Factors affecting treatment decisions for Class I malocclusions.

INTRODUCTION: Orthodontic treatment planning requires skill and expertise with considerable practice variations. The aims of this study were to review retrospectively the pretreatment records of patients with Class I malocclusion and to identify variables that could play a role in the treatment decision. METHODS: From the available records of 1500 orthdontic patients, the pretreatment records of 202 patients were selected at random. Inclusion and exclusion criteria were applied, and the surviving records were divided into extraction (n = 92) and nonextraction (n = 92) treatment groups. Skeletal, dental, and soft tissue measurements were obtained from pretreatment lateral cephalograms and dental casts of subjects with bilateral Class I molar relationships. Data were statistically analyzed by binary logistic regression tests. RESULTS: The results showed that the variables of lower anterior facial height, E-plane to upper lip, and maxillary and mandibular incisor inclinations were significantly increased in the extraction group (P <0.05), whereas spacing in the mandibular arch and increased overbite were statistically significant in the nonextraction treatment group (P <0.05). According to the model, the odds of nonextraction treatment are 1.29 and 1.24 times that of extraction treatment for every 1-mm increase in overbite and spacing in the mandibular arch, respectively. CONCLUSIONS: Vertical facial pattern, overbite, mandibular tooth size-arch length discrepancy, lip position, and maxillary and mandibular incisor inclinations are a few of the important variables that should not be overlooked when planning orthodontic treatment. The findings of this study could facilitate the treatment planning process for patients with Class I malocclusion.

Improvement in Peer Assessment Rating scores after nonextraction, premolar extraction, and mandibular incisor extraction treatments in patients with Class I malocclusion.

INTRODUCTION: Different treatment protocols implemented for correction of Class I malocclusion aim at achieving ideal occlusal characteristics. This study was planned to evaluate the improvement in the occlusal characteristics of Class I patients treated with nonextraction (NE), all first premolar extractions (PME), and mandibular incisor extraction (MIE) as assessed by the percentage of improvement in Peer Assessment Rating (PAR) scores. METHODS: This retrospective cross-sectional study was conducted on the pretreatment and posttreatment dental casts of 108 subjects with Class I malocclusion. The total sample was divided into 3 equal groups according to the treatment protocol implemented: NE, PME, and MIE. The mean pretreatment and posttreatment PAR scores, and the percentages of improvement were compared among the 3 treatment modalities using Kruskal-Wallis and post-hoc Dunnett T3 tests. RESULTS: The mean percentages of improvement in the PAR score were 75.8% ± 25.8% in the NE group, 73.1% ± 19.4% in the PME group, and 70.6% ± 24.1% in the MIE group. There was no significant difference (P = 0.351) in the percentages of improvement in PAR scores among the 3 treatment modalities. However, the mean pretreatment and posttreatment PAR scores varied significantly (P <0.001) in the 3 groups. The average pretreatment and posttreatment PAR scores were highest in the MIE group and lowest in the NE group. CONCLUSIONS: The comparable percentages of improvement in PAR scores among the 3 groups denote that equivalent occlusal corrections were achieved in Class I patients treated with the NE, PME, and MIE protocols.

Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity.

INTRODUCTION: Various methods have been proposed to evaluate a patient's developmental status. However, most of them lacked precision and failed to give a reliable estimate of skeletal maturity. The aims of this study were to evaluate the association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity and to determine its validity in assessing the different stages of the adolescent growth spurt. METHODS: A cross-sectional study was performed on the pretreatment lateral cephalograms of 252 subjects aged 8 to 21 years. The sample was divided into 6 groups based on the cervical vertebral maturation stages. The frontal sinus index was calculated by dividing the frontal sinus height and width, and the cervical stages were evaluated on the same radiograph. The Kruskal-Wallis test was applied to compare frontal sinus index values at different cervical stages, and the post hoc Dunnett T3 test was applied to compare frontal sinus index values between adjacent cervical stages for each sex. The Kendall tau-b values were computed to assess the correlation between the cervical stages and the sinus index. A P value of ≤0.05 was considered statistically significant. RESULTS: The height and width of the frontal sinus were significantly larger in the male subjects than in the females. A significant association was found between the frontal sinus height and width and cervical stages (P ≤0.001) in both sexes. However, the changes in the frontal sinus index across the different cervical stages were found to be significant (P ≤0.001) in male subjects only. Similarly, a weak negative correlation was found between the sinus index and the cervical stages in male subjects (tau-b = -0.271; P <0.001), whereas no correlation was found in female subjects (tau-b = -0.006; P <0.928). However, the post hoc analysis showed that the values of the sinus index were comparable between any 2 adjacent cervical stages. CONCLUSIONS: The frontal sinus index cannot be used to identify the prepubertal, pubertal, and postpubertal stages of the adolescent growth spurt. Therefore, it cannot be used as a reliable maturity indicator.

Exploration of variations in positions of upper and Lower incisors, overjet, overbite, and irregularity Index in orthodontic patients with dissimilar depths of Curve of spee.

BACKGROUND: The position and arrangement of teeth as well as the entire scheme of occlusion differs from one individual to the other .The purpose of this study was to examine differences in position and inclination of incisors, overjet, overbite and lower arch crowding in subjects with different depths of curve of Spee and to determine correlations between depth of curve of Spee and these variables. METHODS: The sample comprised of 114 patients (55 females and 59 males) with fully erupted permanent second molars (age 12-25 years), having no history of previous orthodontic treatment, no craniofacial anomalies, and no missing permanent teeth. Study parameters were assessed by using pretreatment lateral cephalograms and dental casts of orthodontic patients. The entire sample was divided into three groups according to depth of curve of Spee (mild Spee=38, moderate Spee=38, severe Spee=38). Descriptive statistics were calculated. Differences between the Spee groups were assessed by analysis of variance. In addition, correlation coefficients were calculated between curve of Spee and other parameters. RESULTS: Statistically significant differences were found in upper incisor inclination (p=0.000), lower incisor inclination (p=0.003), Steiner's mandibular plane angle (p=0.000), overjet (p=0.001), overbite (p=0.000) and irregularity index (p=0.008) among the Spee groups. Moreover, statistically significant positive correlations were found between curve of Spee and overjet, overbite and irregularity index. Upper and lower incisor inclinations as well as mandibular plane angle were found to have statistically significant but negative correlations with curve of Spee. CONCLUSIONS: Overjet and overbite in severe Spee group are larger than in mild and moderate Spee groups. There is negative correlation between curve of Spee depth and inclinations of upper and lower incisors. There is positive correlation between curve of Spee depth and severity of lower anterior crowding and Steiner's mandibular plane angle.

RELIABILITY OF VARIOUS SKELETAL INDICATORS IN ASSESSING VERTICAL FACIAL SOFT TISSUE PATTERN.

BACKGROUND: Angle's paradigm has ruled the orthodontic diagnosis and treatment planning for past several decades, but the recent introduction of the soft tissue paradigm has significantly changed the dynamics of orthodontic practice. This study was designed to identify skeletal analyses that best correlates with the parameters use to assess facial soft tissue profile that may lead to an accurate diagnosis and efficient treatment plan. METHODS: A total of 192 subjects (96 males and 96 females; mean age 22.95 ± 4.75 years) were included in the study. The total sample was distributed into three equal groups (i.e., long, normal and short face) on the basis of soft tissue vertical pattern. Pre-treatment lateral cephalograms were used to assess various vertical linear and angular parameters. Various skeletal analyses and soft tissue parameters were correlated using the Pearson's correlation in different vertical groups, separately for males and females. RESULTS: In males, a weak positive correlation (r = 0.485) was found between skeletal anterior facial height ratio (Sk. LAFH/TAFH) and soft tissue anterior facial height ratio (LAFH/TAFH'), whereas in females maxillary-mandibular plane angle (MMA) showed a weak positive correlation (r = 0.300). In the long face group, a positive but a weak correlation (r = 0.349) was present between cranial base angle (SN-GoGn) and LAFH/TAFH'. CONCLUSIONS: Skeletal analyses (MMA, Sk. LAFH/TAFH) significantly correlated to soft tissue parameters. Males andlong faced individuals showed a higher correlation between skeletal and soft tissue parameters as compared to that of the females.

FACIAL SOFT TISSUE ANALYSIS AMONG VARIOUS VERTICAL FACIAL PATTERNS.

BACKGROUND: The emergence of soft tissue paradigm in orthodontics has made various soft tissue parameters an integral part of the orthodontic problem list. The purpose of this study was to determine and compare various facial soft tissue parameters on lateral cephalograms among patients with short, average and long facial patterns. METHODS: A cross-sectional study was conducted on the lateral cephalograms of 180 adult subjects divided into three equal groups, i.e., short, average and long face according to the vertical facial pattern. Incisal display at rest, nose height, upper and lower lip lengths, degree of lip procumbency and the nasolabial angle were measured for each individual. The gender differences for these soft tissue parameters were determined using Mann-Whitney U test while the comparison among different facial patterns was performed using Kruskal-Wallis test. RESULTS: Significant differences in the incisal display at rest, total nasal height, lip procumbency, the nasolabial angle and the upper and lower lip lengths were found among the three vertical facial patterns. A significant positive correlation of nose and lip dimensions was found with the underlying skeletal pattern. Similarly, the incisal display at rest, upper and lower lip procumbency and the nasolabial angle were significantly correlated with the lower anterior facial height. CONCLUSION: Short facial pattern is associated with minimal incisal display, recumbent upper and lower lips and acute nasolabial angle while the long facial pattern is associated with excessive incisal display, procumbent upper and lower lips and obtuse nasolabial angle.

Occlusal Outcome Of Non-Extraction And All First Premolars Extraction Treatment In Patients With Class-I Malocclusion.

BACKGROUND: Class-1 malocclusion commonly presents with crowding and poses an aesthetic concern to patients. An orthodontist may encounter a variety of dental problems and must handle them strategically to establish adequate occlusal relationships. Hence, this study was conducted to evaluate the occlusal characteristics of patients who have undergone non-extraction or all first premolars extraction treatment for class I malocclusion using the peer assessment rating (PAR) index. METHODS: The pre-treatment and post treatment dental casts of 94 subjects with class-I malocclusion were retrospectively screened. The sample was distributed into two groups, i.e., nonextraction and all first premolars extraction groups. The Mann Whitney-U test was used to compare the mean percentage improvement in the PAR scores between the two groups. A p-value of ≤0.05 was considered statistically significant. RESULTS: The mean percentage improvement in the non-extraction group was 74.28% in the non-extraction group and 74.5% in the all first premolars extraction group. A significant difference (p=0.04) was found between the pretreatment PAR scores for the two treatment modalities. There was no significant difference between the post treatment PAR scores (p=0.45) and the mean percentage improvement in PAR scores (p=0.41) between the treatment groups. CONCLUSIONS: The improvement in occlusal characteristics in patients who underwent non-extraction treatment and all first premolar extraction treatment was comparable as assessed through mean percentage improvement in PAR scores.

Deep Bite Malocclusion: Exploration Of The Skeletal And Dental Factors.

BACKGROUND: Correction of deep bite is crucial for maintenance of dental hard and soft tissue structures and for prevention of temporomandibular joint disorders. Exploration of underlying skeletal and dental factors is essential for efficient and individualized treatment planning. To date etiological factors of dental and skeletal deep bite have not been explored in Pakistani orthodontic patients. The objectives of this study were to explore frequencies of dental and skeletal etiological factors in deep bite patients and to determine correlations amongst dental and skeletal etiological factors of deep bite. METHODS: The study included a total of 113 subjects (males=35; females=78) with no craniofacial syndromes or prior orthodontic treatment. Pre-treatment orthodontic records were used to evaluate various dental and skeletal parameters. Descriptive statistics of each parameter were calculated. The various study parameters were correlated using Pearson's Correlation. RESULTS: Deep curve of Spee was most frequently seen factor of dental deep bite (72.6%), followed by increased coronal length of upper incisors (28.3%), retroclined upper incisors (17.7%), retroclined lower incisors (8%) and increased coronal length of lower incisors (5.3%). Decreased gonial angle was most commonly found factor of skeletal deep bite (43.4%), followed by decreased mandibular plane angle (27.4%) and maxillary plane's clockwise rotation (26.5%). Frankfort mandibular plane angle and gonial angle showed a strong positive correlation (r=0.66, p=0.000). CONCLUSIONS: Reduced gonial angle is most frequently seen skeletal factor, signifying the importance of angulation and growth of ramus in development of deep bite. Deep curve of Spee is most frequently seen dental etiological component in deep bite subjects, hence signifying the importance of intruding the lower anterior teeth.

CHANGES IN ORO-PHARYNGEAL AIRWAY DIMENSIONS AFTER TREATMENT WITH FUNCTIONAL APPLIANCE IN CLASS II SKELETAL PATTERN.

BACKGROUND: Functional appliances have been used since many decades for the correction of mandibular retrognathism. Similar oral appliances are a treatment modality for patients with Obstructive sleep apnoea. Hence, interception at the right age with these growth modification appliances might benefit a child from developing long-term respiratory insufficiency. Therefore, the purpose of our study was to assess the short-term effects of Twin block appliance (CTB) on pharyngeal airway size in subjects with skeletal Class-II pattern in a sample of Pakistani population. METHODS: A retrospective study was conducted from orthodontic records of 62 children (31 males, 31 females) with retrognathic mandibles using lateral cephalograms obtained at initial visit and after CTB treatment. Paired t-test was used to compare the pre-functional and post-functional treatment airway size. Independent sample t-test was used for comparison between the genders and statistical significance was kept at ≤ 00.5. RESULTS: The upper airway width (p < 0.001), nasopharyngeal depth (p = 0.03) and upper airway thickness (p = 0.008) was substantially improved after CTB treatment. Males showed a greater increase in upper airway width (p = 0.03) and nasopharyngeal depth (p = 0.01) in comparison to the females. CONCLUSION: Functional appliance therapy can improve the narrow pharyngeal airway of growing children presenting with deficient mandibles having Class-II skeletal pattern.

EFFECT OF INCISOR INCLINATION CHANGES ON CEPHALOMETRIC POINTS A AND B.

BACKGROUND: The position of cephalometric points A and B are liable to be affected by alveolar remodelling caused by orthodontic tooth movement during incisor retraction. This study was conducted to evaluate the change in positions of cephalometric points A and B in sagittal and vertical dimensions due to change in incisor inclinations. METHODS: Total sample of 31 subjects were recruited into the study. The inclusion criteria were extraction of premolars in upper and lower arches, completion of growth and orthodontic treatment. The exclusion criteria were patients with craniofacial anomalies and history of orthodontic treatment. By superimposition of pre and post treatment tracings, various linear and angular parameters were measured. Various tests and multiple linear regression analysis were performed to determine changes in outcome variables. Statistically significant p-value was < or = 0.05. RESULTS: One-sample t-test showed that change in position of only point A was statistically significant which was 1.61 mm (p<0.01) in sagittal direction and 1.49 mm (p<0.01) in vertical direction. Multiple linear regression analysis showed that if we retrocline upper incisor by 10 degrees, the point A will move superiorly by 0.6 mm. CONCLUSIONS: Total change in the position of point A is in a downward and forward direction. Total Change in upper incisors inclinations causes change in position of point A only in vertical direction.

Association between sella turcica bridging and palatal canine impaction.

INTRODUCTION: The association of sella turcica bridging and various dental anomalies has been an area of interest for researchers. Based on the evidence of a common embryologic origin between sella turcica and the teeth, the objectives of this study were to measure the dimensions of sella turcica and to test whether an association exists between sella bridging and impacted canines. METHODS: Orthodontic records comprising standard-quality lateral cephalograms and dental panoramic radiographs were selected. Thirty-one patients with palatally impacted canines (20 female, 11 male; mean age, 18.4 ± 8.9 years) and 70 controls with erupted canines (35 male, 35 female; mean age, 17.1 ± 7.5 years) were included in the study. Comparison of sella dimensions between the patients and the controls was carried out by independent sample t tests, whereas the association of sella bridging with impacted canines was analyzed using the chi-square test. RESULTS: The frequencies of complete and partial calcification of sella in the patients were 8 (25.8%) and 17 (54.8%), respectively, whereas those in the controls were 0 and 36 (51.4%), respectively. The frequency of sella bridging was significantly higher in subjects with canine impaction than in the controls (P <0.001). The sagittal interclinoidal distance was found to be significantly reduced in the patients (P = 0.028). According to the statistical analysis, age and sex do not influence the dimensions and calcification of sella turcica. CONCLUSIONS: Sella bridging is frequently found in patients with impacted canines. Hence, sella bridging can complement other diagnostic parameters in confirming the status of canine impaction.

Esthetic impact of tooth extraction in Pakistani patients.

BACKGROUND: The norms of Pakistani female patients differ from other Asian patients, this difference should be considered during diagnosis and treatment planning and they should be treated with different protocols in terms of tooth extraction and non-extraction treatments. The present study will provide clinical guidelines to assist in the decision-making process for borderline patients when considering extraction or non-extraction in the orthodontic treatment plan. METHODS: Panels of 40 dentists and 40 laypersons evaluated randomly presented pre- treatment and post-treatment soft-tissue profiles of 30 extraction and 30 non-extraction female patients. Borderline patients were selected based on their initial diagnostic records. Two panels were asked to compare the pre-treatment and post-treatment soft tissue profile tracings and to quantify their perceptions of the aesthetic impact of treatment change using a visual analogue scale (VAS). RESULTS: The mean VAS scores of dentists and laypersons for extraction treatment strategy were +23.03±27.89 and +19.41±26.79 mm (p=0.182) respectively. For non-extraction treatment strategy, mean VAS scores of dentists and laypersons were +12.51?26.56 and +14.55±21.22 mm (p=0.448) respectively. The mean change in lower lip protrusion after extraction treatment was 2.15±3.38 mm (p=0.002) and after non-extraction treatment was 0.83+2.75 mm (p=0.109). CONCLUSIONS: No significant difference was found between dentists and laypersons in their perception of aesthetic impact of a treatment strategy. There was significant change in lower lip protrusion only after the extraction treatment strategy.

Association of maxillary and mandibular base lengths with dental crowding in different skeletal malocclusions.

BACKGROUND: Dental crowding is the one of the most frequently encountered problem for an orthodontist. The relationship between crowding and various skeletal, dental and soft tissue parameters is important to establish and consider during the overall orthodontic treatment planning. This study aimed to determine the correlation of maxillary and mandibular base lengths with dental arch crowding in different malocclusions and to evaluate the gender dimorphism for these variables. METHODS: A sample of 120 subjects divided into three skeletal malocclusions was further subdivided based on amount of mandibular arch crowding. Maxillary and mandibular base lengths and dental arch crowding were measured on pre-treatment lateral cephalograms and initial casts using vernier calliper respectively. Inter-group comparisons were assessed by univariate analysis of variance. Correlation between base lengths and dental crowding was assessed by Pearson's correlation (p≤0.05). RESULTS: Statistically significant differences were found for maxillary (p=0.008) and mandibular base lengths (p=0.000) between different skeletal malocclusions. Mandibular base length was significantly larger in males (p=0.000). Mandibular crowding was highest in class-II and lowest in class-I (p=0.01). A significant but weak negative correlation was found between dental crowding and maxillary (r=-0.28, p=0.02) and mandibular (r=-0.20, p=0.02) base lengths, significant but moderate positive correlation between maxillary and mandibular base lengths (r=0L566, -0.000) and between maxillary and mandibular crowding (r=-0.408, p-0.000). CONCLUSIONS: Maxillary and mandibular base lengths are largest in skeletal class-II and class-III malocclusions respectively. Mandibular base length is larger in males as compared to females. An increase in amount of dental crowding is weakly associated with smaller skeletal base lengths.

Frequency of dentofacial asymmetries: a cross-sectional study on orthodontic patients.

BACKGROUND: Correction of orthodontic asymmetries is crucial to achieve functional occlusion, aesthetics and stability of post orthodontic treatment results. To date valid frequency data of dentofacial asymmetries in Pakistani orthodontic patients do not exist to document orthodontic treatment need. The objectives of this study were to determine frequency of dento-facial asymmetries, severity of dental asymmetries and to determine difference in frequency of dentofacial asymmetries in mixed and permanent dentition. METHODS: The sample of this cross-sectional study comprised of 280 patients (177 females and 103 males) with no history of previous orthodontic treatment having no craniofacial anomalies. Dento-facial asymmetries were assessed from pre-treatment records of patients. Descriptive statistics were used to determine frequency of dentofacial asymmetries and severity of dental asymmetries. Chi-square test was used to determine difference in frequency of dentofacial asymmetries in mixed and permanent dentition. RESULTS: Seventy eight percent (219) of patients had noncoincident midlines, 67.5% (189) had mandibular midline asymmetry, 43.2% (122) had molar asymmetry, 15.7% (44) had mandibular arch asymmetry, 14.3% (40) had maxillary midline asymmetry, 13.6% (38) had maxillary arch asymmetry, 6.1% (17) had nose deviation, and 12.1% (34) had facial asymmetry and chin deviation. In most patients dental midlines were deviated from one another and from facial midline by » lower incisor widths, while molar asymmetry was found in most patients by » cusp width. Mandibular arch asymmetry was more frequent in permanent than mixed dentition (p = 0.054). CONCLUSIONS: Non-coincident dental midline is most commonly seen. Nose deviation is least commonly observed. Mandibular arch asymmetry is more frequent in permanent than mixed dentition.

Comparison of nasal profiles in various skeletal patterns.

BACKGROUND: The aim of this study was to determine any significant difference in nasal profiles amongst subjects in sagittal and vertical skeletal patterns in a sample Pakistani population, and to determine gender dimorphism if any. MATERIAL: The sample was divided into three sagittal and groups, namely skeletal Class I, II, and III, and three vertical groups, namely, normo-divergent, hypo-divergent and hyper-divergent vertical skeletal patterns. On way ANOVA was used to find any difference in nasal profiles amongst vertical and sagittal skeletal patterns, and to assess gender dimorphism. respectively. RESULTS: Statistically significant differences were found between Skeletal Class I, II and III for naso-labial angle, naso-mental angle and soft tissue facial convexity. Furthermore, statistically significant differences were also obtained between males and females for nasal length, nasal depth, columella convexity and nasal bone length. Statistically significant differences were observed for nasal depth 2 and naso-labial angle in the vertical groups. CONCLUSIONS: Skeletal Class I, II, and III subjects have different nasal profiles. Nasal profiles are significantly different for males and females: hence it should be taken into consideration while planning ideal treatment for patients. Different vertical patterns are also associated with different nasal forms. It is recommended that further research be done to establish norms in our population for nasal profile.

Nasal Morphology as an Indicator of Maxillomandibular Skeletal Pattern.

OBJECTIVE: To determine the correlation of nasal morphology with maxillary and mandibular patterns. STUDY DESIGN: Descriptive cross-sectional study. Place and Duration of the Study: Department of Orthodontics, Liaquat College of Medicine and Dentistry and Qamar Dental Hospital, Karachi, Pakistan, , Liaquat College of Medicine & Dentistry and Darul Sehat Hospital Karachi, Pakistan from January to June, 2022. METHODOLOGY: The pre-treatment lateral cephalograms of 120 patients, aged 18-35 years were included in the study. Eleven nasal parameters were traced on lateral cephalograms and correlated with four maxillary and mandibular skeletal parameters by Pearson correlation coefficient test using SPSS version 26.0. RESULTS: Nasal bone length and nasal base angle showed a negative correlation with maxillary and mandibular position. Nasal upward tip angle was correlated positively with maxillary position whereas nasal tip angle was found to be negatively correlated with maxillary length. A negative correlation was observed between nasolabial angle and mandibular position. Nasal bone angle depicted a positive correlation with maxillary position and a negative correlation with jaw lengths and mandibular inclination. CONCLUSION: Nasal morphology has a strong correlation with maxillary as well as mandibular base lengths and position but not with inclination of the jaws. The acquaintance of the relationship of different nasal parameters with jaw parameters might be helpful in diagnosis and treatment planning and to attain the favourable treatment outcomes in patients undergoing orthodontic treatment, orthopedic interventions, orthognathic, genioplasty, rhinoplasty, profiloplasty and other procedures. KEY WORDS: Nasal morphology, Maxillomandibular skeletal pattern, Jaw length, Jaw position, Jaw inclination.

Reliability Of Orthopantomogram In Comparison To Lateral Cephalogram For Linear Mandibular Measurements.

Background: Mandibular asymmetries are commonly seen as asymmetric traits among orthodontic and orthognathic patients which require bilateral mandibular assessment for diagnosis and treatment. An orthopantomogram can be used to measure and compare right and left sides of mandible. The objective of this study was to investigate the reliability of left and right sides of orthopantomogram for determining the linear mandibular measurements and to check whether these values are identical with the values of linear mandibular measurements determined from lateral cephalogram. Methods: Orthopantomogram and lateral cephalogram were taken from 118 patients of age group 12-35 years from Orthodontic department, Liaquat College of Medicine & Dentistry and Darul Sehat Hospital, Karachi, Pakistan. Linear mandibular measurements were detected and compared between orthopantomograms and lateral cephalograms. Right and the left sides of orthopantomograms were compared for all of the linear mandibular parameters by using paired t-test. Independent sample t-test was performed for the comparison between orthopantomogram and lateral cephalogram using SPSS version 26.0. Results: Statistically significant differences were observed when orthopantomograms were compared with lateral cephalograms for mandibular body length (p=0.000) and total mandibular length (p=0.000). No statistically significant difference was found between orthopantomograms and lateral cephalograms for ramus height (p=0.226, p=0.177). Neither any significant difference was observed between right and left sides of an orthopantomogram. Conclusion: An orthopantomogram can be used to evaluate vertical mandibular measurements as reliably as a lateral cephalogram. However, it is required for clinicians to be vigilant when determining horizontal mandibular measurements from orthopantomograms as they are unpredictable.

Assessing skeletal relationships using the cervical vertebral curvature.

The aim of this study was to determine any association amongst the cervical vertebral morphology and the various sagittal and vertical facial patterns. The results of this study demonstrate a relationship between the cervical vertebral morphology and the skeletal facial patterns. This may be of some assistance to an orthodontist to diagnose a skeletal malocclusion at a glance just by looking at the patient's cervical vertebral curvature.

Esthetic preferences for facial soft tissue profiles.

Our aim was to determine any significant difference in esthetic preferences for facial soft tissue profiles among orthodontists, orthodontic patients and their parents. As orthodontic treatment influences facial profiles, the patients' preference for their profile should be sought before treatment, instead of assuming what the orthodontist feels is ideal.

Comparison of cephalometric norms of esthetically pleasing faces.

OBJECTIVE: To establish cephalometric norms of a sample of aesthetically pleasing Pakistani faces and to analyze differences and similarities with accepted standards for Caucasians. STUDY DESIGN: Analytical cross sectional study. PLACE AND DURATION OF STUDY: Carried out at Alvi Dental Hospital, Karachi, from August 2007 to February 2008. METHODOLOGY: Cephalometric tracings were analyzed on a sample of 40 (20 males and 20 females) Pakistani young adults, aged 18-25 years, with full complement of permanent teeth, no previous orthodontic treatment and pleasing profile. To check the reliability of the measurements, 20 randomly selected cephalograms were retraced. None of the measurements showed a significant difference. Student's 't' test was applied for overall group comparisons. P-value of < 0.05 was considered significant. RESULTS: When compared with some classical standards, the results suggest that the Pakistani sample had greater cranial lengths (p < 0.001), shorter faces anteriorly (p < 0.001), and tended towards bimaxillary dental protrusion with more prominent chin (p < 0.001). Males had greater antero-posterior, horizontal and vertical measurements (p < 0.001). Females showed more dental protrusion (p < 0.01). CONCLUSION: Comparisons revealed statistically significant differences in most variables between Pakistanis and Caucasians and between Pakistani males and females. Pakistanis have distinct cephalometric features, which should be used as a reference in treating Pakistani orthodontic and orthognathic surgery patients.