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Barcelona line. A multicenter validation study of a facial projection reference in orthognathic surgery

  • Hernández-Alfaro Federico
    Correspondence
    Corresponding authors at: University of Washington, 4747 30th AVE NE, D-128, Seattle Washington. 98105. USA
    Affiliations
    Oral and Maxillofacial Surgeon, Head Institute of Maxillofacial Surgery Teknon Medical Center, Barcelona, Spain; Head and Professor, Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Sant Cugat del Vallès, Barcelona, Spain
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  • Vivas-Castillo Jocelyn
    Correspondence
    Corresponding authors at: University of Washington, 4747 30th AVE NE, D-128, Seattle Washington. 98105. USA
    Affiliations
    Oral and Maxillofacial Surgeon, Fellow Institute of Maxillofacial Surgery and Implantology Teknon Medical Center. Clinical guest Instructor Department of Oral and Maxillofacial Surgery. PhD Student Universitat International de Catalunya (UIC), Barcelona, Spain. Fellow Freiburg Univeristy, Germany. Oral Medicine Resident University of Washington, Seattle, USA
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  • Belle de Oliveira Rogerio
    Affiliations
    Oral and Maxillofacial Surgeon, Head Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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  • Haas-Junior Orion
    Affiliations
    Oral and Maxillofacial Surgeon, Associate Professor, Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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  • Giralt-Hernando Mária
    Affiliations
    Oral Surgeon, Associate Professor, Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Sant Cugat del Vallès, Barcelona, Spain. Fellow Institute of Maxillofacial Surgery and Implantology Teknon Medical Center, Barcelona, Spain
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  • Valls-Ontañón Adaia
    Affiliations
    Oral and Maxillofacial Surgeon Institute of Maxillofacial Surgery and Implantology Teknon Medical Center, Barcelona, Spain. Associate Professor, Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Sant Cugat del Vallès, Barcelona, Spain
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Published:October 12, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.10.002

      Abstract

      Purpose

      To validate an already published facial anteroposterior reference: Upper Incisor (UI) to Soft Tissue Plane or so-called Barcelona line (BL) to trace the most aesthetic sagittal position of the maxilla.

      Material and Methods

      A cross-sectional multicentre evaluation of Caucasian patients from Spain and Brazil with different anteroposterior maxillary positions was designed. Sagittal images in Natural Head Orientation of grouped patients according to the horizontal distance from the UI to BL were ranked by healthcares and non-professional Caucasian raters according to the aesthetic perception of each profile, using a digital survey.

      Results

      Seventy-four raters (50 laypeople, 12 orthodontists and 12 maxillofacial surgeons) rated 40 profiles. The best-rated profile corresponded to group 3 (0-4 mm UI-BL) with 61.8% of positive evaluations, followed by group 4 (≥ 4 mm UI-BL): with 61.1%. On the other hand, group 1 (≤ -4 mm UI-BL) was the worst-ranked profile with 71.8% of negative evaluations, followed by group 2 (-4-0 mm UI-BL): with 59.6% of negative evaluations. The correlation between the mean assessment score and UI-BL showed a moderately-strong association (r=0.68, p<0.001). The inter-rater reliability of assessment (74 evaluators) was moderate (k=0.49, 95% CI: 0.39-0.59).

      Conclusion

      The results suggest that protrusive middle-third facial profiles are preferable. The BL is proposed as a simple, individualized, and reproducible tool to trace an aesthetic sagittal position of the maxilla in orthognathic surgery.

      Keywords

      Abbreviations:

      UI (Upper Incisor), UI-STP (Upper Incisor to Soft Tissue Plane), BL (Barcelona line), OS (Orthognathic surgery), DFD (Dentofacial deformity), TVL (True vertical line), THL (True horizontal line), Sn (Subnasale), CI (Confidence interval), SD (Standard deviation), GEE (Estimation equations), UI-GALL (Upper incisor - Goal Anterior Limit Line)
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