Facial surface morphology predicts variation in internal skeletal shape.

INTRODUCTION: The regular collection of 3-dimensional (3D) imaging data is critical to the development and implementation of accurate predictive models of facial skeletal growth. However, repeated exposure to x-ray-based modalities such as cone-beam computed tomography has unknown risks that outweigh many potential benefits, especially in pediatric patients. One solution is to make inferences about the facial skeleton from external 3D surface morphology captured using safe nonionizing imaging modalities alone. However, the degree to which external 3D facial shape is an accurate proxy of skeletal morphology has not been previously quantified. As a first step in validating this approach, we tested the hypothesis that population-level variation in the 3D shape of the face and skeleton significantly covaries. METHODS: We retrospectively analyzed 3D surface and skeletal morphology from a previously collected cross-sectional cone-beam computed tomography database of nonsurgical orthodontics patients and used geometric morphometrics and multivariate statistics to test the hypothesis that shape variation in external face and internal skeleton covaries. RESULTS: External facial morphology is highly predictive of variation in internal skeletal shape ([Rv] = 0.56, P <0.0001; partial least squares [PLS] 1-13 = 98.7% covariance, P <0.001) and asymmetry (Rv = 0.34, P <0.0001; PLS 1-5 = 90.2% covariance, P <0.001), whereas age-related (r(2) = 0.84, P <0.001) and size-related (r(2) = 0.67, P <0.001) shape variation was also highly correlated. CONCLUSIONS: Surface morphology is a reliable source of proxy data for the characterization of skeletal shape variation and thus is particularly valuable in research designs where reducing potential long-term risks associated with radiologic imaging methods is warranted. We propose that longitudinal surface morphology from early childhood through late adolescence can be a valuable source of data that will facilitate the development of personalized craniodental and treatment plans and reduce exposure levels to as low as reasonably achievable.

Accuracy of cone-beam computed tomography in predicting the diameter of unerupted teeth.

INTRODUCTION: An accurate prediction of the mesiodistal diameter (MDD) of the erupting permanent teeth is essential in orthodontic diagnosis and treatment planning during the mixed dentition period. Our objective was to test the accuracy and reproducibility of cone-beam computed tomography (CBCT) in predicting the MDD of unerupted teeth. Our secondary objective was to determine the accuracy and reproducibility of 3 viewing methods by using 2 CBCT software programs, InVivoDental (version 4.0; Anatomage, San Jose, Calif) and CBWorks (version 3.0, CyberMed, Seoul, Korea) in measuring the MDD of teeth in models simulating unerupted teeth. METHODS: CBCT data were collected on the CB MercuRay (Hitachi Medical Corporation, Tokyo, Japan). Models of unerupted teeth (n = 25), created by embedding 25 tooth samples into a polydimethylsiloxane polymer with a similar density to tissues surrounding teeth, were scanned and measured by 2 investigators. Repeated MDD measurements of each sample were made by using 3 CBCT viewing methods: InVivo Section, InVivo Volume Render (both Anatomage), and CBWorks Volume Render (version 3.0, CyberMed). These measurements were then compared with the MDD physically measured by digital calipers before the teeth were embedded and scanned. RESULTS: All 3 of the new methods had mean measurements that were statistically significantly less (P <0.0001) than the physical method, adjusting for investigator and tooth effects. Specifically, InVivo Section measurements were 0.3 mm (95% CI, -0.4 to -0.2) less than the measurements with calipers, InVivo Volume Render measurements were 0.5 mm less (95% CI, -0.6 to -0.4) than those with calipers, and CBWorks Volume Render measurements were 0.4 mm less (95% CI, -0.4 to -0.3) than those with calipers. CONCLUSIONS: Overall, there were high correlation values among the 3 viewing methods, indicating that CBCT can be used to measure the MDD of unerupted teeth. The InVivo Section method had the greatest correlation with the calipers.