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Oliveira PM, Cheib-Vilefort PL, de Pársia Gontijo H, Melgaço CA, Franchi L, McNamara JA, Souki BQ. Three-dimensional changes of the upper airway in patients with Class II malocclusion treated with the Herbst appliance: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2020; 157:205-211. [PMID: 32005472 DOI: 10.1016/j.ajodo.2019.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study aimed to determine the volumetric effects on the upper airways of growing patients with Class II malocclusion treated with the Herbst appliance (HA). METHODS Volumetric measurements of the upper airways of 42 skeletal Class II malocclusion patients (mean age: 13.8 ± 1.2 years; ranging from 12.0 to 16.9 years) were assessed using cone-beam computed tomography scans acquired before treatment (T0) and approximately 1 year later (T1). The sample comprised a Herbst appliance group (HA group [HAG]; n = 24), and a comparison group (comparison group [CG]; n = 18) of orthodontic patients who had received dental treatments other than mandibular advancement with dentofacial orthopedics. RESULTS In CG, nasopharynx and oropharynx volumes decreased slightly during the observation period (9% and 3%, respectively), whereas the nasal cavity volume increased significantly (12%; P = 0.046). In HAG, there was an increase in the volume of all regions (nasal cavity, 5.5%; nasopharynx, 11.7%; and oropharynx, 29.7%). However, only the oropharynx showed a statistically significant increase (P = 0.003), presenting significant volumetric changes along the time (T1-T0) in HAG. CONCLUSION Mandibular advancement with the HA significantly increased the volume of the oropharynx, but no significant volumetric modifications were observed in the nasal cavity and nasopharynx.
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Affiliation(s)
- Paula Moreira Oliveira
- Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Camilo Aquino Melgaço
- School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, Section of Dentistry, The University of Florence, Florence, Italy; Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, Mich
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, Mich; Cell and Developmental Biology, School of Medicine, Center for Human Growth and Development, The University of Michigan; and Private practice, Ann Arbor, Mich
| | - Bernardo Quiroga Souki
- Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil.
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102
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Makaremi M, Lacaule C, Mohammad-Djafari A. Deep Learning and Artificial Intelligence for the Determination of the Cervical Vertebra Maturation Degree from Lateral Radiography. ENTROPY 2019. [PMCID: PMC7514567 DOI: 10.3390/e21121222] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Deep Learning (DL) and Artificial Intelligence (AI) tools have shown great success in different areas of medical diagnostics. In this paper, we show another success in orthodontics. In orthodontics, the right treatment timing of many actions and operations is crucial because many environmental and genetic conditions may modify jaw growth. The stage of growth is related to the Cervical Vertebra Maturation (CVM) degree. Thus, determining the CVM to determine the suitable timing of the treatment is important. In orthodontics, lateral X-ray radiography is used to determine it. Many classical methods need knowledge and time to look and identify some features. Nowadays, ML and AI tools are used for many medical and biological diagnostic imaging. This paper reports on the development of a Deep Learning (DL) Convolutional Neural Network (CNN) method to determine (directly from images) the degree of maturation of CVM classified in six degrees. The results show the performances of the proposed method in different contexts with different number of images for training, evaluation and testing and different pre-processing of these images. The proposed model and method are validated by cross validation. The implemented software is almost ready for use by orthodontists.
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Affiliation(s)
- Masrour Makaremi
- Department of Orthodontics, University of Bordeaux, 33000 Bordeaux, France; (M.M.); (C.L.)
| | - Camille Lacaule
- Department of Orthodontics, University of Bordeaux, 33000 Bordeaux, France; (M.M.); (C.L.)
| | - Ali Mohammad-Djafari
- International Science Consulting and Training (ISCT), 91440 Bures-sur-Yvette, France
- Correspondence: ; Tel.: +33-6-2295-4233
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103
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Liu Y, Tang C. Interdisciplinary treatment with implant-supported prostheses for an adolescent with ectodermal dysplasia: A clinical report. J Prosthet Dent 2019; 123:655-660. [PMID: 31753462 DOI: 10.1016/j.prosdent.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 10/25/2022]
Abstract
This clinical report describes interdisciplinary treatments for a 17-year-old girl with ectodermal dysplasia. The treatment was initiated with orthodontic therapy. After the remaining primary teeth had been extracted, 6 implants were placed in the maxilla with bilateral sinus floor elevations, and 6 implants were placed in the mandible. Immediate restorations were provided. Definitive restorations included screw-retained partial dental prostheses and ceramic crowns.
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Affiliation(s)
- Yajing Liu
- Postgraduate student, Graduate Prosthodontics, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, PR China; Postgraduate student, Department of Dental Implantology, Nanjing Medical University, Nanjing, PR China
| | - Chunbo Tang
- Professor, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, PR China; Professor, Department of Dental Implantology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, PR China.
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104
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Taylor KL, Evangelista K, Muniz L, Ruellas ACDO, Valladares-Neto J, McNamara J, Franchi L, Kim-Berman H, Cevidanes LHS. Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study. Orthod Craniofac Res 2019; 23:72-81. [PMID: 31514261 DOI: 10.1111/ocr.12345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients. SETTING AND SAMPLE POPULATION A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2). MATERIALS AND METHODS Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05). RESULTS Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups. CONCLUSIONS The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.
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Affiliation(s)
- Kyle L Taylor
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Karine Evangelista
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Luciana Muniz
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - James McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, Orthodontics, Università degli Studi di Firenze, Florence, Italy
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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105
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Mollabashi V, Yousefi F, Gharebabaei L, Amini P. The relation between dental age and cervical vertebral maturation in orthodontic patients aged 8 to 16 years: A cross-sectional study. Int Orthod 2019; 17:710-718. [PMID: 31494086 DOI: 10.1016/j.ortho.2019.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to assess the relation between the dental age of seven left mandibular teeth determined by the Demirjian's method and skeletal age determined by the Baccetti's method. MATERIALS AND METHODS This cross-sectional study evaluated 600 patients aged between 8-16 years, who were selected from those presenting to Orthodontics Department of Hamadan dental school and private orthodontic offices. The patients had good-quality panoramic radiographs and lateral cephalograms taken within 2 months of each other. Skeletal age was determined according to the cervical vertebral maturation (CVM) on lateral cephalograms. The dental age of seven left mandibular teeth was determined using the Demirjian's method. Data were analysed by the Spearman's and Pearson's correlation coefficients via SPSS 16. RESULTS CVM had significant correlations with dental age (0.780) and chronological age (0.792). Accordingly, the strongest correlation was noted between CVM and the developmental stage of second molars in both males and females. In males, the highest correlation between dental age and chronological age was in CS5 stage (0.724) while, in females, the highest correlation between dental age and chronological age was in CS4 stage (0.651). CONCLUSION Considering the correlation between skeletal age and dental calcification, dental age, especially the developmental stage of mandibular second molars, based on panoramic radiographs, can be served as a primary diagnostic tool for determining the skeletal maturity stage of patients.
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Affiliation(s)
- Vahid Mollabashi
- Hamadan University of Medical Science, Dental school, Orthodontics Department, Hamadan, Iran
| | - Faezeh Yousefi
- Hamadan University of Medical Science, Dental school, Oral and Maxillofacial Radiology Department, Hamadan, Iran.
| | | | - Payam Amini
- Reproductive Epidemiology Research Center, Department of Epidemiology and Reproductive Health, Royan, Tehran, Iran
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Cheib Vilefort PL, Farah LO, Gontijo HP, Moro A, Ruellas ACDO, Cevidanes LHS, Nguyen T, Franchi L, McNamara JA, Souki BQ. Condyle-glenoid fossa relationship after Herbst appliance treatment during two stages of craniofacial skeletal maturation: A retrospective study. Orthod Craniofac Res 2019; 22:345-353. [PMID: 31419375 DOI: 10.1111/ocr.12338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To perform a three-dimensional evaluation of the position of the condyles in patients treated with Herbst appliance (HA) in two stages of cervical vertebral maturation. SETTING AND SAMPLE POPULATION Retrospective case-control study. Pubertal Herbst group (PHG; n = 24, mean age 14.5 years, CS 3 and CS 4) and pre-pubertal Herbst group (PPHG; n = 17, mean age 9.9 years, CS 1 and CS 2) were contrasted with comparison groups of non-orthopaedically treated Class II patients in pubertal (PCG; n = 17, mean age 13.9 years) and pre-pubertal maturational stages (PPCG; n = 18, mean age 10.6 years). MATERIALS AND METHODS Cone-beam computer tomography scans were taken before treatment (T0) and at T1 after 8 to 12 months. Point-to-point measurements of the displacement of the condyles between T0 and T1, relative to the glenoid fossae, were performed in the X, Y, Z and 3D perspectives. Qualitative assessments using semi-transparent overlays and colour mapping also were produced. RESULTS The displacement of the condyles within the glenoid fossae in the treated groups was small (<0.75 mm; P > .05). Relative to the glenoid fossa, condylar position at T1 was similar to T0 in pre-pubertal and pubertal groups (P > .05). Similar condylar rotations from T0 to T1 were observed in Herbst and comparison groups, and no significant difference was found between pre-pubertal and pubertal patients. CONCLUSIONS Regardless the stage of skeletal maturation, HA treatment did not change the condyle-glenoid fossa relationship.
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Affiliation(s)
| | | | - Henrique Pársia Gontijo
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Moro
- Graduate Program in Dentistry, University Positivo, Curitiba, Brazil
| | | | | | - Tung Nguyen
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Lorenzo Franchi
- School of Dentistry, University of Florence, Florence, Italy
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Bernardo Quiroga Souki
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
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107
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Streva AM, Nahás-Scocate ACR, de Castro Lopes SLP, Costa ALF. MRI as a method of evaluation and predicting mandibular growth based on temporomandibular joint. PEDIATRIC DENTAL JOURNAL 2019. [DOI: 10.1016/j.pdj.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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108
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McNamara JA, Franchi L, McClatchey LM. Orthodontic and orthopedic expansion of the transverse dimension: A four decade perspective. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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109
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Zong C, Tang B, Hua F, He H, Ngan P. Skeletal and dentoalveolar changes in the transverse dimension using microimplant-assisted rapid palatal expansion (MARPE) appliances. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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111
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Fischer B, Masucci C, Ruellas A, Cevidanes L, Giuntini V, Nieri M, Nardi C, Franchi L, McNamara JA, Defraia E. Three-dimensional evaluation of the maxillary effects of two orthopaedic protocols for the treatment of Class III malocclusion: A prospective study. Orthod Craniofac Res 2018; 21:248-257. [DOI: 10.1111/ocr.12247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/28/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Caterina Masucci
- Sous-section Orthopédie Dento-Faciale; Faculté de Chirurgie dentaire; Université de Nice Sophia Antipolis; Nice France
- Department of Surgery and Translational Medicine; Orthodontics; University of Florence; Florence Italy
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry School of Dentistry; University of Rio de Janeiro; Rio de Janeiro RJ Brazil
- Department of Orthodontics and Pediatric Dentistry School of Dentistry; University of Michigan; Ann Arbor Michigan
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry School of Dentistry; University of Michigan; Ann Arbor Michigan
| | - Veronica Giuntini
- Department of Surgery and Translational Medicine; Orthodontics; University of Florence; Florence Italy
| | - Michele Nieri
- Department of Surgery and Translational Medicine; Orthodontics; University of Florence; Florence Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences; Radiodiagnostic Unit n. 2; University of Florence; Florence Italy
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine; Orthodontics; University of Florence; Florence Italy
- Department of Orthodontics and Pediatric Dentistry; University of Michigan; Ann Arbor Michigan
| | - James A. McNamara
- Department of Orthodontics and Pediatric Dentistry School of Dentistry; University of Michigan; Ann Arbor Michigan
- School of Medicine; University of Michigan; Ann Arbor Michigan
- Center for Human Growth and Development; University of Michigan; Ann Arbor Michigan
| | - Efisio Defraia
- Department of Surgery and Translational Medicine; Orthodontics; University of Florence; Florence Italy
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Takahashi Y, Higashihori N, Yasuda Y, Takada JI, Moriyama K. Examination of craniofacial morphology in Japanese patients with congenitally missing teeth: a cross-sectional study. Prog Orthod 2018; 19:38. [PMID: 30270414 PMCID: PMC6165831 DOI: 10.1186/s40510-018-0238-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this cross-sectional study was to investigate the effects of congenitally missing teeth on craniofacial morphology and to characterize the features of maxillofacial morphology of oligodontia patients associated with individual skeletal maturity by assessment with the cervical vertebrae maturation (CVM) method. Methods A total of 106 non-syndromic Japanese patients with congenitally missing teeth (except for third molars) were selected and categorized into two groups according to the severity of congenitally missing teeth (hypodontia group, 1–5 missing teeth [n = 56]; oligodontia group, ≥ 6 missing teeth [n = 50]). A control group included orthodontic patients without either skeletal disharmony or congenitally missing teeth (n = 63). Subjects in oligodontia and control groups were further categorized into two subgroups on the basis of cervical stage (CS): stage I (CS2 or 3; n = 27 and n = 31, respectively) and stage II (CS4 or above; n = 23 and n = 32, respectively). Lateral cephalograms were analyzed by using eight angular and eight linear measurements. Z-scores were formulated on the basis of age and sex and were matched to the Japanese norm. Tukey tests and t tests were performed. Results Compared with the control group, the hypodontia group had significantly smaller U1 to FH plane angle and A-B plane angle; U1-L1 was significantly larger. The oligodontia group had significantly smaller ANS-Me, L1 to mandibular plane angle, and Ptm-A; U1-L1 was significantly larger. At stage I, the oligodontia group had significantly smaller ANS-Me, gonial angle, and ANS-U1. At stage II, the oligodontia group had significantly smaller U1 to FH plane angle, L1 to mandibular plane angle, Ptm-A, and Go-Pog; it also had significantly larger U1-L1. Conclusions The present study suggested that skeletal patterns differ along with the number of congenitally missing teeth and that, in oligodontia patients, skeletal patterns differ before and after growth peak. It is important to consider the skeletal characteristics of tooth agenesis patients when designing a treatment plan.
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Affiliation(s)
- Yuki Takahashi
- Section of Maxillofacial Orthognathics, Department of Maxillofacial/Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Norihisa Higashihori
- Section of Maxillofacial Orthognathics, Department of Maxillofacial/Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Yuko Yasuda
- Section of Maxillofacial Orthognathics, Department of Maxillofacial/Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Jun-Ichi Takada
- Section of Maxillofacial Orthognathics, Department of Maxillofacial/Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Keiji Moriyama
- Section of Maxillofacial Orthognathics, Department of Maxillofacial/Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Mânica S, Wong FSL, Davis G, Liversidge HM. Estimating age using permanent molars and third cervical vertebrae shape with a novel semi-automated method. J Forensic Leg Med 2018; 58:140-144. [PMID: 29966814 DOI: 10.1016/j.jflm.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/10/2018] [Accepted: 05/25/2018] [Indexed: 12/01/2022]
Abstract
Estimating chronological age accurately in young adults is difficult and additional methods are required to increase the accuracy. This study explored a new semi-automated method to assess shape change of third cervical vertebra (C3) with age in the living; comparing this as a method to determine whether individuals could be categorised into being less than 18 years of age (<18), or at least 18 years of age (≥18) with tooth formation of the second and third mandibular molars (M2 and M3). The sample was panoramic and lateral skull radiographs of 174 dental patients (78 males, 96 females aged 15-22 years). Twelve variables were compared in two age categories: younger than 18 and at least 18 years of age in males and females separately using a t-test. Tooth formation of M2 and M3 was assessed. Mean values of eight variables of C3 in males and one variable in females were significantly different between the two age categories (p < 0.05). Results for males showed that the best age indicator for age ≥18 was the ratio between height and width of C3 and for females, the ratio between diagonals. Results for molars showed that M2 was mature in 69% of males and 83% of females, within the expected age range of 14-16 years. M3 was highly variable ranging from stages 6-14 for both; M3 was missing in 24% of males and 28% of females and mature in 14% of males and 15% of females. The conclusion was that shape change of C3 has potential as an additional method to group individuals <18 and ≥ 18 years of age.
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Affiliation(s)
- Scheila Mânica
- Institute of Dentistry, Queen Mary University of London, UK.
| | | | - Graham Davis
- Institute of Dentistry, Queen Mary University of London, UK
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