Search Results (46)

Background/Objectives: This study evaluated whether linear cephalometric measurements show systematic differences in their central values across birth cohort groups in adults from a clinical population and analyzed the implications of these differences for clinical interpretation when norms and clinical deviations are used as a reference framework. Methods: A cross-sectional observational analytical study was conducted based on 604 lateral cephalometric radiographs of adult patients. Eleven linear cephalometric measurements were obtained and compared across predefined birth cohort groups (<1980, 1980–1989, and 1990–1999) using robust estimators of central tendency through median regression models adjusted for sex, age group, and sagittal skeletal classification. Results: Several linear cephalometric measurements revealed different central values between the birth cohorts, even after adjusting for relevant covariates. Cranial length, anterior cranial base length, posterior facial height, and posterior cranial base length had lower adjusted median values in the 1990–1999 cohort than in the <1980 cohort. The effective maxillary length and maxillary length also differed between cohorts. Mandibular measurements, including mandibular length, corpus length, and ramus height, showed the largest adjusted median contrasts between cohorts. These cohort-associated differences were not uniform across all measurements. Conclusions: Routinely used linear cephalometric measurements present different central values across adult birth cohort groups under comparable clinical conditions. The relative position of a cephalometric value within its reference distribution may vary by birth cohort. This suggests that using fixed reference means and standard deviations could lead to systematic misestimation in adults from various birth cohorts. Cohort-aware interpretation is valuable in routine cephalometric assessments. Full article

Background/Objectives: The L5–S1 segment presents unique characteristics that make surgical access challenging in minimally invasive spine surgery (MISS) procedures. Variability in bony and neural anatomy may restrict transforaminal and extraforaminal approaches, yet few studies have combined cadaveric dissection with radiologic analysis to define relevant morphology in L5–S1 approaches. The purpose of the study is to characterize anatomical and radiological features of the lumbosacral region relevant to MISS planning and execution. Methods: Twelve Thiel-embalmed donor bodies underwent CT imaging (lumbopelvic region) followed by posterior dissection. Bony landmarks were used to obtain bilateral anatomical measurements. Qualitative anatomical analysis included iliolumbar ligament morphology and extraforaminal access feasibility. CT-based morphometrics included L5 transverse process (TP) length; maximal and minimal distances between L5 TP and sacral ala; extraforaminal area bounded by L5 TP, L5–S1 facet (zygapophyseal) joint, and sacral ala; iliac crest-based approach angle to the L5–S1 intervertebral disc (IVD); minimal distance between this approach vector and the ventral ramus of the fifth lumbar spinal nerve (VRL5); facet angulation; and iliac crest height. Results: No left–right asymmetry was detected. Except for L5 TP length, all anatomical measurements obtained directly in the donor bodies differed significantly between sexes. A direct IVD access with a uniportal endoscopic working tube was feasible in 25% of cases. On CT analysis, the maximal and minimal distances between the L5 TP and sacral ala were 11.1 (4.0) mm and 5.6 ± 2.9 mm, with a mean extraforaminal area of 202.0 ± 45.9 mm². The mean approach angle was 35.2 ± 5.0°, and an extraforaminal corridor to L5–S1 IVD was feasible in 75% of donated bodies. The median minimal distance between the approach vector and the VRL5 was 5.0 (7.1) mm, with frequent overlap. Conclusions: The results of this study reveal that the L5–S1 segment shows substantial interindividual morphologic variability, compromising the feasibility of transforaminal and extraforaminal MISS approaches, and highlight the need for individualized preoperative planning, neural identification and/or bony resection to create a safe working corridor. Full article

Background and Objectives: Mid-term skeletal stability after bimaxillary orthognathic surgery in patients with facial asymmetry and a relatively normal sagittal skeletal relationship (ANB ≈ 1–4°) remains underreported. This study aimed to determine the three-dimensional characteristics and temporal changes in postoperative skeletal remodeling and symmetry maintenance in such patients. Materials and Methods: This retrospective case series included 25 patients (ANB ≈ 1–4°) undergoing bimaxillary orthognathic surgery. Three-dimensional computed tomography was performed preoperatively (T0), immediately postoperatively (T1), and at 6–12 months postoperatively (T2) to quantify bilateral condylar, ramus, mandibular body, maxillary parameters, and occlusal cant. Statistical analyses were performed using appropriate statistical methods for paired and repeated-measures designs. Results: Preoperatively, the long side exhibited significantly greater condylar volume, ramus height, and mandibular body length than the short side (all p < 0.05). Postoperatively, a “long-side reduction and short-side augmentation” strategy significantly reduced or reversed most bilateral differences, with a marked improvement in occlusal plane cant (p < 0.01). At T2, only mild bone remodeling was observed, with no significant loss of postoperative skeletal symmetry. The occlusal plane remained stable. Conclusions: In patients without marked sagittal discrepancies, bimaxillary orthognathic surgery effectively restores transverse and vertical skeletal symmetry. Mid-term stability is well maintained over 6–12 months, with only mild condylar and ramus remodeling, suggesting adaptive remodeling rather than relapse. Full article

Background/Objectives: Mandibular counterclockwise (CCW) autorotation following maxillary repositioning is a common biomechanical consequence of bimaxillary orthognathic surgery. However, its effect on temporomandibular joint (TMJ) morphology remains controversial. This study aimed to evaluate whether condyle-centered CCW mandibular autorotation influences postoperative TMJ spaces and condylar morphology using cone-beam computed tomography (CBCT). Methods: A total of 24 patients who underwent combined Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were included in this retrospective analysis. Patients were divided into two groups based on virtual surgical planning: those with condyle-centered CCW autorotation (4–7°) and those without autorotation. Preoperative and one-year postoperative CBCT images were analyzed. Sagittal and coronal joint spaces, condylar dimensions, and glenoid fossa thickness were measured. Intra- and intergroup comparisons were performed using nonparametric statistical tests (α = 0.05). Results: Both groups demonstrated significant postoperative reductions in condylar height, width, and depth, reflecting adaptive bone remodeling. Joint space changes were limited overall. A significant intergroup difference was observed only in the change in the right superior joint space (p = 0.024), which decreased in the non-autorotation group but was preserved or slightly increased in the autorotation group. No other joint space or fossa parameter showed significant between-group differences. Conclusions: Condyle-centered CCW mandibular autorotation during bimaxillary orthognathic surgery does not induce adverse TMJ morphological changes beyond physiological adaptation. Preservation of the superior joint space suggests that autorotation may contribute to maintaining a more favorable condyle–fossa relationship. Incorporating controlled mandibular autorotation into surgical planning may support TMJ biomechanical balance and postoperative joint stability. Full article

Background/Objectives: Geometric morphometric analysis (GMA) is a statistical method that captures and quantifies shape variation. This study aimed to assess hard and soft tissue shape variations and changes following orthodontic treatment in Class III skeletal malocclusion using GMA. Methods: A retrospective study was conducted on 84 lateral cephalometric radiographs (pre-treatment and near-end treatment) of Class III patients aged 16–40 years (ANB < 2°). Thirty-five landmarks were digitized in Cartesian coordinates using MorphoJ software for shape analysis. Results: The sample included 62% females and 38% males, with a mean age of 24.7 ± 5.2 years. Vertical dimension variations (hypodivergent to hyperdivergent) contributed most to shape changes PC1 (23.35%), followed by anteroposterior variations PC2 (13.51%). Gender significantly influenced hard and soft tissue variation with 30.91%SS (F = 56.99, p < 0.0001). Males had significantly larger and longer ramus, body of the mandible, alveolar height, LAFH, TAFH and upper lip length. (PD: 0.026, p < 0.05). Significant shape changes were seen in the mandible (PD = 0.018, p < 0.05). SNB increased by 0.41° (from 81.73° ± 3.67°), and ANB improved by 0.46° but remained Class III (−0.33° ± 1.82°). Lower anterior facial height increased by 1.78 mm (p < 0.05). The lower incisors retroclined significantly (from 92° ± 8.56° to 87° ± 6.96°, p < 0.05), while the interincisal angle increased by 5.9°. Upper incisors remained procline (118° ± 11°, p > 0.05). Upper lip length increased by 0.4 mm (p < 0.05). Conclusions: Vertical and anteroposterior shape variations are notable within Class III malocclusion. Post-treatment changes in both hard and soft tissues indicate that orthodontic camouflage can enhance facial esthetics and skeletal balance. GMA provides objective quantification and visualization of these treatment-related craniofacial changes. Full article

Background/Objectives: Precise evaluation of mandibular morphology is essential for orthodontic diagnosis, growth assessment, and treatment planning. While lateral cephalograms are traditionally used for angular measurements, orthopantomograms (OPGs) allow side-specific assessment of mandibular structures. This study aimed to analyze bilateral gonial angles, bigonial width, and ramus heights on OPGs using artificial intelligence (AI)–assisted tracing, with a focus on symmetry, sex-related differences, and clinical applicability. Methods: A cross-sectional study was conducted on 78 Romanian patients (46 females, 32 males; mean age 22.8 ± 8.7 years) seeking orthodontic treatment. Standardized OPGs were obtained and analyzed using WebCeph AI-driven software. Bilateral gonial angles, bigonial width, and ramus heights were measured. Symmetry between sides and differences between sexes were evaluated, and correlation analyses were performed. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Results: The mean right and left gonial angles were 126.3° and 127.1°, respectively, with no significant sex- or side-related differences (p > 0.05). Bigonial width averaged 134.9 mm, being slightly larger in males, although not statistically significant (p = 0.240). Ramus heights were comparable bilaterally (right: 48.4 mm; left: 48.3 mm), with males showing slightly greater values. Correlation analysis demonstrated strong bilateral symmetry for gonial angles (r = 0.795) and ramus heights (r = 0.895). Negative correlations were observed between gonial angles and both bigonial width and ramus height, whereas bigonial width correlated strongly with ramus height. Measurement reproducibility was high (ICC > 0.75). Conclusions: OPGs, when combined with AI-assisted analysis, provide reliable and reproducible measurements of gonial angles and ramus heights, comparable to cephalometric values. Their ability to assess right and left sides separately enhances clinical utility in detecting asymmetries and monitoring mandibular growth. However, caution is advised when interpreting transverse parameters such as bigonial width, where CBCT remains the gold standard. AI-driven OPG analysis represents a cost-effective, accessible, and low-radiation diagnostic tool with significant potential for precision orthodontics. Full article

The mandible of domestic dogs represents a key structure in veterinary anatomy. This study tested the hypothesis that mandibular shape variation in adult mesocephalic dogs follows a non-random modular pattern with limited allometric influence. A total of 168 dry mandibles from academic osteological collections were analyzed using geometric morphometrics. Four anatomical landmarks and two curves of sliding semilandmarks were digitized and processed through Generalized Procrustes Analysis. Principal component analysis revealed that 62.7% of total variance was concentrated in the first two axes, associated with the coronoid height, ramus robustness, and curvature of the mandibular body. Cluster and Canonical Variate Analyses identified two overlapping but statistically distinct configurations, reflecting the intrinsic morphological diversity of mesocephalic dogs. Procrustes regression confirmed a significant yet low allometric effect (2.34%), while modularity tests based on RV coefficients supported a structured organization involving the ramus, coronoid, and angular processes (processus angularis mandibulae) as relatively independent modules. These results indicate that mandibular shape variation is hierarchically organized rather than random, highlighting the coexistence of integration and modular independence within the masticatory apparatus. Beyond its morphometric contribution, this study provides a reproducible anatomical baseline for veterinary and comparative research, facilitating future analyses of sexual dimorphism, functional adaptation, and surgical applications. Full article

Introduction: This manuscript addresses the limitations of traditional orthognathic surgery in achieving both functional and aesthetic correction in patients with Class II malocclusion and severe mandibular retrusion. Current techniques often struggle to simultaneously address mandibular deficiency and inadequate transverse dimension, leading to unsatisfactory outcomes. Methods: Seven male patients underwent bimaxillary osteotomy with mandibular advancement. A novel surgical plate, Implate, was used, which was designed to facilitate precise osteotomy and stabilization. Pre-surgical planning included CBCT scanning, 3D modeling, and surgical simulation. Postoperative assessments included clinical examinations, CT and OPT scans. Results: Implate successfully addressed the challenges of conventional techniques, minimizing the formation of bony steps and achieving a more harmonious facial profile. The minimally invasive procedure, with careful periosteal and muscle management, contributed to stable outcomes, and no complications were reported. At the 6-month follow-up, OPT analysis showed a mean mandibular width increase of 18.1 ± 6.2 mm and vertical ramus height gains of 6.0 ± 3.1 mm (left) and 5.8 ± 1.7 mm (right). Conclusions: According to our preliminary experience, the integration of Implate into surgical practice offers a significant improvement in treating complex Class II malocclusions. By simultaneously correcting mandibular retrusion and width while minimizing complications, Implate provides a superior solution compared to traditional methods. This innovative approach highlights the potential of combining advanced surgical techniques with personalized 3D-printed implants to achieve optimal functional and aesthetic outcomes. Further prospective studies with controls and longer follow-up are needed to validate the efficacy and reproducibility of Implate in wider clinical use. Full article

Background/Objectives: Craniofacial microsomia (CFM), previously known as hemifacial microsomia, is a congenital condition involving structures derived from the first and second pharyngeal arches. CFM is characterized by asymmetrical craniofacial growth, affecting the mandible, ear, orbit, soft tissues, and facial nerve. Functional therapy is among the treatment options for mild to moderate cases. This study aimed to assess the effect of functional therapy on mandibular growth in patients with CFM by comparing mandibular and condylar height on the affected and unaffected sides, using pre- and post-treatment panoramic radiographs. Methods: A retrospective longitudinal study was conducted on 14 patients treated with functional therapy with the Asymmetrical Functional Activator (AFA) appliance. Mandibular ramus height (Co-Go) and condylar height (Co-Is) were measured bilaterally on pre- (T0) and post-treatment (T1) panoramic radiographs. Growth differences and rates were analyzed using descriptive and inferential statistics. Results: A significant increase in the mandibular ramus height (Co-Go) and in condylar height (Co-Is) was observed on the affected side from T0 to T1. The increase in mandibular ramus height was significantly greater on the affected side compared to the unaffected side (p = 0.0016). Although condylar height increased significantly on both sides over time, the difference in growth rate between sides was not statistically significant (p = 0.7148). Conclusions: Functional therapy may contribute to reducing mandibular asymmetry in CFM patients by enhancing the growth of the affected mandibular ramus, but the asymmetry may still be present at the end of treatment. These findings support its use in the early management of mild to moderate CFM. Full article

Background: It has been suggested that the mandible may differ according to gender. The fact that the mandible and the anatomical structures on it show various changes with age and gender differences is important in gender and age determination. The aim of this study was to evaluate the morphometric variation in the condyle and coronoid processes and the gonial angle, which are anatomical structures forming the mandible, with gender and age. Methods: Cone beam CT images of 141 individuals (78 female, 63 male) were used in this study. The images of all patients were obtained with the same X-ray device; the images were obtained at 70 kVp, 10 mA, and a 32 s exposure time in accordance with the manufacturer’s recommendations. Images displayed with 0.3 mm voxel with the IRYS 15.0 program were examined in the axial, sagittal, and coronal planes, and measurements were taken. The gonial angle, coronoid notch, condyle height, condyle–coronoid distance, and sigmoid notch depths were evaluated. Results: The average age of 141 individuals was 43.21 ± 15.96 years, and 55.3% of them were female and 44.7% were male. The mean right gonial angle in females (128.66 ± 5.50°) was significantly higher than in males (125.68 ± 5.10°) (p < 0.005). Similarly, the mean left gonial angle in females (128.84 ± 5.97°) was significantly higher than in males (125.26 ± 4.89°) (p < 0.005). The sigmoid notch depth was found to be greater in men, with an average of 13.88 ± 2.46 mm, while in women, it had an average of 13.13 ± 1.80 mm, and this difference was statistically significant (p < 0.005). The relationship between the two sides’ coronoid notch height, sigmoid notch depth, condyle height, and condyle–coronoid distance and age groups was not statistically significant (p > 0.005). Conclusions: Overall, our findings indicate that the male mandible may have a longer condyle, a narrower gonial angle, and a wider sigmoid notch depth than that of females. It has been observed that ramus measurements such as condyle length and sigmoid notch depth may be important in gender discrimination, and the male mandible exhibits larger values in these parameters. No differences in parameters were observed between age groups. Full article

A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding precise indications for ORIF remain unclear and non-uniform. We aimed to refocus the debate regarding the optimal treatment for CFs by identifying the recent indications for ORIF in the literature and assessing the quality of the existing evidence for each indication. This systematic review searched Medline, Embase and the Cochrane Central Register of Controlled Trials for eligible studies. The included studies consisted of articles from the past 15 years involving patients with any type of CF who underwent ORIF based on specified indications. From 4711 papers, 100 studies were included. In these, 121 indications were identified. The most cited indications for ORIF were those proposed by Zide and Kent, namely displacement/angulation ≥10° and ramus height shortening of ≥2 mm. Evidence supporting these indications is weak, relying mainly on expert opinion rather than robust data, with a focus on treatment comparisons. Clear, evidence-based cutoffs regarding when ORIF is the only viable treatment option are needed for a consensus. Full article

Objectives: Anterior crowding in the lower jaw is a common orthodontic issue often managed through premolar extraction, which can affect facial profile development. This study aimed to evaluate skeletal and dental changes in moderate to severe crowding using a novel mandibular reference line—the Ramus Anterior Vertical (RaV)—to support treatment planning. Methods: A total of 140 patients (LII > 4 mm and < 9 mm; mean age ≈ 12.5 years) were divided into two groups (G1: extraction; G2: nonextraction; total n = 140; n = 70 per group). Skeletal and dental parameters were measured before (T0) and after (T1) orthodontic treatment using 280 lateral cephalograms. RaV was defined as a vertical line through the anterior ramus point, perpendicular to the occlusal plane. Results: Sagittal measurements relative to RaV were reproducible and unaffected by mandibular mobility. Significant vertical skeletal changes were observed in G2 females, with an increased anterior facial height (N–Sp′ and Sp′–Gn) but a stable Hasund Index. In G1, the dental arch length and distances from RaV to i5 and i6 were reduced, while second molars (i7) remained stable. Sagittal incisor axis changes (L1–NB°, SAi1°) and skeletal–dental correlations (ML–NSL, Gn–tGo–Ar) were present only in G1. Conclusions: RaV proved to be a stable mandibular reference for assessing treatment effects. In this study, premolar extraction vs. nonextraction was comparably effective, though some vertical skeletal adaptations, especially in G2 females, took place. Full article

Objectives: To evaluate any changes in condylar and mandibular ramus height and dental malocclusion in adult patients with temporomandibular disorders (TMDs) diagnosed with DC/TMD criteria after treatment with an upper occlusal splint. Methods: This retrospective observational study included 48 adult patients with TMDs treated with an occlusal splint in the upper arch for about 12 months. For each patient, panoramic dental X-rays were analyzed using the Habets method to calculate the asymmetry index between the condyles and mandibular branches before and after treatment. The digital dental models were also studied at T0 and T1 to define the occlusal sagittal molar relationship and the posterior dental crossbite. The statistical analysis was performed using the Shapiro–Wilk normality tests, Student t-tests, or Wilcoxon tests using the R studio software (released version 4.3.3). Results: Condylar height showed a statistically significant difference (p = 0.022) and reduced condylar asymmetry between T0 and T1. The measurement of the condylar branch showed a statistical significance (p = 0.037), revealing an improvement of the mandibular symmetry in the vertical direction after treatment. Moreover, at T0, posterior dental crossbite was found in 37.5% of patients, specifically, bilateral in 12.5%, while unilateral crossbite in 22.9% on the right and 2.1% on the left side, and Class I malocclusion was found in the main part of the sample (72.9%). Conclusions: Patients with TMDs diagnosed according to DC/TMD and treated with an upper stabilization occlusal splint in the case of symptoms of masticatory muscle dysfunction showed a symmetrization in the mandibular ramus and condyle pre- and post-treatment (T0-T1). At the same time, no clinical differences were found in the occlusal characteristics. Full article

Background/Objectives: This study aimed to compare the associations of digital measurements obtained from orthopantomographies (OPGs) or panoramic radiographs and lateral cephalograms in evaluating facial asymmetry in patients with different skeletal classes. The sample consisted of 128 Romanian patients (67 females, 61 males) who sought orthodontic treatment. These measurements are an essential diagnostic tool for evaluating facial asymmetry in order to treat them. Methods: Lateral cephalograms and OPGs were obtained for each patient, and digital tracing was performed using the WebCeph program. Angular measurements (ANB, FMA, gonial angles) and linear measurements (ramus height, mandibular body length) were assessed on both imaging modalities. Results: Strong positive correlations were found between the gonial angle and ramus height measurements obtained from lateral cephalograms and OPGs (rs range: 0.800–0.946; p < 0.001). However, the mandibular body length showed weaker correlations between the two methods. Significant sex differences were observed, with males exhibiting larger craniofacial measurements compared to females (p < 0.05). The study population was quite young, as seen by the cohort’s median age of 21 years and interquartile range (IQR) of 16 to 29 years. Lateral Ceph: the FMA angle median value of 22° (IQR: 17–25), gonial angle median of 121° (IQR: 116–127), mandibular ramus height median value of 44 mm (IQR: 41–48 mm), and mandibular body length median value of 70 mm (IQR of 65 to 76 mm). OPG: gonial angles on the right and left sides yield medians of 121° (IQR: 116–127) and 122° (IQR: 117–127); the mandibular ramus height on the right and left sides shows medians of 44.0 mm (IQR: 40.0–47.0 mm) and 43 mm (IQR: 40–48 mm); and the mandibular body on the right side presents a median of 71 mm (IQR: 67–76 mm) and the left side has a median of 71 mm (IQR: 67–75 mm). Conclusions: The findings suggest that OPGs can be reliably used to measure the gonial angle and ramus height, providing results comparable to lateral cephalograms. However, caution should be exercised when predicting horizontal measurements from OPGs. The standardization of the OPG recording process and further research with larger sample sizes are required to establish standard panoramic norms for OPG parameters in the assessment of facial asymmetry. Full article

Background/Objectives: The aim of this study is to identify the most accurate and consistent landmarks for determining the precise location of the mandibular foramen (MF) and the mandibular ramus, suggesting appropriate adjustments to anesthesia techniques based on these variations in order to improve the success rate of the inferior alveolar nerve (IAN) block. Methods: CT scans of the mandibles from 100 patients were analyzed to measure the distance between the MF and various landmarks, including the sigmoid notch, gonion, posterior and anterior margins of the ramus, temporal crest, and the mandibular ramus height from the condyle to the gonion. The width of the mandibular ramus was also assessed, with correlations made to age and gender. Results: The MF was found to be closer to the sigmoid notch (mean = 21.2 mm), p = 0.393, than to the gonion (mean = 22.6 mm), p = 0.801, and closer to the posterior margin of the ramus (mean = 13.1 mm), p = 0.753, than to the anterior margin of the ramus. Additionally, the MF was closer to the temporal crest. Age also influenced the position of the MF, with a posterior and superior movement of the foramen, reducing the distance between the MF and the posterior margin of the ramus as well as the MF and the sigmoid notch (p < 0.001). Conclusions: A precise understanding of the MF’s location will help dentists and oral and maxillofacial surgeons improve the success of the IAN block, avoid injury to the inferior alveola neurovascular bundle, and minimize surgical complications such as paresthesia, permanent anesthesia, and hemorrhage. Full article