Effect of head rotation on two-dimensional cephalometric measurements using cone beam-computed tomography.

OBJECTIVE: The purpose of this study was to identify the variation of bi-dimensional cephalometric measurements following real head rotation. MATERIAL AND METHODS: Thirty cone beam-computed tomography (CBCT) head films were oriented according to three axes: horizontal Frankfort plane, transverse bi-orbital plane, and Opisthion-Nasion median plane. Axial rotation of 2°, 4°, 6°, and 8° from the Odontoïdale point were performed. Horizontal and vertical linear and angular measurements were studied on lateral cephalograms derived from each rotation T0, T2, T4, T6, and T8. A paired t-test was applied to compare the measurements between T0 and each rotational angle. RESULTS: Of the 18 measurements, 55% showed statistically significant differences (P < 0.05) and 22% showed clinically significant differences, mostly at T6 and T8. Horizontal linear measurements Ba-A and N-Ba decreased, and vertical linear measurement G-Sn increased gradually, as the angle of head rotation increased. Angular measurements studied did not vary. CONCLUSIONS: Head malpositions during X-ray acquisition should be avoided and rotated lateral CBCT cephalograms should be corrected and recentered to prevent any variation in linear measurements.

Ponticulus Posticus: An Important Diagnostic Finding Often Missed in Lateral Cephalograms.

AIM: The purpose of the current study was to investigate the presence of the ponticulus posticus (PP) frequently encountered in lateral cephalograms. MATERIALS AND METHODS: About 500 patients of age 12-40 years were selected whose digital lateral cephalogram was recorded and traced to confirm the presence of the PP and categorize as: (A) Absent, as evidenced by lateral cephalograms. (B) Complete PP evidenced by the presence of circumferential bone bridge that connected the upper articular process to the atlas's posterior arch. (C) Partial PP: presented as a bone spike that protruded from the top articular process or the posterior arch of the atlas and extended above the vertebral artery sulcus. Symptoms of migraine, shoulder discomfort, orofacial pain, and headache were also evaluated on interaction with the patients. Using the Chi-square test, the relationship between the patient's gender and the presence of the PP was assessed. A p-value of 0.05 or less was regarded as statistically significant. RESULTS: About 10% of the patients reported with the presence of complete variant, 70% with partial variant and rest 20% of patients with neither a partial nor a complete form of PP. There was no statistically significant association between the PP and gender, as indicated by the Chi-square values (3.146; p = 0.526). CONCLUSION: On conclusion, according to the findings of the current study, patients with a complete form of PP experience more symptoms than those with a partial form of PP. In both groups, the PP frequency was higher in females. CLINICAL SIGNIFICANCE: In lateral cephalograms, the cervical spine region is typically ignored and given little weight. A common variation of atlas vertebrae is the PP, which is located in the posterior arch of the atlas. The PP exacerbates symptoms, such as migraine, tension headaches, shoulder pain, double vision, vertigo, stroke, and pain in the neck and orofacial region. Therefore, orthodontic specialists serve as initial diagnosticians and direct the patients to qualified physicians so that they can experience symptom relief.

Automatic Cephalometric Landmark Identification System Based on the Multi-Stage Convolutional Neural Networks with CBCT Combination Images.

This study was designed to develop and verify a fully automated cephalometry landmark identification system, based on multi-stage convolutional neural networks (CNNs) architecture, using a combination dataset. In this research, we trained and tested multi-stage CNNs with 430 lateral and 430 MIP lateral cephalograms synthesized by cone-beam computed tomography (CBCT) to make a combination dataset. Fifteen landmarks were manually and respectively identified by experienced examiner, at the preprocessing phase. The intra-examiner reliability was high (ICC = 0.99) in manual identification. The results of prediction of the system for average mean radial error (MRE) and standard deviation (SD) were 1.03 mm and 1.29 mm, respectively. In conclusion, different types of image data might be the one of factors that affect the prediction accuracy of a fully-automated landmark identification system, based on multi-stage CNNs.

Scandcleft trial of primary surgery for unilateral cleft lip and palate: Craniofacial cephalometrics at 8 years.

BACKGROUND: The Scandcleft trial is a randomized controlled trial that includes children with unilateral cleft lip and palate where registrations are standardized and therefore provides the opportunity to describe craniofacial characteristics in a very large sample of patients. OBJECTIVES: The aim of this study was to describe craniofacial growth and morphology in a large study sample of 8-year-old children with unilateral cleft lip and palate (UCLP); before orthodontic treatment and before secondary alveolar bone grafting; and to compare the cephalometric values with age-matched non-cleft children from previous growth studies to identify the differences between untreated cleft- and non-cleft children. MATERIALS: There are 429 eight-year-old UCLP patients in the Scandcleft study group. A total of 408 lateral cephalograms with a mean age of 8.1 years were analysed. Cephalometric analyses were performed digitally. The results from three previously published growth studies on non-cleft children were used for comparison. RESULTS: Cephalometric analyses showed a large variation in craniofacial morphology among the UCLP group. In general, they present with significant maxillary retrusion and reduced intermaxillary relationships compared to the age-matched non-cleft children. In addition, the vertical jaw relationship was decreased, mainly due to decreased maxillary inclination. The upper and lower incisors were retroclined. It can be expected that these differences will increase in significance as the children age. CONCLUSION: Results from this study provide proposed norms for the young UCLP before any orthodontic treatment and can be valuable for the clinician in future treatment planning. TRIAL REGISTRATION: ISRCTN29932826.

Evaluation of palatal support tissues for placement of orthodontic mini-implants in mouth breathers with high-narrow palates versus nose breathers with normal palates: a retrospective study.

OBJECTIVES: The aim of this study was to compare the palatal total support tissues (TSTs) and bone support tissues (BSTs) at 5-mm paramedian section to the midsagittal suture between mouth breathers with high-narrow palates and nose breathers with normal palates and confirm the practicability and limitation on superimposition of lateral cephalograms and plaster models for orthodontic mini-implant (OMI) implantation in these patients. MATERIAL AND METHODS: The sample consisted of 27 mouth breathers with high-narrow palates (study group (SG)) and 27 nose breathers with normal palates (control group (CG)). Upper digital dental models were superimposed with corresponding cone beam computed tomography (CBCT) images; then, TSTs and BSTs vertical to the curvature of the palatal mucosa were measured on the 5-mm paramedian section to the midsagittal suture. The measuring sites were the third ruga (R) and the sites anterior and posterior to R at 2-mm interval (A2, A4, A6, and A8; P2, P4, P6, and P8) along the palatal mucosa outline. TSTs and BSTs were also measured on the superimposition of lateral cephalograms and plaster models, and the site with the largest TST value in each patient was recorded. Descriptive statistics, independent-samples t test, and hierarchical clustering heat map were used for statistical analysis. RESULTS: The greatest average values of TSTs and BSTs in SG were 12.24 ± 2.63 mm and 9.59 ± 2.36 mm at P2 site, and those in CG were 12.96 ± 2.39 mm and 10.56 ± 2.38 mm at R site, respectively. The average values of both TSTs and BSTs in SG were less than those in CG at all insertion sites. Significant differences (P < 0.05) were found at A4, A6, and R for TSTs and at R and P4 for BSTs. P2 and R were clustered together for both TSTs and BSTs by the cluster analysis on heat map in both SG and CG. In both groups, only one patient from SG was found to have the insertion site with the largest TST value on 2D superimposition located in the blue area on the heat map, where the measurement values of TSTs were less than 8.5 mm and those of BSTs were less than 5 mm. CONCLUSIONS: Mouth breathers with high-narrow palates may have less palatal support tissues than nose breathers with normal palates at 5-mm paramedian section to the midsagittal suture of palate. The site a little posterior to R is more suitable for OMI implantation in mouth breathers. Two-dimensional superimposition of lateral cephalograms and plaster models can provide relatively effective assessment for the site choice of OMI implantation in both mouth breathers with high-narrow palates and nose breathers with normal palates. CLINICAL RELEVANCE: Three-dimensional superimposition of CBCT data and digital dental model can provide accurate information for palatal OMI implantation. Meanwhile, 2D superimposition of lateral cephalograms and plaster models can be used for assessing the implantation sites at 5-mm paramedian section to the midsagittal suture of palates in mouth breathers under most conditions even those who have less palatal support tissues.

Significance of Cephalometric Radiograph in Orthodontic Treatment Plan Decision.

AIM: The lateral cephalometric radiograph is a standard component of clinical records taken for orthodontic diagnosis and treatment planning. The present study was conducted to assess the utility of cephalometric radiography and analysis in modern orthodontic diagnosis and treatment planning. MATERIALS AND METHODS: A research survey was conducted at Jacksonville University School of Orthodontics. Thirty-one residents and faculty were the participants. The survey sample was collected from the university patients' pool. A survey was given to participants at two time points. At the first time point (T1), the participants were given full records without lateral cephalogram. At the second time point (T2), they were given full records with lateral cephalogram. Two measures were analyzed: (1) a change in orthodontic treatment decision and (2) a change in the orthodontic treatment plan. A traditional McNemar's test was used on paired binary data. We used the conditional logistic regression model with robust variance at a participant level to adjust for a participant-level clustering effect to test the difference in treatment decision before and after. A statistical significance was determined at p = 0.05. RESULTS: It was found that 93.6% of the treatment decisions and 70% of the extraction decisions were consistent after the introduction of lateral cephalograms. There was no statistically significant association observed between two outcome measures and the use of cephalograms (p = 0.80). CONCLUSION: Sufficient evidence does not exist to warrant lateral cephalometric radiographs be taken as a part of standard diagnostic records on every individual seeking orthodontic treatment. CLINICAL SIGNIFICANCE: Evidenced-based selection criteria for prescribing lateral cephalometric radiographs should be developed to reduce the amount of radiation exposure to the general public.

[Cephalometric study of 9-15 years old patients with maxillofacial anomalies and cerebral palsy]. / Tsefalometricheskie parametry u patsientov v vozraste 9-15 let s zubocheliustnymi anomaliiami i detskim tserebral'nym paralichom.

AIM: To study the morphological state of the maxillofacial system in children with cerebral palsy. MATERIAL AND METHODS: The frequency and prevalence of dental anomalies was studied in 30 9-15 years old children with cerebral palsy. For the registration of maxillofacial anomalies, the Bjork assessment method was used. The severity of sagittal incisive disocclusion and the reverse sagittal incisal disocclusion was measured by the magnitude of the sagittal slit. RESULTS: The study revealed no age-dependent correlation of lower canines and second premolars roots growth. The parameters of the cerebral part of the skull measured on the CT-bases lateral cephalograms were significantly less than normal rates except for the length of the posterior part of the skull. CONCLUSION: The morphological changes that determined the formation of sagittal and vertical incisive disocclusions were defined: the reduction of total anterior morphological face height (N-Me) and anterior upper morphological face height (N-SpP) and the increase in the anterior lower morphological face height (SpP-Me) which are characteristic features for patients with incisive sagittal and vertical diocclusion.

Evaluation of the influence of patient positioning on the reliability of lateral cephalometry.

Two-dimensional cephalometry is widely used for monitoring orthodontic treatments and for quantifying the outcome of maxillofacial surgery. Despite careful use of a cephalostat, successive radiographs might differ due to slight differences in patient posture. This study evaluates the reliability of lateral cephalometric measurements and estimates the impact of patient positioning on this reliability. We studied cephalograms of 104 patients; 31 of them had two radiographs because the first was deemed unsuitable for cephalometric analysis. Using AudaxCeph 3.0 (Audax, Ljubljana, Slovenia), two observers traced each cephalogram twice, one month apart. We evaluated intra- and interobserver agreement via Bland-Altman analysis, intraclass correlation coefficient (ICC), standard error of measurement, and smallest detectable difference (SDD). First, we studied the reliability of the hard tissue part of the Tweed-Merrifield analysis for 73 single cephalograms and for the better ones of patients with two exposures. Then, we studied 31 unsatisfactory cephalograms, and the ones recorded at improved patient posture. Although intraobserver bias was less than 0.5° or 0.3 mm, interobserver bias was significant for most measurements. Intraobserver reliability was high (ICC > 0.9), whereas interobserver reliability was good (ICC > 0.83) except for FMPA, FMIA and OP. Head rotations and inclinations had little impact on reliability (e.g., interobserver SDD decreased for 3 of 11 measurements). We conclude that averaging the positions of bilateral structures enables a reliable cephalometric analysis in spite of imprecise patient posture. Retaking cephalograms is ethically questionable in such cases.

Morphology of the Sella Turcica in Individuals With Different Skeletal Malocclusions in Upper Egypt Assessed Using Lateral Cephalometric Radiographs.

OBJECTIVE: To evaluate the morphology of sella turcica (ST) in individuals with different skeletal malocclusions in upper Egypt. MATERIALS AND METHODS: 300 lateral cephalometric radiographs of adult patients of both sexes, varying ages from 18 to 30 years, were selected and divided into three equal groups, group (1): skeletal class I (control group), group (2): skeletal class II, and group (3): skeletal class III. Pre-treatment lateral cephalograms were taken from the archives of the Department of Orthodontics, Faculty of Dentistry, Minia University. The tuberculum and dorsum sella, the floor of ST, and posterior and anterior clinoid processes (ACPs) were drawn. The direct measurements such as diameter (APD), depth (D), and length(L) of sella were measured using Silverman and Kisling methods. RESULTS: A significant difference was found in depth (D) between class I and class II, with class II having a greater depth. Also, the largest diameter (APD) was found in the class III group. A significant difference was found in diameter (APD) between the two age groups (from 18 to 24 years and from 25 to 30 years) Conclusion: The larger diameter values were seen in the skeletal class III subjects, while the larger depth values were observed in the class II subjects. The older age group (25-30 years) has a greater diameter than the younger one. Highly significant differences were found in length and depth between the sexes.

Comparative assessment of two-phase class II treatment with Activator or Bionator followed by fixed appliances: A retrospective controlled before-and-after study.

AIM: Two-phase treatment for children with Class II malocclusion with several functional appliances is still performed by many orthodontists, while the Activator and the Bionator appliances are two of the most popular ones. Aim of this study was to compare the skeletal and dentoalveolar effects of treatment with these two appliances. METHODS: Class II children treated with Activator or Bionator in the first phase, followed by a phase of fixed appliances were included. Skeletal and dentoalveolar parameters were assessed from lateral cephalograms and analysed with linear regressions at 5%. RESULTS: A total of 89 patients (mean age 10.0 years; 47% female) were included. During the first phase, Bionator increased less the SNB (difference in mean treatment-induced changes [MD] -0.7°; 95% confidence interval [CI] -1.3 to -0.2°; P=0.01) and decreased less the ANB angle (MD 0.6°; 95% CI 0 to 1.1°; P=0.03) compared to Activator. Activator slightly increased the facial axis and Bionator reduced it (MD -1.6°; 95% CI -2.3 to -0.8°; P<0.001). Compared to Activator, the Bionator retroclined more the upper incisors (MD -2.4°; 95% CI -4.6 to -0.2°; P=0.03) and increased more the interincisal angle (MD 2.9°; 95% CI 0.5 to 5.4°; P=0.02). After the second phase (6.2 years after baseline), the only differences were a reduced facial axis (MD -1.3°; 95% CI -2.2 to -0.3°; P=0.008) and an increased maxillary rotation (MD 0.9°; 95% CI 0 to 1.8°; P=0.04) with Bionator compared to Activator. CONCLUSION: Similar dentoalveolar effects were seen overall with two-phase treatment with either appliance, with Bionator being associated with more vertical increase compared to Activator.

Floating norms for individualising the ANB angle and the WITS appraisal in orthodontic cephalometric analysis based on guiding variables.

PURPOSE: The sagittal skeletal relationship of maxilla and mandible (skeletal class) can generally be determined via lateral cephalograms (ANB angle or Wits appraisal) by comparing measurements to empirical norms based on the respective population mean. However, values differing from these empirical norms also enable a therapeutically desired, normal class I occlusion depending on individual craniofacial pattern, thus requiring floating norms based on guiding variables. As available regression equations consider only few predictor variables and are not up-to-date regarding a contemporary patient collective, the aim of this study was to establish improved and extended regression equations for individualising the ANB angle and Wits appraisal. METHODS: This retrospective, cross-sectional multicentre study was based on 71 Caucasian male and female subjects of any age with normal dental occlusion. We cephalometrically analysed digitised pretreatment lateral radiographs and performed multiple linear regression analyses to identify suitable skeletal predictor variables for individualising the ANB angle and Wits appraisal. RESULTS: Inter- and intrarater reliability tests showed mostly perfect measurement concordance. Both original regression equations by Panagiotidis/Witt and Järvinen could be updated for a contemporary population with new regression coefficients. The equation for individualising the ANB could be further optimised in its prediction reliability by adding the skeletal predictor variables NL-NSL, NSBa, facial axis (Ricketts) and index (Hasund), whereas the recalculated Wits equation could not be further improved by additional guiding variables. CONCLUSIONS: The improved regression formulae for individualising the ANB angle and Wits appraisal should help to improve the assessment of sagittal skeletal class in clinical orthodontic practice.

Mandibular antegonial notch depth in postpubertal individuals: A longitudinal cohort study.

OBJECTIVES: To perform an epidemiological analysis of the antegonial notch depth in postpubertal individuals and to analyze the development of deep antegonial notches longitudinally in growing individuals. MATERIAL AND METHODS: Lateral cephalograms of 302 untreated 17/18-year-old subjects (171 males; 131 females), from the craniofacial growth legacy collection, were analysed to measure antegonial notch depth along the mandibular plane. Sex and sagittal malocclusion were investigated as possible factors influencing notch depth. In subjects with deep antegonial notches (>1.5 standard deviation) at the age of 17/18 years, earlier lateral cephalograms at 7/8 and 13/14 years were obtained, and the magnitude of notch depth analyzed longitudinally. Linear regression analyses were used to assess correlations between antegonial notch depth and other recorded variables. RESULTS: Antegonial notch depth ranged from 0 to 5.3 mm (mean 2.0 ± 1.0 mm). Antegonial notches were significantly deeper in males (2.3 ± 1.1 mm) than females (1.5 ± 0.7 mm) (p < .001). Notch depth was on average 0.3 mm deeper in Class I than in Class II or III individuals (p = .019). Twenty-one subjects (all male) were judged to have deep antegonial notches at the age of 17/18. In these subjects, notch depth deepened from 13/14 to 17/18 years (p < .001), whereas no change was observed between 7/8 and 13/14 years. CONCLUSIONS: Antegonial notch depth shows important variation in postpubertal individuals, with males having deeper notches than females on average. In those with deep antegonial notches (all males in the present sample), notch depth increases not during prepubertal growth but during the pubertal growth spurt.

Comparative assessment of cephalometric with its analogous photographic variables.

Objective: The purpose of this study was to evaluate the accuracy of photographic measurements and compare it with its analogous cephalometric variables. Materials and Methods: Lateral cephalograms and standardized facial profile photographs were obtained from a sample of 120 subjects (92 females, 28 males; age 12-22 years with mean age of 17.5 years). A total of 4 linear and 7 angular measurements along with 3 ratios analogous to one another were measured on both. Descriptive statistics for all measurements were computed. Pearson's correlation coefficients were computed between analogous measurements, and regression analysis was done for each variable measured on the photograph to accurately predict the cephalometric variable. Results: The reliability of the standardized photographic technique was satisfactory. Most photographic measurements showed highly significant correlations (P < 0.001) with cephalometric variables. Among all measurements used, the A'N'B' angle was the most effective in explaining the variability of its analogous cephalometric (r2= 0.35). The Frankfort-mandibular plane angle' angle showed best results for vertical assessment (r2= 0.81) along with anterior face height (AFH) and lower anterior facial height (r2= 0.859) and ratio lower posterior facial height/AFH (r2= 0.702). Conclusions: Although we cannot rule out lateral cephalogram as the primary record in orthodontics, photographic assessment can always be used through proper standardization, as an alternative diagnostic aid, and also for large-scale epidemiological purposes and places with unavailability of cephalostat.

Bone age assessment from lateral cephalograms using deep learning algorithms in the Indian population.

Purpose: The assessment of bone age has applications in a wide variety of fields: from orthodontics to immigration. The traditional non-automated methods are time-consuming and subject to inter- and intra-observer variability. This is the first study of its kind done on the Indian population. In this study, we analyse different pre-processing techniques and architectures to determine the degree of maturation (i.e. cervical vertebral maturation [CVM]) from cephalometric radiographs using machine learning algorithms. Methods: Cephalometric radiographs-labelled with the correct CVM stage using Baccetti et al. method-from 383 individuals aged between 10 and 36 years were used in the study. Data expansion and in-place data augmentation were used to handle high data imbalances. Different pre-processing techniques like Sobel filters and canny edge detectors were employed. Several deep learning convolutional neural network (CNN) architectures along with numerous pre-trained models like ResNet-50 and VGG-19 were analysed for their efficacy on the dataset. Results: Models with 6 and 8 convolutional layers trained on 64 × 64-size grayscale images trained the fastest and achieved the highest accuracy of 94%. Pre-trained ResNet-50 with the first 49 layers frozen and VGG-19 with 10 layers frozen to training had remarkable performances on the dataset with accuracies of 91% and 89%, respectively. Conclusions: Custom deep CNN models with 6-8 layers on 64 × 64-sized greyscale images were successfully used to achieve high accuracies to classify the majority classes. This study is a launchpad in the development of an automated method for bone age assessment from lateral cephalograms for clinical purposes.

Individual dental and skeletal age assessment according to Demirjian and Baccetti: Updated norm values for Central-European patients.

PURPOSE: Chronological age often differs from dental and skeletal age. With orthopantomograms and lateral cephalograms, dental and skeletal development can be determined according to the methods published by Demirjian et al. and Baccetti et al. However, gender and skeletal class as possible confounders were frequently not considered and available norm values are not up-to-date. This retrospective cross-sectional study thus aimed to evaluate effects of skeletal class and gender on dental and skeletal age of growing patients and to generate updated norm values for contemporary Central-European patients. METHODS: A total of 551 patients were included in the dental and 733 in the skeletal age assessment, respectively. Dental analysis was based on tooth mineralisation stages in orthopantomograms (Demirjian) and skeletal age was defined by cervical vertebrae maturation stages (CVMS) in lateral cephalograms (Baccetti). Skeletal class was determined by the individualised ANB angle of Panagiotidis/Witt. With nonlinear regression analysis a formula for determining dental age was established. Effects of gender and skeletal class were evaluated and updated norm values generated. RESULTS: Inter- and intrarater reliability tests revealed at least substantial measurement concordance for tooth mineralisation and CVMS. Demirjian stages and CVMS significantly depended on gender with girls developing earlier. Skeletal class significantly affected skeletal age only, but without clinical relevance. Updated norm values for dental age differed significantly from the original values of Demirjian and the values for skeletal age differed from those published by Baccetti. CONCLUSION: Optimised norms, separated by gender, increase precision in determining individual dental and skeletal age during orthodontic treatment planning. Further studies analysing the effect of skeletal class on dental and skeletal development are needed.

Biplanar Low-Dose Radiograph Is Suitable for Cephalometric Analysis in Patients Requiring 3D Evaluation of the Whole Skeleton.

BACKGROUND: The biplanar 2D/3D X-ray technology (BPXR) is a 2D/3D imaging system allowing simultaneous stereo-corresponding posteroanterior (PA) and lateral 2D views of the whole body. The aim of our study was to assess the feasibility of cephalometric analysis based on the BPXR lateral skull view to accurately characterize facial morphology. METHOD: A total of 17 landmarks and 11 angles were placed and/or calculated on lateral BPXR and lateral cephalograms of 13 patients by three investigators. Five methods of angle identification were performed: the direct construction of straight lines on lateral cephalograms (LC-A) and on BPXR (BPXR-A), as well as the calculation of angles based on landmark identification on lateral cephalograms (LA-L) and on BPXR with the PA image (BPXR-LPA) or without (BPXR-L). Intra- and interoperator reliability of landmark identification and angle measurement of each method were calculated. To determine the most reliable method among the BPXR-based methods, their concordance with the reference method, LC-A, was evaluated. RESULTS: Both imaging techniques had excellent intra- and interoperator reliability for landmark identification. On lateral BPXR, BPXR-A presented the best concordance with the reference method and a good intra- and interoperator reliability. CONCLUSION: BPXR provides a lateral view of the skull suitable for cephalometric analysis with good reliability.

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

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

Effect of Oral Submucous Fibrosis on Jaw Dimensions.

OBJECTIVE: The disuse of the jaws owing to the restricted movement of the mandible in advanced cases of oral submucous fibrosis (OSMF) may have an effect on the morphologic features of the jaw bones. The purpose of the present study was to determine the jaw bone measurements in patients with OSMF and to compare the measurements in normal subjects and Caucasian norms. METHODS: The lateral cephalograms of 59 subjects (43 males and 16 females) with OSMF and 44 normal subjects (23 males and 21 females) in the age group of 18-45 years were collected. The jaw measurements were performed using Burstone analysis, and the relevant linear measurements of jaw sizes included were N-A, N-B, N-ANS, ANS-PNS, ANS-Gn, Ar-Go, and Pg-Go. The sex-wise comparison was performed using unpaired t-test, and measurements were compared with other studies using Z test. RESULTS: In the present study, sex-wise comparison was found to be significant with greater jaw measurements in males than in females in patients with OSMF. Overall, the measurements were less or equal in patients with OSMF than in normal subjects except for N-ANS and Pg-Go. When study measurements were compared with Burstone measurements, differences were significant with greater and less measurements. CONCLUSION: Overall, the jaw measurements were less or equal in patients with OSMF than in normal subjects except for mandibular body length and middle third facial height that may need further evaluation.

Análisis de la Distancia entre Hueso Occipital y Atlas en Telerradiografía Lateral de Cráneo / Analysis of the Distance Between the Occipital Bone and Atlas in Lateral Cephalograms

El conocimiento del espacio suboccipital (OA) es esencial para el clínico debido a que su disminución se asocia a posible causa de cefaleas. El objetivo de este estudio fue determinar las diferencias entre la longitud del espacio suboccipital en telerradiografías laterales entre hombres y mujeres de distintos rangos etarios. En este estudio transversal se analizaron un total de 371 telerradiografías laterales de cráneo. Se realizó estadística descriptiva y la aplicación de prueba T-Student y ANOVA para evaluar la asociación entre el espacio suboccipital con el género y la edad. La distancia media del espacio suboccipital fue de 5.62 ± 2.7 mm, siendo mayor en hombres que en mujeres (6.49 ± 2.8 mm y 5.09 ± 2.5 mm respectivamente, p<0.001). Con respecto a la edad, la distancia del espacio suboccipital no presentó variaciones significativas. La longitud del OA entre los hombres y mujeres de distintos grupos tampoco mostró diferencias significativas. Existe una gran variabilidad en la distancia del espacio suboccipital, el cual se observa más disminuido en mujeres, por lo que se sugiere un análisis individual mediante telerradiografía lateral frente a pacientes con cefaleas.

SUMMARY: Knowledge of the suboccipital space (OA) is essential for clinicians because its decrease is associated with headache. The aim of this study was to determine the differences in the length of the suboccipital space in lateral cephalograms of men and women of different age ranges. In this cross-sectional study, a total of 371 lateral cephalograms were analyzed. Descriptive statistics and the application of Student's t-test and ANOVA were performed to evaluate the association between the suboccipital space with sex and age. The mean distance of the suboccipital space was of 5.62 ± 2.7 mm, being higher in men than women (6.49 ± 2.8 mm and 5.09 ± 2.5 mm respectively, p < 0.001). Regarding age, the distance of the suboccipital space did not show significant variations. The length of the OA between men and women of different age groups also showed no significant differences. There is a great variability in the distance of the suboccipital space, which is observed to be more decreased in women; therefore, an individual analysis by lateral cephalograms is suggested in patients with chronic headaches.

Evaluation of the Effect of Age, Gender, and Skeletal Class on the Dimensions of Sella Turcica Using Lateral Cephalogram.

CONTEXT: Sella turcica or pituitary fossa is a saddle-shaped concavity housing the pituitary gland and seen clearly on lateral cephalogram. This makes it a good source of additional diagnostic information related to pathology of the pituitary gland or to various syndromes that affect the craniofacial region. AIMS: The aim of this retrospective study was to determine the average dimensions and morphological variations of the sella turcica in different age groups and to evaluate any difference in size between males and females in the study population. SETTINGS AND DESIGN: All the lateral cephalograms were taken by trained radiographic technicians using Planmeca Promax Ceph X-ray Machine, Finland, Inc., in a standardized manner using the same cephalostat. MATERIALS AND METHODS: Four hundred and eighty lateral cephalograms were obtained under standardized conditions. With age range between 7 and 43 years, all the radiographs were distributed according to skeletal class and gender. Size and morphology of sella turcica were recorded and compared with age, gender, and skeletal class. STATISTICAL ANALYSIS USED: A Student's t-test, one-way ANOVA test, and Pearson's correlation coefficient were used. RESULTS: The mean age of the study population was found to be 16.8 years comprising 48.6% males and 51.3% females. There was a gradual increase in linear dimensions of sella turcica with the advancement of age. The normal sella was observed in 20.6%, whereas 79.35% showed variation in morphology. Oblique anterior wall was a most common abnormal variant, whereas pyramidal shaped dorsum was rarest. CONCLUSIONS: There was no statistically significant difference in linear dimensions or morphological variations with age, gender, or type of malocclusion.