• 대한치과교정학회지
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• 제45권6호
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• pp.308-321
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• 2015

Objective: The efficacy of mandibular advancement devices (MADs) in the treatment of obstructive sleep apnea (OSA) ranges between 42% and 65%. However, it is still unclear which predictive factors can be used to select suitable patients for MAD treatment. This study aimed to systematically review the literature on the predictive value of cephalometric analysis for MAD treatment outcomes in adult OSA patients. Methods: The MEDLINE, Google Scholar, Scopus, and Cochrane Library databases were searched through December 2014. Reference lists from the retrieved publications were also examined. English language studies published in international peer-reviewed journals concerning the predictive value of cephalometric analysis for MAD treatment outcome were considered for inclusion. Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies. Results: Fifteen eligible studies were identified. Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters. Conclusions: Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment. To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed.

• Imaging Science in Dentistry
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• 제32권4호
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• pp.213-219
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• 2002

Purpose : Computed radiography (CR) has been used in cephalometric radiography and many studies have been carried out to improve image quality using various digital enhancement and filtering techniques, During CR image acquisition, the frequency rank and type affect to the image quality. The aim of this study was to compare the diagnostic quality of conventional cephalometric radiographs to those of computed radiography. Materials and Methods : The diagnostic quality of conventional cephalometric radiographs (MO) and their digital image counterparts were compared, and at the same time, six modalities (M1-M6) of spatial frequency-processed digital images were compared by evaluating the reproducibility of 23 cephalometric landmark locations. Reproducibility was defined as an observer's deviation (in mm) from the mean between all observers. Results and Conclusion: In comparison with the conventional cephalometric radiograph (MO), Ml showed statistically significant differences in 8 locations, M2 in 9, M3 12, M4 in 7, M5 in 12, and M6 showed significant differences in 14 of 23 landmark locations (p < 0.05). The number of reproducible landmarks that each modality possesses were 7 in M6, 6 in M5, 5 in M3, 4 in M4, 3 in M2, 2 in Ml, and 1 location in MO. The image modality that observers selected as having the best image quality was M5.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권2호
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• pp.149-165
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• 1999

The pathomechanism of obstructive sleep apnea(OSA) is not clearly elucidated. The possible mechanisms are pathologic reduction of pharyngeal muscular tonus during sleep, abnormal anatomical stenosis of nasopharyx or a combination of the above two mechanisms. It is very important to find the cause(anatomical location or pathologic dynamic change) of OSA in order to treat it. Cephalometric analysis in patients with obstructive sleep apnea is a good method for evaluating anatomical morphologic change but it cannot give any information about the dynamic changes occurring during sleep. On the contrary, nasopharyngeal endoscopy offer 3 dimensional image and information about the dynamic changes. Accordingly, these two diagnostic tools can be utilize in the diagnosis and treatment planning of OSA Cephalometric analysis of craniofacial skeletal and soft tissue morphology in 53 patients with OSA and 43 controls was performed and cephalometric analysis and nasopharygeal endoscopy were performed in 9 patients with OSA in order to come up with individualized therapy plans. Following results were obtained ; Patients with OSA showed 1. body weight gain 2. clockwise mandibular rotation 3. increased anterior lower facial height 4. inferiorly positioned hyoid bone 5. increased length of soft palate 6. decreased sagittal dimension of nasopharyx 7. increased vertical length of inferior collapsable nasopharyx 8. increased length of tongue Through cephalometric analysis and nasopharygeal endoscopy(mutually cooperative in diagnosis), 9. one can find the possible origin of OSA and make a adequate individualized therapy plan and predict accurate prognosis. Cephalometric analysis and nasopharygeal endoscopy are highly recommended as a diagnostic aid in OSA patients

• 치과방사선
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• 제11권1호
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• pp.23-32
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• 1981

The purpose of this study was to assess temporomandibular joint subluxation by means of cephalometry using two lateral cephalograms from each person with in centric occlusion and wide-open mouth position, and to compare patient group with subluxation to normal control group in the measurements and correlation coefficient. The 200 cephalograms of 100 Korean adults, patient group consisted of 24 females and 26 males ranged from 17 to 63 years age and the normal control group consisted of 20 females and 30 males ranged from 18 to 56 years age, were studied and analyzed statistically. The results were as follows; 1. In the comparison of patient group vs normal control group in the measurements, statistically significant differences were found in C-C', C'-PTM, K-FH, K-PTM, Gn-Gn', C-S-C', Gn-S-Gn', Gn-K-Gn', GoGn-SN, and GoGn-Go'Gn'. K-point* of patient group was located antero - superiorly than of normal control group, and the significance level was higher in K-PTM than in K-FH. There was no statistically significant difference found in local relationship of C-point between patient group and normal control group. The values of correlation coefficient among all measurements were in 0.958≥r≥-0.760, and the highest value was in Gn-Gn' to GoGn-Go'Gn' and Gn-K-Gn' to Gn-Gn', and the lowest value was in C'-PTM to Gn-K-Gn' of normal control group. K was determined as a point of intersection by a perpendicular bisector of Gn-Gn' and a perpendicular bisector of C-C'.

• 대한소아치과학회지
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• 제25권1호
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• pp.197-208
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• 1998

This study was carried out to compare the amount of the maxillary bone remodeling and tooth displacement in each three maxillary superimposition methods, Ricketts, Best-fit, Structural method. Forty cases of the lateral cephalometric radiographs from 27 boys and 13 girls who had been treated to correct anterior cross-bite were selected for the study. The initial radiographs were taken at about 8-year-old and the second radiographs were taken in about 3.3 years later. Followings were the results: 1. With the Structural method, backward movement was shown in PNS, while forward movement was observed in ANS and point A. With the Ricketts method, however, all structures were shown significant backward movement comparing with Structural method(P<0.05). With the Best-fit method, the amount of horizontal movement was similar to that of the Structural method(P>0.05). 2. The palate seemed to be moved downward with Structural method, but there was no measured downward remodeling on nasal floor with Ricketts and Best-fit method(P<0.05). 3. Comparing with Structural method, Ricketts and Best-fit method significantly underestimated the eruption of the teeth by 20% to 30% (P<0.05). 4. The Structural method showed the anteroinferior rotation (43%) and posteroinferior rotation(57%) of the palatal plane, while the Best-fit method showed mostly anterosuperior rotation(87%), but no change was found in the Ricketts method. 5. With the Structural method, there was a statistically significant correlation between the amount of the rotation of the palatal plane and that of N-S line(r=0.86). 6. The measured angles of the long axis of the incisors and molars showed no significant difference in each 3 methods(P>0.05).

• Imaging Science in Dentistry
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• 제50권4호
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• pp.339-346
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• 2020

Purpose: The purpose of this study was to evaluate the image quality, diagnostic efficacy, and radiation dose associated with the use of a cadmium telluride (CdTe) detector, compared to charge-coupled device (CCD) and complementary metal oxide semiconductor(CMOS) detectors. Materials and Methods: Lateral cephalographs of a phantom (type 1) composed of synthetic polymer filled with water and another phantom (type 2) composed of human skull macerated with polymer coating were obtained with CdTe, CCD, and CMOS detectors. Dosimeters placed on the type 2 phantom were used to measure radiation. Noise levels from each image were also measured. McNamara cephalometric analysis was conducted, the dentoskeletal configurations were assessed, and a subjective evaluation of image quality was conducted. Parametric data were compared via 1-way analysis of variance with the Tukey post-hoc test, with a significance level of 5%. Subjective image quality and dentoskeletal configuration were described qualitatively. Results: A statistically significant difference was found among the images obtained with the 3 detectors(P<0.05), with the lowest noise level observed among the images obtained with the CdTe detector and a higher subjective preference demonstrated for those images. For the cephalometric analyses, no significant difference (P>0.05) was observed, and perfect agreement was seen with regard to the classifications obtained from the images acquired using the 3 detectors. The radiation dose associated with the CMOS detector was higher than the doses associated with the CCD (P<0.05) and CdTe detectors(P<0.05). Conclusion: Considering the evaluated parameters, the CdTe detector is recommended for use in clinical practice.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권6호
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• pp.427-435
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• 2022

Background: This study aimed to investigate the relationship between pharyngeal morphology and the success or failure of blind nasotracheal intubation using standard lateral cephalometric radiography and to analyze the measurement items affecting the difficulty of blind nasotracheal intubation. Methods: Assuming a line perpendicular to the Frankfort horizontal (FH) plane, the reference point (O) was selected 1 cm above the posterior-most end of the hard palate. A line passing through the reference point and parallel to the FH plane is defined as the X-axis, and a line passing through the reference point and perpendicular to the X-axis is defined as the Y-axis. The shortest length between the tip of the uvula and posterior pharyngeal wall (AW), shortest length between the base of the tongue and posterior pharyngeal wall (BW), and width of the glottis (CW) were measured. The midpoints of the lines representing each width are defined as points A, B, and C, and the X and Y coordinates of each point are obtained (AX, BX, CX, AY, BY, and CY). For each measurement, a t-test was performed to compare the tracheal intubation success and failure groups. A binomial logistic regression analysis was performed using clinically relevant items. Results: The items significantly affecting the success rate of blind nasotracheal intubation included the difference in X coordinates at points A and C (Odds ratio, 0.714; P-value, 0.024) and the ∠ABC (Odds ratio, 1.178; P-value, 0.016). Conclusion: Using binomial logistic regression analysis, we observed statistically significant differences in AX-CX and ∠ABC between the success group and the failure group.

• Imaging Science in Dentistry
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• 제52권3호
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• pp.239-244
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• 2022

Purpose: Despite the proliferation of numerous morphometric and anthropometric methods for sex identification based on linear, angular, and regional measurements of various parts of the body, these methods are subject to error due to the observer's knowledge and expertise. This study aimed to explore the possibility of automated sex determination using convolutional neural networks(CNNs) based on lateral cephalometric radiographs. Materials and Methods: Lateral cephalometric radiographs of 1,476 Iranian subjects (794 women and 682 men) from 18 to 49 years of age were included. Lateral cephalometric radiographs were considered as a network input and output layer including 2 classes(male and female). Eighty percent of the data was used as a training set and the rest as a test set. Hyperparameter tuning of each network was done after preprocessing and data augmentation steps. The predictive performance of different architectures (DenseNet, ResNet, and VGG) was evaluated based on their accuracy in test sets. Results: The CNN based on the DenseNet121 architecture, with an overall accuracy of 90%, had the best predictive power in sex determination. The prediction accuracy of this model was almost equal for men and women. Furthermore, with all architectures, the use of transfer learning improved predictive performance. Conclusion: The results confirmed that a CNN could predict a person's sex with high accuracy. This prediction was independent of human bias because feature extraction was done automatically. However, for more accurate sex determination on a wider scale, further studies with larger sample sizes are desirable.

• Journal of Oral Medicine and Pain
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• 제47권3호
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• pp.135-143
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• 2022

Purpose: This study aimed to evaluate polysomnographic and cephalometric characteristics of patients with OSA according to obesity level based on the World Health Organization (WHO) Asian-Pacific BMI criteria. Methods: One hundred and thirty-one consecutive patients with obstructive sleep apnea (OSA) were evaluated using standard level 1 polysomnography and cephalometric analyses. The subjects were categorized into normal, overweight and obese groups according to the WHO Asian-Pacific BMI criteria. Respiratory indices and cephalometric parameters were compared among groups. Results: The 131 patients consisted of 111 males and 20 females, with a mean age of 44.1±12.4 years. The mean value of BMI was 25.3±3.4 kg/m² for all subjects, 20.6±2.2 kg/m² for normal (n=27), 24.0±0.5 kg/m² for overweight (n=33) and 27.6±2.2 kg/m² for obese (n=71). The obese group had a significantly higher apnea-hypopnea index (AHI) and respiratory arousal index and lower oxygen saturation level than the normal group (p<0.05). Total AHI, mean oxygen saturation level and respiratory arousal index were significantly correlated with BMI (p<0.001). A longer soft palate and anterior position of the hyoid bone were significantly correlated with BMI level (p ≤0.05). Conclusions: Obese patients have a higher risk of compromised craniofacial skeletal features and soft tissue structures, and severe OSA than non-obese patients.

• Imaging Science in Dentistry
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• 제54권2호
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• pp.181-190
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• 2024

Purpose: This study compared sequential changes in skeletal stability and the pharyngeal airway following mandibular setback surgery involving fixation with either a titanium or a bioabsorbable plate and screws. Materials and Methods: Twenty-eight patients with mandibular prognathism undergoing bilateral sagittal split osteotomy by titanium or bioabsorbable fixation were randomly selected in this study. Lateral cephalometric analysis was conducted preoperatively and at 1 week, 3-6 months, and 1 year postoperatively. Mandibular stability was assessed by examining horizontal (BX), vertical (BY), and angular measurements including the sella-nasion to point B angle and the mandibular plane angle (MPA). Pharyngeal airway changes were evaluated by analyzing the nasopharynx, uvula-pharynx, tongue-pharynx, and epiglottis-pharynx (EOP) distances. Mandibular and pharyngeal airway changes were examined sequentially. To evaluate postoperative changes within groups, the Wilcoxon signed-rank test was employed, while the Mann-Whitney U test was used for between-group comparisons. Immediate postoperative changes in the airway were correlated to surgical movements using the Spearman rank test. Results: Significant changes in the MPA were observed in both the titanium and bioabsorbable groups at 3-6 months post-surgery, with significance persisting in the bioabsorbable group at 1 year postoperatively (2.29°±2.28°; P<0.05). The bioabsorbable group also exhibited significant EOP changes (-1.21±1.54 mm; P<0.05) at 3-6 months, which gradually returned to non-significant levels by 1 year postoperatively. Conclusion: Osteofixation using bioabsorbable plates and screws is comparable to that achieved with titanium in long-term skeletal stability and maintaining pharyngeal airway dimensions. However, a tendency for relapse exists, especially regarding the MPA.