Influence of the Rater's Gender on Assessing Facial Beauty in Adult Patients With Vertical and Horizontal Growth Patterns.

Background The evaluation of attractiveness varies from one civilization, culture, and environment to another and between individuals. Gender can also play a role in determining the standards of attractiveness. The purpose of this study was to evaluate the effect of the rater's gender on the assessment of adult facial attractiveness with a vertical and horizontal growth pattern in patients with skeletal Class I malocclusion. Methodology The study sample comprised extraoral photos taken before the treatment of 120 patients (30 males and 30 females in each group) with skeletal Class I malocclusion and vertical and horizontal growth patterns according to the Bjork sum aged between 18 and 25 years. A panel of 30 laypersons (aged 19-25 years with an average age of 23 ± 0.53 years), including raters from both genders, were selected equally using a disproportionate stratified sampling method through a computer-generated list. The raters used the visual analog scale (VAS) to provide a score for each photograph's aesthetic quality. The most attractive group, which received the greatest aesthetic score, and the least attractive group, which received the lowest aesthetic score, were the two groups formed based on each photograph's mean aesthetic scores. Overall, 13 patients were chosen for each group. Subsequently, the average assessment score for every patient photo set was determined. Independent-sample t-tests were employed to ascertain if the raters' gender made a statistically significant difference in assessing patients with vertical and horizontal growth patterns. Results There were statistically significant differences between the gender of raters in evaluating female patients with vertical growth patterns (p < 0.001), where the average rating of the female raters was significantly greater than that of the male raters in evaluating female patients. In addition, there were statistically significant differences between the gender of raters in evaluating female patients with horizontal growth patterns (p = 0.009), where the average rating of the male raters was significantly greater than that of the female raters in evaluating female patients. Conclusions There is a limited effect of the rater's gender in evaluating facial aesthetics. However, the facial features of female patients with long faces are preferred by females more than males, and males are more critical in evaluating these patients. On the other hand, males favor the facial features of female patients with short faces more than females, and females are more critical in evaluating these patients. These results suggest considering patients' personal characteristics with vertical and horizontal growth patterns during diagnosis and treatment planning.

Basal and dentoalveolar transverse parameters in different sagittal and vertical malocclusions in adults: a comparative study.

OBJECTIVE: This study sought to three-dimensionally (3D) evaluate the maxillomandibular basal bone and dentoalveolar widths using cone-beam computed tomography (CBCT) scans in adult Chinese populations with different vertical and sagittal facial skeletal patterns whilst no apparent posterior dental crossbite. MATERIALS AND METHODS: The retrospective cross-sectional comparative study enrolled CBCT images of 259 adult patients (125 males and 134 females). The subjects were divided into the hyperdivergent(n = 82), hypodivergent(n = 88), and normodivergent(n = 89) groups based on the Jarabak ratio (S-GO/N-Me), which were further divided into three subgroups of skeletal Class I, II and III, based on both the ANB angle and AF-BF parameters. ANOVA was used to analyze the extracted data of the studied groups. The intra- and inter-observer reliability was analyzed using the intra-class correlation coefficient (ICC). RESULTS: In all three vertical facial skeletal patterns, the skeletal Class II had significantly smaller mandibular basal bone width compared to skeletal Class I and Class III, both at the first molar and first premolar levels. The skeletal Class III seemed to have smaller maxillary basal bone width compared to skeletal Class I and Class II malocclusions; however, a significant difference was found only in the normodivergent pattern. As for the dentoalveolar compensation, it was most notable that in the hypodivergent growth pattern, the skeletal Class II had significantly smaller maxillary dentoalveolar width compared to the Class I and Class III groups, both at the first molar and first premolar levels. CONCLUSIONS: Based on the sample in the present study, skeletal Class II has the narrowest mandibular basal bone regardless of the vertical facial skeletal pattern. CLINICAL RELEVANCE: For Chinese adults with no apparent transverse discrepancy, the maxillomandibular basal bone and dentoalveolar widths are revealed in specific categories based on different vertical and sagittal facial skeletal patterns. In diagnosis and treatment planning, particular attention should be paid to skeletal Class II for possibly existing mandibular narrowing.

Cone-Beam Computerized Tomography Evaluation of the Relationship between Orthodontic Vertical Direction Parameters and the Distance from the Apex of the Upper Central Tooth to the Nasal Floor and Anterior Nasal Spine.

The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements (p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements (p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans.

Effect of body mass index on soft tissues in adolescents with skeletal class I and normal facial height.

Background: The evaluation of soft tissues in patients undergoing orthodontic treatment plays a critical role in diagnosis and treatment planning. This study aims to evaluate the effect of body mass index (BMI) on facial soft tissues in skeletal Class I patients with normal vertical growth. Methods: The study included 72 patients with a normal vertical growth pattern (SN-GoGn 26-38°) and skeletal Class I (ANB 2‒4°) malocclusion. According to their BMI (kg/m2) values, the patients were divided into three groups of 24 individuals each: underweight (>5th percentile) (13 females, 11 males; mean age, 11.58 ± 1.95 years), normal weight (5‒85th percentile) (12 females, 12 males; mean age, 11.54 ± 1.95 years), overweight (85‒95th percentile) (12 females, 12 males; mean age, 11.62 ± 2.01 years). Soft tissue thickness and height measurements were made on lateral cephalometric radiographs. Results: In all soft tissue thickness measurements, except for the nasion, the overweight weight group had higher values. In comparing the underweight and normal weight groups, statistically significant differences were found in the thickness measurements at the nasion and gnathion (p < 0.05). The differences in thickness measurements at the glabella, labiale superius, stomion, labiale inferius, pogonion, gnathion, and menton are statistically significant between the underweight and overweight groups (p < 0.005). Comparing the normal and overweight groups revealed statistically significant differences the thickness measurements at the glabella, labiale superius, stomion, pogonion and menton (p < 0.05).

Palatal bone thickness for mini-implant insertion in different vertical growth patterns: a systematic review.

Introduction: The purpose of this systematic review was to identify, evaluate, and provide information about palatal bone thickness in different vertical growth patterns for the placement of orthodontic anchorage devices. Methods: We performed a systematic review of the published data in Medline via PubMed, Web of Science, Cochrane Library, and Scopus from January 2000 to August 2022 using eligibility criteria. Data collection analysis and data extraction were performed independently by three reviewers. Sensitivity analyses were performed with the Cochrane risk of bias tool and the ROBINS-I tool was used for non-randomized studies. Results: A total of 343 articles were identified. The inclusion criteria included palatal bone thickness and vertical facial growth. However, both variables were found in 4 studies and only 2 had a control group. The different studies evaluated palatal bone thickness according to sex (male 14.1 mm; female 9.68 mm) and vertical malocclusion (normal 2.2 -12.6 mm; open bite 1.9 -13.2mm) with heterogeneous results. Likewise, the vertical growth pattern with a low angle (9.39 mm) was greater than the normal (8.55 mm) and high angle (7.53 mm). Conclusions: Palatal bone thickness varies according tp different vertical growth patterns, with the greatest thickness being found near the incisive foramen in hypodivergent individuals.

Introducción: El propósito de esta revisión sistemática fue identificar, evaluar y brindar información sobre el espesor óseo palatino en diferentes patrones de crecimiento vertical para la colocación de dispositivos de anclaje ortodónticos. Materiales y métodos: Realizamos una revisión sistemática de los datos publicados de Medline, a través de PubMed, Web of Science, Cochrane Library y Scopus. Se realizaron búsquedas sistemáticas con criterios de elegibilidad desde enero de 2000 hasta agosto de 2022. Tres revisores realizaron de forma independiente el análisis de recopilación de datos y la extracción de datos. Los análisis de sensibilidad se realizaron con la herramienta Cochrane de riesgo de sesgo y para estudios no aleatorios seleccionados de intervenciones se utilizó la herramienta ROBINS-I. Resultados: Se identificaron un total de 343 artículos. La elegibilidad de los estudios incluyó el grosor del hueso palatino y el crecimiento facial vertical. Sin embargo, ambas variables se encontraron en 4 estudios y solo 2 tenían grupo control. El espesor óseo palatino presentó resultados heterogéneos, los estudios evaluaron el espesor óseo palatino en cuanto al sexo (masculino: 14,1 mm; femenino: 9,68 mm), y maloclusión vertical (normal: 2,2-12,6 mm; mordida abierta: 1,9-13,2 mm). Asimismo, el patrón de crecimiento vertical con ángulo bajo (9,39 mm) fue mayor que el ángulo normal (8,55 mm) y ángulo alto (7,53 mm). Conclusiones: El grosor del hueso palatino muestra diferencia en los patrones de crecimiento vertical, el mayor grosor se encontró cerca del foramen incisivo en individuos hipodivergentes.

Anatomical limitations and factors influencing molar distalization.

OBJECTIVES: To analyze the anatomical limitations and characteristics of maxillary and mandibular retromolar regions affecting molar distalization using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 120 qualifying patients were classified into equal groups of skeletal Class II and Class III and stratified by vertical growth pattern, age, sex, and third molar presence. The available distance along the axis of distalization and cortical bone thickness (CBT) were measured in the maxillary and mandibular retromolar regions of Class II and Class III patients, respectively. One-way analysis of variance was used to examine the effects of the factors on the measured data. RESULTS: The minimum available distance of the Class II maxilla was observed at a level 3 mm from the cementoenamel junction (CEJ), while that of the Class III mandible was at a level 9 mm from the CEJ. The average available distance at the limit level was 4.06 ± 1.93 mm in the Class II maxilla, and the average corresponding CBT was 1.00 mm. The average available distance at the limit level in the Class III mandible was 2.80 ± 1.96 mm, and the corresponding CBT was 2.24 mm. In both skeletal Class II and Class III patients, hyperdivergent groups had the least available distance for molar distalization. CONCLUSIONS: The limit for available distance in the Class II maxilla is closer to the coronal level, while that of the Class III mandible is closer to the apical level. A hyperdivergent growth pattern in a patient is indicative of less potential for molar distalization. Axial slices of CBCT images provide valuable evaluation for molar distalization regarding limit levels.

Three-dimensional assessment of the favorability of maxillary posterior teeth intrusion in different facial patterns limited by the vertical relationship with the maxillary sinus floor.

OBJECTIVE: Posterior teeth intrusion is one of the best treatment options for treatment of skeletal open bite in adults; the surrounding anatomical landmarks are one of the restraining factors. This study aimed to assess the vertical relationship between the maxillary posterior teeth (MPT) and the maxillary sinus floor (MSF) in different facial growth patterns in the Chinese adult population. MATERIALS AND METHODS: Cone beam computed tomography images of 298 patients, 145 males and 153 females aged between 20 and 45 years, were analyzed. Based on Jarabak ratio and the mandibular plane inclination, the sample was categorized into 94 hyperdivergent, 102 hypodivergent, and 102 normodivergent facial patterns subjects. The vertical relationship between the root-apex distances were classified as favorable, indicating no contact (type 1), or unfavorable, indicating roots in contact (type 2) for the posterior teeth intrusion. The relationship in the unfavorable group was subdivided into three subgroups (T2C, T2LC, and T2P). Comparative statistical tests were done related to age, gender, tooth side, and type of multiplanar view (sagittal and coronal). The significant level was set to be P < 0.05. RESULTS: There was a statistically significant difference in the mean distance between both genders in the hyperdivergent group (P < 0.001). The measured distance increased with age in all tooth roots (P < 0.001). In both sagittal and coronal views, the most frequent root scores were type 1 and type 2p (54.2%, 27.5%) and (55.1%, 21.4%), respectively. The hyperdivergent group demonstrated a higher prevalence of type 2P (31.6% and 25.5%), whereas the hypodivergent group showed a lower prevalence (25.1% and 19.2%); furthermore, the second molar's mesiobuccal root in hyperdivergent patients showed the closest distance to the maxillary sinus in sagittal and coronal views, 0.3 ± 3.7 and 0.4 ± 3.1 mm, respectively. CONCLUSIONS: Maxillary molars of hyperdivergent patients have the highest possible risk of root resorption due to the possible risk of cortical bone encroachment, while hypodivergent patients have the least possible risk. CLINICAL RELEVANCE: Analysis of apex-sinus distances can be of great help for safe posterior teeth intrusion and providing correct and adequate treatment.

Skeletal Maturation in Different Vertical Facial Growth Pattern.

OBJECTIVE: To assess whether there are differences in skeletal maturation among subjects with horizontal, vertical, and neutral facial growth patterns. MATERIAL AND METHODS: The study was performed on 48 latero-lateral craniographs of patients with horizontal, 48 with vertical and 50 with neutral growth patterns aged 12 to 18 years. Eight variables from the Zagreb 82 MOD, Bracchetti and Accord analysis, were selected for measuring angular and linear parameters on latero-lateral craniographs. The assessment of skeletal maturation was done by using the CVMS method. RESULTS: Statistical analysis showed significant differences in skeletal maturity (p <0.001) between subjects with horizontal and vertical growth pattern and between the subjects with neutral and vertical growth pattern (p <0.05), while no significant difference was found between patients with horizontal and neutral growth pattern. In the younger group (12 - 15 years) there was a statistically significant difference (p <0.05) among subjects with horizontal and vertical growth patterns. In the older group (16 - 18 yrs) there was a statistically significant difference (p > 0.05) in skeletal maturity among subjects with vertical growth patterns compared with horizontal and neutral. In terms of stages of skeletal maturity, patients with a horizontal and neutral growth pattern in the younger group were on average in the fourth stage, and those with a vertical growth pattern in the third stage. In the older group, patients with a horizontal and neutral growth pattern were on average in the fifth stage of skeletal maturity and those with a vertical growth pattern in the fourth stage. CONCLUSION: According to the growth pattern, patients differ in the stage of skeletal maturity.

Palatal plane inclination on vertical growth pattern among Indians.

The skeletal discrepancies in the vertical dimensions can either lead to a long face or a short face. The palatal plane inclination is one such contributing factor. The study sample comprised of 15 lateral cephalograms collected between the time period of June 2019 - March 2020 with 5 cephalograms belonging to skeletal Class I, II and III respectively. The inclination angle and mandibular plane angle were measured using the FACAD software. The obtained results were tabulated and statistically analysed using Pearson's correlation test to determine the correlation between the two variables. There was a statistically significant negative correlation between the skeletal malocclusions with a p value of 0.011. Thus, palatal plane inclination is not a major contributing factor for vertical growth pattern and it is suggestive of a multifactorial influence.

A study of cervical vertebra anomalies among individuals with different sagittal and vertical facial growth patterns.

OBJECTIVE: The objective was to evaluate the prevalence of cervical vertebra anomalies (CVA) in individuals with different sagittal and vertical skeletal growth patterns of jaws and also to establish the associations of anomalies with the type of growth, if any. MATERIALS AND METHODS: A total of 293 lateral cephalograms were evaluated for CVA. Based on the Frankfort mandibular plane angle, cephalograms were categorized into three groups: Group I, II, and III. Based on the ANB angle, cephalograms were classified into three classes, Class 1, 2, and 3. Six types of CVA such as partial cleft (PC), block fusion (BF), dehiscence (D), fusion between C2 and C3 (F23), occipitalization (OC), and spina bifida (SB) were identified on lateral cephalograms. Descriptive statistics were applied along with multinomial logistic regression analysis. P = 0.05 was considered as the level of statistical significance. RESULTS: PC was most common in the overall samples (36%). BF was the least common (3.2%) CVA. The frequency of various CVA was comparable between males and females in all the three classes of individuals. The association of vertical growth patterns with CVA was found to be statistically nonsignificant (P > 0.05). Class 2 malocclusion was found to be statistically significantly associated with the D (P = 0.043). CONCLUSIONS: PC, fusion, and D were the most frequently found CVA, and SB was found only among the hypodivergent growth pattern individuals. The association of CVA with vertical facial growth patterns was not significant, somewhat influenced by age, sex, and sagittal skeletal malocclusions.

Early Treatment of Class III Malocclusion: A Boon or a Burden?

This article presents a case of class III malocclusion, a female patient aged 8 years treated in early stage of its recognition, i.e. treated in early mixed dentition stage, utilizing orthopedic appliance for its correction, utilizing both rapid maxillary expansion and face mask approach. After the skeletal base correction as part of phase of phase I therapy, a retentive plate was given and patient was asked to report every 6 months for review and monitoring of her growth pattern and phase II treatment planning after the eruption of all permanent teeth. How to cite this article: Khan MB, Karra A. Early Treatment of Class III Malocclusion: A Boon or a Burden? Int J Clin Pediatr Dent 2014;7(2):130-136.