Frontal fibrosing alopecia: survey of severity assessment methods in routine clinical practice and validation of the International Frontal Fibrosing Alopecia Cooperative Group measurement guidance.

BACKGROUND: The lack of validated and responsive outcome measures in the management of frontal fibrosing alopecia (FFA) significantly limits assessment of disease progression and treatment response over time. AIM: To understand how FFA extent and progression is currently assessed in UK specialist centres, to validate components of the International FFA Cooperative Group (IFFACG) statement on FFA assessment, and to identify pragmatic advice to improve FFA management in clinic. METHODS: Consultant dermatologists with a specialist interest in hair loss (n = 17) were invited to take part. Preferred FFA assessment methods were explored using questionnaires and clinical scenarios. Participants were asked to identify and mark the current hairline in 10 frontal and 10 temporal hairline images (Questionnaire 1), with assessment repeated 3 months later to assess intraindividual variability (Questionnaire 2) and 12 months later to test whether interindividual accuracy could be improved with simple instruction (Questionnaire 3). RESULTS: All 17 clinicians (100%) completed the questionnaire at each time interval. We identified a wide variation in assessment techniques used by our experts. Measurements were perceived as the most accurate method of assessing frontal recession whereas photography was preferred for temporal recession. Inter-rater reliability between clinicians measuring the frontal hairline scenarios indicated a moderate strength of agreement [intraclass coefficient (ICC) = 0.61; 95% CI 0.40-0.85], yet intrarater reliability was found to be poor with wide limits of agreement (-8.71 mm to 9.92 mm) on follow-up. Importantly, when clear guidance was provided on how the hairline should be identified (Questionnaire 3), inter-rater reliability improved significantly, with ICC = 0.70, suggesting moderate agreement (95% CI 0.51-0.89; P < 0.001). A similar pattern was seen with temporal hairline measurements, which again improved in accuracy with instruction. CONCLUSION: We found that accuracy of measurements in FFA can be improved with simple instruction and we have validated components of the IFFACG measurement recommendations.

Effects of orthodontic treatment on the growth of individuals with Class II division 1 malocclusion.

The purpose of this study was to determine the effects of orthodontic treatment on the growth potential and dentofacial characteristics of individuals with Class II, division 1 malocclusion over a 5-year period. The changes were compared to matched, untreated normal individuals. Lateral cephalograms were available on 91 treated Class II, division 1 cases. Of these, 44 individuals (21 males and 23 females) were treated with first premolar extractions and 47 (20 males and 27 females) were treated nonextraction. The Class II groups were compared to 35 normal individuals (20 males and 15 females) matched for age and sex. Pretreatment, the Class II individuals had larger overjet, deeper overbite, larger ANB angle, more retrusive mandible and a convex soft tissue profile. In addition, the upper and lower lips in males, and the lower lip in females were significantly more protrusive in the subjects that were eventually treated with the extraction of four first premolars. At the end of the 5-year observation period, there was an overall "normalization" of the skeletal relationships of the treated Class II subjects in both the extraction and the nonextraction groups when compared to normals. Treatment had a differential impact on the dental relationships as well as on lip prominence as a result of the extraction decision. At the end of the observation period, both males and females in the extraction group had more retrusive maxillary and mandibular incisors as well as more retrusive lips than the corresponding normals. In the nonextraction groups, there was a tendency for both the incisors and the lips to be relatively more protrusive.

A computer assisted photogrammetric analysis of soft tissue changes after orthodontic treatment. Part II: Results.

The purpose of this study was to use standardized facial photographs to compare the soft tissue profile changes in persons with Class II, Division 1 malocclusions who were treated with either an extraction or a nonextraction treatment modalities. Ninety-one patients (44 extraction and 47 nonextraction) were evaluated using standardized facial photographs, available at pretreatment, posttreatment and 2-years in retention. The photographs were digitized and displayed on a computer monitor. Thirty-eight landmarks (18 frontal and 20 lateral) were located. From these landmarks, 29 angular and linear dimensions (8 frontal and 21 lateral) were constructed. Descriptive and analytical statistics were used to compare the absolute dimensions, as well as the incremental changes, between the extraction and nonextraction groups. The present findings indicate: (1) After treatment the upper and lower lips were retracted significantly more in the extraction group compared with the nonextraction group. These differences persisted into retention. (2) The upper lip length increased more among subjects who were treated without extractions. (3) The upper vermilion height in male subjects and the upper and lower vermilion heights in female subjects increased among subjects who were treated without extractions and decreased among subjects who were treated with four first premolar extractions. (4) The nasolabial angle became significantly more obtuse among the female subjects who were treated with four first premolar extractions.

The morphologic basis for the extraction decision in Class II, division 1 malocclusions: a comparative study.

The purpose of this study was to compare the pretreatment dentofacial characteristics of persons with Class II, Division 1 malocclusions treated with either an extraction or a nonextraction approach. Such comparisons might help identify which parameters influence the extraction decision. Lateral cephalograms were available on 91 Class II, Division 1 cases, 44 were eventually treated with first premolar extractions and 47 were treated nonextraction. Twenty-four landmarks were located and digitized on each cephalogram. From these landmarks, 33 angular and linear dimensions were obtained. The Class II cases were also compared with normal subjects matched for age and sex. Comparisons between the Class II, Division 1 groups and normals indicated that, in general, the Class II, Division 1 malocclusion is associated with a larger overjet, deeper overbite, larger ANB angle, more retrusive mandible, and a convex soft tissue profile. Comparisons between subjects treated with and without extractions indicated that at pretreatment, the extraction groups had significantly larger tooth size-arch length discrepancies in both the maxillary and mandibular arches. In addition, the upper and lower lips in male subjects, and the lower lip in female subjects were significantly more protrusive in the subjects who were eventually treated with four first premolar extractions. These results indicate that in this group of patients, lip protrusion is one of the important parameters on which the extraction decision was based.

Treatment and posttreatment changes in patients with Class II, Division 1 malocclusion after extraction and nonextraction treatment.

The purpose of this study was to evaluate the treatment and posttreatment changes in the facial and dental parameters in two groups of patients with Class II, Division 1 malocclusions. In one group (n = 46), the patients were treated with a nonextraction approach, whereas in the second group (n = 45), the treatment included the extraction of four first premolars. The treatment groups were compared with matched untreated normals (n = 35) from the Iowa Growth Study. Lateral cephalograms and dental casts were evaluated at three stages: pretreatment, posttreatment, and approximately 2 years after treatment. Student's t tests were used to compare the extraction and nonextraction groups. Significance was predetermined at p < or = 0.05. The cephalometric findings indicate that before treatment, the subjects treated with four first premolar extractions had more protrusive upper and lower lips and a larger tooth size-arch length discrepancy. After treatment the upper and lower lips were more retrusive in the extraction groups, and more protrusive in the nonextraction groups. The extraction groups tended to have straighter faces and slightly more upright maxillary and mandibular incisors, whereas the nonextraction groups had the opposite tendencies. The average soft tissue and skeletal measurements for both groups were close to, but on opposite sides of, the corresponding averages derived from the Iowa normative standards. The findings from the dental arch measurements indicate that after treatment both the extraction and nonextraction groups experienced an increase in tooth size-arch length discrepancy and a reduction in arch length. In general, extractions did not significantly alter the direction of the overall posttreatment trends. Furthermore, the trends in the posttreatment changes were similar in male and female patients, as well as in the maxillary and mandibular arches. The current findings suggest that the extraction/nonextraction decision, if based on sound diagnostic criteria, does not have a systematic detrimental effect on the facial profile. But clinicians should be aware of the trends introduced by the two treatment modalities to avoid accentuating undesirable profile characteristics.

Dentofacial and soft tissue changes in Class II, division 1 cases treated with and without extractions.

The purpose of this study was to compare the changes in subjects with Class II division 1 malocclusions treated with and without the extraction of four first premolars. Lateral cephalograms on 91 patients (44 extraction and 47 nonextraction) were evaluated at three stages: pretreatment, posttreatment, and approximately 2 years after treatment. The present findings indicate that before treatment, the upper and lower lips were more protrusive relative to the esthetic plane among the subjects treated with four first premolar extractions. After treatment the upper and lower lips were more retrusive in the extraction group, and more protrusive in the nonextraction groups. The extraction group tended to have straighter faces and slightly more upright maxillary and mandibular incisors, whereas the nonextraction group had the opposite tendencies. The average soft tissue and skeletal measurements for both groups were close to the corresponding averages derived from the Iowa normative standards. In general, differences between the groups after treatment were preserved into retention. The present findings indicate that the extraction or nonextraction decision, if based on sound diagnostic criteria, seem to have no deleterious effects on the facial profile.

A computer assisted photogrammetric analysis of soft tissue changes after orthodontic treatment. Part I: Methodology and reliability.

The purpose of this study was to use standardized facial photographs to compare the soft tissue profile changes in persons with Class II, Division 1 malocclusions who were treated with either an extraction or a nonextraction treatment modality. Ninety-one patients (44 extraction and 47 nonextraction) were evaluated with standardized facial photographs, available at pretreatment, posttreatment, and 2 years in retention. The photographs were digitized and displayed on a computer monitor. Thirty-eight landmarks (18 frontal and 20 lateral) were located. From these landmarks, 29 angular and linear dimensions (8 frontal and 21 lateral) were constructed. Descriptive and analytical statistics were used to compare the absolute dimensions, as well as the incremental changes, between the extraction and nonextraction groups. The present findings indicate that (1) Photographs allow for measurement of structures from a profile, as well as frontal orientations. (2) Measurement of profile changes from facial photographs appear to be fairly reliable but also have significant limitations. (3) Certain landmarks tended to be less reliable than others, e.g., subnasale and gnathion. In general, measurements from frontal photographs were more reliable than those obtained from lateral photographs and linear measurements were more reliable than angular measurements. (4) Changes in head posture within the cephalostat have an impact on vertical facial dimensions measured from frontal photographs. Horizontal dimensions were effected to a lesser degree. (5) Facial structures that lie closer to the camera appeared to be relatively larger than structures located farther from the camera. (6) The overall process of evaluating facial changes from photographs is both technique and operator sensitive. (7) More research specifically testing the photogrammetric method in a clinical setting is needed.