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Papers by rania nada

Research paper thumbnail of The suitability of panoramic radiographs for clinical decision making regarding root angulation compared to cone-beam computed tomography

BMC Medical Imaging

Background The study compared clinical decisions regarding root angulation correction and root pr... more Background The study compared clinical decisions regarding root angulation correction and root proximity based on the interpretation of Panoramic (PAN) versus Cone-Beam Computed Tomography (CBCT) images. Methods A total of 864 teeth from 36 existing, radiographic patient records at a university dental clinic with concurrent PAN and CBCT images were assessed using PANs, then using CBCTs in a blinded manner by two orthodontists. Teeth were rated regarding the need for root repositioning, the direction of repositioning and existence of root proximity. Frequencies, rating time and intra- and inter-examiner Cohen’s Kappa were calculated. Results There was 73.7–84.5% agreement between PAN-based and CBCT-based orthodontists’ decisions regarding the need to reposition roots. Root proximity was more frequently reported on PANs than CBCTs by one examiner (p = 0.001 and p = 0.168). Both PANs and CBCTs had moderate to substantial intra-examiner, within-radiograph-type reliability with Kappa val...

Research paper thumbnail of Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces

PeerJ

Background Stereophotogrammetry can be used to study facial morphology in both healthy individual... more Background Stereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate. Methods Thirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on no...

Research paper thumbnail of The Amalgamated Technique

Research paper thumbnail of Uniform 3D meshes to establish normative facial averages of healthy infants during the first year of life

PLOS ONE

Three-dimensional (3D) surface imaging systems are replacing direct anthropometry as the preferre... more Three-dimensional (3D) surface imaging systems are replacing direct anthropometry as the preferred method for capturing facial soft-tissues. Aims of this study were: (1) to develop normative average 3D faces of healthy infants aged 3, 6, 9, and 12 months and (2) to describe normative average 3D facial growth data in infants aged 3 to 12 months. Threedimensional images of 50 healthy children were acquired at 3, 6, 9, and 12 months of age using the 3dMDcranial system. Four average faces with uniform meshes (3, 6, 9, and 12 months) were developed and registered based on the children's reference frames. Distance maps of growth of the total facial surface and of the nose, upper lip, chin, forehead and cheeks for the intervals 3 to 6 months, 6 to 9 months, and 9 to 12 months of age were calculated. Mean growth of the total facial surface was 3.9 mm (standard deviation [SD] 1.2 mm), 3.5 mm (SD 0.9 mm), and 1.6 mm (SD 0.7 mm) at 3 to 6 months, 6 to 9 months, and 9 to 12 months, respectively. Regarding the selected regions of the face, the mean growth of the nose and upper lip were the largest (3.7 mm and 3.6 mm, respectively) between 6 and 9 months of age. The mean growth of the forehead, cheeks and chin were the largest (5.4 mm, 3.2, and 4.7 mm, respectively) between 3 and 6 months of age. For all facial regions, growth clearly diminished from 9 to 12 months of age. Normative data on the growth of the full face, nose, upper lip, chin, forehead and cheeks are presented. Such data can be used in future studies to identify the effectiveness of treatment of orofacial deformities such as orofacial clefts during the first year of life.

Research paper thumbnail of Influence of involuntary facial expressions on reproducibility of 3D stereophotogrammetry in children with and without complete unilateral cleft lip and palate from 3 to 18 months of age

Clinical oral investigations, Jan 25, 2018

To assess the influence of involuntary facial expressions on 3D facial stereophotogrammetry repro... more To assess the influence of involuntary facial expressions on 3D facial stereophotogrammetry reproducibility in children with and without unilateral cleft lip, alveolus and palate (UCLP) aged 3-18 months. Three to eight 3D facial images per time point were acquired within 10 min of 31 children with UCLP and 50 controls at 3, 12 and 18 months of age. 3D mapping of two 3D facial images per subject per age was performed. Distance kits of the full face and nasolabial area were calculated. In the total subject pool, mean variation between two 3D facial images ranged from 0.38-0.88 mm. There were no significant differences within groups for the various ages. Variation between controls and UCLP subjects did not differ significantly. Variation was higher in the nasolabial area than in the full face. The influence of involuntary facial expressions on the estimation of facial growth should not be underestimated, especially in the nasolabial region of UCLP subjects aged 3 months. To improve 3D ...

Research paper thumbnail of Regional facial asymmetries and attractiveness of the face

European journal of orthodontics, Dec 13, 2015

Facial attractiveness is an important factor in our social interactions. It is still not entirely... more Facial attractiveness is an important factor in our social interactions. It is still not entirely clear which factors influence the attractiveness of a face and facial asymmetry appears to play a certain role. The aim of the present study was to assess the association between facial attractiveness and regional facial asymmetries evaluated on three-dimensional (3D) images. 3D facial images of 59 (23 male, 36 female) young adult patients (age 16-25 years) before orthodontic treatment were evaluated for asymmetry. The same 3D images were presented to 12 lay judges who rated the attractiveness of each subject on a 100mm visual analogue scale. Reliability of the method was assessed with Bland-Altman plots and Cronbach's alpha coefficient. All subjects showed a certain amount of asymmetry in all regions of the face; most asymmetry was found in the chin and cheek areas and less in the lip, nose and forehead areas. No statistically significant differences in regional facial asymmetries ...

Research paper thumbnail of Rating dental arch relationships and palatal morphology with the EUROCRAN index on three different formats of dental casts in children with unilateral cleft lip and palate

Clinical oral investigations, Jan 13, 2015

The EUROCRAN index has been used in inter-center studies to assess dental arch relationship (DAR)... more The EUROCRAN index has been used in inter-center studies to assess dental arch relationship (DAR) and palatal morphology (PM) in children with unilateral cleft lip and palate (UCLP). For this type of inter-center research, a scoring method that could be performed over the internet would be the most effective. Therefore, the aim of this study was to investigate the reliability of application of the EUROCRAN index on 3D digital models or photographs of plaster models instead of using plaster models. The EUROCRAN reference models were presented in three formats: plaster models, 2D photographs of plaster models, and 3D digital models. Plaster models of children with UCLP (n = 45) were rated. Of each case, all three formats were rated by six calibrated observers in random order. The strength of agreement of the ratings was assessed with kappa statistics. Concordance among observers was evaluated with the intra-class correlation coefficient (ICC). The ICC showed a good inter-observer agre...

Research paper thumbnail of Regional facial asymmetries in unilateral orofacial clefts

European journal of orthodontics, Jan 19, 2015

Summary OBJECTIVES : Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilate... more Summary OBJECTIVES : Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus, and palate (UCLP), and to evaluate which area of the face is most asymmetrical. Standardized three-dimensional facial images of 58 patients (9 UCL, 21 UCLA, and 28 UCLP; age range: 8.6-12.3 years) and 121 controls (age range 9-12 years) were mirrored and distance maps were created. Absolute mean asymmetry values were calculated for the whole face, cheek, nose, lips, and chin. One-way analysis of variance, Kruskal-Wallis, and t-test were used to assess the differences between clefts and controls for the whole face and separate areas. Clefts and controls differ significantly for the whole face as well as in all areas. Asymmetry is distributed differently over the face for all groups. In UCLA, the nose was significantly more asymmetric compared with chin and cheek (P = 0.038 and 0.024, respectively). For UCL, significant...

Research paper thumbnail of Soft tissue facial asymmetry in children with orofacial clefts

Objective: to assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cle... more Objective: to assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus and palate (UCLAP), and to evaluate which area of the face is the most asymmetrical. Method: standardized three-dimensional facial images (3dMD face™ System) of 58 patients (9 UCL, 21 UCLA, and 28 UCLAP; age range: 8.6 – 12.3 yr) and 121 controls (age range 9-12 yr) were mirrored and distance maps created for each subject in Maxilim® 3D. Absolute mean asymmetry values were calculated from distance maps for the whole face and areas (cheek, nose, lips and chin). One-way ANOVA and t-test were used to assess differences between controls and clefts for the whole face and separate areas. T-test was used to assess the most asymmetric facial areas in controls and clefts. Gender differences were assessed by using a Mann-Whitney test. Result: controls and clefts differed significantly for whole face as well as in all areas (p from <...

Research paper thumbnail of Accuracy and Reproducibility of Voxel Based Superimposition of Cone Beam Computed Tomography Models on the Anterior Cranial Base and the Zygomatic Arches

PLoS ONE, 2011

Superimposition of serial Cone Beam Computed Tomography (CBCT) scans has become a valuable tool f... more Superimposition of serial Cone Beam Computed Tomography (CBCT) scans has become a valuable tool for three dimensional (3D) assessment of treatment effects and stability. Voxel based image registration is a newly developed semiautomated technique for superimposition and comparison of two CBCT scans. The accuracy and reproducibility of CBCT superimposition on the anterior cranial base or the zygomatic arches using voxel based image registration was tested in this study. 16 pairs of 3D CBCT models were constructed from pre and post treatment CBCT scans of 16 adult dysgnathic patients. Each pair was registered on the anterior cranial base three times and on the left zygomatic arch twice. Following each superimposition, the mean absolute distances between the 2 models were calculated at 4 regions: anterior cranial base, forehead, left and right zygomatic arches. The mean distances between the models ranged from 0.2 to 0.37 mm (SD 0.08-0.16) for the anterior cranial base registration and from 0.2 to 0.45 mm (SD 0.09-0.27) for the zygomatic arch registration. The mean differences between the two registration zones ranged between 0.12 to 0.19 mm at the 4 regions. Voxel based image registration on both zones could be considered as an accurate and a reproducible method for CBCT superimposition. The left zygomatic arch could be used as a stable structure for the superimposition of smaller field of view CBCT scans where the anterior cranial base is not visible.

Research paper thumbnail of Three-dimensional Imaging Methods for Quantitative Analysis of Facial Soft Tissues and Skeletal Morphology in Patients with Orofacial Clefts: A Systematic Review

PLoS ONE, 2014

Background: Current guidelines for evaluating cleft palate treatments are mostly based on two-dim... more Background: Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective: To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate.

Research paper thumbnail of Nasolabial appearance after two palatoplasty types in cleft lip and palate

Orthodontics & Craniofacial Research, 2014

Facial appearance is important for normal psychosocial development in children with cleft lip and... more Facial appearance is important for normal psychosocial development in children with cleft lip and palate (CLP). There is conflicting evidence on how deficient maxillary growth may affect nasolabial esthetics. We retrospectively investigated nasolabial appearance in two groups, the Langenback (35 children; mean age 11.1 years; range: 7.9-13.6) and Vomerplasty (58 children; mean age 10.8 years; range: 7.8-14), who received unilateral CLP surgery by the same surgeon. The hard palate repair technique differed between the two groups. In the Langenback group, palatal bone on the non-cleft side only was left denuded, inducing scar formation and inhibiting maxillary growth. In the Vomerplasty group, a vomerplasty with tight closure of the soft tissues on the palate was applied. Thirteen lay judges rated nasolabial esthetics on photographs using a modified Asher-McDade&amp;amp;#39;s index. Nasolabial esthetics in both groups was comparable (p &amp;amp;gt; 0.1 for each nasolabial component). Inferior view was judged as the least esthetic component and demonstrated mean scores 3.18 (SD = 0.63) and 3.13 (SD = 0.47) in the Langenback and Vomerplasty groups, respectively. Mean scores for other components were from 2.52 (SD = 0.63) to 2.81 (SD = 0.62). Regression analysis showed that vomerplasty is related with slight improvement in the nasal profile only (coefficient B = -0.287; p = 0.043; R(2 ) = 0.096). This study demonstrates that the use of vomerplasty instead of the Langenbeck technique is weakly associated with the nasolabial appearance among pre-adolescent patients with UCLP.

Research paper thumbnail of A systematic review of the effects of bone-borne surgical assisted rapid maxillary expansion

Journal of Cranio-Maxillofacial Surgery, 2010

A systematic literature review was conducted to find out if bone-borne maxillary expansion with c... more A systematic literature review was conducted to find out if bone-borne maxillary expansion with corticotomies is an effective and secure orthodontic/orthopaedic treatment modality, eliminating orthodontic and periodontal side effects of tooth-borne maxillary expansion with corticotomies. Randomized controlled trials (RCT), controlled clinical trials (CCT) and case series with a sample size &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=5 were electronically searched in PubMED, MEDLINE, EMBASE Excerpta Medica, CINAHL, Biological Abstracts and CENTRAL till June 2008. Data were extracted by 2 observers. Ten studies fulfilled the inclusion criteria, of which 9 were prospective and 1 was a retrospective case series. No RCT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s or CCT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s were published on bone-borne surgically assisted rapid maxillary expansion (SARME). For expected advantages compared to tooth-borne SARME, only weak evidence was found for less buccal tipping of the teeth used as anchor teeth in tooth-borne expansion. The heterogeneity of the retrieved publications and the wide variety of outcome variables posed serious restrictions on the review of the literature in a quantitative systematic manner. There is a need for well designed clinical trials research on the effects of tooth-borne and bone-borne SARME.

Research paper thumbnail of Three-dimensional prospective evaluation of tooth-borne and bone-borne surgically assisted rapid maxillary expansion

Journal of Cranio-Maxillofacial Surgery, 2012

To three-dimensionally (3D) assess the long-term effects of tooth-borne and bone-borne surgically... more To three-dimensionally (3D) assess the long-term effects of tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME). This prospective cohort study comprised 45 consecutive skeletally mature non-syndromic patients with transverse maxillary hypoplasia. In 28 patients, a tooth-borne distractor (Hyrax) was used for expansion, whereas in the remaining 17 a bone-borne distractor (transpalatal distractor, TPD) was used. Cone beam computed tomography (CBCT) scans were performed before treatment (T0) and 22 months later, after fixed appliance treatment (T1). 3D models were constructed from CBCT data and superimposed using voxel-based matching. Distance maps between the superimposed models were computed to evaluate the amount of skeletal changes. The distance maps of the superimposed models showed positive distances on the right and left posterior alveolar segments of the maxilla indicating lateral expansion. The anterior maxillary region showed negative distances or posterior displacement and remodelling of the anterior alveolar region. There was no statistically significant difference between TPD and Hyrax for the three alveolar segments (p values ranged 0.63-0.81). Bone-borne and tooth-borne SARME were found to produce comparable results at the end of fixed appliance treatment regarding skeletal changes.

Research paper thumbnail of Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion

European Journal of Oral Sciences, 2013

This study aimed to assess the effects of bone-borne and tooth-borne surgically assisted rapid ma... more This study aimed to assess the effects of bone-borne and tooth-borne surgically assisted rapid maxillary expansion on the volumes of the nose and nasal airway 2 yr after maxillary expansion. This prospective cohort study included 32 patients with transverse maxillary hypoplasia. Expansion was performed with a tooth-borne distractor (Hyrax) in 19 patients and with a bone-borne distractor [transpalatal distractor (TPD)] in the remaining 13. Cone beam computed tomography scans and three-dimensional (3D) photographs of the face were acquired before treatment and 22 ± 7 months later, and were used to evaluate the volumes of the nose and nasal airway. Nasal volume increased by 1.01 ± 1.6% in the Hyrax group and by 2.39 ± 2.4% in the TPD group. Nasal airway volume increased by 9.7 ± 5.6% in the Hyrax group and by 12.9 ± 12.7% in the TPD group. Changes in the nasal volume and in the nasal airway volume between the pre- and post-treatment measurements were statistically significant, whereas differences between the treatment groups were not; 22 months after surgically assisted rapid maxillary expansion, the increases in the nasal volume and in the nasal airway volume were comparable between tooth-borne and bone-borne devices.

Research paper thumbnail of Phenotypic and genotypic characterization of enterotoxigenic Escherichia coli isolated from U.S. military personnel participating in Operation Bright Star, Egypt, from 2005 to 2009

Diagnostic Microbiology and Infectious Disease, 2013

Research paper thumbnail of Current practice of distraction osteogenesis for craniofacial anomalies in Europe: A web based survey

Aim of the study was to get more insight into the opinion of European surgeons and orthodontists ... more Aim of the study was to get more insight into the opinion of European surgeons and orthodontists on the use of distraction osteogenesis (DO) for patients with different diagnoses and treatment protocols. A web based survey was set up, showing records of four patients with different conditions: hemifacial microsomia (case 1), bilateral mandibular deficiency (case 2), cleft lip and palate (case 3) and Crouzon syndrome (case 4). Respondents from 181 Eurocleft centres were asked to fill out a questionnaire for each patient. Most of the respondents considered case 1 (80%), case 3 (81%) and case 4 (86%) suitable for DO, while only 31% were considering case 2 for DO. There was lack of consensus among the respondents about many aspects of DO. Out of six different treatment parameters, an acceptable degree of agreement was only seen in two: a latency period of 3-7 days and a distraction rate of 1mm per day. Furthermore, there was noticeable disagreement on the ideal age for treatment, surgical technique, distraction device, and retention period. Our results showed that there is a wide variety in treatment approaches for craniofacial anomalies in Europe. There is disagreement on essential steps in the distraction procedures.

Research paper thumbnail of The suitability of panoramic radiographs for clinical decision making regarding root angulation compared to cone-beam computed tomography

BMC Medical Imaging

Background The study compared clinical decisions regarding root angulation correction and root pr... more Background The study compared clinical decisions regarding root angulation correction and root proximity based on the interpretation of Panoramic (PAN) versus Cone-Beam Computed Tomography (CBCT) images. Methods A total of 864 teeth from 36 existing, radiographic patient records at a university dental clinic with concurrent PAN and CBCT images were assessed using PANs, then using CBCTs in a blinded manner by two orthodontists. Teeth were rated regarding the need for root repositioning, the direction of repositioning and existence of root proximity. Frequencies, rating time and intra- and inter-examiner Cohen’s Kappa were calculated. Results There was 73.7–84.5% agreement between PAN-based and CBCT-based orthodontists’ decisions regarding the need to reposition roots. Root proximity was more frequently reported on PANs than CBCTs by one examiner (p = 0.001 and p = 0.168). Both PANs and CBCTs had moderate to substantial intra-examiner, within-radiograph-type reliability with Kappa val...

Research paper thumbnail of Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces

PeerJ

Background Stereophotogrammetry can be used to study facial morphology in both healthy individual... more Background Stereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate. Methods Thirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on no...

Research paper thumbnail of The Amalgamated Technique

Research paper thumbnail of Uniform 3D meshes to establish normative facial averages of healthy infants during the first year of life

PLOS ONE

Three-dimensional (3D) surface imaging systems are replacing direct anthropometry as the preferre... more Three-dimensional (3D) surface imaging systems are replacing direct anthropometry as the preferred method for capturing facial soft-tissues. Aims of this study were: (1) to develop normative average 3D faces of healthy infants aged 3, 6, 9, and 12 months and (2) to describe normative average 3D facial growth data in infants aged 3 to 12 months. Threedimensional images of 50 healthy children were acquired at 3, 6, 9, and 12 months of age using the 3dMDcranial system. Four average faces with uniform meshes (3, 6, 9, and 12 months) were developed and registered based on the children's reference frames. Distance maps of growth of the total facial surface and of the nose, upper lip, chin, forehead and cheeks for the intervals 3 to 6 months, 6 to 9 months, and 9 to 12 months of age were calculated. Mean growth of the total facial surface was 3.9 mm (standard deviation [SD] 1.2 mm), 3.5 mm (SD 0.9 mm), and 1.6 mm (SD 0.7 mm) at 3 to 6 months, 6 to 9 months, and 9 to 12 months, respectively. Regarding the selected regions of the face, the mean growth of the nose and upper lip were the largest (3.7 mm and 3.6 mm, respectively) between 6 and 9 months of age. The mean growth of the forehead, cheeks and chin were the largest (5.4 mm, 3.2, and 4.7 mm, respectively) between 3 and 6 months of age. For all facial regions, growth clearly diminished from 9 to 12 months of age. Normative data on the growth of the full face, nose, upper lip, chin, forehead and cheeks are presented. Such data can be used in future studies to identify the effectiveness of treatment of orofacial deformities such as orofacial clefts during the first year of life.

Research paper thumbnail of Influence of involuntary facial expressions on reproducibility of 3D stereophotogrammetry in children with and without complete unilateral cleft lip and palate from 3 to 18 months of age

Clinical oral investigations, Jan 25, 2018

To assess the influence of involuntary facial expressions on 3D facial stereophotogrammetry repro... more To assess the influence of involuntary facial expressions on 3D facial stereophotogrammetry reproducibility in children with and without unilateral cleft lip, alveolus and palate (UCLP) aged 3-18 months. Three to eight 3D facial images per time point were acquired within 10 min of 31 children with UCLP and 50 controls at 3, 12 and 18 months of age. 3D mapping of two 3D facial images per subject per age was performed. Distance kits of the full face and nasolabial area were calculated. In the total subject pool, mean variation between two 3D facial images ranged from 0.38-0.88 mm. There were no significant differences within groups for the various ages. Variation between controls and UCLP subjects did not differ significantly. Variation was higher in the nasolabial area than in the full face. The influence of involuntary facial expressions on the estimation of facial growth should not be underestimated, especially in the nasolabial region of UCLP subjects aged 3 months. To improve 3D ...

Research paper thumbnail of Regional facial asymmetries and attractiveness of the face

European journal of orthodontics, Dec 13, 2015

Facial attractiveness is an important factor in our social interactions. It is still not entirely... more Facial attractiveness is an important factor in our social interactions. It is still not entirely clear which factors influence the attractiveness of a face and facial asymmetry appears to play a certain role. The aim of the present study was to assess the association between facial attractiveness and regional facial asymmetries evaluated on three-dimensional (3D) images. 3D facial images of 59 (23 male, 36 female) young adult patients (age 16-25 years) before orthodontic treatment were evaluated for asymmetry. The same 3D images were presented to 12 lay judges who rated the attractiveness of each subject on a 100mm visual analogue scale. Reliability of the method was assessed with Bland-Altman plots and Cronbach's alpha coefficient. All subjects showed a certain amount of asymmetry in all regions of the face; most asymmetry was found in the chin and cheek areas and less in the lip, nose and forehead areas. No statistically significant differences in regional facial asymmetries ...

Research paper thumbnail of Rating dental arch relationships and palatal morphology with the EUROCRAN index on three different formats of dental casts in children with unilateral cleft lip and palate

Clinical oral investigations, Jan 13, 2015

The EUROCRAN index has been used in inter-center studies to assess dental arch relationship (DAR)... more The EUROCRAN index has been used in inter-center studies to assess dental arch relationship (DAR) and palatal morphology (PM) in children with unilateral cleft lip and palate (UCLP). For this type of inter-center research, a scoring method that could be performed over the internet would be the most effective. Therefore, the aim of this study was to investigate the reliability of application of the EUROCRAN index on 3D digital models or photographs of plaster models instead of using plaster models. The EUROCRAN reference models were presented in three formats: plaster models, 2D photographs of plaster models, and 3D digital models. Plaster models of children with UCLP (n = 45) were rated. Of each case, all three formats were rated by six calibrated observers in random order. The strength of agreement of the ratings was assessed with kappa statistics. Concordance among observers was evaluated with the intra-class correlation coefficient (ICC). The ICC showed a good inter-observer agre...

Research paper thumbnail of Regional facial asymmetries in unilateral orofacial clefts

European journal of orthodontics, Jan 19, 2015

Summary OBJECTIVES : Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilate... more Summary OBJECTIVES : Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus, and palate (UCLP), and to evaluate which area of the face is most asymmetrical. Standardized three-dimensional facial images of 58 patients (9 UCL, 21 UCLA, and 28 UCLP; age range: 8.6-12.3 years) and 121 controls (age range 9-12 years) were mirrored and distance maps were created. Absolute mean asymmetry values were calculated for the whole face, cheek, nose, lips, and chin. One-way analysis of variance, Kruskal-Wallis, and t-test were used to assess the differences between clefts and controls for the whole face and separate areas. Clefts and controls differ significantly for the whole face as well as in all areas. Asymmetry is distributed differently over the face for all groups. In UCLA, the nose was significantly more asymmetric compared with chin and cheek (P = 0.038 and 0.024, respectively). For UCL, significant...

Research paper thumbnail of Soft tissue facial asymmetry in children with orofacial clefts

Objective: to assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cle... more Objective: to assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus and palate (UCLAP), and to evaluate which area of the face is the most asymmetrical. Method: standardized three-dimensional facial images (3dMD face™ System) of 58 patients (9 UCL, 21 UCLA, and 28 UCLAP; age range: 8.6 – 12.3 yr) and 121 controls (age range 9-12 yr) were mirrored and distance maps created for each subject in Maxilim® 3D. Absolute mean asymmetry values were calculated from distance maps for the whole face and areas (cheek, nose, lips and chin). One-way ANOVA and t-test were used to assess differences between controls and clefts for the whole face and separate areas. T-test was used to assess the most asymmetric facial areas in controls and clefts. Gender differences were assessed by using a Mann-Whitney test. Result: controls and clefts differed significantly for whole face as well as in all areas (p from <...

Research paper thumbnail of Accuracy and Reproducibility of Voxel Based Superimposition of Cone Beam Computed Tomography Models on the Anterior Cranial Base and the Zygomatic Arches

PLoS ONE, 2011

Superimposition of serial Cone Beam Computed Tomography (CBCT) scans has become a valuable tool f... more Superimposition of serial Cone Beam Computed Tomography (CBCT) scans has become a valuable tool for three dimensional (3D) assessment of treatment effects and stability. Voxel based image registration is a newly developed semiautomated technique for superimposition and comparison of two CBCT scans. The accuracy and reproducibility of CBCT superimposition on the anterior cranial base or the zygomatic arches using voxel based image registration was tested in this study. 16 pairs of 3D CBCT models were constructed from pre and post treatment CBCT scans of 16 adult dysgnathic patients. Each pair was registered on the anterior cranial base three times and on the left zygomatic arch twice. Following each superimposition, the mean absolute distances between the 2 models were calculated at 4 regions: anterior cranial base, forehead, left and right zygomatic arches. The mean distances between the models ranged from 0.2 to 0.37 mm (SD 0.08-0.16) for the anterior cranial base registration and from 0.2 to 0.45 mm (SD 0.09-0.27) for the zygomatic arch registration. The mean differences between the two registration zones ranged between 0.12 to 0.19 mm at the 4 regions. Voxel based image registration on both zones could be considered as an accurate and a reproducible method for CBCT superimposition. The left zygomatic arch could be used as a stable structure for the superimposition of smaller field of view CBCT scans where the anterior cranial base is not visible.

Research paper thumbnail of Three-dimensional Imaging Methods for Quantitative Analysis of Facial Soft Tissues and Skeletal Morphology in Patients with Orofacial Clefts: A Systematic Review

PLoS ONE, 2014

Background: Current guidelines for evaluating cleft palate treatments are mostly based on two-dim... more Background: Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective: To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate.

Research paper thumbnail of Nasolabial appearance after two palatoplasty types in cleft lip and palate

Orthodontics & Craniofacial Research, 2014

Facial appearance is important for normal psychosocial development in children with cleft lip and... more Facial appearance is important for normal psychosocial development in children with cleft lip and palate (CLP). There is conflicting evidence on how deficient maxillary growth may affect nasolabial esthetics. We retrospectively investigated nasolabial appearance in two groups, the Langenback (35 children; mean age 11.1 years; range: 7.9-13.6) and Vomerplasty (58 children; mean age 10.8 years; range: 7.8-14), who received unilateral CLP surgery by the same surgeon. The hard palate repair technique differed between the two groups. In the Langenback group, palatal bone on the non-cleft side only was left denuded, inducing scar formation and inhibiting maxillary growth. In the Vomerplasty group, a vomerplasty with tight closure of the soft tissues on the palate was applied. Thirteen lay judges rated nasolabial esthetics on photographs using a modified Asher-McDade&amp;amp;#39;s index. Nasolabial esthetics in both groups was comparable (p &amp;amp;gt; 0.1 for each nasolabial component). Inferior view was judged as the least esthetic component and demonstrated mean scores 3.18 (SD = 0.63) and 3.13 (SD = 0.47) in the Langenback and Vomerplasty groups, respectively. Mean scores for other components were from 2.52 (SD = 0.63) to 2.81 (SD = 0.62). Regression analysis showed that vomerplasty is related with slight improvement in the nasal profile only (coefficient B = -0.287; p = 0.043; R(2 ) = 0.096). This study demonstrates that the use of vomerplasty instead of the Langenbeck technique is weakly associated with the nasolabial appearance among pre-adolescent patients with UCLP.

Research paper thumbnail of A systematic review of the effects of bone-borne surgical assisted rapid maxillary expansion

Journal of Cranio-Maxillofacial Surgery, 2010

A systematic literature review was conducted to find out if bone-borne maxillary expansion with c... more A systematic literature review was conducted to find out if bone-borne maxillary expansion with corticotomies is an effective and secure orthodontic/orthopaedic treatment modality, eliminating orthodontic and periodontal side effects of tooth-borne maxillary expansion with corticotomies. Randomized controlled trials (RCT), controlled clinical trials (CCT) and case series with a sample size &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=5 were electronically searched in PubMED, MEDLINE, EMBASE Excerpta Medica, CINAHL, Biological Abstracts and CENTRAL till June 2008. Data were extracted by 2 observers. Ten studies fulfilled the inclusion criteria, of which 9 were prospective and 1 was a retrospective case series. No RCT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s or CCT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s were published on bone-borne surgically assisted rapid maxillary expansion (SARME). For expected advantages compared to tooth-borne SARME, only weak evidence was found for less buccal tipping of the teeth used as anchor teeth in tooth-borne expansion. The heterogeneity of the retrieved publications and the wide variety of outcome variables posed serious restrictions on the review of the literature in a quantitative systematic manner. There is a need for well designed clinical trials research on the effects of tooth-borne and bone-borne SARME.

Research paper thumbnail of Three-dimensional prospective evaluation of tooth-borne and bone-borne surgically assisted rapid maxillary expansion

Journal of Cranio-Maxillofacial Surgery, 2012

To three-dimensionally (3D) assess the long-term effects of tooth-borne and bone-borne surgically... more To three-dimensionally (3D) assess the long-term effects of tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME). This prospective cohort study comprised 45 consecutive skeletally mature non-syndromic patients with transverse maxillary hypoplasia. In 28 patients, a tooth-borne distractor (Hyrax) was used for expansion, whereas in the remaining 17 a bone-borne distractor (transpalatal distractor, TPD) was used. Cone beam computed tomography (CBCT) scans were performed before treatment (T0) and 22 months later, after fixed appliance treatment (T1). 3D models were constructed from CBCT data and superimposed using voxel-based matching. Distance maps between the superimposed models were computed to evaluate the amount of skeletal changes. The distance maps of the superimposed models showed positive distances on the right and left posterior alveolar segments of the maxilla indicating lateral expansion. The anterior maxillary region showed negative distances or posterior displacement and remodelling of the anterior alveolar region. There was no statistically significant difference between TPD and Hyrax for the three alveolar segments (p values ranged 0.63-0.81). Bone-borne and tooth-borne SARME were found to produce comparable results at the end of fixed appliance treatment regarding skeletal changes.

Research paper thumbnail of Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion

European Journal of Oral Sciences, 2013

This study aimed to assess the effects of bone-borne and tooth-borne surgically assisted rapid ma... more This study aimed to assess the effects of bone-borne and tooth-borne surgically assisted rapid maxillary expansion on the volumes of the nose and nasal airway 2 yr after maxillary expansion. This prospective cohort study included 32 patients with transverse maxillary hypoplasia. Expansion was performed with a tooth-borne distractor (Hyrax) in 19 patients and with a bone-borne distractor [transpalatal distractor (TPD)] in the remaining 13. Cone beam computed tomography scans and three-dimensional (3D) photographs of the face were acquired before treatment and 22 ± 7 months later, and were used to evaluate the volumes of the nose and nasal airway. Nasal volume increased by 1.01 ± 1.6% in the Hyrax group and by 2.39 ± 2.4% in the TPD group. Nasal airway volume increased by 9.7 ± 5.6% in the Hyrax group and by 12.9 ± 12.7% in the TPD group. Changes in the nasal volume and in the nasal airway volume between the pre- and post-treatment measurements were statistically significant, whereas differences between the treatment groups were not; 22 months after surgically assisted rapid maxillary expansion, the increases in the nasal volume and in the nasal airway volume were comparable between tooth-borne and bone-borne devices.

Research paper thumbnail of Phenotypic and genotypic characterization of enterotoxigenic Escherichia coli isolated from U.S. military personnel participating in Operation Bright Star, Egypt, from 2005 to 2009

Diagnostic Microbiology and Infectious Disease, 2013

Research paper thumbnail of Current practice of distraction osteogenesis for craniofacial anomalies in Europe: A web based survey

Aim of the study was to get more insight into the opinion of European surgeons and orthodontists ... more Aim of the study was to get more insight into the opinion of European surgeons and orthodontists on the use of distraction osteogenesis (DO) for patients with different diagnoses and treatment protocols. A web based survey was set up, showing records of four patients with different conditions: hemifacial microsomia (case 1), bilateral mandibular deficiency (case 2), cleft lip and palate (case 3) and Crouzon syndrome (case 4). Respondents from 181 Eurocleft centres were asked to fill out a questionnaire for each patient. Most of the respondents considered case 1 (80%), case 3 (81%) and case 4 (86%) suitable for DO, while only 31% were considering case 2 for DO. There was lack of consensus among the respondents about many aspects of DO. Out of six different treatment parameters, an acceptable degree of agreement was only seen in two: a latency period of 3-7 days and a distraction rate of 1mm per day. Furthermore, there was noticeable disagreement on the ideal age for treatment, surgical technique, distraction device, and retention period. Our results showed that there is a wide variety in treatment approaches for craniofacial anomalies in Europe. There is disagreement on essential steps in the distraction procedures.