Post-orthodontic cephalometric variations in bimaxillary protrusion cases managed by premolar extraction - A retrospective study.

BACKGROUND: Bimaxillary protrusion is a common dentofacial condition associated with proclination of maxillary and mandibular incisors in relation to the dental and cranial bases resulting in soft tissue procumbency. The present retrospective study aimed to investigate dental and soft tissue profile changes using cephalometric analysis to evaluate bimaxillary protrusion patients after extraction of the first four premolars and subsequent retraction of the anterior teeth. MATERIALS AND METHODS: Pre-treatment and post-treatment cephalometric radiographs of 46 Saudi patients (16 males and 30 females), 18-30 years of age with bimaxillary protrusion, were selected based on inclusion criteria. Dental and soft tissue landmarks were traced using the Dolphin® imaging software and statistically analyzed with SPSS® 21 software. RESULTS: The upper and lower incisors retroclined by a mean value of 9.6° and 9.65°, respectively, and an average distance of 4.1 mm. The level of maxillary incisor exposure was reduced by approximately 1.1 mm after treatment. A mean increase of 6.6° in the nasolabial angle was also observed. Multiple regression analysis showed that retraction of both upper and lower incisors by 1 mm would result in a 0.44 mm retraction of the upper and lower lips. CONCLUSION: A statistically significant increase in the nasolabial angle and upper lip length was found in relation to upper and lower incisor retraction and retroclination. A significant reduction was also evident in the post treatment upper incisor exposure, facial convexity angle and mentolabial sulcus depth.

Prevalence of caries and malocclusion in an indigenous population in Chiapas, Mexico.

OBJECTIVES: To assess the prevalence of caries and malocclusion in Mayan Mexican adolescents, 14-20 years of age, living in Chiapas, Mexico. METHODS: This was a cross-sectional, population-based, quantitative, epidemiological study. Sites were chosen to capture subjects representative of the state's Mayan population. A total of 354 subjects were recruited. Caries experience was quantified, via visual inspection, using the Decayed, Missing and Filled Surface (DMFS) index. Malocclusion was quantified using the Index of Complexity, Outcome and Need (ICON). RESULTS: Our data showed that 99% of the population had caries experience, with a median DMFS score of 8. Of the 99% with caries experience, over half had caries affecting more than five tooth surfaces. Thirty-seven per cent of the students had unmet orthodontic treatment need, and 46.46% presented a Class II, and 39.09% a Class III, anterior-posterior relationship. CONCLUSIONS: Less than 1% of the population had any exposure to orthodontics, demonstrating the lack of access to care. Likewise, only 1% of the population was found to have no caries experience, exhibiting a large unmet treatment need. The median DMFS score of 8 was also high in comparison with the median DMFS in the USA of 6. Our data suggest a correlation between the lack of access to care and high prevalence of caries and malocclusion in Mexican Mayans who inhabit Chiapas, Mexico.

The psychosocial impact of dental aesthetics questionnaire--translation and cross-cultural validation in Croatia.

PURPOSE: To perform a translation and validation of the psychosocial impact of dental aesthetics questionnaire (PIDAQ) in the Croatian cultural context. METHODS: A total of 262 subjects (34 % males) aged 18-30 years (mean age 22.7 ± 2.6) were included. The questionnaire included the PIDAQ, a self-assessment of satisfaction with dental aesthetics, a self-perceived dental treatment need assessment, self-reported malocclusion, an aesthetic component of index of orthodontic treatment need (IOTN AC) and an oral health impact profile (OHIP-14 CRO). The subjects' orthodontic treatment needs were assessed by a dentist using the dental health and aesthetic component of the IOTN. The internal consistency, test-retest reliability, validity and responsiveness were assessed. Little's Irregularity index was used to correlate the amount of resolution of dental crowding by orthodontic treatment with the change in PIDAQ domains. RESULTS: The domains of the Croatian version of the PIDAQ showed satisfactory internal consistency (α ranging from 0.79 to 0.95) and high test-retest reliability (r > 0.85). The significant association between the PIDAQ domains and self-reported satisfaction with teeth appearance, IOTN AC and OHIP-14 CRO (p < 0.001) confirmed the convergent validity. The domains were able to detect differences in the subjects' psychosocial impact related to orthodontic treatment that improved dental aesthetics in responsiveness testing (p < 0.001). CONCLUSION: The Croatian version of the PIDAQ demonstrated good psychometric properties, similar to those of the original.

Influence of third molar space on angulation and dental arch crowding.

The influence of the third molars on mandibular incisor crowding has been extensively studied but remains controversial. The purpose of this study was to ascertain whether, in Mongolian subjects, the lower third molar can affect anterior crowding and/or the inclination of teeth in the lower lateral segments. Panoramic radiographs, 45° oblique cephalograms, and dental casts were taken from Mongolian subjects (age range 18.3-24.1 years, mean 21.0 years) exhibiting impaction of all four third molars and an Angle Class I molar relationship. The Ganss ratio was calculated using panoramic radiographs, whereas the gonial angle and angulation of lower canines, premolars and molars were measured using 45° oblique cephalograms. Little's index of irregularity was calculated using dental casts. Significant relationships between the angulation of the third and second molars and between the first molars and second premolars were found. Conversely, there was no significant correlation between the angulation of third molars, first premolars and canines. The Ganss ratio calculations showed that the lower first and second molars and the second premolars inclined mesially if there was insufficient space for the lower third molars. However, there was no significant correlation between Little's index of irregularity and third molar angulation. Furthermore, although the third molar influences the lateral segments, no obvious relationship between the third molar and anterior crowding was observed. Therefore, the angulation of the third molar appears not to cause anterior crowding.

Impact of malocclusion on quality of life among New Zealand adolescents.

OBJECTIVES: To determine whether malocclusion is associated with oral-health-related quality of life (OHRQoL) in New Zealand adolescents. METHODS: Data from two cross-sectional epidemiological studies of adolescents in Taranaki and Otago were used. Each participant completed a self-administered questionnaire and underwent a clinical examination. Information collected included sociodemographic characteristics (sex, ethnicity and household deprivation), and clinical measures (caries and malocclusion, the latter measured with the Dental Aesthetic Index, or DAI). OHRQoL was measured using the validated 16-item impact short-form Child Perceptions Questionnaire (CPQ11-14). Linear regression was used to model the CPQ11-14 score. RESULTS: 783 adolescents (52.6% male) took part. One-fifth had a handicapping malocclusion and one-third had a minor malocclusion or none. The overall mean DMFS was 2.3 (SD, 3.8), with slightly more than 50% being caries-free. With the exception of the oral symptoms domain, females presented with higher mean CPQ11-14 and domain scores, while Mãori had lower scores. There was a distinct gradient in mean CPQ11-14 and domain scores across the categories of malocclusion severity, whereby those in the 'handicapping' category of the DAI had the highest CPQ11-14 score. Linear regression modeling of the CPQ11-14 score showed that, after controlling for DMFS and socio-demographic characteristics, malocclusion category and being female were positively associated with higher CPQ11-14 scores. CONCLUSION: A severe malocclusion appears to have a negative impact on the OHRQoL of New Zealand adolescents.

An assessment of interocclusal space in a dentate Nigerian population.

AIMS AND OBJECTIVES: To determine the average interocclusal space values in a dentate Nigerian population,and to examine the effect of gender, age and different molar relationships on the values obtained. SUBJECTS AND METHODS: Three hundred and fifty one subjects mainly of Yoruba extraction with ages ranging from 16 to 78 years were involved in the study. They included 165 males and 186 females. Inclusion criteria in the study included the presence of a stable posterior occlusion with all first molars present and the absence of moderate to deep wear facets suggestive of parafunction. Subject's occlusal dimensions were measured with a calliper at rest and in occlusion. Interocclusal distances were determined by subtracting the occlusal vertical dimension from the rest vertical dimension. The Angles molar relationship was then recorded for each subject. RESULTS: The average freeway space was 2.93 mm with a standard deviation of 1.38; with the females having marginally higher values. The mean values according to age groups were 15-25 years: 3.15 mm, 26-35 years: 2.68 mm, 36-45 years: 2.66 mm, 46-55 years: 3.2 2mm, 56-65 years: 2.74 mm and 66 years and over: 3.10mm.Class Imolar relationship predominated in the sample with 312 patients (88.9%).Nineteen patients (5.4%) had Class II and 20 patients (5.7%) had Class III.Mean freeway space values for Class I, Class II and Class III were: 2.84 mm, 3.88 mm and 3.37 mm respectively. The difference in values was statistically significant. CONCLUSION: The average interocclusal space amongst the population assessed was 2.93 mm; a value which is similar to that previously reported for Nigerians. Marginally higher values were observed in females while the 26-35 and 36-45 year old groups had lower values than the other age groups. Angle's Class II and III subjects had higher values when compared to class I subjects and was statistically significant. A multi-centre study is recommended to assess possible ethnic variations in these values.

Degenerative changes of the temporomandibular joint. Relationship to ethnicity, sex and occlusal supporting zones based on a skull material.

OBJECTIVE: The first aim of this study was to examine a contemporary human skull material for possible ethnic differences in respect of degenerative changes in the temporomandibular joints (TMJs). A second aim was to see if there was any correlation between such changes and occlusal support in any of the two groups and, if so, if this correlation was sex-related. MATERIALS AND METHODS: The material consisted of 129 Caucasian skulls and 76 skulls from Afro-Americans. Ninety-four of the Caucasian skulls came from males (73%) and the corresponding figure for the Afro-Americans was 40 (53%). Their mean age at death was 46 years (range: 19-89 years) and 37 years (range: 18-70 years), respectively. RESULTS: Dental status was in general poor and 13% of the Afro-Americans and 26% of the Caucasians were edentulous. Form and surface changes of the TMJs were more common in the present material compared to most previous studies. No differences could be found between the two ethnic groups in respect of degenerative joint changes in the TMJs. In men, no correlation of clinical relevance could be found between severity of joint changes and occlusal support. However, in both Caucasian and Afro-American women, such a correlation was obvious, especially in higher age. CONCLUSIONS: The present findings give no evidence for any differences in the prevalence of degenerative changes in the TMJs in Caucasians and Afro-Americans. The strong correlation found between such changes and occlusal support in women but not in men might be explained by hormonal differences.

Intermaxillary tooth-size discrepancies in different sexes, malocclusion groups, and ethnicities.

INTRODUCTION: To achieve proper occlusion, practitioners must consider tooth-size discrepancies between the jaws. Previous studies have shown considerable differences in tooth sizes between sexes, ethnicities, and malocclusion categories. The aim of this study was to compare mean tooth-size statistics between these groups, specifically determining a maxillary or a mandibular excess tooth-size discrepancy in clinically relevant cases. METHODS: This study involved 306 subjects of varying sex, ethnicity, and malocclusion category, randomly chosen from the treatment population of the orthodontic clinic at the New Jersey Dental School, University of Medicine and Dentistry of New Jersey. The prevalence of discrepancies (±1 and 2 SD) between all groups and within groups was measured. RESULTS: Fifty percent of the subjects had anterior Bolton tooth-size discrepancies, and 41% had overall Bolton tooth-size discrepancies of ±1 SD. Tooth-size ratios compared with analysis of variance (ANOVA) showed no significant correlation between and among the sexes, ethnicities, and malocclusion groups. Compared with Caucasian and Hispanic patients, African-American patients had significantly greater odds of having a clinically significant (±2 SD) anterior ratio. When we compared the numbers of subjects above or below the clinically significant ratio, there was equal distribution of maxillary and mandibular excess in Class II and Class III patients. Caucasian and African-American patients had equal distributions of maxillary and mandibular excess, whereas Hispanic patients displayed a higher bias toward mandibular excess. CONCLUSIONS: Tooth-size discrepancies are common in orthodontic populations and are evenly distributed among sex, ethnicity, and malocclusion category, with some exceptions.

Immigrant background and orthodontic treatment need. Quantitative and qualitative studies in Swedish adolescents.

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20-year-old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self-perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to "Index of Orthodontic Treatment Need--Dental Health Component" (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 per cent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory "Being under the pressure of social norms" was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

Objective, subjective, and self-assessment of preadolescent orthodontic treatment need--a function of age, gender, and ethnic/racial background?

UNLABELLED: Children from socioeconomically disadvantaged and/or underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment. OBJECTIVES: To determine whether preadolescents' (a) objectively assessed orthodontic treatment need; (b) subjectively assessed orthodontic treatment need; and (c) self-perceptions of the psychologic aspects of their oral health-related quality of life and desire to have braces vary as a function of age, gender, ethnicity/race, and socioeconomic status (SES). METHODS: Data were collected from 1,566 preadolescents (age range: 8 to 11 years; 47.3 percent male/52.7 percent female; 55.7 percent African-American/39.7 percent White/2.9 percent Hispanic) in oral exams and in face to face interviews. Malocclusion was determined with the Index of Orthodontic Treatment Need. RESULTS: Children (17.2 percent) had definite treatment need, 33.7 percent were borderline, and 49.1 percent had little or no need. Objectively and subjectively assessed treatment need was not affected by the children's age or gender. However, girls were more critical of their smiles and wanted braces more than boys. The older the children were, the more critical they were and the more they wanted braces. African-American children and children in schools with higher percentages of children on free school lunches had less treatment need than White children and children in schools with lower percentages of students with free school lunches. While the provider-assessed treatment need was higher for White children than for Black children, Black children were less happy with their smiles than White children, and wanted braces more than White children. SES did not affect the children's self-perceptions. CONCLUSIONS: Findings showed that substantial percentages of the preadolescents have an orthodontic treatment need. Orthodontic need and child self-perceptions varied as a function of the children's age, gender, ethnicity/race, and SES.

Three-dimensional analysis of occlusal curvature in healthy Japanese young adults.

Knowledge of the standard value of the occlusal curvature would be helpful when providing oral rehabilitation for patients with or without occlusal derangement. Dentists often use a 4-inch radii arc as the standard based on Monson spherical theory. However, the validity of application of this theory in Japanese has not yet been verified. The objective of this study was to determine the typical shape of the occlusal curvature in Japanese adults and investigate the relative contribution of each factor to the depth of the curvature, as the initial phase, to prove the validity of determination of occlusal curvature. Seventy-nine Japanese adults (42 males and 37 females, aged 18 to 37 years) with intact dental arches were recruited, and the occlusal curvature was estimated by calculating the radius and center position of the approximate sphere. Besides, the relative contribution of gender, age, dental arch length and width, overjet, overbite for the radii was calculated. The median radius of the sphere was 110.6 mm, larger than the 4-inch value advocated by Monson. This indicates the necessity to reconsider the application of the method of occlusal plane analysis in Japanese individuals. Median position of the centre was 64.6 mm anterior to and 68.5 mm above the mid-point between condyles. Relative contribution of overbite for the radii was 10.9%, the highest amongst the factors. Therefore, a typical shape of the occlusal curvature was observed in Japanese subjects. Overbite is considered as one of the principal factors correlated to the depth of the occlusal curvature.

Correlations between cephalometric and photographic measurements of facial attractiveness in Chinese and US patients after orthodontic treatment.

INTRODUCTION: Orthodontists rely on esthetic judgments from facial photographs. Concordance between estimates of facial attractiveness made from lateral cephalograms and those made from clinical photographs has not been determined. We conducted a preliminary examination to correlate clinicians' rankings of facial attractiveness from standardized end-of-treatment facial photographs (Photo Attractiveness Rank) with cephalometric measurements of facial attractiveness made for the same subjects at the same time. METHODS: Forty-five Chinese and US orthodontic clinicians ranked end-of-treatment photographs of separate samples of 45 US and 48 Chinese adolescent patients for facial attractiveness. Separately for each sample, the photographic rankings were correlated with the values of 21 conventional hard- and soft-tissue measures from lateral cephalograms taken at the same visits as the photographs. RESULTS: Among US patients, higher rank for facial attractiveness on the photographs was strongly associated with higher values for profile angle, chin prominence, lower lip prominence, and Z-angle, and also with lower values for angle of convexity, H-angle, and ANB. Among Chinese patients, higher rank for facial attractiveness on the photographs was strongly associated with higher values for Z-angle and chin prominence, and also with lower values for angle of convexity, H-angle, B-line to upper lip, and mandibular plane angle. Chinese patients whose %lower face height values approximated the ethnic "ideal" (54%) tended to rank higher for facial attractiveness than patients with either higher or lower values for %lower face height. The absolute values of the correlations for the 7 US measures noted above ranged from 0.41 to 0.59; those of the 7 Chinese measures ranged from 0.39 to 0.49.The P value of the least statistically significant of these 14 correlations was 0.006, unadjusted for multiple comparisons. On the other hand, many cephalometric measures believed by clinicians to be indicators of facial attractiveness failed to correlate with facial attractiveness rank for either ethnicity at even the P <0.05 level, including SN-pogonion angle, lower incisor to mandibular plane angle, and Wits appraisal. CONCLUSIONS: In general, there was less association than expected or desired between objective measurements on the lateral cephalograms and clinicians' rankings of facial attractiveness on sets of clinical photographs.

Thin-plate spline analysis of the cranial base in African, Asian and European populations and its relationship with different malocclusions.

OBJECTIVES: To test the hypothesis that midline basicranial orientation and posterior cranial base length are discriminating factors between adults of different populations and its potential maxillo/mandibular disharmonies. DESIGN: Twenty-nine 2D landmarks of the midline cranial base, the face and the mandible of dry skull X-rays from three major populations (45 Asians, 34 Africans, 64 Europeans) were digitized and analysed by geometric morphometrics. We used, first, MANOVA to test for mean shape differences between populations; then, principal components analysis (PCA) to assess the overall variation in the sample and finally, canonical variate analysis (CVA) with jack-knife validations (N=1000) to analyse the anatomical features that best distinguished among populations. RESULTS: Significant mean shapes differences were shown between populations (P<0.001). CVA revealed two significant axes of discrimination (P<0.001). Jack-knife validation correctly identified 92% of 15,000 unknowns. In Africans the whole cranial base is rotated into a forward-downward position, while in Asians it is rotated in the opposite way. The Europeans occupied an intermediate position. African and Asian samples showed a maxillo/mandibular prognathism. African prognathism was produced by an anterior positioned maxilla, Asian prognathism by retruded anterior cranial base and increase of the posterior cranial base length. Europeans showed a trend towards retracted mandibles with relatively shorter posterior cranial bases. CONCLUSIONS: The results supported the hypothesis that basicranial orientation and posterior cranial base length are valid factors to distinguish between geographic groups. The whole craniofacial configuration underlying a particular maxillo-facial disharmony must be considered in diagnosis, growth predictions and resulting treatment planning.

Racial/ethnic disparities in self-reported pediatric orthodontic visits in the United States.

OBJECTIVE: Studies in orthodontics have focused primarily on clinical care and techniques. Little, however, has been reported from epidemiological studies using national data on orthodontic dental visits as a measure of orthodontic service utilization and access to care in minority populations. We examined the effect of race/ethnicity and socioeconomic factors on pediatric orthodontic visits in the United States. METHODS: We analyzed data from the Medical Expenditure Panel Survey, 1996-2004. Descriptive and multiple regression analyses were performed, with self-reported orthodontic visits in a given year as the main outcome variable. RESULTS: The prevalence of an orthodontic visit among children ages 9 to 18 years remained relatively constant (ranged between 14.3 percent and 16.8 percent) from 1996 to 2004. Multiple regression analyses revealed significantly lower odds of an orthodontic visit for Black and Hispanic children in comparison with White children. Males, children from low-income families, children eligible for Medicaid, and children with other public or no insurance were generally less likely to have made an orthodontic visit. CONCLUSION: Substantial racial/ethnic disparities in self-reported orthodontic visits exist for Black and Hispanic children even after adjusting for possible covariates. Children from lower-income families and those without private health insurance were less likely to report an orthodontic visit in the United States.

Orthodontic treatment need and demand in Senegalese school children aged 12-13 years. An appraisal using IOTN and ICON.

OBJECTIVE: To assess the normative need, knowledge of, and demand for orthodontic treatment in Senegalese schoolchildren aged 12-13 years. MATERIALS AND METHODS: The sample consisted of 665 Senegalese schoolchildren randomly selected from different ethnic and socioeconomic backgrounds. The normative orthodontic treatment need was assessed using the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) and the Index of Complexity, Outcome, and Need (ICON). Knowledge of and demand for orthodontic treatment were assessed with a questionnaire. RESULTS: The DHC and the AC of the IOTN and the ICON classified respectively 42.6%, 8.7%, and 44.1% of the children as having a definite need for orthodontic treatment. There were no ethnic or gender differences with respect to normative orthodontic treatment need. The mean ICON score ranged from 42.31 to 44.46 according to the ethnic group. Only 10% of the children had some knowledge of orthodontics. However, between 17% and 30% of the children clearly expressed a need for orthodontic treatment, and the distribution between ethnic groups was significant. In contrast, there were no significant gender differences concerning this demand for treatment. CONCLUSIONS: The present study shows that the need for orthodontic treatment far exceeds the actual available supply.

Facial profile perceptions in a group of South African blacks.

INTRODUCTION: Each society has its own general perceptions of facial aesthetics and one study show that there is significant agreement among populations regarding facial preferences. People of African decent generally have a bimaxillary protrusive profile which in some orthodontic circles is regarded as a malocclusion that should be treated. OBJECTIVES: The purpose of the study was to evaluate Black South African student perceptions on the facial profile of Black South African subjects with bimaxillary protrusion. METHODS: Silhouetted lateral facial profiles of 30 Black South Africans with bimaxillary dento-alveolar protrusion were subjected to an initial evaluation process by 128 students extracted from secondary schools, junior tertiary and senior tertiary university institutions. These evaluators were asked to select the 5 most attractive and 5 most unattractive profiles. Due to a tied ranking 13 instead of 10 of the 30 profiles were selected. The 13 selected profiles were subjected to further evaluation by a group of 605 evaluators from the same educational institutions that had to select five profiles in the categories of the most attractive, attractive, average, unattractive and most unattractive profile. The results were subjected to pairwise comparisons with a Fisher extact test and Z-test for normal approximation of the binomial distribution. RESULTS: From the first evaluation process the average age and gender distribution for the evaluators were 21.8 yrs (75 females and 51 males). The most attractive profiles chosen were nos. 27 (12.19%), 11 (6.88%), 13 (6.88%) and 8 (6.56%). Profiles nos. 2, 12 and 14 (6.25%) were chosen in equal frequency as the fifth most attractive profile. The most unattractive profiles were nos. 18 (9.38%), 29 (8.91%), 22 (7.81%), 30 (7.34%), 6 (6.56%) and 7 (6.56%). The second evaluation process had an age and gender distribution of 21.6 yrs (307 females and 275 males). Profiles no. 1 was chosen as the most attractive, no. 11 as attractive, no. 5 as average and no.6 as unattractive and most unattractive. There was no statistical significant difference between male and female profile preferences. There was a highly statistical significant difference for the most attractive and most unattractive profile. A statistical significant difference was also found between the scholars and the senior tertiary university students in the category of the most unattractive profiles. CONCLUSION: Profile no. 1 was chosen as the most attractive profile. Results indicate that Black South Africans from this sample prefer exaggerated bimaxillary protrusive profiles with lip competence and normal overjet/overbite relationships.

Soft tissue profile analysis in a sample of South African Blacks with bimaxillary protrusion.

INTRODUCTION: Evaluation of facial proportions and shape is one of the most important steps in determining treatment options and outcomes for the orthodontist and maxillo-facial surgeon. Balancing the position of the lips in relation to the nose and chin has a direct relationship with the patient's aesthetic preference. OBJECTIVES: The purpose of this study was to analyse the soft tissue profile preferences in a sample of South African Blacks and to establish a Profile Index for bimaxillary protrusion. METHODS: An earlier study by Beukes, Dawjee and Hlongwa was undertaken to determine facial profile perceptions by a group of South African Black evaluators. Adjudicators were drawn from Black students from Medunsa campus, University of Limpopo, the Holy Trinity secondary school and the Mphwe secondary school, and had to evaluate silhouetted facial profiles of 30 bimaxillary dento-alveolar protrusive patients. After an initial group of 128 Black evaluator chose 13 profiles as the most attractive and most unattractive, a second group of 605 Black evaluators (also drawn from the same academic institutions) chose three profiles as acceptable and four profiles as unacceptable. From this final selection, a soft tissue analysis was undertaken to evaluate the nasolabial angle, nasofacial angle, the facial contour angle, the lower lip-chin-throat angle and the lower and upper lip prominence in relation to the Burstone "B"- line. A Fisher exact test was done to determine the statistical difference between the mean values for the acceptable and unacceptable profiles. RESULTS: The three acceptable profiles, which were chosen by more than 69% of the evaluators, had a lip prominence of 5 to 6mm more than their African American counterparts. The angular measurements of the nose, lip and chin were in close proximity to the values given by Naidoo and Miles and Flynn et al. The three acceptable profiles had normal overjet, overbite, minimal incisor visibility and efficient lip function. CONCLUSION: A "Profile index for bimaxillary protrusion" has been concluded from this study and proposes acceptable soft tissue values for bimaxillary protrusive Black South Africans.

Spectrum and management of dentofacial deformities in a multiethnic Asian population.

OBJECTIVE: The aim of this retrospective study is to investigate the spectrum and management of dentofacial deformities in a multiethnic Asian community. MATERIALS AND METHODS: Over a period of 3 years (2001 to 2003), 212 patients with dentofacial deformities who had undergone orthognathic surgery in a national tertiary specialist center in Singapore were reviewed. Patients with cleft lip and palate or syndromes were excluded. RESULTS: The mean age (range: 16 to 58 years) of the patients was 24.0 years (SD 6.4) and the ratio of female to male was 1.3:1. The predominant ethnic group was Chinese (91.5%). The majority of the patients had skeletal Class III pattern (68%). Asymmetry was diagnosed in 36% of all cases and in 48% of skeletal Class III cases. Vertical maxillary excess was diagnosed in 21% of all cases and in 47% of skeletal Class II cases. Bimaxillary surgery involving LeFort and bilateral sagittal split osteotomies was performed in 84% of skeletal Class III cases and in 73% of all cases. Segmental osteotomy and genioplasty were performed in 41% of the cases. CONCLUSIONS: The findings suggest that the majority of the patients were young Chinese adults with two-jaw deformities requiring bimaxillary surgeries with genioplasty or segmental osteotomy. This finding may reflect the greater severity of dentofacial deformities in patients in the Asian community.

Occlusion in the primary dentition. Part 2: a comparison of some occlusal traits among pre-school children of the 3 major ethnic groups in Nigeria.

This paper attempted to compare some of the other occlusal variations in the primary dentition of the children from the 3 major ethnic groups in Nigeria. Cross-sectional epidemiological study involving two major cities in Nigeria. 269, 3-5 year-old children from the 3 major ethnic groups in Nigeria consisting of 125 (46.5%) males and 144 (53.6%) females selected from pre-primary schools/centres. Only children with confirmed ages were included in the study and the criteria of Foster and Hamilton were used in assessing the occlusal features. Although some ethnic differences were observed in relation to the assessed occlusal features, overjet, overbite, cross bite, scissors bite and midline relationship, none was found to be statistically significant (P > 0.05). The occlusal features among the children from the ethnic groups do not differ significantly. Prospective longitudinal study could be worthwhile in further understanding their occlusal developments.