Three-dimensional dental arch and palatal form changes after extraction and nonextraction treatment. Part 1. Arch length and area

A Systematic Review of the Use of Intraoral Scanning for Human Identification Based on Palatal Morphology

A common application for intraoral scanners is the digitization of the morphology of teeth and palatal rugae. Palatal scans are most commonly required to fabricate complete dentures and immediate transitional dentures and serve as a reference point for assessing orthodontic results. However, they are also frequently included by accident, even though the main purpose of intraoral scanning is to reconstruct dentition using computer-aided manufacturing (CAM). The literature shows that the identification of disaster victims has frequently involved palatal rugae impressions. As the skull provides sound insulation, the rugae are resistant to heat, chemicals, and stress. Antemortem data might be difficult to find during a forensic inquiry, particularly in disaster victim identification cases. In contrast with DNA and fingerprints, there is a greater likelihood of having a dental record that contains palatal scans. With specialized software, the scans can be exported as open stereolithography (STL) files. Considering that a full case consumes up to about 100 MB of hard drive space, long-term storage should not be an issue compared to a plaster model. Additionally, dentists widely use online databases to exchange data for smile design, implant registration, and orthodontic purposes. This will produce a digital database that grows quickly and is readily usable for forensic investigations. The uniqueness of forensic features is frequently challenged; however, palatal morphology's unique trait could make it possible as it is characteristic of individuals as well as the most distinguishing factor. This review will highlight how rugae, palatal morphology, mirroring, superimposition, and geometrics can serve in forensic identification.

Palatal shape covariation in extraction versus nonextraction borderline patients: A geometric morphometric study

INTRODUCTION

This study aimed to evaluate changes in palatal shape after orthodontic treatment from a borderline sample of extraction and nonextraction patients with a Class I relationship.

METHODS

A borderline sample regarding premolar extractions was obtained through discriminant analysis and comprised 30 nonextraction and 23 extraction patients. The digital dental casts of these patients were digitized with 3 curves and 239 landmarks placed on the hard palate. Procrustes superimposition and principal component analysis were implemented to assess group shape variability patterns.

RESULTS

The success of the discriminant analysis in identifying a borderline sample regarding the extraction modality was validated using geometric morphometrics. Concerning palatal shape, no sexual dimorphism was found (P = 0.78). The first 6 principal components that were statistically significant accounted for 79.2% of the total shape variance. Palatal changes were 61% more pronounced in the extraction group, which exhibited a decrease in palatal length (P = 0.02; 10,000 permutations). In contrast, the nonextraction group showed an increase in the palatal width (P <0.001; 10,000 permutations). Intergroup comparisons indicated that the nonextraction group exhibited longer palates, whereas the extraction group exhibited higher palates (P = 0.02; 10,000 permutations).

CONCLUSIONS

Considerable changes in palatal shape were seen for the nonextraction and extraction treatment group, with the latter exhibiting more pronounced changes, mainly in terms of palatal length. Further investigations are needed to clarify the clinical significance of the palatal shape changes in borderline patients after extraction and nonextraction treatment.

Finite Element Analysis of Orthodontic Relapse in Different Maxillary Arch Form

Abstract Background: Orthodontic relapse is fairly common; however, the mechanisms between relapse and the dental arch form remain unclear. The purpose of our study was to establish three-dimensional (3D) finite element models of different dental arch forms after orthodontic treatment and to analyze the states of different arches applied with various sagittal forces.Methods: By calculating the equations of different dental arch forms and combining them with a full maxillary arch (14 teeth), 3D finite element models of square, oval, and tapered dental arches were established; they were designed to be subjected to anterior lingual, posterior mesial, and combined forces, respectively.Results: The von Mises stress and displacement of teeth under different forces were calculated for each loading scenario. Under the different forcing scenarios, all incisors had irregularity trends, and the inclination and intrusion of the canines were increased, and the premolars had a tendency to buccal or lingual crown tipping or even intrusion in our study. The tapered arch was the most stable and had the smallest displacement and von Mises stress, followed by the ovoid arch; the most unstable arch was the square arch.Conclusions: To achieve a stable orthodontic effect, a tapered or ovoid arch, rather than a square arch, should be chosen as the final outcome of treatment.

Exploring palatal and dental shape variation with 3D shape analysis and geometric deep learning

OBJECTIVES

Palatal shape contains a lot of information that is of clinical interest. Moreover, palatal shape analysis can be used to guide or evaluate orthodontic treatments. A statistical shape model (SSM) is a tool that, by means of dimensionality reduction, aims at compactly modeling the variance of complex shapes for efficient analysis. In this report, we evaluate several competing approaches to constructing SSMs for the human palate.

SETTING AND SAMPLE POPULATION

This study used a sample comprising digitized 3D maxillary dental casts from 1,324 individuals.

MATERIALS AND METHODS

Principal component analysis (PCA) and autoencoders (AE) are popular approaches to construct SSMs. PCA is a dimension reduction technique that provides a compact description of shapes by uncorrelated variables. AEs are situated in the field of deep learning and provide a non-linear framework for dimension reduction. This work introduces the singular autoencoder (SAE), a hybrid approach that combines the most important properties of PCA and AEs. We assess the performance of the SAE using standard evaluation tools for SSMs, including accuracy, generalization, and specificity.

RESULTS

We found that the SAE obtains equivalent results to PCA and AEs for all evaluation metrics. SAE scores were found to be uncorrelated and provided an optimally compact representation of the shapes.

CONCLUSION

We conclude that the SAE is a promising tool for 3D palatal shape analysis, which effectively combines the power of PCA with the flexibility of deep learning. This opens future AI driven applications of shape analysis in orthodontics and other related clinical disciplines.

Automated landmarking for palatal shape analysis using geometric deep learning

OBJECTIVES

To develop and evaluate a geometric deep-learning network to automatically place seven palatal landmarks on digitized maxillary dental casts.

SETTINGS AND SAMPLE POPULATION

The sample comprised individuals with permanent dentition of various ethnicities. The network was trained from manual landmark annotations on 732 dental casts and evaluated on 104 dental casts.

MATERIALS AND METHODS

A geometric deep-learning network was developed to hierarchically learn features from point-clouds representing the 3D surface of each cast. These features predict the locations of seven palatal landmarks.

RESULTS

Repeat-measurement reliability was <0.3 mm for all landmarks on all casts. Accuracy is promising. The proportion of test subjects with errors less than 2 mm was between 0.93 and 0.68, depending on the landmark. Unusually shaped and large palates generate the highest errors. There was no evidence for a difference in mean palatal shape estimated from manual compared to the automatic landmarking. The automatic landmarking reduces sample variation around the mean and reduces measurements of palatal size.

CONCLUSIONS

The automatic landmarking method shows excellent repeatability and promising accuracy, which can streamline patient assessment and research studies. However, landmark indications should be subject to visual quality control.

3D evaluation of the morphological and volumetric changes of the tongue and oral cavity before and after orthognathic surgery for mandibular prognathism: a preliminary study

BACKGROUND

The volumetric ratio of the tongue to the oral cavity has been recognized to be one of the important factors for the maintenance of stable occlusion. Oral cavity capacity is changed after orthognathic surgery in patients with mandibular prognathism; however, the volumetric changes of the oral cavity including the tongue before and after surgery have not been analyzed. The purpose of this study was to evaluate the morphological and volumetric changes of the tongue and oral cavity following orthognathic surgery using a newly developed vinyl polysiloxane impression method.

MATERIALS AND METHODS

The study was performed in fifteen subjects who underwent surgical orthognathic treatment. Impressions of the tongue together with the oral cavity were obtained before orthognathic surgery and 1, 3, and 6 months after orthognathic surgery. These impression patterns were scanned using cone-beam computed tomography (CT), and three-dimensional (3D) images of the oral cavity including the tongue, and the upper and lower dental arches were reconstructed. The morphological and volumetric changes in the oral cavity capacity and the tongue volume were examined.

RESULTS

The volume of the tongue with the volume of the oral cavity decreased after orthognathic surgery. There was a correlation between the decrease in the oral cavity capacity and tongue volume. The volumetric ratio of the tongue to the oral cavity seems to be maintained before and after orthognathic surgery.

CONCLUSION

VPS method, free from radiation exposure, may be useful for investigating the morphological and volumetric changes of the tongue and oral cavity, which may possibly influence the stability of the dental arch and occlusion during surgical orthodontic treatment.

Variation of upper lip pressure on upper teeth during non-extraction orthodontic treatment: A prospective clinical study

OBJECTIVE

The objectives of this prospective clinical study are to quantify the variation of pressure exerted by the upper lip on the upper teeth during the alignment phase and to evaluate its capacity to adapt to changes in dental position.

MATERIALS AND METHODS

Thirty young subjects in skeletal Class I relationship requiring non-extraction orthodontic treatment were included in this study. The pressure exerted by the upper lip on the upper central incisors and right canine were measured during rest and swallowing positions using a pressure transducer before bracket placement (T0), after bracket placement (T1), three months (T2) and six months later (T3). Maxillary intercanine width (CC), upper arch length (U) and crowding (C) were measured on stone models at T1, T2 and T3 to determine the existence of a correlation between the variation of lip pressure and these variables.

RESULTS

The lip pressure significantly increased after bracket placement and remained relatively stable during the six-month period. The labial pressure on the incisors was the only variable to significantly decrease at T3, though remaining significantly higher than the starting pressure. A positive correlation was found between the variation of the inter-canine distance and the labial pressure on the canine at rest whereas a negative correlation exists between the crowding and the labial pressure on the incisors at rest.

CONCLUSION

This study showed that increasing inter-canine width disrupts the muscle equilibrium and therefore is prone to relapse, whereas the upper lip can better adapt to the protrusion of upper incisors.

Stability of maxillary anterior crowding treatment

OBJECTIVE: To evaluate the stability and the relapse of maxillary anterior crowding treatment on cases with premolar extraction and evaluate the tendency of the teeth to return to their pretreatment position. METHODS: The experimental sample consisted of 70 patients of both sex with an initial Class I and Class II maloclusion and treated with first premolar extractions. The initial mean age was 13,08 years. Dental casts' measurements were obtained at three stages (pretreatment, posttreatment and posttreatment of 9 years on average) and the variables assessed were Little Irregularity Index, maxillary arch length and intercanine. Pearson correlation coefficient was used to know if some studied variable would have influence on the crowding in the three stages (LII1, LII2, LII3) and in each linear displacement of the Little irregularity index (A, B, C, D, E) in the initial and post-retention phases. RESULTS: The maxillary crowding relapse ( LII3-2) is influenced by the initial ( LII1), and the teeth tend to return to their pretreatment position. CONCLUSION: The results underline the attention that the orthodontist should be given to the maxillary anterior relapse, primarily on those teeth that are crowded before the treatment.

Stability and relapse of maxillary anterior crowding treatment in class I and class II Division 1 malocclusions

INTRODUCTION

The maxillary anterior teeth are the most important to facial esthetics because they are the first to show on a smile. Therefore, stability of the maxillary anterior teeth alignment is an important issue. The objective of this study was to compare the stability of maxillary anterior tooth alignment in Class I and Class II Division 1 malocclusions.

METHODS

The sample comprised dental casts of 70 patients with Class I and Class II Division 1 malocclusions and a minimum of 3 mm of maxillary anterior crowding measured by an irregularity index. The patients were treated with extractions and evaluated at pretreatment and posttreatment and at least 5 years after treatment. The sample was divided into 3 groups: group 1, Class I malocclusion treated with 4 first premolar extractions comprising 30 subjects, with an initial age of 13.16 years and 8.59 mm of initial maxillary irregularity; group 2, Class II malocclusion treated with 4 first premolar extractions comprising 20 subjects, with an initial age of 12.95 years and 11.10 mm of maxillary irregularity; and group 3, Class II malocclusion treated with 2 first maxillary premolar extractions comprising 20 subjects, with an initial age of 13.09 years and 9.68 mm of maxillary irregularity.

RESULTS

The decrease in the maxillary irregularity index was significantly greater in group 2 than in group 1 during treatment. The stability of maxillary anterior alignment was 88.12% over the long term; 77% of the linear displacement of the anatomic contact points tended to return to their original positions.

CONCLUSIONS

Stability of maxillary anterior alignment between the 3 groups was similar. The stability of maxillary anterior alignment was high over the long term, but a high percentage of teeth tended to return to their original positions.

Palatal configuration in Class II Division 1 malocclusion: a longitudinal study

INTRODUCTION

The purpose of this study was to evaluate palatal contours in nonextraction orthodontic treatment and long-term stability in patients with Class II Division 1 malocclusions.

METHODS

Data were obtained from maxillary study models before treatment, after treatment, and at least 5 years postretention. Data were collected with a digital pantograph in the canine, second premolar, and first molar regions. Palatal width, base width, palatal height, and alveolar angle were evaluated.

RESULTS

During treatment, the canine region was stable; in the premolar and molar regions, there were statistically significant increases in transverse (palatal and base widths) and palatal height measurements, whereas the alveolar angle decreased. In the postretention evaluation, the canine region showed the greatest modifications, except for alveolar angulation, which was stable. The premolar region showed stability, but, in the molar region, palatal width and alveolar angulation decreased.

CONCLUSIONS

In analyzing alterations in the geometry of palatal configuration, we concluded that a favorable transverse gain of the palatal base, from growth or orthodontics, was important for stability. The transverse gain of palatal base width during Class II treatment is important to compensate for the expected transverse loss in the cervical region and the decrease of alveolar angle in the long term.

Pattern and amount of change after orthodontic correction of upper front teeth 7 years postretention

OBJECTIVE

To investigate the amount and pattern of changes of maxillary front teeth 7 years postretention, which previously were retained with a bonded retainer.

MATERIALS AND METHODS

The study group consisted of 27 patients. Study models before treatment (T1), at debonding (T2), 1 year after removal of the upper bonded retainer (T3), and 7 years postretention (T4) were present. The irregularity index (sum of contact point displacements) and the rotations of front teeth toward the raphe line were calculated.

RESULTS

The irregularity index of the maxillary front teeth changes very little or not at all during the first year postretention. Further change long term resulted in an irregularity index of mean 2.0 (range 0.0-5.8). The contact relationship between the laterals and centrals seems to be the most critical. Forty rotated teeth in 21 patients were corrected more than 20 degrees . Mean relapse during the first year postretention was 6.7 degrees (range 0.0 degrees -14.7 degrees ). Mean changes during 7 years was 8.2 degrees (range 0.0 degrees -19.3 degrees ).

CONCLUSIONS

Relapse of upper front teeth retained with a bonded retainer is minor in both the short and long term. If permanent retention is required after 3 years of retention, it is enough to retain the incisors.

Effects on the Dental Arch Form Using a Preadjusted Appliance with Premolar Extraction in Class I Crowding

Objective: To determine the dental arch form effects of treatment with a preadjusted appliance (0.022″ slot) performed concomitantly with extraction of premolars in Class I crowding.

Materials and Methods: Twenty-six patients (20.17 ± 12.15 years) with Class I crowding who attained a favorable occlusion after treatment were divided into nonextraction and extraction groups. The three-dimensional coordinates of the FA point of each tooth were determined. The dental arch form was expressed as a quartic polynomial expression with log F value used to represent the dental arch form and calculated using the quadratic and quartic coefficients. Changes in the dental arch form before and after treatment were compared between the groups.

Results: In the extraction group, log F value was significantly higher after treatment, and the upper dental arch became more tapered. The U1-APo was significantly lower after treatment. No change was observed in U1-FH. The anterior teeth demonstrated posterior movement due to sliding mechanics, and torque was controlled. The anterior length of the dental arch became significantly longer after treatment for the maxilla and mandible in both groups. Results demonstrated that the upper dental arch might become tapered after treatment used concomitantly with premolar extraction, as a result of the increase in anterior length while maintaining intercanine width for dealing with crowding of the anterior teeth.

Conclusion: It is necessary to anticipate that the upper dental arch form will become tapered during extraction treatment for Class I crowding and to select an appropriate arch form.

Long-term stability of orthodontic treatment and patient satisfaction. A systematic review

OBJECTIVE

To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment.

MATERIALS AND METHODS

Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies.

RESULTS

The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective.

CONCLUSIONS

This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.

Three-dimensional dental arch and palatal form changes after extraction and nonextraction treatment. Part 2. Palatal volume and height

The purpose of this study was to investigate the changes in palatal volume and palatal height in patients treated with and without premolar extractions. Records were collected at pretreatment, at bracket removal, at the end of retention, and 5 years out of retention. Stone casts were mounted in a SAM 2 articulator with an anatomic face-bow and a central wax record, and measurements were made with a 3-dimensional digitizer. The hypothesis, that orthodontic treatment with premolar extractions changes the palatal form, was verified. Increases in palatal volume and height were demonstrated in the nonextraction group. The extraction group showed a decrease in palatal volume but could compensate for some loss by an increase in volume in the anterior segment.

Three-dimensional dental arch and palatal form changes after extraction and nonextraction treatment. Part 3. Transversal and sagittal palatal form

The purpose of this study was to investigate changes in the palatal form in patients treated with and without premolar extractions. Records collected at pretreatment, at bracket removal, at the end of retention, and 5 years out of retention were examined. Stone casts were mounted on an articulator with an anatomic face-bow and a central wax record, and measurements were made with a 3-dimensional digitizer. The hypothesis that orthodontic treatment with premolar extractions changes the palatal form was verified.