Introduction: The anterior cranial base has long been considered a stable reference structure for superimpos-
ing radiographs. However, some studies have questioned its stability. Therefore, the purposes of this systematic
review were to give an overview of the studies evaluating growth and development of the anterior cranial base,
assess their methodologic quality, and evaluate their validity and accuracy. Methods: Medline, Embase, and
Google Scholar were searched without limitations up to June 2013. Additionally, the bibliographies of the nally
selected articles were hand searched to identify any relevant publications that were not identied before. The
lowest levels of evidence accepted for inclusion were cohort and cross-sectional studies. Results: A total of
11 articles met all inclusion criteria. They were published between 1955 and 2009. The sample sizes of these
studies ranged from 28 to 464 subjects. Their methodologic quality ranged from moderate to low.
Conclusions: Sella turcica remodels backward and downward, and nasion moves forward because of the
increase in size of the frontal sinus. These events lead to a continuous increase in the length of the cranial
base until adulthood. The presphenoid and cribriform plate regions can be considered stable after age 7, making
them the best cranial-base superimposition areas. (Am J Orthod Dentofacial Orthop 2014;146:21-32)
A
n understanding of craniofacial growth is crucial bone. However, some cartilaginous growth centers
for improved diagnosis, treatment planning, called synchondroses remain active between ossied
outcome evaluation, and long-term stability.1 areas and mature at different times of life. Bastir et al2
Historically, orthodontists have used the cranial-base stated that the earliest structure to mature in shape
structures as reference structures to evaluate craniofacial and size in the skull is the midline cranial base (at
growth. The anterior cranial base is considered to have 7.7 years of age). However, this has been recently ques-
completed its most signicant growth before other facial tioned. Malta et al4 found that the anterior cranial base
skeletal structures.2 Hence, the anterior cranial base has is not stable in size and grows during all pubertal phases
long been considered a stable craniofacial structure to be (CS1 to CS6 of the cervical maturation stages). They
used for cephalometric superimpositions during the reported that the anterior cranial-base length (sella to
usual orthodontic treatment age range.1,3 nasion) increases until early adulthood.
The cranial base is initially formed in cartilage, with Various methods have been described to evaluate
ossication centers appearing early in embryonic life; craniofacial growth. Craniometry was the rst measure-
with time, they progressively replace the cartilage with ment approach for evaluating growth, used since the
15th century.5 The advantage of this technique is that
precise measurements can be made on dry skulls, but
a
Postgraduate student, Department of Dentistry, Faculty of Medicine and the limitation is that all the growth data are cross-
Dentistry, University of Alberta, Edmonton, Alberta, Canada.
b
sectional.1 Anthropometry was then used as the gold
Private practice, Edmonton, Alberta, Canada.
c
Associate professor and division head of orthodontics, Department of Dentistry, standard because it can follow growth directly on each
Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada. subject. Despite its accuracy, however, obtaining growth
d
Assistant professor, Department of Dentistry, Faculty of Medicine and Dentistry, measurements through direct measurements is difcult
University of Alberta, Edmonton, Alberta, Canada.
All authors have completed and submitted the ICMJE Form for Disclosure of because it is time-consuming and requires patient
Potential Conicts of Interest, and none were reported. compliance to remain still for a long time.6 Early in the
Address correspondence to: Carlos Flores-Mir, Department of Dentistry, Faculty 1900s, serial photographs started to be used to assess
of Medicine and Dentistry, 5-528 Edmonton Clinic Health Academy, 11405 87
Avenue NW, 5th oor, University of Alberta, Edmonton, Alberta, Canada T6G facial growth. However, they only show trends of growth
1C9; e-mail, carlosores@ualberta.ca. rate and direction, and they lack accuracy for some mea-
Submitted, August 2013; revised and accepted, March 2014. surements. Later during the last century, the metallic
0889-5406/$36.00
Copyright 2014 by the American Association of Orthodontists. implant radiography method provided new information
http://dx.doi.org/10.1016/j.ajodo.2014.03.019 about the growth pattern, but the disadvantage was that
21
22 Afrand et al
Table I. Search strategy for MEDLINE via OVIDSP (1950 to the present)
Search
group Medical subject heading (MeSH) or key word
1 Maxillofacial development/OR growth/
2 *skull/or ethmoid bone/or exp facial bones/or exp skull base/or expsphenoid bone/OR exp *mandible/or *maxilla/OR cranial base.mp
3 Cephalometry/is, mt, st, td, ut [Instrumentation, Methods, Standards, Trends, Utilization] OR exp Cone-Beam Computed Tomography/is,
mt, st, td, ut [Instrumentation, Methods, Standards, Trends, Utilization] OR exp Imaging, Three-Dimensional/is, mt, st, td, ut
[Instrumentation, Methods, Standards, Trends, Utilization] OR superimpos*.mp. [mp 5 title, abstract, original title, name of substance
word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique
identier] OR exp Methods/is, mt, st, ut [Instrumentation, Methods, Standards, Utilization]
4 1 AND 2 AND 3
Limitation: human subjects.
July 2014 Vol 146 Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
American Journal of Orthodontics and Dentofacial Orthopedics
Afrand et al
Table II. Summary of characteristics of included articles
Growth
Sample size percentage
Article Study design and sex Age Method change Results Validity/reliability
1 Malta et al4 Longitudinal 36 Mean age at Lateral S-N: The cranial base grew Interreliability determined
(2009) F 5 21 T1 5 10.4 y cephalometry T1-T2: 3.5% during all pubertal for CVM, tracings and
M 5 15 (SD, 0.98) Linear increase phases. landmarks.
T1 Prepeak measurements (P \ 0.001) The largest growth is Intrareliability of
(CS1 & CS2) at T1, T2, T3 T2-T3: 4.0% during the interval between measurements determined,
T2 Peak S-Ba, S-N, increase the prepeak and peak phases, no measurement error
(CS3 & CS4) Ba-N, CC- Ba, (P \ 0.001) decreasing in the postpeak reported.
T3 Postpeak CC-N, FC-Po T1-T3: 7.1% period. ICC reported more than 0.95
(CS5 & CS6) increase These data show that (0.946-0.998).
(P \ 0.001) cranial-base growth
occurs until adulthood.
2 Jiang et al24 Longitudinal 28 Annual records Lateral NA The anterior cranial base Reliability determined (does
(2007) F 5 15 from 13-18 y cephalometry continued to grow and not mention intra or inter)
M 5 13 Modied mesh the length increased Measurement error: no more
diagram analysis during the study period. than 0.04 (Dahlberg's
Scaled average In females, most structures formula)
18 y diagram increased in size uniformly
superimposed across 6 y of growth. There is
on the 13-y disproportionately enhanced
average growth of the anterior
diagram cranial base upward in
males only.
3 Franchi et al20 Longitudinal 34 T1 Prepubertal Lateral S-N: The longitudinal changes Intrareliability determined
(2007) F 5 10 CS1 Mean age: cephalometry T1-T2: 7.1% in the shape of the cranial for landmarks and CVM.
M 5 24 10 y Thin plate spline increase base from T1-T2 were not Landmarks measured twice
T2:Postpubertal analysis registered at (P \ 0.05) signicant. and the average was taken.
SC6 Ba, S, Na On the other hand, No values reported.
differences in (centroid)
size changes were
signicant.
Lewis & Roche18 Longitudinal T1: 17 or 18 y Lateral The mean age at which None
July 2014 Vol 146 Issue 1
4 20 NA
(1988) F 5 12 - 8 succeeding cephalometry the maximum lengths were
M58 x- rays for S-N, Ba-N, Ba-S identied ranged from 29 to
everyone measured 39 y among the various
1 x-ray between dimensions.
40 and 50 y There were small but real
increments of growth after
17 or 18 y.
23
July 2014 Vol 146 Issue 1
24
Table II. Continued
Growth
Sample size percentage
Article Study design and sex Age Method change Results Validity/reliability
5 Melsen14 Cross- 126 Ages: 0-20 y Autopsy tissue NA The cribriform plate was Reliability: 2 sets of double
(1974) sectional F 5 50 blocks stable after the age of 4. registrations, a repeated
M 5 76 Conventional Jugum sphenoidale (t-plane) blind registration of the rst
histologic and showed appositional growth set of sections. Magnitude of
macroradiography up to 4-5 y and again in the error due to inconsistency in
Categorized bone prepubertal period. the registration procedures
surfaces based Growth of both was of order of 10%. No
on growth sphenoethmoidale and other values reported.
activity frontoethmoid
1. apposition synchondroses completed
2. resorption by age 7.
3. inactivity Tuberculum sella showed
variable growth pattern until
age 18.
Anterior wall of sella was
stable after age 5-6 y.
Posterior wall of sella showed
American Journal of Orthodontics and Dentofacial Orthopedics
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American Journal of Orthodontics and Dentofacial Orthopedics
Afrand et al
Table II. Continued
Growth
Sample size percentage
Article Study design and sex Age Method change Results Validity/reliability
6 Steuer19 (1972) Longitudinal 54 Ages: 5-11 y Lateral cephalometry NA 95% of comparisons up to None
F 5 31 40% of cases 8-10 y Tracing from dorsum sella 5 y apart had 3 or more
M 5 23 Annual x-rays to planum spheniodale segments congruent, which
5 patients had 5-y was divided into 7 segments indicates that
interval records, At least 3 segments should be superimposition on the
one 7 y, and one 8 y congruent for valid middle outline of sphenoidal
portion of cranial base is
Total 274 superimposition.
acceptable during the usual
orthodontic age range, but
generally the trend is toward
less congruence with time
because of slight craniofacial
growth changes.
Deepening of the hypophysial
fossa was noted in the recall
group of 7 subjects who had
cephalograms taken a
number of years after the
last one.
7 Knott21 (1971) Longitudinal 66 Measurements at ages T1: 6; Lateral NF 1 FW 1 From age 6-12 y for each Intrareliability of
F 5 19 T2: 9; T3: 12; and T4: early cephalometry WP(N-S): sex, the frontal segment measurements
M 5 23 adulthood (Norma lateralis T1-T3 (6-12): increased in average size determined in
Mean ages: males, 25.1 y; roentgenograms) 6.1% increase by 2.8 mm, the ethmoid instances greater
females, 25.8 y Linear (no P values) segment by 1.0 mm, no than 0.2 mm
2/3 of subjects at age 15 y measurements: T3-T4 (12-adult): change in average size for (average obtained).
N-F, F-W, W-P, 5.1% increase the presphenoid dimension.
P-O (no P values) Downward movement of
Angular Frontal nasion is found in
measurements: segment NF: measurements from the line
NPO, FPO, WPO T1-T4: 3.3% extended through the frontal
increase point and the sphenoid wing
(P \ 0.01)
July 2014 Vol 146 Issue 1
25
July 2014 Vol 146 Issue 1
26
Table II. Continued
Growth
Sample size percentage
Article Study design and sex Age Method change Results Validity/reliability
8 Melsen15 Cross- 132 48: All deciduous Lateral cephalometry NS: The reference point sella on Intrareliability:
(1969) sectional Dry skulls sex: dentitions erupted of the skull Primary 8s average was moved 2 mm measurements repeated on
not specied 64: mixed dentition 22 linear measurements erupted: 10% downward and backward in 10 skulls from different ages.
20: 8s fully erupted & 2 angular increase relation to the tuberculum No systematic error found.
Mixed-8s sella from the full deciduous No values reported.
erupted: 2.3% dentition stage to the stage
increase when canines and premolars
S-S0 :(depth of are erupting, which indicates
sella turcica): eccentric growth of sella
Primary 8s turcica.
erupted: 2.3%
increase
(no P values)
9 Stramrud16 Cross- 464, all Subjects from 3-15 y Lateral NA The anterior cranial fossa (N- None (systematic
(1959) sectional males (average 30 subjects roentgenograms S minus the thickness of the error mentioned in
in each age group) 7 linear measurements frontal bone) increases in some tables)
and adults from and 9 angular length markedly until age 7
American Journal of Orthodontics and Dentofacial Orthopedics
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American Journal of Orthodontics and Dentofacial Orthopedics
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Table II. Continued
Growth
Sample size percentage
Article Study design and sex Age Method change Results Validity/reliability
10 Ford13 (1958) Cross-sectional 71 Age: 0 to over 20 y Dry skulls (measured NA Pituitary pointnasion None
Sex notspecied by divider and ruler) dimension continues to grow
7 linear measurements after eruption of permanent
rst molars (6-8 y)
The cribriform plate
completes its growth by the
age of 2 years
The sphenomesethmoid
synchondrosis ceases growth
completely by age 7
Increase in the thickness of
the frontal bone accounts for
increase in the pituitary
point-nasion diameter after
eruption of the permanent
rst molars. This is
associated with the increase
in the size of the frontal
sinus.
11 Bjork17 (1955) Longitudinal 243, all males T1: 12 y Lateral cephalometry NS:T1-T2: 6.6% The cranial base is elongated None
T2: 20 y Anterior cranial base increase (no P value) due to apposition at the
structural glabella region
superimposition Eccentric remodeling of sella
technique turcica during growth results
in displacement of the
midpoint (S) backward and
downward or upward
In 90% of cases, only a small
change could be detected
relative to the position of the
contour of the ethmoid plate
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27
28 Afrand et al
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Afrand et al 29
cranial base and evaluate their methodologic quality. structure for 2-dimensional growth studies require high-
Our results indicate a consistent agreement that the quality lateral x-rays and experienced eyes. However,
anterior cranial base as a whole is not a stable struc- overlapping of structures is of no concern in 3D imaging
ture, and different areas of this structure complete techniques; thus, considering the cribriform plate in a 3D
growth at different stages of life. Considering that superimposition could be valuable.
the anterior cranial base is composed of frontal (which The presphenoid region's anteroposterior length was
includes nasion), ethmoid, presphenoid, and sella tur- reported to be stable after the age of 7 years as assessed
cica (which includes sella) regions, based on the studies by different methods.13,14,21 Some appositional activity
in this review, the presphenoid and ethmoid regions was observed in the histologic assessments of the
should be considered as fully developed before the presphenoid region in the prepubertal stages.14 Even
usual orthodontic age (by age 7 for the presphenoid though the appositional activity in this region would
and age 4 for the ethmoid regions); however, the fron- not change the length of presphenoid region, it would
tal and sella turcica regions continue remodeling until modify its height. Therefore, caution should be exercised
early adulthood. when using this structure as a reference because it could
A longitudinal study of serial cephalometric radio- lead to inaccurate vertical evaluation of growth.
graphs reported only a 1-mm average increase in the It has been stated in the literature that about 86% of
length of the ethmoid region from ages 6 to 12 years.21 the growth of the anterior cranial base is considered
The magnitude of this measurement most likely has no complete by the age of 4.5 years; however, the remaining
signicance and could well be due to measurement er- growth contributes to increases in the length of the
rors. Moreover, measurements in millimeters should be anterior cranial base (sella-nasion) even after puberty.22
taken with caution because they can be misleading Increases in the thickness of the frontal bone, apposi-
and a source of error. Reporting changes in percentages tion in the glabella region, and increases in the size of the
would be more appropriate because these would take in- frontal sinus contribute to increases in the length of the
dividual variations into consideration. One could argue anterior cranial base and forward movement of nasion
that locating the cribriform plate structure on the lateral until adulthood (3.3% increase in the frontal bone
cephalometric radiographs can be difcult because of segment from age 6 until early adulthood, P \ 0.01, as
overlapping of bilateral structures in this area. Therefore, reported by Knott21).13,16,17 A cross-sectional study
identifying and using the cribriform plate as a reference assessing the growth of children from 3 years of age to
American Journal of Orthodontics and Dentofacial Orthopedics July 2014 Vol 146 Issue 1
30 Afrand et al
A to J, methodologic criteria in Table III. Two consecutive symbols means that 2 criteria were evaluated as per Table III.
UFullled satisfactorily the methodologic criteria (1 check point).
#Fullled partially the methodologic criteria (0.5 check point).
xDid not fulll the methodologic criteria (0 check point).
early adulthood found that the distance from nasion to used for superimposition, but the same study mentioned
the nearest point on the internal contour of the frontal that the hypophysial fossa deepened in a small sample of
bone increases linearly during those years.16 Even though subjects who were observed for longer than 5 years.19
the cross-sectional data of this study did not give infor- Bjork,17 who presented the sella-nasion line as a stable
mation about individual variations of growth, the results reference for superimposing, also observed eccentric re-
agree with longitudinal evaluations of growth. modeling of sella turcica during growth, resulting in
One longitudinal study reported that nasion moves displacement of sella downward and backward. He also
downward or upward, depending on the angle measured recorded an elevation of the tuberculum sella in relation
or relative to the structures in the cranial base where the to other structures of the anterior cranial fossa. He might
measurement was made.21 The counteracting results re- have taken into account the counteracting resorptive
ported in this study could be due to weak or no statistical and appositional remodeling processes in the sella region
analysis, depending on the measurement. The amount and assumed that sella remains stable. With these
of upward movement of nasion was statistically insignif- observations, it seems that downward and backward
icant (less than 1 ) over a 2-year period. Measurement displacements of sella occur during growth.14,15,17,19 A
error was not reported. Whether nasion moves down- cross-sectional study detected only a 2.3%
ward also remains questionable for the same reasons. displacement of sella from the deciduous dentition
No other studies evaluated the direction of movement stage until adulthood.15 The signicance of the move-
of nasion during growth. Because nasion is outside the ment of sella remains to be investigated. Because resorp-
anterior cranial fossa, it is possible that it migrates dur- tion takes place on both the oor and the rear wall of sella
ing growth, since it is inuenced by several structures: turcica, both height and length of these structures would
eg, the frontonasal suture, the frontal sinus, and the be affected, as well as the angular measurements of sella
growth of the cranial base. used in cephalometric analyses.
A unique histologic study of the cranial base showed The sella-nasion line is a frequently used reference
that as a result of remodeling of the sella region, sella will line to assess growth of both jaws; however, both sella
be displaced downward and backward relative to the and nasion could be displaced during growth and give
anterior wall of sella turcica.14 Therefore, the size of sella rise to erroneous results when that line is used as the
turcica increases. The anterior part of sella was the most reference.3 Technologic advances in imaging could be
stable, and resting (inactive) bone was observed in almost used to assess the changes of the anterior cranial-base
all subjects over 5 years old. Changes in sella turcica were structures during growth to obtain accurate results of
most likely to some degree due to resorptive activity in the true changes in this area. For accurate results, inter-
the lower half of the posterior wall and the oor. A 5- pretation of facial changes should be done only by
year longitudinal study evaluating exclusively the growth superimposing on truly stable structures.
of the area, from planum sphenoidale to dorsum sella, Two-dimensional cephalometry is the most common
indicated that this area has reasonable stability to be technique used to evaluate growth of the cranial
July 2014 Vol 146 Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Afrand et al 31
American Journal of Orthodontics and Dentofacial Orthopedics July 2014 Vol 146 Issue 1
32 Afrand et al
12. Gordon JM, Rosenblatt M, Witmans M, Carey JP, Heo G, Major PW, 20. Franchi L, Baccetti T, Stahl F, McNamara JA Jr. Thin-plate spline
et al. Rapid palatal expansion effects on nasal airway dimensions analysis of craniofacial growth in Class I and Class II subjects.
as measured by acoustic rhinometry: a systematic review. Angle Angle Orthod 2007;77:595-601.
Orthod 2009;79:1000-7. 21. Knott V. Change in cranial base measures of human males and females
13. Ford E. Growth of the human cranial base. Am J Orthod 1958;44: from age 6 years to early adulthood. Growth 1971;35:145-58.
498-506. 22. Ranly DM. Craniofacial growth. Dent Clin North Am 2000;44:
14. Melsen B. The cranial base: the postnatal development of the cra- 457-70, v.
nial base studied histologically on human autopsy material. Arhus; 23. Brodie AG Jr. The behavior of the cranial base and its components
1974. as revealed by serial cephalometric roentgenograms*. Angle
15. Melsen B. Time of closure of the spheno-occipital synchondrosis Orthod 1955;25:148-60.
determined on dry skulls a radiographic craniometric study. Acta 24. Jiang J, Xu T, Lin J, Harris EF. Proportional analysis of longitudinal
Odontol Scand 1969;27:73-90. craniofacial growth using modied mesh diagrams. Angle Orthod
16. Stramrud L. External and internal cranial base: a cross sectional 2007;77:794-802.
study of growth and of association in form. Acta Odontol 1959; 25. Robinson KA, Dickersin K. Development of a highly sensitive search
17:239-66. strategy for the retrieval of reports of controlled trials using
17. Bj
ork A. Cranial base development: a follow-up x-ray study of the PubMed. Int J Epidemiol 2002;31:150-3.
individual variation in growth occurring between the ages of 12 26. Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and
and 20 years and its relation to brain case and face development. susceptibility to bias in observational studies in epidemiology: a
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18. Lewis AB, Roche AF. Late growth changes in the craniofacial skel- 2007;36:666-76.
eton. Angle Orthod 1988;58:127-35. 27. Odegaard J. The sum of the angles as a growth indicator of the
19. Steuer I. The cranial base for superimposition of lateral cephalo- facial skull. A geometric study. Zahn Mund Kieferheilkd Zentralbl
metric radiographs. Am J Orthod 1972;61:493-500. 1988;76:583-7.
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32.e2 Afrand et al
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Afrand et al 32.e3
Rousset & Blocquel43 Cranial-base growth was not Jakobsson & Paulin63 Cranial-base growth was not
assessed assessed
Kusnoto et al44 Not well explained, exact Motoyoshi et al64 Cranial-base growth was not
landmarks and orientation of assessed
superimpositioning.
Nielsen65 Only maxillary superimposi-
Cranial-base growth was not
tion discussed
assessed
Peltomaki66 Cranial-base growth was not
Buschang & Santos-Pinto45 Cranial-base growth was not assessed
assessed
Odegaard67 Was not able to retrieve
Kapust et al46 Cranial-base growth was not
assessed Arai Ishikawa 68
Only orthodontically treated
cases studied
Pae47
No superimpositions
Cranial-base growth was not McDonald69 Case report
assessed Lavelle70 Cranial-base growth was not
Hall & Bollen48 Only evaluated treated pa- assessed
tients
Zeng71 Cranial-base growth was not
Battagel 49
Not evaluated cranial base, assessed
just maxilla and mandible Solow & Siersbaek-Nielsen72 Cranial-base growth was not
and soft tissues assessed
Ferrario et al50 Cranial base growth was not
McNamara et al73 Does not assess cranial base,
assessed only jaws
Isaacson51 Review/editorial Burke & Healy74 Soft-tissue facial changes
Jensen & Kreiborg 52
Cranial-base growth was not assessed
assessed Son & Park75 Cranial-base growth was not
Iseri & Solor 53
Cranial-base growth was not assessed
assessed Baumrind et al76 Cranial-base growth was not
Battagel 54
No superimpositioning, assessed
compared shape changes Moss et al77 Describing a new method to
Cranial-base growth was not
analyze growth
assessed Cranial-base growth was not
assessed
American Journal of Orthodontics and Dentofacial Orthopedics July 2014 Vol 146 Issue 1
32.e4 Afrand et al
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26. Wahl N. Orthodontics in 3 millennia. Chapter 7: facial analysis 45. Buschang PH, Santos-Pinto A. Condylar growth and glenoid fossa
before the advent of the cephalometer. Am J Orthod Dentofacial displacement during childhood and adolescence. Am J Orthod
Orthop 2006;129:293-8. Dentofacial Orthop 1998;113:437-42.
27. Simon Y. The Procuste superimpositions: its value in the study of 46. Kapust AJ, Sinclair PM, Turley PK. Cephalometric effects of face
typology and its development during edgewise Tweed-Merrield mask/expansion therapy in Class III children: a comparison of three
treatment. Orthod Fr 2005;76:333-43. age groups. Am J Orthod Dentofacial Orthop 1998;113:204-12.
28. Veleminska J, Smahel Z, Mullerova Z. Predicting the development 47. Pae E. Cephalometry needs innovation, not renovation. Angle Or-
of jaws in patients with complete unilateral cleft of the lip and pal- thod 1997;67:395-6.
ate. Acta Chir Plast 2005;47:81-4. 48. Hall DL, Bollen AM. A comparison of sonically derived and tradi-
29. Chang HP, Lin HC, Liu PH, Chang CH. Geometric morphometric tional cephalometric values. Angle Orthod 1997;67:365-72.
assessment of treatment effects of maxillary protraction combined 49. Battagel JM. The use of tensor analysis to investigate facial
with chin cup appliance on the maxillofacial complex. J Oral Reha- changes in treated class II division 1 malocclusions. Eur J Orthod
bil 2005;32:720-8. 1996;18:41-54.
30. Sakima MT, Sakima CG, Melsen B. The validity of superimposing 50. Ferrario VF, Sforza C, Poggio CE, D'Addona A, Taroni A. Fourier
oblique cephalometric radiographs to assess tooth movement: an analysis of cephalometric shapes. Cleft Palate Craniofac J 1996;
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31. Greiner P, Muller B, Dibbets J. The angle between the Frankfort 51. Isaacson RJ. Superimposition and structural analysis. Am J Orthod
horizontal and the sella-nasion line. Changes in porion and orbi- Dentofacial Orthop 1996;109:193-5.
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32. Goel S, Bansal M, Kalra A. A preliminary assessment of cephalometric dysplasiaa roentgencephalometric study. J Craniofac Genet Dev
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34. Langford RJ, Sgouros S, Natarajan K, Nishikawa H, Dover MS, 54. Battagel J. Facial growth of males and females compared by tensor
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