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Facial morphology is influenced by hard and soft tissues, including bone and muscle. While numerous factors can lead to changes in bone tissue, soft tissues such as muscle also have an important influence. It is widely acknowledged that the function, shape and thickness of masticatory muscles have substantial effects on facial morphology and skeletal development, and are correlate with other anthropometric variables. Furthermore, a correlation has been observed between masseter muscle thickness and various characteristics of the dental arches, such as alveolar process thickness and intermaxillary width.
The evaluation of soft tissue in the region of the face is a more challenging process in comparison to that of hard tissue.The recent development of cone beam computed tomography has improved the analysis of three-dimensional skeletal morphology and jaw. However, the radiographic assessment of soft tissue remains more difficult.The thickness of masticatory muscles can be measured using computerised tomography; however, this has the disadvantage of exposing the patient to radiation. Magnetic resonance imaging (MRI) is an imaging technique that can be used to assess soft tissues. However, this technique is expensive and time-consuming. Furthermore, MRI is a static rather than a dynamic imaging technique, which makes it difficult to analyse during muscle contraction and relaxation. Ultrasound is a technique that provides dynamic imaging that can assess the masticatory muscles without the use of ionising radiation.
There are many publications in the literature that indicate that malocclusions in the vertical and sagittal dimensions can be assessed with measurements from lateral cephalometric radiographs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Class I | Patients with ANB angle between 0-4 degrees were classified as class I. |
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| Class II | Patients with ANB angle greater than 4 degrees were classified as class II. |
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| Class III | Patients with ANB angle less than 0 degrees were classified as class III. |
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| Normodivergent | Patients with SN/GoGn angle between 28 and 36 were classified as normodivergent. |
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| Hyperdivergent | Patients with SN/GoGn angle greater than 36 degrees were classified as hyperdivergent. |
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| Hypodivergent | Patients with SN/GoGn angle less than 28 degrees were classified as hypodivergent. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasonography | Other | The masseter muscle thickness measurements were performed in B mode of ultrasound, midline between the zygomatic arch and mandibular plane, parallel to the mandibular plane and perpendicular to the mandibular ramus. Prior to the examination being performed in the resting position, the patient was instructed to make minimal contact between the lips without the teeth touching each other.The first USG image was recorded in this position. The patient was then requested to clench their teeth as firmly as possible, after which a second USG image was recorded from the same area. The thickness of the muscles was measured again on second recorded images. To ensure the reliability of the measurements, these procedures were repeated by the same researcher after the patients rested for five minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| The correlation between masseter muscle thickness and sagittal skeletal malocclusions | The masseter muscle was measured in millimetres using ultrasound, while different skeletal malocclusions were classified using the angles between anatomical landmarks on lateral cephalometric radiographs. Intertermolar distance was measured in millimetres using an electronic caliper intraorally in the clinic. Facial index was calculated and classified using standard facial photographs, with millimetre measurements obtained using ImageJ software. The patients' height and weight were measured in centimetres and kilograms, respectively, and their body mass index was calculated. | Just at the enrollment of the patients |
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Inclusion Criteria: Patients who
Exclusion Criteria: Patients who
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Healthy patients with orthodontic malocclusion were included in the study.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kutahya Health Science University | Kütahya | 43100 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39245691 | Result | Togninalli D, Antonarakis GS, Papadopoulou AK. Relationship between craniofacial skeletal patterns and anatomic characteristics of masticatory muscles: a systematic review and meta-analysis. Prog Orthod. 2024 Sep 9;25(1):36. doi: 10.1186/s40510-024-00534-2. | |
| 41957744 | Derived | Kurt SS, Ayyildiz H. Evaluation of masseter muscle thickness in relation to sagittal skeletal pattern, intermolar width and masseter echogenicity: a prospective ultrasonographic and lateral cephalometric radiographic study. BMC Oral Health. 2026 Apr 9;26(1):976. doi: 10.1186/s12903-026-08234-5. |
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| ID | Term |
|---|---|
| D008310 | Malocclusion |
| ID | Term |
|---|---|
| D014076 | Tooth Diseases |
| D009057 | Stomatognathic Diseases |
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| ID | Term |
|---|---|
| D019220 | High-Energy Shock Waves |
| ID | Term |
|---|---|
| D000069453 | Ultrasonic Waves |
| D013016 | Sound |
| D011840 | Radiation, Nonionizing |
| D011827 | Radiation |
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| Brachyfacial | If the facial index value was less than 84%, it was classified as brachyfacial. |
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| Mesofacial | A facial index value between 84% and 88% was classified as mesofacial. |
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| Dolichofacial | If the facial index value was greater than 88%, it was classified as dolichofacial. |
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| Intermolar width | The intertermolar distance was measured in millimetres. This measurement was taken from the mesiopalatinal surfaces of two maxillary first permanent molars at the level of the cervical. The measurement was taken using an electronic caliper. |
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| Body Mass Index | The Body Mass Index is calculated by measuring with a standardised scale and height chart. |
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| Masseter muscle thickness |
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| Lateral cephalometric radiography | Other | Standard lateral cephalometric radiographs were obtained from the patients. |
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| Facial photograph | Other | Standard facial photographs were taken from a distance of 1.5 metres. |
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| Weigth and Heigth | Other | The Body Mass Index is calculated by measuring with a standardised scale and height chart. |
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| Electronic caliper | Other | The intermaxillary distance is measured from the cervical level of the palatal surfaces of the first permanent molars to their mesial corners using an electronic caliper. |
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| D055585 |
| Physical Phenomena |