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Chang JS, Ma CY, Ko EWC. Prediction of surgery-first approach orthognathic surgery using deep learning models. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00148-6. [PMID: 38821731 DOI: 10.1016/j.ijom.2024.05.003] [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: 11/26/2023] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 06/02/2024]
Abstract
The surgery-first approach (SFA) orthognathic surgery can be beneficial due to reduced overall treatment time and earlier profile improvement. The objective of this study was to utilize deep learning to predict the treatment modality of SFA or the orthodontics-first approach (OFA) in orthognathic surgery patients and assess its clinical accuracy. A supervised deep learning model using three convolutional neural networks (CNNs) was trained based on lateral cephalograms and occlusal views of 3D dental model scans from 228 skeletal Class III malocclusion patients (114 treated by SFA and 114 by OFA). An ablation study of five groups (lateral cephalogram only, mandible image only, maxilla image only, maxilla and mandible images, and all data combined) was conducted to assess the influence of each input type. The results showed the average validation accuracy, precision, recall, F1 score, and AUROC for the five folds were 0.978, 0.980, 0.980, 0.980, and 0.998 ; the average testing results for the five folds were 0.906, 0.986, 0.828, 0.892, and 0.952. The lateral cephalogram only group had the least accuracy, while the maxilla image only group had the best accuracy. Deep learning provides a novel method for an accelerated workflow, automated assisted decision-making, and personalized treatment planning.
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Affiliation(s)
- J-S Chang
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - C-Y Ma
- Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan; Artificial Intelligence Research Center, Chang Gung University, Taoyuan, Taiwan; Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - E W-C Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Çınarsoy Ciğerim S, Sezen Erhamza T. Cone-Beam Computerized Tomography Evaluation of the Relationship between Orthodontic Vertical Direction Parameters and the Distance from the Apex of the Upper Central Tooth to the Nasal Floor and Anterior Nasal Spine. Tomography 2024; 10:37-46. [PMID: 38250950 PMCID: PMC10818777 DOI: 10.3390/tomography10010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements (p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements (p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans.
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Affiliation(s)
- Saadet Çınarsoy Ciğerim
- Department of Orthodontics, Faculty of Dentistry, Van Yuzuncu Yil University, 65090 Van, Turkey
| | - Türkan Sezen Erhamza
- Department of Orthodontics, Faculty of Dentistry, Kirikkale University, 71450 Kırıkkale, Turkey;
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Kiełczykowski M, Kamiński K, Perkowski K, Zadurska M, Czochrowska E. Application of Artificial Intelligence (AI) in a Cephalometric Analysis: A Narrative Review. Diagnostics (Basel) 2023; 13:2640. [PMID: 37627899 PMCID: PMC10453867 DOI: 10.3390/diagnostics13162640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, the application of artificial intelligence (AI) has become more and more widespread in medicine and dentistry. It may contribute to improved quality of health care as diagnostic methods are getting more accurate and diagnostic errors are rarer in daily medical practice. The aim of this paper was to present data from the literature on the effectiveness of AI in orthodontic diagnostics based on the analysis of lateral cephalometric radiographs. A review of the literature from 2009 to 2023 has been performed using PubMed, Medline, Scopus and Dentistry & Oral Sciences Source databases. The accuracy of determining cephalometric landmarks using widely available commercial AI-based software and advanced AI algorithms was presented and discussed. Most AI algorithms used for the automated positioning of landmarks on cephalometric radiographs had relatively high accuracy. At the same time, the effectiveness of using AI in cephalometry varies depending on the algorithm or the application type, which has to be accounted for during the interpretation of the results. In conclusion, artificial intelligence is a promising tool that facilitates the identification of cephalometric landmarks in everyday clinical practice, may support orthodontic treatment planning for less experienced clinicians and shorten radiological examination in orthodontics. In the future, AI algorithms used for the automated localisation of cephalometric landmarks may be more accurate than manual analysis.
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Affiliation(s)
| | | | | | | | - Ewa Czochrowska
- Department of Orthodontics, Medical University in Warsaw, 02-097 Warsaw, Poland; (M.K.); (K.K.); (K.P.); (M.Z.)
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Azeez SM. Evaluating diagnostic performance of three cephalometric vertical parameters. Indian J Dent Res 2023; 34:49-53. [PMID: 37417057 DOI: 10.4103/ijdr.ijdr_233_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Objectives The goal of this research was to see how reliable and valid three selected parameters from different analysis were in detecting the vertical skeletal pattern. Methods There were 94 cephalometric x-rays used in all. The vertical skeletal pattern was assessed using the mandibular plane angle by Steiner, Frankfort mandibular angle by Tweed, and facial axis angle by McNamara. According to the diagnostic results of the majority of the measures, the samples were classified as normo-divergent, hypodivergent, or hyperdivergent. Kappa statistics, positive predictive value, and sensitivity were employed to verify the validity and reliability of the analyses. Results A statistically significant weak negative correlation was found between Frankfort mandibular angle and facial axis angle in female group (p value < 0.01). A good agreement was found between mandibular plane angle with final diagnosis (K = 0.726). The mandibular plane angle showed highest sensitivity and positive predictive value in hypodivergent group (0.939, 0.816) and normo-divergent group (0.795, 0.833), respectively. Conclusion For determining the facial vertical growth pattern the most accurate indicators were identified to be mandibular plane angle (SN-GoGn) and Frankfort mandibular angle.
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Affiliation(s)
- Saya M Azeez
- Department of Orthodontics, Faculty of Dentistry, Tishk International University-Erbil, Kurdistan Region, Iraq
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5
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Zhu R, Zheng YH, Zhang ZH, Fan PD, Wang J, Xiong X. Development of a new category system for the profile morphology of temporomandibular disorders patients based on cephalograms using cluster analysis. Front Public Health 2022; 10:1045815. [PMID: 36466455 PMCID: PMC9713943 DOI: 10.3389/fpubh.2022.1045815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This study aims to develop a new category scheme for the profile morphology of temporomandibular disorders (TMDs) based on lateral cephalometric morphology. Methods Five hundred and one adult patients (91 males and 410 females) with TMD were enrolled in this study. Cluster tendency analysis, principal component analysis and cluster analysis were performed using 36 lateral cephalometric measurements. Classification and regression tree (CART) algorithm was used to construct a binary decision tree based on the clustering results. Results Twelve principal components were discovered in the TMD patients and were responsible for 91.2% of the variability. Cluster tendency of cephalometric data from TMD patients were confirmed and three subgroups were revealed by cluster analysis: (a) cluster 1: skeletal class I malocclusion; (b) cluster 2: skeletal class I malocclusion with increased facial height; (c) cluster 3: skeletal class II malocclusion with clockwise rotation of the mandible. Besides, CART model was built and the eight key morphological indicators from the decision tree model were convenient for clinical application, with the prediction accuracy up to 85.4%. Conclusion Our study proposed a novel category system for the profile morphology of TMDs with three subgroups according to the cephalometric morphology, which may supplement the morphological understanding of TMD and benefit the management of the categorical treatment of TMD.
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Affiliation(s)
- Rui Zhu
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Yun-Hao Zheng
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Zi-Han Zhang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Pei-Di Fan
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Jun Wang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Xin Xiong
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China,Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Sichuan, China,*Correspondence: Xin Xiong
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Wiechens B, Brockmeyer P, Sevinc T, Hoene G, Schliephake H, Hahn W. Diagnostic value of routine dental radiographs for predicting the mandibular canal localization validated by cone-beam computed tomogram measurements. Clin Exp Dent Res 2022; 8:1440-1448. [PMID: 35938927 PMCID: PMC9760152 DOI: 10.1002/cre2.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To test the hypothesis that routine dental radiographs can be used to draw conclusions regarding the mandibular canal (MC) localization. MATERIAL AND METHODS: A total of 108 radiographs (36 orthopantomograms [OPTs], 36 lateral cephalograms [LCs], and 36 cone-beam computed tomograms [CBCTs]) of 36 patients were analyzed. Statistical analysis included all cephalometric parameters obtained by OPTs, LCs, and CBCTs. Potential influencing parameters were calculated using linear and logistic regression with a backward removal algorithm. For predictability of MC localization, parameters were correlated using Pearson's correlation. RESULTS The MC ran along the lingual half (n = 24) twice as often as in the buccal half (n = 12) in the population studied. The position was always symmetrical contralaterally. No sex-specific influence was observed (p = .34). Lingual and buccal MC courses were statistically significantly correlated to increased and decreased jaw angles (LC/OPT), respectively (p = .003; r = -.48/p = .010; r = -.42). An increased jaw angle was significantly correlated with a more cranial MC position (p = .013; r = -.41); a deep and distal bite position was significantly correlated with a caudal and buccal MC position (p = .004; r = -.47/p = .001; r = .57). Moreover, an increase of 1 point in the Hasund score predicted an increased probability of a buccal MC position by 18.6%. The jaw angle analyzed in OPT and LC images were positively correlated (r = .89, p < .001). CONCLUSIONS Routine dental radiographs provide informative guidance on the location of the MC in the vertical and transverse levels. This finding could be used in the initial consultation and treatment planning to consider more invasive diagnostic methods further down the line.
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Affiliation(s)
- Bernhard Wiechens
- Department of OrthodonticsUniversity Medical Center GöttingenGöttingenGermany
| | - Phillipp Brockmeyer
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GöttingenGöttingenGermany
| | | | - Georg Hoene
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GöttingenGöttingenGermany
| | - Henning Schliephake
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GöttingenGöttingenGermany
| | - Wolfram Hahn
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GöttingenGöttingenGermany,Private practiceGöttingenGermany
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Kotuła J, Kuc AE, Lis J, Kawala B, Sarul M. New Sagittal and Vertical Cephalometric Analysis Methods: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12071723. [PMID: 35885628 PMCID: PMC9315495 DOI: 10.3390/diagnostics12071723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Cephalometric analysis is an essential tool used in orthodontic diagnosis and treatment planning. The main objectives of correct cephalometric analysis include resolving anteroposterior and vertical maxillary and mandibular base discrepancies. For a diagnostic tool to be of value, it should be precise, reliable and reproducible. Unfortunately, according to some studies, the accuracy of input and, therefore, the diagnostic reliability of some of the points and measurements may not be satisfactory. To this end, new cephalometric measurements are being developed with increased precision. In order to properly and definitively determine the usefulness of a given measurement in cephalometric diagnosis, it is necessary to carry out a critical evaluation of available studies. The aim of this systematic review was to evaluate the available scientific literature describing new landmarks and reference linear and angular measurements of 2D cephalometric analyses assessing the sagittal and vertical discrepancy in the position of jaw bases since the last systematic review in 2013. The secondary aim was to assess the accuracy and reliability of new anthropometric landmarks and reference planes in relation to those used previously, and their instability in relation to growth and orthodontic tooth movements. To carry out the intended plan, electronic databases such as PubMed, Scholar Google, Web of Science and Pro Quest were searched using specific keywords. Initially, a total of 1451 articles were retrieved. Then, duplicate articles in all databases were excluded from the resulting publications. The results showed that despite such a high number of articles published in peer-reviewed scientific journals, only 12 studies on new cephalometric analyses in the sagittal plane and 4 studies on new cephalometric analyses in the horizontal plane met the criteria and, as a result, were included in the review.
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Affiliation(s)
- Jacek Kotuła
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; (J.L.); (B.K.); (M.S.)
- Correspondence:
| | - Anna Ewa Kuc
- Dental Star Specjalistyczne Centrum Stomatologii Estetycznej, 15-215 Białystok, Poland;
| | - Joanna Lis
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; (J.L.); (B.K.); (M.S.)
| | - Beata Kawala
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; (J.L.); (B.K.); (M.S.)
| | - Michał Sarul
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; (J.L.); (B.K.); (M.S.)
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Algahefi AL, Alhammadi MS, Zheng B, Almashraqi AA, Zhao Y, Liu Y. Morphological and dimensional variations of the frontal air sinuses in a group of adolescent Caucasians and Chinese in different skeletal malocclusions: a cross-sectional cephalometric study. Clin Oral Investig 2022; 26:5711-5719. [PMID: 35552533 DOI: 10.1007/s00784-022-04527-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the morphological and dimensional variations of the frontal air sinuses in a group of adolescent Caucasians and Chinese with different skeletal malocclusions in both genders. MATERIALS AND METHODS This retrospective study included 290 adolescent Caucasians and Chinese patients with 145 each. Each sample included 90 females and 55 males and was categorized based on ANB angle in reference to each population norms into 65 skeletal class I, 50 skeletal class II, and 30 skeletal class III malocclusions. All linear, angular, and surface area measurements of the frontal air sinuses were evaluated using lateral cephalometric radiographs and calculated using Winceph version 8 software. The frontal air sinus parameters were compared between genders and the two ethnic groups using an independent sample t-test. ANOVA with Tukey's post hoc tests were used to compare the frontal air sinus parameters between the three skeletal malocclusions. RESULT The frontal air sinus width and surface area were found to be significantly greater in Caucasians when compared with Chinese patients. According to gender, the frontal air sinus length, width, and surface area, as well as the glabella convexity, were greater in males than females, while the frontal air sinus index (length/width) was significantly greater in females than males in both ethnic groups. In both ethnic groups, the frontal air sinus surface area was significantly greater in skeletal class III malocclusion when compared to skeletal class I and class II malocclusions in Caucasians (P = 0.0022) and Chinese (P = 0.0097). There was a weak-to-moderate correlation between the frontal air sinus parameters and the nasio, sella, and glabella positions (R = -0.56 to 0.62). CONCLUSION The frontal air sinus dimensions and surface area varied greatly in between ethnic groups, genders, and malocclusion types. The frontal air sinus parameters were correlated with nasion, sella, and glabella positions. CLINICAL RELEVANCE These findings could assist orthodontists, ENT specialist, and forensic medical investigators to focus on the size of frontal sinus during treatment planning, the relationship between the size of frontal air sinus and malocclusions, and age determination.
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Affiliation(s)
- Ahmed Lotf Algahefi
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
- Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
| | - Maged S Alhammadi
- Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
- Postgraduate Orthodontic Program, Department of Orthodontics, Pedodontics and Preventive Dentistry, Faculty of Dentistry, Sana'a University, Sana'a, Republic of Yemen
| | - Bowen Zheng
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Abeer A Almashraqi
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Yang Zhao
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Yi Liu
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China.
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Lyros I, Ferdianakis E, Halazonetis D, Lykogeorgos T, Alexiou A, Alexiou KE, Georgaki M, Vardas E, Yfanti Z, Tsolakis AI. Three-Dimensional Analysis of Posterior Mandibular Displacement in Rats. Vet Sci 2022; 9:vetsci9030144. [PMID: 35324872 PMCID: PMC8953185 DOI: 10.3390/vetsci9030144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/16/2022] Open
Abstract
Mandibular protrusion and its treatment is challenging for the orthodontist. The aim of the present research was to identify macroscopic changes in the mandible, based on three-dimensional Cone Beam Computed Tomography analysis. Seventy-two male Wistar rats were divided into two equal groups, experimental (group A) and control (group B). Each consisted of three equal subgroups of 12 rats (A1, A2, A3, B1, B2, B3). Full-cast orthodontic intraoral devices were attached to the maxillary incisors of the experimental animals, and effected functional posterior mandibular displacement. Throughout the experimental period, all animals were fed with mashed food. Animals were sacrificed at 30 days (A1, B1), 60 days (A2, B2) and 90 days (A3, B3). At the 60th day of the experiment, the orthodontic devices were removed from the remaining experimental subgroup A3. Measurements revealed significant differences in the anteroposterior dimensions between experimental and control subgroups. However, the observed changes in the vertical dimensions, Condylion/Go’–Menton and the Intercondylar distance proved insignificant. Posterior mandibular displacement of the mandible in growing rats affects the morphology of the mandible and culminates in the development of a smaller mandible at a grown age.
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Affiliation(s)
- Ioannis Lyros
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.F.); (D.H.); (A.A.); (A.I.T.)
- Correspondence:
| | - Efstratios Ferdianakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.F.); (D.H.); (A.A.); (A.I.T.)
| | - Demetrios Halazonetis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.F.); (D.H.); (A.A.); (A.I.T.)
| | | | - Antigoni Alexiou
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.F.); (D.H.); (A.A.); (A.I.T.)
| | - Konstantina-Eleni Alexiou
- Department of Oral Diagnosis & Radiology, School of Dentistry, National and Kapodistrian University of Athens, 10679 Athens, Greece; (K.-E.A.); (Z.Y.)
| | - Maria Georgaki
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 10679 Athens, Greece; (M.G.); (E.V.)
| | - Emmanouil Vardas
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 10679 Athens, Greece; (M.G.); (E.V.)
| | - Zafeiroula Yfanti
- Department of Oral Diagnosis & Radiology, School of Dentistry, National and Kapodistrian University of Athens, 10679 Athens, Greece; (K.-E.A.); (Z.Y.)
| | - Apostolos I. Tsolakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.F.); (D.H.); (A.A.); (A.I.T.)
- Department of Orthodontics, Case Western Reserve University, Cleveland, OH 44106, USA
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10
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MacDonald D, Patel A, Zou B, Yen E, Vora SR. A retrospective study of incidental findings occurring in a consecutive case series of lateral cephalograms of 12- to 20-year-old patients referred for routine orthodontic treatment. Imaging Sci Dent 2022; 52:295-302. [PMID: 36238700 PMCID: PMC9530292 DOI: 10.5624/isd.20220402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Lateral cephalograms of orthodontic patients may contain incidental findings that could potentially lead to harm. Materials and Methods The lateral cephalograms of 1765 consecutive 12- to 20-year-old patients, being considered for routine orthodontic treatment, were retrospectively reviewed. These patients were considered normal, because no abnormalities were found either in their medical history or on their clinical examination. Results The overall prevalence of incidental findings was 18.8%, of which 10.3% were ponticulus posticus and 4.2% were bridging of the sella turcica. Although occipital spurs and ponticulus posticus were more prevalent in males, the size of the sella turcicas did not differ between sexes. Of the 1156 patients completing treatment about 2 years later, only one lateral cephalogram displayed progression of the ponticulus posticus in that time. Conclusion The prevalence of incidental findings on lateral cephalograms of otherwise normal orthodontic 12- to 20-year-old patients was almost a fifth, of which ponticulus posticus, vertebral fusion, and enlarged parietal foramina were clinically significant.
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Affiliation(s)
- David MacDonald
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Akash Patel
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bingshuang Zou
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edwin Yen
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siddharth R. Vora
- Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Putra RH, Doi C, Yoda N, Astuti ER, Sasaki K. Current applications and development of artificial intelligence for digital dental radiography. Dentomaxillofac Radiol 2022; 51:20210197. [PMID: 34233515 PMCID: PMC8693331 DOI: 10.1259/dmfr.20210197] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In the last few years, artificial intelligence (AI) research has been rapidly developing and emerging in the field of dental and maxillofacial radiology. Dental radiography, which is commonly used in daily practices, provides an incredibly rich resource for AI development and attracted many researchers to develop its application for various purposes. This study reviewed the applicability of AI for dental radiography from the current studies. Online searches on PubMed and IEEE Xplore databases, up to December 2020, and subsequent manual searches were performed. Then, we categorized the application of AI according to similarity of the following purposes: diagnosis of dental caries, periapical pathologies, and periodontal bone loss; cyst and tumor classification; cephalometric analysis; screening of osteoporosis; tooth recognition and forensic odontology; dental implant system recognition; and image quality enhancement. Current development of AI methodology in each aforementioned application were subsequently discussed. Although most of the reviewed studies demonstrated a great potential of AI application for dental radiography, further development is still needed before implementation in clinical routine due to several challenges and limitations, such as lack of datasets size justification and unstandardized reporting format. Considering the current limitations and challenges, future AI research in dental radiography should follow standardized reporting formats in order to align the research designs and enhance the impact of AI development globally.
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Affiliation(s)
| | - Chiaki Doi
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4–1 Seiryo-machi, Sendai, Japan
| | - Nobuhiro Yoda
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4–1 Seiryo-machi, Sendai, Japan
| | - Eha Renwi Astuti
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo no 47, Surabaya, Indonesia
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4–1 Seiryo-machi, Sendai, Japan
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Pawar R, Mane D, Patil C, Bhalerao S, Parkar A, Agarwal S. To check the reliability of various cephalometric parameters used for predicting the type of malocclusions and growth patterns. J Pharm Bioallied Sci 2022; 14:S808-S811. [PMID: 36110773 PMCID: PMC9469322 DOI: 10.4103/jpbs.jpbs_6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/09/2022] Open
Abstract
Background: There are many different types of malocclusions that may result from the sagittal, vertical, or transverse deviations in normal craniofacial development. When it comes to orthodontic problems, malocclusions in the sagittal plane may have a considerable impact on a person's self-esteem as well as their ability to speak and eat properly. Sagittal anomalies in the skeletal, dental, and soft tissue systems may now be accurately diagnosed using a universally accepted standard lateral cephalogram (SLCE). Methods and Materials: The principal investigator manually traced the cephalograms, identified skeletal landmarks, and measured the following data. The ANB angle (normal range: 0° to 4°) is the angle framed by the point A, Nasion, and B. Estimated oppositely from point A and B on the functional occlusal plane, with Wits evaluation: AO-to-BO direct distance. AB plane angle : the angle formed by the AB and the Npog plane (normal range = -9° to 0°). Beta angle: the angle framed by the A-CB and AB lines, with a typical range of 27° to 35°. W angle: this is the angle created by the opposite line from M to the S-G line and the M-G line, with a typical range of 51 to 55 degrees. The angle of convexity: the angle between N-point A and A-Pog. (Normal range: -8.5 to 10 degree) Results: We utilised Pearson correlation to see how well the different skeletal studies correlated with one another. Wits and the ANB angle of convexity exhibited an excellent relationship with each other, with r = 0.831 and Downs angle of convexity (both r = 0.823 and P = 0.01) being statistically significant. This study used Kappa statistics to assess the degree of agreement between several cephalometric diagnostic criteria. The agreement between the ANB and final groups was strong (k = 0.802, P = 0.01). Conclusion: There was a strong link between all of the cephalometric measures. The cephalometric landmark and valid indication was determined to be the most dependable in evaluating malocclusion and development pattern.
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Al-Zoubi EM, Al-Nimri KS. A comparative study between the effect of reverse curve of Spee archwires and anterior bite turbos in the treatment of deep overbite cases: A randomized clinical trial. Angle Orthod 2021; 92:36-44. [PMID: 34329389 DOI: 10.2319/020921-117.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare deep overbite treatment using 0.016 × 0.022 nickel-titanium lower reverse curve of Spee archwire (LRCA) or metal anterior bite turbos (ABTs). MATERIALS AND METHODS 48 patients with deep overbite malocclusion were randomly allocated into two groups. Group I (age = 18.4 ± 2.8 years, overbite = 5.8 ± 0.6 mm) was treated with LRCA, while Group II (age = 18.2 ± 3.1 years, overbite = 5.2 ± 0.4 mm) was treated with ABTs bonded to the palatal surface of the upper central incisors. Two cephalograms were taken for each patient, at post-alignment stage (T1) and post-leveling stage (T2). The primary outcomes were the anteroposterior and vertical changes of the lower teeth. The secondary outcomes were the effect on upper incisor inclination and the vertical linear changes of upper teeth, to assess the sagittal and vertical skeletal changes, and to compare the duration of overbite correction. RESULTS 42 of the 48 patients recruited completed the study (21 in each group). At T2, the lower incisors proclined more in Group I (P ≤ .001). Both lower second molars (P ≤ .001) and lower first molars (P = .001) tipped more distally, while the lower first premolar tipped more mesially, in Group I (P < .05). All cusps of both lower molars showed more extrusion in Group II (P < .05) except for the mesial cusp of lower second molars (P = .095). The duration of overbite correction was shorter using the ABTs by 1.7 months (4.85 ± 1.56 and 3.15 ± 0.93 months for Group I and Group II, respectively). CONCLUSIONS LRCA causes lower incisor proclination with distal tipping of lower molars, while ABTs result in lower posterior tooth extrusion.
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Tadinada A, Dinesh A. Letters From Our Readers. Angle Orthod 2021; 91:570. [PMID: 34181724 DOI: 10.2319/0003-3219-91.4.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Xu K, Hasan SE, Chen G, Liu S, Chambers DW, Xu T. Measuring orthodontic treatment impact: Description or judgment, challenge or result. Am J Orthod Dentofacial Orthop 2021; 159:e389-e397. [PMID: 33931225 DOI: 10.1016/j.ajodo.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Determination of improvement in orthodontic treatment may depend on the measurement method used and the purpose. METHODS Improvement after orthodontic treatment (from T1 to T2 [beginning to end of treatment]) was assessed 3 ways from a set of 98 patient records: (1) calculated by subtracting judges' assessments at T2 from T1 for records presented in random order, (2) judged as a holistic impression viewing T1 and T2 records side by side, and (3) determined from proxies (American Board of Orthodontics Discrepancy Index, the American Board of Orthodontics Objective Grading System, and the Peer Assessment Rating index). RESULTS High levels of intramethod consistency were observed, with intraclass correlation coefficient clustering around an intraclass correlation coefficient of 0.900, and distributions were normal. Calculated and judged improvements correlated at r = 0.606. Calculated or judged improvements were correlated at a lower level with proxies. Calculated improvement was significantly associated with "challenge" (T1) scores and judged improvement associated with "results" (T2) scores. Common method bias was observed, with higher correlations among similar indexes than among indexes at the same time that used various methods. Relative to differences in Peer Assessment Rating scores, calculated improvement overestimated low scores and underestimated high ones. The same effect, but statistically greater, was observed using direct judgment of improvement. CONCLUSIONS These findings are consistent with decision science and measurement theory. In some circumstances, such as third-party reimbursement and research, operationally defined measures of occlusion are appropriate. In practice, the determination of occlusion and improvement are best performed by judgment that naturally corrects for biases in proxies and incorporates background information.
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Affiliation(s)
- Kaiyuan Xu
- University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | | | - Gui Chen
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Siqi Liu
- Peking University School and Hospital of Stomatology, Beijing, China
| | - David W Chambers
- University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif.
| | - Tianmin Xu
- Peking University School and Hospital of Stomatology, Beijing, China
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Estimation of x-ray radiation related cancers in US dental offices: Is it worth the risk? Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:597-608. [PMID: 33741287 DOI: 10.1016/j.oooo.2021.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The objective of this study was to estimate the possible number of cancer cases produced during 2019 in US dental offices from radiography, estimate the possible reduction in those rates resulting from use of intraoral rectangular collimation and selection criteria, and determine the frequency and quality of website radiation risk information and informed consent forms. STUDY DESIGN An analysis of dental radiation examinations in 2014 to 2015 US national survey data, Nationwide Evaluation of X-ray Trends, and National Council on Radiation Protection and Measurements surveys was performed, in addition to an analysis of 2008 to 2020 Journal of Clinical Orthodontics national orthodontic surveys for radiographic examination frequencies. Lifetime attributable cancer risk estimates from US and European studies were used to generate the total dental and orthodontic office cancer totals. In total, 150 offices were examined online for the quality and frequency of risk information in websites and consent forms. RESULTS The 2019 estimate for all office cancers is 967. Collimation and selection criteria could reduce this to 237 cancer cases. Most cancers arise from intraoral and cone beam computed tomography examinations, with 135 orthodontic cancers over 21 months (average treatment time). Collimation and selection criteria could reduce this to 68. Only 1% of offices use collimators or informed consent for radiography. The website and consent information were of poor quality. CONCLUSIONS Dentists are not following selection criteria or using collimators according to guidelines. Up to 75% of cancer cases could be avoided.
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Modern 3D cephalometry in pediatric orthodontics-downsizing the FOV and development of a new 3D cephalometric analysis within a minimized large FOV for dose reduction. Clin Oral Investig 2021; 25:4651-4670. [PMID: 33492515 DOI: 10.1007/s00784-021-03779-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Dose reduction achieved by downsizing the field of view (FOV) in CBCT scans has brought no benefit for pediatric orthodontics, until now. Standard 2D or 3D full-size cephalometric analyses require large FOVs and high effective doses. The aim of this study was to compare a new 3D reduced-FOV analysis using the Frankfurt horizontal (FH) plane as reference plane with a conventional full-size analysis using the Sella-Nasion (S-N) plane as reference plane. MATERIALS AND METHODS Thirty-eight CBCT data sets were evaluated using full- and reduced-FOV analysis. The measurements of a total of 20 skeletal and dental standard 3D full-size variables were compared with the measurements of 22 corresponding 3D reduced-FOV variables. Statistical analysis was performed to prove mathematic relation between standard and alternative variables. Regression analyses were carried out. RESULTS Coefficients of determination (R2) between 0.15 and 0.95 (p < 0.001-0.055) were described. All variables showed obvious relations of different strength except for SNA and its alternative Po_R-Or_R-A (°) (R2 = 0.15, p = 0.055), but a second variable Ba_A (mm) showed stronger relation (R2 = 0.28, p = 0.003). CONCLUSIONS All standard variables related to the reference plane S-N could be described with alternative variables related to the FH. Further research should define more reliable landmarks for coordinate systems and reference points. CLINICAL RELEVANCE Minimized large FOVs meet the demand of 3D cephalometric analyses and enable the application of CBCT scans in pediatric orthodontic patients in many specific indications. Dose reduction is accompanied by increasing access to all the advantages of 3D imaging over 2D imaging.
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Kapetanović A, Oosterkamp BCM, Lamberts AA, Schols JGJH. Orthodontic radiology: development of a clinical practice guideline. LA RADIOLOGIA MEDICA 2021; 126:72-82. [PMID: 32462471 PMCID: PMC7870627 DOI: 10.1007/s11547-020-01219-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Radiographs are considered essential in orthodontics. However, their diagnostic value and indications for use are still uncertain, while exposure to radiation carries health risks. This study aimed to report on the development of a clinical practice guideline on orthodontic radiology. METHODS A Guideline Development Taskforce was set up. The GRADE methodology was used for development and the RIGHT Statement for reporting of the guideline. We systematically reviewed articles to address the main clinical question: how different types of radiographs contribute to orthodontic diagnosis, treatment planning and post-treatment outcome evaluation. After a literature search and data extraction, we formulated conclusions and assessed the strength of the evidence according to the GRADE method. Both literature conclusions and the most important considerations, such as patient preferences, organizational matters and expert opinions were taken into account to finally issue recommendations. RESULTS 7 clinical questions focused on orthopantomograms, lateral cephalograms, hand-wrist radiographs, peri-apical radiographs, bitewings, antero-occlusal radiographs, and cone-beam computer tomographic imaging. The literature search lead to 484 unique studies, of which 17 were included in the analysis. The strength of evidence of the conclusions was graded low or very low. We formulated considerations and took them into account when issuing the 13 clinical recommendations to address the clinical questions. CONCLUSIONS There was a considerable lack of scientific evidence on this topic. Nonetheless, this guideline provides clinicians with a tool for decision-making regarding radiographic records while enhancing patient radiation protection. More research of higher quality is recommended for a future update.
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Affiliation(s)
- Aldin Kapetanović
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Barbara C M Oosterkamp
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Antoon A Lamberts
- Knowledge Institute of the Federation of Medical Specialists, Utrecht, The Netherlands
| | - Jan G J H Schols
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Dinesh A, Mutalik S, Feldman J, Tadinada A. Value-addition of lateral cephalometric radiographs in orthodontic diagnosis and treatment planning. Angle Orthod 2020; 90:665-671. [PMID: 33378477 DOI: 10.2319/062319-425.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the value-addition of obtaining lateral cephalometric radiographs during the treatment planning phase of orthodontic treatment. MATERIALS AND METHODS The records of 100 orthodontic patients were presented to seven scorers during two phases that were 6 weeks apart. In the first phase, scorers completed a seven-question survey with questions regarding treatment planning. They were given various diagnostic records that did not include a lateral cephalometric radiograph. Six weeks later, the same scorers completed the same survey for the same patient cases with the same diagnostic records that additionally included a lateral cephalometric radiograph. Correlation coefficients were used to calculate intrarater agreement and inter-rater agreement within the study. RESULTS Cohen's kappa values showed moderate to almost perfect agreement for the majority of survey questions. Intrarater agreement ranged between 0.430 and 1. Cronbach's alpha reliability statistics showed good interrater agreement for all questions in the survey. Agreement ranged from 0.710 to 0.913 across the survey questions. Diagnosing Angle classification of occlusion had the highest level of agreement and differentiating between skeletal and dental malocclusion had the lowest level of agreement. CONCLUSIONS The lateral cephalometric radiograph is not a necessary diagnostic tool for most cases in orthodontic diagnosis and treatment planning. Weighing the usefulness of a lateral cephalometric on a case-by-case basis should be recommended to align with the principle of ALARA (as low as reasonably achievable), especially in a primarily pediatric population.
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Surface-based 3-dimensional cephalometry: An objective analysis of cranio-mandibular morphology. Am J Orthod Dentofacial Orthop 2020; 158:535-546. [PMID: 32826124 DOI: 10.1016/j.ajodo.2019.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/01/2019] [Accepted: 09/01/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The purpose of this study was to apply a previously reported homologous model for quantifying and visualizing the three-dimensional (3D) cranio-mandibular morphology. METHODS Twenty-eight 3D cone-beam computed tomography (CBCT) images of Japanese patients (7 to 13 years of age) showing skeletal Class 1 malocclusions were used in this study. Wire mesh fitting was conducted for each patient based on the assignment of landmarks to each 3D surface (homologous modeling). Cranial and mandibular images were generated using surface rendering of the CBCT images. The mean and standard deviation of each point on the wire mesh were calculated as the normative mean. Two operators conducted the process twice for seven patients, with a one-week interval between fittings. The intra- and inter-examiner reliability were determined using the 95% confidence interval minimal detectable change (MDC95) for random error and intra-class correlation coefficients (ICCs). RESULTS The intra- and inter-examiner reliability of the mesh fitting method were almost perfect. Normative ranges of the cranial and mandibular surfaces of Japanese were determined. CONCLUSIONS A clinical method that enables practitioners to quantify and visualize the hard tissues of a patient's face in three dimensions with almost perfect reliability is presented. This method allows practitioners to evaluate how patients' skeletal characteristics differ from normative means in three dimensions.
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Angular changes in implants placed in the anterior maxillae of adults: a cephalometric pilot study. Clin Oral Investig 2020; 25:1375-1381. [PMID: 32661606 PMCID: PMC7878256 DOI: 10.1007/s00784-020-03445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/03/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Completion of adolescent growth represents the earliest time point for implant placement, yet craniofacial growth persists into adulthood and may affect implant position. We aimed to assess whether implants placed in the anterior maxillae of adults show angular changes over time. MATERIAL AND METHODS We conducted a cephalometric pilot study in postpubertal patients with no growth disorders, skeletal malformations, or parafunctions. The patients received a single implant in the anterior maxilla and no orthodontic or orthognathic treatment afterwards. We measured angular changes of implants and central incisors on cephalograms taken immediately and after at least 5 years postoperatively with the Sella-Nasion line (SNL) and the nasal line (NL) as references. Changes in implant-SNL angles were the primary outcome. RESULTS In 21 patients (30.2 ± 11.5 years at surgery) after a mean follow-up of 8.6 ± 1.3 years, implant-SNL angles and implant-NL angles changed in 81% and 57% of implants, respectively. Implant-SNL changes ranged from 3° counterclockwise to 4° clockwise and were more prevalent in males (100% vs. 58%) and patients under 30 at surgery (85% vs. 63%); mean absolute differences were larger in males (1.8 ± 1.0° vs. 1.3 ± 1.4°) and patients under 30 at surgery (1.5 ± 1.4° vs. 1.1 ± 1.4°). Incisor-SNL angles and incisor-NL angles changed in 89% and 32% of incisors, respectively. CONCLUSIONS Implants placed in the anterior maxillae of adults show modest angular changes over time. CLINICAL RELEVANCE Changes in implant angles have potential functional and esthetic consequences.
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Park JA, Ha TJ, Lee JS, Song WC, Koh KS. Use of the orbito-occipital line as an alternative to the Frankfort line. Anat Cell Biol 2020; 53:21-26. [PMID: 32274245 PMCID: PMC7118258 DOI: 10.5115/acb.19.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022] Open
Abstract
Frankfort horizontal line, the line passing through the orbitale and porion, is one of the most widely used intracranial landmarks in cephalometric analysis. This study investigated the use of the orbito-occipital line extending from the orbitale to the external occipital protuberance as a novel horizontal line of the skull for substituting the Frankfort horizontal line. We evaluated the reproducibility of the new landmark and measured the angle between the orbito-occipital line and the Frankfort line. This study was conducted on 170 facial computed tomography (CT) scans of living adults from the Department of Plastic Surgery. After three-dimensionally reconstructed images were obtained from facial CT, the porion, orbitale, and external occipital protuberance were indicated by two observers twice. The angles between the orbito-meatal line (inferior orbital rim to porion; the Frankfort line) and the orbito-occipital line (inferior orbital rim to external occipital protuberance) were measured. There was no significant intraobserver or interobserver bias. The overall angle between the Frankfort line and orbito-occipital line was −0.5°±2.2° (mean±standard deviation). There was no statistically significant difference among side and sex. This study demonstrated good reproducibility of a new landmark—the external occipital protuberance—tested to replace the porion. The orbito-occipital line is a reliable, reproducible, and easily identifiable line, and has potential as a novel standard horizontal line to replace or at least supplement the Frankfort line in anthropological studies and certain clinical applications.
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Affiliation(s)
- Jung-Ah Park
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Tae-Jun Ha
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Je-Sung Lee
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Wu-Chul Song
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Ki-Seok Koh
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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Selected Orthodontic Principles for Management of Cranio-Maxillofacial Deformities. Oral Maxillofac Surg Clin North Am 2020; 32:321-338. [PMID: 32146029 DOI: 10.1016/j.coms.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An understanding of fundamental orthodontic principles involving diagnosis, treatment planning, and clinical strategies is essential for achieving successful outcomes in the treatment of craniofacial patients, particularly cleft lip/palate. This article focuses on: customizing a mandibular dental arch form using the WALA ridge; accurately diagnosing the maxillary skeletal transverse dimension (cusp to cusp/fossa to fossa); coordinating the upper dental arch with the lower; using a smiling profile and glabella vertical to assess anteroposterior jaw position; and leveling the mandibular curve of Spee while considering the lower one-third of the face. These concepts influence treatment outcomes to the extent they are used.
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Svystun O, Schropp L, Wenzel A, Fuglsig JMDCES, Pedersen MH, Spin-Neto R. Prevalence and severity of image-stitching artifacts in charge-coupled device–based cephalograms of orthodontic patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:158-164. [DOI: 10.1016/j.oooo.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
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Castillo JC, Gianneschi G, Azer D, Manosudprasit A, Haghi A, Bansal N, Allareddy V, Masoud MI. The relationship between 3D dentofacial photogrammetry measurements and traditional cephalometric measurements. Angle Orthod 2019; 89:275-283. [PMID: 30779676 DOI: 10.2319/120317-825.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To determine the relationship between traditional cephalometric measurements and corresponding nonradiographic three-dimensional (3D) photogrammetry measurements. MATERIALS AND METHODS This was a cross-sectional study of 20 orthodontic patients (10 male and 10 female) who received lateral cephalometric radiographs and 3D dentofacial photogrammetric records with each subject serving as his or her own control for a total sample size of 40 images (20 per method). A 3D analysis that resembled a traditional cephalometric analysis was established using the eyes and natural head orientation as substitutes for the cranial base. Pearson correlation coefficients and multivariable linear regression plots were calculated to evaluate the relationship between the photogrammetry measurements and the cephalometric measurements. RESULTS The ANB angle, mandibular plane angle, lower anterior face height, upper incisor angle to SN, upper incisor angle to NA, and all measurements of lower incisor position and inclination had strong positive Pearson correlation coefficients with the corresponding 3D photogrammetry measurements ( P < .004). Statistically significant regression plots demonstrated that cephalometric relationships between the jaws and incisor orientation can be predicted from corresponding 3D photogrammetry measurements. CONCLUSIONS 3D photogrammetry measurements relating the jaws to each other and incisor orientation has a strong positive correlation with corresponding traditional cephalometric measurements and can serve as cephalometric predictors. Capturing the eyes using 3D photogrammetry can obviate the need to expose the cranial base and allow limiting the radiographic field to the area of interest.
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Svystun O, Wenzel A, Schropp L, Spin-Neto R. Image-stitching artefacts and distortion in CCD-based cephalograms and their association with sensor type and head movement: ex vivo study. Dentomaxillofac Radiol 2019; 49:20190315. [PMID: 31697180 DOI: 10.1259/dmfr.20190315] [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: 11/05/2022] Open
Abstract
OBJECTIVES To assess presence and severity of image-stitching artefacts and distortion in lateral cephalograms acquired by CCD-based sensors and their association with movement. METHODS A human skull was mounted on a robot simulating five head movement types (anteroposterior translation/lifting/nodding/lateral rotation/tremor), at three distances (0.75/1.5/3 mm), based on two patterns (skull returning/not returning to the initial position, except for tremor). Three cephalometric units, two ProMax-2D (Planmeca Oy, Finland), one with Dimax-3 (D-3) and one with Dimax-4 (D-4) sensor, and one Orthophos-SL (ORT, Dentsply-Sirona, Germany), acquired cephalograms during the predetermined movements, in duplicate (54 with movement and 28 controls with no movement per unit). One observer assessed the presence of an image-stitching line (none/thin/thin with vertical stripes or thick), misalignment between the anatomical structure display (none/<1/1-3/>3 mm), and distortion in each image quadrant (present/absent), in duplicate. Severe image-stitching artefacts were defined for images scored with a thin line with vertical stripes or thick line and/or misalignment between anatomical structure display ≥1 mm. Severe distortion was defined for images scored with distortion in both anterior quadrants of the skull. κ-statistics provided intraobserver agreement. RESULTS Intraobserver reproducibility was >0.8 (all assessed parameters). Severe image-stitching artefacts were scored in 70.4 and 18.5% of D-3 and D-4 movement images, respectively. Severe distortion was scored in 64.8% of D-3, 5.6% of D-4 and 37% of ORT movement images. Neither severe image-stitching artefacts nor severe distortion were observed in control images. CONCLUSION Sensor type, movement type, distance and pattern affected presence and severity of image-stitching artefacts and distortion in CCD-based cephalograms.
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Affiliation(s)
- Olesya Svystun
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark
| | - Ann Wenzel
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark
| | - Lars Schropp
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark
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Ahmed M, Shaikh A, Fida M. Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern. Dental Press J Orthod 2019; 23:75-81. [PMID: 30427496 PMCID: PMC6266314 DOI: 10.1590/2177-6709.23.5.075-081.oar] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/01/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. OBJECTIVE This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. METHODS A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). RESULTS A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). CONCLUSION The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.
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Affiliation(s)
- Maheen Ahmed
- Bakhtawer Amin Medical and Dental College, Dental Section, Department of Orthodontics (Multan, Pakistan)
| | - Attiya Shaikh
- Liaquat College of Medicine and Dentistry (Karachi, Pakistan)
| | - Mubassar Fida
- The Aga Khan University, Department of Surgery, Section of Dentistry (Karachi, Pakistan)
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Tanikawa C, Akcam MO, Takada K. Quantifying faces three-dimensionally in orthodontic practice. J Craniomaxillofac Surg 2019; 47:867-875. [PMID: 30926238 DOI: 10.1016/j.jcms.2019.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/21/2018] [Accepted: 02/27/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to formulate and demonstrate a method for quantifying and visualizing the three-dimensional (3-D) configuration of the soft tissues of the face at rest to facilitate a quantitative and instantaneous understanding of a patient's static facial form characteristics. MATERIALS AND METHODS 3-D facial images of 200 Japanese adult volunteers at rest were recorded using a 3-D photogrammetric system. For each participant, a wire mesh fitting was conducted based on the assignment of landmarks to each 3-D facial image. This method generated 6,017 points on the wire mesh (i.e., the nodes of the fitted mesh). For each point, the mean and standard deviation were calculated and used for patient evaluation. The system performance was exemplified with three orthodontic patients with skeletal Class II and III malocclusions and laterotrusion. RESULTS Three patients with severe skeletal Class II and III deformities and laterotrusion were evaluated with the proposed method. CONCLUSION A clinical method for practitioners to quantify and visualize the soft tissues of a patient's face in 3 dimensions has been presented with clinical applications and considerations. This method allows practitioners to evaluate how patients' facial characteristics differ from normative faces.
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Affiliation(s)
- Chihiro Tanikawa
- Graduate School of Dentistry, Osaka University, Suita, Osaka, 5650871, Japan; Global Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Osaka, 5650871, Japan.
| | - M Okan Akcam
- Department of Orthodontics, School of Dentistry, Ankara University, Ankara, Turkey
| | - Kenji Takada
- Global Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Osaka, 5650871, Japan; Faculty of Dentistry, National University of Singapore, Singapore, 119083, Republic of Singapore
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Sabharwal A, Patil A, Shinde S, Swami V. Analysis of frontal sinus in various malocclusions. INTERNATIONAL JOURNAL OF ORTHODONTIC REHABILITATION 2019. [DOI: 10.4103/ijor.ijor_16_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sabharwal A, Kadam P, Patil A, Sabane A, Bhosale V. Study of patterns of sella turcica with different malocclusions. INTERNATIONAL JOURNAL OF ORTHODONTIC REHABILITATION 2019. [DOI: 10.4103/ijor.ijor_17_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nucera R, Lo Giudice A, Bellocchio M, Spinuzza P, Caprioglio A, Cordasco G. Diagnostic concordance between skeletal cephalometrics, radiograph-based soft-tissue cephalometrics, and photograph-based soft-tissue cephalometrics. Eur J Orthod 2018; 39:352-357. [PMID: 27932406 DOI: 10.1093/ejo/cjw072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective This study aims to investigate the diagnostic concordance between skeletal cephalometrics and soft-tissue cephalometrics in identifying facial lower third characteristics. Materials and methods We compared a skeletal cephalometric analysis (SCA) to a soft-tissue analysis performed on cephalometric radiographs (rSTCA) and to one performed on profile photograph (pSTCA). Ninety-six pre-treatment digital lateral cephalometric radiographs and 96 digital profile photographs were randomly selected for this study (patients' mean age: 18.33, SD: 3.38, age range: 14-29). Inclusion criteria were as follows: no skeletal asymmetry, well-aligned upper and lower dental arches, no history of orthodontic treatment, prosthodontic treatment, facial surgery and trauma, patient's age between 14 and 30 years, high-resolution images, exams taken with natural head position. Kruskas-Wallis and post hoc pairwise comparisons tests were used to find differences among the considered cephalometric methods. The diagnostic performance of the three methods was also assessed using the receiver-operating characteristic (ROC) curve analysis. Results Significant differences were found between SCA and rSTCA and between SCA and pSTCA in defining sagittal and vertical facial lower third characteristics (P < 0.05). No differences were found between rSTCA and pSTCA (P > 0.05) for the same facial characteristics. For each parameters investigated, pSTCA showed an area under the curve much closer to the perfect value of 1.00. Conclusion Poor diagnostic concordance was found between SCA and rSTCA and between SCA and pSTCA. pSTCA is a reliable method for evaluating the soft-tissue profile characteristics compared to that performed on cephalograms.
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Affiliation(s)
- Riccardo Nucera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Antonino Lo Giudice
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Mirea Bellocchio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Paola Spinuzza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Alberto Caprioglio
- Department of Surgical and Morphological Sciences-Section of Orthodontics, School of Medicine, University of Insubria, Varese, Italy
| | - Giancarlo Cordasco
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
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Abdelkarim A, Jerrold L. Clinical considerations and potential liability associated with the use of ionizing radiation in orthodontics. Am J Orthod Dentofacial Orthop 2018; 154:15-25. [DOI: 10.1016/j.ajodo.2018.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 10/28/2022]
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Stupar I, Yetkiner E, Wiedemeier D, Attin T, Attin R. Influence of Lateral Cephalometric Radiographs on Orthodontic Treatment Planning of Class II Patients. Open Dent J 2018; 12:296-302. [PMID: 29760822 PMCID: PMC5906967 DOI: 10.2174/1874210601812010296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 02/28/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Lateral Cephalometric Radiographs (LCR) are a common decision-making aid in orthodontic treatment planning and are routinely used in clinical practice. The aim of this present study was to test the null hypothesis that LCR evaluation does not alter specific components of orthodontic treatment planning in Class II patients. Materials and Methods: Records of 75 patients, who had been treated at the Department of Orthodontics, Centre of Dental Medicine, University of Zurich comprised the study material. Inclusion criteria were: (1) adolescents between the age of 12-15, (2) permanent dentition with Class II buccal segment relationship (3) absence of craniofacial and dento-alveolar malformations. Fifteen orthodontists from the dental faculties of Istanbul University, Istanbul and Ege University, Izmir filled out Likert-type linear scale questionnaires without knowing that they would repeat the same procedure with and without LCRs at two different time points. Equivalence and clinical relevance were assessed using (%95 CI) Wilcoxon signed rank tests. Results: Extraction decision did not differ between groups (p=0.68). Preference of functional appliance use (p=0.006) and inter-maxillary fixed functional appliance (p=0.043) was different among groups. Conclusion: LCR evaluation has minor influence on treatment planning procedure of Class II patients. It might be beneficial to consider its prescription not in a routine manner but as a supplementary tool considering possible reduction of radiation exposure.
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Affiliation(s)
- Irina Stupar
- Private Practice, Schulzahnklinik Nord, Hofwiesenstrasse 379, 8050 Zürich, Switzerland
| | - Enver Yetkiner
- Faculty of Dentistry, Ege University, Bornova 35100 Izmir, Turkey
| | - Daniel Wiedemeier
- Department of Preventive, Periodontology, Cariology University of Zurich, Zürich, Switzerland
| | - Thomas Attin
- Department of Orthodontics, Faculty of Dentistry, University of Zurich, Zürich, Switzerland
| | - Rengin Attin
- Department of Orthodontics, Faculty of Dentistry, University of Zurich, Zürich, Switzerland
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Oliver GR, Grimes K, Pandis N, Fleming PS. A cross-sectional analysis of Wits and Riedel in adults with skeletal III malocclusion: How informative are they? Orthod Craniofac Res 2018; 21:119-124. [PMID: 29624856 DOI: 10.1111/ocr.12225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the relationship between Riedel and Wits appraisal in skeletal III malocclusions and to assess the effect of variation in the vertical skeletal measurements. SETTING AND SAMPLE POPULATION One-hundred and twenty consecutive subjects with Class III malocclusions attending orthognathic clinics were analysed. MATERIALS AND METHODS Lateral cephalograms were hand-traced under standardized conditions. Cephalometric measurements included Riedel analysis, Wits appraisal, A point/B point to Frankfurt plane (AF-BF) and vertical measurements. RESULTS The mean ANB and Wits values were -3.22° and -11.39 mm, respectively. A positive correlation was found between ANB and Wits overall (r = -.49; P < .001). However, there was poor agreement between both Wits (r = .087) and Riedel (r = .089) with AF-BF (P > .05). A negative correlation existed between Wits and LAFH% (r = -.64, P-value < .001); however, no relationship was observed between ANB and LAFH% (P > .05) based on linear regression analysis. CONCLUSIONS There is a positive relationship between ANB and Wits; however, neither correlated well with a purer antero-posterior assessment (AF-BF). Furthermore, variations in the vertical skeletal measurements affect the strength of agreement. Caution is advised in the interpretation of antero-posterior analysis especially in the presence of vertical discrepancy.
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Affiliation(s)
- G R Oliver
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - K Grimes
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - N Pandis
- University of Bern, Bern, Switzerland
| | - P S Fleming
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Scarfe WC, Azevedo B, Toghyani S, Farman AG. Cone Beam Computed Tomographic imaging in orthodontics. Aust Dent J 2017; 62 Suppl 1:33-50. [PMID: 28297089 DOI: 10.1111/adj.12479] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Over the last 15 years, cone beam computed tomographic (CBCT) imaging has emerged as an important supplemental radiographic technique for orthodontic diagnosis and treatment planning, especially in situations which require an understanding of the complex anatomic relationships and surrounding structures of the maxillofacial skeleton. CBCT imaging provides unique features and advantages to enhance orthodontic practice over conventional extraoral radiographic imaging. While it is the responsibility of each practitioner to make a decision, in tandem with the patient/family, consensus-derived, evidence-based clinical guidelines are available to assist the clinician in the decision-making process. Specific recommendations provide selection guidance based on variables such as phase of treatment, clinically-assessed treatment difficulty, the presence of dental and/or skeletal modifying conditions, and pathology. CBCT imaging in orthodontics should always be considered wisely as children have conservatively, on average, a three to five times greater radiation risk compared with adults for the same exposure. The purpose of this paper is to provide an understanding of the operation of CBCT equipment as it relates to image quality and dose, highlight the benefits of the technique in orthodontic practice, and provide guidance on appropriate clinical use with respect to radiation dose and relative risk, particularly for the paediatric patient.
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Affiliation(s)
- W C Scarfe
- Division of Radiology and Imaging Sciences, Department of Surgical and Hospital Dentistry, The University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - B Azevedo
- Division of Radiology and Imaging Sciences, Department of Surgical and Hospital Dentistry, The University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - S Toghyani
- Division of Radiology and Imaging Sciences, Department of Surgical and Hospital Dentistry, The University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - A G Farman
- University of Louisville School of Dentistry and Independent Consultant in Oral and Maxillofacial Radiology, Chicago, Illinois, USA
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Masoud MI, Bansal N, C Castillo J, Manosudprasit A, Allareddy V, Haghi A, Hawkins HC, Otárola-Castillo E. 3D dentofacial photogrammetry reference values: a novel approach to orthodontic diagnosis. Eur J Orthod 2017; 39:215-225. [PMID: 28339510 DOI: 10.1093/ejo/cjw055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Orthodontic diagnostic standards generally use the cranial base as a reference and rely on samples selected by orthodontists. Objective The purpose of this study was to provide male and female standards for a novel non-radiographic approach for orthodontic diagnosis that utilizes 3D dentofacial photogrammetry using the eyes and natural head orientation as references instead of the cranial base. Methods One hundred and eighty females and 200 males between the ages of 18 and 35 years from 2 modeling agencies were orthodontically screened for near ideal occlusion. Subjects that met the inclusion criteria were rated by a sample of 40 lay people for attractiveness on a visual analogue scale. The final sample that had 3D facial and dental imaging included 49 subjects 25 males and 24 females with near ideal occlusion and considered attractive by the public. Results Inter and Intra-examiner ICC were greater than 0.8 for both landmarking and indexing. Relative to a coronal plane contacting the pupils (MC), the mean sagittal position of the alar curvature (representing the nasomaxillary complex) was 14.36 ± 3.08 mm in males and 12.4 ± 3.58 mm in females. The sagittal position of soft tissue pogonion relative to the pupils was 14.84 ± 3.63 mm in males and 12.78 ± 5.68 mm in females. The angle between the alar curvature and pogonion relative to the pupils was 9° in males and 10° in females. With the exception of the occlusal plane which was steeper in females, no ratios or angular facial measurements showed a significant gender difference. Relative to MC, males had more proclined upper incisors (20° vs 16°) and more retroclined Lower incisors (27° vs 31°; P > 0.05). A Procrustes ANOVA and permutation test showed that the shapes of males and females are different enough to be considered two distinct populations. Conclusions 1. When using the proposed method for orthodontic diagnosis, male and female patients should be compared to their respective dentofacial standards. 2. Validation of the proposed method and standards on an orthodontic population is underway to determine the scope its use.
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Affiliation(s)
- Mohamed I Masoud
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Neetu Bansal
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Jose C Castillo
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Amornrut Manosudprasit
- Department Orthodontics, Boston University, Henry M. Goldman School of Dental Medicine.,Department of Orthodontics, Khon Kaen University, Khon Kaen, Thailand
| | - Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry and Dental Clinics, The University of Iowa, IA, USA, and
| | - Arshan Haghi
- Department of Orthodontics, College of Dentistry and Dental Clinics, The University of Iowa, IA, USA, and
| | - Hannah C Hawkins
- Department of Anthropology, Purdue University, West Lafayette, IN, USA
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Manosudprasit A, Haghi A, Allareddy V, Masoud MI. Diagnosis and treatment planning of orthodontic patients with 3-dimensional dentofacial records. Am J Orthod Dentofacial Orthop 2017; 151:1083-1091. [PMID: 28554454 DOI: 10.1016/j.ajodo.2016.10.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cephalometrics has been the foundation of orthodontic diagnosis for many years. However, for many orthodontic patients, a lateral cephalogram might not be necessary. The aim of this study was to compare the diagnosis and treatment planning agreement between standard records and nonradiographic 3-dimensional (3D) dentofacial photogrammetry records. METHODS Twenty patients had standard orthodontic records taken for their treatment as well as extraoral and intraoral 3D images. Twelve evaluators examined the standard records and then completed diagnosis and treatment planning questionnaires. They repeated the process 4 to 6 weeks later by using 3D photographic images along with the panoramic radiographs. Each evaluator also evaluated 2 random orthodontic cases twice with each method to evaluate consistency within each method. At the end of study, each evaluator was asked to complete a survey to document his or her experiences with the 3D photogrammetry method. Descriptive and kappa statistics were used to determine the agreement. RESULTS Most diagnosis parameters had fair agreement between the methods and within each method. Skeletal and dental relationships had excellent agreement between and within the methods as well as most treatment decisions such as the need for extractions and surgery. Most evaluators (91.7%) thought that cephalometric x-rays would be needed only some of the time in diagnosis and treatment planning. Most evaluators (83.33%) thought that cephalometric radiographs are not needed in patients with a Class I ± a quarter cusp with crowding or spacing. CONCLUSIONS Most diagnostic decisions had fair agreement within and between the 2 methods. The decision to extract and the need for orthognathic surgery had excellent agreement between the cephalometric and photogrammetric methods. The majority of examiners agreed that patients with Class I malocclusions ± a quarter cusp with no obvious skeletal discrepancy can be diagnosed and planned without a cephalometric radiograph.
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Affiliation(s)
- Amornrut Manosudprasit
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass.
| | - Arshan Haghi
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Mohamed I Masoud
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Mass
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Di Blasio A, Di Blasio C, Pedrazzi G, Cassi D, Magnifico M, Manfredi E, Gandolfini M. Combined photographic and ultrasonographic measurement of the ANB angle: a pilot study. Oral Radiol 2017; 33:212-218. [PMID: 28890606 PMCID: PMC5570769 DOI: 10.1007/s11282-017-0275-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/23/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study was performed to evaluate the feasibility of noninvasive measurement of the ANB angle using photographic and ultrasonographic methods. METHODS Twenty consecutive orthodontic patients were evaluated. The ANB angle and soft tissue thickness covering the N, A, and B cephalometric points were measured by lateral teleradiography; these measurements were made by two expert operators. The soft tissue thickness covering the N, A, and B cephalometric points was measured by ultrasonography; these measurements were also made by two expert operators. On a 1:1 photographic profile print on which the ultrasonographic points were marked, the ANB ultrasonographic angle was measured. The following comparisons were considered: averaged and single measurements of N, A, and B points by first versus second ultrasonographer; averaged and single ultrasonographic versus radiographic soft tissue thickness covering the N, A, B points; and averaged and single ultrasonographic versus radiographic measurements of ANB angle. RESULTS High correlation and concordance of the averaged and single measurements, but no significant difference, was found between the two ultrasonographers. No statistically significant difference was found between the two methods for measuring averaged soft tissue thickness, but a 20% difference was found for the single measurements. High correlation and concordance between the ultrasonographic and radiographic measurements, but no significant difference, was found between the single and averaged ANB angle measurements. CONCLUSION Ultrasonography seems to be a noninvasive and reliable technique for measurement of the ANB angle and may replace radiographic measurement in some cases.
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Affiliation(s)
- Alberto Di Blasio
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Di Blasio
- Head and Neck Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Giuseppe Pedrazzi
- Neuroscience Department, University of Parma (Italy), Via Volturno 39, 43125 Parma, Italy
| | - Diana Cassi
- Doctoral School in Life and Health Science, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Marisabel Magnifico
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Edoardo Manfredi
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
| | - Mauro Gandolfini
- S.Bi.Bi.T. Department, University of Parma (Italy), Via Gramsci 14, 43126 Parma, Italy
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Wellens HLL, BeGole EA, Kuijpers-Jagtman AM. ROC surface assessment of the ANB angle and Wits appraisal’s diagnostic performance with a statistically derived ‘gold standard’: does normalizing measurements have any merit? Eur J Orthod 2017; 39:358-364. [DOI: 10.1093/ejo/cjx002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Stupar I, Yetkiner E, Attin T, Attin R. Influence of Lateral Cephalometric Radiography on Treatment Planning and Preferences in Skeletal Open-Bite Patients: Do Lateral Cephalograms Influence Treatment Planning? Turk J Orthod 2016; 29:87-90. [PMID: 30112480 DOI: 10.5152/turkjorthod.2016.1609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022]
Abstract
Objective To investigate the influence of diagnostic data derived from lateral cephalometric radiographs (LCR) on treatment preferences of specialists planning skeletal open-bite treatment. Methods Diagnostic records of 25 patients who had been treated at the University of Zurich, Department of Orthodontics, between 1988 and 2007 comprised the study material. Inclusion criteria were 1) skeletal open-bite with no marked antero-posterior discrepancy, 2) dental open-bite, and 3) crowding less than 5 mm. Records consisted of extra-intraoral photographs, panoramic-cephalometric X-rays, casts, and results of analyses. Records, with cephalograms of randomly chosen patients removed, were digitally presented to two orthodontists (A and B), and treatment preferences were asked using Likert-type questionnaires. Three months later, the same records were redelivered with missing cephalograms provided and present cephalograms removed with the questionnaire. Data were evaluated for consistency and tendency to extract using Kappa-κ and McNemar tests. Results Orthodontist B had no poor-agreement scores, whereas orthodontist A presented very-poor agreement for headgear use. Both A (κ=0.833) and B (κ=0.737) had good to very-good agreement in terms of extraction decisions. Neither orthodontist had any significant tendency for extraction/non-extraction therapy (A=0.99; B=0.5). Conclusion Information deduced from LCRs had limited influence on treatment planning preferences in skeletal/dental open-bite patients with no marked antero-posterior discrepancy and no influence on extraction/non-extraction decision.
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Affiliation(s)
- Irina Stupar
- Department of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich School of Dentistry, Zurich, Switzerland
| | - Enver Yetkiner
- Department of Orthodontics, Ege University School of Dentistry, İzmir, Turkey
| | - Thomas Attin
- Department of Periodontology and Cariology, Clinic for Preventive Dentistry, University of Zurich School of Dentistry, Zurich, Switzerland
| | - Rengin Attin
- Department of Periodontology and Cariology, Clinic for Preventive Dentistry, University of Zurich School of Dentistry, Zurich, Switzerland
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Correlation Assessment between Three-Dimensional Facial Soft Tissue Scan and Lateral Cephalometric Radiography in Orthodontic Diagnosis. Int J Dent 2016; 2016:1473918. [PMID: 27313615 PMCID: PMC4903122 DOI: 10.1155/2016/1473918] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/12/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of the present prospective study was to investigate correlations between 3D facial soft tissue scan and lateral cephalometric radiography measurements. Materials and Methods. The study sample comprised 312 subjects of Caucasian ethnic origin. Exclusion criteria were all the craniofacial anomalies, noticeable asymmetries, and previous or current orthodontic treatment. A cephalometric analysis was developed employing 11 soft tissue landmarks and 14 sagittal and 14 vertical angular measurements corresponding to skeletal cephalometric variables. Cephalometric analyses on lateral cephalometric radiographies were performed for all subjects. The measurements were analysed in terms of their reliability and gender-age specific differences. Then, the soft tissue values were analysed for any correlations with lateral cephalometric radiography variables using Pearson correlation coefficient analysis. Results. Low, medium, and high correlations were found for sagittal and vertical measurements. Sagittal measurements seemed to be more reliable in providing a soft tissue diagnosis than vertical measurements. Conclusions. Sagittal parameters seemed to be more reliable in providing a soft tissue diagnosis similar to lateral cephalometric radiography. Vertical soft tissue measurements meanwhile showed a little less correlation with the corresponding cephalometric values perhaps due to the low reproducibility of cranial base and mandibular landmarks.
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Jung SK, Kim TW. New approach for the diagnosis of extractions with neural network machine learning. Am J Orthod Dentofacial Orthop 2016; 149:127-33. [PMID: 26718386 DOI: 10.1016/j.ajodo.2015.07.030] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The decision to extract teeth for orthodontic treatment is important and difficult because it tends to be based on the practitioner's experiences. The purposes of this study were to construct an artificial intelligence expert system for the diagnosis of extractions using neural network machine learning and to evaluate the performance of this model. METHODS The subjects included 156 patients. Input data consisted of 12 cephalometric variables and an additional 6 indexes. Output data consisted of 3 bits to divide the extraction patterns. Four neural network machine learning models for the diagnosis of extractions were constructed using a back-propagation algorithm and were evaluated. RESULTS The success rates of the models were 93% for the diagnosis of extraction vs nonextraction and 84% for the detailed diagnosis of the extraction patterns. CONCLUSIONS This study suggests that artificial intelligence expert systems with neural network machine learning could be useful in orthodontics. Improved performance was achieved by components such as proper selection of the input data, appropriate organization of the modeling, and preferable generalization.
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Affiliation(s)
- Seok-Ki Jung
- Clinical instructor, Department of Orthodontics, Korea University Ansan Hospital, Ansan, Korea
| | - Tae-Woo Kim
- Professor, Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Korea.
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History of imaging in orthodontics: A history of overdiagnosis? Am J Orthod Dentofacial Orthop 2016; 149:591. [PMID: 27131236 DOI: 10.1016/j.ajodo.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 12/30/2015] [Accepted: 02/04/2016] [Indexed: 11/24/2022]
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Wellens HLL, Kuijpers-Jagtman AM. Connecting the new with the old: modifying the combined application of Procrustes superimposition and principal component analysis, to allow for comparison with traditional lateral cephalometric variables. Eur J Orthod 2016; 38:569-576. [PMID: 26739558 DOI: 10.1093/ejo/cjv096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The combination of generalized Procrustes superimposition (GPS) and principal component analysis (PCA) has been hypothesized to solve some of the problems plaguing traditional cephalometry. This study demonstrates how to establish the currently unclear relationship between the shape space defined by the first two principal components to the ANB angle, Wits appraisal, and GoGnSN angle, and to elucidate possible clinical applications thereof. METHODS Digitized landmarks of 200 lateral cephalograms were subjected to GPS and PCA, after which the sample mean shape was deformed along/parallel to principal components (PC) 1 and 2, recording the ANB, Wits, and GoGnSN value at each location. Trajectories were then calculated through the PC1-PC2 space connecting locations with the same values. These were finally utilized to renormalize the PC1-PC2 space. RESULTS The trajectories for the Wits appraisal were almost straight and parallel to PC1.Those for the ANB angle were angled approximately 20degrees downward relative to PC1, with a more accentuated curvature. The GoGnSN curves were mildly angled relative to the PC2 axis, their curvature increasing slightly with increasing PC1 scores. By combining the aforementioned trajectories, it was possible to delineate the region of the PC1-PC2 shape space which would be regarded as normodivergent and skeletal Class I in traditional cephalometry. Geometric distortion could be avoided by assigning patients the ANB, Wits, or GoGnSN value of the sample mean shape, deformed to the patient's position within the PC1-PC2 plot. CONCLUSION The methodology successfully relates the shape space resulting from the GPS-PCA results with traditional cephalometric variables.
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Affiliation(s)
- Hans L L Wellens
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Anne M Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, The Netherlands
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Martina R, D'Antò V, Chiodini P, Casillo M, Galeotti A, Tagliaferri R, Michelotti A, Cioffi I. Reproducibility of the assessment of the Fränkel manoeuvre for the evaluation of sagittal skeletal discrepancies in Class II individuals. Eur J Orthod 2015; 38:409-13. [PMID: 26433220 DOI: 10.1093/ejo/cjv072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The Fränkel manoeuvre is a procedure by which the mandible of Class II individuals is postured forward in dental Class I relationship. The evaluation of the resulting facial profile provides information concerning the components determining the sagittal discrepancy. Data concerning the reproducibility of its assessment are not available. This study aimed to evaluate the intra-observer and inter-observer reproducibility of the assessment of the manoeuvre and to assess whether the amount of clinical experience affects its reproducibility. METHODS Two lateral photographs, one in centric occlusion, and the other with the mandible postured forward (Fränkel manoeuvre) of 100 Angle Class II individuals aged between 9 and 13 years were evaluated by six orthodontists (T0). Each examiner was asked whether the facial profile worsen or not with the manoeuvre after being trained by an expert orthodontist. The test was repeated after 2 weeks interval (T1). Intra-observer and inter-observer agreement were evaluated by computing the Cohen's K. RESULTS The agreement (K values) between observations (T0 versus T1) for each examiner ranged from 0.49 to 0.72. The overall agreement was 0.65 [95% confidence interval (CI) = 0.54-0.75]. The agreement in the group with less clinical experience was 0.61 (95% CI = 0.46-0.76), while it was 0.68 (95% CI = 0.53-0.83) in the more experienced group. The amount of clinical experience did not affect intra-observer agreement (P = 0.50). The overall agreement between the examiners and the trainer was 0.74 (95% CI = 0.65-0.83) and 0.73 (95% CI = 0.64-0.83) at T0 and T1 respectively. CONCLUSION The assessment of the Fränkel manoeuvre is reproducible and it is not influenced by the amount of clinical experience.
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Affiliation(s)
- Roberto Martina
- *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy
| | - Vincenzo D'Antò
- *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy, Bambino Gesù Hospital, Division of Dentistry and Orthodontics, Rome, Italy, and
| | - Paolo Chiodini
- Medical Statistics Unit - Second University of Naples, Italy
| | - Marianna Casillo
- *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy
| | - Angela Galeotti
- Bambino Gesù Hospital, Division of Dentistry and Orthodontics, Rome, Italy, and
| | - Renato Tagliaferri
- *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy
| | - Ambrosina Michelotti
- *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy
| | - Iacopo Cioffi
- *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy, Department of Orthodontics, Faculty of Dentistry, University of Toronto, Ontario, Canada
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Mavreas D, Kuppens E, Buyl R, Vande Vannet B. How orthodontic records can influence torque choice decisions? Eur J Orthod 2015; 38:212-6. [PMID: 26409048 DOI: 10.1093/ejo/cjv068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. METHODS Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. RESULTS The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. CONCLUSIONS This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.
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Affiliation(s)
| | - Enya Kuppens
- GF - ORHE - Orthodontics, Vrije Universiteit Brussel and
| | - Ronald Buyl
- GF - BISI - Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Belgium
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Comparison of lateral photographic and radiographic sagittal analysis in relation to Angle's classification. J Orofac Orthop 2015; 76:294-304. [PMID: 26123731 DOI: 10.1007/s00056-015-0292-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The goal of this study was to compare sagittal jaw relationships derived from standardized profile photographs (soft tissue) to those derived from lateral cephalograms (hard tissue) with respect to Angle's classification of malocclusion. METHODS A total of 110 randomly selected subjects (mean age: 13.75 ± 1.46 years) undergoing treatment (Postgraduate Program in Orthodontics at Tel Aviv University) were assigned to three groups based on Angle's classification (Class I: n = 30; Class II: n = 50; Class III: n = 30). Standardized profile-view photographs and lateral radiographs (cephalograms) were compared using 11 soft tissue and 8 skeletal measurements, respectively. RESULTS Tragus, infra-orbital, nasion, A point, B point, and pogonion were found to be the most reliable soft tissue reference points. A similar pattern of diversity was found between the three groups of Angle's classification (Class I/II/III) for the photographic soft,-tissue and the radiographic skeletal measurements (e.g., soft tissue A'N'B' =11.43°/13.30°/8.85° and hard tissue ANB = 3.13°/4.64°/-1.31°). Soft tissue A'N'B' measurement provides complementary information to hard tissue ANB measurement. CONCLUSION Analyzing profile photographs for evaluating sagittal jaw relationships is a practical tool in determining soft tissue harmony. Soft tissue measurements provide a sagittal differential diagnosis in relation to Angle's classification of malocclusion.
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Pakbaznejad Esmaeili E, Ekholm M, Haukka J, Waltimo-Sirén J. Quality assessment of orthodontic radiography in children. Eur J Orthod 2015; 38:96-102. [PMID: 25979226 DOI: 10.1093/ejo/cjv033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Numbers of dental panoramic tomographs (DPTs) and lateral cephalometric radiographs (LCRs) outweigh other radiographic examinations in 7- to 12-year-old Finns. Orthodontists and general practitioners (GPs) involved in orthodontics hold therefore the highest responsibility of the exposure of children to ionising radiation with its risks. Against this background, lack of reports on the quality of orthodontic radiography is surprising. The purpose of our study was to shed some light and draw the awareness of the orthodontic community on the subject by analyzing the quality of orthodontic radiography in Oral Healthcare Department of City of Helsinki, in the capital of Finland. MATERIALS AND METHODS We analyzed randomly selected 241 patient files with DPTs and 118 patient files with LCRs of 7- to 12-year-olds for the indications of radiography, quality of referrals, status of interpretation, and number of failed radiographs. RESULTS The majority of DPTs (95%) and all LCRs had been ordered for orthodontic reasons. Of the DPTs, 60% were ordered by GPs, and of the LCRs, 64% by orthodontists. The referrals were adequate for most DPTs (78%) and LCRs (73%), orthodontists being responsible for the majority of inadequate referrals. Of the DPTs, 80% had been interpreted. Of the LCRs, 65% lacked interpretation, but 67% had been analysed cephalometrically. Failed radiographs, leading to repeated exposure, were found in 2-3%. CONCLUSION The quality assessment revealed that orthodontic radiography may not completely fulfill the criteria of good practice. Our results stress further need of continuing education in radiation protection among both orthodontists and GPs involved in orthodontics.
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Affiliation(s)
- Elmira Pakbaznejad Esmaeili
- *Oral Radiology, Department of Oral and Maxillofacial Diseases, University of Helsinki, .,**Oral Healthcare Department of City of Helsinki
| | - Marja Ekholm
- *Oral Radiology, Department of Oral and Maxillofacial Diseases, University of Helsinki.,***University Dental Clinic of City of Helsinki
| | - Jari Haukka
- ****Department of Public Health, University of Helsinki
| | - Janna Waltimo-Sirén
- ***University Dental Clinic of City of Helsinki.,*****Orthodontics, Department of Oral and Maxillofacial Diseases, University of Helsinki, Finland
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Naish H, Dunbar C, Crouch-Baker J, Shah K, Wallis C, Atack NE, Sherriff M, Sandy JR, Ireland AJ. Does a true knowledge of dental crowding affect orthodontic treatment decisions? Eur J Orthod 2015; 38:66-70. [PMID: 25788331 DOI: 10.1093/ejo/cjv011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess whether a true knowledge of crowding alters treatment decisions compared with estimates of crowding. MATERIALS AND METHODS Thirty-six orthodontists were asked to estimate crowding using visualization on eight mandibular arch study models and to indicate possible extraction choices. For each model, the intermolar widths, intercanine widths, and clinical scenarios were identical, but the true crowding varied from 0.2 to 8.4mm as to a lesser extent did the curve of Spee. Eleven orthodontists repeated the visualization exercise after 2 weeks to assess reliability. All 36 of the orthodontists were asked to repeat the treatment planning exercise on the same models, but this time was provided with the true amount of crowding in each case. RESULTS When the 36 orthodontists used direct visualization of the models to assess crowding, the range of their estimates of crowding increased as the crowding increased. As might be expected, they also tended to move towards extraction treatments as the crowding increased (P = 0.013, odds ratio = 3). Although the reliability of the repeat estimates of crowding were moderate, the mean estimates were greater than the true crowding for each model. When orthodontists were presented with the true amount of crowding, rather than their estimate of crowding, it had a significant effect on the decision to extract, with fewer orthodontists recommending extractions. LIMITATIONS The principal limitation of this study is that it was a laboratory-based study and utilized just the mandibular arch model for estimation and treatment planning. CONCLUSIONS Direct visualization may overestimate the amount of crowding present. When the true amount of crowding is known, it can lead to more consistent treatment planning, with the decision to extract fewer teeth in the borderline cases. A formal space analysis is likely to assist with treatment planning.
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Affiliation(s)
- Hywel Naish
- *School of Oral and Dental Sciences, University of Bristol
| | - Claire Dunbar
- **Orthodontic Department, Dorset County Hospital, Dorchester, and
| | | | - Kiran Shah
- *School of Oral and Dental Sciences, University of Bristol
| | - Colin Wallis
- ***The Specialist Orthodontic Practice, Epping, United Kingdom
| | - Nikki E Atack
- *School of Oral and Dental Sciences, University of Bristol
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Durão AR, Alqerban A, Ferreira AP, Jacobs R. Influence of lateral cephalometric radiography in orthodontic diagnosis and treatment planning. Angle Orthod 2015; 85:206-210. [PMID: 25191839 PMCID: PMC8631877 DOI: 10.2319/011214-41.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/01/2014] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To evaluate the impact of additional lateral cephalometric radiography in orthodontic diagnosis and treatment planning. MATERIALS AND METHODS Forty-three patients seeking orthodontic treatment, and for whom pretreatment diagnostic records were available, were randomly selected. Ten qualified orthodontists were involved in this study. The patients' records included three photographs of the angle trimmed dental casts, digital lateral cephalometric and panoramic radiographs, and standard clinical photographs comprising seven intra- and four extraoral pictures. Records were evaluated in two sessions. At the first session, orthodontists evaluated records without lateral cephalometric radiography (LCR). In the second session, the same information was presented, but with LCR. Between the two sessions the order in which the cases were presented was altered to avoid bias. RESULTS The percentage of agreement between sessions was lower for diagnosis than for treatment planning. Concerning skeletal classification, the least experienced orthodontist was the least consistent (28%), while the more experienced orthodontist was the more reliable (67%). In terms of treatment modalities, in general there was an agreement of 64%. The most frequent modifications in treatment modalities were seen in Class II malocclusion patients. CONCLUSIONS The results of our study suggest that the majority of Portuguese orthodontists judge that LCR is important to producing a treatment plan. Despite that, it does not seem to have an influence on orthodontic treatment planning.
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Affiliation(s)
- Ana Reis Durão
- Invited Assistant, Department of Dental Radiology, Faculty of Dental Medicine, University of Porto, Portugal
| | - Ali Alqerban
- Doctorandus, Department of Oral Health Sciences, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Afonso Pinhão Ferreira
- Full Professor, Department of Orthodontics, Faculty of Dental Medicine, University of Porto, Portugal
| | - Reinhilde Jacobs
- Full Professor, OIC, OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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