Effect of low-intensity pulsed ultrasound on orthodontically induced root resorption in beagle dogs

We investigated the effect of low-intensity pulsed ultrasound (LIPUS) on orthodontically induced inflammatory root resorption in vivo. Ten beagle dogs were treated with an orthodontic appliance to move the mandibular fourth premolars bodily. The orthodontic movement was carried out for 4 wk with a continuous force of 1 N/side; using a split-mouth model, LIPUS was applied daily for 20 min. Fourth premolar and surrounding periodontal tissue were evaluated with micro-computed tomography and hematoxylin and eosin and tartrate-resistant acid phosphatase staining. We calculated the number, volume and distribution of root resorption lacunae and their percentage relative to total root volume, orthodontic tooth movement and periodontal ligament space. There was no significant difference in orthodontic tooth movement between the two sides. LIPUS significantly reduced the number of orthodontically induced inflammatory root resorption initiation areas by 71%, reduced their total volume by 68% and reduced their volume relative to the affected root total volume by 70%. LIPUS induced the formation of a precementum layer, thicker cementum and reparative cellular cementum.

Effect of wire size on maxillary arch force/couple systems for a simulated high canine malocclusion

AIMS

To better understand the effects of copper nickel titanium (CuNiTi) archwire size on bracket-archwire mechanics through the analysis of force/couple distributions along the maxillary arch. The hypothesis is that wire size is linearly related to the forces and moments produced along the arch.

MATERIALS AND METHODS

An Orthodontic Simulator was utilized to study a simplified high canine malocclusion. Force/couple distributions produced by passive and elastic ligation using two wire sizes (Damon 0.014 and 0.018 inch) measured with a sample size of 144.

RESULTS

The distribution and variation in force/couple loading around the arch is a complicated function of wire size. The use of a thicker wire increases the force/couple magnitudes regardless of ligation method. Owing to the non-linear material behaviour of CuNiTi, this increase is less than would occur based on linear theory as would apply for stainless steel wires.

CONCLUSIONS

The results demonstrate that an increase in wire size does not result in a proportional increase of applied force/moment. This discrepancy is explained in terms of the non-linear properties of CuNiTi wires. This non-proportional force response in relation to increased wire size warrants careful consideration when selecting wires in a clinical setting.

Analysis of anterior dentoalveolar and perioral aesthetic characteristics and their impact on the decision to undergo a Phase II orthodontic treatment

OBJECTIVES

Researchers have conducted extensive studies regarding dentoalveolar factors that affect anterior dental aesthetics; however, there is no consensus regarding how these factors affect orthodontic treatment decisions. Only a few studies have included multiple factors simultaneously. Therefore, the objective was to investigate if there are identifiable dentofacial and perioral aesthetic factors that bias laypeople towards discontinuing treatment after a phase I treatment with this fixed class II corrector.

METHODS

An analysis of photos and dental casts of 60 children (23 males, 37 females) having received phase I orthodontic treatment with the Xbow appliance was conducted. Variables considered were incisor height and width measurements, incisor proportions, incisor angulations, vertical lip thickness, gingival/incisal display, smile width per cent, diastema, midline deviation, smile arc, gender, and use of a 2×4. A principal component analysis and a logistic regression were used to determine which factors related to a patient's likelihood of receiving further orthodontic treatment.

RESULTS

Only the angulation of the right maxillary incisors was significantly related to a patient's likelihood (odds ratio 1.886 (1.004-3.466); P = 0.049) to proceed to phase II orthodontic treatment following phase I orthodontic treatment with the Xbow appliance. The odds of proceeding to phase II treatment were 86.6% greater with a one standard deviation increase in the angulation of the right central and lateral incisors. Other factors demonstrated trends but were not statistically significant.

LIMITATIONS

Sample in subgroups was small, excluded smiles that did not expose the upper incisor crowns significantly, smiles in real life are observed three-dimensionally, other factors outside the aesthetic measurements were not considered in the analysis.

CONCLUSIONS

In this sample, the angulation of the maxillary right incisors was the most significant factor influencing the decision to undergo an orthodontic phase II.

A descriptive analysis of oral health systematic reviews published 1991-2012: cross sectional study

Objectives

To identify all systematic reviews (SRs) published in the domain of oral health research and describe them in terms of their epidemiological and descriptive characteristics.

Design

Cross sectional, descriptive study.

Methods

An electronic search of seven databases was performed from inception through May 2012; bibliographies of relevant publications were also reviewed. Studies were considered for inclusion if they were oral health SRs defined as therapeutic or non-therapeutic investigations that studied a topic or an intervention related to dental, oral or craniofacial diseases/disorders. Data were extracted from all the SRs based on a number of epidemiological and descriptive characteristics. Data were analysed descriptively for all the SRs, within each of the nine dental specialities, and for Cochrane and non-Cochrane SRs separately.

Results

1,188 oral health (126 Cochrane and 1062 non-Cochrane) SRs published from 1991 through May 2012 were identified, encompassing the nine dental specialties. Over half (n = 676; 56.9%) of the SRs were published in specialty oral health journals, with almost all (n = 1,178; 99.2%) of the SRs published in English and almost none of the non-Cochrane SRs (n = 11; 0.9%) consisting of updates of previously published SRs. 75.3% of the SRs were categorized as therapeutic, with 64.5% examining non-drug interventions, while approximately half (n = 150/294; 51%) of the non-therapeutic SRs were classified as epidemiological SRs. The SRs included a median of 15 studies, with a meta-analysis conducted in 43.6%, in which a median of 9 studies/1 randomized trial were included in the largest meta-analysis conducted. Funding was received for 25.1% of the SRs, including nearly three-quarters (n = 96; 76.2%) of the Cochrane SRs.

Conclusion

Epidemiological and descriptive characteristics of the 1,188 oral health SRs varied across the nine dental specialties and by SR category (Cochrane vs. non-Cochrane). There is a clear need for more updates of SRs in all the dental specialties.

Craniofacial morphology in pediatric patients with persistent obstructive sleep apnea with or without positive airway pressure therapy: a cross-sectional cephalometric comparison with controls

INTRODUCTION

Compression on the midface with nasal mask-delivered positive airway pressure (PAP) therapy in growing patients might contribute to midface retrusion. The objective of this study was to investigate the association between long-term PAP use and craniofacial morphologic pattern in children with persistent obstructive sleep apnea.

METHODS

Images generated with cone-beam volumetric imaging were used to complete lateral cephalometric analyses of anteroposterior projection of the midface region. The study group included 12 subjects (10 boys, 2 girls; mean age, 9.0 years) who used PAP therapy for at least 6 months and at least 6 hours per night. Measurements from this group were compared with those of a control group of 11 subjects (5 boys, 6 girls; mean age, 9.6 years) with obstructive sleep apnea who did not have PAP. Measurements were taken at 1 time point.

RESULTS

No significant differences were identified between the groups for any cephalometric variable. Multivariate linear regression analysis also did not identify a significant association between the number of months of PAP therapy and the cephalometric variables. Cephalometric data for both groups were pooled for comparison with appropriate published normative values for age and sex. Anterior cranial base length, overall anteroposterior length of the maxillary base, and mandibular body length were significantly shorter than normal in the subjects compared with published normative values.

CONCLUSIONS

No association was demonstrated between midface projection and PAP use in growing patients. When compared with normative data for anterior cranial base, children with obstructive sleep apnea had shorter maxillary and mandibular lengths.

Efficiency of molar distalization associated with second and third molar eruption stage

OBJECTIVE

To evaluate the efficiency of molar distalization associated with the second and third molar eruption stage.

MATERIALS AND METHODS

A systematic computerized database search was conducted using several databases. Adaptations of the terms molar distalization and distalizing appliances were used. The reference lists of all the selected articles were also searched for any potential articles that might have been missed in the electronic search. The data provided in the selected publications were grouped and analyzed in terms of molar distalization with respect to various eruption stages of maxillary second and third molars.

RESULTS

Out of the 13 initially identified articles only four fulfilled the final selection criteria. Three of the four studies showed no statistical significance in linear molar distalization based on the eruptive stage of the second and/or third molars, while one study found that the amount of distal movement of the first molars was significantly greater in the group with unerupted second molars. Only one study found that the amount of molar tipping that occurred as a result of distalization was related to the eruption stage of the maxillary molars. Similarly, three of the four studies found that molar distalization time was not significantly affected by eruption of the second or third molars.

CONCLUSION

The effect of maxillary second and third molar eruption stage on molar distalization-both linear and angular distalization-appears to be minimal. This conclusion is only based on low-level of evidence clinical trials. The large variability in the outcomes should be considered clinically.

Three-dimensional deformation of orthodontic brackets

Braces are used by orthodontists to correct the misalignment of teeth in the mouth. Archwire rotation is a particular procedure used to correct tooth inclination. Wire rotation can result in deformation to the orthodontic brackets, and an orthodontic torque simulator has been designed to examine this wire–bracket interaction. An optical technique has been employed to measure the deformation due to size and geometric constraints of the orthodontic brackets. Images of orthodontic brackets are collected using a stereo microscope and two charge-coupled device cameras, and deformation of orthodontic brackets is measured using a three-dimensional digital image correlation technique. The three-dimensional deformation of orthodontic brackets will be evaluated. The repeatability of the three-dimensional digital image correlation measurement method was evaluated by performing 30 archwire rotation tests using the same bracket and archwire. Finally, five Damon 3MX and five In-Ovation R self-ligating brackets will be compared using this technique to demonstrate the effect of archwire rotation on bracket design.

Short-term effect of low-intensity pulsed ultrasound on an ex-vivo 3-d tooth culture

We investigated the short-term effect of LIPUS on human dentin-pulp complex in vitro. We collected sixty-three premolars from patients who needed the extraction. The premolars were sectioned transversely into 600-μm-thick slices, and then divided into five groups according to LIPUS application time (control, 5, 10, 15 and 20 min). LIPUS transducer produced an incident intensity of 30 mW/cm(2). After 24 h, tissue was harvested for histomorphometrical analysis and RT-PCR (Genes of interest: Collagen I, DMP1, DSPP, TGF β1, RANKL and OPG). Histomorphometric analysis showed no significant difference among the five groups in the odontoblast count and predentin thickness. RT-PCR demonstrated no expression of TGF β1, low amounts of DSPP, a twofold increase in collagen I expression in the 5- and 10-minute LIPUS groups and a threefold increase in DMP1 expression in the 10-minute LIPUS group. LIPUS application was stimulatory to the dentin-pulp complex in vitro and increased the expression of collagen I and DMP1.

Towards a viscoelastic model for the unfused midpalatal suture: development and validation using the midsagittal suture in New Zealand white rabbits

Maxillary expansion treatment is a commonly used procedure by orthodontists to widen a patient's upper jaw. As this is typically performed in adolescent patients, the midpalatal suture, connective tissue adjoining the two maxilla halves, remains unfused. Studies that have investigated patient response to expansion treatment, generally through finite element analysis, have considered this suture to behave in a linear elastic manner or it was left vacant. The purpose of the study presented here was to develop a model that could represent the midpalatal suture's viscoelastic behavior. Quasilinear viscoelastic, modified superposition, Schapery's, and Burgers modeling approaches were all considered. Raw data from a previously published study using New Zealand White Rabbits was utilized for model parameter estimation and validation. In this study, Sentalloy(®) coil springs at load levels of 0.49N (50g), 0.98N (100g), and 1.96N (200g) were used to widen the midsagittal suture of live rabbits over a period of 6 weeks. Evaluation was based on a models ability to represent experimental data well over all three load sets. Ideally, a single set of model constants could be used to represent data over all loads tested. Upon completion of the analysis it was found that the modified superposition method was able to replicate experimental data within one standard deviation of the means using a single set of constants for all loads. Future work should focus on model improvement as well as prediction of treatment outcomes.

Topical contrast agents to improve soft-tissue contrast in the upper airway using cone beam CT: a pilot study

The purpose of this study is to explore the topical use of radiographic contrast agents to enhance soft-tissue contrast on cone beam CT (CBCT) images. Different barium sulphate concentrations were first tested using an airway phantom. Different methods of barium sulphate application (nasal drops, syringe, spray and sinus wash) were then tested on four volunteers, and nebulized iodine was tested in one volunteer. CBCT images were performed and then assessed subjectively by two examiners for contrast agent uniformity and lack of streak artefact. 25.0% barium sulphate presented adequate viscosity and radiodensity. Barium sulphate administered via nasal drops and sprays showed non-uniform collection at the nostrils, along the inferior and/or middle nasal meatuses and posterior nasal choana. The syringe and sinus wash showed similar results with larger volumes collecting in the naso-oropharynx. Nebulized iodine failed to distribute into the nasal cavity and scarcely collected at the nostrils. All methods of nasal application failed to adequately reach or uniformly coat the nasal cavity beyond the inferior nasal meatuses. The key factors to consider for optimum topical radiographic contrast in the nasal airway are particle size, flow velocity and radio-opacity.

The validity, reliability, and time requirement of study model analysis using cone-beam computed tomography-generated virtual study models

OBJECTIVES

To investigate the validity, reliability, and time spent to perform a full orthodontic study model analysis (SMA) on cone-beam computed tomography (CBCT)-generated dental models (Anatomodels) compared with conventional plaster models and a subset of extracted premolars.

SETTING AND SAMPLE POPULATION

A retrospective sample of 30 consecutive patient records with fully erupted permanent dentition, good-quality plaster study models, and CBCT scans. Twenty-two extracted premolars were available from eleven of these patients.

MATERIALS AND METHODS

Five evaluators participated in the inter-rater reliability study and one evaluator for the intrarater reliability and validity studies. Agreement was assessed by ICC and cross-tabulations, while mean differences were investigated using paired-sample t-tests and repeated-measures anova.

RESULTS

For all three modalities studied, intrarater reliability was excellent, inter-rater reliability was moderate to excellent, validity was poor to moderate, and performing SMA on Anatomodels took twice as long as on plaster.

CONCLUSIONS

Study model analysis using CBCT-generated study models was reliable but not always valid and required more time to perform when compared with plaster models.

Role of the midpalatal suture in FEA simulations of maxillary expansion treatment for adolescents: a review

The overall goal of this review was to observe how the material properties of the unfused midpalatal suture have been considered by researchers in finite element analyses of maxillary expansion. Literature from Scopus, PubMed, and Biosis were all considered. Upon completion of the review, it was found that researchers assumed the suture to be vacant, have the same elastic properties as bone, or have elastic properties indicative of soft tissues. By performing a simplified analysis of the maxilla complex during expansion, it is shown that the suture may have a significant influence on treatment outcome. As a result, despite valuable contributions from previous studies, it would be ideal to incorporate a more representative model of the midpalatal suture into finite element simulations.

MRI findings of radiation-induced changes of masticatory muscles: a systematic review

BACKGROUND

Radiotherapy to the head and neck regions can result in serious consequences to the temporomandibular joint (TMJ) and chewing muscles. Magnetic resonance imaging (MRI) demonstrates soft-tissue alterations after radiotherapy, such as morphology and signal intensity.

OBJECTIVE

The purpose of this review is to critically and systematically analyse the available evidence regarding the masticatory muscles alterations, as demonstrated on MRI, after radiotherapy for head and neck cancer.

DATA SOURCES

Electronic search of MEDLINE, EMBASE, EBM reviews and Scopus.

INCLUSION CRITERIA

Reports of any study design investigating radiation-induced changes in masticatory muscles after radiotherapy in patients with head and neck cancer were included.

RESULTS AND SYNTHESIS METHODS

An electronic database search resulted in 162 papers. Sixteen papers were initially selected as potentially relevant studies; however, only four papers satisfied all inclusion criteria. The included papers focused on the MRI appearance of masticatory muscles following radiotherapy protocol. Two papers reported outcome based on retrospective clinical and imaging records, whereas the remaining two papers were case reports. Irradiated muscles frequently show diffuse increase in T2 signal and post-gadolinium enhancement post-irradiation. Also, muscle size changes were reported based on subjective comparison with the contralateral side. The quality of all included papers was considered poor with high risk of bias.

CONCLUSION

There is no evidence that MRI interpretations indicate specific radiation-induced changes in masticatory muscles. There is a clear need for a cohort study comparing patients with pre- and post-radiotherapy MRI.

A novel experimental model for studying transverse orthodontic tooth movement in the rat mandible

OBJECTIVES

To establish a rat model of a one-piece mandible using the principles of gingivoperiosteoplasty and guided bone regeneration to fuse the midline symphyseal area.

MATERIAL AND METHODS

Twenty-four Sprague-Dawley female rats were divided into two groups: 12 experimental and 12 control. Both groups were imaged using in vivo micro-computed tomography at baseline and at end point (5 months). The experimental group received regenerative surgery at the symphysis area; the control group received no treatment. Outcomes were evaluated by radiographic examination of gross and volumetric bony changes in the symphyseal region of interest marked between the mental foramina bilaterally and the two central incisors near the most coronal margin of the alveolar crests. These landmarks were chosen as they can be reproduced on the computed tomography images at baseline and end point. Histologic examination was performed on all samples at a level 5 mm apical to the alveolar bone crest.

RESULTS

Radiologic and histologic examinations of the experimental group revealed complete bony fusion of the symphyseal area in three subjects, partial fusion in five subjects, and thickening of the alveolar bony socket in three subjects; one rat died of anesthesia-related complications. No evidence of fusion or alveolar bone thickening was found in any of the controls.

CONCLUSIONS

This surgical animal model demonstrates that a rat mandible can be surgically manipulated to mimic the one-piece human mandible. This novel model may prove useful in studying mandibular bone remodeling and orthodontic mandibular tooth movement.

Indices to assess malocclusions in patients with cleft lip and palate

BACKGROUND

Several indices are now available to assess the severity of the malocclusion in cleft lip and/or palate (CLP) patients; and although it has been quite some time since the introduction of these indices, there is no consensus as to which index should be used for CLP populations.

OBJECTIVE

To systematically review the available literature on the indices used to assess the occlusal schemes in dental models of CLP patients, with respect to the most commonly used index and the index that most fulfils the World Health Organization (WHO) criteria.

SEARCH METHODS

Ten electronic databases, grey literature, and reference list searches were conducted.

SELECTION CRITERIA

The inclusion criteria consisted of studies that aimed to assess a particular malocclusion index on study models of patients with CLP.

DATA COLLECTION AND ANALYSIS

Full articles were retrieved from abstracts/titles that appeared to have met the inclusion -exclusion criteria which were subsequently reviewed using more detailed criteria for a final selection decision. The Quality Assessment of Diagnostic Accuracy Studies tool was used to appraise the methodological quality of the finally included studies. Due to the heterogeneity of the data, only a qualitative analysis was performed.

RESULTS

A total of 13 studies met the inclusion -exclusion criteria. These studies revealed seven utilized indices, namely the GOSLON Yardstick, Five-Year-Old, Bauru-Bilateral Cleft Lip and Palate Yardstick, Huddart -Bodenham, Modified Huddart -Bodenham, EUROCRAN Yardstick, and GOAL Yardstick. The GOSLON Yardstick was the most commonly used index, and the Modified Huddart -Bodenham performed the best according to the WHO criteria.

CONCLUSIONS

Current evidence suggests that the Modified Huddart -Bodenham Index equalled or outperformed the rest of the indices on all the WHO criteria and that the GOSLON Yardstick was the most commonly used index, possibly due to a longer time in use. Therefore, the Modified Huddart -Bodenham could be considered as the standard to measure outcomes of patients with CLP.

Transverse dental changes after tooth-borne and bone-borne maxillary expansion

OBJECTIVE

Determine the differences in skeletal and dental maxillary expansion as evidenced by the degree of dental tipping and if this is symmetrical or not.

METHODS

Sixty-two patients who were diagnosed as requiring maxillary expansion treatment were recruited over an 18-month period. Patients were randomly allocated into three groups where a total of three to four cone-beam computerized tomographies (CBCT) were obtained throughout a one-year period depending on the group allocated. Landmarks used were from the first and second molars and premolars of the maxilla. For each of the eight teeth, three landmarks were identified: the root apex, alveolar bone and pulp chamber. Statistical analysis consisted in the use of MANOVA and after significant overall effects were detected, the univariate repeated measures results were analyzed along with separate ANOVA for each variable at each of the four time points.

RESULTS

There was strong overall significance for time, group, and time*group. The first and second molars saw both bone- and tooth-anchored treatment groups with significantly different dental inclination than the control group. For the second premolars, only the tooth-anchored group was significantly different from control. The tooth-anchored group was also significantly different than the control group in the first premolar measurements. For the analysis of asymmetry in dental inclination, no significant time, group, or time*group effects were seen overall.

CONCLUSION

The analysis provided evidence that dental tipping does occur in the molars for both RME treatments, while the premolars showed increased tipping in the tooth-anchored, but not the bone-anchored group.

Efficiency of molar distalization with the XBow appliance related to second molar eruption stage

To quantitatively evaluate on lateral cephalograms horizontal, vertical, and angular changes in the position of the maxillary first molar based on the presence and absence of erupted maxillary second molars when it is distalized with the XBow appliance. In this retrospective study, a total of 102 consecutively treated cases were assessed. Lateral cephalograms were obtained at the start and after completion of active treatment with the XBow appliance. In one group of patients, distal movement of the maxillary first molars was performed before the eruption of maxillary second molars; in the other group of patients, both first and second maxillary molars were simultaneously moved distally. All cephalograms were superimposed on palatal plane using the method of best-fit. In order to compare the mean horizontal, vertical, and angular changes in molar position between the treatment groups and gender, a multivariate analysis of covariance (MANCOVA) was performed with the pre-treatment class II severity used as a covariate. Regression analysis was also performed to further explore any possible relationships between the predictor variables and the quantity and quality of distalization. A MANCOVA revealed that the eruption stage of the maxillary second molar did not have a significant effect on the change in position of the maxillary first molar after treatment with a XBow appliance. When distalizing maxillary first molars with a XBow appliance, there is no difference in the amount of distalization in patients with erupted and unerupted maxillary second molars.

Linear measurements using virtual study models

OBJECTIVE

To perform a systematic review of the literature to assess the reliability and validity of linear measurements using virtual vs plaster study models.

MATERIALS AND METHODS

A search strategy was developed for four online databases, and references were further hand searched for studies additional papers. Three researchers determined the eligibility of papers by applying specific selection criteria and ultimately selected 17 papers. Grouped by virtual model acquisition type and the number of landmarks used in a given measurement, the data were weighted by sample size and analyzed in terms of the reliability and validity of linear measurements.

RESULTS

The intrarater reliability was high for two-landmark and >two-landmark linear measurements performed on laser-acquired models or cone-beam computed tomography (CBCT)-acquired models and were similar to measurements on plaster models. Validity was high for two-landmark and >two-landmark linear measurements comparing laser-acquired models or CBCT-acquired models to plaster study models, and the weighted mean differences were clinically insignificant. Agreement of measurements was excellent, with less variability than correlation. Acquisition type had no perceived influences on reliability and validity. More than two-landmark measures tended to have higher mean differences than two-landmark measures.

CONCLUSIONS

Virtual study models are clinically acceptable compared with plaster study models with regard to intrarater reliability and validity of selected linear measurements.

A new method to measure mesiodistal angulation and faciolingual inclination of each whole tooth with volumetric cone-beam computed tomography images

INTRODUCTION

The purpose of this study was to develop a methodology to measure the mesiodistal angulation and the faciolingual inclination of each whole tooth (including the root) by using 3-dimensional volumetric images generated from cone-beam computed tomography scans.

METHODS

A plastic typodont with 28 teeth in ideal occlusion was fixed in position in a dry human skull. Stainless steel balls were fixed to the occlusal centers of the crowns and to the apices or bifurcation or trifurcation centers of the roots. Cone-beam computed tomography images were taken and rendered in Dolphin 3D (Dolphin, Chatsworth, Calif). The University of Southern California root vector analysis program was developed and customized to digitize the crown and root centers that define the long axis of each whole tooth. Special algorithms were used to automatically calculate the mesiodistal angulation and the faciolingual inclination of each whole tooth. Angulation measurements repeated 5 times by using this new method were compared with the true values from the coordinate measuring machine measurements. Next, the root points of 8 selected typodont teeth were modified to generate known angulation and inclination values, and 5-time repeated measurements of these teeth were compared with the known values.

RESULTS

Intraclass correlation coefficients for the repeated mesiodistal angulation and faciolingual inclination measurements were close to 1. Comparisons between our 5-time repeated angulation measurements and the coordinate measuring machine's true angulation values showed 5 teeth with statistically significant differences. However, only the maxillary right lateral incisor showed a mean difference that might exceed 2.5° for clinical significance. Comparisons between the 5-repeated measurements of 8 teeth with known mesiodistal angulation and faciolingual inclination values showed no statistically significant differences between the measured and the known values, and no measurement had a 95% confidence interval beyond 1°.

CONCLUSIONS

We have developed the novel University of Southern California root vector analysis program to accurately measure each whole tooth mesiodistal angulation and faciolingual inclination, in a clinically significant level, directly from the cone-beam computed tomography volumetric images.