Head & Face Medicine最新文献

Introduction: Esthetics plays a crucial role in orthodontics and many other dental and medical fields. To date, no study has assessed the combined effects of the 3 facial features 'facial height, gingival display (GD), and buccal corridor size (BC)' on facial/smile beauty. Therefore, this study was conducted for the first time.

Methods: In this psychometric diagnostic study, beauty of 27 randomized perceptometric images of a female model with variations in facial heights (short, normal, long), gingival displays (0, 2, 4, 6 mm), and buccal corridor sizes (2%, 10%, 15%, 20%, 25%) were evaluated by 108 judges (36 orthodontists, 36 dentists, 36 laypeople) using a 5-scale Likert scale (1 to 5). Combined effects of facial heights, GDs, BCs, judges' sexes, ages, and jobs, and their 2-way interactions were tested using a mixed-model multiple linear regression and a Bonferroni test. Zones of ideal features were determined for all judges and also for each group using repeated-measures ANOVAs and the Bonferroni test (α=0.05).

Results: Judges' sex but not their age or expertise might affect their perception of female beauty: men gave higher scores. The normal face was perceived as more beautiful than the long face (the short face being the least attractive). Zero GD was the most attractive followed by 4 mm; 6 mm was the least appealing. BCs of 15% followed by 10% were the most attractive ones, while 25% BC was the worst. The zone of ideal anatomy was: long face + 0mm GD + 15% BC; normal face + 2mm GD + 15% BC; long face + 2mm GD + 15% BC; normal face + 0mm GD + 15% BC.

Conclusions: Normal faces, zero GDs, and 15% BCs may be the most appealing. Facial heights affect the perception of beauty towards GDs but not BCs.

The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion.

Background: The main aim of this systematic review and meta-analysis was to identify peer-reviewed scholarly journal articles reporting the significance of physiotherapy interventions in managing TMJ ankylosis. In addition, this study aimed to critically appraise the existing evidence on the prevalence and clinical presentation, physiotherapy intervention approaches, efficacy of physiotherapy interventions, adverse effects, and safety of physiotherapy interventions in TMJ ankylosis management.

Methods: An all-inclusive literature search was conducted using the PubMed, Google Scholar, and Scopus electronic databases. The researchers screened the potential articles and assessed for eligibility based on the reported inclusion and exclusion criteria. The quality evaluation tool for observational cohort and cross-sectional studies developed by the National Institutes of Health (NIH) and the Cochrane Collaboration's Risk of Bias Tool were used to assess the quality of the included studies. Researchers also comprehensively analyzed the data, reported the results, and discussed them according to the predominant themes.

Results: The primary electronic database search yielded 409 articles, of which 25 were included in this review. A secondary search was conducted from citations of the included studies, yielding 74 articles, of which six were included in the study. A significantly higher prevalence of bony ankylosis than fibrous ankylosis, with an overall effect size of p < 0.00001. In addition, there were significantly more unilateral than bilateral presentations with an overall effect size of p < 0.00001. Moreover, there were 78 reported complications out of 245 subjects according to five included studies demonstrating a significant effect size with p = 0.001 following the treatment protocols.

Conclusion: This study highlighted the prevalence of bony ankylosis in temporomandibular joint ankylosis, emphasizing its impact on patients' well-being. On the other hand, the results show that physiotherapy is essential to optimize postoperative outcomes and minimize adverse events such as re-ankylosis. Practitioners and healthcare professionals must monitor postoperative recovery and ensure strict adherence to physiotherapy protocols for optimal outcomes.

Objectives: PITX2 is required for mammalian development and single nucleotide polymorphisms (SNPs) in this gene could be involved in dental agenesis and sella turcica patterns. Thus, the present study evaluated the association between SNPs in PITX2, third molars agenesis and sella turcica phenotypes.

Materials and methods: The sample consisted of healthy orthodontic German patients with lateral cephalometric radiographs with clearly visualization of the sella turcica, and dental orthopantomograms. The morphological variations of the sella turcica were evaluated using the lateral cephalograms, while third molar agenesis was evaluated using orthopantomograms. DNA isolated from buccal cells was used for genotyping three SNPs in PITX2 (rs3796902, rs1947187, and rs2595110). The analyzes were performed using a significance of 5%. There was no association between third molar agenesis and sella turcica phenotypes (p > 0.05). SNPs in PITX2 were also not associated with third molars agenesis (p > 0.05).

Results: SNPs in PITX2 were associated with sella turcica phenotypes. The rs3796902 was associated with hypertrophic posterior clinoid process (p = 0.013). The rs1947187 and rs2595110 were associated with sella turcica bridge type A (p = 0.013 and p = 0.011, respectively for genotype distribution). Patients that carry the genotypes GG-CC-AG (rs3796902- rs1947187- rs2595110) had 7.2 higher chance to present sella turcica bridge type A (p = 0.002; Odds ratio = 7.2, Confidence interval 95% 2.04-27.04).

Conclusions: Third molar agenesis was not associated with SNPs in PITX2 and sella turcica phenotypes. SNPs in PITX2 may have an important role in sella turcica pattern.

Background: Facial infiltrating lipomatosis (FIL) is a rare condition characterized by congenital facial enlargement. Beyond its impact on physical appearance, FIL can also impair essential facial functions such as swallowing, chewing, vision, and breathing, imposing a substantial physiological and psychological burden. Currently, fewer than 80 cases of FIL have been reported, and the characteristics and management strategies for FIL remain unclear.

Methods: We reviewed the clinical, surgical, and radiological records of 39 FIL patients who were treated at our center. Of these, genetic testing was performed for 21 patients.

Results: Aberrant overgrowth involves subcutaneous fat, bones, muscles, glands, tongue, lips, and teeth. Epidermal nevi could be observed in the dermatomes innervated by the three branches of the trigeminal nerve, with the highest frequency seen in the dermatome of the mandibular branch. Four patients exhibited concurrent hemimegalencephaly (HMEG), with one case presenting HMEG on the opposite side of the FIL. Nineteen patients were confirmed to harbor the PIK3CA mutation. Thirty-three patients underwent surgical procedures, with a post resection recurrence rate of approximately 25%.

Conclusions: A variety of maxillofacial structures may be involved in FIL. PIK3CA mutations are important pathogenic factors. Emerging targeted therapies could present an additional treatment avenue in the future. However, surgery currently remains the predominant treatment choice for FIL. The timing and modality of surgery should be individually customized, taking into account each patient's unique circumstances. Notably, there is a significant possibility of postoperative recurrence during childhood and adolescence, necessitating early strategic planning of disease management.

Objective: The purpose of this retrospective study was to assess the airway volume changes associated with the use of Frankel appliance (FR II) in Class II malocclusion patients using three-dimensional cone beam computed tomography (3D CBCT) imaging.

Materials and methods: The sample consisted of 31 Class II malocclusion patients (mean age 9.24 ± 1.93 years old, 17 males (54.8%) and 14 females (45.2%)) treated with FR II appliance by the same orthodontist for an average of 9 months ± 20 days. CBCT images were taken before and after treatment and upper airway volume changes were measured using Dolphin 3D software version11.0 (Dolphin Imaging, Chatsworth, CA) and statistically compared.

Results: Airway volume of nasal cavity, nasopharynx, oropharynx, hypopharynx and the total airway volume significantly increased after the use of FR II appliance. In addition, significant increase was reported in maxillary base, inter-molar, inter-premolar and inter-canine width. Significant increase in soft tissue thickness was only recorded opposite to CV2.

Conclusion: The use of the FR II appliance in growing subjects with Class II malocclusion led to a significant increase in the upper airway volume in addition to the anticipated dental and skeletal transverse expansion effects.

Background: Real-time magnetic resonance imaging (rtMRI) is essential for diagnosing and comprehending temporomandibular joint (TMJ) movements. Current methods for tracking and analysis require manual landmark placement on each acquisition frame. Therefore, our study aimed to assess the inter- and intra-rater reliability of placing cephalometric landmarks in frames from a dynamic real-time TMJ MRI.

Material and methods: Four real-time MRIs of the right TMJ were taken during mandibular movement at ten frames per second. Seven dentists identified ten landmarks on two frames (intercuspal position-ICP-and maximum mouth opening-MMO) twice at a two-week interval, yielding 112 tracings. Six typical cephalometric measurements (angles and distances) were derived from these landmarks. The reliabilities of landmarks and measurements were evaluated using distance-based (dbICC), linear mixed effect model intraclass correlation (lmeICC), and standard ICC.

Results: The average inter-rater reliability for the landmarks stood at 0.92 (dbICC) and 0.93 (lmeICC). The intra-rater reliability scores were 0.97 and 0.98. Over 80% of the landmarks showed an ICC greater than 0.98 (inter-rater) and over 0.99 (intra-rater). The lowest landmark ICC was observed for the orbitale and the oblique ridge of the mandibular ramus. However, the cephalometric angle and distance measurements derived from these landmarks showed only moderate to good reliability, whereas the reliability in the frames with ICP was better than those with MMO. Measurements performed in the ICP frame were more reliable than measurements in the MMO frame.

Conclusion: While dentists reliably localize isolated landmarks in real-time MRIs, the cephalometric measurements derived from them remain inconsistent. The better results in ICP than MMO are probably due to a more familiar jaw position. The higher error rate of the TMJ measurements in MMO could be associated with a lack of training in real-time MRI analysis in dentistry.

Background: This prospective study aimed to evaluate the influence of the computer type (tablet or desktop) on accuracy and tracing time of cephalometric analyses.

Methods: Dental students used a web-based application specifically developed for this purpose to perform cephalometric analyses on tablet and desktop computers. Landmark locations and timestamps were exported to measure the accuracy, successful detection rate and tracing time. Reference landmarks were established by six experienced orthodontists. Statistical analysis included reliability assessment, descriptive statistics, and linear mixed effect models.

Results: Over a period of 8 semesters a total of 277 cephalometric analyses by 161 students were included. The interrater reliability of the orthodontists establishing the reference coordinates was excellent (ICC > 0.9). For the students, the mean landmark deviation was 2.05 mm and the successful detection rate for the clinically acceptable threshold of 2 mm suggested in the literature was 68.6%, with large variations among landmarks. No effect of the computer type on accuracy and tracing time of the cephalometric analyses could be found.

Conclusion: The use of tablet computers for cephalometric analyses can be recommended.

Background: This study aims to evaluate the difference of three-dimensional (3D) reconstructed palatal morphology between subjects with skeletal Class III and skeletal Class I in different vertical patterns using cone beam computed tomography (CBCT).

Methods: In this study, 89 subjects with skeletal Class III (49 females, 40 males; 25.45 ± 3.81 years) and 85 subjects with skeletal Class I (45 females, 40 males; 23.95 ± 4.45 years) were collected retrospectively and divided into hyperdivergent, normodivergent and hypodivergent groups. Dolphin software was used to reorient the CBCT images of these subjects. After segmenting 3D object of maxilla from the 3D skull by ProPlan software, Geomagic Studio was used to reconstruct 3D palatal morphology and establish an average 3D palatal morphology for each group. The differences of 3D palatal morphology between different groups were compared by deviation patterns on 3D colored map analysis.

Results: 3D colored map analysis showed the posterior part of male's palate was higher and wider than that of female's palate in skeletal Class III subjects. In skeletal Class III subjects, males with hyperdivergent pattern had a higher and narrower palate compared with hypodivergent subjects, while females with hyperdivergent had a higher but not obviously narrower palate compared with hypodivergent subjects. In the similar vertical patterns, skeletal Class III subjects had a flatter but not narrower palate compared with skeletal Class I subjects, along with a smaller palate volume.

Conclusions: This method allows more intuitive between-group comparisons of the differences of 3D palatal morphology. In skeletal Class III subjects, as the vertical dimension increased, the palate tends to be higher and narrower. Therefore, the influence of vertical patterns on the palatal morphology should be fully considered in the orthodontic and orthognathic treatment of skeletal Class III subjects.