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Kwon C. READER'S FORUM. Korean J Orthod 2024; 54:1-2. [PMID: 38268458 PMCID: PMC10811356 DOI: 10.4041/kjod54.0001rf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Affiliation(s)
- Changbeom Kwon
- Department of Orthodontics, Seoul National University Dental Hospital, Seoul, Korea
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Kim SS, Kim YI, Park SB, Kim SH. Three-dimensional evaluation of the pharyngeal airway space in patients with anterior open bite. Korean J Orthod 2023; 53:358-364. [PMID: 36718119 PMCID: PMC10663578 DOI: 10.4041/kjod22.187] [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: 08/26/2022] [Revised: 10/12/2022] [Accepted: 11/18/2022] [Indexed: 02/01/2023] Open
Abstract
Objective : This study aimed to three-dimensionally evaluate the pharyngeal airway space (PAS) of patients with anterior open bite (AOB) by using cone-beam computed tomography (CBCT) and compare the findings with those obtained in individuals with normal occlusion. Methods : The open bite group (OBG, n = 25) consisted of patients with an anterior overbite of -3 mm or less, while the control group (n = 25) consisted of age- and sex-matched individuals with an anterior overbite of 1-3 mm, Angle Class I malocclusion (1° ≤ point A-nasion-point B angle ≤ 4°), and a normodivergent profile (22° ≤ Frankfort mandibular plane angle ≤ 28°). After the CBCT data were reconstructed into a three-dimensional image, the PAS was segmented into four parts, and the volume of each part was measured. Pharyngeal airway length (PAL) and the area and transverse width of the part showing minimal constriction were also measured. Pearson's correlation analysis was used to evaluate the correlation between changes in the PAS and the amount of anterior overbite. Results : The OBG showed a significantly narrower airway space in the nasopharyngeal, hypopharyngeal, and total airway volumes. The OBG also showed a significantly smaller area and transverse width of the part with minimal constriction. The OBG showed a significantly longer PAL, but there was no correlation between the amount of anterior overbite and the changes in PAS. Conclusions : The PAS was associated with AOB. Patients with AOB had a narrower PAS and a smaller part showing minimal constriction.
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Affiliation(s)
- Seong-Sik Kim
- Department of Orthodontics, Dental Research Institute, and Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yong-Il Kim
- Department of Orthodontics, Dental Research Institute, and Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Soo-Byung Park
- Department of Orthodontics, Dental Research Institute, and Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sung-Hun Kim
- Department of Orthodontics, Dental Research Institute, and Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan, Korea
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Steegman RM, Renkema AM, Schoeman A, Kuijpers-Jagtman AM, Ren Y. Volumetric changes in the upper airway on CBCT after dentofacial orthopedic interventions - a systematic review. Clin Oral Investig 2023; 27:5737-5754. [PMID: 37723313 PMCID: PMC10560168 DOI: 10.1007/s00784-023-05207-8] [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: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To provide a critical overview of the effect of various orthodontic and/or dentofacial orthopedic interventions on three-dimensional volumetric changes in the upper airway. MATERIALS AND METHODS Four databases were searched for clinical studies concerning 3D volumetric assessments based on CBCT before and after orthodontics interventions. The quality of the studies was assessed using the quality assessment tool of the National Heart, Lung and Blood Institute. After the use of inclusion and exclusion criteria, the pre-and post-treatment volumes were used to visualize the effect of various orthodontics interventions. RESULTS A total of 48 studies were included in this review and none of which were RCTs. The quality of all included studies was assessed as medium. Overall, there is a tendency for an increase in airway volumes after various orthodontic interventions, except for studies concerning extraction therapy with fixed appliances in adults, in which both increases and decreases in airway volumes have been reported. CONCLUSION Orthodontic treatment by growth modification and non-extraction therapy with fixed appliances, regardless of the malocclusion, generally showed positive effects on the airway volume. Orthodontic treatment in combination with extractions does not provide an unambiguous insight. A consensus on the methodology of the airway measurement and nomenclature is urgently needed in order to gain insight into the effect of different interventions on three-dimensional airway changes. CLINICAL RELEVANCE Various orthodontic treatments do not negatively influence the upper airway volume. However, extraction therapy in adults should be chosen with caution, especially in subjects belonging to a group susceptible to airway obstruction.
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Affiliation(s)
- Ralph M. Steegman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
- Zijlweg Orthodontie, Orthodontic Private Practice, Haarlem, The Netherlands
| | - Anne-Marie Renkema
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
| | - Adriaan Schoeman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta, 10430 Indonesia
| | - Yijin Ren
- Department of Orthodontics, W.J. Kolff Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Fonseca C, Cavadas F, Fonseca P. Upper airway assessment in CBCT for OSAS Screening: Protocol in Dentistry (Preprint). JMIR Res Protoc 2022; 12:e41049. [PMID: 37145857 DOI: 10.2196/41049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The upper airways are formed by the nasal cavities, pharynx, and larynx. There are several radiographic methods that allow evaluation of the craniofacial structure. Upper airway analysis in cone-beam computed tomography (CBCT) may be useful in diagnosing some pathologies such as obstructive sleep apnea syndrome (OSAS). OSAS prevalence has increased significantly in recent decades, justified by increased obesity and average life expectancy. It can be associated with cardiovascular, respiratory, and neurovascular diseases, diabetes, and hypertension. In some individuals with OSAS, the upper airway is compromised and narrowed. Nowadays, CBCT is widely used in dentistry by clinicians. Its use for upper airway assessment would be an advantage for screening some abnormalities related to an increased risk of pathologies such as OSAS. CBCT helps to calculate the total volume of the airways and their area in different anatomical planes (sagittal, coronal, and transverse). It also helps identify regions with the highest anteroposterior and laterolateral constriction of the airways. Despite its undoubted advantages, airway assessment is not routinely performed in dentistry. There is no protocol that allows comparisons between studies, which makes it difficult to obtain scientific evidence in this area. Hence, there is an urgent need to standardize the protocol for upper airway measurement to help clinicians identify at-risk patients. OBJECTIVE Our main aim is to develop a standard protocol for upper airway evaluation in CBCT for OSAS screening in dentistry. METHODS To measure and evaluate the upper airways, data are obtained using Planmeca ProMax 3D (Planmeca). Patient orientation is performed in accordance with the manufacturer's indications at the time of image acquisition. The exposure corresponds to 90 kV, 8 mA, and 13,713 seconds. The software used for upper airway analysis is Romexis (version 5.1.O.R; Planmeca). The images are exhibited in accordance with the field of view of 20.1×17.4 cm, size of 502×502×436 mm, and voxel size of 400 μm. RESULTS The protocol described and illustrated here allows for automatic calculation of the total volume of the pharyngeal airspace, its area of greatest narrowing, its location, and the smallest anteroposterior and laterolateral dimensions of the pharynx. These measurements are carried out automatically by the imaging software whose reliability is proven by the existing literature. Thus, we could reduce the possible bias of manual measurement, aiming at data collection. CONCLUSIONS The use of this protocol by dentists will allow for standardization of the measurements and constitutes a valuable screening tool for OSAS. This protocol may also be suitable for other imaging software. The anatomical points used as reference are most relevant for standardizing studies in this field. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/41049.
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Affiliation(s)
- Catarina Fonseca
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
- Center for Interdisciplinary Research in Health, Viseu, Portugal
| | - Francisca Cavadas
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
| | - Patrícia Fonseca
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
- Center for Interdisciplinary Research in Health, Viseu, Portugal
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Lo Giudice A, Ronsivalle V, Gastaldi G, Leonardi R. Assessment of the accuracy of imaging software for 3D rendering of the upper airway, usable in orthodontic and craniofacial clinical settings. Prog Orthod 2022; 23:22. [PMID: 35691961 PMCID: PMC9189077 DOI: 10.1186/s40510-022-00413-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several semi-automatic software are available for the three-dimensional reconstruction of the airway from DICOM files. The aim of this study was to evaluate the accuracy of the segmentation of the upper airway testing four free source and one commercially available semi-automatic software. A total of 20 cone-beam computed tomography (CBCT) were selected to perform semi-automatic segmentation of the upper airway. The software tested were Invesalius, ITK-Snap, Dolphin 3D, 3D Slicer and Seg3D. The same upper airway models were manually segmented (Mimics software) and set as the gold standard (GS) reference of the investigation. A specific 3D imaging technology was used to perform the superimposition between the upper airway model obtained with semi-automatic software and the GS model, and to perform the surface-to-surface matching analysis. The accuracy of semi-automatic segmentation was evaluated calculating the volumetric mean differences (mean bias and limits of agreement) and the percentage of matching of the upper airway models compared to the manual segmentation (GS). Qualitative assessments were performed using color-coded maps. All data were statistically analyzed for software comparisons. RESULTS Statistically significant differences were found in the volumetric dimensions of the upper airway models and in the matching percentage among the tested software (p < 0.001). Invesalius was the most accurate software for 3D rendering of the upper airway (mean bias = 1.54 cm3; matching = 90.05%) followed by ITK-Snap (mean bias = - 2.52 cm3; matching = 84.44%), Seg 3D (mean bias = 3.21 cm3, matching = 87.36%), 3D Slicer (mean bias = - 4.77 cm3; matching = 82.08%) and Dolphin 3D (difference mean = - 6.06 cm3; matching = 78.26%). According to the color-coded map, the dis-matched area was mainly located at the most anterior nasal region of the airway. Volumetric data showed excellent inter-software reliability (GS vs semi-automatic software), with coefficient values ranging from 0.904 to 0.993, confirming proportional equivalence with manual segmentation. CONCLUSION Despite the excellent inter-software reliability, different semi-automatic segmentation algorithms could generate different patterns of inaccuracy error (underestimation/overestimation) of the upper airway models. Thus, is unreasonable to expect volumetric agreement among different software packages for the 3D rendering of the upper airway anatomy.
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Affiliation(s)
- Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, Unit of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, Unit of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giorgio Gastaldi
- Department Orthodontics, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, Unit of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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Comparison of the accuracy of 2D and 3D cephalometry: a systematic review and meta-analysis. AUSTRALASIAN ORTHODONTIC JOURNAL 2022. [DOI: 10.2478/aoj-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Objectives
To compare the measurement of cephalometric parameters using 3D images obtained from CBCT to 2D images obtained from a conventional cephalogram.
Methods
An electronic literature search was conducted using PubMed, Embase, Web of Science, CNKI, CENTRAL, and the grey literature database of SIGLE (up to May 2021). The selection of the eligible studies, data extraction, and an evaluation for possible risk of bias (Quality Assessment of Measurement Accuracy Studies tool) were performed independently by two authors. Inconsistencies were judged by a third author. Statistical pooling, subgroup analysis, a sensitivity analysis and an evaluation of publication bias were performed using Comprehensive Meta-Analysis (version 2.2.064, Biostat, Englewood, NJ).
Results
A total of eight articles were eligible for final meta-analysis. The differences in two of the skeletal measurement parameters [Ar(Co)-Gn, Me-Go] and one of the dental measurement parameters (U1-L1) were found to be statistically significant when using CBCT and conventional cephalograms (P = 0.000, P = 0.004, P = 0.000, respectively).
Conclusions
CBCT can be used as a supplementary option to support conventional cephalometric measurements. In clinical situations in which three-dimensional information is required, patients can benefit from CBCT analysis to improve diagnosis and treatment planning.
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Muñoz-Galván A, Fiori-Chíncaro GA, Agudelo-Botero AM. [Applications of cone beam computed tomography of the craneofacial structure in medical specialties. A review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2022; 10:e100. [PMID: 38389916 PMCID: PMC10880726 DOI: 10.21142/2523-2754-1001-2022-100] [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: 09/02/2021] [Accepted: 01/01/2022] [Indexed: 02/24/2024] Open
Abstract
Cone-beam computed tomography (CBCT) of the craniofacial structure has demonstrated its usefulness in the dental area during the last decades, thus it has become a fundamental tool in the diagnosis, planning, and evaluation of treatment, and although it was not developed for the exclusive use in dentistry, as it is commonly considered, it is used in other areas such as medicine. It is specifically used in the head and neck area where different medical specialties interact, and at the same time these interact with dental specialties, so knowing the advantages of CBCT over different imaging technologies in the medical area is necessary. The purpose of this review was to describe the applications of observation, diagnosis, planning, and evolution of treatments using maxillofacial HSCT in different medical specialties. This work highlights the use of TCHC in different medical applications and highlights where it is most useful compared to other technologies.
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Affiliation(s)
- Agustín Muñoz-Galván
- Division de Radiologia Bucal y Maxilofacial, Universidad Cientifica del Sur. Lima, Peru. Universidad Científica del Sur Division de Radiologia Bucal y Maxilofacial Universidad Cientifica del Sur Lima Peru
| | - Gustavo Adolfo Fiori-Chíncaro
- Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE). Lima, Peru. , Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE) Lima Peru
| | - Ana María Agudelo-Botero
- Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE). Lima, Peru. , Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE) Lima Peru
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Maret D, Vergnes JN, Peters OA, Peters C, Nasr K, Monsarrat P. Recent Advances in Cone-beam CT in Oral Medicine. Curr Med Imaging 2021; 16:553-564. [PMID: 32484089 DOI: 10.2174/1573405615666190114152003] [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: 09/24/2018] [Revised: 12/09/2018] [Accepted: 12/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The cone-beam computed tomography (CBCT) technology has continuously evolved since its appearance in oral medicine in the early 2000s. OBJECTIVES To present recent advances in CBCT in oral medicine: i) selection of recent and consensual evidence-based sources, ii) structured summary of the information based on an iterative framework and iii) compliance with ethical, public health and patient-centered concerns. MAIN FINDINGS We will focus on technological advances, such as sensors and reconstruction algorithms used to improve the constant quality of the image and dosimetry. CBCT examination is now performed in almost all disciplines of oral medicine: currently, the main clinical disciplines that use CBCT acquisitions are endodontics and oral surgery, with clearly defined indications. Periodontology and ear, nose and throat medicine are more recent fields of application. For a given application and indication, the smallest possible field of view must be used. One of the major challenges in contemporary healthcare is ensuring that technological developments do not take precedence over admitted standards of care. The entire volume should be reviewed in full, with a systematic approach. All findings are noted in the patient's record and explained to the patient, including incidental findings. This presupposes the person reviewing the images is sufficiently trained to interpret such images, inform the patient and organize the clinical pathway, with referrals to other medical or oral medicine specialties as needed. CONCLUSION A close collaboration between dentists, medical physicists, radiologists, radiographers and engineers is critical for all aspects of CBCT technology.
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Affiliation(s)
- Delphine Maret
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,AMIS Laboratory - Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse, Université de Toulouse, UMR 5288 CNRS, UPS, Toulouse, France
| | - Jean-Noel Vergnes
- Epidemiology and Public Health Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Ove A Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States.,School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Christine Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States
| | - Karim Nasr
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France
| | - Paul Monsarrat
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, ENVT, Inserm U1031, UPS, Toulouse, France
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Niu X, Madhan S, Cornelis MA, Cattaneo PM. Novel three-dimensional methods to analyze the morphology of the nasal cavity and pharyngeal airway. Angle Orthod 2021; 91:320-328. [PMID: 33523094 DOI: 10.2319/070620-610.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/01/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To assess the intraexaminer and interexaminer reliabilities of novel semiautomatic methods to segment the nasal cavity (NC) and pharyngeal airway (PA) and to determine the minimal cross-sectional area (CS) and hydraulic diameter (HD) of the PA. MATERIALS AND METHODS To test reproducibility, two examiners analyzed the NC and PA independently in 10 retrospectively selected cone beam computed tomography (CBCT) images using semiautomatic segmentation. The PA centerline was determined to assess the minimal CS and HD. The intraclass correlation coefficient (ICC) was used to calculate intraexaminer and interexaminer reliabilities. Measurement errors were assessed by Dahlberg's formula and paired t-tests. The level of agreement was assessed using the Bland-Altman method. RESULTS Intraexaminer and interexaminer reliabilities were excellent (minimal ICC, 0.960). The error of the method was good except for interexaminer values for the oropharynx (P = .016). The minimal CS and HD measurements were reliable (minimal ICC, 0.993; narrow limits of agreement). CONCLUSIONS The novel methods for analysis of the NC and PA are reliable. The minimal CS and HD demonstrated excellent reliabilities, which are critical to detect the most constricted part of the PA. Separation of the oropharynx from the voids close to the retroglossal area is not trivial and should be considered with caution.
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The Usefulness of Modified Mallampati Score and CT Upper Airway Volume Measurements in Diagnosing OSA among Patients with Breathing-Related Sleep Disorders. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11093764] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Obstructive sleep apnea (OSA) is a condition causing restriction of the airflow through the upper airways during sleep, despite preserved inspiratory muscle activity. This may lead to the development of secondary hypertension, ischemic heart disease, myocardial infarction, and arrhythmia. Moreover, the prevalence of OSA is on the rise. Methods: Comparison of scores from the Berlin Questionnaire, modified Mallampati scores (MMP), pulse oximetry readings and Upper Airway Volume (UAV) data obtained from CBCT (Cone Beam Computed Tomography). The study group of 129 patients of both sexes reporting sleep-related breathing problems completed the Berlin Questionnaire, had their oxygen saturation (SpO2) measured with a PO40 pulse oximeter, and oropharyngeal tissues assessed according to MMP. CBCT scans were put into 3D Amira TM 3D computer analysisto obtain UAV values. Results: Snoring was associated with significantly higher BMI compared to non-snoring patients. Furthermore, snoring patients had higher heart rate, modified Mallampati score, and lower UAV than the non-snoring group. The multifactorial analysis showed MMP as a useful indicator of the risk of snoring (OR = 7.468 (3863–14, 507, p < 0.001)). Conclusions: The composition of MMP together with UAV and the Berlin questionnaire might be reliable indicators to assess the risk of snoring.
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Deep Learning Based Airway Segmentation Using Key Point Prediction. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to investigate the accuracy of the airway volume measurement by a Regression Neural Network-based deep-learning model. A set of manually outlined airway data was set to build the algorithm for fully automatic segmentation of a deep learning process. Manual landmarks of the airway were determined by one examiner using a mid-sagittal plane of cone-beam computed tomography (CBCT) images of 315 patients. Clinical dataset-based training with data augmentation was conducted. Based on the annotated landmarks, the airway passage was measured and segmented. The accuracy of our model was confirmed by measuring the following between the examiner and the program: (1) a difference in volume of nasopharynx, oropharynx, and hypopharynx, and (2) the Euclidean distance. For the agreement analysis, 61 samples were extracted and compared. The correlation test showed a range of good to excellent reliability. A difference between volumes were analyzed using regression analysis. The slope of the two measurements was close to 1 and showed a linear regression correlation (r2 = 0.975, slope = 1.02, p < 0.001). These results indicate that fully automatic segmentation of the airway is possible by training via deep learning of artificial intelligence. Additionally, a high correlation between manual data and deep learning data was estimated.
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Gaêta-Araujo H, Leite AF, Vasconcelos KDF, Jacobs R. Two decades of research on CBCT imaging in DMFR - an appraisal of scientific evidence. Dentomaxillofac Radiol 2021; 50:20200367. [PMID: 33555198 DOI: 10.1259/dmfr.20200367] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This article aims to appraise how scientific evidence related to CBCT has changed over the years, based on levels of evidence and diagnostic efficacy. METHODS A general search strategy was used in different databases (Pubmed, Embase, and Web of Science) to identify systematic reviews (SRs) on CBCT until November of 2020. The SRs included were divided according to different specialties of dentistry. A critical review of the articles was made, describing the level of evidence and efficacy. RESULTS In total, 75 articles were selected. There was an increase in the number of SRs on CBCT from 2014 onwards, as 83% of the SRs on this topic were published after 2013, and 72% between 2016 and to date. Twenty SRs (27%) performed meta-analysis. Only 28% of the SRs provided a detailed description of CBCT protocols. According to SR evidence, almost all specialties of dentistry have advanced concomitantly with the introduction of CBCT. The majority of SRs were related to clinical applications (level 2 of efficacy), followed by technical parameters (level 1 of efficacy). Only some CBCT models were mentioned in the SRs selected. CONCLUSION Over the course of 20 years, SRs related to CBCT applications for a broad range of dental specialties have been published, with the vast majority of studies at levels 1 and 2 of diagnostic efficacy. Not all CBCT models available on the market have been scientifically validated. At all times, one should remain cautious as such not to simply extrapolate in vitro results to the clinical setting. Also, considering the wide variety of CBCT devices and protocols, reported results should not be overstated or generalized, as outcomes often refer to specific CBCT devices and protocols.
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Affiliation(s)
- Hugo Gaêta-Araujo
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, 13414-903, Piracicaba, Sao Paulo, Brazil
| | - André Ferreira Leite
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dentistry, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Lobbezoo F, Lavigne GJ, Kato T, de Almeida FR, Aarab G. The face of Dental Sleep Medicine in the 21st century. J Oral Rehabil 2020; 47:1579-1589. [PMID: 32799330 PMCID: PMC7754359 DOI: 10.1111/joor.13075] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
It becomes increasingly clear that some sleep disorders have important diagnostic and/or management links to the dental domain, hence the emergence of the discipline ‘Dental Sleep Medicine’. In this review, the following topics are discussed: 1. the reciprocal associations between oro‐facial pain and sleep; 2. the associations between sleep bruxism and other sleep‐related disorders; 3. the role of the dentist in the assessment and management of sleep bruxism; and 4. the dental management of obstructive sleep apnoea. From these topics' descriptions, it becomes clear that the role of the dentist in the recognition and management of sleep‐related oro‐facial pain, sleep bruxism and obstructive sleep apnoea is large and important. Since many dental sleep disorders can have severe consequences for the individual's general health and well‐being, it is imperative that dentists are not only willing to take on that role, but are also able to do so. This requires more attention for Dental Sleep Medicine in the dental curricula worldwide, as well as better postgraduate training of dentists who are interested in specialising in this intriguing domain. This review contributes to increasing the dental researcher's, teacher's and care professional's insight into the discipline ‘Dental Sleep Medicine’ as it has taken shape in the 21st century, to the benefit of all patients suffering from dental sleep disorders.
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Affiliation(s)
- Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gilles J Lavigne
- Faculty of Dental Medicine, Centre d'étude du sommeil, Université de Montréal and Hôpital du Sacré Coeur, Montréal, QC, Canada
| | - Takafumi Kato
- Department of Oral Physiology, Sleep Medicine Center, Osaka University Hospital, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Fernanda R de Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Monsarrat P, Galibourg A, Nasr K, Telmon N, Maret D. Incidental Findings in Dental Radiology are Concerning for Family Doctors. Open Med (Wars) 2019; 14:467-478. [PMID: 31410365 PMCID: PMC6689204 DOI: 10.1515/med-2019-0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 05/05/2019] [Indexed: 12/23/2022] Open
Abstract
Cone Beam Computerized Tomography (CBCT) is an imaging technology increasingly used in dentistry. Depending on the size of the examination area, visualization of anatomical structures outside the indication area may reveal incidental findings (IF). The aims of this systematic review and meta-analysis were to 1) evaluate the frequency, location and different types of incidental findings (IF) revealed during CBCT examinations; 2) identify potential influencing factors such as gender or age; 3) highlight what the family doctor should know about CBCT and the benefits for medical care. 70 retrospective studies were included. 60% of IF are in the naso-oropharyngeal airway and paranasal sinuses. Carotid calcifications were observed with a mean prevalence of 9% CI95% [2-21]). Meta-regression showed a significant association of this prevalence with age, irrespective of gender. Given the high frequency of IF, with varying severity, the whole medical community is fully involved, and its opinion should be sought to ensure the best possible management for the patients. Physicians may also require CBCT examinations that would have been previously prescribed by a dentist, that may serve to better orientate investigations toward another imaging technique. The family doctor is therefore the dentist’s main interlocutor and the main coordinator of the follow-up of IF.
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Affiliation(s)
- Paul Monsarrat
- Department of Anatomical Sciences and Radiology, Dental Faculty, Paul Sabatier University, Toulouse University Hospital, UFR Odontologie de Toulouse 3, Chemin des Maraîchers 31062 Toulouse Cedex 9 Toulouse, France.,STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, ENVT, Inserm, UPS, Toulouse, France
| | - Antoine Galibourg
- Department of Prostheses, Dental Faculty, Paul Sabatier University, Toulouse University Hospital, Toulouse, France.,AMIS Laboratory - Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse, Université de Toulouse, UMR 5288 CNRS, UPS, Toulouse, France
| | - Karim Nasr
- Department of Anatomical Sciences and Radiology, Dental Faculty, Paul Sabatier University, Toulouse University Hospital, UFR Odontologie de Toulouse 3, Chemin des Maraîchers 31062 Toulouse Cedex 9 Toulouse, France
| | - Norbert Telmon
- AMIS Laboratory - Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse, Université de Toulouse, UMR 5288 CNRS, UPS, Toulouse, France.,Service de Médecine Légale, Centre Hospitalier Universitaire Rangueil, avenue du Professeur Jean Poulhès, 31059, Toulouse Cedex 9, Toulouse, France
| | - Delphine Maret
- AMIS Laboratory - Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse, Université de Toulouse, UMR 5288 CNRS, UPS, Toulouse, France.,Department of Restorative Dentistry, Endodontics, Paul Sabatier University, Toulouse University Hospital, Toulouse, France
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15
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Zhang C, Bruggink R, Baan F, Bronkhorst E, Maal T, He H, Ongkosuwito EM. A new segmentation algorithm for measuring CBCT images of nasal airway: a pilot study. PeerJ 2019; 7:e6246. [PMID: 30713816 PMCID: PMC6354662 DOI: 10.7717/peerj.6246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022] Open
Abstract
Background Three-dimensional (3D) modeling of the nasal airway space is becoming increasingly important for assessment in breathing disorders. Processing cone beam computed tomography (CBCT) scans of this region is complicated, however, by the intricate anatomy of the sinuses compared to the simpler nasopharynx. A gold standard for these measures also is lacking. Previous work has shown that software programs can vary in accuracy and reproducibility outcomes of these measurements. This study reports the reproducibility and accuracy of an algorithm, airway segmentor (AS), designed for nasal airway space analysis using a 3D printed anthropomorphic nasal airway model. Methods To test reproducibility, two examiners independently used AS to edit and segment 10 nasal airway CBCT scans. The intra- and inter-examiner reproducibility of the nasal airway volume was evaluated using paired t-tests and intraclass correlation coefficients. For accuracy testing, the CBCT data for pairs of nasal cavities were 3D printed to form hollow shell models. The water-equivalent method was used to calculate the inner volume as the gold standard, and the models were then embedded into a dry human skull as a phantom and subjected to CBCT. AS, along with the software programs MIMICS 19.0 and INVIVO 5, was applied to calculate the inner volume of the models from the CBCT scan of the phantom. The accuracy was reported as a percentage of the gold standard. Results The intra-examiner reproducibility was high, and the inter-examiner reproducibility was clinically acceptable. AS and MIMICS presented accurate volume calculations, while INVIVO 5 significantly overestimated the mockup of the nasal airway volume. Conclusion With the aid of a 3D printing technique, the new algorithm AS was found to be a clinically reliable and accurate tool for the segmentation and reconstruction of the nasal airway space.
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Affiliation(s)
- Chen Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Robin Bruggink
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands.,3DLAB The Netherlands, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Frank Baan
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands.,3DLAB The Netherlands, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Ewald Bronkhorst
- Department of Dentistry, Section of Preventive and Restorative Dentistry, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Thomas Maal
- 3DLAB The Netherlands, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Hong He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Edwin M Ongkosuwito
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
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