Potential of finite element analysis for cephalometric investigation

In view of concerns relating to the validity of traditional cephalometric appraisals, we undertook this study to use a potentially powerful method, finite element analysis, to compare cephalometric changes between two samples (subjects with and without orthodontic treatment). The derived data show varying sample contrasts depending on the particular finite element array included in the analysis. Thus, although finite element analysis facilitates rigorous morphometric analysis, further investigation is required before it can be applied universally in cephalometric studies.     

Finite element scaling analysis of human craniofacial growth

The study of form change is central to traditional cephalometric research. Unfortunately, traditional cephalometric studies operate within systems of measurement that are based on registration and orientation. Measurements produced in registered systems are insufficient for the craniofacial biologist who is interested in locating morphological differences between forms. In this article we apply a registration-free method called finite element scaling analysis in a study of the form change occurring during growth of the normal human craniofacial complex. The method provides form change data that can be summarized at various morphological levels. Twenty normal male individuals are used to analyze the form change that occurs from age 4 to ages 5, 7, 8, 9, 10, 12, 13, and 15 years. The magnitude and direction of growth expressed as shape and size change specific to craniofacial landmarks are presented. Although exceptions occur, our analysis shows that localized size change is, on the average, greater than localized shape change. The relation between size and shape change during growth shows allometry (shape change increasing during growth along with size change) but at a lesser magnitude and slower rate. We conclude that although shape change occurs throughout ontogeny, the magnitude and rate of shape change in relation to size change diminishes as age increases. This analysis represents new insights into the understanding of human craniofacial growth at various levels of morphological integration.     

Change in facial shape in micro-, macro- and normocephalics

In view of the dubious scientific validity of traditional cephalometric analyses, the more accurate technique of biorthogonal analysis was used in this study. Developed from D'Arcy Thompson's transformation grids, this technique showed similar craniofacial shape changes in micro-, macro- and normocephalics between the ages of 12 and 16 years, implying the contrasts in facial form between these 3 samples predominantly reflect size rather than shape differences.     

3-D finite element modelling of facial soft tissue and preliminary application in orthodontics

Prediction of soft tissue aesthetics is important for achieving an optimal outcome in orthodontic treatment planning. Previously, applicable procedures were mainly restricted to 2-D profile prediction. In this study, a generic 3-D finite element (FE) model of the craniofacial soft and hard tissue was constructed, and individualisation of the generic model based on cone beam CT data and mathematical transformation was investigated. The result indicated that patient-specific 3-D facial FE model including different layers of soft tissue could be obtained through mathematical model transformation. Average deviation between the transformed model and the real reconstructed one was 0.47?±?0.77?mm and 0.75?±?0.84?mm in soft and hard tissue, respectively. With boundary condition defined according to treatment plan, such FE model could be used to predict the result of orthodontic treatment on facial soft tissue.     

3-D finite element modelling of facial soft tissue and preliminary application in orthodontics

Prediction of soft tissue aesthetics is important for achieving an optimal outcome in orthodontic treatment planning. Previously, applicable procedures were mainly restricted to 2-D profile prediction. In this study, a generic 3-D finite element (FE) model of the craniofacial soft and hard tissue was constructed, and individualisation of the generic model based on cone beam CT data and mathematical transformation was investigated. The result indicated that patient-specific 3-D facial FE model including different layers of soft tissue could be obtained through mathematical model transformation. Average deviation between the transformed model and the real reconstructed one was 0.47 ± 0.77 mm and 0.75 ± 0.84 mm in soft and hard tissue, respectively. With boundary condition defined according to treatment plan, such FE model could be used to predict the result of orthodontic treatment on facial soft tissue.     

Dentofacial pattern of two Jewish ethnic groups compared with accepted norms

The population of immigrant communities is often composed of various ethnic groups who may differ in their dentofacial pattern. The objective of this study was to define the dentofacial pattern of Jewish adolescents of Kurdish origin, and to compare it with another ethnic group and with accepted cephalometric norms. Lateral cephalograms of 20 individuals of both sexes, aged 11–13 years, with normal occlusion in the early permanent dentition, were chosen from the Jerusalem Growth Study material. The cephalograms were traced twice and were processed by means of a computer aided cephalometric program. Downs' as well as some other common cephalometric measurements were used for the analyses. Several comparisons were made: a) with an Ashkenazi (East-European Jewish) group; b) with the findings on non-Jewish Iranian youths of similar geographic background as our Kurdish group; c) with classical cephalometric standards. Close similarity was found with the Ashkenazi group and almost identical pattern of the non-Jewish Iranian youths of similar geographic background. The comparison with the classical cephalometric standards indicated a higher FMA, a more convex profile, accompanied by a mild skeletal Class II tendency and mandibular incisor proclination in our sample. Therefore it stands to reason that the classical North American cephalometric standards for its white population are not applicable in their totality for the clinical evaluation of the two Jewish ethnic groups examined. Thus establishment of specific norms for specific groups within a heterogeneous community is indicated. In addition, a tendency to accept a more convex profile as normal, as apparent from the review of the contemporary orthodontic literature, may suggest the desirability for a revision of the accepted strict norms for a harmonious dentofacial pattern. Based on a thesis submitted to the graduate faculty, Hebrew University, in partial fulfillment of the requirements for the DMD degree.     

Splint纠正CR—CO不调时对下颌骨位置的影响

目的：研究Splint在纠正CR-CO不调时对下颌骨位置变化的影响,为正畸治疗前正确的诊断和治疗提供参考。方法：随机选取门诊戴用Splint治疗的患者23例,在其治疗前后拍摄头颅定位侧位片,应用Jarabak分析法测量并进行统计学分析。结果：患者戴用Splint治疗后,出现下颌后缩,面下1／3变长;口内表现为前牙覆盖变大,覆牙合变浅或者开牙合,可见早接触点;前后头影测量结果比较显示N—Go-Me显著增加（P〈0．05）,后面高／前面高、S-Ar-Go和N—Go-Me较治疗前显著减小（P〈0．05）,N—S—Ar和Ar-Go—Me治疗前后无明显差异（P〉0．05）。结论：Splint在纠正CR—CO不调时,同时改变了下颌骨的位置,使下颌骨发生顺时针方向旋转。因此,在正畸治疗之前,应该充分考虑下颌骨可能发生的这种变化,以便更好的确定正畸治疗方案。     

Craniofacial manifestations in the Marfan syndrome: palatal dimensions and a comparative cephalometric analysis

The purpose of this study was to determine how the craniofacial morphology, evaluated from dental casts and lateral cephalograms, in individuals affected by the Marfan syndrome diverge from healthy control groups. The high and narrow palatal vault as well as maxillary and mandibular retrognathy were strongly correlated to the syndrome. About 70% of the Marfan syndrome patients (n = 76) had been referred for orthodontic treatment, mostly because of crowded teeth or extreme maxillary overjet. In 36%, the orthodontic treatment was carried out before diagnosis or suspicion about the Marfan syndrome. In comparison to healthy orthodontic patients (n = 86), selected because of presence of high and narrow palatal vaults, crowding of teeth, extreme maxillary overjet, and open bite were much more prevalent in the Marfan syndrome patients than in the orthodontic control group.     

Analysis and visualization of growth-related and treatment-induced craniofacial changes

An analysis and visualization of craniofacial shape changes due to growth or orthodontic treatment is presented. The suggested method is based on an adapted Karhunen-Loève decomposition of time-discrete data based on landmarks in lateral X-rays of the skull. It allows for a reduction of the high-dimensional dynamic problem to a few spatial modes representing synchronous components of growth patterns with time-dependent mode coefficients. The growth-related shape changes as well as the orthodontic treatment effects are visualized by overdrawing the underlying shape changes. The results based on this technique give insight into the still controversially discussed question to which degree the craniofacial skeletal structures can be influenced by orthodontic appliances.     

Assessment of the effects on growth of porous hydroxyapatite granule cranioplasty in the immature guinea pig craniofacial skeleton

The immature guinea pig was used to study the effects on growth of porous granular hydroxyapatite used as an onlay cranioplasty and inlay cranioplasty to reconstruct full-thickness cranial defects in a growing craniofacial skeleton. Forty Hartley guinea pigs, 20 immature animals and 20 mature animals, were divided into four groups each containing five mature and five immature animals. The mature animals served as controls. Group I underwent elevation and replacement of the parietal periosteum. Group II underwent placement of hydroxyapatite between periosteum and parietal bone. Group III underwent elevation and replacement of autogenous bone flap after the formation of a 1 x 1-cm craniectomy defect in the parietal skull. Group IV underwent elevation of a 1 x 1-cm parietal craniectomy and reconstruction of the defect with hydroxyapatite granules placed between the dura and periosteum. Immature animals were killed at maturity at 3.5 months and mature animals were killed 2.5 months postoperatively. Macroscopic examination of the operative field, transverse and longitudinal cephalometric measurements, and histological sections encompassing the operative sites were compared. Macroscopically, all reconstructed operative sites were fully incorporated into the cranium. Histological staining of the sectioned operative site revealed no hydroxyapatite migration through the cranial bone or dura. No inflammatory or foreign body reaction was evident in the subcutaneous tissue, periosteum, or dura. No statistically significant cephalometric intergroup or intragroup differences were found at the conclusion of the study. The results of this study indicate that a granular porous form of hydroxyapatite may be used as an onlay or inlay cranioplasty in the immature guinea pig craniofacial skeleton without evidence of dural inflammation, granule migration, or growth restriction or retardation.     

Factors Influencing Superimposition Error of 3D Cephalometric Landmarks by Plane Orientation Method Using 4 Reference Points: 4 Point Superimposition Error Regression Model

Superimposition has been used as a method to evaluate the changes of orthodontic or orthopedic treatment in the dental field. With the introduction of cone beam CT (CBCT), evaluating 3 dimensional changes after treatment became possible by superimposition. 4 point plane orientation is one of the simplest ways to achieve superimposition of 3 dimensional images. To find factors influencing superimposition error of cephalometric landmarks by 4 point plane orientation method and to evaluate the reproducibility of cephalometric landmarks for analyzing superimposition error, 20 patients were analyzed who had normal skeletal and occlusal relationship and took CBCT for diagnosis of temporomandibular disorder. The nasion, sella turcica, basion and midpoint between the left and the right most posterior point of the lesser wing of sphenoidal bone were used to define a three-dimensional (3D) anatomical reference co-ordinate system. Another 15 reference cephalometric points were also determined three times in the same image. Reorientation error of each landmark could be explained substantially (23%) by linear regression model, which consists of 3 factors describing position of each landmark towards reference axes and locating error. 4 point plane orientation system may produce an amount of reorientation error that may vary according to the perpendicular distance between the landmark and the x-axis; the reorientation error also increases as the locating error and shift of reference axes viewed from each landmark increases. Therefore, in order to reduce the reorientation error, accuracy of all landmarks including the reference points is important. Construction of the regression model using reference points of greater precision is required for the clinical application of this model.     

An evaluation of head position and craniofacial reference line variation

Natural head position (NHP) is the usual, balanced position of the head which is adopted for viewing the horizon or an object at eye level. Determination of NHP is useful when reconstructing facial form in art, forensics, orthodontic diagnosis and treatment planning for surgical management of craniofacial dysmorphic conditions. When NHP is uncertain, correction such as orientation to Frankfurt horizontal (FH) has been advocated. However, FH angulation varies between individuals and is subject to landmark identification error. Previous studies have measured FH and other craniofacial planes in relation to the true horizontal (HOR) with subjects in NHP and have found similar variation to that found with FH. This study measured craniofacial planes in 40 Aboriginal Australians (20 male, 20 female, aged 17 years or greater) from lateral cephalographs and compared its results with classical previous studies. Four planes, the neutral horizontal axis (NHA), FH, Krogman-Walker line (KW line), and palatal plane (P plane) demonstrated near parallelism and averaged between −1° and −2° from HOR. The combined use of NHA, FH, KW line, and P plane enables more effective corrected head position (CHP).     

Growth potential in suture bone inlay grafts: a comparison of vascularized and free calvarial bone grafts

The present study investigates transsutural growth in vascularized and free calvarial bone grafts and notes the effects of such growth on craniofacial development. The temporalis myoosseous flap served as a model of vascularized graft. In ten 8-week-old dogs, a standardized skeletal defect, including a segment of the zygomatico-maxillary suture, was created. The defect was reconstructed with a vascularized graft in half the animals and a corresponding free graft in the remaining animals. Growth was assessed by means of serial cephalometric radiography and direct osteometry. Vascularized bone grafts demonstrated persistent transsutural growth following transplantation. Growth at the recipient site was preserved, resulting in less restriction of vertical maxillary development.     

Velopharyngeal function following maxillary advancement.

In a series of 40 patients who had maxillary advancements, none developed velopharyngeal incompetence. Unlike the cleft palate patient who is more at risk, there are distinct anatomical characteristics in craniofacial dysostosis which favor maintenance of the integrity of the velopharyngeal mechanism. Hyponasality was eliminated in 5 patients with Crouzon's disease. On cephalometric study, it was observed that after maxillary advancement the nasopharyngeal volume was expanded and the angle formed by the hard and soft palates was increased. On phonating cephalograms, the velopharyngeal contact became more physiological after maxillary advancement in the craniofacial dysostosis patient. The only postoperative articulatory changes after maxillary advancement were in the production of the /s/ sound, which is particularly sensitive to changes in dentoalveolar relationships.     

A comparison of the craniofacial morphology in 2-month-old unoperated infants with unilateral complete cleft lip and palate, and unilateral incomplete cleft lip.

This paper reports a cephalometric analysis of the craniofacial morphology in infants with unoperated unilateral complete cleft lip and palate (UCCLP) and unoperated unilateral incomplete cleft lip (UICL). The purpose of the study was to determine the nature and extent of the craniofacial deviations in UCCLP as compared to the morphology in UICL, which has previously been shown to be close to normal. The samples comprised 82 infants with UCCLP (58 males and 24 females) and 75 with UICL (48 males and 27 females). The mean age was about 2 months in both groups. The cephalometric analysis of craniofacial morphology included the lateral, frontal, and axial projections. The data were presented as mean plots of the craniofacial region including the calvaria, cranial base, orbits, nasal bone, maxilla, mandible, cervical column, pharynx, and soft-tissue profile. The most pronounced deviations in the UCCLP group were observed in the maxillary complex and the mandible. The most striking findings were: markedly increased width of the maxilla, a short mandible, and bimaxillary retrognathia except for the premaxillary area, which was relatively protruding and asymmetric. The study did not support the hypothesis previously suggested in the literature that cleft lip and palate is a craniofacial anomaly as size and shape of the calvaria and cranial base were found to be normal. The etiology of cleft lip and palate is still incompletely understood. Based on the present study, we suggest that facial type may be a liability factor that could represent a developmental threshold increasing the probability of cleft lip and palate.     

Simulation of bone remodelling in orthodontic treatment

Orthodontic treatments not only displace irregular teeth but also induce responses in surrounding bone tissues. Bone remodelling is regarded as the regulatory mechanism triggered by mechanical loading. This study was aimed at investigating the effect of orthodontic loading on both tooth movement and neighbouring bone density distribution. A set of computational algorithms incorporating both external and internal remodelling mechanisms was implemented into a patient-specific 3D finite element (FE) model to investigate and analyse orthodontic treatment under four typical modes of orthodontic loading. The consequence of orthodontic treatment was reproduced numerically by using this FE-based technique. The results indicated that the diverse modes of orthodontic loading would result in different magnitudes of tooth movement and particular morphology of bone density distribution. It is illuminated that the newly developed algorithms may replicate the clinical situation more closely compared with the previous proposed method.     

Three-dimensional analysis of orthodontic tooth movement

A three-dimensional finite element model was used to investigate the biomechanical response of an upper canine tooth. The physical model was developed from ceramic replicas and X-rays, and consisted of cancellous and cortical bone, the periodontal ligament, dentine and pulp chamber. Horizontal forces were applied at the tip of the crown and at the cervical margin and a rotational force was applied at the cervical margin of the tooth crown. The resulting displacements and stress field for each load case are presented with particular emphasis being placed on the response of the periodontal ligament. The investigation shows that quantitative information on initial tooth movement can be accurately predicted and used to evaluate the response of orthodontic treatment.     

Distribution of craniofacial variables in south Dalmatian and middle Croatian populations

The objective of the present work was to determine some relevant craniofacial parameters, particularly in relation to sex, for the study of the distribution of basic head and face types, and to investigate craniofacial and morphological differences between two population samples. The study sample comprised 100 subjects of both sex aged 18 to 30 from South Dalmatia and 200 subjects from Middle Croatia. Eight basic craniofacial variables were measured to obtain head, forehead and face indexes. The data indicate that average values of all variables can be used as standard craniofacial parameters for the examined population groups. All the craniofacial variables are considerably higher in men than in women (p < 0.05). In the South Dalmatian population mesocephalia (48.0%) and leptoprosopia (82.0%) prevail, while in the Middle Croatian population the brachycephalia (62.0%), and euriprosopia (73.5%) are present to a greater degree. The most significant craniofacial and morphological differences between the examined study samples are head width (Eu-Eu), face width (Zy-Zy), and forehead height (Tr-N). They were found to be statistically significant in the examined Middle Croatian population (p < 0.05). The presented measurements are highly relevant to orthodontic diagnostics and therapy.     

Craniofacial growth in subjects with unilateral complete cleft lip and palate, and unilateral incomplete cleft lip, from 2 to 22 months of age

This paper reports a longitudinal quantitative cephalometric analysis of the craniofacial growth in subjects with unilateral complete cleft lip and palate (UCCLP), and unilateral incomplete cleft lip (UICL), from 2 to 22 months of age. The purpose of the study was to determine the amount and direction of growth in UCCLP compared to UICL (control group) from 2 months of age (just prior to lip repair) to 22 months of age, 20 months later. The sample comprised of 49 subjects with UCCLP (37 males and 11 females) and 45 with UICL (29 males and 16 females). The cephalometric analysis of the craniofacial morphology included lateral, frontal, and axial projections. The data were presented as mean plots of the craniofacial region including the calvaria, cranial base, orbits, nasal bone, maxilla, mandible, cervical column, pharynx, and soft-tissue profile. A valid common coordinate system (registration according to the n-s line in the lateral projection, latero-orbitale line in the frontal projection, and meatus acusticus externus line in the axial projection for the landmark positions at examination 1 and 2) was ascertained. The growth at a specific anatomical location in a patient was defined as the displacement vector from the coordinate of the corresponding landmark in the X-ray at examination 1 to its coordinate at examination 2, corrected for X-ray magnification. The growth of an anatomical region in a patient was assessed by investigating the growth pattern formed by a collection of individual growth vectors in that region. The amount of growth in the UCCLP and UICL group was very similar. The general craniofacial growth pattern, in terms of the direction of growth, was also fairly similar in the UCCLP group and the control group. However, the maxilla and mandible showed a more vertical growth pattern than that observed in the control group. This study confirms that UCCLP is a localized deviation, and not a craniofacial anomaly, due to the fact that a normal growth potential has been observed in all craniofacial regions, except where the growth had been directly influenced by surgical intervention. Furthermore, the vertical growth pattern of the maxilla and mandible supports the hypothesis of a special facial type in cleft lip and palate individuals, and the facial type as a liability factor increasing the probability of cleft lip and palate.     

Neural crest cell survival is dependent on Rho kinase and is required for development of the mid face in mouse embryos

Neural crest cells (NCC) give rise to much of the tissue that forms the vertebrate head and face, including cartilage and bone, cranial ganglia and teeth. In this study we show that conditional expression of a dominant-negative (DN) form of Rho kinase (Rock) in mouse NCC results in severe hypoplasia of the frontonasal processes and first pharyngeal arch, ultimately resulting in reduction of the maxilla and nasal bones and severe craniofacial clefting affecting the nose, palate and lip. These defects resemble frontonasal dysplasia in humans. Disruption of the actin cytoskeleton, which leads to abnormalities in cell-matrix attachment, is seen in the RockDN;Wnt1-cre mutant embryos. This leads to elevated cell death, resulting in NCC deficiency and hypoplastic NCC-derived craniofacial structures. Rock is thus essential for survival of NCC that form the craniofacial region. We propose that reduced NCC numbers in the frontonasal processes and first pharyngeal arch, resulting from exacerbated cell death, may be the common mechanism underlying frontonasal dysplasia.