Can anteroposterior skeletal pattern be determined from a silhouetted profile photograph? A cross-sectional study

Objective: To determine the degree to which the anteroposterior (AP) skeletal jaw relation can accurately be determined from a silhouetted clinical profile photograph and whether the level of agreement is influenced by patient vertical proportions. Design: Cross-sectional study. Setting: University Dental Hospital of Manchester, United Kingdom. Participants: Specialist orthodontists Method: Eight specialist orthodontists assessed 37 silhouetted profile photographs of individuals aged 11–19 years and determined the class and severity of AP skeletal pattern. These assessments were compared to corresponding lateral cephalometric radiographs, where ANB values, supplemented by an Eastman Correction and a Wits Appraisal, where appropriate, were used for sagittal skeletal classification. Results: The agreement between silhouette and cephalometric AP determination yielded a weighted kappa score of 0.207 (95% confidence interval [CI] 0.135–0.278), which indicates only a fair level of agreement. The silhouetted sagittal skeletal pattern classification, along with severity, agreed with the lateral cephalometric radiograph in 29% of instances. Class III individuals were identified correctly 19.2% of the time. There was a statistically significant difference in kappa scores between the high angle (K= 0.439; 95% CI 0.310–0.568) and low angle (K = 0.068; 95% CI 0.007–0.130) patients ( P < 0.001), as well as the high and average angle (K= 0.151; 95% CI 0.031–0.270) patients ( P < 0.05). Conclusion: AP skeletal pattern, as determined from a lateral cephalometric radiograph, has only a fair level of agreement to that from a silhouetted profile photograph. Vertical proportions were shown to have a significant effect on the determination of the sagittal skeletal pattern and class III skeletal patterns were shown to be the most difficult to identify from profile silhouettes.

Assessment of nasopharynx area and level of severity posterior crossbite on children with cleft lips and palate post-palatoplasty

Introduction: Many children with post palatoplasty had crossbite posterior. This study was aimed to assess the nasopharynx area and the posterior crossbite severity level of children with cleft lip and palate (CLP) who received palatoplasty treatment compared to normal children. Methods: The study was observational analytic. The research subject was 14 children with CLP post-palatoplasty and 14 normal children. The object of research was 28 study models and secondary data of lateral cephalometric radiograph of children with CLP post palatoplasty and normal children. The measurement of PTM-ad1-Ad2-PTM and PTM-So-Ba-PTM were used to measure the nasopharyngeal area. Study models were assessed to analyse the level of severity of posterior crossbite. Results: The average of the soft tissues (the nasopharynx) area children with CLP post-palatoplasty was 35.02 mm2, which was lower than the normal child (35.73 mm2). Similarly, the average of the hard tissues (the nasopharynx) area children with CLP post-palatoplasty was 301.40 mm2, which was smaller than the normal children (315.54 mm2). Statistical analysis of the nasopharynx area resulted in non-significant difference. All children with CLP post-palatoplasty was suffered from posterior crossbite. The level of severity posterior crossbite, which was categorised as good was 42.9%, poor criteria was 35.7%, moderate criteria was 14.3%, and very good criteria was 7.1%. Conclusion: There is no difference between the average size of the nasopharynx area on children with CLP post-palatoplasty and normal children. The level of severity posterior crossbite after palatoplasty in CLP children mostly included in the good criteria.

Value-addition of lateral cephalometric radiographs in orthodontic diagnosis and treatment planning

ABSTRACT Objective To investigate the value-addition of obtaining lateral cephalometric radiographs during the treatment planning phase of orthodontic treatment. Materials and Methods The records of 100 orthodontic patients were presented to seven scorers during two phases that were 6 weeks apart. In the first phase, scorers completed a seven-question survey with questions regarding treatment planning. They were given various diagnostic records that did not include a lateral cephalometric radiograph. Six weeks later, the same scorers completed the same survey for the same patient cases with the same diagnostic records that additionally included a lateral cephalometric radiograph. Correlation coefficients were used to calculate intrarater agreement and inter-rater agreement within the study. Results Cohen's kappa values showed moderate to almost perfect agreement for the majority of survey questions. Intrarater agreement ranged between 0.430 and 1. Cronbach's alpha reliability statistics showed good interrater agreement for all questions in the survey. Agreement ranged from 0.710 to 0.913 across the survey questions. Diagnosing Angle classification of occlusion had the highest level of agreement and differentiating between skeletal and dental malocclusion had the lowest level of agreement. Conclusions The lateral cephalometric radiograph is not a necessary diagnostic tool for most cases in orthodontic diagnosis and treatment planning. Weighing the usefulness of a lateral cephalometric on a case-by-case basis should be recommended to align with the principle of ALARA (as low as reasonably achievable), especially in a primarily pediatric population.

Moorrees-like mesh diagram for Romanian patients - a pilot study

diagrams to ease the orthodontic diagnosis and treatment of North-American patients. Subsequently, the system was adapted by different authors to other races and populations. The objective of this study is to provide a system of Moorrees-like mesh diagrams for the Romanian population, Caucasian race, which would help orthodontists, surgeons and prosthetists. Methods. 40 patients were introduced in the study, 20 males and 20 females, with ages between 12-33 years, permanent dentition and slight dental-maxillary abnormalities, class I and II Angle. For each patient, a lateral cephalometric radiograph was taken, with CRANEX 3D, head straight, maximum intercuspation. On tracing paper were drawn 35 anthropometric points and 3 planes, Frankfurt plane, as the horizontal landmark, a perpendicular line through nasion as the vertical landmark and the occlusal plane. From each point we measured the distance in millimeters to the horizontal landmark and to the vertical landmark, respectively. The obtained values were introduced into 40 tables, using Microsoft Office Excel 2007 and 3 arithmetic means were calculated, for males, for females and a general one, for children under 12 years old. The arithmetic means were transferred on millimetric paper and tracing paper, joining the obtained points and completing the templates. Results. Three different Moorrees-like mesh diagrams were obtained, one for male, one for female and a mixt one for children under 12 years, Romanian patients, Caucasian race, respectively. Conclusions. Mesh diagram comes in the support of a better perspective of the anatomical elements of the face and the facial growth, being a useful tool in predicting treatment. Computer based programs with Moorrees-like diagrams adapted to Romanian patients may be the object of further studies.

Correlation of cervical vertebral maturity and teeth calcification stages in children with cleft lip and palate

Cleft lip and palate are the most common craniofacial anomalies in Indonesia. Recent publications report that there was delayed skeletal and dental age in cleft lip and palate patients. Panoramic and lateral cephalometric radiograph to evaluate growth and development through skeletal and dental age is still rarely used. The research aimed to determine the correlation between cervical vertebral maturation and teeth calcification stages in children aged 7 to 16 years old with cleft lip and palate in Unpad Dental Hospital. The research design was analytic correlation and the sample was selected using purposive sampling cross-sectional using secondary data panoramic and lateral cephalometric radiograph. The scores of cervical maturation and teeth calcification stages were then analyzed statistically using SPSS version 16. Spearman coefficient of rank correlation test showed strong correlation between cervical vertebral maturation and teeth calcification stages on all teeth, with the highest rs score was secondary molar (0.734) and p value 0.000 The conclusion of this research is that there is a strong correlation between cervical vertebral maturation and teeth calcification stages in children aged 7 to 16 years old with cleft lip and palate.

The assessment of resting tongue posture in different sagittal skeletal patterns

ABSTRACT Introduction: Resting tongue posture affects the surrounding structures and, theoretically, may result in altered arch form and jaw relationship. Objective: The objective of the present study was to investigate the association between resting tongue posture as observed in lateral cephalometric radiograph, sagittal jaw relationship and arch form. Methods: The study was conducted on pretreatment lateral cephalograms and dental casts of 90 subjects. Subjects were equally divided into three groups, based on sagittal jaw relationship (Class I, II and III). Tongue posture was determined in terms of tongue-to-palate distances at six different points (distances 1 to 6) using ViewPro-X software, according to the method described by Graber et al in 1997. The arch widths (intercanine and intermolar widths) were evaluated on pretreatment dental casts. Results: Tongue-to-palate distances were found to be comparable among different study groups. Significant differences were found in intercanine and intermolar widths at the cuspal and gingival levels among the study groups, except for intercanine width at cuspal level in maxilla and intermolar width at cuspal level in mandible. Moderate positive correlation was found between arch widths ratios at distances 3 and 4 in skeletal Class III group. Effect size was found to be moderate to large in different sagittal skeletal patterns and arch widths. Conclusion: The results of the current study showed no significant differences in the resting tongue posture among the groups, and moderate to weak correlation between tongue posture and dental arch widths.

Long-term skeletodental stability of mandibular symphyseal distraction osteogenesis: Tooth-borne vs hybrid distraction appliances

ABSTRACT Objective: To evaluate and compare the long-term skeletodental stability of mandibular symphyseal distraction osteogenesis (MSDO) achieved with the use of tooth-borne vs. hybrid distraction appliances. Materials and Methods: Posttreatment and follow-up orthodontic records were collected for 33 patients. The 14 patients who underwent distraction with a tooth-borne appliance had a mean follow-up of 5.08 years. The 19 patients who underwent distraction with a hybrid appliance had a mean follow-up of 6.07 years. Records included intraoral photographs, study models, postero-anterior cephalometric radiographs, and lateral cephalometric radiographs. Total changes of 16 measurements were analyzed to compare patients who underwent the tooth-borne vs. the hybrid distraction. Results: Both groups shared several similar and significant (P &lt; .05) changes from posttreatment to follow-up records. Cast analysis showed a decrease in intercanine width and arch length and an increase in irregularity index. The postero-anterior cephalometric radiograph showed an increase in the width of the interincisal apices. The lateral cephalometric radiograph showed a decrease in the MP-L1 angle. The only statistically significant difference between the two appliances was the intercentral incisor contact point. Conclusion: Changes found are consistent with those found in untreated and orthodontically treated individuals over time. The long-term changes in the current patient sample can be determined to be expected and acceptable. MSDO is a viable treatment option with the use of either a hybrid or tooth-borne appliance.