Three-Dimensional Anthropometric Database of Attractive Caucasian Women: Standards and Comparisons.

The aim of this paper is to develop a database to determine a new biomorphometric standard of attractiveness. Sampling was carried out using noninvasive three-dimensional relief methods to measure the soft tissues of the face. These anthropometric measurements were analyzed to verify the existence of any canons with respect to shape, size, and measurement proportions which proved to be significant with regard to the aesthetics of the face. Finally, the anthropometric parameters obtained were compared with findings described in the international literature.The study sample was made up competitors in the Miss Italy 2010 and 2009 beauty contest. The three-dimensional (3D) scanning of soft tissue surfaces allowed 3D digital models of the faces and the spatial 3D coordinates of 25 anthropometric landmarks to be obtained and used to calculate linear and angular measurements. A paired Student t test for the analysis of the means allowed 3 key questions in the study of biomorphometric parameters of the face to be addressed through comparison with the data available in the literature.The question of statistical evidence for the samples analyzed being members of the populations samples reported in literature was also addressed.The critical analysis of the data helped to identify the anthropometric measurements of the upper, middle, and lower thirds of the face, variations in which have a major influence on the attractiveness of the face. These changes involve facial width, height, and depth. Changes in measurements of length, angles, and proportions found in the sample considered were also analyzed.

Bilateral condylar resorption in down syndrome.

Asymptomatic idiopathic condylar resorption is a rare disease of difficult diagnosis and treatment. We review the literature about this rare condition and report a case of a patient, affected by Down syndrome, who underwent a complete untreated bilateral condylar resorption in adolescence and then developed pain on chewing only 20 years later. Despite a precise orthodontic and surgical therapeutic plan, treatment had to be discontinued because of patient lack of compliance. This case is the first of its kind to be reported and emphasizes the need for special attention in patients with disability.

Accurate facial morphologic measurements using a 3-camera photogrammetric method.

OBJECTIVES: A new, low-cost photogrammetric method has been developed for facial morphometry applications. To evaluate the system, tests for the measurement and comparison of three-dimensional virtual faces were carried out in different subjects. MATERIALS AND METHODS: Twenty adult white Italian subjects, 10 men and 10 women, of ages ranging from 23 to 37 years, were included in this study. Three cameras were finely calibrated, and the point precision vector length was calculated, together with the quality parameters. For each subject, 3 different acquisitions were performed. A tessellated surface was obtained from each point cloud. The comparison was made by aligning three-dimensional information from different models. Differences between 2 different models were estimated by analysis of the distances. RESULTS: For the cases analyzed, the mean point precision overall root-mean-square vector length was 0.07 mm, with a SD of 0.027 mm. The results are reported for the system's capability of discriminating between the faces of different people. Results of comparisons between facial models of a single person were compared with those of comparisons between different subjects. Student's t-test revealed that the system was able to discriminate among different people, with a P > 95%. Two sex subgroups were formed: the mean error between subgroups ranged from 1.65 to 3.43 mm, and the mean ranged from 1.76 to 2.72 mm. CONCLUSIONS: The experiments confirmed the capabilities and the accuracy of the proposed photogrammetric system. Facial comparison was performed by analysis of distances on three-dimensional virtual models.

Three-dimensional analysis and treatment planning of hemimandibular hyperplasia.

INTRODUCTION: The advent of computed tomography (CT) provided a useful instrument for diagnosis and surgical treatment of patients with craniofacial malformations. The development of software for three-dimensional graphic simulation applied to CT scan has made possible the three-dimensional computerized analysis, surgical planning, and simulation. This kind of analysis is particularly useful in case of complex facial malformations, making reliable a surgical treatment in 1 step. The purpose of this report was to present the diagnosis and treatment planning on a patient with hemimandibular hyperplasia by three-dimensional cephalometric analysis. METHODS: A 20-year-old young woman who presented with hemimandibular hyperplasia was investigated with CT scan and plaster cast mounted on an articulator; a two-dimensional manual and computerized cephalometric analysis was also developed on frontal and lateral cephalograms. Images in DICOM format were processed on a PC by means of commercial software, thus obtaining the three-dimensional reconstruction of the skeletal structures. RESULTS: Three-dimensional CT permits to program skeletal corrections and to foresee surgical outcomes with adequate realism. Surgical planning based on three-dimensional CT makes it easy and reliable to achieve the correction of the malformation in a single surgical intervention. CONCLUSIONS: The virtual three-dimensional CT model, a versatile diagnostic aid, has proven to be effective in the exact reproduction of bone and soft tissue anatomy, thus helping in the diagnosis, surgical planning, and simulations. Three-dimensional analysis is particularly indicated in case of complex asymmetric malformations, in which the more accurate reproduction of the individual anatomy can be very useful in implementing surgical results.

The mandibular response in Class II malocclusions correction.

The "mandibular response" is pursued in treatment of Class II malocclusions by mandibular retrusion. The keys for correction of Class II malocclusion--in addition to a favorable natural growth--are differential diagnosis and a carefully monitored force system to allow a good dental movement and a satisfactory mandibular replacement.

Automated landmark extraction for orthodontic measurement of faces using the 3-camera photogrammetry methodology.

OBJECTIVES: To set up a three-dimensional photogrammetric scanning system for precise landmark measurements, without any physical contact, using a low-cost and noninvasive digital photogrammetric solution, for supporting several necessity in clinical orthodontics and/or surgery diagnosis. MATERIALS AND METHODS: Thirty coded targets were directly applied onto the subject's face on the soft tissue landmarks, and then, 3 simultaneous photos were acquired using photogrammetry, at room light conditions. For comparison, a dummy head was digitized both with a photogrammetric technique and with the laser scanner Minolta Vivid 910i (Konica Minolta, Tokyo, Japan). RESULTS: The precise measurement of the landmarks is ranged between 0.017 and 0.029 mm. The system automatically measures spatial position of face landmarks, from which distances and angles can be obtained. The facial measurements were compared with those done using laser scanning and manual caliper. The adopted method gives higher precision than the others (0.022-mm mean value on points and 0.038-mm mean value on linear distances on a dummy head), is simple, and can be used easily as a standard routine. CONCLUSIONS: The study demonstrated the validity of photogrammetry for accurate digitization of human face landmarks. This research points out the potential of this low-cost photogrammetry approach for medical digitization.

BaS analysis: a new cephalometric study for craniofacial malformations.

OBJECT: Patients submitted to surgical advancement of the upper and middle facial third might have a relapse of the skeletal retraction after the removal of the distractor devices. Clinical signs related to this process are usually represented by exophthalmos, Obstructive sleep apnea syndrome (OSAS) or prognathism; however, the analytic definition of the relapse is very difficult , conventional cephalometric methods being influenced by the spatial movement of "N" (nasion) or "Or" (orbital) points. The authors present a new cephalometric technique that could be used as a more objective mean of follow-up evaluation of patients undergoing craniofacial advancement. MATERIALS AND METHODS: The cephalometric analysis proposed is based on angles, lines, areas and distances between BaS (Basion-Sella) axis and other craniofacial landmark points. We have defined this cephalometric technique as "BaS Analysis". CONCLUSION: The "BaS analysis" is not influenced by splanchnocranium movements in the space; for this reason, it can be considered a useful method for cephalometric analysis in the follow-up of patients with craniofacial malformations.

Evaluation of 2 different reference planes used for the study of asymmetric facial malformations.

The purpose of this study was to evaluate if Frankfort plane (FH) and plane passing through the lateral semicircular canals (LS) can be used as reference planes in three-dimensional analysis.Ten patients with facial asymmetry underwent a three-dimensional computed tomography. Computed tomographic images were processed by means of a commercial software and a personal computer to obtain a three-dimensional virtual craniofacial model. The average Frankfort plane and the plane passing through the LS were identified. The distance from the above-mentioned planes to the first upper molar and upper canine cusp was measured.It was not possible to detect an FH plane in any of the patients. Right FH, left FH, average FH, and LS plane were traced. The discrepancies among reference planes were significant in cases with severe asymmetry. A minimal discrepancy was noticed in patients with light asymmetry.In patients with severe asymmetry, the LS plane results in steady, reproducible, detectable, and closer to the patient's anatomy, representing a valid reference plane for three-dimensional computed tomography analysis.

BaS analysis: suggesting a new cephalometric model in follow-up of patients with craniostenosis who underwent craniofacial advancement surgery after 1 year from the end of the distraction protocol.

Evaluation of the relapse in patients with craniofacial malformation who underwent craniofacial advancement surgery is very difficult, and data are often unreliable. This is because common skeletal landmarks move from their original position, making standard cephalometries completely useless. To solve this problem, some authors proposed evaluations based on 2- and 3-dimensional computed tomographies, but the biologic risk and the economic outcome do not consent to repeat this kind of examination too often. In this paper, the authors propose a new cephalometric model based on the evaluation of facial skeletal landmarks on the BaS axis. This method, named BaS analysis, might be useful in evaluating improvements of the splanchnocranium in patients who underwent craniofacial advancement.

The excellence challenge in orthodontics: clinical use of an objective grading system for orthodontic cases.

OBJECTIVES: The aim of this study was to assess objectively some important factors for an accurate diagnosis and an optimal planning of finishing. The 8 criteria of the ABO "Objective Grading System"(OGS) were evaluated: alignment, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships, interproximal contacts, and root angulation. This study focused on whether this method of evaluation is really applicable and useful in daily clinical practice. MATERIALS AND METHODS: 15 subject (7 males, 8 females), with ages ranging between 8.5 and 55 years, were retrospectively examined. Both pre-treatment and post-treatment criteria were analyzed using the OGS, and measurements were made with the special device as described by the ABO. For each parameter that deviated from normal, 1 or 2 points were subtracted. Descriptive statistics were performed for OGS scores. Additionally, differences between scores for the pre-treatment versus the post-treatment were assessed using Wilcoxon signed-rank test. RESULTS: All criteria used in the ABO OGS improved after treatment, except occlusal contacts. Alignment, overjet, occlusal relationships and root angulation improved significantly after treatment (p < .05). Marginal ridges, buccolingual inclination, interproximal contacts measurement did not show statistically significant differences between pre-treatment and post-treatment (p > .05). CONCLUSIONS: Only 3 of 15 examined cases lost 30 points or fewer and would have passed the ABO Phase III examination. Quantitative evaluation of the OGS criteria might help to attain better scores and achieve a more functional and aesthetic outcome. Pre-treatment and post-treatment use of this system can help clinicians to assess treatment difficulties, to set goals and achieve an achieve an objective finishing for completed patients.

Long-term outcome in a patient with a dentoskeletal open-bite malocclusion treated without extraction.

This case report describes the treatment of a patient with a Class II malocclusion with an anterior open bite. The patient, a girl 16 years of age, had a significant anteroposterior discrepancy and a high-angle tendency. Her face was convex, with competent lips. Intraorally she had an anterior open bite of 3 mm, space in the mandibular arch, and an overjet of 2 mm. High-pull headgear, anterior intermaxillary elastics, and appropriate wire bending were used to close the bite and to correct the anteroposterior dental relationship. Modification of a tongue thrust habit helped to correct this significant malocclusion and provided stability at 11 years posttreatment.

Palatally impacted canines: the double traction technique.

When closed eruption is used to recover palatally impacted canines, patients risk a second surgical operation because the traction attachment could come off or the wire ligature, which is connected to the attachment, could break. In order to reduce this risk, a new simple technique has been developed. Instead of the classic single one, two attachments are bonded to the impacted canine. During the orthodontic finishing, the technique includes a mandibular premolar bracket bonded to the ectopic canine. This device should produce a more negative torque (Torque -17 degrees rather than -7 degrees) over the root, which usually remains in palatal position soon after the performed crown recovery.

A hybrid straightwire technique.

An original straightwire appliance was developed in order to easily adapt force and friction to the different stages and needs of treatment. The appliance features: (1) conventional brackets with a 0.020×0.030″ slot in the anterior area, passive self-ligating brackets with a 0.022×0.030″ slot in the lateral area, and tubes with a 0.022×0.030″ slot in the molar area; (2) archwires which adapt to the different stages of treatment and increase their section and stiffness progressively, starting with 0.014″ superelastic NiTi, passing through 0.016×0.025″ and 0.019×0.025″ heat-activated NiTi and reaching 0.019×0.025″ stainless steel working archwires; (3) use of several ligation systems which progressively increase their binding (low-friction ligatures, "O"- or "8"-shape elastomeric ligatures). Clinical cases are shown to illustrate the technique.

Numbers of Beauty: An Innovative Aesthetic Analysis for Orthognathic Surgery Treatment Planning.

The aim of this study was to validate a new aesthetic analysis and establish the sagittal position of the maxilla on an ideal group of reference. We want to demonstrate the usefulness of these findings in the treatment planning of patients undergoing orthognathic surgery. We took a reference group of 81 Italian women participating in a national beauty contest in 2011 on which we performed Arnett's soft tissues cephalometric analysis and our new "Vertical Planning Line" analysis. We used the ideal values to elaborate the surgical treatment planning of a second group of 60 consecutive female patients affected by skeletal class III malocclusion. Finally we compared both pre- and postoperative pictures with the reference values of the ideal group. The ideal group of reference does not perfectly fit in Arnett's proposed norms. From the descriptive statistical comparison of the patients' values before and after orthognathic surgery with the reference values we observed how all parameters considered got closer to the ideal population. We consider our "Vertical Planning Line" a useful help for orthodontist and surgeon in the treatment planning of patients with skeletal malocclusions, in combination with the clinical facial examination and the classical cephalometric analysis of bone structures.

Correlations between mandibular asymmetries and temporomandibular disorders (TMD).

INTRODUCTION: Mandibular asymmetries are the fulcrum of many debates among modern orthodontists and maxillofacial surgeons. The interest is even greater when facial asymmetries are correlated to the development of TMJ symptoms and temporomandibular disorders (TMD). OBJECTIVE: The aim of this study is to investigate how mandibular asymmetries constitute etiological or predisposing factors for the development of temporomandibular disorders (TMD). We considered patients with mandibular asymmetries associated with TMD. Using orthodontic or surgical-orthodontic treatment, patients experienced correction of their TMJ symptoms. Thus, mandibular asymmetries represent a major risk factor for the development of TMD. MATERIAL AND METHODS: We studied a sample of 16 subjects aged between 14 and 36-years-old (11 females and 5 males) with mandibular asymmetries (81% structural asymmetry, 19% functional asymmetry). These subjects presented skeletal and dental malocclusions combined with several temporomandibular disorders, mostly due to muscle tension. In 100% of cases, patients received orthodontic treatment. We compared pre- and post-treatment postero-anterior (PA) cephalometric analyses in order to evaluate asymmetry resolution. RESULTS: Comparison of measurements from pre- and post-therapy PA cephalograms showed resolution of mandibular asymmetries after treatment. The treatment resolved mandibular asymmetries and completely eliminated temporomandibular symptoms. CONCLUSIONS: Orthodontic treatment of patients presenting mandibular asymmetry enables correction of all TMJ symptoms and TMD. Mandibular symmetries can therefore be considered to constitute etiological or predisposing factors for the development of TMD.

Uprighting of mandibular second molars with the sectional modified Loca system.

A new way to upright the mandibular second molar is described. The principles of the Loca system, originally used for molar distalization, are employed in the mandibular arch.

Relationship between vertical facial patterns and dental arch form in class II malocclusion.

BACKGROUND: The purpose of this study is to evaluate the relationship between dental arch form and the vertical facial pattern determined by the angle between the mandibular plane and the anterior cranial base (Sella-nasion/mandibular plane angle (SN-MP)) in skeletal class II untreated patients. METHODS: A sample of 73 Caucasians patients with untreated skeletal class II in permanent dentition was divided into three groups according to the values of the angle SN-MP. An evaluation of the arch form was performed by angular and linear relation values on each patient. Regression analysis was used to determine the statistical significance of the relationships between SN-MP angle and dental arch form. The differences among the three groups were analyzed for significance using a variance analysis. RESULTS: A decrease of the upper arch transversal diameters in high SN-MP angle patients and an increase in low angle SN-MP ones (P<0.05) were shown. Result analysis showed a change in upper arch shape, with a smaller intercanine width in patients with high SN-MP angle and a greater one in low angle patients. As SN-MP angle increased, the upper arch form tended to be narrower. No statistically significant difference in mandibular arch form among the three groups was found, except the angle value related to incisors position. CONCLUSIONS: The results showed the association between the upper dental arch form and the vertical facial pattern. On the contrary, the lower arch form was not related to the mandibular divergence.

Three-dimensional methodology for photogrammetric acquisition of the soft tissues of the face: a new clinical-instrumental protocol.

BACKGROUND: The objective of this study is to define an acquisition protocol that is clear, precise, repeatable, simple, fast and that is useful for analysis of the anthropometric characteristics of the soft tissue of the face. METHODS: The analysis was carried out according to a new clinical-instrumental protocol that comprises four distinct phases: (1) setup of portable equipment in the space in which field analysis will be performed, (2) preparation of the subject and spatial positioning, (3) scanning of the subject with different facial expressions, and (4) treatment and processing of data. The protocol was tested on a sample comprising 66 female subjects (64 Caucasian, 1 Ethiopian, and 1 Brazilian) who were the finalists of an Italian national beauty contest in 2010. To illustrate the potential of the method, we report here the measurements and full analysis that were carried out on the facial model of one of the subjects who was scanned. RESULTS: This new protocol for the acquisition of faces is shown to be fast (phase 1, about 1 h; phase 2, about 1.5 min; phase 3, about 1.5 min; phase 4, about 15 min), simple (phases 1 to 3 requiring a short operator training period; only phase 4 requires expert operators), repeatable (with direct palpation of anatomical landmarks and marking of their positions on the face, the problem of identification of these same landmarks on the digital model is solved), reliable and precise (average precision of measurements, 0.5 to 0.6 mm over the entire surface of the face). CONCLUSIONS: This standardization allows the mapping of the subjects to be carried out following the same conditions in a reliable and fast process for all of the subjects scanned.