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PubMed1996

Achieving improved visualization of the temporomandibular joint condyle and fossa in the sagittal cephalogram and a pilot study of their relationships in habitual occlusion.

Improved glenoid fossa and condyle visualization is achieved by adapting the Denar TMJ Orthoceph Slimline Cassette (Denar Corp., Anaheim, Calif.) to sagittal cephalometry. This cassette contains rare-earth intensifying screens to enhance the temporomandibular joint region. A plastic template of circles of varying diameters is positioned so that the appropriate circle size is tangent to the superior, anterior, and posterior borders of the glenoid fossa seen on the resultant radiograph. The planar geometric center of the glenoid fossa is then identified coincident with the center of the template circle. The condyle planar geometric center is similarly identified. The relationships of these centers with respect to each other is described by using a rectangular coordinate system with the origin at the glenoid fossa geometric center. The condyle center is further described as being in any one of four quadrant locations or concentric with the glenoid fossa geometric center. This method was then applied to 38 patients who were free of temporomandibular joint symptoms in a pilot study relating the condyle quadrant location with the dentition in habitual occlusion. Findings revealed 89% of the condyles were in any one of the four possible quadrants. Fifty-three percent of the condyles were located in a downward and forward position (quadrant IV). Eleven percent of the condyle geometric centers were concentric with the glenoid fossa geometric center.

Adolescent↗
PubMed1996

Distal movement of buccal segments with the "en masse" removable appliance: its value in treating patients with mild Class II, Division 1 malocclusion. Part II: the model measuring system and results.

The model of 25 children with mild Class II, Division 1 malocclusions who had their upper buccal segments moved distally with an en masse appliance were measured at the beginning of treatment and at the completion of buccal segment retraction. A reflex microscope, interfaced to a personal computer, was adapted for this purpose. A custom-made jig and linear stepping motor permitted the recording of both buccal and incisal measurements of the teeth in occlusion, as well as individual arch parameters. Software was designed to record and calculate the required measurements. The method error associated with this approach ranged from 0.01 to 0.5 mm. Results indicated that mean distal movement of the buccal segments approximated 6 mm, equivalent to a full cusp of buccal segment retraction. A small spontaneous reduction in overjet was seen. The upper arch showed spontaneous alignment and increases in width, length, and perimeter. In the lower jaw, transverse expansion was accompanied by a small increase in arch perimeter. Arch length, however, was slightly reduced. It was concluded that the system was an acceptable method of recording occlusal changes during orthodontic treatment, supplementing routine cephalometry. Furthermore, a full unit of buccal segment retraction could be expected, by using a removable appliance/headgear technique.

Bicuspid↗
PubMed1997

An evaluation of condyle position in centric relation obtained by manipulation of the mandible with and without leaf gauge deprogramming.

Centric relation records of 19 dental students were obtained with leaf gauges and by mandibular manipulation. The condyle/fossa relationships were subsequently evaluated with enhanced sagittal cephalometry. Both clinical methods of obtaining centric relation revealed considerable variation of the condyle location within the glenoid fossa. Only 10% of the patients showed a condyle position "upward and forward" in the fossa with the leaf gauge method. In the mandibular manipulation technique of obtaining centric relation, 10% of the patients showed an "upward and rearward" position of the condyle.

Adult↗
PubMed2003

Differences in cephalometric and occlusal outcome of cleft palate patients regarding different surgical techniques.

INTRODUCTION: The purpose of this study was to assess differences of the long-term results following surgical treatment in patients with cleft palate treated by two different surgical concepts. PATIENTS: Fifty-nine adult patients operated on for cleft palate were examined. Thirty palates were closed by a two stage (Widmaier and Veau) and 29 by a single-stage procedure (Veau's pedicled flap). METHODS: Lateral cephalometric and model analysis was performed. In the cephalometric analysis, the vertical and horizontal parameters of the position of maxilla and midface and transverse and sagittal dimensions of the models were compared between the two groups. RESULTS: Model analysis: According to the Bolton analysis the maxillary dental arch was too large in 22 patients in each group. The other patients had mandibular arches that were too large. In 18 patients with two-stage closure and in 9 patients with one-stage closure, a space deficit in the lateral part of the maxilla was observed. Persisting transverse deficits were seen in all patients with two-stage repairs and in 11 patients with one-stage repairs. The deficit was more severe in the molar area in the first group and almost equally severe in the premolar and the molar regions of the second group. A sagittal deficiency was found more often in patients with two-stage repairs while Angle's class I occlusion was seen more often in patients with one-stage surgery. Lateral cephalometry: Similar SNA-angles were seen in both groups whereas the ANB-angle was greater following two-stage repair. In both patient groups a low inclination of the midface was seen. The vertical dimension of the midface in comparison with the lower face was normal in the one-stage group; in the other group a deficiency of the anterior midface height was registered. CONCLUSION: There was a more severe growth impairment of the midface in patients with this type of two-stage palatal repair. The horizontal deficiency was similar in both groups. The long-term occlusal result revealed smaller sagittal and transverse deficiencies in patients with this type of single-stage closure.

Adolescent↗
PubMed2003

Cephalometric assessment of cranial abnormalities in patients with acromegaly.

OBJECTIVE AND PATIENTS: Patients with acromegaly (12 women, 26 men) and a control group (36 women, 50 men) were chosen for cephalometry to assess the size, shape and positional characteristics of the craniofacial bones and the upper airways. RESULTS: When compared with the controls, patients of both sexes with acromegaly were found to have significant anomalies in the orofacial skeleton: increased facial height, elongated ascending ramus mandibulae and greater basion-supramentale distance, a negative difference between maxillary and mandibular protrusions, enlarged lower part of the gonion angle and of the angle of inclination of the maxilla, as well as alterations in the neurocranium: enlargement of sella turcica and of sinus frontalis and protrusion of the supraorbital ridges. As for the soft tissues, patients with acromegaly exhibited an elongated soft palate and a diminished angle between the uvular axis and the palatal plane. A comparison between the cephalometric parameters of patients with active acromegaly and those without active disease revealed no significant differences in either sex. CONCLUSION: Patients with acromegaly exhibited an enlargement of all parts of the neurocranium and orofacial bones except the maxilla. The greatest anomaly was seen in the mandible, with greater enlargement of the ascending ramus than of the body of the mandible. The shape of this bone was also altered.

Acromegaly↗
PubMed1989

Orbital measurements in 63 hyperteloric patients. Differences between the anthropometric and cephalometric findings.

Anthropometric and cephalometric orbital measurements were compared in 63 North American Caucasian patients (24 males, 39 females) aged 3 to 29 years who had 13 craniofacial syndromes involving hypertelorism. The hypertelorism, which was diagnosed anthropometrically, was mild in 11 patients, moderate in 25 and severe in 27. The surface intercanthal width was larger than the bony interorbital distance in all patients (mean 12.2 mm). The differences were smaller in mild cases and larger in severe cases. The soft-tissue binocular width was shorter than the bony lateral orbital distance in 53 patients, by a mean of 4.4 mm; in the other 10 patients the two measurements were identical. The hypertelorism was confirmed by cephalometry in 8 of the 11 cases identified as mild by anthropometry (72.7%), 24 of the 25 moderate cases (96.0%) and 25 of the 27 severe cases (92.6%). The abnormally wide surface intercanthal distance was matched by an abnormally wide bony interorbital distance in 57 of the 63 patients (90.5%). In the other six patients (3 with the mild form, 1 with the moderate form and 2 with the severe form) the bony widths were near the upper limit of the normal range (mean + 2 standard deviations).

Adolescent↗
PubMed1997

Obstructive sleep apnoea syndrome: results and conclusions of a principal component analysis.

A cephalometric analysis according to Hasund, supplemented by special obstructive sleep apnoea syndrome (OSAS) parameters, was performed on 169 patients who had been referred from the sleep laboratory. Statistical analysis showed a correlation between specific cephalometric landmarks including posterior airway space (PAS), a soft palate length, hyoid position and posterior growth development of the mandible and OSAS severity. A principal component analysis differentiated between four subgroups of OSAS patients: (1) orthognathic obese subjects; (2) patients with a long soft palate and low-positioned hyoid; (3) retrognathic patients with narrow PAS; and (4) prognathic ones. Lateral cephalometry is an important contribution to OSAS diagnostics and oral and maxillofacial therapy procedures.

Adult↗
PubMed2001

Comparison of patient dose from imaging protocols for dental implant planning using conventional radiography and computed tomography.

OBJECTIVES: To compare the radiation doses from imaging protocols for dental implant planning either using conventional radiography only (dental panoramic radiography (DPR), cephalometry and linear cross-sectional tomography) or involving computed tomography (CT). METHODS: Organ absorbed doses were measured using a female Rando anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters (TLD). Standard mandibular protocols for dental implant planning were followed using either a conventional dental radiographic unit (PM 2002 CC Planmeca, Helsinki, Finland) or CT scanner (Excel Twin Elscint, Haifa, Israel). Organ absorbed and effective doses were calculated. Effective dose was calculated using two approaches, one based on the ICRP method which excludes the salivary tissue from the remainder organs (designated E(exc)), and the other with its inclusion (E(inc)). RESULTS: The greatest individual organ doses for any examination were measured in the salivary tissue. E(exc) for panoramic, cephalometric and cross-sectional tomography using DPR was 0.004 mSv, 0.002 mSv and 0.002 mSv, respectively, whereas with CT it was 0.314 mSv. The value of E(inc) calculated using these data was between two and five times E(exc). CONCLUSIONS: E(inc) greatly increases the apparent radiation burden, especially with high dose procedures. CT techniques can provide excellent images, but at the cost of increased radiation detriment. DPR with a cross-sectional tomography facility may give adequate clinical information at a greatly reduced dose.

Absorption↗
PubMed1985

Malocclusion and facial morphology is there a relationship? An epidemiologic study.

The purpose of this study is to examine associations between facial morphology and malocclusion, and to test for sexual dimorphism in such relationships. The sample of 500 subjects is studied by roentgenographic cephalometry, using the Facial Height Ratio (FHR) of Jarabak as the mensurational approach to describe craniofacial morphology. Significant findings are: Neutral pattern is dominant in Class I and Class II1 malocclusions. Hypodivergent pattern is dominant in Class II2 and Class III malocclusions. The majority of females demonstrate a neutral pattern, whereas the majority of males demonstrate a hypodivergent pattern. Sexual dimorphism in pattern is greatest in Class II1 and Class III. Males show a greater tendency toward prognathism, while females tend toward orthognathism and retrognathism. Mean values of all linear measurements in males are larger than in females. Relatively strong correlations are found between facial height ratio and ramus height, gonial angle, lower gonial angle, mandibular plane angle, occlusal/mandibular plane angle, palatal/mandibular plane angle, Frankfurt/mandibular plane angle, S-N-B, Y-axis angle, and the sum of the saddle + articular + gonial angles.

Cephalometry↗
PubMed1996

Digital imaging of cephalometric radiography, Part 1: Advantages and limitations of digital imaging.

Digital imaging has several potential advantages over traditional cephalometry. These include storage, transmission, and enhancement of images, reduced exposure to radiation for patients, and the possibility of automated cephalometric analysis. This paper outlines some of these advantages, discusses the limitations of digital imaging and suggests possible future developments.

Cephalometry↗
PubMed1999

Finite-element morphometry of soft tissue morphology in subjects with untreated Class III malocclusions.

Soft tissue dynamics may contribute to maxillomandibular allometry (size-related changes in shape) associated with the development of Class III malocclusions. Lateral cephalographs of 124 prepubertal European American children were traced and 12 soft tissue landmarks were digitized. Resultant geometries were normalized, and Procrustes analysis established the statistical difference (p<0.001) between mean Class III and Class I configurations. Comparing the Class III configurations with normals for size-change, color-coded finite element analysis revealed a superoinferior gradient of positive allometry of the Class III facial nodal mesh. A conspicuous area of negative allometry (approximately 40%) was localized near soft subspinale, with a approximately 70% increase in size in the mental region. For shape-change, the Class III facial mesh was isotropic, except in the anisotropic circumoral regions. Conventional cephalometry revealed that about 50% of linear and 75% of angular parameters differed statistically (p<0.001). Soft tissue dynamics during early postnatal development may contribute to the development of Class III malocclusions.

Case-Control Studies↗
PubMed1999

A technique for three-dimensional cephalometric analysis as an aid in evaluating changes in the craniofacial skeleton.

A technique is presented for creating a standardized view for use in three-dimensional cephalometry. Three-dimensional cephalometric analysis has become a valuable tool in the assessment of skeletal remodeling, contour changes, and changes in proportion that occur with aging. Computer-assisted tomographic data can be used in either coronal or axial sections; the present study was performed with axially acquired data that was processed in several steps to achieve a standardized position of the facial skeleton for further evaluation. This technique may be a useful adjunct to standard cephalometrics to evaluate the craniofacial skeleton.

Anatomy, Cross-Sectional↗
PubMed1999

Cephalometric characteristics of nonobese patients with severe OSA.

The purpose of this study was to determine the facial characteristics of nonobese patients with obstructive sleep apnea (OSA). Observational data on a cohort of patients was analyzed retrospectively. The subjects were classified into four groups: nonobese mild, obese mild, nonobese severe, and obese severe. The nonobese mild group included patients with a body mass index (BMI = kilogram/meter2) <25 and an apnea-hypopnea index (AHI) >5 and <15; the obese mild patients had a BMI >35 and an AHI >5 and <15; the nonobese severe patients had a BMI <25 and an AHI >40; the obese severe group had a BMI >35 and AHI >40. Thirty-three male patients referred for overnight polysomnography and lateral cephalometry who met the selection criteria were included. Between-group differences were examined pairwise by analysis of variance (ANOVA) with Bonferroni correction. Only two variables--lower facial height and overbite--were significantly different at p<0.05 between the nonobese severe group and the obese mild group. A discriminant analysis on the cephalometric measurements revealed that patients in the nonobese severe group could be distinguished from patients in other groups by their facial characteristics. OSA patients do not have a homogenous bony structure of the face. In particular, OSA severity in nonobese severe patients may be associated with a vertical skeletal disharmony.

Adult↗
PubMed2003

Maxillary expansion in Class II correction with orthopedic cervical headgear. A posteroanterior cephalometric study.

Class-II, division-1 malocclusion appears to be associated with a narrow maxilla. A Class-II malocclusion may be corrected to a Class-I relationship in children using a cervical headgear provided that the narrow maxilla is expanded. This expansion is possible using headgear by dental cast analysis, but this has not been confirmed by cephalometry. We studied the effects of orthopedic cervical headgear on dental and skeletal facial widths in 40 children aged 9.1 (7.2-11.5) who had Class-II, division-I malocclusions. The headgear consisted of a long outer bow bent 15 degrees upward and a large inner bow expanded by 10 mm. Posteroanterior cephalographs and dental casts were taken before and after treatment. The results were compared with the control values presented in the literature. The malocclusion was treated to a Class-I relationship in all children. The average treatment time was 1.6 (0.3-3.1) years. The maxilla was widened significantly (P < .0001). The upper first molar width (um-um) and maxillary width (mx-mx) increased 3.2 and 1.6 mm/y, respectively. Maxillary widening was also observed in the nasal structure as indicated by an increase in lateronasal width (lap-lap) by 1.0 mm/y (P < .005). With maxillary widening, the mandibular dental arch widened spontaneously. The lower first molar width (lm-lm) increased 0.8 mm/y, which was more than the increase in the controls (P < .0001). However, the antegonial width (ag-ag) remained unaffected. By using a widened inner bow in headgear therapy with Class-II malocclusions, a widening of maxilla and nasal cavity may be obtained.

Cephalometry↗
PubMed2000

Comparison of three facebow/semi-adjustable articulator systems for planning orthognathic surgery.

Our aim was to measure the steepness of the occlusal plane produced by three different semi-adjustable articulators: the Dentatus Type ARL, Denar MkII, and the Whipmix Quickmount 8800, and to assess the influence of possible systematic errors in positioning of study casts on articulators that are used to plan orthognathic surgery. Twenty patients (10 skeletal class II, and 10 skeletal class III) who were having pre-surgical orthodontics at Liverpool University Dental Hospital were studied. The measurement of the steepness of the occlusal plane was taken as the angle between the facebow bite-fork and the horizontal arm of the articulator. This was compared with the angle of the maxillary occlusal plane to the Frankfort plane as measured on lateral cephalometry (the gold standard). The Whipmix was closest to the gold standard as it flattened the occlusal plane by only 2 degrees (P<0.05). The results of the Denar and Dentatus differed significantly from those of the cephalogram as they flattened the occlusal plane by 5 degrees and 6. 5 degrees (P<0.01), respectively. Clinicians are encouraged to verify the steepness of the occlusal plane on mounted study casts before the technician makes the model.

Analysis of Variance↗
PubMed2001

Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients.

We examined the craniofacial characteristics of patients with obstructive sleep apnoea syndrome (OSAS) and correlated them with the body mass index (BMI (weight (kg) x height (m2)). Eighty-five men with OSAS diagnosed by conventional polysomonography were divided into two groups according to their BMI (< 30 and > or = 30). Cephalometry was analysed by using 31 measurements of the size of the bone structures, their relationships and the size of the airways. The groups were comparable for age and the apnoea-hypopnoea index (mean 49, standard deviation (SD) 23). Patient with a BMI < 30 had a shorter anterior floor of cranial base, a smaller mandible and retroposition of the mandible compared with severly obese patients. These skeletal differences were associated with narrower velopharyngeal and linguopharyngeal spaces. This study sh ows that there is a craniofacial difference between two populations, divided according to their BMI.

Body Mass Index↗
PubMed1990

[Differences in sonographic measurements of the fetal head and chest].

Differences in measurements using cephalometry and thoracometry ante partum are reported. Two examiners performed fetal head and thorax measurements shortly after one another using the same ultrasonic equipment without knowing the measurements achieved by each other. A series of 195 measurements were made by a few less experienced examiners. The values measured showed a considerable scatter. The average difference between the biparietal head measurements was 2.23 mm, and the standard deviation of the differences of the values measured was 1.94 mm. In a further group of 175 fetuses the measurements were performed by two skilled examiners. For the diameter of the head there was an average measured difference of 1.38 mm and a standard deviation of the differences of 1.11 mm. For the average thorax diameter--corresponding to the arithmetical average from the straight and transverse diameter--the following results were achieved. 4.14 mm average difference of value measured an 3.41 mm standard deviation in the measuring run performed by less experienced ultrasonic examiners as opposed to 2.57 mm average difference and 1.74 mm standard deviation in the group of practised examiners. The average thorax diameter showed a considerably smaller scatter than the transverse thorax measurement on its own. The differences in the values measured could not be seen to be dependent on the gestational age.

Cephalometry↗