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Zhang X, Guo N, Cheng J, Xi W. Three-Dimensional Evaluation of Changes in Condylar Position After Orthognathic Surgery With Different Types of Jaw Deformities. J Oral Maxillofac Surg 2024:S0278-2391(24)00338-0. [PMID: 38901470 DOI: 10.1016/j.joms.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Assessing condyle position postorthognathic surgery is pivotal for optimizing surgical accuracy, sustaining postoperative stability, and ensuring predictable treatment outcomes. PURPOSE The aim of this study was to analyze the changes of condyle position after orthognathic surgery with different types of jaw deformity and to analyze whether the changes of condyle position are different. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was designed and conducted, involving adults who underwent orthognathic surgery for jaw deformities at the affiliated Stomatological Hospital of Nanchang University between 2019 and 2022. Patients with incomplete computerized tomography data were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable was time (preoperative and postoperative) and types of jaw deformities (skeletal Class III, skeletal Class II, and mandibular deviation). MAIN OUTCOME VARIABLE(S) The main outcome variables were the three-dimensional linear and rotational positional changes of the condyle. COVARIATES Evaluated covariates included sex and age. ANALYSES MIMICS 20.0 software measured all data, and SPSS 22.0 software facilitated statistical analyses. Intragroup and intergroup correlation analyses employed paired t-tests and independent t-tests, with statistical significance set at P < .05. RESULTS The study sample was composed of 32 subjects with a mean age of 22.43 ± 1.6 and 9 were male. The analysis of changes of condylar position from virtual surgical planning to the immediate postoperative period showed that the maximum condylar displacement was 1.74 mm and the maximum angular change was 3.92°. The analysis of changes in condylar position from the immediate postoperative period to 1 year postoperatively showed no statistically significant changes for the same type of jaw deformity. But patients with Class II malocclusion exhibited distinct condylar displacement and rotation patterns compared to those with Class III malocclusion and mandibular deformity. CONCLUSION AND RELEVANCE The application of virtual surgical planning in orthognathic surgery ensures a high degree of consistency in achieving the desired condylar position. Moreover, no significant change in condylar position was observed after orthognathic surgery for the same type of jaw deformity. However, patients with Class II deformities exhibited a higher susceptibility to rotational displacement of the condyles compared to those with other types of jaw deformities.
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Affiliation(s)
- Xue'e Zhang
- PhD student, Resident, School of Stomatology, Jiangxi Medical College, Nanchang University Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Nan Guo
- Master student, Resident, School of Stomatology, Jiangxi Medical College, Nanchang University Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Jialong Cheng
- Master, Attending, Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University. Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Weihong Xi
- PhD, Professor, Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China.
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Sencak RC, Benavides E, Cevidanes L, Yatabe M, Koerich L, Souki BQ, Ruellas ACDO. Asymmetry in Class II subdivision malocclusion: Assessment based on 3D surface models. Orthod Craniofac Res 2024; 27:267-275. [PMID: 37882502 DOI: 10.1111/ocr.12723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/24/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION There is currently no consensus in the literature whether the aetiology of a Class II subdivision is dental, skeletal or both. The aim of this study was to identify and quantify skeletal and dental asymmetries in Class II subdivision malocclusions. METHODS CBCTs from 33 Class II subdivision malocclusion patients were used to construct 3D volumetric label maps. Eighteen landmarks were identified. The original scan and associated 3D volumetric label map were mirrored. Registration of the original and mirrored images relative to the anterior cranial base, maxilla and mandible were performed. Surface models were generated, and 3D differences were quantified. Statistical analysis was performed. RESULTS Anterior cranial base registration showed significant differences for fossa vertical difference, fossa roll, mandibular yaw, mandibular lateral displacement and lower midline displacement. Regional registrations showed significant differences for antero-posterior (A-P) mandibular length, maxillary roll, A-P maxillary first molar position, maxillary first molar yaw and maxillary first molar roll. Class II subdivision patients also show an asymmetric mandibular length as well as an asymmetric gonial angle. Moderate correlations were found between the A-P molar relationship and fossa A-P difference, mandibular first molar A-P difference, maxillary first molar A-P difference and maxillary first molar yaw. CONCLUSIONS This study suggests that Class II subdivisions can result from both significant skeletal and dental factors. Skeletal factors include a shorter mandible as well as posterior and higher displacement of the fossa on the Class II side, resulting in mandibular yaw. Dental factors include maxillary and mandibular first molar antero-posterior asymmetry.
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Affiliation(s)
- Regina C Sencak
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Bernardo Quiroga Souki
- Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Barone S, Cevidanes L, Miranda F, Gurgel ML, Anchling L, Hutin N, Bianchi J, Goncalves JR, Giudice A. Enhancing skeletal stability and Class III correction through active orthodontist engagement in virtual surgical planning: A voxel-based 3-dimensional analysis. Am J Orthod Dentofacial Orthop 2024; 165:321-331. [PMID: 38010236 PMCID: PMC10923113 DOI: 10.1016/j.ajodo.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Skeletal stability after bimaxillary surgical correction of Class III malocclusion was investigated through a qualitative and quantitative analysis of the maxilla and the distal and proximal mandibular segments using a 3-dimensional voxel-based superimposition among virtual surgical predictions performed by the orthodontist in close communication with the maxillofacial surgeon and 12-18 months postoperative outcomes. METHODS A comprehensive secondary data analysis was conducted on deidentified preoperative (1 month before surgery [T1]) and 12-18 months postoperative (midterm [T2]) cone-beam computed tomography scans, along with virtual surgical planning (VSP) data obtained by Dolphin Imaging software. The sample for the study consisted of 17 patients (mean age, 24.8 ± 3.5 years). Using 3D Slicer software, automated tools based on deep-learning approaches were used for cone-beam computed tomography orientation, registration, bone segmentation, and landmark identification. Colormaps were generated for qualitative analysis, whereas linear and angular differences between the planned (T1-VSP) and observed (T1-T2) outcomes were calculated for quantitative assessments. Statistical analysis was conducted with a significance level of α = 0.05. RESULTS The midterm surgical outcomes revealed a slight but significantly less maxillary advancement compared with the planned position (mean difference, 1.84 ± 1.50 mm; P = 0.004). The repositioning of the mandibular distal segment was stable, with insignificant differences in linear (T1-VSP, 1.01 ± 3.66 mm; T1-T2, 0.32 ± 4.17 mm) and angular (T1-VSP, 1.53° ± 1.60°; T1-T2, 1.54° ± 1.50°) displacements (P >0.05). The proximal segments exhibited lateral displacement within 1.5° for both the mandibular right and left ramus at T1-VSP and T1-T2 (P >0.05). CONCLUSIONS The analysis of fully digital planned and surgically repositioned maxilla and mandible revealed excellent precision. In the midterm surgical outcomes of maxillary advancement, a minor deviation from the planned anterior movement was observed.
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Affiliation(s)
- Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Luc Anchling
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Nathan Hutin
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Jonas Bianchi
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, Calif
| | - Joao Roberto Goncalves
- Department of Pediatric Dentistry, School of Dentist, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Bedoya-Valiente A, Llamas-Carreras JM, Pastor F, Rodríguez JC, Espinar-Escalona E, Barrera-Mora JM. Upper incisor position in the sagittal plane when smiling. A photographic and CBCT study. J Clin Exp Dent 2024; 16:e282-e291. [PMID: 38600929 PMCID: PMC11003288 DOI: 10.4317/jced.61308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024] Open
Abstract
Background The aim of this study was to analyze the anteroposterior position between the upper incisors (UI) and the soft tissues based on photographs in which the head has been oriented along the Frankfort Horizontal Plane. Material and Methods Restrospective case-control study carried out by analizing photographic and CBCT images of 109 patientes. The sample was divided into 4 different groups: 21 normocclusive (N), 29 Class II/1st, 29 Class II/2nd y 30 Class III. All patients were positioned using the Frankfurt plane (FH). From this aligned position of the head, a vertical line was drawn perpendicular to the FH passing through the Soft-Tissue Nasion (LN), and the distance in centimeters from of the UI to this vertical line was measured on both the CBCT and the photo of the patient's profile. Results The UI was located in front of the LN in the groups N, Class II/1st y Class III (0,4, 0,2, 0,1cm respectively) and behind the LN in the group Class II/2nd (0,2cm). There were significant differences between the Class II/2nd and Normocclusive groups and Class II/2nd and Class II/1st (p<0.001 y p=0.004 respectively). Conclusions Orthodontic and/or surgical correction of various malocclusions can be planned based on the position of the UI with respect to the LN established in Normocclusive patients. Key words:Upper incisors, facial profile, CBCT, photograph, Frankfurt plane, Soft-Tissue Nasion.
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Shi Y, Luo S, Wang H, Yao Q, Shi Y, Cheng J. Three-dimensional bone remodelling of glenoid fossa in patients with skeletal Class III malocclusion after bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 2024; 53:133-140. [PMID: 37442687 DOI: 10.1016/j.ijom.2023.06.006] [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: 11/08/2022] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
This study aimed to characterize three-dimensional quantitative morphological changes of glenoid fossa in patients with skeletal Class III malocclusion treated with bimaxillary orthognathic surgery. Ninety-five eligible patients (50 male, 45 female; mean age 22.09 years) were enrolled retrospectively. Cone beam computed tomography obtained at 1 week preoperatively (T0), immediately after surgery (T1), and at ≥ 12 months postoperatively (T2) were registered based on cranial base using voxel-based registration in 3D Slicer. Glenoid fossa surface was divided spatially into four regions, and bone modelling in these regions was visualized with color maps. Our data revealed that the mean surface variations of glenoid fossa were small, with modest bone formation as a whole. No significant associations between anteroposterior or vertical mandibular displacement and overall glenoid fossa remodeling were found (P > 0.05). Moreover, bone deposition was frequently observed in the anterior-lateral region of glenoid fossa in patients with a larger mandibular movement during T0-T1 (P < 0.001). Paired bone formation in the anterior-lateral region of glenoid fossa and bone resorption in the anterior-lateral region of condylar head was frequently observed. Collectively, our results revealed that glenoid fossa underwent complex but modest bone remodeling after bimaxillary surgery in skeletal Class III patients.
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Affiliation(s)
- Y Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China
| | - S Luo
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China; Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, PR China
| | - H Wang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - Q Yao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - Y Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - J Cheng
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China.
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Pereira A, Gurgel M, Pereira R, Fabbro CD, de Barros Silva P, Costa F, Leite L, Moro A, Cevidanes L, Junior CM. Evaluation of condylar and mandibular movements on the upper airway during the use of mandibular advancement device for obstructive sleep apnea treatment. Clin Oral Investig 2024; 28:122. [PMID: 38286954 PMCID: PMC11066818 DOI: 10.1007/s00784-024-05513-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment. MATERIALS AND METHODS Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed. RESULTS Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation. CONCLUSION Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation. CLINICAL RELEVANCE Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.
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Affiliation(s)
| | | | | | | | | | - Fabio Costa
- Federal University of Ceará, Fortaleza, Brazil
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Feng B, Wu Q, Wang J, Jiang Y, Liu Z, Lu M, Liu Z, Yu M, Zhu F. Developing a universal and reliable temporomandibular joint reference system for quantifying morphological and positional changes. Eur J Orthod 2024; 46:cjad055. [PMID: 37824439 DOI: 10.1093/ejo/cjad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVES This study aimed to provide a universal and reliable reference system quantifying temporomandibular joint (TMJ) morphological and positional changes. METHODS Large field-of-view (FOV) cone-beam computed tomography (CBCT) images (20 TMJs) from 10 preorthognathic surgery patients and limited FOV CBCT images (40 TMJs) from 20 splint therapy-treated patients with temporomandibular disorders were collected. TMJ-specific reference system including a TMJ horizontal reference plane (TMJHP) and a local coordinate system (TMJCS) was constructed with landmarks on cranial base. Its application for TMJ measurements and its spatial relationship to common Frankfort horizontal plane (FHP) and maxillofacial coordinate system (MFCS) were evaluated. RESULTS Five relevant landmarks were selected to optimally construct TMJ-specific reference system. General parallelism between TMJHP and FHP was demonstrated by minimal angular and constant distance deviation (1.714 ± 0.811º; 2.925 ± 0.817 mm). Additionally, tiny axial orientational deviations (0.181 ± 6.805º) suggested TMJCS rivaled MFCS. Moreover, small deviations in orientations and distances (1.232 ± 0.609º; 0.310 ± 0.202 mm) indicated considerable reliability for TMJCS construction, with intraclass correlation coefficients (ICCs) ranging from 0.999 to 1.000. Lastly, slight discrepancies in translations and rotations revealed high reliability for condylar positional and morphological measurements (ICC, 0.918-0.999). LIMITATIONS TMJ-specific reference system was merely tested in two representative FOVs. CONCLUSIONS This study provides a universal and reliable reference system for TMJ assessment that is applicable to both limited and large FOV CBCT. It would improve comparability among diverse studies and enable comprehensive evaluations of TMJ positional and morphological changes during TMJ-related treatment follow-up such as splint therapy and disease progression.
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Affiliation(s)
- Bin Feng
- Department of Oral and Maxillofacial Radiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Qinxin Wu
- Department of Maxillofacial Surgery and Oral Implantology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Jun Wang
- Department of Oral and Maxillofacial Radiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Yun Jiang
- Department of Maxillofacial Surgery and Oral Implantology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Zi'ang Liu
- Department of Maxillofacial Surgery and Oral Implantology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Mengting Lu
- Department of Orthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Zuozhu Liu
- College of Information Science and Electrical Engineering, the Stomatology Hospital, School of Stomatology, and the ZJU-UIUC Institute, ZJU-Angelaling Research and Development Institute for Intelligence Healthcare, Zhejiang University, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Mengfei Yu
- Department of Maxillofacial Surgery and Oral Implantology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
| | - Fudong Zhu
- Department of Maxillofacial Surgery and Oral Implantology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, No.166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China
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Biggs EV, Benavides E, McNamara JA, Cevidanes LHS, Copello F, Lints RR, Lints JP, Ruellas ACO. Three-dimensional Evaluation of the Carriere Motion 3D Appliance in the treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop 2023; 164:824-836. [PMID: 37598337 DOI: 10.1016/j.ajodo.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION This study aimed to quantify the outcomes of adolescent patients with Class II malocclusion treated with the Carriere Motion 3D Appliance (CMA) combined with full fixed appliances. METHODS Cone-beam computed tomography scans of 22 patients were available before orthodontic treatment (T1), at removal of the CMA (T2), and posttreatment (T3). The average age of the patients was 13.5 ± 1.6 years at T1, 14.1 ± 0.2 years at T2, and 15.6 ± 0.5 years at T3. The 3-dimensional image analysis procedures were performed using ITK-SNAP (version 3.6.0; www.itksnap.org, Hatfield, Pa) and SlicerCMF (version 4.11.0; http://www.slicer.org, Cambridge, Mass); skeletal and dentoalveolar changes relative to cranial base, maxillary, and mandibular regional superimpositions were evaluated. RESULTS Changes were analyzed with 1 sample t tests using the mean differences during the CMA phase (T1 to T2) and total treatment time (T1 to T3). Significant skeletal changes included a slight reduction of ANB from T1 to T3, mandibular growth (Co-Gn increment of 1.2 mm and 3.3 mm from T1 to T2 and T1 to T3, respectively), inferior displacement of point A, and anterior and inferior displacement of point B. The mandibular plane did not change significantly during treatment. During the CMA treatment, posterior tipping and distal rotation of the maxillary molars, tip back and inferior displacement of the maxillary canines, significant mesial rotation, and superior displacement of the mandibular molars were observed. These movements rebounded during the full fixed appliance phase except for the molar and canine vertical displacements. Clinically significant dental changes during treatment included a reduction in overjet and overbite, Class II correction of the molar and canine relationship, and proclination of the mandibular incisors. CONCLUSIONS The CMA is an effective treatment modality for Class II correction in growing patients because of a combination of mesial movement of the mandibular molar, distal rotation of the maxillary molar, and anterior displacement of the mandible.
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Affiliation(s)
- Elizabeth V Biggs
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Private practice, Novi, Mich
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Flavio Copello
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland, Baltimore, Md
| | | | | | - Antonio C O Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
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de Souza Reis A, de Mendonca Copello F, de Castro ACR, Cevidanes LHS, do Rego MV, Visconti MA, de Oliveira Ruellas AC. 3D analysis of maxillomandibular morphology in hyperdivergent and hypodivergent individuals: A cross-sectional study. Orthod Craniofac Res 2023; 26:687-694. [PMID: 37246594 PMCID: PMC10592316 DOI: 10.1111/ocr.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The aim of this cross-sectional study was to investigate maxillomandibular morphology in hyperdivergent and hypodivergent individuals, using 3D surface models generated by cone-beam computed tomography (CBCT). METHODS The sample consisted of 60 CBCTs (30 males, 30 females) patients aged 12-30 years, divided into two groups comprising hyperdivergent (≥35°) and hypodivergent (≤30°) individuals, according to the mandibular plane (MP) angle. Multiplanar reconstructions were used to mark the landmarks, and 3D surface models were created to evaluate structures of the maxillomandibular complex, including condyle, ramus, symphysis and palatal height. Intergroup comparisons were performed by independent t-test. Pearson's correlation test was used (P < .05) to evaluate the correlation of the MP angle with the angles and linear measurements of other structures. RESULTS Significant differences were found between the groups regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. No differences (P > .05) were found for the condylar height, symphysis inclination angle or palatal height. Correlations (P < .05) were found between the MP angle and structures of the maxillomandibular complex. CONCLUSIONS Hyperdivergent (MP ≥ 35°) and hypodivergent (MP ≤ 30°) individuals present different skeletal morphology regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. There is a significant correlation between MP angle and morphological structures such as condyle, ramus, symphysis, palatal plane angle and palatal-mandibular angle.
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Affiliation(s)
- Alyson de Souza Reis
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Amanda Cunha Regal de Castro
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcus Vinicius do Rego
- Department of Pathology and Clinical Dentistry, Universidade Federal do Piaui, Teresina, Brazil
| | - Maria Augusta Visconti
- Department of Oral Pathology and Diagnosis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Gillot M, Miranda F, Baquero B, Ruellas A, Gurgel M, Al Turkestani N, Anchling L, Hutin N, Biggs E, Yatabe M, Paniagua B, Fillion-Robin JC, Allemang D, Bianchi J, Cevidanes L, Prieto JC. Automatic landmark identification in cone-beam computed tomography. Orthod Craniofac Res 2023; 26:560-567. [PMID: 36811276 PMCID: PMC10440369 DOI: 10.1111/ocr.12642] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To present and validate an open-source fully automated landmark placement (ALICBCT) tool for cone-beam computed tomography scans. MATERIALS AND METHODS One hundred and forty-three large and medium field of view cone-beam computed tomography (CBCT) were used to train and test a novel approach, called ALICBCT that reformulates landmark detection as a classification problem through a virtual agent placed inside volumetric images. The landmark agents were trained to navigate in a multi-scale volumetric space to reach the estimated landmark position. The agent movements decision relies on a combination of DenseNet feature network and fully connected layers. For each CBCT, 32 ground truth landmark positions were identified by 2 clinician experts. After validation of the 32 landmarks, new models were trained to identify a total of 119 landmarks that are commonly used in clinical studies for the quantification of changes in bone morphology and tooth position. RESULTS Our method achieved a high accuracy with an average of 1.54 ± 0.87 mm error for the 32 landmark positions with rare failures, taking an average of 4.2 second computation time to identify each landmark in one large 3D-CBCT scan using a conventional GPU. CONCLUSION The ALICBCT algorithm is a robust automatic identification tool that has been deployed for clinical and research use as an extension in the 3D Slicer platform allowing continuous updates for increased precision.
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Affiliation(s)
- Maxime Gillot
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
- CPE Lyon, Lyon, France
| | - Felicia Miranda
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - Baptiste Baquero
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
- CPE Lyon, Lyon, France
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcela Gurgel
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Luc Anchling
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
- CPE Lyon, Lyon, France
| | - Nathan Hutin
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
- CPE Lyon, Lyon, France
| | - Elizabeth Biggs
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
| | | | | | | | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, San Francisco, CA, USA
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, MI, Ann Arbor, USA
| | - Juan Carlos Prieto
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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11
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Souza RXSD, Souza GASD, Colares JP, Ianni TMDS, Magalhães CSD, Guerrero-Vargas JA, Montalvany-Antonucci CC, Macari S. A new way of analyzing tooth movement using universal coordinate system geometry single point superposition in a 3D model. Dental Press J Orthod 2023; 28:e232333. [PMID: 37820226 PMCID: PMC10564451 DOI: 10.1590/2177-6709.28.4.e232333.oar] [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: 02/16/2023] [Accepted: 05/24/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Superposing 3D models is an imminent need. However, current methods rely on marking multiple points on the maxilla and mandible, which could increase point marking and overlapping errors. OBJECTIVE This study aimed at developing a method for superimposing 3D models of the maxillary and mandibular arches with Autodesk Inventor® engineering software, using a single universal coordinate system (UCS) point superposition. METHODS A total of 104 STL (stereolithography) models of the maxillary and mandibular arches exported from My iTero® platform were retrospectively selected, in which T0 and T1 were the initial and refinement periods, respectively (n=26 per group). The X, Y, and Z coordinates associated with a single point in each arch were inserted into the models with SlicerCMF® software for model orientation. The arch models with UCS registration were transferred to Autodesk Inventor® for superimposition and to measure tooth movements performed during Invisalign® treatment. Arch expansion, intrusion and rotation were analyzed by two examiners. The statistics were performed using intraclass correlation coefficients (ICC), Dahlberg's formula, and t-test (p<0.05). RESULTS A reliable method of superimposing 3D digital models using a single UCS point in the maxilla and mandible was developed. ICC showed excellent intra- and inter-examiner correlation (ICC>0.90). A systematic error was not found concerning linear and angular measurements (<1mm and <1.5°, respectively). Digital dental movements could be analyzed, including arch expansion, dental intrusion, and tooth rotation. CONCLUSIONS The developed method was proven reliable and reproducible for superimposing 3D models of the maxillary and mandibular arches by using UCS system.
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Affiliation(s)
| | | | - João Pacheco Colares
- Federal University of Minas Gerais, Faculty of Dentistry, Department of Restorative Dentistry (Belo Horizonte/MG, Brazil)
| | - Tânia Mara de Souza Ianni
- Federal University of Minas Gerais, Faculty of Dentistry, Department of Restorative Dentistry (Belo Horizonte/MG, Brazil)
| | - Cláudia Silami de Magalhães
- Federal University of Minas Gerais, Faculty of Dentistry, Department of Restorative Dentistry (Belo Horizonte/MG, Brazil)
| | - José Alejandro Guerrero-Vargas
- Federal University of Minas Gerais, Faculty of Dentistry, Department of Restorative Dentistry (Belo Horizonte/MG, Brazil)
- Universidad ECCI, Faculty of Engineering, Department of Mechanical Engineering (Bogotá, Colombia)
| | | | - Soraia Macari
- Federal University of Minas Gerais, Faculty of Dentistry, Department of Restorative Dentistry (Belo Horizonte/MG, Brazil)
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12
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Anchling L, Hutin N, Huang Y, Barone S, Roberts S, Miranda F, Gurgel M, Al Turkestani N, Tinawi S, Bianchi J, Yatabe M, Ruellas A, Prieto JC, Cevidanes L. Automated Orientation and Registration of Cone-Beam Computed Tomography Scans. CLINICAL IMAGE-BASED PROCEDURES, FAIRNESS OF AI IN MEDICAL IMAGING, AND ETHICAL AND PHILOSOPHICAL ISSUES IN MEDICAL IMAGING : 12TH INTERNATIONAL WORKSHOP, CLIP 2023 1ST INTERNATIONAL WORKSHOP, FAIMI 2023 AND 2ND INTERNATIONAL WORKSHOP, ... 2023; 14242:43-58. [PMID: 38770027 PMCID: PMC11104011 DOI: 10.1007/978-3-031-45249-9_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Automated clinical decision support systems rely on accurate analysis of three-dimensional (3D) medical and dental images to assist clinicians in diagnosis, treatment planning, intervention, and assessment of growth and treatment effects. However, analyzing longitudinal 3D images requires standardized orientation and registration, which can be laborious and error-prone tasks dependent on structures of reference for registration. This paper proposes two novel tools to automatically perform the orientation and registration of 3D Cone-Beam Computed Tomography (CBCT) scans with high accuracy (<3° and <2mm of angular and linear errors when compared to expert clinicians). These tools have undergone rigorous testing, and are currently being evaluated by clinicians who utilize the 3D Slicer open-source platform. Our work aims to reduce the sources of error in the 3D medical image analysis workflow by automating these operations. These methods combine conventional image processing approaches and Artificial Intelligence (AI) based models trained and tested on de-identified CBCT volumetric images. Our results showed robust performance for standardized and reproducible image orientation and registration that provide a more complete understanding of individual patient facial growth and response to orthopedic treatment in less than 5 min.
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Affiliation(s)
- Luc Anchling
- University of Michigan, Ann Arbor, MI, USA
- CPE Lyon, Lyon, France
| | - Nathan Hutin
- University of Michigan, Ann Arbor, MI, USA
- CPE Lyon, Lyon, France
| | | | - Selene Barone
- University of Michigan, Ann Arbor, MI, USA
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sophie Roberts
- Department of Orthodontics, University of Melbourne, Melbourne, Australia
| | - Felicia Miranda
- University of Michigan, Ann Arbor, MI, USA
- Bauru Dental School, University of Sao Paulo, Bauru, SP, Brazil
| | | | - Najla Al Turkestani
- University of Michigan, Ann Arbor, MI, USA
- King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Jonas Bianchi
- University of Michigan, Ann Arbor, MI, USA
- University of the Pacific, San Francisco, USA
| | | | - Antonio Ruellas
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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13
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Miranda F, Choudhari V, Barone S, Anchling L, Hutin N, Gurgel M, Al Turkestani N, Yatabe M, Bianchi J, Aliaga-Del Castillo A, Zupelari-Gonçalves P, Edwards S, Garib D, Cevidanes L, Prieto J. Interpretable artificial intelligence for classification of alveolar bone defect in patients with cleft lip and palate. Sci Rep 2023; 13:15861. [PMID: 37740091 PMCID: PMC10516946 DOI: 10.1038/s41598-023-43125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023] Open
Abstract
Cleft lip and/or palate (CLP) is the most common congenital craniofacial anomaly and requires bone grafting of the alveolar cleft. This study aimed to develop a novel classification algorithm to assess the severity of alveolar bone defects in patients with CLP using three-dimensional (3D) surface models and to demonstrate through an interpretable artificial intelligence (AI)-based algorithm the decisions provided by the classifier. Cone-beam computed tomography scans of 194 patients with CLP were used to train and test the performance of an automatic classification of the severity of alveolar bone defect. The shape, height, and width of the alveolar bone defect were assessed in automatically segmented maxillary 3D surface models to determine the ground truth classification index of its severity. The novel classifier algorithm renders the 3D surface models from different viewpoints and captures 2D image snapshots fed into a 2D Convolutional Neural Network. An interpretable AI algorithm was developed that uses features from each view and aggregated via Attention Layers to explain the classification. The precision, recall and F-1 score were 0.823, 0.816, and 0.817, respectively, with agreement ranging from 97.4 to 100% on the severity index within 1 group difference. The new classifier and interpretable AI algorithm presented satisfactory accuracy to classify the severity of alveolar bone defect morphology using 3D surface models of patients with CLP and graphically displaying the features that were considered during the deep learning model's classification decision.
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Affiliation(s)
- Felicia Miranda
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil.
| | - Vishakha Choudhari
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Selene Barone
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Health Science, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Luc Anchling
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- CPE Lyon, Lyon, France
| | - Nathan Hutin
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- CPE Lyon, Lyon, France
| | - Marcela Gurgel
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
| | - Aron Aliaga-Del Castillo
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Paulo Zupelari-Gonçalves
- Department of Oral and Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Sean Edwards
- Department of Oral and Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
- Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Juan Prieto
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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14
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Gurgel M, Cevidanes L, Costa F, Pereira R, Cunali P, Bittencourt L, Ruellas A, Gonçalves J, Bianchi J, Chaves C. Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway. BMC Oral Health 2023; 23:436. [PMID: 37391785 PMCID: PMC10314553 DOI: 10.1186/s12903-023-03125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA. METHODS The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation. RESULTS Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region. CONCLUSIONS The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil.
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joao Gonçalves
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Cauby Chaves
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
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15
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Ertty E, Méndez-Manjón I, Haas OL, Hernández-Alfaro F, Meloti F. Definition of New Three-Dimensional Cephalometric Analysis of Maxillomandibular Sagittal Relationship for Orthodontics and Orthognathic Surgery: Normative Data Based on 700 CBCT Scans. J Craniofac Surg 2023; 34:1291-1295. [PMID: 36922378 DOI: 10.1097/scs.0000000000009267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/05/2022] [Indexed: 03/18/2023] Open
Abstract
The objective of the study was to define the norm of new 3-dimensional cephalometric analysis of maxillomandibular sagittal relationship with the patient in Natural Head Position. A cross-sectional study was performed using 700 consecutives cone beam computed tomography datasets of pre-orthodontic patients received for three-dimensional craniofacial analysis. To stablish the clinical norm of the new sagittal reference (linear distance A-B), the correlation with the gold standard (ANB angle) was estimated with the Pearson's correlation coefficient. Subsequently, the prognostic values of the linear distance A-B was calculated to define the clinical norm. The sample was composed by 463 women (66.1%) and 237 men (33.9%). The mean age was 30 ± 14,5 years old (range 6-71 y old). According to the skeletal class classification (ANB), 46.1% (323) were class I, 42% (294) class II, and 11.9% (83) class III. The regression model found that each additional grade of the ANB angle imply a mean increase of 1.24 mm of the distance A-B ( P <0.001). The normative value of the linear distance A-B was obtained through the prognostic values of the distance for the limits of the ANB norm 0 to 4. These values were on the range of 0.52 to 5.48 mm. Therefore, the clinical norm for cephalometric maxillomandibular sagittal relationship using linear distance from point A-B is: 3±2.48 mm. With this new approach, we can define the skeletal sagittal relationship of the patient in natural head position overcoming the limitations of using intracranial or occlusal plane references improving the diagnosis and orthognathic surgical planning process.
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Affiliation(s)
- Ertty Ertty
- Department of Orthodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP)
- Ertty Ortodontia, Ertty Ortodontia, Brasília. Distrito Federal (DF), Brazil
| | - Irene Méndez-Manjón
- Ertty Ortodontia, Ertty Ortodontia, Brasília. Distrito Federal (DF), Brazil
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Orion Luiz Haas
- Department of Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Federico Hernández-Alfaro
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
- Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain
| | - Fernanda Meloti
- Department of Orthodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP)
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16
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Trevisiol L, Bersani M, Martinez Garza A, Alvarado E, Arnett GW, D'Agostino A. Accuracy of virtual surgical planning in bimaxillary orthognathic surgery with mandible first sequence: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00093-8. [PMID: 37355372 DOI: 10.1016/j.jcms.2023.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to verify treatment accuracy using virtual surgical planning (VSP) with a mandible-first sequence and strict surgical protocol to determine what surgical and methodological factors might influence outcomes. VSP transfer accuracy was evaluated retrospectively through a modified method involving voxel-based superimposition in patients who had undergone bimaxillary surgery with a mandible-first sequence to correct dentoskeletal deformities. Data analysis showed that the movements planned and those executed were substantially equivalent (p < 0.01), with the exception of mandibular and maxillary sagittal movements that were 0.72 ± 0.90 mm and 1.41 ± 1.04 mm smaller, respectively, than planned. This study showed that a mandible-first sequence is accurate for transferring virtual surgical planning intraoperatively. There are several factors involved in the proper transfer of virtual planning beyond the software, such as surgical technique and sequencing. Inaccurate sagittal movements and maxillary repositioning seem to depend mainly on surgical factors.
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Affiliation(s)
- Lorenzo Trevisiol
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Massimo Bersani
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
| | | | | | | | - Antonio D'Agostino
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
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17
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Bazzani M, Cevidanes LHS, Al Turkestani NN, Annarumma F, McMullen C, Ruellas ACO, Massaro C, Rego MVNN, Yatabe MS, Kim-Berman H, McNamara JA, Franchi L, Ngan P, He H, Angelieri F, Aghazada H, Migliorati M. Three-dimensional comparison of bone-borne and tooth-bone-borne maxillary expansion in young adults with maxillary skeletal deficiency. Orthod Craniofac Res 2023; 26:151-162. [PMID: 35737876 PMCID: PMC10257795 DOI: 10.1111/ocr.12595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the transverse dental and skeletal changes in patients treated with bone-anchored palatal expander (bone-borne, BB) compared to patients treated with tooth and bone-anchored palatal expanders (tooth-bone-borne, TBB) using cone-beam computer tomography (CBCT) and 3D image analysis. METHODS The sample comprised 30 patients with transverse maxillary discrepancy treated with two different types of appliances: bone-borne (Group BB) and tooth-bone-borne (Group TBB) expanders. CBCT scans were acquired before (T1) and after completion of maxillary expansion (T2); the interval was 5.4 ± 3.4 and 6.2 ± 2.1 months between the T1 and the T2 scans of Group TBB (tooth-bone-borne) and Group BB (bone-borne), respectively. Transverse, anteroposterior and vertical linear and angular three-dimensional dentoskeletal changes were assessed after cranial base superimposition. RESULTS Both groups displayed marked transverse skeletal expansion with a greater ratio of skeletal to dental changes. Greater changes at the nasal cavity, zygoma and orbital levels were found in Group BB. A relatively parallel sutural opening in an anterior-posterior direction was observed in Group TBB; however, the Group BB presented a somewhat triangular (V-shaped) opening of the suture that was wider anteriorly. Small downward-forward displacements were observed in both groups. Asymmetric expansion occurred in approximately 50% of the patients in both groups. CONCLUSION Greater skeletal vs dental expansion ratio and expansion of the circummaxillary regions were found in Group BB, the group in which a bone-borne expander was used. Both groups presented skeletal and dental changes, with a similar amount of posterior palate expansion. Asymmetric expansion was observed in both groups.
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Affiliation(s)
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Craig McMullen
- Private Practice of Orthodontics, Brighton, Michigan, USA
| | - Antonio C O Ruellas
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Marcus V N N Rego
- Department of Orthodontics, Centero Universitário Uninovafapi, Teresina, Brazil
| | - Marilia S Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, West Virginia, USA
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fernanda Angelieri
- Department of Orthodontics, Methodist University of São Paulo, São Paulo, Brazil
| | | | - Marco Migliorati
- Department of Orthodontics, Genoa University School of Dentistry, Genoa, Italy
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Gurgel ML, de Oliveira Ruellas AC, Bianchi J, McNamara JA, Tai S, Franchi L, Deleat-Besson R, Le C, Logan C, Turkestani NA, Massaro C, Del Castillo AA, Arruda KEM, Benavides E, Yatabe M, Cevidanes L. Clear aligner mandibular advancement in growing patients with Class II malocclusion. AJO-DO CLINICAL COMPANION 2023; 3:93-109. [PMID: 37636594 PMCID: PMC10454533 DOI: 10.1016/j.xaor.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Treatment effects occurring during Class II malocclusion treatment with the clear aligner mandibular advancement protocol were evaluated in two growing patients: one male (12 years, 3 months) and one female (11 years, 9 months). Both patients presented with full cusp Class II molar and canine relationships. Intraoral scans and cone-beam computed tomography were acquired before treatment and after mandibular advancement. Three-dimensional skeletal and dental long-axis changes were quantified, in which the dental long axis was determined by registering the dental crowns obtained from intraoral scans to the root canals in cone-beam computed tomography scans obtained at the same time points. Class II correction was achieved by a combination of mandibular skeletal and dental changes. A similar direction of skeletal and dental changes was observed in both patients, with downward and forward displacement of the mandible resulting from the growth of the mandibular condyle and ramus. Dental changes in both patients included mesialization of the mandibular posterior teeth with flaring of mandibular anterior teeth. In these two patients, clear aligner mandibular advancement was an effective treatment modality for Class II malocclusion correction with skeletal and dental effects and facial profile improvement.
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Affiliation(s)
- Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - James A. McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Sandra Tai
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, School of Dentistry, University of Florence, Florence, Tuscany, Italy
| | - Romain Deleat-Besson
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Celia Le
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Candice Logan
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Camila Massaro
- Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Aron Aliaga Del Castillo
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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Gurgel ML, Junior CC, Cevidanes LHS, de Barros Silva PG, Carvalho FSR, Kurita LM, Cunha TCA, Dal Fabbro C, Costa FWG. Methodological parameters for upper airway assessment by cone-beam computed tomography in adults with obstructive sleep apnea: a systematic review of the literature and meta-analysis. Sleep Breath 2023; 27:1-30. [PMID: 35190957 PMCID: PMC9392812 DOI: 10.1007/s11325-022-02582-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND A reliable method for analyzing the upper airway (UA) remains a challenge. This study aimed to report the methods for UA assessment using cone-beam computed tomography (CBCT) in adults with obstructive sleep apnea (OSA). METHODS We performed a systematic review (PROSPERO #CRD42021237490 and PRISMA checklist) that applied a search strategy to seven databases and grey literature. RESULTS In 29 studies with moderate-to-high risk of bias, investigators mostly reported the body position during CBCT (upright or supine) and hard tissue references, diverging in UA delimitation and terminologies. The meta-analysis showed two subgroups (upright and supine), and no statistical differences were identified (p = 0.18) considering the UA area. The volume in the OSA group was smaller than that in the control group (p < 0.003 and Cohen's d = - 0.81) in the upright position. Patients with OSA showed smaller anteroposterior dimensions than the control group and were not affected by the position during image acquisition (p = 0.02; Cohen's d = - 0.52). The lateral measurements were also lower in the OSA group (supine) (p = 0.002; Cohen's d = - 0.6). CONCLUSIONS Patients with OSA showed smaller UA measurements in the upright (volume) and supine (lateral dimension) positions. The anteroposterior dimension was also reduced in patients with OSA compared to the control group, regardless of the position during CBCT acquisition.
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Affiliation(s)
- Marcela Lima Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | - Cauby Chaves Junior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil.
| | | | | | | | - Lúcio Mitsuo Kurita
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | | | - Cibele Dal Fabbro
- Faculty of Dental Medicine, Center for Advance Research in Sleep Medicine & Stomatology, Universite de Montreal & CIUSSS Nord Ile de Montreal, CHUM, Montreal, QC, Canada
| | - Fabio Wildson Gurgel Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
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20
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Mangal U, Lee SM, Lee S, Cha JY, Lee KJ, Yu HS, Jung H, Choi SH. Reorientation methodology for reproducible head posture in serial cone beam computed tomography images. Sci Rep 2023; 13:3220. [PMID: 36828940 PMCID: PMC9958024 DOI: 10.1038/s41598-023-30430-4] [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: 12/13/2022] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
Low dose and accessibility have increased the application of cone beam computed tomography (CBCT). Often serial images are captured for patients to diagnose and plan treatment in the craniofacial region. However, CBCT images are highly variable and lack harmonious reproduction, especially in the head's orientation. Though user-defined orientation methods have been suggested, the reproducibility remains controversial. Here, we propose a landmark-free reorientation methodology based on principal component analysis (PCA) for harmonious orientation of serially captured CBCTs. We analyzed three serial CBCT scans collected for 29 individuals who underwent orthognathic surgery. We first defined a region of interest with the proposed protocol by combining 2D rendering and 3D convex hull method, and identified an intermediary arrangement point. PCA identified the y-axis (anterioposterior) followed by the secondary x-axis (transverse). Finally, by defining the perpendicular z-axis, a new global orientation was assigned. The goodness of alignment (Hausdorff distance) showed a marked improvement (> 50%). Furthermore, we clustered cases based on clinical asymmetry and validated that the protocol was unaffected by the severity of the skeletal deformity. Therefore, it could be suggested that integrating the proposed algorithm as the preliminary step in CBCT evaluation will address a fundamental step towards harmonizing the craniofacial imaging records.
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Affiliation(s)
- Utkarsh Mangal
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | | | - Seeyoon Lee
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | - Jung-Yul Cha
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | - Kee-Joon Lee
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | - Hyung-Seog Yu
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | | | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722, Korea.
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21
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CASAGRANDE CPM, CASAGRANDE MVS, TEIXEIRA AODB, ALENCAR DS, DIAS BSDB, ALMEIDA RCC, QUINTÃO CA, CARVALHO FAR. Cartesian three-dimensional method to quantify displacements between cone beam computed tomography models. Dental Press J Orthod 2023; 27:e222199. [PMID: 36629628 PMCID: PMC9829105 DOI: 10.1590/2177-6709.27.5.e222199.oar] [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: 07/10/2020] [Accepted: 11/24/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Research in Orthodontics and Oral Surgery has been relying on three-dimensional (3D) models to evaluate treatment results with displacement color map techniques, even though it has important limitations. OBJECTIVES This study proposed a method of tracking translational movements of 3D objects to evaluate displacements in surfaces with no shape modification. METHODS Cone Beam Computed Tomography (CBCT) data of ten patients were imported to the Dolphin software. A hypothetical virtual surgical plan (randomly defined) was developed in the software and afterwards verified using the proposed method. All the procedures were carried out by two evaluators, in two different time-points, with a 15-day interval. ITK-Snap software was used to generate high quality STL models. Centroid points were automatically generated and their coordinates were compared to confirm if they represented the known displacements simulated. The paired t-test and the Bland-Altman plots were used, as well as the intraclass correlation coefficient. RESULTS Interexaminers and intra-examiner tests showed excellent reliability of the method, with mean displacement measurement error values under 0.1mm. The paired t-test did not show any statistically significant differences. CONCLUSION The method showed excellent reliability to track the simulated translational displacements of bone segments.
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Affiliation(s)
| | | | | | - David Silveira ALENCAR
- Universidade do Estado do Rio de Janeiro, Faculdade de Odontologia (Rio de Janeiro/RJ, Brazil).
| | | | | | - Cátia Abdo QUINTÃO
- Universidade do Estado do Rio de Janeiro, Faculdade de Odontologia (Rio de Janeiro/RJ, Brazil).
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Sheeran S, Hartsfield J, Omami G, Bazina M. Comparison of two 3-dimensional user-friendly voxel-based maxillary and 2-dimensional superimposition methods. Am J Orthod Dentofacial Orthop 2023; 163:117-125. [PMID: 36549828 DOI: 10.1016/j.ajodo.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/01/2022] [Accepted: 10/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cephalometric superimpositions have many uses in orthodontics, including growth evaluation and outcome assessment. However, 2-dimensional (2D) cephalograms can be distorted and yield incomplete 2D data. Cone-beam computed tomography (CBCT) imaging provides a 3-dimensional (3D), undistorted, and more complete patient analysis. CBCT imaging provides many unique advantages to the orthodontic practice and can influence how treatment outcomes are assessed. This study aimed to investigate the validity of 3D maxillary voxel-based superimpositions compared with the 2D method recommended by the American Board of Orthodontists. METHODS This retrospective study included pretreatment and posttreatment CBCT images of 30 adolescent patients. The images were superimposed using the 3D voxel-based tools in Dolphin Imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif). Two different 3D anatomic registration areas (3DA-3DB) were tested for the validity and reproducibility of the 3D maxillary superimpositions as compared with the 2D method. Linear and angular measurements were used to evaluate the dental changes of the maxillary right central incisor and first molar. Data distribution was normal by the Shapiro-Wilk W test. A mixed model analysis of variance test was done to compare the 3 superimposition types within each subject, followed by pairwise Tukey-Kramer comparisons when indicated. RESULTS After applying the Benjamini-Hochberg procedure to control the false discovery rate at 0.05 with multiple testing, the U1 vertical difference was statistically significant (P <0.0001) for the superimposition method, though the mean differences were clinically nonsignificant (0.52 mm, 0.76 mm). The U1 angular and U6 vertical differences were not statistically significant for the superimposition method (P = 0.3636 and P = 0.1863, respectively). CONCLUSIONS The 3D voxel-based maxillary superimpositions showed similar results to conventional 2D superimpositions recommended by the American Board of Orthodontists.
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Affiliation(s)
- Shelby Sheeran
- Division of Orthodontics, College of Dentistry, University of Kentucky, Lexington, Ky
| | - James Hartsfield
- Division of Orthodontics, College of Dentistry, University of Kentucky, Lexington, Ky
| | - Galal Omami
- Division of Oral Medicine, College of Dentistry, University of Kentucky, Lexington, Ky
| | - Mohamed Bazina
- Division of Orthodontics, College of Dentistry, University of Kentucky, Lexington, Ky.
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Gulcek BN, Ozbilen EO, Biren S. Changes in the condylar head after orthognathic surgery in Class III patients: a retrospective three-dimensional study. Angle Orthod 2022; 93:488611. [PMID: 36409284 PMCID: PMC9933558 DOI: 10.2319/052922-394.1] [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: 05/01/2022] [Accepted: 10/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the axial and dimensional changes of the condylar head after orthognathic surgery, including Le Fort I and bilateral sagittal split ramus osteotomies, and to assess condylar remodeling through three-dimensional (3D) surface superimposition. MATERIALS AND METHODS Twenty-four patients (15 females, 9 males; mean age: 32.22 ± 6.92 years) with skeletal Class III deformity were included in the study. Cone-beam computed tomography data obtained in the preoperative (T0) and postoperative (T1) periods were examined using Mimics and 3-Matic software. The height, depth, and width of the condylar head and its angular changes were measured. The volumes of the 3D reconstructed models were calculated, and remodeling amounts were evaluated through regional surface superimposition. Statistical significance was set at P < .05. RESULTS Following the surgery, there was a significant decrease in the size of condyles (P < .05). An inward rotation of the condyles was found in the axial plane (T0: 79.60 ± 6.01°, T1: 76.6 ± 6.48°, P < .05). The maximum resorption, maximum apposition, mean remodeling, and mean absolute remodeling were -2.63 ± 1.23 mm, 1.15 ± 0.4 mm, -0.30 ± 0.34 mm, and 0.73 ± 0.43 mm, respectively. No correlation was found between the angular changes and remodeling parameters or linear and volumetric changes of the condylar head (P > .05). CONCLUSIONS Condyles undergo a remodeling process with a resorptive character following orthognathic surgery, without clinically significant effects in the present study.
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24
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A Novel Method to Combine Maxilla-Based Coordinate System and Mandibular Voxel-Based Superimposition with Cone-Bean Computed Tomography. J Clin Med 2022; 11:jcm11175229. [PMID: 36079159 PMCID: PMC9456660 DOI: 10.3390/jcm11175229] [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: 08/05/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The objective of this study was to propose a method that combines a maxilla-based coordinate system and mandibular voxel-based superimposition for an accurate evaluation of mandibular structural and positional changes and a direct comparison between maxillary and mandibular structural changes with the same 3D vectors. Methods: Mandibular voxel-based superimposition was firstly performed to reorient the mandibles and eliminate the mandibular positional changes. Then, a maxilla-based coordinate system was constructed with four maxillary skeletal landmarks (ANS, PNS, OrL and OrR). After settling the reoriented mandibles into this coordinate system, the mandibular structural changes were accurately evaluated. To assess the accuracy and reproducibility of this method, CBCT images of a skull specimen before and after orthodontic treatment (which was simulated by rearranging the skull and the mandible) were collected. Five mandibular skeletal landmarks, three mandibular dental landmarks and two mandibular measurement planes of this skull were used to evaluate the linear and angular changes in the mandibular structures. Results: There were significant differences in the linear and angular measurements of the mandibular structures of the skull (p ˂ 0.05), which indicated mandibular positional changes after orthodontic treatment. After mandibular voxel-based superimposition, there were no significant differences in the linear and angular measurements of mandibular structures, which indicated that the mandibular positional changes were eliminated. The intraclass correlation coefficient (ICC) value of the inter- and intra-observer agreement of all measurements was 0.99. Conclusions: This method has proven advantages in terms of accuracy, reproducibility and validity; with this method, mandibular structural and positional changes can be accurately evaluated and maxillary and mandibular structural changes can be directly compared with same 3D vectors.
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Lee YH, Tsai CY, Wang LC, Lai UK, Lai JP, Lin SS, Chang YJ. Comparison of the Post-Surgical Position of the Temporomandibular Joint after Orthognathic Surgery in Skeletal Class III Patients and Patients with Cleft Lip and Palate. J Pers Med 2022; 12:jpm12091437. [PMID: 36143222 PMCID: PMC9506436 DOI: 10.3390/jpm12091437] [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: 08/17/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: The purpose of our research is to compare the post-surgical position of the temporomandibular joint in skeletal Class III patients and patients with cleft lip and palate treated with two-jaw orthognathic surgery using a three-dimensional computer tomography image. Materials and Methods: Twenty-three skeletal Class III patients with mandibular prognathism associated with maxillary retrognathism in group 1 and twenty cleft mid-face retrusion skeletal Class III patients in group 2 were enrolled in this study. All subjects were treated with two-jaw orthognathic surgery. Computed tomography scans were taken in all subjects at 3 weeks preoperatively and 6 months postoperatively. Three-dimensional craniofacial skeletal structures were build-up, and assessed the temporomandibular joint position changes before and after surgery. Results: Forty-three selected patients were separated into two groups. The mean age of patients was 22.39 ± 4.8 years in group 1 and 20.25 ± 3.8 years in group 2. The range of mean three-dimensional discrepancy of the selected condylar points was 0.95–1.23 mm in group 1 and 2.37–2.86 mm in group 2. The mean alteration of intercondylar angle was 2.33 ± 1.34° in group 1 and 6.30 ± 2.22° in group 2. The significant differences in the discrepancy of TMJ and changes in intercondylar angle were confirmed within the intra-group and between the two groups. Conclusions: Significant changes in postoperative TMJ position were present in both groups. Furthermore, the cleft group presented significantly more postoperative discrepancy of TMJ and more changes in intercondylar angle after surgery. This finding may be a reason leading to greater postoperative instability in cleft patients compared with skeletal Class III non-cleft patients. Clinical Trial Registration Number: IRB No: 202201108B0.
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Affiliation(s)
- Yi-Hao Lee
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chi-Yu Tsai
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ling-Chun Wang
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - U-Kei Lai
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Jui-Pin Lai
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Shiu-Shiung Lin
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Jen Chang
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Correspondence: ; Tel.: +886-7-7317123 (ext. 8291)
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Tinano MM, Becker HMG, Franco LP, dos Anjos CPG, Ramos VM, Nader CMFF, Godinho J, de Párcia Gontijo H, Souki BQ. Morphofunctional changes following adenotonsillectomy of obstructive sleep apnea children: a case series analysis. Prog Orthod 2022; 23:29. [PMID: 35934732 PMCID: PMC9357578 DOI: 10.1186/s40510-022-00422-7] [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: 02/15/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To perform a case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA).
Materials and methods
Retrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1).
Results
PASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients.
Conclusion
Pulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.
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Bates WR, Cevidanes LS, Larson BE, Adams D, De Oliveira Ruellas AC. Three-dimensional cone-beam computed technology evaluation of skeletal and dental changes in growing patients with Class II malocclusion treated with the cervical pull face-bow headgear appliance. Am J Orthod Dentofacial Orthop 2022; 162:491-501. [DOI: 10.1016/j.ajodo.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/01/2022]
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Santana LG, Cheib PL, de Pársia HG, Franchi L, Moro A, Souki BQ. Stability of fiducial cephalometric landmarks of growing Class II malocclusion patients: a three-dimensional retrospective study. Angle Orthod 2022; 92:482423. [PMID: 35653223 PMCID: PMC9374362 DOI: 10.2319/090721-692.1] [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: 09/01/2021] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate three-dimensionally (3D) the stability of Nasion (Na), Sella (S), Basion (Ba), Porion (Po), and Orbitale (Or) in different age groups of growing Class II malocclusion patients and, additionally, to assess rotational changes of the S-Na and Ba-Na lines and the Frankfurt Horizontal Plane (FHP). MATERIALS AND METHODS Cone-beam computed tomography studies of 67 Class II division 1 malocclusion patients, acquired at baseline (T0) and 1 year later (T1), were retrospectively assessed. Anterior cranial fossa was used for volumetric superimposition. Subjects were grouped according to their age at T0: group 1 (G1) (8-10 years), G2 (11-13 years), and G3 (14-17 years). Quantitative assessments of the 3D linear displacements (Euclidean distance) in the position of Na, S, Ba, Po, and Or were performed. Displacement in the X, Y, and Z projections and the rotation of S-Na, Na-Ba, and FHP were also quantified. RESULTS All cephalometric landmarks showed 3D displacement (P = .001) in the three age groups. Orbitale remained stable in the vertical and sagittal dimension from 8 to 17 years (P > .05). S-Na, Na-Ba, and the FHP showed statistically significant angular rotation (P < .05) in younger patients (G1), while in older individuals (G2 and G3) they were stable (P > .05). CONCLUSIONS Na, S, Ba, and Po showed vertical and sagittal positional changes relative to the anterior cranial fossa during the growth of Class II individuals. After age 11, S-Na, Na-Ba, and FHP did not show rotation and, thus, are valid parameters for angular cephalometric analysis in Class II growing patients.
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McMullen C, Al Turkestani NN, Ruellas ACO, Massaro C, Rego MVNN, Yatabe MS, Kim-Berman H, McNamara JA, Angelieri F, Franchi L, Ngan P, He H, Cevidanes LHS. Three-dimensional evaluation of skeletal and dental effects of treatment with maxillary skeletal expansion. Am J Orthod Dentofacial Orthop 2022; 161:666-678. [PMID: 34980520 PMCID: PMC9050833 DOI: 10.1016/j.ajodo.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The objective was to determine the skeletal and dental changes with microimplant assisted rapid palatal expansion (MARPE) appliances in growing (GR) and nongrowing (NG) patients using cone-beam computed tomography and 3-dimensional imaging analysis. METHODS The sample consisted of 25 patients with transverse maxillary discrepancy treated with a maxillary skeletal expander, a type of MARPE appliance. Cone-beam computed tomography scans were taken before and after maxillary expansion; the interval was 6.0 ± 4.3 months. The sample was divided into GR and NG groups using cervical vertebral and midpalatal suture maturation. Linear and angular 3-dimensional dentoskeletal changes were assessed after cranial base superimposition. Groups were compared with independent-samples t test (P <0.05). RESULTS Both groups displayed marked transverse changes with a similar ratio of skeletal to dental transverse changes and parallel sutural opening from the posterior nasal spine-anterior nasal spine; a similar amount of expansion occurred in the anterior and the posterior regions of the maxilla. The maxilla expanded skeletally without rotational displacements in both groups. The small downward-forward displacements were similar in both groups, except that the GR group had a significantly greater vertical displacement of the canines (GR, 1.7 ±1.0 mm; NG, 0.6 ± 0.8 mm; P = 0.02) and anterior nasal spine (GR, 1.1 ± 0.6 mm; NG, 0.5 ± 0.5 mm; P = 0.004). CONCLUSIONS Treatment of patients with MARPE appliance is effective in GR and NG patients. Although greater skeletal and dental changes were observed in GR patients, a similar ratio of skeletal to dental transverse changes was observed in both groups.
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Affiliation(s)
- Craig McMullen
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Antonio C O Ruellas
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Marcus V N N Rego
- Department of Orthodontics, Centero Universitário Uninovafapi, Teresina, Brazil
| | - Marilia S Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Fernanda Angelieri
- Department of Orthodontics, Methodist University of São Paulo, São Paulo, Brazil
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, W Va
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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Carvalho FSR, Soares ECS, de Medeiros JR, Júnior JMM, Hyppolito JOP, de Barros Silva PG, Ribeiro TR, Costa FWG. Surgically assisted maxillary expansion with or without pterygoid disjunction alters maxillomandibular positioning. Oral Maxillofac Surg 2022:10.1007/s10006-022-01062-1. [PMID: 35426586 DOI: 10.1007/s10006-022-01062-1] [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: 08/19/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to analyze alterations in mandibular positioning after surgically assisted maxillary expansion (SARME) with and without pterygoid disjunction (PD). METHODS Cone-beam computed tomography scans of 24 healthy individuals (18-45 years old) with transverse deficiency, superior to 5 mm, underwent SARME with or without PD. The aspects prospectively assessed were (1) alignment and position of the head (ITK-Snap and 3D Slicer software); (2) McNamara's and Steiner-Tweed-Wits' cephalometric analysis (Dolphin Imaging®); and (3) colorimetric evaluation based on 3D correspondence analysis (3D Slicer software). RESULTS A decrease in 1-NA and 1-SN angles as well as an increased occlusal plane in both groups was observed. Superior-inferior and anteroposterior spatial displacements of the chin were statistically significant in the PD group. Altered colorimetric patterns were also observed in the PD group. CONCLUSIONS This study found more evident tooth inclination in the group without PD; mandibular alterations were more evident in the PD group. Further studies with 3D analysis are strongly recommended for more comprehensive results.
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Affiliation(s)
| | - Eduardo Costa Studart Soares
- Department of Oral and Maxillofacial Surgery, Post-Graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - José Rômulo de Medeiros
- Post-Graduation Program in Dentistry, Federal University of Ceará. Department of Oral and Maxillofacial Surgery, University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | | | | | | | - Thyciana Rodrigues Ribeiro
- Department of Patients With Special Needs, Post-Graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Fábio Wildson Gurgel Costa
- Department of Oral and Maxillofacial Radiology, Post-Graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Romano F, Sverzut CE, Trivellato AE, Saraiva MCP, Nguyen TT. Surgically assisted rapid palatal expansion (SARPE): three-dimensional superimposition on cranial base. Clin Oral Investig 2022; 26:3885-3897. [PMID: 35013784 DOI: 10.1007/s00784-021-04355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 12/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate dental and skeletal changes caused by surgically assisted rapid palatal expansion (SARPE) using the superimposition of three-dimensional cone-beam computed tomography (CBCT) images on the cranial base. MATERIAL AND METHODS This is a retrospective quasi-experiment before-and-after study using a convenience sample. Twenty-four adult patients (13 male and 11 female) were evaluated before SARPE (T0), immediately after expansion (T1), and after 6 months of retention (T2). CBCT scans were superimposed on the anterior cranial base using voxel-based registration. Measurements from different reference points were used for comparisons between times. RESULTS At T1, all teeth had significant buccal tipping. At T2, most teeth remained in the same position as at T1, except the first premolar and the first molar, whose buccal roots moved slightly. The amount of bony expansion was 65 to 70% of the amount of tooth movement. The A point and maxillary incisors moved anteriorly from T0 to T1 and T2 (p < 0.0001). Inter-nasal distance had increased significantly at T1 (p < 0.0001) and remained stable at T2 (p = 0.478). No expansion was achieved at the zygomatic arch (p = 0.114). CONCLUSION SARPE promoted substantial buccal tipping of posterior teeth and some bone displacement; it also moved the maxilla and teeth forward and increased nasal width. CLINICAL RELEVANCE No other clinical studies have evaluated dental and skeletal changes caused by SARPE using superimposition of 3D CBCT images on the cranial base. This study findings may help clinical dentists plan treatments using safe and reliable information.
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Affiliation(s)
- Fábio Romano
- Department of Pediatric Dentistry, Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. .,Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.
| | - Cássio Edvard Sverzut
- Department of Oral & Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral & Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Maria Conceição Pereira Saraiva
- Department of Pediatric Dentistry, Epidemiology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Tung T Nguyen
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Gurgel M, Cevidanes L, Pereira R, Costa F, Ruellas A, Bianchi J, Cunali P, Bittencourt L, Chaves Junior C. Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes. Clin Oral Investig 2022; 26:875-887. [PMID: 34273012 PMCID: PMC8761785 DOI: 10.1007/s00784-021-04066-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes. MATERIALS AND METHODS Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied. RESULTS Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly. CONCLUSIONS The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment. CLINICAL RELEVANCE The craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America.,Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cauby Chaves Junior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
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Apostolopoulos K, Palomo JM, Rizzante FAP, Pugliese F. A 3D mirroring and colormap asymmetry study of Class II subdivision patients. Orthod Craniofac Res 2021; 25:429-436. [PMID: 34863033 DOI: 10.1111/ocr.12553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with Class II subdivision malocclusion present skeletal and dental asymmetries. The purpose of this study is to assess those asymmetries by 3D mirroring and colormap quantification. METHODS This study analyzed 50 initial CBCTs divided into two groups: Class I (control group) and Class II subdivision (study group) malocclusion patients. CBCTs were oriented and full skull was segmented generating a 3D model. The right side of the 3D models was mirrored, using a midsagittal plane as reference, resulting in a perfectly symmetric skull based on two right sides. Original and mirrored models were superimposed on the unchanged right half, and differences were quantified using a colormap. Eight regions of interest were assessed: gonion, mandibular front, maxillary front, zygomatic process, maxillary and mandibular canine and molar areas. RESULTS Statistically significant differences using the Mann-Whitney test were found in six of the eight evaluated areas when comparing the control to the study group. The maxillary skeletal areas did not show any difference between the groups. CONCLUSIONS Patients with Class II subdivision malocclusion show true skeletal and dental asymmetries when comparing right and left sides. The maxilla showed no significant skeletal asymmetry, but the maxillary teeth were positioned more mesially on the Class II side. The maxillary canine on the Class II side was also more bucally positioned. The mandible showed significant asymmetries with both skeletal and dental areas in the Class II side more distally and bucally positioned.
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Affiliation(s)
- Konstantinos Apostolopoulos
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Juan Martin Palomo
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fabio Antonio Piola Rizzante
- Department of Comprehensive Care, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fernando Pugliese
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Three-Dimensional Cephalometric Landmarking and Frankfort Horizontal Plane Construction: Reproducibility of Conventional and Novel Landmarks. J Clin Med 2021; 10:jcm10225303. [PMID: 34830583 PMCID: PMC8624462 DOI: 10.3390/jcm10225303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/21/2022] Open
Abstract
In some dentofacial deformity patients, especially patients undergoing surgical orthodontic treatments, Computed Tomography (CT) scans are useful to assess complex asymmetry or to plan orthognathic surgery. This assessment would be made easier for orthodontists and surgeons with a three-dimensional (3D) cephalometric analysis, which would require the localization of landmarks and the construction of reference planes. The objectives of this study were to assess manual landmarking repeatability and reproducibility (R&R) of a set of 3D landmarks and to evaluate R&R of vertical cephalometric measurements using two Frankfort Horizontal (FH) planes as references for horizontal 3D imaging reorientation. Thirty-three landmarks, divided into “conventional”, “foraminal” and “dental”, were manually located twice by three experienced operators on 20 randomly-selected CT scans of orthognathic surgery patients. R&R confidence intervals (CI) of each landmark in the -x, -y and -z directions were computed according to the ISO 5725 standard. These landmarks were then used to construct 2 FH planes: a conventional FH plane (orbitale left, porion right and left) and a newly proposed FH plane (midinternal acoustic foramen, orbitale right and left). R&R of vertical cephalometric measurements were computed using these 2 FH planes as horizontal references for CT reorientation. Landmarks showing a 95% CI of repeatability and/or reproducibility > 2 mm were found exclusively in the “conventional” landmarks group. Vertical measurements showed excellent R&R (95% CI < 1 mm) with either FH plane as horizontal reference. However, the 2 FH planes were not found to be parallel (absolute angular difference of 2.41°, SD 1.27°). Overall, “dental” and “foraminal” landmarks were more reliable than the “conventional” landmarks. Despite the poor reliability of the landmarks orbitale and porion, the construction of the conventional FH plane provided a reliable horizontal reference for 3D craniofacial CT scan reorientation.
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Pandey M, Gupta A. A systematic review of the automatic kidney segmentation methods in abdominal images. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Postsurgical Stability of Temporomandibular Joint of Skeletal Class III Patients Treated with 2-Jaw Orthognathic Surgery via Computer-Aided Three-Dimensional Simulation and Navigation in Orthognathic Surgery (CASNOS). BIOMED RESEARCH INTERNATIONAL 2021; 2021:1563551. [PMID: 34409098 PMCID: PMC8367535 DOI: 10.1155/2021/1563551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study is to clarify the postsurgical stability of temporomandibular joints in skeletal class III patients treated with 2-jaw orthognathic surgery which was performed utilizing computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS) protocol. Materials and Methods 23 consecutive nongrowing skeletal class III patients with mandibular prognathism associated with maxillary retrognathism treated with 2-jaw orthognathic surgery between 2018 and 2019 were enrolled in this study. The surgery was planned according to the standardized protocol of CASNOS (computer-aided three-dimensional simulation and navigation in orthognathic surgery). Computed tomography (CT) scans were performed in all patients 3 weeks presurgically and 6 months postsurgically. ITKSNAP and 3D Slicer software were used to reconstruct three-dimensional facial skeletal images, to carry out image segmentation, and to superimpose and quantify the TMJ position changes before and after surgery. Amount of displacement of the most medial and lateral points of the condyles and the change of intercondylar angles were measured to evaluate the postsurgical stability of TMJ. Results A total amount of 23 skeletal class III patients (female : male = 12 : 11) with age ranged from 20.3 to 33.5 years (mean: 24.39 ± 4.8 years old) underwent Le Fort I maxillary advancement and BSSO setback of the mandible. The surgical outcome revealed the satisfactory correction of their skeletal deformities. The mean displacement of the right most lateral condylar point (RL-RL′) was 1.04 ± 0.42 mm and the mean displacement of the left most lateral condylar point (LL-LL′) was 1.19 ± 0.41 mm. The mean displacement of the right most medial condylar point (RM-RM′) was 1.03 ± 0.39 mm and the left most medial condylar point (LM-LM′) was 0.96 ± 0.39 mm. The mean intercondylar angle was 161.61 ± 5.08° presurgically and 159.28 ± 4.92° postsurgically. Conclusion The postsurgical position of TM joint condyles in our study only presented a mild change with all the landmark displacement within a range of 1.2 mm. This indicates the bimaxillary orthognathic surgery via 3D CASNOS protocol can achieve a desired and stable result of TMJ position in treating skeletal class III adult patients with retrognathic maxilla and prognathic mandible.
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Gallagher AL, Ruellas ACDO, Benavides E, Soki FN, Aronovich S, Magraw CBL, Turvey T, Cevidanes L. Mandibular condylar remodeling characteristics after simultaneous condylectomy and orthognathic surgery. Am J Orthod Dentofacial Orthop 2021; 160:705-717. [PMID: 34353687 DOI: 10.1016/j.ajodo.2020.06.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objectives of this study were to evaluate postsurgical condylar remodeling using a radiographical interpretation, quantify condylar volumetric asymmetry, and assess soft tissue symmetry after simultaneous unilateral high condylectomy and bimaxillary osteotomies. METHODS Sixteen patients diagnosed with unilateral condylar hyperplasia underwent unilateral high condylectomy and orthognathic surgery to correct skeletal and facial asymmetries. Cone-beam computed tomography scans were acquired before and 1-year after surgery. A radiographic consensus was evaluated for signs of reparative or degenerative changes. The condyles were mirrored and registered for assessment of volumetric and morphologic asymmetry. Soft tissue symmetry was evaluated by measurement of the distance of soft tissue pogonion from the skeletal midsagittal plane. RESULTS Patients who undergo unilateral high condylectomy and orthognathic surgery present radiographic signs suggestive of degenerative changes, including sclerosis, osteophytes, flattening, and erosion in both the surgical and nonsurgical condyles (P ≤0.01). There was an average volumetric improvement of 531.9 ± 662.3 mm3 1-year postsurgery (P = 0.006). Soft tissue symmetry improved in all patients, with an average improvement of 65.8% (4.0 mm ± 2.6 mm, P ≤ 0.01). There was no correlation between the change in condylar volumetric asymmetry and the stability of the soft tissue correction. CONCLUSIONS High condylectomy for the correction of a skeletal asymmetry in patients with condylar hyperplasia successfully reduces the volumetric asymmetry between the condyles. Postsurgical dysmorphic remodeling and degenerative changes were noted in both the surgical and nonsurgical condyles. Despite remarkable changes and remaining joint asymmetry, the soft tissue correction is stable 1-year postsurgery.
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Affiliation(s)
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Erika Benavides
- University of Michigan School of Dentistry, Department of Periodontics and Oral Medicine, Ann Arbor, Mich
| | - Fabiana Naomi Soki
- University of Michigan School of Dentistry, Department of Periodontics and Oral Medicine, Ann Arbor, Mich
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan Health System, Ann Arbor, Mich
| | | | - Timothy Turvey
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich.
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Effect of vomer position following surgically assisted rapid palatal expansion. Oral Maxillofac Surg 2021; 26:113-121. [PMID: 33987751 DOI: 10.1007/s10006-021-00968-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effect of vomer position and prevalence of periodontal dehiscence in patients who underwent surgically assisted rapid palatal expansion (SARPE). The null hypotheses were the following: (1) vomer position in the coronal plane does not influence the degree of skeletal and dental expansion; and (2) there is no association between expansion, periodontal dehiscence and vomer position. METHODS Twenty-one patients were evaluated before treatment (T0) and immediately after SARPE expansion (T1). After SARPE, the vomer was in the right side in 11 patients and in the left in 10 patients. Skeletal and dental effects were evaluated using CBCT, landmarks and measurements. RESULTS The maxilla and the nasal cavity expanded asymmetrically. The side containing the vomer had less skeletal expansion but more dental tipping. Dehiscence increased significantly from T0 to T1 and was associated with the amount of skeletal displacement, especially when greater than 3.20 mm. In the first premolars region, there was more than 2 mm of asymmetric expansion observed in 38.5% of the patients. CONCLUSION The null hypotheses were rejected. The side containing the vomer had less skeletal expansion of the maxilla and nasal cavity but more dental tipping. Dehiscence increased after expansion, but there were no differences between sides.
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Parizotto JDOL, Peixoto AP, Borsato KT, Bianchi J, Vendramini Pittoli S, Tonello C, Gonçalves JR. Craniofacial and airway morphology of individuals with oculoauriculovertebral spectrum. Orthod Craniofac Res 2021; 24:575-584. [PMID: 33713375 DOI: 10.1111/ocr.12483] [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: 11/09/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study were to characterize the craniofacial and airway morphology of oculo-auriculo-vertebral spectrum (OAVS) individuals using computed tomography (CT) examination. SETTING AND SAMPLE POPULATION This sample included individuals in the age range from 5 to 14 years, consisted of a group of 18 OAVS individuals (12 females and 6 males), Pruzansky-Kaban1 IIB and III and by a paired control group matched by age and sex for comparison of morphometric and airway variables. MATERIALS AND METHODS Through the CT examination, airway analysis was performed using Dolphin Imaging® Software, and seven morphometric measurements were performed to evaluate craniofacial morphology by Materialize Mimics® Software. To compare airway and morphometric variables, the control group was used. Student's t test and Mann-Whitney U test were performed to compare differences between the groups. RESULTS Statistically significant differences were showed between the control and OAVS groups for the variables: total airway (TA) area, volume and MAA, RP area, RP volume, RP MAA, RG volume, RG MAA, total posterior height diff, Md incl and y-axis asymmetry. Pearson and Spearman's correlation showed mostly moderate correlations between Mand Occlusal canting AS with TA area and RP volume, Ax-Gn with TA area and Hy-C3 with TA volume. CONCLUSIONS The OAVS's airway was altered and worse than the control group. Our results suggest that the contralateral side of OAVS individuals is unaffected; however, longitudinal assessments are needed to confirm it. Hyoid bone and postural measures play an important role in interpreting airway features of individuals with and without OAVS.
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Affiliation(s)
| | - Adriano Porto Peixoto
- Department of Orthodontics, University of São Paulo (USP), Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil
| | - Karina Tostes Borsato
- Department of Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - Jonas Bianchi
- Department of Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil.,Department of Orthodontics Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, United States.,Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States
| | - Siulan Vendramini Pittoli
- Department of Clinical Genetics, University of São Paulo (USP), Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil
| | - Cristiano Tonello
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (USP), São Paulo, Brazil
| | - João Roberto Gonçalves
- Department of Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
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Apostolopoulos K, Bous RM, ElNaghy R, Kumar AR, Valiathan M. Examining the variability of bone and soft tissue morphology in Hemifacial Microsomia: A case series of 8 patients. J Craniomaxillofac Surg 2021; 49:352-357. [PMID: 33612409 DOI: 10.1016/j.jcms.2021.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/08/2020] [Accepted: 02/07/2021] [Indexed: 11/28/2022] Open
Abstract
AIM OF THE STUDY Patients with Hemifacial Microsomia (HFM) exhibit highly variable skeletal and soft tissue asymmetries. The purpose of this study was to evaluate soft tissue discrepancies in patients with HFM and correlate them to the skeletal discrepancy. Eight patients were selected and studied retrospectively using 3-dimensional (3D) superimposition and color mapping of the soft and hard tissues. The skeletal and soft tissue facial structures were segmented and mirrored, resulting in a perfectly symmetric skull and face. Original and mirrored 3D models were superimposed. Differences between the affected and normal side were assessed in seven areas: frontal, endocanthion, exocanthion, malar, maxillary frontal, mandibular frontal and gonion area. The correlations between the skeletal and soft tissue asymmetry were evaluated by Pearson correlations. Hard tissue asymmetry ranged from 1.4 mm (Endocanthion) to 5.5 mm (Gonion), while soft tissue asymmetry ranged from 1.5 mm (Endocanthion) to 5.6 mm (Malar). Correlation between skeletal and soft tissue deficiency were highly variable, with the highest correlation at gonion and the lowest at exocanthion. Bone and soft tissue hypoplasia were highly correlated at the gonion and the malar area, while the remaining evaluated areas demonstrated poor correlation between skeletal and soft tissue asymmetries. Future studies will determine if target treatment can reliably improve bone and soft tissue hypoplasia in this area.
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Affiliation(s)
- Konstantinos Apostolopoulos
- Department of Craniofacial and Special Care Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Rany M Bous
- Department of Craniofacial and Special Care Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Rahma ElNaghy
- Department of Orthodontics, School of Dentistry, University of Detroit Mercy, Detroit, MI, USA.
| | - Anand R Kumar
- Division of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Manish Valiathan
- Department of Craniofacial and Special Care Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Maxillary dentoskeletal outcomes of the expander with differential opening and the fan-type expander: a randomized controlled trial. Clin Oral Investig 2021; 25:5247-5256. [PMID: 33580351 DOI: 10.1007/s00784-021-03832-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/05/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to compare the maxillary dentoskeletal outcomes of the expander with differential opening (EDO) and the fan-type expander (FE). MATERIAL AND METHODS Forty-eight patients with maxillary arch constriction in the mixed dentition were randomly allocated into EDO and FE groups. Cone-beam computed tomography scans were acquired before and after expansion. Linear and angular three-dimensional changes were assessed after cranial base superimposition using the ITK-SNAP and the 3D Slicer software. T or Mann-Whitney U tests were used for intergroup comparisons (P<0.05). RESULTS The EDO group comprised 24 patients treated with the EDO (13 female, 11 male; 7.6 years). The FE group comprised 24 patients treated with the FE (14 female, 10 male; 7.8 years). Skeletal lateral displacements were greater in the EDO group with greater expansion in the orbital, nasal cavity, zygomatic bone, and palate regions (mean intergroup differences of 0.4, 0.8, 0.9, and 1.1 mm, respectively). Intercanine expansion and canine buccal inclination were greater in the FE group, while intermolar distance changes and molar buccal inclination were greater in the EDO group. Similar changes were observed for vertical and anteroposterior displacements and palatal plane rotation. CONCLUSIONS The EDO produced greater transverse skeletal expansion compared to the FE, with similar vertical and anteroposterior effects. Dental changes were greater in the molar region for patients treated with the EDO and in the canine region for patients treated with the FE. CLINICAL RELEVANCE The EDO and the FE are capable of producing skeletal changes in the mixed dentition. The decision between both expanders will depend on the amount of expansion required in the molar region and in the nasomaxillary complex. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov , under the identifier NCT03705871.
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Kim MJ, Liu Y, Oh SH, Ahn HW, Kim SH, Nelson G. Automatic Cephalometric Landmark Identification System Based on the Multi-Stage Convolutional Neural Networks with CBCT Combination Images. SENSORS (BASEL, SWITZERLAND) 2021; 21:E505. [PMID: 33445758 PMCID: PMC7828192 DOI: 10.3390/s21020505] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/08/2023]
Abstract
This study was designed to develop and verify a fully automated cephalometry landmark identification system, based on multi-stage convolutional neural networks (CNNs) architecture, using a combination dataset. In this research, we trained and tested multi-stage CNNs with 430 lateral and 430 MIP lateral cephalograms synthesized by cone-beam computed tomography (CBCT) to make a combination dataset. Fifteen landmarks were manually and respectively identified by experienced examiner, at the preprocessing phase. The intra-examiner reliability was high (ICC = 0.99) in manual identification. The results of prediction of the system for average mean radial error (MRE) and standard deviation (SD) were 1.03 mm and 1.29 mm, respectively. In conclusion, different types of image data might be the one of factors that affect the prediction accuracy of a fully-automated landmark identification system, based on multi-stage CNNs.
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Affiliation(s)
- Min-Jung Kim
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul 02447, Korea; (M.-J.K.); (H.-W.A.)
| | - Yi Liu
- Department of Orthodontics, Peking University School of Stomatology, Beijing 100081, China;
| | - Song Hee Oh
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Hyo-Won Ahn
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul 02447, Korea; (M.-J.K.); (H.-W.A.)
| | - Seong-Hun Kim
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul 02447, Korea; (M.-J.K.); (H.-W.A.)
| | - Gerald Nelson
- Division of Orthodontics, Department of Orofacial Science, University of California San Francisco, San Francisco, CA 94143, USA;
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Tonello C, Cevidanes LHS, Ruellas ACO, Alonso N. Midface Morphology and Growth in Syndromic Craniosynostosis Patients Following Frontofacial Monobloc Distraction. J Craniofac Surg 2020; 32:87-91. [PMID: 33136785 DOI: 10.1097/scs.0000000000006997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Facial advancement represents the essence of the surgical treatment of syndromic craniosynostosis. Frontofacial monobloc distraction is an effective surgical approach to correct midface retrusion although someone consider it very hazardous procedure. The authors evaluated a group of patients who underwent frontofacial monobloc distraction with the aim to identify the advancement results performed in immature skeletal regarding the midface morphologic characteristics and its effects on growth. METHODS Sixteen patients who underwent frontofacial monobloc distraction with pre- and postsurgical computed tomography (CT) scans were evaluated and compared to a control group of 9 nonsyndromic children with CT scans at 1-year intervals during craniofacial growth. Three-dimensional measurements and superimposition of the CT scans were used to evaluate midface morphologic features and longitudinal changes during the craniofacial growth and following the advancement. Presurgical growth was evaluated in 4 patients and postsurgical growth was evaluated in 9 patients. RESULTS Syndromic maxillary width and length were reduced and the most obtuse facial angles showed a lack in forward projection of the central portion in these patients. Three-dimensional distances and images superimposition demonstrated the age did not influence the course of abnormal midface growth. CONCLUSION The syndromic midface is hypoplastic and the sagittal deficiency is associated to axial facial concavity. The advancement performed in mixed dentition stages allowed the normalization of facial position comparable to nonsyndromic group. However, the procedure was not able to change the abnormal midface architecture and craniofacial growth.
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Affiliation(s)
- Cristiano Tonello
- Craniofacial Department, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Antonio C O Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI.,Federal University of Rio de Janeiro, Rio de Janeiro
| | - Nivaldo Alonso
- Department of Plastic Surgery, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Dot G, Rafflenbeul F, Salmon B. Voxel-based superimposition of Cone Beam CT scans for orthodontic and craniofacial follow-up: Overview and clinical implementation. Int Orthod 2020; 18:739-748. [PMID: 33011138 DOI: 10.1016/j.ortho.2020.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The increasing use of three-dimensional (3D) imaging in orthodontics has led to the development of 3D superimposition techniques. These techniques use stable anatomic structures as references in order to compare Cone Beam CT (CBCT) scans of the same subject at different time-points. Three methods have been described in the literature: landmark-based, surface-based and voxel-based 3D superimpositions. OBJECTIVE This article focuses on the voxel-based approach, which is the most described and the only one that can be fully automatized. The aim of this paper is to offer clinicians a practical tutorial on craniofacial voxel-based 3D superimposition. MATERIAL AND METHODS We provide an updated overview of the available implementation methods, describing their methodology, validations, main steps, advantages and drawbacks. The historical open-source method is the most widespread for research purposes, but takes around three hours to achieve for an experienced operator. Several commercially-available software perform superimpositions in a few minutes. RESULTS We used two of the available methods to conduct the superimposition process with three representative clinical cases in order to illustrate the different types of results that can be obtained. CONCLUSIONS Commercially-available software provide user-friendly and fully automatized superimposition methods, allowing clinicians to perform it easily and helping to reduce human error in image analysis. Still, quantitative evaluation of the results remains the main challenge of this technique.
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Affiliation(s)
- Gauthier Dot
- Université de Paris, Service d'Odontologie, AP-HP, Hopital Pitié-Salpétrière, 75013 Paris, France.
| | - Frédéric Rafflenbeul
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Département d'Orthopédie Dento-Faciale, 67000 Strasbourg, France
| | - Benjamin Salmon
- France laboratoire pathologie, imagerie et biothérapies orofaciales, EA2496, université Paris Descartes, UFR odontologie, 92120 Montrouge, France; Université Paris, Service de Médecine Buccodentaire, Hôpital Bretonneau, AP-HP, 75018 Paris, France
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Wei RY, Atresh A, Ruellas A, Cevidanes LHS, Nguyen T, Larson BE, Mangum JE, Manton DJ, Schneider PM. Three-dimensional condylar changes from Herbst appliance and multibracket treatment: A comparison with matched Class II elastics. Am J Orthod Dentofacial Orthop 2020; 158:505-517.e6. [PMID: 32828608 DOI: 10.1016/j.ajodo.2019.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/01/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to quantify and qualify the 3-dimensional (3D) condylar changes using mandibular 3D regional superimposition techniques in adolescent patients with Class II Division 1 malocclusions treated with either a 2-phase or single-phase approach. METHODS Twenty patients with Herbst appliances who met the inclusion criteria and had cone-beam computed tomography (CBCT) images taken before, 8 weeks after Herbst removal, and after the completion of multibracket appliance treatment constituted the Herbst group. They were compared with 11 subjects with Class II malocclusion who were treated with elastics and multibracket appliances and who had CBCT images taken before and after treatment. Three-dimensional models generated from the CBCT images were registered on the mandible using 3D voxel-based superimposition techniques and analyzed using semitransparent overlays and point-to-point measurements. RESULTS The magnitude of lateral condylar growth during the orthodontic phase (T2-T3) was greater than that during the orthopedic phase (T1-T2) for all condylar fiducials with the exception of the superior condyle (P <0.05). Conversely, posterior condylar growth was greater during the orthopedic phase than the subsequent orthodontic phase for all condylar fiducials (P <0.05). The magnitude of vertical condylar development was similar during both the orthopedic (T1-T2) and orthodontic phases (T2-T3) across all condylar fiducials (P <0.05). Posterior condylar growth during the orthodontic phase (T2-T3) of the 2-phase approach decreased for all condylar fiducials with the exception of the posterior condylar fiducial (P <0.05) when compared with the single-phase approach. CONCLUSIONS Two-phase treatment using a Herbst appliance accelerates condylar growth when compared with a single-phase regime with Class II elastics. Whereas the posterior condylar growth manifested primarily during the orthopedic phase, the vertical condylar gains occurred in equal magnitude throughout both phases of the 2-phase treatment regime.
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Affiliation(s)
- Robert Y Wei
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Arjun Atresh
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Tung Nguyen
- Department of Orthodontics, University of North Carolina, Chapel Hill, NC
| | - Brent E Larson
- Division of Orthodontics, University of Minnesota, Minneapolis, Minn
| | - Jonathan E Mangum
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia
| | - David J Manton
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Centrum voor Tandheelkunde en Mondzorgkunde UMCG, University of Groningen, Groningen, The Netherlands
| | - Paul M Schneider
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Rodríguez-Cárdenas YA, Arriola-Guillén LE, Ruíz-Mora GA, Aliaga-Del Castillo A, Boessio-Vizzotto M, Dias-Da Silveira HL. Root changes in buccal versus palatal maxillary impacted canines of adults: A longitudinal and retrospective 3-dimensional study before and after orthodontic traction. Int Orthod 2020; 18:490-502. [PMID: 32513608 DOI: 10.1016/j.ortho.2020.05.007] [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: 04/10/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Maxillary impacted canines (MIC) could suffer root changes after canine traction. The aim of this study was to evaluate the 3-dimensional root changes in buccal versus palatal MIC after orthodontic traction. MATERIALS AND METHODS This longitudinal and retrospective study included pre-treatment and after traction cone beam computed tomography scans (CBCTs) of 30 subjects with unilateral/bilateral MIC. A total of 43 MIC were divided into 2 groups: buccal (n=17) or palatal (n=26). Root changes in length and area after orthodontic traction were measured at sagittal, coronal and axial sections. Intergroup comparison was carried out by t or U Mann-Whitney tests, depending on normality. Multiple linear regression analysis was used to evaluate the influence of all predictor variables on root changes (P<0.05). RESULTS Significant difference between groups was found for root area changes in the upper limit of the cervical third at axial section that showed greater appositional values for the palatal impacted canine group (-1.18mm2) and resorptive values for the buccal impacted canine group (0.62mm2) (P=0.024). Position of impaction palatal influenced the increase of root area in the coronal section and in the upper limit of the cervical third at axial section. Age directly influenced the decrease of total length and root area in sagittal and coronal sections, respectively. CONCLUSION Orthodontic traction of MIC produced an important appositional root change in the palatal impaction group in the axial root area of the upper limit of the cervical third. Impaction position and age influenced the increase and decrease of root area and length of some specific radicular regions.
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Affiliation(s)
| | - Luis Ernesto Arriola-Guillén
- Division of Orthodontics and Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Peru.
| | - Gustavo Armando Ruíz-Mora
- Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Aron Aliaga-Del Castillo
- Department of Orthodontics. Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Mariana Boessio-Vizzotto
- Division of Oral Radiology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Heraldo Luis Dias-Da Silveira
- Division of Oral Radiology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Evangelista K, Valladares-Neto J, Garcia Silva MA, Soares Cevidanes LH, de Oliveira Ruellas AC. Three-dimensional assessment of mandibular asymmetry in skeletal Class I and unilateral crossbite malocclusion in 3 different age groups. Am J Orthod Dentofacial Orthop 2020; 158:209-220. [PMID: 32451206 DOI: 10.1016/j.ajodo.2019.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study aimed to evaluate the morphologic and positional features of the mandible in children, adolescents, and adults with skeletal Class I and unilateral posterior crossbite. METHODS The sample included cone-beam computerized tomography images of 76 subjects, divided in 3 groups: (1) children (aged 6.77 ± 1.5 years; n = 25), (2) adolescents (aged 14.3 ± 1.7 years; n = 26), and (3) adults (aged 32.66 ± 13.4 years; n = 25) with unilateral posterior crossbite. Condylar and mandibular linear distances and angles were performed using a mirrored 3-dimensional overlapped model. Intragroup asymmetries were determined by a comparison between crossbite and no crossbite sides. The differences between both sides of all measurements were compared among groups and correlated to mandibular horizontal rotation (yaw) and age. RESULTS The crossbite side showed shorter distances in the condyle and mandibular regions. Asymmetries were slightly but significantly greater in adults, as expressed by the lateromedial condylar distance, total ramus height, and mandibular length with an average 0.7 mm, 2.0 mm, and 1.5 mm, respectively. The mandibular yaw rotation was not correlated to age but moderately associated (r = 0.467) to asymmetry in mandibular length and total ramus height. CONCLUSIONS Patients with skeletal Class I and unilateral crossbite showed small mandibular asymmetries and these conditions were slightly greater in adults, specifically in lateromedial condylar distances and mandibular body and length.
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Affiliation(s)
- Karine Evangelista
- Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, Brazil.
| | - José Valladares-Neto
- Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Maria Alves Garcia Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | | | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Orthodontics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Chang YJ, Lai JP, Tsai CY, Wu TJ, Lin SS. Accuracy assessment of computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS). J Formos Med Assoc 2020; 119:701-711. [DOI: 10.1016/j.jfma.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/19/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022] Open
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Evangelista K, Ferrari-Piloni C, Barros LAN, Avelino MAG, Helena Soares Cevidanes L, Ruellas ACDO, Valladares-Neto J, Silva MAG. Three-dimensional assessment of craniofacial asymmetry in children with transverse maxillary deficiency after rapid maxillary expansion: A prospective study. Orthod Craniofac Res 2020; 23:300-312. [PMID: 32022986 DOI: 10.1111/ocr.12370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate craniofacial asymmetry in children with transverse maxillary deficiency, with or without functional unilateral posterior crossbite (UPC), before and after rapid maxillary expansion (RME). SETTING AND SAMPLE POPULATION A sample of 51 children with cone beam computed tomography scans obtained before RME (T1) and a year after RME (T2). MATERIAL AND METHODS This prospective study consisted of 2 groups: 25 children with functional UPC (6.77 ± 1.5 years) and 26 children without UPC (7.41 ± 1.31 years). Linear and angular measurements were obtained from zygomatic, maxilla, glenoid fossa and mandible, using original and mirrored 3D overlapped models. All right and left side comparisons in both groups and intergroups asymmetries were compared using MANOVA and t test for independent samples, respectively, statistically significant at P < .05. RESULTS The UPC group showed no side differences, but mandibular horizontal rotation at T1, and this asymmetry was improved in T2. The non-UPC group showed at baseline significant lateral asymmetry in orbitale, position of palatine foramen, respectively, in average 2.95 mm and 1.16 mm, and 0.49 mm of average asymmetry in condylar height. The glenoid fossa was symmetric in both groups at T1 and T2. CONCLUSIONS Children with transverse maxillary deficiency showed slight morphological asymmetry, located in the mandible position in cases of UPC, and in the orbital and maxillary regions in cases without UPC. One year after RME, patients improved their craniofacial asymmetry, with significant changes in the mandible and correction of the mandibular rotation in patients who presented UPC.
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Lee EH, Yu HS, Lee KJ, Han SS, Jung HD, Hwang CJ. Comparison of three midsagittal planes for three-dimensional cone beam computed tomography head reorientation. Korean J Orthod 2020; 50:3-12. [PMID: 32042715 PMCID: PMC6995832 DOI: 10.4041/kjod.2020.50.1.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022] Open
Abstract
Objective This study compared three prominent midsagittal planes (MSPs) to identify the MSP that best approximates the true symmetrical MSP. Methods Forty-three patients (mean age, 23.0 ± 8.20 years) were grouped as follows: group 1 consisted of 10 patients with skeletal Class I and a menton (Me) deviation of < 2 mm; group 2, 11 patients with skeletal Class III and a Me deviation < 2 mm; group 3, nine patients with skeletal Class III and a Me deviation of 2 to less than 4 mm; and group 4, 13 patients with skeletal Class III and an Me deviation ≥ 4 mm. The candidate MSPs were established by three-dimensional (3D) cone beam computed tomography (CBCT) reorientation methods (RMs): (1) the MSP perpendicular to the Frankfort horizontal (FH) plane while passing through the crista galli and basion; (2) the MSP including the nasion, incisive foramen, and basion; (3) the MSP including the nasion, anterior nasal spine, and posterior nasal spine. The mean absolute distances (MADs) to the MSPs were calculated from the coordinates of 1,548 points on 129 CBCT images. The differences in the values of the 3D coordinates among RMs were compared. Results The MADs of the three RMs showed significant differences (p < 0.05). Most of the differences in values of the coordinates were not significant among RMs. Conclusions Although the differences in distance among the three MSPs were minor, the MSP perpendicular to the FH plane while passing through the crista galli and basion best approximated the true symmetrical MSP.
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Affiliation(s)
- Eon-Hwa Lee
- Department of Orthodontics, Korea University Anam Hospital, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics and The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics and The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hwi-Dong Jung
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- Department of Orthodontics and The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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