Craniofacial morphology and growth in Muenke syndrome, Saethre-Chotzen syndrome, and TCF12-related craniosynostosis

Objectives To determine whether the midface of patients with Muenke syndrome, Saethre-Chotzen syndrome, or TCF12-related craniosynostosis is hypoplastic compared to skeletal facial proportions of a Dutch control group. Material and methods We included seventy-four patients (43 patients with Muenke syndrome, 22 patients with Saethre-Chotzen syndrome, and 9 patients with TCF12-related craniosynostosis) who were referred between 1990 and 2020 (age range 4.84 to 16.83 years) and were treated at the Department of Oral Maxillofacial Surgery, Special Dental Care and Orthodontics, Children’s Hospital Erasmus University Medical Center, Sophia, Rotterdam, the Netherlands. The control group consisted of 208 healthy children. Results Cephalometric values comprising the midface were decreased in Muenke syndrome (ANB: β = –1.87, p = 0.001; and PC1: p < 0,001), Saethre-Chotzen syndrome (ANB: β = –1.76, p = 0.001; and PC1: p < 0.001), and TCF12-related craniosynostosis (ANB: β = –1.70, p = 0.015; and PC1: p < 0.033). Conclusions In this study, we showed that the midface is hypoplastic in Muenke syndrome, Saethre-Chotzen syndrome, and TCF12-related craniosynostosis compared to the Dutch control group. Furthermore, the rotation of the maxilla and the typical craniofacial buildup is significantly different in these three craniosynostosis syndromes compared to the controls. Clinical relevance The maxillary growth in patients with Muenke syndrome, Saethre-Chotzen syndrome, or TCF12-related craniosynostosis is impaired, leading to a deviant dental development. Therefore, timely orthodontic follow-up is recommended. In order to increase expertise and support treatment planning by medical and dental specialists for these patients, and also because of the specific differences between the syndromes, we recommend the management of patients with Muenke syndrome, Saethre-Chotzen syndrome, or TCF12-related craniosynostosis in specialized multidisciplinary teams.

Face Proportions, and Analysis of Maxillary Anterior Teeth and Facial Proportions in a Thai Population

Background: Esthetics is the primary consideration for patients looking for prosthetic treatment. Determining the facial types of Thai populations is important because most studies conducted in Caucasian populations mention their facial types, and describe the gender comparisons, and GP of the teeth. Objectives: This study compared facial proportions, analyzed the maxillary anterior teeth proportions and determined the relationships between teeth with facial measurements using the Golden Proportion (GP) and Golden Standard (GS) in a Thai population. Methods: A total of 200 students (18-35 years) with well-aligned maxillary anterior teeth participated in this study. Face heights and widths were measured from the face using digital calipers and faces were classified as narrow, average, and broad. Teeth and face proportions were compared with GP and GS. One-way ANOVA was performed to compare maxillary anterior teeth proportions and facial proportions with different face types (α= 0.05). Pearson’s correlation was used (α= 0.05) to determine the correlation between facial proportion and teeth dimension among different facial types. Results: The findings showed 82.50% narrow face, 13.50% average, and 4% broad face among Thai subjects. No GP or GS was found in the face and anterior teeth, but teeth and face proportions other than GP and GS were found. No significant correlation was found between the Width of the Central Incisor (WCI) with interpupillary distance and alar width. Conclusion: In this study, the GP was not found in the facial and teeth proportion. The data obtained from this study may help to provide guidelines for prosthetic and orthodontic management and help to select the proper size and form of the maxillary anterior teeth to achieve proper esthetic outcomes in the Thai population.

Kajian Proporsi Wajah Wayang Potehi Perempuan di Gudo, Jombang dengan Proporsi Rasio Emas

The interaction of Nusantara with various nations that has occurred since long ago led to the acculturation of local and immigrant cultures and produced a new culture. One of them is Wayang Potehi which comes from China and develops in Java. The purpose of this study is to find and describe the facial proportions of the female character of Wayang Potehi in Gudo, Jombang. The method used is a quantitative research method by measuring the facial proportions of several female characters of Wayang Potehi in Gudo with the golden ratio theory and calculating the average. In addition, this research also applies interviews with the chairman, Toni, and the puppeteer of Hok Ho An (Wayang Potehi Gudo group), Sonny, as well as direct observation. The golden ratio theory is not used to assess the proportion of Wayang Potehi but as a tool to find the average size of the proportion. The result of this study is the acculturation of Chinese and Javanese culture in visuals, language, stories, characters and characteristics as well as the artists behind the Potehi Wayang. The majority of Wayang Potehi are recognized by the symbols on their clothes and accessories, especially for female characters. Some of the female characters of Wayang Potehi created by the sculptor and Toni's team are quite different from the female characters of Wayang Potehi from China. This shows that the background of the artist (Javanese) influences the work of Wayang Potehi production.

Computed tomography assessment of maxillary bone density for orthodontic mini-implant placement with respect to vertical growth patterns

Objective: To quantitatively measure and report bone density of maxilla in the interradicular (alveolar and basal bone) and infrazygomatic crest (IZC) region in various growth patterns among Dravidian individuals. Design: This was a retrospective spiral computed tomography (CT) study. Setting: The study was conducted at the Department of Orthodontics, Saveetha Dental College and Hospital, Tamil Nadu, India. Methods: Sixty CT scans (24 men, 36 women; mean age = 25.3 years and 23.8 years, respectively) divided equally into three groups based on vertical facial proportions were included. Bone density measurements in Hounsfield units (HU) were performed using Philips and RadiAnt DICOM viewers. Buccal cortical, palatal cortical and cancellous bone regions were analysed in a Philips DICOM viewer and IZC region was analysed in a RadiAnt DICOM viewer. Statistical analysis with one-way ANOVA and post-hoc Tukey HSD test was done. Results: The hypodivergent group had a significantly higher bone density at the buccal cortex in posterior region ( P < 0.05) when compared to the normodivergent and hyperdivergent groups. Buccal basal bone was denser than buccal alveolar bone ( P < 0.05) in all three groups. In the IZC region, hypodivergent groups had significantly higher density values when compared to the normodivergent and hyperdivergent groups ( P < 0.05). Conclusion: The present study concluded that cancellous bone density in the interradicular regions was greatest in the anterior sites and was not influenced by growth pattern. Hypodivergent groups tend to have higher density in the posterior regions (buccal and palatal cortical bone) and at the IZC region compared to normodivergent and hyperdivergent groups.

Photoanthropometry in forensics: Comparison of facial images with frontal and lateral views

Photoanthropometry quantify the facial proportions of an individual facilitating the comparison of facial patterns for human identification. The coordinates and vertical distances in pixels of the photoanthropometric landmarks on images of the same individual in frontal and profile views were analyzed and compared. A total of 116 pairs of photographs of Brazilian individuals were evaluated. The photographs were adjusted in size and rotation, and marked in the software Two-dimensional Forensic Facial Analysis System. For each face, 16 landmarks were considered: glabella (g), nasion (n), ectocanthion (ec), pronasale (prn), subnasale (sn), alare (al), cheilion (ch), upper lip (ls), lower lip (li), stomion (sto), labiomental (lm), gnathion (gn), superaurale (sa), subaurale (sba), postaurale (pa) and upper ear lobe (slb); the x- and y-coordinates of each landmark were obtained. Twenty-seven vertical distances between the points were proposed, which were measured by subtracting the values of the y-coordinate. The data were analyzed descriptively and inferentially using the Kolmogorov-Smirnov test, intraclass correlation coefficient (ICC) and Mann-Whitney test (α=5%). The mean age of the sample was 25.9 years (± 4.7), and 50.9% (n=59) were males. When the coordinates were evaluated, a low correlation was obtained between the images (ICC<0.4). Of the 27 proposed measures, 77.7% (n=21) indicated agreement between the images in the two views (p>0.05). A comparison of ls-g, sa-ec, pa-ec, slb-ec, sba-sa and slb-sa showed disagreement between the images. Therefore, there is agreement between the facial measures in the frontal and lateral images, except for ls-g and for the distances between the ear landmarks.

Esthetic Considerations in Orthodontics: An Overview

Esthetics has been an ever-evolving concept and has gained considerable importance in the field of orthodontics in the last few decades. The re-emergence of the soft tissue paradigm has further catapulted the interest of the orthodontist. So much so that achieving a harmonious profile and an esthetically pleasing smile has become the ideal goal of treatment and is no longer secondary to achieving a functional dental occlusion and/or a rigid adherence to skeletal and dental norms. Esthetics in the orthodontic sense can be divided into three categories: macroesthetics, miniesthetics, and microesthetics. Macroesthetics includes the evaluation of the face and involves frontal assessment and profile analysis. The frontal assessment involves assessment of facial proportions, while the profile analysis involves evaluation of anterior–posterior position of jaws, mandibular plane, and incisor prominence and lip posture. Miniesthetics involves study of the smile framework involving the vertical tooth–lip relationship, smile type, transverse dimensions of smile, smile arc, and midline. Microesthetics involves the assessment of tooth proportions, height-width relationships, connectors and embrasures, gingival contours and heights, and tooth shade and color. The harmony between these factors enables an orthodontist to achieve the idealized esthetic result and hence these parameters deserve due consideration. The importance placed on a pleasing profile cannot be undermined and the orthodontist should aim for a harmonious facial profile over rigid adherence to standard average cephalometric norms. This article aims to give an overview of the macro, mini, and microesthetic considerations in relation to orthodontic diagnosis and treatment planning.

To Check the Validity of Neoclassical Canon in Western Maharashtra- An Anthropometric Study

Introduction: In ancient days, it was believed that attractive and harmonious faces were having certain fixed proportions known as neoclassical canons. These canons were used extensively by Leonardo Da Vinci, Durer in their art during renaissance. They served as guidelines for artists as well as for aesthetic surgeons for centuries and proved to be helpful till now. From ancient days to modern era, the exact formula of beauty is not yet calculated. The norms of beauty changes from country to country and race to race. A face is beautiful and shows harmonious features if the individual components are proportional, this is what is referred as facial balance. In ancient Greece, they calculated the formula for creation of art and these formulae are called as neoclassical canons. The classical Greek canons of facial balance are still foundation of modern reconstructive and aesthetic surgery. Aim: To check the validity of neoclassical canon in Western Maharashtrian population. Materials and Methods: This was an observational type of study carried out from March 2018 to January 2020. The validity of Naso-oral canon was checked in Western Maharashtrian population. According to this canon ideal mouth width (ch-ch) (mouth width (distance between right and left corners of mouth called chelion)) is 1.5 times of Nose width/alar width (al-al) (alar width (distance between right and left ala of nose)). Mouth width=1.5 times of Nose width. However, the mouth width can be less than 1.5 times of nose width or mouth width can be greater than 1.5 times of nose width. This study was carried out in the five cities Sangli, Kolhapur, Islampur, Karad and Satara of Western Maharashtra, India. Total 1500 male and female students, 300 from each city, between the age group of 18-20 years were selected. Measurements were taken with the help of digital Vernier caliper. The methodology adopted for the measurements was taken from the guidelines given by Farkas LG in his book- “Anthropometric facial proportions in Medicine”. Results: In present study, total 68.33% subjects including males and females were having mouth width (ch-ch) lesser than one and half times of nose width/alar width (al-al) i.e., ch-ch <1.5 (al-al). Remaining 31.67% subjects were having mouth width greater than one and half times of nose width/alar width i.e., ch-ch >1.5 (al-al). Conclusion: Naso-oral neoclassical canon was not found valid in Western Maharashtrian young adults. In 78.32% male and 62.80% female population of Western Maharashtra, mouth width was found lesser than one and half times of nose width.

Evaluation of Facial Esthetics using Golden Proportion Values in Dravidian Population for Different Classes of Malocclusions

Improvement in esthetic appearance and functional occlusion are the pillars of contemporary orthodontic procedures. The aim of this study was to assess variations in facial proportions between skeletal classes I, II, III populations in order to establish objective departures from Golden Proportion norms. The study sample was divided into three groups based on the skeletal malocclusion, namely skeletal class I, class II and class III groups. Various markers were identified in these photographs in order to define facial symmetry and balance with the ideal values. Golden Proportion values were compared with that of the obtained results, and these values were checked for skeletal class I, II, III malocclusions. Our study showed a significant difference between skeletal class II and III malocclusions when correlated with Golden Proportion values. Skeletal Class I malocclusions showed a greater correlation with golden proportion values. Golden proportion ratios are more valid in cases of skeletal class I malocclusions. Hence, the objective of treating class II and class III malocclusions should be more focused on attaining values closer to the desired ratio for optimal facial balance and symmetry.

Thresholds of Abnormality Perception in Facial Esthetics among Laypersons and Dental Professionals: Frontal Esthetics

Aim. To find thresholds at which laypersons and dental professionals perceive abnormalities in two facial frontal esthetics variables: facial symmetry and vertical harmony. Materials and Methods. A baseline frontal image of a young male face with optimum facial proportions was generated from a real image using a photo editing software. Different facial asymmetry images were then generated from this image by manipulating the chin point position at 2 mm increment to the left side. Vertical harmony was perceived through manipulating lower anterior facial height (LAFH) at a ratio of 2% of increased and decreased heights. A total of 120 raters divided equally into four groups of laypersons, general dental practitioners (GDPs), orthodontists, and oral and maxillofacial surgeons (OMFSs) rated these images using an analog scale of 100 mm long. Using ANOVA and Tukey post hoc tests at P < 0.05 , the image that showed the first statistical difference compared to the baseline was considered as a threshold of abnormality. Results. The image of 4 mm asymmetry was defined by the laypersons and GDPs as the threshold of abnormality, while the orthodontists and OMFSs realized that at 2 mm. Laypersons and GDPs defined a threshold of 46% as an abnormal decrease in the LAFH and the other 2 groups at 48%. All dental professionals groups rated the image of 54% as an abnormal increase in the LAFH while laypersons perceived that at 56%. Conclusion. These thresholds regarding frontal esthetics may contribute to the process of establishing proper orthodontic treatment planning that suits the highest facial esthetic standards.

Aplicabilidade do digital smile design em reabilitações estéticas: revisão de literatura

OBJECTIVE: To review the literature on the digital planning and diagnosis protocol known as "Digital Smile Design", highlighting its main advantages concerning aesthetic rehabilitation in restorative dentistry. MATERIAL AND METHOD: 60 articles were searched in Pubmed, Scielo, and Bireme databases, using the search terms Dental photography, cosmetic dentistry, treatment protocols. Inclusion criteria were: In vivo studies, systematic reviews and meta-analysis, literature addressing variables under study, language in Portuguese and English, and articles published from 1990 to 2020. Exclusion criteria were: letter to the editor, literature review, and clinical case. RESULTS: DSD is a treatment planning tool used in interdisciplinary aesthetic dentistry to strengthen the diagnostic vision, improve communication between specialists and patient guidance. Smile design refers to the many scientific and artistic principles that, collectively, can create a beautiful smile. These principles are established through data collected from patients as diagnostic models, anamnesis, and measurement of facial proportions. In turn, the aesthetic composition of the smile depends on many points of reference and anatomical parameters for the formation of a harmonious and beautiful set. FINAL CONSIDERATIONS: the DSD is an important tool to be used for aesthetics rehabilitations in restorative dentistry, since it is an instrument that facilitates the diagnosis, improves communication between the multidisciplinary team and assists in the orientation and motivation of the patient, increasing the predictability of treatments.