Are the Reasons Why Patients Are Referred for an Orthodontic Visit Correct?

Who does refer patients for an orthodontic consultation? Which are the main reasons for the referral? Does the visit of the orthodontic specialist confirm these reasons or reveal undiagnosed problems? Is there the risk that only evident dental problems are addressed, while craniofacial malformations remain underdiagnosed? This cross-sectional epidemiologic study aims to answer these questions, analysing the clinical data collected during the orthodontic visits of 500 Caucasian young patients referred to a public health structure of northern Italy. All patients were visited by the same expert specialist in orthodontics. Clinical data were collected, analysing both dental and skeletal features. The reasons for the referral of the visit were analysed and compared with the specialistic diagnoses. In our sample, dentists, relatives/friends and paediatricians were the major source of the referrals, followed by family doctors and other facial specialists. In most cases, the reasons for the referral were dental irregularities, but approximately 80% of dental irregularities were associated with undiagnosed facial dysmorphism. Skeletal facial anomalies need an early diagnosis to prevent the development of severe facial malformations that would require invasive and expensive treatments. These findings reveal poor diagnostic skills regarding skeletal anomalies in dentists and paediatricians and the need for better specific training.

Does Head Orientation Influence 3D Facial Imaging? A Study on Accuracy and Precision of Stereophotogrammetric Acquisition.

This study investigates the reliability and precision of anthropometric measurements collected from 3D images and acquired under different conditions of head rotation. Various sources of error were examined, and the equivalence between craniofacial data generated from alternative head positions was assessed. 3D captures of a mannequin head were obtained with a stereophotogrammetric system (Face Shape 3D MaxiLine). Image acquisition was performed with no rotations and with various pitch, roll, and yaw angulations. On 3D images, 14 linear distances were measured. Various indices were used to quantify error magnitude, among them the acquisition error, the mean and the maximum intra- and inter-operator measurement error, repeatability and reproducibility error, the standard deviation, and the standard error of errors. Two one-sided tests (TOST) were performed to assess the equivalence between measurements recorded in different head angulations. The maximum intra-operator error was very low (0.336 mm), closely followed by the acquisition error (0.496 mm). The maximum inter-operator error was 0.532 mm, and the highest degree of error was found in reproducibility (0.890 mm). Anthropometric measurements from alternative acquisition conditions resulted in significantly equivalent TOST, with the exception of Zygion (l)-Tragion (l) and Cheek (l)-Tragion (l) distances measured with pitch angulation compared to no rotation position. Face Shape 3D Maxiline has sufficient accuracy for orthodontic and surgical use. Precision was not altered by head orientation, making the acquisition simpler and not constrained to a critical precision as in 2D photographs.

Three-dimensional evaluation of facial asymmetry in patients with hemifacial microsomia using stereophotogrammetry.

PURPOSE: To quantify the surface facial asymmetry in a group of young patients with hemifacial microsomia (HFM) and to investigate differences with a homogeneous sample of healthy subjects, using a novel stereophotogrammetric method. MATERIALS AND METHODS: Twelve patients (mean age 13.1 ± 3.1 years) with different degrees of HFM and 15 healthy controls (mean age 12.2 ± 3.5 years) were imaged with a stereophotogrammetric facial scanner. The root mean square error (RMSE) of the distances between the corresponding points of each original photograph and its mirror copy was calculated for the whole face and for each trigeminal third, as defined by the innervation of trigeminal branches. A statistical analysis was performed to compare the RMSE value of all facial areas within each group and between patients and controls. RESULTS: RMSE values progressively increased from the upper to the lower third of face, both in patients and controls. The level of asymmetry was significantly higher in HFM subjects for middle third (p < 0.01), lower third (p < 0.001) and whole face (p < 0.001); no statistically significant differences were found between the groups for the upper third. CONCLUSIONS: The reported technique provides an accurate topographic analysis of the facial asymmetry, and is recommended for conditions such as HFM affecting only part of the face.

Orthodontics and Moebius syndrome: an observational study.

BACKGROUND: Moebius syndrome is a rare condition characterized by bilateral facial and abducens nerve paralysis. The aim of this study is to evaluate the main orthodontic features and the frequency of associated clinical characteristics in patients with Moebius syndrome (MS). METHODS: According to Terzis classifications, 58 patients with MS aged 8 months to 46 years old underwent orthodontics and clinical examination. RESULTS: Strabismus, upper and lower limb malformations, lip and palatal cleft were frequently associated with MS. Reduced TM movements were noted (48%). Cephalometric analysis did not allow identifying a typical facies and a characteristic cephalometric pattern; we have noticed a higher prevalence of Class II (56%) with micrognathia and excessive maxillary development probably due to the lack of lip seal. Early treatment is recommended, with a multidisciplinary approach to reduce the impact of sequelae on the lives of MS patients or their families. CONCLUSIONS: Early treatment is recommended, with a multidisciplinary approach to diminish the impact of sequelae on the lives of MS patients or their families.

Combined photographic and ultrasonographic measurement of the ANB angle: a pilot study.

OBJECTIVE: This study was performed to evaluate the feasibility of noninvasive measurement of the ANB angle using photographic and ultrasonographic methods. METHODS: Twenty consecutive orthodontic patients were evaluated. The ANB angle and soft tissue thickness covering the N, A, and B cephalometric points were measured by lateral teleradiography; these measurements were made by two expert operators. The soft tissue thickness covering the N, A, and B cephalometric points was measured by ultrasonography; these measurements were also made by two expert operators. On a 1:1 photographic profile print on which the ultrasonographic points were marked, the ANB ultrasonographic angle was measured. The following comparisons were considered: averaged and single measurements of N, A, and B points by first versus second ultrasonographer; averaged and single ultrasonographic versus radiographic soft tissue thickness covering the N, A, B points; and averaged and single ultrasonographic versus radiographic measurements of ANB angle. RESULTS: High correlation and concordance of the averaged and single measurements, but no significant difference, was found between the two ultrasonographers. No statistically significant difference was found between the two methods for measuring averaged soft tissue thickness, but a 20% difference was found for the single measurements. High correlation and concordance between the ultrasonographic and radiographic measurements, but no significant difference, was found between the single and averaged ANB angle measurements. CONCLUSION: Ultrasonography seems to be a noninvasive and reliable technique for measurement of the ANB angle and may replace radiographic measurement in some cases.

Dentoalveolar Effects of Early Orthodontic Treatment in Patients With Cleft Lip and Palate.

No agreement exists on the most appropriate timing of orthodontic treatment in patients with cleft lip and palate. The aim of this study is to investigate the effect of early orthodontic treatment on development of the dental arches and alveolar bone.A dental casts analysis was performed on 28 children with cleft lip and palate before orthodontic treatment (T0; mean age, 6.5 ±â€Š1.7) and at the end of active treatment (T1; mean age, 9.2 ±â€Š2.1 years). The considered variables were: intercanine and intermolar distances; dental arch relationships, evaluated according to the modified Huddart/Bodenham system.The study group was divided into 2 samples according to the age at T0: Group A (age < 6 years) and Group B (age ≥ 6 years). A statistical comparison of the treatment effects between the 2 samples was performed.Patients in Group A exhibited a greater increase of intercanine distance (8 mm versus 2.7 mm; P<0.001), intermolar distance (7.2 mm versus 5 mm; P = 0.06), and Huddart/Bodenham score (7.1 versus 3; P < 0.05) when compared with patients in Group B.Early orthodontic treatment strongly improved the dental arch relationship, since subjects starting the therapy before the age of 6 had a better response in terms of anterior maxillary expansion.

Asymmetric Expansion with a Modified Quad Helix for Treatment of Isolated Crossbite.

Unilateral posterior crossbite often involves only one tooth, especially upper first molar; in these cases it is never easy to obtain an asymmetrical movement of a molar and a proper planning of the orthodontic device with its anchorage is necessary to avoid arch overexpansion. Thanks to its simplicity and efficacy, the modified Quad Helix here described represents a valid therapeutic tool in cases of isolated posterior crossbite.

Functional Treatment of a Child with Extracapsular Mandibular Fracture.

Condylar fractures are among the most frequent fractures in the context of traumatic lesions of the face. The management of condylar fractures is still controversial, especially when fractures occur in children: if overlooked or inappropriately treated, these lesions may lead to severe sequelae, both cosmetic and functional. The therapy must be careful because severe long-term complications can occur. In this case report, the authors present a case of mandibular fracture in which the decision between surgical therapy and functional therapeutic regimen may be controversial due to the particular anatomy of the fracture line and the age of the patient.

Pre- and Postsurgical Orthodontics in Patients with Moebius Syndrome.

The authors report a combined orthodontic-surgical correction of an adult patient's malocclusion affected by Moebius Syndrome (MS). The treatment was conducted at the Dentistry Unit and the Maxillofacial Surgery Unit of the University Hospital of Parma. Treatment of malocclusion was performed after the correction of facial mimic mobility with smile surgery. The postoperative stability and orthodontic results were good and the correction of the morphological problems related to the syndrome was very satisfactory.

Early Orthopaedic Treatment of Hemifacial Microsomia.

The aim of this paper is to report treatment effects of functional therapy in a growing patient affected by hemifacial microsomia (HM). According to Kaban's classification, the patient was classified as grade IIa as she presented all mandibular and temporomandibular joint components and a normal shaped, hypoplastic mandible. The therapeutic approach included the use of an asymmetrical functional activator (AFA) to stimulate the growth of the affected side and consequently to improve symmetry of the mandible and maxillary deficiency. Further effects were the lengthening of the mandibular ramus, restoration of occlusion, and expansion of soft tissues.