertal spurt in mandibular growth.

MATERIALS AND METHODS

A total of 50 subjects (29 females, 21 males) were selected from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection, the University of Michigan Growth Study, and the Denver Child Growth study. A total of 456 lateral cephalograms were analyzed, and a multilevel logistic model was applied. The outcome variable was the presence or absence of the mandibular pubertal growth peak. The predictive variables were chronological age up to the third order, sex, presence or absence of CS 3 interactions between age and sex, age and CS 3, sex and CS 3.

RESULTS

The mean age ± standard deviation (SD) at the first cephalogram was 8.2 ± 0.5 years, whereas the mean age at the last cephalogram was 16.5 ± 1.1 years. The mean interval ± SD between two consecutive cephalograms was 1.0 ± 0.1 years. The mean age ± SD at the lateral cephalogram obtained immediately before the mandibular pubertal growth peak was 12.1 ± 1.1 years for females and 13.2 ± 0.8 years for males. The greatest increase in mandibular length occurred after CS 3 in 78% of the subjects. The presence of CS 3, age, second-order age, sex, and the interaction between age and sex were all statistically significant predictors of the mandibular pubertal growth spurt.

CONCLUSIONS

CS 3, chronological age, and sex can be used jointly to predict the pubertal peak in mandibular growth.

Relationship between rotational disc displacement of the temporomandibular joint and the dentoskeletal morphology

Objective

The purpose of this study was to evaluate the relationship between rotational disk displacement (DD) of the temporomandibular joint (TMJ) and the dentoskeletal morphology.

Methods

Women aged > 17 years were included in this study. Each subject had a primary complaint of malocclusion and underwent routine cephalometric examinations. They were divided into five groups according to the findings on sagittal and coronal magnetic resonance images of their TMJs bilateral normal disk position, bilateral anterior DD with reduction (ADDR), bilateral rotational DD with reduction (RDDR), bilateral anterior DD without reduction (ADDNR), and bilateral rotational DD without reduction (RDDNR). Twenty-three cephalometric variables were analyzed, and the Kruskal–Wallis test was used to evaluate differences in the dentoskeletal morphology among the five groups.

Results

Patients with TMJ DD exhibited a hyperdivergent pattern with a retrognathic mandible, unlike those with a normal disk position. These specific skeletal characteristics were more severe in patients exhibiting DD without reduction than in those with reduction, regardless of the presence of rotational DD. Rotational DD significantly influenced horizontal and vertical skeletal patterns only in the stage of DD with reduction, and the mandible exhibited a more backward position and rotation in patients with RDDR than in those with ADDR. However, there were no significant dentoskeletal differences between ADDNR and RDDNR.

Conclusions

The results of this study suggest that rotational DD of TMJ plays an important role in the dentoskeletal morphology, particularly in patients showing DD with reduction.

Differences in mandibular condyle and glenoid fossa morphology in relation to vertical and sagittal skeletal patterns: A cone-beam computed tomography study

Objective

This study aimed to evaluate the following null hypothesis: there are no differences in the morphology of the temporomandibular joint (TMJ) structures in relation to vertical and sagittal cephalometric patterns.

Methods

This retrospective study was performed with 131 participants showing no TMJ symptoms. The participants were divided into Class I, II, and III groups on the basis of their sagittal cephalometric relationships and into hyperdivergent, normodivergent, and hypodivergent groups on the basis of their vertical cephalometric relationships. The following measurements were performed using cone-beam computed tomography images and compared among the groups: condylar volume, condylar size (width, length, and height), fossa size (length and height), and condyle-to-fossa joint spaces at the anterior, superior, and posterior condylar poles.

Results

The null hypothesis was rejected. The Class III group showed larger values for condylar width, condylar height, and fossa height than the Class II group (p < 0.05). Condylar volume and superior joint space in the hyperdivergent group were significantly smaller than those in the other two vertical groups (p < 0.001), whereas fossa length and height were significantly larger in the hyperdivergent group than in the other groups (p < 0.01). The hypodivergent group showed a greater condylar width than the hyperdivergent group (p < 0.01). The sagittal and vertical cephalometric patterns showed statistically significant interactions for fossa length and height.

Conclusions

TMJ morphology differed across diverse skeletal cephalometric patterns. The fossa length and height were affected by the interactions of the vertical and sagittal skeletal patterns.

Evaluation of adolescent and adult patients treated with the Carriere Motion Class III appliance followed by fixed appliances

OBJECTIVES

To determine dentoalveolar and skeletal effects produced in mature patients by the Carriere Motion Class III (CM3) appliance followed by fixed appliances.

MATERIALS AND METHODS

This retrospective study evaluated 32 patients at three time points: T1 (initial), T2 (removal of CM3), and T3 (posttreatment). Serial cephalograms were traced and digitized, and best-fit regional superimpositions were constructed. Eleven linear and 7 angular variables were measured. The starting forms of the CM3 patients were compared with a sample of untreated subjects with normal occlusions and well-balanced faces.

RESULTS

The CM3 phase lasted 6.3 months, followed by a phase of fixed appliances lasting 12.9 months; the total duration of treatment was 19.2 months. Minimal skeletal changes were measured sagittally, with only a slight increase in lower anterior facial height observed during treatment. Most treatment changes were dentoalveolar in nature. Wits appraisal increased 4.0 mm during treatment. The molar relationship improved by 6.0 mm during phase I, a value that rebounded slightly during phase II, resulting in an improvement toward Class I of 4.8 mm. Best-fit regional superimpositions revealed anterior movement of upper molars relative to the maxilla and posterior movement of lower molars relative to the mandible.

CONCLUSIONS

The Carriere Motion Class III appliance is an effective and efficient method of resolving occlusal problems in minimally growing Class III patients. Primary treatment effects are dentoalveolar in nature with minimal skeletal alterations.

Evaluation of the distance between the root apices of the upper first molars and the hard palate in an Eastern Mediterranean population: A retrospective study

OBJECTIVE

The aims of this retrospective study were, first to evaluate the distance between the root apices of the upper first molars and the palatal plane (PP), and second to determine the validity (accuracy) of the use of cephalometric radiographs or panoramic X-rays compared to cone beam computed tomography (CBCT) in determining this distance.

MATERIAL AND METHODS

The distance was calculated from the root apices of the first molars to PP, on the cephalometric radiographs of 204 subjects and then 57 measurements were compared to those obtained on panoramic X-rays and CBCT images, in order to find a statistically significant difference according to age, sex, side, vertical and sagittal skeletal patterns, and to determine if 2D radiographs are suitable for this task.

RESULTS

The distance increased significantly in subjects after 20 years of age and in hyperdivergent patients, but was not influenced by sex, side or anteroposterior position of the mandible. No statistical significance was found between the calculated measurements on cephalometric and CBCT radiographs, but both were different from those taken on panoramic X-rays.

CONCLUSIONS

Cephalometric radiographs are reliable in the assessment of the distance between the roots of the upper molars and the PP. In hyperdivergent and adult patients, posterior teeth have enough space between their roots and the upper limit of the hard palate to undergo intrusion mechanics using miniscrews, but care must be taken while planning and managing these movements in order to minimize the unwanted side effects.

Relationship between vertical components of maxillary molar and craniofacial frame in normal occlusion: cephalometric calibration on the vertical axis of coordinates

Objective

The aim of this study was to evaluate the correlation between the vertical position of maxillary first molar and vertical skeletal measurements in lateral cephalograms by using new linear measurements on the vertical axis of coordinates with calibration.

Methods

The vertical position of maxillary first molar (U6-SN), and the conventionally used variables (ConV) and the newly derived linear variables (NwLin) for vertical skeletal patterns were measured in the lateral cephalograms of 103 Korean adults with normal occlusions. Pearson correlation analyses and multiple linear regression analyses were performed with and without calibration using the anterior and posterior cranial base (ACB and PCB, respectively) lengths to identify variables related to U6-SN.

Results

The PCB-calibrated statistics showed the best power of explanation. ConV indicating skeletal hyperdivergency was significantly correlated with U6-SN. Six NwLin regarding the position of palatal plane were positively correlated with U6-SN. Each multiple linear regression analysis generated a two-variable model sella and nasion to palatal plane. Among the three models, the PCB-calibrated model yielded highest adjusted R² value, 0.880.

Conclusions

U6-SN could be determined by the vertical position of the maxilla, which could then be used to plan the amount of molar intrusion and estimate its clinical stability. Cephalometric calibration on the vertical axis of coordinates by using PCB for vertical linear measurements could strengthen the analysis itself.

Second Class Functional Treatment: Andreasen Activator vs Twin Block

Aim

The purpose of this research is to analyze and compare the dental and skeletal changes induced by two functional devices, Andreasen Activator and Clark's twin block, on the sagittal and vertical plane, by means of cephalometric analysis, of the lateral cephalograms prescribed at the beginning and at the end of the treatment for a second skeletal class, first division with normal or deep bite.

Materials and methods

Twenty patients, 8 females and 12 males, fulfilling criteria for inclusion, were divided randomly into two groups: group I was treated with Andreasen activator, the second group with Clark's twin block. The duration of the therapy was about 18 months plus less 2 months. Pretreatment and posttreatment cephalometric radiographs were analyzed using angular (SNA, SNB, ANB, SnaSnp–GoGn angles), linear (Sna–Snp, Co–Gn, Co–Go, Go–Gn) skeletal parameters and dental one (U1–SnaSnp angle, L1–GoGn angle, Overjet and Overbite). To evaluate the posttreatment changes in the single groups and between them, paired and unpaired t-test was used.

Results

In both of the two groups analyzed, all the sagittal and vertical, angular and linear, skeletal measurements appear to be increased in a statistically significant way, except SNA angle and the distance Sna–Snp. Regarding the dental parameters, in the group treated with Andreasen activator, only Overjet and Overbite showed statistically significant differences. On the other hand, twin block induced statistical changes about Overjet, Overbite and also U1/SnaSnp, but not about L1/GoGn. The advancement of the mandible determines a greater prominence of the chin and lower lip, an increment of the labial mental angle and a reduction of the convexity of the profile. Also, the decrease of the overjet and, consequently, of the dental exposure improve the esthetic appearance of the patient's face.

Conclusion

Both functional treatments showed a lower jaw advanced on the sagittal plane and increased in size. In the upper jaw no significant changes were observed. It was also evident a dental compensation both on sagittal and vertical planes.

Clinical significance

The functional devices studied, Andreasen activator and twin block, seem to obtain more skeletal than dental results when the patients were treated at the peak of pubertal growth.

How to cite this article

Baccaglione G, Rota E, Ferrari M, et al. Second Class Functional Treatment: Andreasen Activator vs Twin Block. Int J Clin Pediatr Dent 2020;13(2):144–149.

Distribution of Various Maxilla-Mandibular Positions and Cephalometric Comparison in Chinese Skeletal Class II Malocclusions

AIM

To obtain the distribution of different maxilla-mandibular characteristics in Chinese skeletal class II mixed dentition patients and to compare the differences of cephalometric variables among different maxilla-mandibular types.

MATERIALS AND METHODS

A cross-sectional study was conducted among 310 skeletal class II patients in mixed dentition. The patients were divided into 6 groups according to SNA and SNB angle of the cephalogram. A total of 38 cephalometric measurements were measured on their cephalograms. Differences among groups were tested by one-way analysis of variance.

RESULTS

There were 34 (10.97%) patients in group I, 10 (3.23%) in group II, 4(1.29%) in group III, 69 (22.26%) in group IV, 133 (42.90%) in group V, and 60 (19.35%) in group VI. In all, 14.19% of the patients exhibited maxillary protrusion (MxP), and 62.26% exhibited mandibular retrusion (MnR) with either normal or retruded maxilla. Groups II and III were excluded for statistical comparison due to a limited sample size. Statistical differences were found in 25 cephalometric measurements among the other 4 groups. Patients with MnR (groups V and VI) exhibited bigger sella angle, gonial angle, Frankfort mandibular plane angle, and smaller mandibular body length and ramus height than patients without MnR (p value < 0.05).

CONCLUSION

The most common etiology forming skeletal class II malocclusion in Chinese children was MnR, which was mainly caused by the small size and hyperdivergent growth direction of mandible.

CLINICAL SIGNIFICANCE

The study presents various cephalometric characteristics of Chinese skeletal class II malocclusions. The results indicated that for the early orthodontic treatment of Chinese class II children with mixed dentition, orthodontists might emphasize more importance to mandibular length augmentation and growth direction change in mandible.

Airway Analysis in Skeletal Class I and Class II Subjects with Different Growth Patterns: A 2D Cephalometric Study

OBJECTIVE

A two-dimensional cephalometric study was carried out to assess the airway among individuals with Class I and Class II skeletal base.

MATERIALS AND METHODS

Class II subjects were further categorized into horizontal and vertical growers and average growth patterns to check the possible relationship between the facial skeleton and pharyngeal airway. Lateral cephalograms of 150 subjects were obtained using standard protocol in natural head position (NHP). Nasopharyngeal and oropharyngeal linear, and angular and nasopharyngeal area measurements were obtained using standardized tracing technique. Analysis of variance (ANOVA), level of significance, and post hoc Turkey's test were performed to assess the correlation between skeletal pattern of the individual and airway dimension. Gender discrimination was assessed using independent sample t test.

RESULTS

In linear measurements, significant differences were observed among upper pharynx (0.039), adenoid tissue 1 (0.036), and adenoid tissue 2 (0.01). In angular measurements, differences were observed with angle of nasopharynx (0.008). The nasopharyngeal area measurements were also associated with significant difference (0.038) with Class II vertical growers less than those with Class I average and Class II horizontal groups.

CONCLUSION

Class II vertical growers had significantly reduced nasopharyngeal airways.

Serum DHEA-S levels could be used as a comparable diagnostic test to assess the pubertal growth spurt in dentofacial orthopedics

Background

Pubertal growth spurt assessment guides the timing of intervention for correcting the skeletal discrepancies in dentofacial orthopedics. Serum hormones are being studied for the skeletal age assessment to avoid unnecessary radiographic exposure. The present study is to evaluate the relationship of serum hormones dehydroepiandrosterone-sulfate (DHEA-S), insulin-like growth factor (IGF-1), and cervical vertebral stages (CS stages) in the skeletal age assessment of orthodontics patients around the circumpubertal age.

Methods

A total of ninety subjects with age ranging from 7 to 21 years were selected and divided into two groups based on the sex (45 males, 45 females). They were further distributed in each group based on the six CS stages determined from the lateral cephalogram. Blood samples from each subject were collected to evaluate the serum DHEA-S and IGF-1 levels by using the enzyme-linked immunosorbent assay (ELISA). Collected data were analyzed in SPSS software with a test of normalcy, unpaired t test, and one-way analysis of variance (ANOVA) followed by the least significant difference (LSD) post hoc comparison test and univariate regression analysis.

Results

The highest mean serum hormone levels were found in CS 4 in group A (male) and CS 3 in group B (female). ANOVA results showed that there was a significant difference in the serum hormone levels among the different CS stages in both the groups for both the hormones. Statistically, a significant difference was found between each CS stages for both the hormones except in the DHEA-S levels between CS 5 and CS 6.

Conclusions

The mean serum DHEA-S levels followed a typical pattern from the CS 1 till CS 6 which was comparable and similar to the mean serum IGF-1 levels in respect to CS stages. Thus, serum DHEA-S levels could be used as a possible diagnostic test for the assessment of the skeletal pubertal growth spurt in dentofacial orthopedics.

Evaluation of cephalometric characteristics and skeletal maturation of the cervical vertebrae and hand-wrist in girls with central precocious puberty

Objective

This study aimed to evaluate the differences in cephalometric characteristics and skeletal maturation in girls with central precocious puberty (CPP) via lateral and hand-wrist radiographs. We also aimed to identify the indicators that are most effective for determining skeletal maturity in these patients.

Methods

The study included 70 Korean girls (mean age, 8.5 ± 0.5 years) diagnosed with CPP at the Department of Pediatrics, and 48 normal healthy age-matched girls who visited the Department of Orthodontics and had no history of hormone treatment or growth problems. Skeletal maturation was evaluated using lateral cephalometric and hand-wrist radiographs using cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI).

Results

The mean mandibular plane angle was smaller in the CPP group than in the control group (35.8° ± 4.9° vs. 39.0° ± 6.5°), resulting in greater posterior facial height (p = 0.003). SMI was significantly greater in the CPP group (3.5 ± 1.4 vs. 2.0 ± 1.0) than in the control group (p = 0.001) and was significantly associated with CPP (r = 0.492; p = 0.001), whereas CVMI was not.

Conclusions

In comparison with the control group, the CPP group exhibited a smaller mandibular plane angle, greater posterior facial height, and greater skeletal maturation. SMI may be more suitable than CVMI for determining skeletal maturation in CPP. Hand-wrist radiography is recommended in addition to lateral cephalogram for predicting growth in girls with CPP.

Evaluation of an automated superimposition method for computer-aided cephalometrics

OBJECTIVES

To evaluate a new superimposition method compatible with computer-aided cephalometrics and to compare superimposition error to that of the conventional Sella-Nasion (SN) superimposition method.

MATERIALS AND METHODS

A total of 283 lateral cephalometric radiographs were collected and cephalometric landmark identification was performed twice by the same examiner at a 3-month interval. The second tracing was superimposed on the first tracing by both the SN superimposition method and the new, proposed method. The proposed method not only relied on SN landmarks but also minimized the differences between four additional landmarks: Porion, Orbitale, Basion, and Pterygoid. The errors between the landmarks of the duplicate tracings oriented by the two superimposition methods were calculated at Anterior Nasal Spine, Point A, Point B, Pogonion, and Gonion. The paired t-test was used to find any statistical difference in the superimposition errors by the two superimposition methods and to investigate whether there existed clinically significant differences between the two methods.

RESULTS

The proposed method demonstrated smaller superimposition errors than did the conventional SN superimposition method. When comparisons between the two superimposition methods were made with a 1-mm error range, there were clinically significant differences between them.

CONCLUSIONS

The proposed method that was compatible with computer-aided cephalometrics might be a reliable superimposition method for superimposing serial cephalometric images.

Distalization with a modified C-palatal plate for severe upper crowding and a missing lower incisor

This case report presents the orthodontic treatment of a 25-year-old patient with skeletal Class II and severe maxillary arch crowding, moderate mandibular arch crowding, anterior crossbite, and a missing lower incisor. He was treated with molar distalization using a modified C-palatal plate and temporary anchorage devices to create sufficient space for retraction. The total treatment duration was 21 months. After treatment, his occlusion and smile esthetics showed significant improvement. The modified C-palatal plate represents a treatment modality that enhances the prospects of non-extraction treatment and reduces the need for extraction.

Le Fort I osteotomy in cleft patients: Maxillary advancement and velopharyngeal function

BACKGROUND

Maxillary advancement may affect speech in cleft patients.

AIMS

To evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects velopharyngeal function (VPF) in cleft patients.

METHODS

Ninety-three non-syndromic cleft patients (51 females, 42 males) were evaluated retrospectively. All patients had undergone a Le Fort I or bimaxillary (n = 24) osteotomy at Helsinki Cleft Palate and Craniofacial Center. Preoperative and postoperative lateral cephalometric radiographs were digitized to measure the amount of maxillary advancement. Pre- and postoperative speech was assessed perceptually and instrumentally by experienced speech therapists. Student's t-test and Mann-Whitney's U-test were used in the statistical analyses. Kappa statistics were calculated to assess reliability.

RESULTS

The mean advancement of A point was 4.0 mm horizontally (range: -2.8-11.3) and 3.9 mm vertically (range -14.2-3.9). Although there was a negative change in VPF, the amount of maxillary horizontal or vertical movement did not significantly influence the VPF. There was no difference between the patients with maxillary and bimaxillary osteotomy.

CONCLUSIONS

The amount of maxillary advancement does not affect the velopharyngeal function in cleft patients.

The relationship between 3D dentofacial photogrammetry measurements and traditional cephalometric measurements

OBJECTIVES

To determine the relationship between traditional cephalometric measurements and corresponding nonradiographic three-dimensional (3D) photogrammetry measurements.

MATERIALS AND METHODS

This was a cross-sectional study of 20 orthodontic patients (10 male and 10 female) who received lateral cephalometric radiographs and 3D dentofacial photogrammetric records with each subject serving as his or her own control for a total sample size of 40 images (20 per method). A 3D analysis that resembled a traditional cephalometric analysis was established using the eyes and natural head orientation as substitutes for the cranial base. Pearson correlation coefficients and multivariable linear regression plots were calculated to evaluate the relationship between the photogrammetry measurements and the cephalometric measurements.

RESULTS

The ANB angle, mandibular plane angle, lower anterior face height, upper incisor angle to SN, upper incisor angle to NA, and all measurements of lower incisor position and inclination had strong positive Pearson correlation coefficients with the corresponding 3D photogrammetry measurements ( P < .004). Statistically significant regression plots demonstrated that cephalometric relationships between the jaws and incisor orientation can be predicted from corresponding 3D photogrammetry measurements.

CONCLUSIONS

3D photogrammetry measurements relating the jaws to each other and incisor orientation has a strong positive correlation with corresponding traditional cephalometric measurements and can serve as cephalometric predictors. Capturing the eyes using 3D photogrammetry can obviate the need to expose the cranial base and allow limiting the radiographic field to the area of interest.

Comparative Evaluation of Conventional and OnyxCeph™ Dental Software Measurements on Cephalometric Radiography

Objective

Cephalometry can be measured with traditionally conventional analysing methods (hand tracing), as well as using computers. Many dental softwares have been developed for this purpose. The reliability of these programs are often compared with the conventional method. The aim of the present study was to compare the conventional method of manual cephalometric analysis with a computerized one, OnyxCeph ™ (Image Instruments, Chemnitz, Germany) dental software.

Methods

Lateral cephalometric radiographs of 150 patients (75 males and 75 females) age range 12-34 were traced by two methods. Conventional method and computerized (OnyxCeph) cephalometric analysis method. 2 maxillar, 3 mandibular, 2 maxillo-mandibular, 3 vertical, 7 dental and 1 soft tissue parameters; 10 angular, 8 linear totally 18 cephalometric parameters were measured. Intra-class correlation coefficients were performed for both methods to assess the reliability of the measurements.

Results

The results 9 of 18 parameters were found statistically significant. They were Cd-A distance, Cd-Gn distance, Go-Me distance, GoGnSN angle, ANS-Me distance, upper incisor-NA distance, lower incisor-NB distance, lower incisor-NB angle, overbite distance.

Conclusion

Despite some discrepancies in measured values between hand-tracing cephalometric analysis method and the OnyxCeph cephalometric analysis method, statistical differences were minimal and only Cd-A, Cd-Gn, Go-Me, ANS-Me, GoGnSN° were clinically important for cephalometric analysis OnyxCeph was evaluated as an efficient method to replace conventional method.

Morphometric Evaluation of Soft Palate in OSMF Patients Using Cephalometrics

Oral submucous fibrosis (OSF) is a chronic disease and a well-recognized potentially malignant condition of the oral cavity characterized by inflammation and a progressive fibrosis of the lamina propria and deeper connective tissues. To study the morphology of soft palate in different stages of OSF on digital lateral cephalogram. To compare the changes in morphology of soft palate in OSF patients with control. The study was conducted from 2017 to 2018 on 217 patients with their age ranging from 17 to 60 years. All patients detailed clinical examination and history was taken and cephalometric evaluation was done. Type I (51.14%) was found to be the most common in OSF group followed by type II (21.86%) and type VI (13.64%). The present study highlighted the variable radiographic appearances of the soft palate on lateral cephalograms with type I as most common morphology. Cephalometric analysis is one of the most commonly accepted techniques for evaluating the soft palate in both normal individuals and in those with cleft lip and palate.

Concurrent validity and reliability of cephalometric analysis using smartphone apps and computer software

OBJECTIVES

To assess the diagnostic accuracy of two smartphone cephalometric analysis apps compared with Viewbox software.

MATERIALS AND METHODS

Pretreatment digital lateral cephalograms of 50 consecutive orthodontic patients (20 males, 30 females; mean age, 19.1 years; SD, 11.7) were traced twice using two apps (ie, CephNinja and OneCeph), with Viewbox used as the gold standard computer software program. Seven angular and two linear measurements, originally derived from Steiner cephalometric analysis, were performed.

RESULTS

Regarding validity, intraclass correlation coefficients (ICCs) ranged from .903-.983 and .786-.978 for OneCeph vs Viewbox and CephNinja vs Viewbox, respectively. The ICC values for intratool reliability ranged from .647-.993. None of the CephNinja measurements was below the recommended cutoff values of ICCs for reliability.

CONCLUSIONS

OneCeph has a high validity compared with Viewbox, while CephNinja is the best alternative to Viewbox regarding reliability. Smartphone apps may have a great potential in supplementing traditional cephalometric analysis.

Does Gender Have an Effect on Craniofacial Measurements?

Objective

The aim of this cross-sectional study was to evaluate craniofacial structures in terms of different sagittal relations and gender in adolescent individuals.

Methods

Pre-treatment dental models, lateral cephalometric, and hand-wrist radiographs of 223 adolescent subjects (102 male, 121 female) were evaluated. Subjects were divided into the Angle Class I, II, and III (skeletally) subgroups according to the ANB angle. Four angular and 33 linear measurements were used to evaluate the lateral cephalometric radiographs relative to the R1 and R2 coordinate system. The Kolmogorov-Smirnov test was performed to assess the normal distribution of the data. The independent samples t-test and Mann-Whitney U test were used for the comparison of male and female subjects in each group. The values were considered statistically significant at p<0.05.

Results

The vertical facial dimension was found to be significantly greater in Class I male subjects than in female subjects (SGo, p=0.023; ANS-M, p=0.036), and there was a protrusive maxilla (R2ANS, p=0.038; R2A, p=0.016), while the mandibular sagittal position and the mandibular dimension were similar. The maxilla was placed protrusively (R2ANS, p=0.001; R2A, p=0.002), while the mandible was found to be larger both in the position and dimension (CoGn, p=0.003; R2M, p=0.014) in Class II male subjects. Class III male and female subjects were found to have similar maxillary and mandibular vertical and sagittal location and dimensions.

Conclusion

Class I and II subjects showed more gender variation than Class III subjects. The gender-related results of this study declare that treatment planning of malocclusions should be based on gender differences rather than general treatment procedures, which will be useful in achieving successful orthodontic treatment results.

Cephalometric Evaluation of Natural Head Position in Lingayat Population of Karnataka

Aims and Objectives:

To ascertain norms in cephalometry for 11- to 13-year-old Lingayat children in natural head position (NHP).

Materials and Methods:

Lateral cephalograms of children were obtained by using fluid level device. We determined the variance in Frankfort horizontal plane (FHP) inclination to extracranial horizontal in NHP. The G^*Power, version 20 for Windows was used for analysis.

Results:

Reduced facial convexity was observed when the analysis was carried out in relation to true horizontal with significant difference of “t” value of 3.05 and percentage difference of 1.1 (P < 0.01) and for girls “t” value of 9.69 and percentage difference of 2.5 (P < 0.001). The highest correlation coefficient for Lingayat boys (r = 0.77) was seen between palatal plane and occlusal plane. We found least correlation coefficient among FHP and Sella–nasion plane (SNP). The coefficient was r = 0.62 and correlation coefficient of r = 0.70 was between FHP and determination coefficient r² = 0.38 or 38%. For girls, highest correlation coefficient of r = 0.70 was seen among FHP and palatal plane.

Conclusion:

Conventional study of craniofacial forms of Lingayat children showed the average skeletal pattern as Class II with retrognathic mandible in comparison to Caucasians. However, when seen in NHP by new method of analysis based on the true horizontal, the skeletal model was Class III in comparison to Caucasians.

Treatment of class II malocclussion: A comparative study of the effects of twin-block and fatigue resistant device

Aim

This is a retrospective cephalometric study aimed to compare the treatment effects of Twin-Block (TB) appliance with The Forsus Fatigue Resistant Device (FRD) appliance in class II division I patients in a composite of peak and post peak growth of period time.

Materials and Methods

The experimental sample consisted of the lateral cephalograms of 40 patients who were treated with either TB appliance (n = 15), FRD (n = 15) or the untreated control ones. In treatment groups lateral cephalograms taken before therapy as initial records (T1) and at the completion of functional therapy (T2) were used. The control group comprised 10 children with untreated skeletal Class II malocclusions. The normality of distribution of continuous variables was tested by Shaphiro wilk test. Oneway ANOVA and LSD test in parametric; Kruskall Wallis and all pairwaise multible comparison tests in non-parametric samples were used for comparing differences among 3 groups.

Results

Cephalometric analysis revealed that both TB and FRD appliances stimulated mandibular growth (P < 0.05) and no restriction was seen in maxilla in both groups (P > 0.05). The unwanted mandibular proclination was seen more in FRD group (P ≤ 0.001). Soft tissue didn't imitate the hard tissue (P > 0.05).

Conclusion

FRD group produced skeletal effects as much as TB group in peak and post peak period of growth with still more mandibular incisor proclination.

Cephalometric Changes Produced by the Distal Jet and Pendulum Appliances in Class II Malocclusion Treatment

AIM

This study aimed to compare the dentoskeletal and soft tissue changes promoted by the Distal Jet and Pendulum, followed by fixed appliances, in class II malocclusion treatment, evaluated in relation to an untreated control group.

MATERIALS AND METHODS

Group 1 comprised 20 patients (15 female; 5 male) with class II malocclusion, at an initial mean age of 12.77 years. These patients were treated with the Distal Jet followed by fixed appliances for a mean period of 4.15 years. Group 2 consisted of 15 patients (10 female; 5 male) with class II malocclusion, at an initial mean age of 13.42 years, treated with the Pendulum followed by fixed appliances for a mean period of 4.41 years. Group 3 comprised 16 subjects (8 female; 8 male), with class II malocclusion, not submitted to any orthodontic treatment. This group had an initial mean age of 12.25 years. The mean observation period was 3.73 years. Comparison of the three groups was performed by one-way ANOVA followed by Tukey tests.

RESULTS

The Distal Jet appliance showed more palatal tipping of the maxillary incisors than the Pendulum. The treated groups showed more overjet reduction and improvement of molar relationship than the control group.

CONCLUSION

It was concluded that the effects of these two appliances in Class II malocclusion correction are very similar.

CLINICAL SIGNIFICANCE

Both Distal Jet and Pendulum appliances corrected the class II malocclusion with similar cephalometric treatment changes.