Differential Diagnosis of Skeletal Class II: Orthodontic-Surgical Approach with Surgery First

Orthodontic-surgical treatment with the “Surgery First Approach” provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient’s aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent results. Keywords: Malocclusion, Angle Class II. Orthognathic Surgery. Orthodontics, Corrective. ResumoO tratamento ortodôntico-cirúrgico por meio do benefício antecipado proporciona melhorias estéticas faciais imediatas e reduz de maneira significativa o tempo de tratamento ortodôntico do paciente, evitando a piora transitória do perfil facial devido à descompensação dentária que ocorre em casos cirúrgicos. Assim, este caso clínico descreve o retratamento de uma paciente com 22 anos de idade, leucoderma, sexo feminino, que apresentava queixa principal relacionada à inclinação vestibular dos dentes anteriores. Após uso de placa miorrelaxante por 30 dias, verificou-se a presença de Classe II esquelética com deficiência mandibular e ½ Classe II dentária bilateral. Considerando a demanda estética da paciente, optou-se pela abordagem ortodôntico-cirúrgica com Benefício Antecipado associada à extração de 4 pré-molares para correção da inclinação dentária anterior. O uso da placa miorrelaxante foi fundamental para o diagnóstico real da deficiência mandibular e a técnica empregada possibilitou concluir o tratamento evitando o comprometimento estético pré-cirúrgico, com obtenção de excelentes resultados. Palavras-chave: Maloclusão Classe II de Angle. Cirurgia Ortognática. Ortodontia Corretiva.

Spondyloocular Syndrome: A Novel XYLT2 Variant with Description of the Neonatal Phenotype

Spondyloocular syndrome (SOS) is a skeletal disorder caused by pathogenic variants in XYLT2 gene encoding a xylotransferase involved in the biosynthesis of proteoglycans. This condition, with autosomal recessive inheritance, has a high phenotypic variability. It is characterized by bone abnormalities (osteoporosis, fractures), eye and cardiac defects, hearing impairment, and varying degrees of developmental delay. Until now only 20 mutated individuals have been reported worldwide. Here, we describe two siblings from consanguineous healthy parents in which a novel homozygous frameshift variant c.1586dup p(Thr530Hisfs*) in the XYLT2 gene was detected by exome sequencing (ES). The first patient (9 years) presented short stature with skeletal defects, long face, hearing loss and cataract. The second patient, evaluated at a few days of life, showed macrosomia, diffuse hypertrichosis on the back, overabundant skin in the retronucal area, flattened facial profile with drooping cheeks, elongated eyelid rims, wide and flattened nasal bridge and turned down corners of the mouth. During the prenatal period, high nuchal translucency and intestinal hyperechogenicity were observed at ultrasound. In conclusion, these two siblings with a novel pathogenic variant in XYLT2 further expand the clinical and mutational spectrum of SOS.

Success rate to complete optimal 20 + 2 ISUOG planes for foetal ultrasonographic structural screening during early second trimester pregnancy in Thailand

Objective To compare the success rates of obtaining optimal 20 + 2 (2 overview + 20 planes) International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) planes for foetal ultrasound structural screening between pregnant women at gestational age (GA) 18–20 weeks and 20–22 weeks 6 days Methods A prospective descriptive study was conducted. Singleton pregnant women at GA 18–22 weeks + 6 days attending antenatal clinic between December 2019 and March 2020 were invited to participate in the study. Women whose foetuses had obvious structural anomalies were excluded. The ultrasound screening using 20 + 2 ISUOG protocol was performed by 21 operators who had completed the online ISUOG basic training programme with an experience of ultrasound scanning of at least 30 cases. The success rates of achieving optimal planes between GA 18–20 weeks and 20–22 weeks 6 days were compared using Chi-square test. Common suboptimal planes in the ultrasound scan were also presented. Results Optimal 20 + 2 ISUOG planes were successfully assessed in 97/126 (77%) and 112/126 (88.9%) patients in the group with a GA < 20 weeks and in the group with a GA ≥ 20 weeks, respectively. Overall success rate was 82.9%. The success rate for the GA < 20 weeks group was significantly lower than that for the GA ≥ 20 weeks group. The group with a GA ≥ 20 weeks had a 1.2 times higher success rate than the group with a GA < 20 weeks. The most common suboptimal planes were the facial planes, especially the median facial profile, and foetal thoracic planes. Conclusions We prefer to perform foetal structural screening using US with the 20 + 2 ISUOG protocol at a GA 20 to 22 weeks and 6 days with the aim reducing the need for repeat scans.

Automated Analysis of Three-dimensional CBCT Images Taken in Natural Head Position That Combines Facial Profile Processing and Multiple Deep-learning Models

Analysing cephalometric X-rays, which is mostly performed by orthodontists or dentists, is an indispensable procedure for diagnosis and treatment planning with orthodontic patients. Artificial intelligence, especially deep-learning techniques for analysing image data, shows great potential for medical and dental image analysis and diagnosis. To explore the feasibility of automating measurement of 13 geometric parameters from three-dimensional cone beam computed tomography (CBCT) images taken in a natural head position, we here describe a smart system that combines a facial profile analysis algorithm with deep-learning models. Using multiple views extracted from the CBCT data as the dataset, our proposed method partitions and detects regions of interest by extracting the facial profile and applying Mask-RCNN, a trained decentralized convolutional neural network (CNN) that positions the key parameters. All the techniques are integrated into a software application with a graphical user interface designed for user convenience. To demonstrate the system’s ability to replace human experts, we validated the performance of the proposed method by comparing it with measurements made by two orthodontists and one advanced general dentist using a commercial dental program. The time savings compared with the traditional approach was remarkable, reducing the processing time from about 30 minutes to about 30 seconds.

Patterns of Facial Profile Preference in a Large Sample of Dental Students: A Cross-Sectional Study

The objective of this study was to explore dental students’ facial profile preferences in a large sample of students. Nine hundred and nineteen dental students of four dental schools were involved. As part of a larger study on dentofacial esthetics, six photo series consisting of one unaltered and four altered variants of the same female profile were distributed among the students. The altered features were ones that are esthetically significant according to the literature. The students had to indicate the photo in each series that they preferred. The data were analyzed in a regression model in which preference in the given photo series was the dependent variable and gender, grade of studies, and dental school were the factors. Eight hundred and sixty-one students (93.7%) responded. Gender and dental school were not associated with the observed preferences, but the grade of studies was associated for three of the modified parameters: chin prominence, the sagittal position of the maxillary dental arch, and the simultaneous modification of the prominence of the chin and the nose. This study has confirmed several earlier observations, and new observations have also been made. We have demonstrated that the anteroposterior position of the maxillary incisors may be an important determinant of profile esthetics, even if this position does not influence the situation of the soft tissues and if the forehead cannot be used as a reference. We have also shown that the harmony between the nose and the chin overrides the importance of their individual dimensions.

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

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

Soft Tissue Facial Profile Changes Associated with Incisors Retraction

Background: The general tendency of facial soft tissue response toward incisors retraction could be expected in various malocclusions. However, different initial malocclusion no doubt leads to differences in this response. Material and method: This retrospective study consisted of thirty-seven pre- and posttreatment lateral cephalographs belongs to adolescent female with mean age of 15.03 years. The twenty-four landmarks (skeletal, dental, soft tissue) were located and horizontal and vertical reference planes were used. Sixteen linear and six angular measurements were evaluated statistically. The pretreatment and posttreatment lateral cephalograms were superimposed on best fit cribriform plate of the ethmoid to analyze soft tissue facial profile changes after orthodontic treatment. Results: The three methods of error indicated that measurements were valid and reliable. The Labrale superius retraction exhibited the best predictability among upper lip components (Sn, Ss), whereas the lower lip showed better predictability and correlation than the upper lip. The upper and the lower lips revealed relatively similar mean retraction value (2.92 mm) and (2.6 mm) although the upper incisors retracted more (5.25 mm) than the lower incisors (2.86 mm). Conclusion: The upper incisors to Labrale superius ratio (1.99:1, UIP:Ls) exhibited the highest correlation (r=0.55**) among the other established ratios. The lower incisors to Labrale inferius ratio was (1.13:1, LIP: Is) with significant correlation (r=0.44**), whereas no significant correlation was observed with Labrale superius (r=0.27).

INFECTED SILICONE CHIN IMPLANT AFTER IMPLANT-SUPPORTED JAW REHABILITATION: CASE REPORT AND LITERATURE REVIEW

To report the infected silicone chin implant due to the non-ideal placement of dental implants, in female patient, 67 years old. A patient unsatisfied with her facial profile had installed a silicone chin implant 25 years ago. Recently underwent surgery for the placement of dental implants in a region close to the silicone implant. The non-ideal positioning of the dental implants and close contact with the silicone implant led to the absence of osseointegration, with consequent mobility and infection of both. The silicone implant was removed with dental implant that shows mobility. In the imaging exams could be noted others complications of silicone implant like bone resorption and the formation of a narrow bone layer around the inferior border of implant. Alloplastic implants are an option for the esthetic correction of chin deformities. Solid silicone is biocompatible and highly resistant to degradation, with a minimal allergic reaction and risk of toxicity. However, a number of postoperative complications may arise, such as migration or displacement, extrusion, foreign body reaction, bone resorption, heterotopic bone formation and infection. The precise imaging exams are critical to arrive at a diagnosis and the best treatment plan.