Analysis of reliability, accuracy, sensitivity and predictive value of a subjective method to classify facial pattern in adults

Abstract

Introduction: Craniofacial pattern diagnosis is vital in Orthodontics, as it influences decision-making regarding treatment options and prognosis. Capelozza Filho proposed a subjective method for facial classification comprising five patterns: I, II, III, Long Face and Short Face. Objective:To investigate the accuracy of a subjective classification method of facial patterns applied to adults. Methods:A sample consisting of 52 adults was used for this study. Frontal and lateral view photographs were taken with subjects at rest position, including frontal smile. Lateral cephalometric radiographs were organized in a PowerPoint® presentation and submitted to 20 raters. Method performance was assessed by examining reproducibility with Kappa test and calculating accuracy, sensitivity and positive predictive values, for which 70% was set as critical value. The gold standard of the classification was personally set by the author of the method. Results: Reproducibility was considered moderate (Kappa = 0.501); while accuracy, sensitivity and positive predictive values yielded similar results, but below 70%. Conclusions:The subjective method of facial classification employed in the present study still needs to have its morphological criteria improved in order to be used to discriminate the five facial patterns.

Mandibular advancement analysis among orthodontists, lay people and patients in class II malocclusion subjects. A three‐dimensional imaging study

“…When evaluating the method error of the 3D images used, it was observed that most of the analyses performed showed a concordance of moderate or good, attesting to the fact that the 3D images obtained by a light scanner have a satisfactory replicability for clinical use. However, this subjective diagnosis does not seem to be replicated with accuracy, a fact already reported in the literature in studies using 2D images 19,21 . A recent study has shown that Fr__nkel manoeuvre was less reproducible when performed on 3D records than on 2D pictures 22 .…”

“…However, this subjective diagnosis does not seem to be replicated with accuracy, a fact already reported in the literature in studies using 2D images. 19,21 A recent study has shown that Frӓnkel manoeuvre was less reproducible when performed on 3D records than on 2D pictures. 22 It is possible that this greater variability in 3D images can be explained by the fact that this method provides greater detail of information, including features that cannot be viewed in 2D images.…”

“…Some studies 8,14 have examined the impact of mandibular advancement in these patients, reporting that orthodontists, lay people and patients themselves differently assessed the facial profile of class II individuals with mandibular deficiency; but the analysis was performed using two-dimensional methods such as the viewing of photographs which have several limitations 14 and may not represent a three-dimensional (3D) effect analysis of the observed gain as those one provided by the tomography or light scanner which are capable of contributing to a more reliable analysis of facial aesthetics and allow a complete observation of soft tissues. [15][16][17][18][19] Thus, our aim was to comparatively evaluate the acceptance and perception of orthodontists, laypeople and patients themselves after mild-to-moderate progressive mandibular advancements in class II patients with mandibular retrognathism. The null hypothesis is that there is no perception difference between the evaluators group.…”

“…The methodology used for this analysis is two‐dimensional photographs or silhouettes. Some studies 8,14 have examined the impact of mandibular advancement in these patients, reporting that orthodontists, lay people and patients themselves differently assessed the facial profile of class II individuals with mandibular deficiency; but the analysis was performed using two‐dimensional methods such as the viewing of photographs which have several limitations 14 and may not represent a three‐dimensional (3D) effect analysis of the observed gain as those one provided by the tomography or light scanner which are capable of contributing to a more reliable analysis of facial aesthetics and allow a complete observation of soft tissues 15‐19 …”

Temporomandibular Disorders at the Preoperative Time of Orthognathic Surgery

“…Profile I is a straight profile, and profile II presents a negative step between the maxilla and mandible corresponding to patients with mandibular retrognathism. Profile III presents a positive step between the maxilla and mandible, thereby indicating anteroposterior maxillary deficiency, mandibular prognathism, or both [ 18 ]. They were also evaluated to consider mandibular asymmetry (higher than 4 mm) and vertical facial patterns: an anterior open bite, vertical maxillary excess, and vertical maxillary deficiency.…”