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Grillo R, Borba AM, da Silva YS, Brozoski MA, Miloro M, Naclério-Homem MDG. Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:101-112. [PMID: 38155010 DOI: 10.1016/j.oooo.2023.07.018] [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: 05/02/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Alexandre Meireles Borba
- Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá-MT, Brazil
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
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Kazimierczak N, Kazimierczak W, Serafin Z, Nowicki P, Lemanowicz A, Nadolska K, Janiszewska-Olszowska J. Correlation Analysis of Nasal Septum Deviation and Results of AI-Driven Automated 3D Cephalometric Analysis. J Clin Med 2023; 12:6621. [PMID: 37892759 PMCID: PMC10607148 DOI: 10.3390/jcm12206621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The nasal septum is believed to play a crucial role in the development of the craniofacial skeleton. Nasal septum deviation (NSD) is a common condition, affecting 18-65% of individuals. This study aimed to assess the prevalence of NSD and its potential association with abnormalities detected through cephalometric analysis using artificial intelligence (AI) algorithms. The study included CT scans of 120 consecutive, post-traumatic patients aged 18-30. Cephalometric analysis was performed using an AI web-based software, CephX. The automatic analysis comprised all the available cephalometric analyses. NSD was assessed using two methods: maximum deviation from an ideal non-deviated septum and septal deviation angle (SDA). The concordance of repeated manual measurements and automatic analyses was assessed. Of the 120 cases, 90 met the inclusion criteria. The AI-based cephalometric analysis provided comprehensive reports with over 100 measurements. Only the hinge axis angle (HAA) and SDA showed significant (p = 0.039) negative correlations. The rest of the cephalometric analyses showed no correlation with the NSD indicators. The analysis of the agreement between repeated manual measurements and automatic analyses showed good-to-excellent concordance, except in the case of two angular measurements: LI-N-B and Pr-N-A. The CephX AI platform showed high repeatability in automatic cephalometric analyses, demonstrating the reliability of the AI model for most cephalometric analyses.
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Affiliation(s)
| | - Wojciech Kazimierczak
- Kazimierczak Private Dental Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland; (Z.S.)
| | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland; (Z.S.)
| | - Paweł Nowicki
- Kazimierczak Private Dental Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland
| | - Adam Lemanowicz
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland; (Z.S.)
| | - Katarzyna Nadolska
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland; (Z.S.)
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Stamm T, Kanemeier M, Dirksen D, Middelberg C, Hohoff A, Kleinheinz J, Schmid JQ. The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis. J Clin Med 2023; 12:jcm12103582. [PMID: 37240688 DOI: 10.3390/jcm12103582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle α between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and α=8∘, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and α=11∘, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and α=2∘, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters.
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Affiliation(s)
- Thomas Stamm
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Moritz Kanemeier
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Dieter Dirksen
- Department of Prosthetic Dentistry and Biomaterials, University of Münster, 48149 Münster, Germany
| | | | - Ariane Hohoff
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University of Münster, 48149 Münster, Germany
| | - Jonas Q Schmid
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
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Yang W, Chen Y, Li J, Jiang N. Assessment of condylar positional changes in severe skeletal class II malocclusion after surgical-orthodontic treatment. Clin Oral Investig 2023:10.1007/s00784-023-04984-6. [PMID: 37017754 DOI: 10.1007/s00784-023-04984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES This study aimed to determine the positional changes in the condyle in the temporomandibular joint (TMJ) of severe skeletal class II malocclusion patients treated with surgical-orthodontics. MATERIALS AND METHODS The measurements of TMJ space in 97 severe skeletal class II malocclusion patients (20 males, 77 females, mean age, 24.8 years, mean ANB = 7.41°) were assessed using limited cone-beam computed tomography (LCBCT) images acquired before orthodontics (T0) and 12 months after surgery (T1). 3D remodeling of the TMJ and measurements of the anterior space (AS), superior space (SS), and posterior space (PS) were performed to determine the position of the condyle for each joint. All data were analyzed by t test, correlation analysis, and Pearson correlation coefficient. RESULTS The mean AS, SS, and PS values after the therapy changed from 1.684 to 1.680 mm (0.24%), 3.086 to 2.748 mm (10.968%), and 2.873 to 2.155 mm (24.985%), respectively. The decreases in SS and PS were statistically significant. Positive correlations were found in the mean AS, SS, and PS values between the right and left sides. CONCLUSIONS The combination of orthodontic and surgical treatment makes the condyle move counterclockwise in the TMJ in severe skeletal class II patients. CLINICAL RELEVANCE Studies of temporomandibular joint (TMJ) intervals changes in patients with severe skeletal class II after sagittal split ramus osteotomy (SSRO) are limited. The postoperative joint remodeling, resorption, and related complications remain unstudied.
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Affiliation(s)
- Wen Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China, 14 Third Section, Renmin South Road, Chengdu, 610041, Republic of China
| | - Yanbin Chen
- Sichuan University, 14 Third Section, Renmin South Road, Chengdu, 610041, Republic of China
| | - Jiaxuan Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China, 14 Third Section, Renmin South Road, Chengdu, 610041, Republic of China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China, 14 Third Section, Renmin South Road, Chengdu, 610041, Republic of China.
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Togninalli D, Antonarakis GS, Schatz JP. Condylar resorption following mandibular advancement or bimaxillary osteotomies: A systematic review of systematic reviews. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e948-e955. [PMID: 35263683 DOI: 10.1016/j.jormas.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Several systematic reviews have been published on the effects of mandibular surgery on condylar remodeling without reaching a consensus. The purpose of this systematic review of systematic reviews was to assess the impact of mandibular advancement or bimaxillary surgeries on condylar resorption. A literature search, using several electronic databases, was carried out by two reviewers independently. Article preselection was based on titles and abstracts, and final article selection based on full-text analysis of preselected studies. After final study selection, the quality of studies was assessed using the AMSTAR 2 tool. A decision algorithm was subsequently established to choose the best body of evidence. From an initial yield of 1'848 articles, 23 systematic reviews were identified for further analysis, with ten studies being included in the final selection. Despite the generally low quality of the reviews, certain associations could be made: young patients, female patients, and those with a high mandibular plane angle are more prone to condylar resorption following mandibular advancement osteotomies, especially if anterior rotation of the mandible is performed during surgery. Patients undergoing bimaxillary surgery also appear to have a higher risk of developing condylar resorption. In conclusion, these results confirm the multi-factorial nature of condylar resorption, stressing the need for well-controlled prospective studies with long-term follow-up to clearly identify potential risk factors associated with orthognathic surgery.
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Affiliation(s)
- David Togninalli
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Gregory S Antonarakis
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Jean-Paul Schatz
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
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Melhem-Elias F, Reis BAQ, Afonso FAC, Barretto MDA, Deboni MCZ. An innovative universal protocol for orthognathic surgery three-dimensional virtual simulation. Int J Oral Maxillofac Surg 2022; 52:691-695. [PMID: 36115779 DOI: 10.1016/j.ijom.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
The aim of this technical note is to describe a protocol for three-dimensional virtual simulation of orthognathic surgery that has been designed to be easily implemented, without the need for any special clinical apparatus, software brand, or computed tomography sequence. The protocol comprises innovative concepts and simplified steps for image segmentation, creation of a composite skull, control of the condylar position, and sequencing of bimaxillary surgery. This protocol was applied by the developers in about 2000 cases performed between 2015 and 2022, and has become quite popular among local surgeons. Previous preliminary studies have shown that it meets the accuracy standards for clinical use, although further studies with larger numbers of patients are desirable for additional validation.
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Affiliation(s)
- F Melhem-Elias
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Private Practice in Oral and Maxillofacial Surgery, São Paulo-SP, Brazil.
| | - B A Q Reis
- Private Practice in Oral and Maxillofacial Surgery, São Paulo-SP, Brazil
| | - F A C Afonso
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
| | - M D A Barretto
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
| | - M C Z Deboni
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
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