Vertical Mandibular and Trunk Symmetry in Indonesian Orthodontic Patients

Abstract Objective: To analyze differences in vertical mandibular and trunk symmetry in orthodontic patients. Material and Methods: This was a cross-sectional study of 129 growing orthodontic patients who sought orthodontic treatment at the Dental Hospital Universitas Sumatera Utara, Indonesia. Mandibular symmetry index was observed with pre-treatment panoramic radiography based on Kjellberg's technique and trunk symmetry was evaluated based on questionnaires and visual observation. Vertical mandibular asymmetry was decided if the index of asymmetry was lower than 93.7%. The bivariate analysis used the chi-squared and Fisher's exact tests, with a significance level of 5%. Results: There was a significant association between vertical mandibular and trunk symmetry (p<0.05). The prevalence odds ratio for the association with vertical mandibular asymmetry was 3.007 (95% CI = 1.016-8.905) for trunk asymmetry. Conclusion: The necessity to consider trunk symmetry could be included in orthodontics treatment of any malocclusion with vertical mandibular asymmetry that might require a multidisciplinary approach in the future.

Three-dimensional evaluation of mandibular asymmetry: a new classification and three-dimensional cephalometric analysis.

Mandibular asymmetry is common among orthognathic patients and exhibits great variation. The aim of this study was to propose a new classification of mandibular asymmetry by anatomical regions; namely R (ramus), B (mandibular body) and C (chin), in conjunction with a corresponding 'RBC' three-dimensional (3D) cephalometric analysis. The cone beam computed tomography data of 65 patients with mandibular asymmetry was retrieved to perform the RBC 3D cephalometric analysis and to investigate the characteristics of mandibular asymmetry. It was found that the more posteriorly in mandible, the more pronounced was the vertical asymmetry. Significant transverse asymmetry was only noted in mandibular body. Both mandibular body and chin were significantly asymmetric in length. Seven significant morphologic predictors of menton deviation were identified, namely lower dental midline shift, difference in ramus height, difference in chin length, difference in body length, body height on contralateral side, coronoid height on deviated side and body width on contralateral side, confirming the complex nature of mandibular asymmetry. This simple and concise classification allows comprehensive assessment of mandible morphology by anatomical regions which also facilitates diagnosis, treatment planning and communication in both clinical and research settings.

Cleft Skeletal Asymmetry: Asymmetry Index, Classification and Application.

OBJECTIVE: To quantitatively measure the extent of 3D asymmetry of the facial skeleton in patients with unilateral cleft lip and palate (UCLP) using an asymmetry index (AI) approach, and to illustrate the applicability of the index in guiding and measuring treatment outcome. METHOD: Two groups of subjects between the ages of 15 and 20 who had archived CBCT scan were included in this study. Twenty-five patients with complete UCLP were compared with 50 age-matched noncleft subjects. The CBCT scans were segmented and landmarked for 3D anthropometric analysis. An AI was calculated as a quantitative measure of the extent of facial skeletal asymmetry. RESULTS: For the control group, the AI ranged from 0.72 ± 0.47 at A point to 4.77 ± 1.59 at Gonion. The degree of asymmetry increased with the increasing laterality of the landmark from the midsagittal plane. In the UCLP group, the values of AI significantly increased compared to the control group at nearly all measured landmarks. The extent of the asymmetry to involve the upper, middle, and lower facial skeleton varied widely with the individual patient with UCLP. CONCLUSION: The asymmetry index is capable of capturing the 3D facial asymmetry of subjects with UCLP and as a basis for classification of the extent of the asymmetry. We found the index to be applicable in surgical planning and in measuring the outcome in improving the symmetry in patients who have undergone orthognathic surgery.

Three-dimensional analysis of cranial base morphology in patients with hemifacial microsomia.

BACKGROUND: Many researchers have studied the relationship between facial asymmetry and cranial base morphology, but they have failed to reach a consensus. In this study, we aimed to verify whether the cranial base is involved in hemifacial microsomia (HFM). METHODS: We included 66 patients with HFM who were treated at the Plastic and Reconstructive Surgery Department of Shanghai Ninth People's Hospital from January 2013 to October 2016. The patients were divided into three groups according to Pruzansky and OMENS classifications, separately. The controls were 20 patients diagnosed with mandibular angle hypertrophy but with no facial asymmetry. Angular and linear measurements of the cranial base were obtained for all patients. RESULTS: The two classification methods yielded similar results. The intersection angle between two planes showed differences in the severe group. In the moderate and severe groups, the middle and posterior cranial angles were significantly different and the CIP and SP lengths were shorter in the affected side. Landmarks such as the carotid canal and internal acoustic canal could be considered as references. CONCLUSIONS: The cranial base is involved in hemifacial microsomia. This relationship supports the hypothesis of HFM pathogenesis and opens new avenues to classification methods.

ENPP1 and ESR1 genotypes associated with subclassifications of craniofacial asymmetry and severity of temporomandibular disorders.

INTRODUCTION: We investigated whether ACTN3, ENPP1, ESR1, PITX1, and PITX2 genes which contribute to sagittal and vertical malocclusions also contribute to facial asymmetries and temporomandibular disorders (TMD) before and after orthodontic and orthognathic surgery treatment. METHODS: One hundred seventy-four patients with a dentofacial deformity were diagnosed as symmetric or subdivided into 4 asymmetric groups according to posteroanterior cephalometric measurements. TMD examination diagnosis and jaw pain and function (JPF) questionnaires assessed the presence and severity of TMD. RESULTS: Fifty-two percent of the patients were symmetric, and 48% were asymmetric. The asymmetry classification demonstrated significant cephalometric differences between the symmetric and asymmetric groups, and across the 4 asymmetric subtypes: group 1, mandibular body asymmetry; group 2, ramus asymmetry; group 3, atypical asymmetry; and group 4, C-shaped asymmetry. ENPP1 SNP-rs6569759 was associated with group 1 (P = 0.004), and rs858339 was associated with group 3 (P = 0.002). ESR1 SNP-rs164321 was associated with group 4 (P = 0.019). These results were confirmed by principal component analysis that showed 3 principal components explaining almost 80% of the variations in the studied groups. Principal components 1 and 2 were associated with ESR1 SNP-rs3020318 (P <0.05). Diagnoses of disc displacement with reduction, masticatory muscle myalgia, and arthralgia were highly prevalent in the asymmetry groups, and all had strong statistical associations with ENPP1 rs858339. The average JPF scores for asymmetric subjects before surgery (JPF, 7) were significantly higher than for symmetric subjects (JPF, 2). Patients in group 3 had the highest preoperative JPF scores, and groups 2 and 3 were most likely to be cured of TMD 1 year after treatment. CONCLUSIONS: Posteroanterior cephalometrics can classify asymmetry into distinct groups and identify the probability of TMD and genotype associations. Orthodontic and orthognathic treatments of facial asymmetry are effective at eliminating TMD in most patients.

[Validation of the German Version of the Sunnybrook Facial Grading System]. / Validierung einer Deutschen Version des Sunnybrook Facial Grading Systems.

Background: The Sunnybrook facial grading system (SFGS) is frequently applied to evaluate facial function in patients with facial palsy, but still now there is no validated German version of this evaluation sheet. Methods: The original English version of the SFGS was translated and validated in accordance with international standards. The interrater reliability from 5 raters (speech therapy students) and the intrarater reliability from repeated ratings at 2 time points using video tapes of 18 patients with different types of facial palsy were analyzed by calculating the intraclass correlation coefficient (ICC) and other reliability measures. Results: ICC for the interrater reliability for the 4 components of the SFGS, resting symmetry, symmetry during voluntary movements, synkinesis, and the composite score were ICC 0.845; 0.903; 0.731 and 0.918, respectively, for the first evaluation and ICC 0.881; 0.932; 0.818 and 0.940, respectively, for the second evaluation. The mean intrarater reliability for the 4 SFGS scores was ICC=0.791; 0.906; 0.770 and 0.905. Discussion: There is now a valid German version of the SFGS available that can be used even by novices. The German version is suitable for evaluation of facial palsies in clinical routine and studies to allow a better comparability of German patients with results of the international literature.

Weighting of Facial Grading Variables to Disfigurement in Facial Palsy.

IMPORTANCE: A universal, health care professional-graded scale for facial assessment would be a useful tool for reporting, comparing, and assessing facial function among patients with facial paralysis. OBJECTIVES: To correlate scores of an assessment tool, the eFACE scale, with expert-rated facial disfigurement and to determine the relative contributions of facial features to facial palsy-related disfigurement. DESIGN, SETTING, AND PARTICIPANTS: The eFACE scale yields 15 individual variable scores, in addition to subscores for static, dynamic, and synkinesis elements, and a total score that is based on 100-point scales. Two hundred patients with varying degrees of unilateral facial palsy underwent independent eFACE assessment and assignment of a disfigurement score by 2 facial nerve surgeons. The mean scores were determined, and multivariate regression analysis was performed to fit eFACE subset scores (static, dynamic, and synkinesis) to disfigurement ratings. A hybrid regression model was then used to weight each of the 15 eFACE variables, using stepwise regression to control for the effect of the other variables. Scoring was performed during an 8-week period from March 16 to May 8, 2015. MAIN OUTCOME AND MEASURE: Use of the 100-point eFACE variables, together with a 100-point visual analog scale of disfigurement, with 0 representing the most extreme disfigurement possible from a facial nerve disorder and 100 representing no discernible facial disfigurement. RESULTS: In the 200 patients included in analysis (126 [63.0% female]; mean [SD] age, 46.5 [16.4] years]), predicted disfigurement scores based on eFACE subset scores demonstrated excellent agreement with surgeon-graded disfigurement severity (r2 = 0.79). Variable weighting demonstrated that the 6 key contributors to overall disfigurement were (in order of importance) nasolabial fold depth at rest (normalized coefficient [NC], 0.18; P < .001), oral commissure position at rest (NC, 0.15; P < .001), lower lip asymmetry while pronouncing the long /e/ (NC, 0.09; P < .001), palpebral fissure width at rest (NC, 0.09; P < .001), nasolabial fold orientation with smiling (NC, 0.08; P = .001), and palpebral fissure width during attempts at full eye closure (NC, 0.06; P = .03). CONCLUSIONS AND RELEVANCE: A mathematical association between eFACE-measured facial features and overall expert-graded disfigurement in facial paralysis has been established. For those using the eFACE grading scale, predictions of the specific effects of various interventions on expert-rated disfigurement are now possible and may guide therapy. LEVEL OF EVIDENCE: NA.

Frequency and Characteristics of Facial Asymmetry in Patients With Deviated Noses.

IMPORTANCE: Facial asymmetry is frequently detected in patients who are seeking rhinoplasty for a deviated nose, and its presence often leads to failure to create a straight-looking nose. OBJECTIVE: To analyze the frequency and characteristics of facial asymmetry in patients with a deviated nose and to identify representative parameters to describe types and severity of facial asymmetry. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of at a tertiary referral center of preoperative photographs of 152 patients who underwent rhinoplasty for a deviated nose between January 2008 and December 2012. The incidence of facial asymmetry in these patients was compared with the incidence in 60 control patients undergoing septoplasty without external nose deviation. INTERVENTIONS: Using frontal photographs, the presence of facial asymmetry and the types of deviated nose were noted and measured by 2 observers. MAIN OUTCOMES AND MEASURES: Facial asymmetry was categorized into 4 types depending on which subunit of the face was affected, and deviated nose shapes were classified into 5 types. Anthropometric measurements were also performed. RESULTS: Facial asymmetry was more common in patients with a deviated nose (84 of 152 [55%]) than in controls (19 of 60 [32%]) (P = .04). Mixed-type facial asymmetry was the most common type in the patient group. Among the anthropometric measurement parameters, the distance between the midpoint of the interpupil line to the most prominent malar point, lateral canthal angle, lateral alar angle, lip margin angle, and tilted chin angle were significantly different between the patient group and the control group (P < .05 for all comparisons). There was no difference in the incidence of asymmetry with respect to deviation type. CONCLUSIONS AND RELEVANCE: Facial asymmetry was more common in patients with a deviated nose than in control patients, and mixed-type facial asymmetry was the asymmetry most often associated with deviated nose. This study suggests that deviated nose may be a developmental defect caused by a discrepancy in the growth of facial bony skeleton between the 2 sides of the face. The objective anthropometric measurements developed in this study could be useful for making appropriate preoperative facial assessments. LEVEL OF EVIDENCE: NA.

Measured symmetry of facial 3D shape and perceived facial symmetry and attractiveness before and after orthognathic surgery.

One aim of cranio-maxillo-facial surgery is to strive for an esthetical appearance. Do facial symmetry and attractiveness correlate? How are they affected by surgery? Within this study faces of patients with orthognathic surgery were captured and analyzed regarding their symmetry. A total of 25 faces of patients were measured three-dimensionally by an optical sensor using the fringe projection technique before and after orthognathic surgery. Based upon this data an asymmetry index was calculated for each case. In order to gather subjective ratings each face was presented to 100 independent test subjects in a 3D rotation sequence. Those were asked to rate the symmetry and the attractiveness of the faces. It was analyzed to what extend the ratings correlate with the measured asymmetry indices and whether pre- and post-surgical data differ. The measured asymmetry indices correlate significantly with the subjective ratings of both items. The measured symmetry as well as the rated symmetry and attractiveness increased on average after surgery. The increase of the ratings was even statistically significant. A larger enhancement of symmetry is achieved in pre-surgical strongly asymmetric faces than in rather symmetric faces.

Análisis de la Simetría Transversal del Maxilar Anterior en Niños con Fisura Labiopalatina Operada / Transverse Symmetry Analysis of Anterior Maxilla in Children with Operated Unilateral Cleft Lip and Palate

El objetivo de este trabajo fue comparar la simetría transversal del maxilar desde los caninos hacia anterior, contrastando el lado fisurado con el lado no fisurado respecto a la línea mediana. Se diseño un estudio retrospectivo, comparativo de tipo cuantitativo, con doble enmascaramiento. Se analizaron 60 modelos de estudio dental de niños en dentición mixta con labio leporino unilateral y fisura velopalatina, operados, pertenecientes al IRMADEMA y al Hospital Luis Calvo Mackenna. Se determinó la longitud transversal anterior del maxilar a nivel de caninos. Luego se determino la longitud anterior del maxilar a nivel de la línea media, la cual se dividió en tercios. Se determinó la longitud transversal de cada lado, desde estos puntos hasta el punto medio del reborde alveolar. Existe una diferencia significativa entre la longitud transversal del lado fisurado y el lado no fisurado en relación a la línea mediana, siendo este último mayor en los tres niveles de medición. No se observó diferencia por sexo (p>0,05) La zona anterior del maxilar se presenta en forma asimétrica en el sentido transversal, en pacientes con labio leporino unilateral y fisura velopalatina operada. La diferencia es mayor a nivel de caninos y tiende a un aplanamiento del lado fisurado. Se sugiere un estudio longitudinal que muestre la evolución en el tiempo de dicha asimetría.

The objective of this study was to compare the transversal symmetry of the upper maxilla starting from the canine towards the anterior contrasting the cleft side and the non-cleft side with respect to the centerline. A retrospective and comparative study of the quantitative type. Sixty study models of children were analyzed with mixed dentition with unilateral cleft lip and operated velum cleft, these patients were from the Craniofacial Malformation Unit and the Luis Calvo Mackenna Hospital. The anterior transversal length of the maxilla wasdetermined at the canine level, then the anterior length of the maxilla at the level of the center line was determined, which was split into thirds. The transversal length of each side was determined from these points to the center point of the alveolar ridge. There is a significant stastistical difference between the transversal length of the cleft and non cleft side with regards to the center line, with the latter being greater on all three measuring levels. No difference was shown regarding sex (P>0.05). On patients with unilateral cleft lip and operated cleft palate, the anterior zone of the upper maxilla shows an asymmetry in the transversal direction. The difference is greater at the canine level and tends to flatten out on the cleft side. A longitudinal study is suggested that this would show an evolution of such asymmetry in a time period.

Regional facial asymmetries in unilateral orofacial clefts.

OBJECTIVES: Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus, and palate (UCLP), and to evaluate which area of the face is most asymmetrical. METHODS: Standardized three-dimensional facial images of 58 patients (9 UCL, 21 UCLA, and 28 UCLP; age range: 8.6-12.3 years) and 121 controls (age range 9-12 years) were mirrored and distance maps were created. Absolute mean asymmetry values were calculated for the whole face, cheek, nose, lips, and chin. One-way analysis of variance, Kruskal-Wallis, and t-test were used to assess the differences between clefts and controls for the whole face and separate areas. RESULTS: Clefts and controls differ significantly for the whole face as well as in all areas. Asymmetry is distributed differently over the face for all groups. In UCLA, the nose was significantly more asymmetric compared with chin and cheek (P = 0.038 and 0.024, respectively). For UCL, significant differences in asymmetry between nose and chin and chin and cheek were present (P = 0.038 and 0.046, respectively). In the control group, the chin was the most asymmetric area compared to lip and nose (P = 0.002 and P = 0.001, respectively) followed by the nose (P = 0.004). In UCLP, the nose, followed by the lips, was the most asymmetric area compared to chin, cheek (P < 0.001 and P = 0.016, respectively). LIMITATIONS: Despite division into regional areas, the method may still exclude or underrate smaller local areas in the face, which are better visualized in a facial colour coded distance map than quantified by distance numbers. The UCL subsample is small. CONCLUSION: Each type of cleft has its own distinct asymmetry pattern. Children with unilateral clefts show more facial asymmetry than children without clefts.

Evaluation of intra-articular distance narrowing during temporomandibular joint movement in patients with facial asymmetry using 3-dimensional computed tomography image and tracking camera system.

INTRODUCTION: Functional overloading can lead to disc displacement in the temporomandibular joint (TMJ), and a high incidence of disc displacement has been reported in patients with facial asymmetry. The aim of this study was to assess the dynamic condylar movement in patients (n = 26) with facial asymmetry using a simulation system with 3-dimensional computed tomographic images and tracking camera system. MATERIAL AND METHODS: The intra-articular distance (IAD) between the condyle and glenoid fossa was recorded during TMJ movement as a parameter for functional overloading and compared between Group I with severe asymmetry and Group II with mild asymmetry. RESULTS: The average IAD was shorter in Group I than Group II, especially at the lowest point (P < 0.05). The ratio of IAD narrowing in Group I was significantly larger than in Group II (P < 0.05). The mean IAD were slightly smaller on the deviated side (3.41 mm) than on the nondeviated side (3.55 mm) in Group I, even though there was no statistical significance. The maximum displacement in Group I was longer than in Group II and had no significant difference between deviated side and nondeviated side. CONCLUSION: We suggested that the reduced IAD resulting from TMJ overloading can lead to internal derangement in severe facial asymmetry.

Is mandibular asymmetry more frequent and severe with unilateral disc displacement?

PURPOSE: To investigate the prevalence of mandibular asymmetry (MA) within the symptomatic unilateral anterior disc displacement (ADD) patients, and analyze the influence TMJ factors of the MA severity. METHODS: Patients aged under 20 years old with symptomatic unilateral ADD and asymptomatic volunteers with normal disc-condyle relationship diagnosed by magnetic resonance imaging (MRI) were included in this study. Posteroanterior cephalometric radiographs were taken to measure MA. Condylar height, disc length and disc displacement were measured by MRI. The prevalence and severity of MA were compared between the ADD and the control groups. The correlation between the severity of MA with the amount of condylar height shortage, disc deformity and distance of disc displacement were also evaluated within the ADD group. RESULTS: There were 165 cases in the unilateral ADD group, and 156 cases in the control group. One hundred and nineteen cases had MA which accounted 72.12% (119/165) in the ADD group; while in the control group, only 25.64% (40/156) exhibited MA. The mean horizontal menton deviation and condylar height shortage in the unilateral ADD group were significantly larger than that in the control group (5.62 mm vs. 4.19 mm; 3.14 mm vs. 1.32 mm, p < 0.01). The severity of MA was significantly correlated with the amount of disc displacement, disc deformity and condylar height shortage (correlation coefficient: 0.80, 0.70, and 0.82). CONCLUSION: MA is much more common and severe in young unilateral ADD patients. The severity of MA is correlated with the height of condyle and the status of the disc.

Quantifying facial paralysis using the Kinect v2.

Assessment of facial paralysis (FP) and quantitative grading of facial asymmetry are essential in order to quantify the extent of the condition as well as to follow its improvement or progression. As such, there is a need for an accurate quantitative grading system that is easy to use, inexpensive and has minimal inter-observer variability. A comprehensive automated system to quantify and grade FP is the main objective of this work. An initial prototype has been presented by the authors. The present research aims to enhance the accuracy and robustness of one of this system's modules: the resting symmetry module. This is achieved by including several modifications to the computation method of the symmetry index (SI) for the eyebrows, eyes and mouth. These modifications are the gamma correction technique, the area of the eyes, and the slope of the mouth. The system was tested on normal subjects and showed promising results. The mean SI of the eyebrows decreased slightly from 98.42% to 98.04% using the modified method while the mean SI for the eyes and mouth increased from 96.93% to 99.63% and from 95.6% to 98.11% respectively while using the modified method. The system is easy to use, inexpensive, automated and fast, has no inter-observer variability and is thus well suited for clinical use.

Lateral cephalometric diagnosis of asymmetry in Angle Class II subdivision compared to Class I and II.

INTRODUCTION: Lateral cephalometric radiographs are traditionally required for orthodontic treatment, yet rarely used to assess asymmetries. OBJECTIVE: The objective of the present study was to use lateral cephalometric radiographs to identify existing skeletal and dentoalveolar morphological alterations in Class II subdivision and to compare them with the existing morphology in Class I and II relationship. MATERIAL AND METHODS: Ninety initial lateral cephalometric radiographs of male and female Brazilian children aged between 12 to 15 years old were randomly and proportionally divided into three groups: Group 1 (Class I), Group 2 (Class II) and Group 3 (Class II subdivision). Analysis of lateral cephalometric radiographs included angular measurements, horizontal linear measurements and two indexes of asymmetry that were prepared for this study. RESULTS: In accordance with an Index of Dental Asymmetry (IDA), greater mandibular dental asymmetry was identified in Group 3. An Index of Mandibular Asymmetry (IMA) revealed less skeletal and dental mandibular asymmetry in Group 2, greater skeletal mandibular asymmetry in Group 1, and greater mandibular dental asymmetry in Group 3. CONCLUSION: Both IDA and IMA revealed greater mandibular dental asymmetry for Group 3 in comparison to Groups 1 and 2. These results are in accordance with those found by other diagnostic methods, showing that lateral cephalometric radiography is an acceptable method to identify existing skeletal and dentoalveolar morphological alterations in malocclusions.

Lateral cephalometric diagnosis of asymmetry in Angle Class II subdivision compared to Class I and II

INTRODUCTION: Lateral cephalometric radiographs are traditionally required for orthodontic treatment, yet rarely used to assess asymmetries. OBJECTIVE: The objective of the present study was to use lateral cephalometric radiographs to identify existing skeletal and dentoalveolar morphological alterations in Class II subdivision and to compare them with the existing morphology in Class I and II relationship. MATERIAL AND METHODS: Ninety initial lateral cephalometric radiographs of male and female Brazilian children aged between 12 to 15 years old were randomly and proportionally divided into three groups: Group 1 (Class I), Group 2 (Class II) and Group 3 (Class II subdivision). Analysis of lateral cephalometric radiographs included angular measurements, horizontal linear measurements and two indexes of asymmetry that were prepared for this study. RESULTS: In accordance with an Index of Dental Asymmetry (IDA), greater mandibular dental asymmetry was identified in Group 3. An Index of Mandibular Asymmetry (IMA) revealed less skeletal and dental mandibular asymmetry in Group 2, greater skeletal mandibular asymmetry in Group 1, and greater mandibular dental asymmetry in Group 3. CONCLUSION: Both IDA and IMA revealed greater mandibular dental asymmetry for Group 3 in comparison to Groups 1 and 2. These results are in accordance with those found by other diagnostic methods, showing that lateral cephalometric radiography is an acceptable method to identify existing skeletal and dentoalveolar morphological alterations in malocclusions. .

INTRODUÇÃO: as telerradiografias laterais são tradicionalmente solicitadas para planejamento ortodôntico, mas raramente utilizadas para avaliar assimetrias. OBJETIVO: o objetivo do presente estudo foi utilizar as telerradiografias laterais para identificar as alterações morfológicas esqueléticas e dentoalveolares existentes na má oclusão de Classe II subdivisão e compará-las com a morfologia existente nas más oclusões de Classe I e II. MÉTODOS: noventa telerradiografias laterais iniciais de adolescentes brasileiros de ambos os sexos, com idade cronológica entre 12 e 15 anos, foram divididas em três grupos randomizados e proporcionais: Grupo 1 (Classe I), Grupo 2 (Classe II) e Grupo 3 (Classe II subdivisão). A análise das telerradiografias laterais envolveu mensurações angulares, mensurações lineares horizontais e dois índices de assimetria, estipulados para o presente estudo. RESULTADOS: foi identificada, de acordo com o Índice de assimetria dentária (IAD), uma maior assimetria dentária inferior no Grupo 3. O Índice de assimetria mandibular (IAM) revelou menor assimetria esquelética e dentária no Grupo 2, maior assimetria esquelética no Grupo 1 e maior assimetria dentária inferior no Grupo 3. CONCLUSÃO: o IAD e o IAM mostraram maior assimetria dentária inferior no Grupo 3 do que nos Grupos 1 e 2. Esses resultados estão de acordo com os encontrados em outros métodos de diagnóstico, indicando que a telerradiografia lateral é um método aceitável para avaliar alterações morfológicas esqueléticas e dentoalveolares nas más oclusões. .

Maxillary involvement in hemifacial microsomia: an objective three-dimensional analysis of the craniofacial skeleton.

The aim of our study is to better understand the maxillary involvement in relation to the mandibular deformation in hemifacial microsomia (HFM). To do so, consecutive patients with HFM treated at The Children's Hospital of Philadelphia from 2000 to 2012 were included in our study. Both two-dimensional and three-dimensional analyses of the bony and sinus structures of the midface and mandible were performed using three-dimensional segmentation software. Patients were stratified into groups based on the Kaban-Pruzansky classification--mild (0-1), moderate (2A), and severe (2B-3)--as well as rank ordering based on overall severity. Analyses involved paired t-tests within severity groups, 1-way analysis of variance when assessing across groups (ipsilateral/contralateral ratio), and regression to assess for trends. Thirty patients were included (4 mild, 12 moderate, and 14 severe). The mandibular volume ratio differed across all patient groups (P < 0.001) and trended with rank order (P < 0.001). No significant difference in maxillary bony volume ratio was found across all patient groups (P = 0.16). In patients with severe disease, the maxillary bone volume was found to be significantly decreased on the ipsilateral side as compared with the contralateral side (P = 0.0123). There was no difference in maxillary sinus volume between ipsilateral and contralateral sides within any patient groups or in comparing across groups (P = 0.10). No significant trend was found in the volume ratio of mandible and maxilla (P = 0.41). To conclude, the maxillary sinus seems to show no difference in volume when comparing between laterality and severity groupings. These findings suggest that there may be alternative influences other than the vascular insult acting as the driving force behind the mandibular deformity and the additional classic clinical findings of HFM.

An index of orthognathic functional treatment need (IOFTN).

OBJECTIVE: To design a new index categorizing the functional need for orthognathic treatment. DESIGN: Laboratory-based study. SETTING: Records were obtained from two UK hospital-based orthodontic departments. PARTICIPANTS: A panel of four consultant orthodontists, experienced in providing orthognathic care, devised a new index of Orthognathic Functional Treatment Need (IOFTN) with the aid of the membership of the British Orthodontic Society Consultant Orthodontists Group (COG). Twenty-three consultants and post-CCST level specialists took part in the study as raters to test the validity and reliability of the new index. METHODS: A total of 163 start study models of patients who had previously undergone orthognathic treatment were assessed by the panel of four consultant orthodontists using the new index (IOFTN) and the agreed category was set as the 'gold standard'. Twenty-one consultants and post-CCST level specialists then scored the models on one occasion and two scored 50 sets of models twice to determine the test-re-test reliability. RESULTS: Kappa scores for inter-rater agreement with the expert panel for the major categories (1-5) demonstrated good to very good agreement (kappa: 0·64-0·89) for all raters. The percentage agreement ranged from 68·1 to 92% in all cases. Intra-rater agreement for the major categories was moderate to good (kappa: 0·53-0·80). CONCLUSIONS: A new index, the IOFTN, has been developed to help in the prioritization of severe malocclusions not amenable to orthodontic treatment alone. It demonstrates good content validity and good inter-rater and moderate to good intra-rater reliability. As a result of being an evolution of the IOTN, the familiar format should make it easy to determine functional treatment need within daily orthognathic practice.

Classification and treatment of Class II subdivision malocclusions.

INTRODUCTION: Patients with Class II subdivision malocclusions are a challenge for clinicians because reestablishing symmetry in 1 arch or both arches is often a treatment goal. In patients with mandibular skeletal asymmetry, surgery is often a treatment option. However, patients may be unwilling to undergo surgery, and other options might have to be considered. The aim of this study was to evaluate the etiologies and outcomes of Class II subdivision patients treated at the University of Washington graduate orthodontic clinic in Seattle from 1995 through 2011. METHODS: A search of patients treated between 1995 and 2011 resulted in the identification of 110 consecutively treated Class II subdivision subjects with complete records. Ninety-eight subjects could be classified into 1 of 3 groups, based on midline position and dental or skeletal etiology. Initial and final models were used to measure the peer assessment rating scores, midlines, overjet, overbite, and molar positions. Initial and final cephalograms were traced and measured. Charts were reviewed for information regarding treatment. RESULTS: Twenty-five percent of the 98 subjects had their maxillary and mandibular midlines coincident with the facial midline; their asymmetries were due to a maxillary posterior dental asymmetry. Another 15% had maxillary midlines deviated from their facial midlines, caused by maxillary anterior and posterior dental asymmetry. About 50% of the subjects had mandibular midlines that were not coincident with their facial midlines, and most of them exhibited some degree of mandibular skeletal asymmetry. Over the past 15 years, treatment strategies used at the University of Washington indicated trends toward less surgery, fewer extractions, less use of headgear, and more reliance on fixed functional appliances. Ideal correction of midlines was not always achieved, especially in patients with mandibular skeletal asymmetry, with undercorrection occurring more commonly than overcorrection. Final peer assessment rating scores were comparable, regardless of the origin of the asymmetry or the extractions status. Mandibular incisor proclination was increased when fixed functional appliances were used, as well as when a Class I molar relationship was the target for the Class II side. CONCLUSIONS: Class II subdivision malocclusions were grouped into 3 main categories; the largest category was mandibular asymmetry. Interesting trends were noted with regard to treatment strategies, midline and molar corrections, and mandibular incisor proclination.