Nenad Nedeljkovic

Evaluation of Facial Beauty Using Anthropometric Proportions

The improvement of a patients facial appearance is one of the main goals of contemporary orthodontic treatment. The aim of this investigation was to evaluate the difference in facial proportions between attractive and anonymous females in order to establish objective facial features which are widely considered as beautiful. The study included two groups: first group consisted of 83 Caucasian female subjects between 22 and 28 years of age who were selected from the population of students at the University of Belgrade, and the second group included 24 attractive celebrity Caucasian females. The en face facial photographs were taken in natural head position (NHP). Numerous parameters were recorded on these photographs, in order to establish facial symmetry and correlation with the ideal set of proportions. This study showed significant difference between anonymous and attractive females. Attractive females showed smaller face in general and uniformity of the facial thirds and fifths, and most of the facial parameters meet the criteria of the ideal proportions.

Accuracy of Cameriere's third molar maturity index in assessing legal adulthood on Serbian population

At the moment, a large number of asylum seekers from the Middle East are passing through Serbia. Most of them do not have identification documents. Also, the past wars in the Balkan region have left many unidentified victims and missing persons. From a legal point of view, it is crucial to determine whether a person is a minor or an adult (≥18 years of age). In recent years, methods based on the third molar development have been used for this purpose. The present article aims to verify the third molar maturity index (I3M) based on the correlation between the chronological age and normalized measures of the open apices and height of the third mandibular molar. The sample consisted of 598 panoramic radiographs (290 males and 299 females) from 13 to 24 years of age. The cut-off value of I3M=0.08 was used to discriminate adults and minors. The results demonstrated high sensitivity (0.96, 0.86) and specificity (0.94, 0.98) in males and females, respectively. The proportion of correctly classified individuals was 0.95 in males and 0.91 in females. In conclusion, the suggested value of I3M=0.08 can be used on Serbian population with high accuracy.

[Dentaoalveolar changes in young adult patients with class II/1 malocclusion treated with the herbst appliance and an activator].

BACKGROUND/AIM Functional appliances can be used effectively in the treatment of skeletal Class II/1 malocclusions. The best treatment results are obtained during active period of facial growth when skeletal, as well as dentoalveolar, changes occur. In comparison with removable functional appliances, such as activator, that are effective only during adolescent period of growth, the Herbst fixed appliance is also successful at the end of the growth period. It also offers a shorter treatment time and a patient compliance is not necessary. The aim of this study was to analyze and compare dentoalveolar changes in the group of young adult patients with Class II/1 malocclusion treated with the Herbst appliance and an activator. METHODS The sample for this study consisted of 50 patients of both sexes, 14-21 years of age with Class II/1 malocclusion. For estimating the effect of functional appliances used, the following cephalometrics parameters were determined: inclination of the upper and lower incisors, interincisal angle, antero-posterior molars relationships, overjet and overbite. The results obtained were statistically tested. RESULTS The cephalometric findings after the treatment indicated retroinclination of upper incisors (average value of 9 degrees) and proclination of lower incisors (average value of 7 degrees), mostly expressed in the patients treated by Herbst appliance (p < 0.001). Increased overjet and distocclusion were completely corrected in the group of patients treated with the Herbst appliance, while the correction of malocclusion in the activator group was only partially accomplished. No changes in the overbite were noticed at the end of the treatment in both groups. CONCLUSION The results of this study revealed that the Herbst appliance is more effective in the treatment of Class II/1 malocclusion in young adults in comparison with the activator.

Changes in soft tissue profile following the treatment using a Herbst appliance--a photographic analysis.

BACKGROUND/AIM Aesthetics is the reason for most of the class II malocclusion patients to opt for orthodontic treatment. In order to regulate retrognathic profile Herbst appliance for anterior movement of the mandible can be a treatment of choice. The aim of this study was to determine the soft tissue profile changes following Herbst appliance therapy on before and after treatment photos, using the computer program. METHODS This investigation was performed on profile photographs of 20 class II patients (12 females and 8 males) aged 18-23 years. Analysis of the changes in soft tissue facial structure relationships evident on the photographs before and after the Herbst appliance therapy was performed using Bentley Micro Station program. The first contour of the soft tissue profile was marked. The following reference lines were subsequently traced: Ricketts aesthetic E line and Juanita line. The area enclosed by these two lines included the nose, upper and lower lip, chin and free space in front of the lips. Using the computer program, the surfaces of the soft tissue structures and free space defined by the reference lines and profile contours were measured. Calculation of the relative proportion of surfaces was done for each photograph. The data obtained were then compared for each patient before and after the treatment. Skeletal and dentoalveolar treatment effects that support soft tissue changes were presented by the profile cephalometric parameters of sagital occlusion (SO) analysis. RESULTS A reduction in the relative surface of the upper lip in males (p < 0.01) and females (p < 0.05) was shown by the pictures. The space occupied by the chin was reduced after the treatment for females only (p < 0.05). The relative surface of the nasal soft tissues, that was included in the reference space was increased (p < 0.01) in both genders. The relationship between the soft tissue and empty surface was changed in favor of the empty surface (p < 0.05) in females. No statistically significant differences were found between the males and the females, before or after the Herbst appliance therapy. The soft tissue changes were the consequence of skeletal and dentoalveolar treatment effects: upper incisors retrusion, lower incisor protrusion and forward movement of the lower jaw. CONCLUSIONS The Herbst appliance therapy caused a significant improvement of the profile appearance. The extent of soft tissue changes that occur on its dentoalveolar and skeletal support is a complex issue.

The third molars for indicating legal adult age in Montenegro

AIM From a medico-legal and penalty point of view, it is essential to conclude if an individual is a minor or an adult (18 years of age). Methods based on the third molar development have been used for this purpose. The present article aims to verify the Nollas stages of mineralization of the third molars and a third molar maturity index (I3M) which is based on the measures of the projections of open apices normalized by their height in the sample of Montenegrins. METHOD AND SAMPLE The sample consisted of 683 panoramic radiographs (324 males and 359 females) between 13 and 24 years of age. The specific mineralization stages of Nolla and the cut-off value of I3M < 0.08 was used to discriminate adults and minors. RESULTS The best performance in discriminating adults and minors was for I3M < 0.08 followed by the Nolla stage 9. For I3M < 0.08 the results demonstrated high sensitivity of 0.92 and 0.82 and specificity of 0.94 and 0.96 in males and females, respectively. The proportions of correctly classified individuals were 0.93 in males and 0.89 in females. The Nolla stage 9 demonstrated the sensitivity of 0.95 and 0.85 and the specificity of 0.84 and 0.90 in males and females, respectively. The proportions of correctly classified individuals were 0.90 in males and 0.87 in females. CONCLUSION The suggested value of I3M < 0.08 followed by Nolla stage 9 can be used to discriminate adults from minors with high specificity.

Radiographic assessment of lower third molar eruption in different anteroposterior skeletal patterns and age-related groups

OBJECTIVE To analyze radiographic predictors for lower third molar eruption among subjects with different anteroposterior skeletal relations and of different age groups. MATERIALS AND METHODS In total, 300 lower third molars were recorded on diagnostic digital orthopantomograms (DPTs) and lateral cephalograms (LCs). The radiographs were grouped according to sagittal intermaxillary angle (ANB), subject age, and level of lower third molar eruption. The DPT was used to analyze retromolar space, mesiodistal crown width, space/width ratio, third and second molar angulation (α, γ), third molar inclination (β), and gonion angle. The LC was used to determine ANB, angles of maxillar and mandibular prognathism (SNA, SNB), mandibular plane angle (SN/MP), and mandibular lengths. A logistic regression model was created using the statistically significant predictors. RESULTS The logistic regression analysis revealed a statistically significant impact of β angle and distance between gonion and gnathion (Go-Gn) on the level of lower third molar eruption (P < .001 and P < .015, respectively). The retromolar space was significantly increased in the adult subgroup for all skeletal classes. The lower third molar impaction rate was significantly higher in the adult subgroup with the Class II (62.3%) compared with Class III subjects (31.7%; P < .013). CONCLUSION The most favorable values of linear and angular predictors of mandibular third molar eruption were measured in Class III subjects. For valid estimation of mandibular third molar eruption, certain linear and angular measures (β angle, Go-Gn), as well as the size of the retromolar space, need to be considered.

Orthodontic treatment of nongrowing patient with class II division 2 malocclusion by Herbst appliance

BACKGROUND Inheritance is most casual etiological factor of Class II division 2 malocclusion. This kind of malocclusion is very difficult for treatment specially in older patients. CASE REPORT In the female patient, 20 years old, at the beginning of the treatment at the School of Dentistry in Belgrade, lateral cephalogram showed skeletal and dentoalveolar Class II division 2 malocclusion. She was in the Herbst treatment for 8 months and 12 months more with a fixed multibracket appliance. The measurements were performed on lateral cephalograms before and after the treatment: ii, is, mi, ms, Pg and ss. The distance from these points to occlusal perpendicular line (Olp) were measured and compared from cephalogram before to cephalogram after the treatment. Temporomandibular joint (TMJ) tomograms were compared from before and after the treatment by superimposition. Correction was found in molar and incisor relation, overjet and overbite. There were found sagital skeletal changes and soft tissue profile improvement. CONCLUSION Herbst appliance is effective in the treatment of Class II malocclusions, even in adult patients. Dental and skeletal changes as a result of Herbst treatment could be good choice instead of camouflage orthodontics or surgical decision.

Facial profile esthetics change of class II malocclusion patients treated with the Herbst appliance as perceived by orthodontists and laypersons

Today’s orthodontic patients are mainly concerned about the esthetic outcome of the treatment, given the fact that their facial esthetics is jeopardized by a different type of malocclusion [1, 2]. The class II malocclusion deeply affects facial harmony and changes the patient’s appearance. For the majority of class II patients, esthetic issues such as convex profile and retruded chin are the chief complaints when seeking orthodontic treatment and thus of primary importance [3]. Among various treatments of the class II malocclusion, combined orthodontics twophase treatment which includes the Herbst and multibracket appliances provides significant skeletal changes, especially in adolescents and young adults, and highly improves the soft-tissue profile of these patients [4, 5, 6]. This fixed functional appliance straightens the facial profile due to the sagittal mandibular growth and has high efficiency even after the adolescent period. This appliance can be considered as an alternative to orthognathic surgery in adult patients, especially hesitating ones [7, 8]. Patients with less severe profile convexity problems are reluctant to accept surgical procedure, given the fact that problems like teeth alignment, large overjet, and beauty of the smile and face can be successfully treated with the fixed functional appliance. Therefore, for adult patients whose main concern is not their profile, the Herbst appliance can be considered a reliable alternative to orthognathic surgery [6]. Facial attractiveness is a complex issue, especially among adolescents, who tend to be strongly concerned about their facial appearance [9]. The recognition of differences in individual assessment of facial attractiveness could be valuable assistance in planning the orthodontic treatment. Several studies have shown that the perception of facial attractiveness differs between patients, peers, and dental professionals [10, 11, 12]. Some studies showed orthodontists being more generous than laypersons [13–17], assumingly based on their clinical experience, while others reported agreement between evaluators of different professions [18, 19]. Nevertheless, prior knowledge of the treatReceived • Примљено: September 26, 2016

The characteristics of craniofacial and cervicovertebral morphology in different genetic syndromes – a literature review and three case reports

Craniofacial and cervicovertebral anomalies can occur primarily as a result of alterations in the embryonic development or secondary after birth as a result of pathologic processes or through trauma. 1 ABSTRACT Introduction: Patients with genetic syndromes were characterized by variety of skeletal craniofacial and cervicovertebral morphology. Skeletal anomalies are recognized concomitants of the various genetic syndromes. The aim of the study was to review the current literature on this topic and to present the characteristics of craniofacial and cervicovertebral morphology and subsequent anomalies in three patients with Crouzon syndrome, Treacher Collins syndrome and cleidocranial dysplasia. Materials and methods: A comprehensive electronic search was performed using PubMed via Medline, Web of Science and SCOPUS. A manual search involved references form articles retrieved for possible inclusion. There were no restrictions as to date of publication, study design or language. The search, evaluation of relevant articles, and their critical appraisal were performed by two independent judges. Discrepancies between reviewers were resolved through a consensus with a third party. Case reports: Additionally, this paper presents a radiographic analysis of craniofacial and cervicovertebral morphology in patients with cleidocranial dysplasia, Crouzon, and Treacher Collins syndromes. The most characteristic findings of cervicovertebral morphology were the presence of cervical spine fusions in all three patients. The intervertebral fusions in patients with Crouzon and Treacher Collins syndromes have been characterized with “block vertebrae”. Cervicovertebral complex of the patient with cleidocranial dysplasia is characterized by delayed mineralization of vertebral bodies (C1–C7). Results: Although craniofacial and cervicovertebral anomalies in presented syndromes have different phenotype expression, the vast majority of cases are caused by mutations in specific, syndrome-related genes (FGFR2, FGFR3, RUNX2, TCOF1, POLR1C, POLR1D). Craniofacial anomalies, that include changes in development of hard and soft tissues, were considered as traditional concomitant of presented syndromes. Apart from these changes, cervicovertebral region could also be affected. Recent reports show different changes in vertebral structure (delayed mineralization) and unphysiological relations (cervical spine fusions). Conclusion: The limitation of cervical range of motion resulting from these anomalies may have clinical significance on multidisciplinary management approach in these patients. Recent progress in dentistry resulted in better diagnostic and therapeutic options and outcomes for individuals with genetic syndromes.

Changes in Cervical Lordosis and Cervicovertebral Morphology in Different Ages with the Possibility of Estimating Skeletal Maturity.

INTRODUCTION During growth, proportions of craniofacial and cervical structures are changed. Craniofacial and cervicovertebral structures are morphologically and functionally connected, but their each others influence is still unknown. OBJECTIVE The aim of this study was to determine the changes in cervical lordosis and cervicovertebral morphology in different age periods and the possibility of estimating skeletal maturity, based on the percentage of anterior cervical vertebrae body height sum in the total anterior C2-C5 height. METHODS The study included lateral radiographs of 120 patients of both sexes, divided into three different age groups: eight, 12-13 and 17-18 years of age. Five craniofacial and 15 cervical parameters were measured and analyzed. RESULTS The results showed significant correlation between cervical lordosis angle and age, gender, anterior and posterior body height of C3, C4, C5, anterior C4-C5 and posterior C2-C3, C3-C4, C4-C5 intervertebral space, anterior body height of C2-C5. Overall values of all cervical body heights were more present in the total height of the spine in females, while all intervertebral spaces were more present in males. The percentage of anterior and posterior C2, C3, C4, C5 body height sum compared to total C2-C5 height increases with age. CONCLUSION The cervical lordosis becomes more curved and vertebral bodies occupy more space in females, while intervertebral spaces occupy more in males. Skeletal maturity could be estimated following vertebral percentage distribution in the total anterior C2-C5 part.