OBJECTIVE: To evaluate the accuracy and reliability of the diagnostic tools available for assessing maxillary transverse deficiencies. METHODS: An electronic search of three databases was performed from their date of establishment to April 2015, with manual searching of reference lists of relevant articles. Articles were considered for inclusion if they reported the accuracy or reliability of a diagnostic method or evaluation technique for maxillary transverse dimensions in mixed or permanent dentitions. Risk of bias was assessed in the included articles, using the Quality Assessment of Diagnostic Accuracy Studies tool-2. RESULTS: Nine articles were selected. The studies were heterogeneous, with moderate to low methodological quality, and all had a high risk of bias. Four suggested that the use of arch width prediction indices with dental cast measurements is unreliable for use in diagnosis. Frontal cephalograms derived from cone-beam computed tomography (CBCT) images were reportedly more reliable for assessing intermaxillary transverse discrepancies than posteroanterior cephalograms. Two studies proposed new three-dimensional transverse analyses with CBCT images that were reportedly reliable, but have not been validated for clinical sensitivity or specificity. No studies reported sensitivity, specificity, positive or negative predictive values or likelihood ratios, or ROC curves of the methods for the diagnosis of transverse deficiencies. CONCLUSIONS: Current evidence does not enable solid conclusions to be drawn, owing to a lack of reliable high quality diagnostic studies evaluating maxillary transverse deficiencies. CBCT images are reportedly more reliable for diagnosis, but further validation is required to confirm CBCT's accuracy and diagnostic superiority.
Bias (Epidemiology) ; Cone-Beam Computed Tomography ; Dentition ; Diagnosis ; Methods* ; ROC Curve ; Sensitivity and Specificity

PURPOSE: This study aimed to measure the bilateral differences of facial lines in spherical coordinates from faces within a normal range of asymmetry utilizing cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT scans from 22 females with normal symmetric-looking faces (mean age 24 years and 8 months) were selected for the study. The average menton deviation was 1.01+/-0.66 mm. The spherical coordinates, length, and midsagittal and coronal inclination angles of the ramal and mandibular lines were calculated from CBCT. The bilateral differences in the facial lines were determined. RESULTS: All of the study subjects had minimal bilateral differences of facial lines. The normal range of facial asymmetry of the ramal and mandibular lines was obtained in spherical coordinates. CONCLUSION: The normal range of facial asymmetry in the spherical coordinate system in this study should be useful as a reference for diagnosing facial asymmetry.
Cone-Beam Computed Tomography ; Facial Asymmetry ; Female ; Humans ; Imaging, Three-Dimensional ; Reference Values

PURPOSE: This study aimed to investigate the deviation of landmarks from horizontal or midsagittal reference planes according to the methods of establishing reference planes. MATERIALS AND METHODS: Computed tomography (CT) scans of 18 patients who received orthodontic and orthognathic surgical treatment were reviewed. Each CT scan was reconstructed by three methods for establishing three orthogonal reference planes (namely, the horizontal, midsagittal, and coronal reference planes). The horizontal (bilateral porions and bilateral orbitales) and midsagittal (crista galli, nasion, prechiasmatic point, opisthion, and anterior nasal spine) landmarks were identified on each CT scan. Vertical deviation of the horizontal landmarks and horizontal deviation of the midsagittal landmarks were measured. RESULTS: The porion and orbitale, which were not involved in establishing the horizontal reference plane, were found to deviate vertically from the horizontal reference plane in the three methods. The midsagittal landmarks, which were not used for the midsagittal reference plane, deviated horizontally from the midsagittal reference plane in the three methods. CONCLUSION: In a three-dimensional facial analysis, the vertical and horizontal deviations of the landmarks from the horizontal and midsagittal reference planes could vary depending on the methods of establishing reference planes.
Facial Asymmetry ; Humans ; Orthognathic Surgery ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to compare asymmetric mandibular prognathism individuals with symmetric mandibular prognathism individuals using a new alternate spherical coordinate system. MATERIALS AND METHODS: This study consisted of 47 computed tomographic images of patients with mandibular prognathism. The patients were classified into symmetric and asymmetric groups. Mandibular and ramal lines were analyzed using an alternate spherical coordinate system. The length as well as midsagittal and coronal inclination angle of the lines was obtained. The bilateral differences of the spherical coordinates of the facial lines were statistically analyzed in the groups. RESULTS: There were significant differences between the groups in bilateral difference of the length and midsagittal inclination angle of the lines (p<0.05). The bilateral difference of the length and midsagittal inclination angle of the lines has significant correlation with chin deviation (p<0.05). CONCLUSION: The new alternate spherical coordinate system was able to effectively evaluate facial lines. The bilateral difference of lengths and midsagittal inclination of the facial lines might contribute to the facial asymmetry in mandibular prognathism individuals.
Chin ; Evaluation Studies as Topic ; Facial Asymmetry ; Humans ; Prognathism ; Tomography, X-Ray Computed