A three-dimensional cephalometric analysis of Japanese adults and its usefulness in orthognathic surgery: A retrospective study

Yoshikawa, Hiroshi; Tanikawa, Chihiro; Ito, Shinsuke; Tsukiboshi, Yosuke; Ishii, Hitomi; Kanomi, Ryuzo; Yamashiro, Takashi

doi:10.1016/j.jcms.2022.02.002

Cited by 9 publications

(10 citation statements)

References 35 publications

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“…3DCA is poorly described in the literature, and no general consensus has been reached regarding standard landmarks and measurements to adopt [8,11,13,17]. To our knowledge, no study describes a 3D cephalometric analysis to be employed as a diagnostic and planning tool with a focus on surgery-first approach.…”

Section: Discussionmentioning

confidence: 99%

“…On a literature basis, we selected 3D cephalometric measurements which transpose 2D cephalometry in a three-dimensional environment [8,9], adding new measurements which are purely three-dimensional [10][11][12][13]. Thus, we here introduce a 3DCA based on our clinical practice, by means of which we analysed a cohort of SF patients, with the aim of deepening our comprehension of the uncertain aspects in this approach.…”

Section: Open Accessmentioning

confidence: 99%

“…VOSP and PostOp 3D cephalometric measurements: Norm values (NORM)[8,9], Average (Avg), and Standard Deviation (S.D. )…”

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confidence: 99%

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Three-dimensional cephalometric outcome predictability of virtual orthodontic-surgical planning in surgery-first approach

et al. 2022

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Objectives The aim of this study is to introduce a novel 3D cephalometric analysis (3DCA) and to validate its use in evaluating the reproducibility of virtual orthodontic-surgical planning (VOSP) in surgery-first approach (SF) comparing VOSP and post-operative outcome (PostOp). Methods The cohort of nineteen patients underwent bimaxillary orthognathic surgery following the VOSP designed in SimPlant O&O software by processing cone-beam computed tomography (CBCT) scans and intraoral digital scanning of the dental arches. Said records were re-acquired once the post-operative orthodontic treatment was completed. The 3DCA was performed by three expert operators on VOSP and PostOp 3D models. Descriptive statistics of 3DCA measures were evaluated, and outcomes were compared via Wilcoxon test. Results In the comparison between cephalometric outcomes against planned ones, the following values showed significant differences: Wits Index, which suggests a tendency towards skeletal class III in PostOp (p = 0.033); decreased PFH/AFH ratio (p = 0.010); decreased upper incisors inclination (p < 0.001); and increased OVJ (p = 0.001). However not significant (p = 0.053), a tendency towards maxillary retroposition was found in PostOp (A/McNamara VOSP: 5.05 ± 2.64 mm; PostOp: 4.1 ± 2.6 mm). On average, however, when McNamara’s plane was considered as reference, a tendency to biprotrusion was found. Upper incisal protrusion was greater in PostOp as an orthodontic compensation for residual maxillary retrusion (VOSP: 5.68 ± 2.56 mm; PostOp: 6.53 ± 2.63 mm; p = 0.084). Finally, the frontal symmetry in relation to the median sagittal plane decreased in craniocaudal direction. Limitations A potential limit of studies making use of closest point distance analysis is represented by the complexity that surgeons and orthodontists face in applying this three-dimensional evaluation of SF accuracy/predictability to everyday clinical practice and diagnosis. Also, heterogeneity and limited sample size may impact the results of the study comparison. Conclusions The presented 3DCA offers a valid aid in performing VOSP and analysing orthognathic surgery outcomes, especially in SF. Thanks to the cephalometric analysis, we found that surgery-first approach outcome unpredictability is mainly tied to the sagittal positioning of the maxilla and that the transverse symmetry is progressively less predictable in a craniocaudal direction.

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Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

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Three-dimensional cephalometric outcome predictability of virtual orthodontic-surgical planning in surgery-first approach

et al. 2022

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“…Currently, many technologies (such as computed tomography (CT) [23,24], cone beam computed tomography (CBCT) [25], magnetic resonance imaging (MRI) [26,27], and facial scanning [28]) can provide high-resolution images without overlapping or distortion, which results in high-quality diagnostic images. In three-dimensional cephalometry, more landmarks, reference planes, and measurement parameters can be selected to enrich the analysis content of bone, soft tissue, and airway anatomy [29][30][31][32][33][34][35][36]. Measuring volumes (especially airway volumes) and visual asymmetry evaluation become possible.…”

Section: Introductionmentioning

confidence: 99%

The Reliability of Three-Dimensional Landmark-Based Craniomaxillofacial and Airway Cephalometric Analysis

et al. 2023

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Cephalometric analysis is a standard diagnostic tool in orthodontics and craniofacial surgery. Today, as conventional 2D cephalometry is limited and susceptible to analysis bias, a more reliable and user-friendly three-dimensional system that includes hard tissue, soft tissue, and airways is demanded in clinical practice. We launched our study to develop such a system based on CT data and landmarks. This study aims to determine whether the data labeled through our process is highly qualified and whether the soft tissue and airway data derived from CT scans are reliable. We enrolled 15 patients (seven males, eight females, 26.47 ± 3.44 years old) diagnosed with either non-syndromic dento–maxillofacial deformities or OSDB in this study to evaluate the intra- and inter-examiner reliability of our system. A total of 126 landmarks were adopted and divided into five sets by region: 28 cranial points, 25 mandibular points, 20 teeth points, 48 soft tissue points, and 6 airway points. All the landmarks were labeled by two experienced clinical practitioners, either of whom had labeled all the data twice at least one month apart. Furthermore, 78 parameters of three sets were calculated in this study: 42 skeletal parameters (23 angular and 19 linear), 27 soft tissue parameters (9 angular and 18 linear), and 9 upper airway parameters (2 linear, 4 areal, and 3 voluminal). Intraclass correlation coefficient (ICC) was used to evaluate the inter-examiner and intra-examiner reliability of landmark coordinate values and measurement parameters. The overwhelming majority of the landmarks showed excellent intra- and inter-examiner reliability. For skeletal parameters, angular parameters indicated better reliability, while linear parameters performed better for soft tissue parameters. The intra- and inter-examiner ICCs of airway parameters referred to excellent reliability. In summary, the data labeled through our process are qualified, and the soft tissue and airway data derived from CT scans are reliable. Landmarks that are not commonly used in clinical practice may require additional attention while labeling as they are prone to poor reliability. Measurement parameters with values close to 0 tend to have low reliability. We believe this three-dimensional cephalometric system would reach clinical application.

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“…Ethical issues prevent CBCT images from being obtained in cases of normal occlusion. To solve this problem, a previous study 7 sampled patients who underwent CBCT for non-skeletal problems (e.g., impacted teeth) in private orthodontic clinics using a propensity score to match these patients with a historic cohort in a report that included cephalograms of individuals with normal occlusion. A previous study also calculated the optimal sample size (n = 56) to represent the population corresponding to individuals with normal occlusion based on a power analysis with the ANB angle from a total of approximately 1000 patients 7 .…”

Section: Introductionmentioning

confidence: 99%

Sex differences in airway volume and 3-dimensional shape in Japanese adults

Tanikawa,

Oka,

Shiraishi

et al. 2023

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Abstract(1) To establish normative data for three-dimensional (3D) measurements of the upper airway in young Japanese adults, and (2) to investigate sex-related differences in linear and volumetric measurements, as well as shape. This study employed cone-beam computed tomography (CBCT) images of 56 Japanese young adults preselected from among 1000 patients, so that samples matched a historic 2D cephalometric cohort with normal occlusion using propensity score matching. Three-dimensional models of the oropharynx and hypopharynx were reconstructed from CBCT images and their volumes were calculated. We defined 20 landmarks on the surface of the 3D model and performed seven linear measurements between them. The mean and standard deviation of the linear measurements were calculated as the normative data for each sex as well as the volumes. Sex-related differences were analyzed using t-test (p < 0.05). Principal component discriminant analysis of the coordinate values of the landmarks was also performed to examine sex differences in shape. The normative ranges of the 3D measurements of the oropharynx and hypopharynx were determined according to sex. Sex-related differences in the measurement results were observed in hypopharyngeal length but not in volume. The hypopharynx length in males was significantly longer than that in females. The discriminant analysis showed that males tended to show longer and straight shapes, while females showed inversed triangular shapes from the frontal view. This result will allow clinicians to evaluate how patient airway characteristics differ from the normative 3D morphology of the upper airway.

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A three-dimensional cephalometric analysis of Japanese adults and its usefulness in orthognathic surgery: A retrospective study

Cited by 9 publications

References 35 publications

Three-dimensional cephalometric outcome predictability of virtual orthodontic-surgical planning in surgery-first approach

Three-dimensional cephalometric outcome predictability of virtual orthodontic-surgical planning in surgery-first approach

The Reliability of Three-Dimensional Landmark-Based Craniomaxillofacial and Airway Cephalometric Analysis

Sex differences in airway volume and 3-dimensional shape in Japanese adults

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