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Kazmierski RH. Obstructive sleep apnea: What is an orthodontist's role? Prog Orthod 2024; 25:21. [PMID: 38945976 PMCID: PMC11214936 DOI: 10.1186/s40510-024-00524-4] [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: 03/05/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper's release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. RESULTS Part of an orthodontist's role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. CONCLUSIONS Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.
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Affiliation(s)
- Robert H Kazmierski
- Solo Private Orthodontic Practice, 110 Marter Ave., Suite 404, Moorestown, NJ, 08057, USA.
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Owayda A, Al-Sabbagh R, Farah H, Owayda T, Al-Ahmad S. The effectiveness of the total-maxillary-arch-distalization approach in treating class II division 1 malocclusion: A systematic review. Clin Oral Investig 2024; 28:333. [PMID: 38780877 DOI: 10.1007/s00784-024-05728-w] [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: 08/02/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The objective of this review is to assess the effect of total maxillary arch distalization (TMAD) treatment on the dental, skeletal, soft tissues, and airways during non-extraction camouflage treatment of class II division 1 patients. METHODS We performed a systematic review of the published data in four electronic databases up to April 2023. We considered studies for inclusion if they were examining the effects of TMAD during treatment of class II division 1 malocclusion in the permanent dentition. Study selection, data extraction, risk of bias assessment, and assessment of the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool were performed in duplicate. RESULTS Out of the 27 articles that met the initial eligibility criteria, 19 studies were finally selected. Fair to relatively good quality evidence was identified after the risk of bias assessment of the included studies. Out of the 19 selected studies, 5 studies used inter-radicular TADs, 10 studies used modified C- palatal plate (MCPP), 3 studies used infra zygomatic crest (IZC) TADs, 1 study compared buccal TADs versus MCPP, and 1 study compared between cervical headgear and MCPP. The maximum amount of maxillary arch distalization using buccal TADs, MCPP, IZC TADs, and headgear was 4.2mm, 5.4mm, 5mm, and 2.5mm respectively. Different results regarding the amount of dental, skeletal, and soft tissue changes were observed. CONCLUSIONS The current low to very low certainty level of evidence suggests that TMAD is effective in camouflaging class II division 1 malocclusion. Future well-conducted and clearly reported randomized controlled trials that include a control group are needed to make robust recommendations regarding the effect of TMAD with different appliances on dental, skeletal, and soft tissue structures. CLINICAL RELEVANCE TMAD should be given priority with caution in class II patients who refuse the extraction of premolars. TMAD may be considered an adjunctive approach to solve cases associated with high anchorage need or anchorage loss.
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Affiliation(s)
- Amer Owayda
- PhD student, Department of Orthodontics, University of Hama Dental School, Hama, Syria.
| | - Rabab Al-Sabbagh
- Professor of Orthodontics, Department of Orthodontic, University of Hama Dental School, Hama, Syria
| | - Hassan Farah
- Professor of Orthodontics, Department of Orthodontic, University of Hama Dental School, Hama, Syria
| | - Tareq Owayda
- Master student, Department of Pediatric Dentistry, University of Tishreen Dental School, Lattakia, Syria
| | - Sally Al-Ahmad
- Assistant Professor of Orthodontics, Department of Orthodontics, Al Wataniya Private University, Hama, Syria
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Rangarajan H, Ayub II, Padmanabhan S. Assessment of maximal inspiratory and expiratory pressures in skeletal Class II patients with different growth patterns. Angle Orthod 2024; 94:328-335. [PMID: 38639454 PMCID: PMC11050465 DOI: 10.2319/071723-496.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/01/2023] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES To evaluate maximal inspiratory (MIP) and expiratory (MEP) pressures, which are reflective of respiratory muscle strength, in skeletal Class II patients with different growth patterns (horizontal, average, and vertical) and to correlate those with airway dimension. MATERIALS AND METHODS Patients with a Class II skeletal base seeking orthodontic treatment were assigned to the following groups: average, horizontal, and vertical growth pattern. The control group (n = 14) comprised patients with a Class I skeletal base and average growth pattern. Airway dimensions were obtained using cone-beam computed tomography scans, and a spirometer with a pressure transducer was used for assessment of MIP and MEP. Routine spirometry for assessment of lung function was also performed. RESULTS No significant differences were found in maximal inspiratory and expiratory pressures for the study groups in comparison with the control group. Class I patients had significantly greater oropharyngeal and nasopharyngeal airway volumes compared with the study groups. No significant difference in minimal cross-section area of the airway was observed among groups. A weak positive correlation between maximal inspiratory pressure and airway volume was observed. CONCLUSIONS Although Class I patients displayed significantly greater oropharyngeal and nasopharyngeal airway volumes, there was no significant difference in respiratory muscle strength or airway function between Class II patients with different growth patterns and the Class I control group. The findings underscore the significance of exploring factors beyond craniofacial growth patterns that may contribute to sleep-related breathing disorders.
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Pop SI, Procopciuc A, Arsintescu B, Mițariu M, Mițariu L, Pop RV, Cerghizan D, Jánosi KM. Three-Dimensional Assessment of Upper Airway Volume and Morphology in Patients with Different Sagittal Skeletal Patterns. Diagnostics (Basel) 2024; 14:903. [PMID: 38732317 PMCID: PMC11083622 DOI: 10.3390/diagnostics14090903] [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: 03/24/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The relationship between respiratory function and craniofacial morphology has garnered significant attention due to its implications for upper airway and stomatognathic development. Nasal breathing plays a key role in craniofacial growth and dental positioning. This study investigated upper airway morphology and volume differences among individuals with class I, II, and III skeletal anomalies. METHODS Ninety orthodontic patients' CBCT scans were analyzed to assess the oropharynx and hypopharynx volumes. Skeletal diagnosis was established based on the cephalometric analysis. RESULTS A significant volume change in the oropharynx and pharynx was demonstrated when comparing class II with class III anomalies (p = 0.0414, p = 0.0313). The total volume of the pharynx was increased in class III anomalies. The area of the narrowest part of the pharynx (MIN-CSA) significantly decreased in classes I and II compared to class III (p = 0.0289, p = 0.0003). Patients with Angle class III anomalies exhibited higher values in the narrowest pharyngeal segment. Gender differences were significant in pharyngeal volumes and morphologies across malocclusion classes. CONCLUSIONS The narrowest segment of the pharynx had the highest values in patients with Angle class III. The volume of the oropharynx was found to be greater in patients with Angle class III versus patients with Angle class II.
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Affiliation(s)
- Silvia Izabella Pop
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Ana Procopciuc
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Bianca Arsintescu
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Mihai Mițariu
- Faculty of Dental Medicine, Lucian Balga University, Bd-ul. Victoriei, 550024 Sibiu, Romania
| | - Loredana Mițariu
- Faculty of Dental Medicine, Lucian Balga University, Bd-ul. Victoriei, 550024 Sibiu, Romania
| | - Radu Vasile Pop
- Private Practice, Natural Smile Dental Clinic, 76 Gh Doja Str., 540232 Târgu Mureș, Romania
| | - Diana Cerghizan
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Kinga Mária Jánosi
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
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Savoldi F, Dagassan-Berndt D, Patcas R, Mak WS, Kanavakis G, Verna C, Gu M, Bornstein MM. The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing. Dentomaxillofac Radiol 2024; 53:178-188. [PMID: 38265247 PMCID: PMC11003665 DOI: 10.1093/dmfr/twae001] [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: 09/05/2023] [Revised: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
Applications of cone-beam CT (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing. The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis-including soft tissue diagnosis and airway morphology-needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognized guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.
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Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Raphael Patcas
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032, Switzerland
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR
| | - Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
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Benetti M, Montresor L, Cantarella D, Zerman N, Spinas E. Does Miniscrew-Assisted Rapid Palatal Expansion Influence Upper Airway in Adult Patients? A Scoping Review. Dent J (Basel) 2024; 12:60. [PMID: 38534284 DOI: 10.3390/dj12030060] [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: 12/19/2023] [Revised: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
(1) Objective: This scoping review evaluates the effects of miniscrew-assisted rapid palatal expansion (MARPE) on different regions of the upper airway in adult patients and investigates various methods of measurement. (2) Methods: The search encompassed Pubmed, Cochrane Library, Scopus and Web of Science. This review was conducted following the PRISMA_ScR guidelines, and the inclusion criteria for examined studies were chosen in accordance with the PICOS framework. (3) Results: Seven studies were included in this review, comprising four retrospective studies, one prospective and two case reports. All studies involved the use of Cone Beam Computed Tomography (CBCT) for measurements of the areas of interest. The percentage of increase in the volume of the nasal cavity varied between 31% and 9.9%, depending on the study. Volumetric variations in the nasopharynx were reported as increases between T0 (before expansion) and T1 (immediately after expansion) of 6.4%, 20.7% and 14.1%. All studies considered T0 before expansion and T1 immediately after expansion. Only one study evaluated remote follow-up to assess if the results were maintained after one year. (4) Conclusions: MARPE appears to lead to a statistically significant increase in the upper airway, especially in the nasal cavity and nasopharynx immediately after expansion. However, further prospective and retrospective trails with long-term controls are required to verify the effects of MARPE on the upper airway.
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Affiliation(s)
- Mariachiara Benetti
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
| | - Luca Montresor
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
| | - Daniele Cantarella
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Commenda 10, 20122 Milan, Italy
| | - Nicoletta Zerman
- Department of Pediatric Dentistry and Dental Hygiene, University of Verona, Via San Marco 121, 37138 Verona, Italy
| | - Enrico Spinas
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
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Sfondrini MF, Gallo S, Pascadopoli M, Gandini P, Roncoroni C, Scribante A. Upper Airway Dimensions among Different Skeletal Malocclusions: A Retrospective Observational Study by Cephalometric Analysis. Dent J (Basel) 2024; 12:12. [PMID: 38248220 PMCID: PMC10813941 DOI: 10.3390/dj12010012] [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: 09/17/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
The aim of the present work was to investigate the upper airway dimensions in adult non-orthodontic patients, equally divided according to their skeletal class. METHODS In this retrospective cross-sectional study, lateral cephalometric radiographs of adult patients referred for orthodontic consultation were collected. Cephalometric tracing was performed with dedicated software. For each measure, descriptive statistics were calculated. Cephalometric measurements between the different skeletal classes were compared. Linear regressions were performed between upper airway diameters and cephalometric measurements, sex and age. Significance was predetermined for p < 0.05. RESULTS Lateral cephalometric radiographs of 120 patients were reviewed. Nasopharynx length (NL) and depth (PD) measurements were significantly shorter in skeletal class III patients (p < 0.05). The superior pharyngeal airway space (SPAS) was found to be significantly shorter in class III patients as compared to class II patients (p < 0.05), and the mean airway space (MAS) of class I patients was found to be significantly shorter compared to class II patients (p < 0.05). Palate length (PL) values were found to be significantly longer in class I (p < 0.05). Linear regressions showed that the sella-nasion-A point angle (SNA) and Riedel's angle between point A, the nasion and point B (ANB) significantly influenced NL and PD (p < 0.05). CONCLUSIONS Class III patients show significantly shorter nasopharynx measurements; clinicians should consider that this sagittal discrepancy could be related to an altered anatomy of the upper respiratory tract.
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Affiliation(s)
- Maria Francesca Sfondrini
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Simone Gallo
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Maurizio Pascadopoli
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paola Gandini
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Caterina Roncoroni
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Andrea Scribante
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Mao F, Lu C, Liu N, Liu Z, Zhang Y, Qi H, Hu M. Effects of Twin-Block with an expanding device on the upper airway in growing children with skeletal class II malocclusion-a retrospective study based on the consistency of three-dimensional and two-dimensional data. Clin Oral Investig 2023; 28:4. [PMID: 38123880 DOI: 10.1007/s00784-023-05388-2] [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: 07/03/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Skeletal class II malocclusion is one of the most common malocclusions. Among the functional appliances for skeletal class II malocclusion, the Twin-Block appliance with a maxillary expander is effective in repositioning the mandible forward. In this study, we focused our efforts on investigating the effects of Twin-Block appliances with maxillary expanders on the upper airway in growing children with skeletal class II malocclusion by tracing and measuring lateral cephalograms after evaluating the consistency of three-dimensional CBCT data and two-dimensional lateral cephalogram data. MATERIALS AND METHODS A total of 102 patients ranging from 9 to 15 years old (11.37 ± 2.80, male/female ratio = 1:1) with skeletal class II malocclusion were selected to evaluate the consistency of CBCT data and lateral cephalogram data. The strongly and moderately correlated segments were then selected to study the effects of Twin-Block with a maxillary expander on the upper airway in 66 growing children with skeletal class II malocclusion (11.31 ± 1.23 years old, male/female ratio = 1:1) by lateral cephalograms. RESULTS The results showed a strong significant correlation in the nasopharynx (r = 0.708) and moderate significant correlations in the overall upper airway (r = 0.641), palatopharynx (r = 0.553), and glossopharynx (r = 0.575) but a weak correlation in the hypopharynx (r = 0.323). The corresponding determination coefficient (R2) was also determined by scatter plot analysis. Moreover, compared with the pretreatment data (T1), the total area of the upper airway and the areas of the nasopharynx, palatopharynx, and glossopharynx after functional treatment (T2) increased statistically and significantly. CONCLUSIONS Lateral cephalograms can reflect the volume of the nasopharynx and oropharynx in skeletal class II children to a certain extent, while Twin-Block appliances with maxillary expanders can widen the volume of the nasopharynx and oropharynx significantly. CLINICAL RELEVANCE The lateral cephalogram is reliable for analyzing the nasopharynx, palatopharynx, and glossopharynx in orthodontic clinical practice. Twin-Block appliances with maxillary expanders have a positive effect on skeletal class II patients with airway stenosis.
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Affiliation(s)
- Feng Mao
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
| | - Chenmeng Lu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
- Department of Orthodontics, Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Nan Liu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
- Department of Orthodontics, Suzhou Stomatological Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Zhiqing Liu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
| | - Yi Zhang
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
| | - Huichuan Qi
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China.
| | - Min Hu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China.
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Vejwarakul W, Ko EWC, Lin CH. Evaluation of pharyngeal airway space after orthodontic extraction treatment in class II malocclusion integrating with the subjective sleep quality assessment. Sci Rep 2023; 13:9210. [PMID: 37280305 PMCID: PMC10244355 DOI: 10.1038/s41598-023-36467-9] [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: 12/09/2022] [Accepted: 06/04/2023] [Indexed: 06/08/2023] Open
Abstract
Orthodontic treatment with premolar extractions is typically used to relieve dental crowding and retract anterior teeth for lip profile improvement. The aim of the study is to compare the changes in regional pharyngeal airway space (PAS) after orthodontic treatment with Class II malocclusion and to identify the correlations between questionnaire results and PAS dimensions after orthodontic treatment. In this retrospective cohort study, 79 consecutive patients were divided into normodivergent nonextraction, normodivergent extraction, and hyperdivergent extraction groups. Serial lateral cephalograms were used to evaluate the patients' PASs and hyoid bone positions. The Pittsburgh Sleep Quality Index and STOP-Bang questionnaire were used for sleep quality evaluation and obstructive sleep apnea (OSA) risk assessment, respectively, after treatment. The greatest airway reduction was observed in hyperdivergent extraction group. However, the changes in PAS and hyoid positions did not differ significantly among three groups. According to questionnaire results, all three groups had high sleep quality and low risk of OSA, with no significant intergroup differences. Moreover, pretreatment-to-posttreatment changes in PAS were not correlated with sleep quality or risk of OSA. Orthodontic retraction with premolar extractions nither exhibit significant reduction in airway dimensions nor increase their risk of OSA.
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Affiliation(s)
- Weerayuth Vejwarakul
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Ellen Wen-Ching Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 6F, 199, Tung Hwa North Road, Taipei, 105, Taiwan.
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
| | - Cheng-Hui Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Dong W, Chen Y, Li A, Mei X, Yang Y. Automatic detection of adenoid hypertrophy on cone-beam computed tomography based on deep learning. Am J Orthod Dentofacial Orthop 2023; 163:553-560.e3. [PMID: 36990529 DOI: 10.1016/j.ajodo.2022.11.011] [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: 05/01/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION This study proposed an automatic diagnosis method based on deep learning for adenoid hypertrophy detection on cone-beam computed tomography. METHODS The hierarchical masks self-attention U-net (HMSAU-Net) for segmentation of the upper airway and the 3-dimensional (3D)-ResNet for diagnosing adenoid hypertrophy were constructed on the basis of 87 cone-beam computed tomography samples. A self-attention encoder module was added to the SAU-Net to optimize upper airway segmentation precision. The hierarchical masks were introduced to ensure that the HMSAU-Net captured sufficient local semantic information. RESULTS We used Dice to evaluate the performance of HMSAU-Net and used diagnostic method indicators to test the performance of 3D-ResNet. The average Dice value of our proposed model was 0.960, which was superior to the 3DU-Net and SAU-Net models. In the diagnostic models, 3D-ResNet10 had an excellent ability to diagnose adenoid hypertrophy automatically with a mean accuracy of 0.912, a mean sensitivity of 0.976, a mean specificity of 0.867, a mean positive predictive value of 0.837, a mean negative predictive value of 0.981, and a F1 score of 0.901. CONCLUSIONS The value of this diagnostic system lies in that it provides a new method for the rapid and accurate early clinical diagnosis of adenoid hypertrophy in children, allows us to look at the upper airway obstruction in three-dimensional space and relieves the work pressure of imaging doctors.
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Affiliation(s)
- Wenjie Dong
- Department of Stomatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yaosen Chen
- Department of Stomatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ankang Li
- Computer Science School, Wuhan University, Wuhan, Hubei, China
| | - Xiaoguang Mei
- Electronic Information School, Wuhan University, Wuhan, Hubei, China
| | - Yan Yang
- Department of Stomatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Chen B, Zhang H. The study on the morphological changes of oropharynx in patients with complete unilateral cleft lip and palate after palatopharyngeal closure. Front Neurosci 2022; 16:997057. [PMID: 36248646 PMCID: PMC9560779 DOI: 10.3389/fnins.2022.997057] [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: 07/18/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
Cleft lip and palate can be treated as one of the most common craniofacial congenital malformations in humans. Such disease influences tens of millions of patients all over the world. Cleft lip and palate deformity affects many important physiological functions, including breathing, swallowing, speech, chewing, and aesthetics. This work focuses on investigating the morphology and airway volume of oropharynx patients with unilateral complete cleft lip and palate after palatopharyngeal closure. In addition, this work evaluated the similarities and differences between patients with cleft lip and palate and those without such an issue. The employed data, selected from the Department of Stomatology of Xuzhou First People's Hospital, are based on the conical beam CT images. The study sample was divided into two groups: the selected experimental group, who confronted the cleft lip, cleft palate, and velopharyngeal closure surgery, and the selected control group, who are healthy children at the corresponding age. The parameters, including the airway volume, the airway volume of velopharyngeal and oropharyngeal segments, the minimum cross-sectional area of the pharynx, the horizontal plane airway area of the hard palate and soft one, the horizontal airway area of the hyoid bone, and the vertical distance between the hard palate and soft palate, can be measured by Dolphin. These parameters were analyzed with a statistical approach. The analysis of the above-mentioned parameters reveals that the airway volume, the minimum cross-sectional area of the pharynx, the horizontal cross-sectional area of the hyoid, and the distance between the hard palate and soft palate tip in patients with complete unilateral cleft lip and palate show significant differences between the experimental group and the control group. Meanwhile, other parameters, including the horizontal cross-sectional area of the airway in the horizontal plane of the hard palate and the horizontal plane of the soft palate, did not show noticeable differences in the two groups. The patients, who confronted the unilateral complete cleft lip and palate, can improve with the velopharyngeal closure surgery. Furthermore, the length and vertical distance of the soft palate and the volume of each segment of the airway exhibit differences between the experimental group and the control group.
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Oropharynx and hyoid bone changes in female extraction patients with distinct sagittal and vertical skeletal patterns: a retrospective study. Head Face Med 2022; 18:31. [PMID: 36064714 PMCID: PMC9442905 DOI: 10.1186/s13005-022-00334-1] [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: 03/31/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Previous studies have reported inconsistent effects of premolar extraction on the oropharynx and hyoid bones. Currently, no strong evidence is available regarding the effect of extraction on upper airway size. Hence, the aim of this study was to analyse the effects of first premolar extraction on the oropharynx and hyoid bone positions in female adult patients, and further explored differences in oropharynx and hyoid bone changes among skeletal patterns. Methods The study population included 40 female adult patients who did not undergo extraction and 120 female adult patients who underwent extraction of four premolars; the including patients had four distinct sagittal and vertical skeletal patterns. Cone-beam computed tomography was performed before (T0) and after (T1) orthodontic treatment. Eight oropharynx variables and five hyoid bone variables were measured using Dolphin 3D Imaging software. Paired and independent t-tests were used to analyse measurements between timepoints and groups, respectively. Results The oropharynx volume increased significantly in the extraction group; changes did not differ significantly between extraction and non-extraction groups. Oropharynx variables did not differ significantly at T0 among the four skeletal pattern groups. After orthodontic extraction treatment, the oropharynx volume increased significantly in the class I-norm and class I-hyper subgroups, but not in the class II-norm and class II-hyper subgroups. Significant increases were observed in the oropharynx volume and most constricted axial area from T0 to T1 in the moderate retraction group, but not in the maximum retraction group. Extraction patients exhibited significant posterior movement of the hyoid, particularly among maximum retraction patients. Conclusions In female adult patients, first premolar extraction tends to increase the oropharynx size and cause posterior movement of the hyoid bone, particularly in skeletal class I patients. For skeletal class II and hyperdivergent patients with a narrow oropharynx, first premolar extraction does not negatively influence oropharynx size or hyoid bone position. The differences of oropharyngeal changes between moderate retraction patients and maximum retraction patients were not significant. Supplementary Information The online version contains supplementary material available at 10.1186/s13005-022-00334-1.
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Cho HN, Gwon E, Kim KA, Baek SH, Kim N, Kim SJ. Accuracy of convolutional neural networks-based automatic segmentation of pharyngeal airway sections according to craniofacial skeletal pattern. Am J Orthod Dentofacial Orthop 2022; 162:e53-e62. [PMID: 35654686 DOI: 10.1016/j.ajodo.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aimed to evaluate a 3-dimensional (3D) U-Net-based convolutional neural networks model for the fully automatic segmentation of regional pharyngeal volume of interests (VOIs) in cone-beam computed tomography scans to compare the accuracy of the model performance across different skeletal patterns presenting with various pharyngeal dimensions. METHODS Two-hundred sixteen cone-beam computed tomography scans of adult patients were randomly divided into training (n = 100), validation (n = 16), and test (n = 100) datasets. We trained the 3D U-Net model for fully automatic segmentation of pharyngeal VOIs and their measurements: nasopharyngeal, velopharyngeal, glossopharyngeal, and hypopharyngeal sections as well as total pharyngeal airway space (PAS). The test datasets were subdivided according to the sagittal and vertical skeletal patterns. The segmentation performance was assessed by dice similarity coefficient, volumetric similarity, precision, and recall values, compared with the ground truth created by 1 expert's manual processing using semiautomatic software. RESULTS The proposed model achieved highly accurate performance, showing a mean dice similarity coefficient of 0.928 ± 0.023, the volumetric similarity of 0.928 ± 0.023, precision of 0.925 ± 0.030, and recall of 0.921 ± 0.029 for total PAS segmentation. The performance showed region-specific differences, revealing lower accuracy in the glossopharyngeal and hypopharyngeal sections than in the upper sections (P <0.001). However, the accuracy of model performance at each pharyngeal VOI showed no significant difference according to sagittal or vertical skeletal patterns. CONCLUSIONS The 3D-convolutional neural network performance for region-specific PAS analysis is promising to substitute for laborious and time-consuming manual analysis in every skeletal and pharyngeal pattern.
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Affiliation(s)
- Ha-Nul Cho
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Eunseo Gwon
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-A Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Seung-Hak Baek
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Radiology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Su-Jung Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea.
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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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Diaconu A, Holte MB, Cattaneo PM, Pinholt EM. A semi-automatic approach for longitudinal 3D upper airway analysis using voxel-based registration. Dentomaxillofac Radiol 2022; 51:20210253. [PMID: 34644181 PMCID: PMC8925868 DOI: 10.1259/dmfr.20210253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To propose and validate a reliable semi-automatic approach for three-dimensional (3D) analysis of the upper airway (UA) based on voxel-based registration (VBR). METHODS Post-operative cone beam computed tomography (CBCT) scans of 10 orthognathic surgery patients were superimposed to the pre-operative CBCT scans by VBR using the anterior cranial base as reference. Anatomic landmarks were used to automatically cut the UA and calculate volumes and cross-sectional areas (CSA). The 3D analysis was performed by two observers twice, at an interval of two weeks. Intraclass correlations and Bland-Altman plots were used to quantify the measurement error and reliability of the method. The relative Dahlberg error was calculated and compared with a similar method based on landmark re-identification and manual measurements. RESULTS Intraclass correlation coefficient (ICC) showed excellent intra- and inter-observer reliability (ICC ≥ 0.995). Bland-Altman plots showed good observer agreement, low bias and no systematic errors. The relative Dahlberg error ranged between 0.51 and 4.30% for volume and 0.24 and 2.90% for CSA. This was lower when compared with a similar, manual method. Voxel-based registration introduced 0.05-1.44% method error. CONCLUSIONS The proposed method was shown to have excellent reliability and high observer agreement. The method is feasible for longitudinal clinical trials on large cohorts due to being semi-automatic.
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Affiliation(s)
- Alexandru Diaconu
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark
| | | | - Paolo Maria Cattaneo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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Miranda F, Garib D, Pugliese F, da Cunha Bastos JC, Janson G, Palomo JM. Upper airway changes in Class III patients using miniscrew-anchored maxillary protraction with hybrid and hyrax expanders: a randomized controlled trial. Clin Oral Investig 2022; 26:183-195. [PMID: 34041608 DOI: 10.1007/s00784-021-03989-3] [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: 08/04/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to compare the upper airway space changes after miniscrew-anchored maxillary protraction with hybrid (HH) and conventional hyrax (CH) expanders. MATERIAL AND METHODS The sample comprised Class III malocclusion growing patients that were randomized into two groups of miniscrew-anchored maxillary protraction. The group HH was treated with a hybrid hyrax appliance in the maxilla and two miniscrews distally to the canines in the mandible. Class III elastics were used from the maxillary first molar to the mandibular miniscrews until anterior crossbite correction. The group CH was treated with a similar protocol except for the conventional hyrax expander in the maxilla. Cone-beam computed tomography was obtained before (T1) and after 12 months of therapy (T2). The shape and size of upper airway were assessed. Intergroup comparisons were performed using Mann-Whitney U test (p < 0.05). RESULTS The group HH was composed of 20 patients (8 female, 12 male) with a mean age of 10.76 years. The group CH was composed of 15 patients (6 female, 9 male) with a mean age of 11.52 years. Anteroposterior and transverse increases of the upper airway were found for both groups. The oropharynx and the most constricted area increased similarly in both groups. CONCLUSIONS No differences in upper airway changes were observed using protraction anchored on hybrid or conventional hyrax expanders. CLINICAL RELEVANCE Maxillary protraction anchored on hybrid or conventional hyrax expanders may benefit patients with breathing disorders due to the increase of the upper airway volume and most constricted area. Registration: ClinicalTrials.gov (NCT03712007).
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Affiliation(s)
- Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, SP, 17012-901, Bauru, Brazil.
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, SP, 17012-901, Bauru, Brazil
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Silvio Marchione 3-20, SP 17012-900, Bauru, Brazil
| | - Fernando Pugliese
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, 9601 Chester Avenue, OH, 44106, Cleveland, USA
| | - José Carlos da Cunha Bastos
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Silvio Marchione 3-20, SP 17012-900, Bauru, Brazil
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, SP, 17012-901, Bauru, Brazil
| | - Juan Martin Palomo
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, 9601 Chester Avenue, OH, 44106, Cleveland, USA
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Mamedov AA, Timoschenko TV, Slynko AY. [Cephalometric CBCT analysis of the upper airways]. STOMATOLOGIIA 2022; 101:31-36. [PMID: 36268917 DOI: 10.17116/stomat202210105131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The purpose of this literature review is to optimize the use of cephalometric diagnostic methods for assessing the condition of the upper respiratory tract. The article examines the areas of the upper respiratory tract associated with obstructive sleep apnea syndrome (OSA). Cephalometric analysis can be a useful tool for screening this pathology. However, it should be noted that there is still no clear understanding of the results of cephalometric changes in OSA, and therefore further research is necessary.
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Affiliation(s)
- A A Mamedov
- E.V. Borovskiy Institution of Dentistry I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - T V Timoschenko
- E.V. Borovskiy Institution of Dentistry I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - A Y Slynko
- E.V. Borovskiy Institution of Dentistry I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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Zhou N, Ho JPTF, Klop C, Schreurs R, Beenen LFM, Aarab G, de Lange J. Intra-individual variation of upper airway measurements based on computed tomography. PLoS One 2021; 16:e0259739. [PMID: 34739525 PMCID: PMC8570503 DOI: 10.1371/journal.pone.0259739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
The aims of this study were (1) to quantify the intra-individual variation in the upper airway measurements on supine computed tomography (CT) scans at two different time points; and (2) to identify the most stable parameters of the upper airway measurements over time. Ten subjects with paired CT datasets (3-6 months interval) were studied, using computer software to segment and measure the upper airway. The minimum cross-sectional area of the total airway and all its segments (velopharynx, oropharynx, tongue base, and epiglottis) generally had the largest variation, while the length of the total airway had the lowest variation. Sphericity was the only parameter that was stable over time (relative difference <15%), both in the total airway and each subregion. There was considerable intra-individual variation in CT measurements of the upper airway, with the same patient instruction protocol for image acquisitions. The length of the total airway, and the sphericity of the total upper airway and each segment were stable over time. Hence, such intra-individual variation should be taken into account when interpreting and comparing upper airway evaluation parameters on CT in order to quantify treatment results or disease progress.
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Affiliation(s)
- Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jean-Pierre T. F. Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Ludo F. M. Beenen
- Department of Radiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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ElShebiny T, Morcos S, El H, Palomo JM. Comparing different software packages for measuring the oropharynx and minimum cross-sectional area. Am J Orthod Dentofacial Orthop 2021; 161:228-237.e32. [PMID: 34563428 DOI: 10.1016/j.ajodo.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Several imaging software packages report the ability to measure the oropharynx and minimum cross-sectional area (MCA). This study aimed to compare 4 imaging software packages for measuring the oropharynx volume and MCA. METHODS Twenty-eight randomly selected cone-beam computed tomography scans had oropharynx volume and MCA calculated by 2 experienced operators using 4 different programs: Dolphin 3D (version 11.95.8.64; Dolphin Imaging & Management Solutions and Management Solutions, Chatsworth, Calif), InVivo Dental (version 6; Anatomage Inc, San Jose, Calif), OnDemand3D (version 1.0.10.7510; CyberMed, Seoul, South Korea), and ITK-SNAP (version 3.8.0; www.itksnap.org). The measurements were repeated after 2 weeks, and intraclass correlation coefficients were used for the reliability tests. Analysis of variance with the Tukey post-hoc test was used to compare the measurements of oropharynx and MCA with different software programs. Paired t tests were used to compare measurements of both investigators and software programs. Bland-Altman analysis was used to assess interexaminer reliability and agreement between the software programs. RESULTS The intraclass correlation coefficients revealed excellent repeatability for the 4 programs for both investigators. Analysis of variance showed no statistically significant difference between programs when comparing the oropharynx and MCA. There were no significant differences in software programs when measuring the airway. Bland-Altman showed the maximum difference as 4.1 cm3 for volume and 35 mm2 for MCA. Those differences were below the standard deviations of 5.33 cm3 for volume and 73.75 mm2 for MCA. CONCLUSIONS The use of 4 different software packages to measure the airway for oropharynx volume and MCA showed high intraoperator and interoperator reliability, no statistically significant difference when using analysis of variance, Tukey post-hoc, paired t tests, and variations within one standard deviation when using Bland-Altman.
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Affiliation(s)
- Tarek ElShebiny
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio; Private Practice T Smile Orthodontics, Solon, Ohio
| | - Sherif Morcos
- Faculty of Dentistry, Department of Orthodontics, Suez Canal University, Ismailia, Egypt
| | - Hakan El
- Faculty of Dentistry, Department of Orthodontics, Hacettepe University, Ankara, Turkey
| | - Juan Martin Palomo
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
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Iwasaki T, Papageorgiou SN, Yamasaki Y, Ali Darendeliler M, Papadopoulou AK. Nasal ventilation and rapid maxillary expansion (RME): a randomized trial. Eur J Orthod 2021; 43:283-292. [PMID: 33564835 DOI: 10.1093/ejo/cjab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess three rapid maxillary expansion (RME) appliances in nasal ventilation. TRIAL DESIGN Three-arm parallel randomized clinical trial. METHODS Sixty-six growing subjects (10-16 years old) needing RME as part of their orthodontic treatment were randomly allocated (1:1:1 ratio) to three groups of 22 patients receiving Hyrax (H), Hybrid-Hyrax (HH), or Keles keyless expander (K). The primary outcome of nasal ventilation (pressure and velocity) and secondary outcomes (skeletal, dental, soft tissue, and nasal obstruction changes) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone-beam computed tomography (CBCT) data by applying computational fluid dynamics (CFD) method. Differences across groups were assessed with crude and adjusted for baseline values and confounders (gender, age, skeletal maturation, expansion amount, mucosal/adenoid hypertrophy, nasal septum deviation) regression models with alpha = 5%. RESULTS Fifty-four patients were analysed (19H, 21HH, 14K). RME reduced both nasal pressure (H: -45.8%, HH: -75.5%, K: -63.2%) and velocity (H: -30%, HH: -58.5%, K: -35%) accompanied with nasal obstruction resolution (H: 26%, HH: 62%, K: 50%). Regressions accounting for baseline severity indicated HH expander performing better in terms of post-expansion maximum velocity (P = 0.03) and nasal obstruction resolution (P = 0.04), which was robust to confounders. Mucosal/adenoid hypertrophy and nasal septum deviation changes were variable, minimal, and similar across groups. The HH resulted in significantly greater increase in the nasal cross-sectional area (62.3%), anterior (14.6%), and posterior (10.5%) nasal widths. Nasal obstruction resolution was more probable among younger (P = 0.04), skeletally immature (P = 0.03), and male patients (P = 0.02) without pre-treatment mucosal hypertrophy (P = 0.04), while HH was associated with marginal greater probability for obstruction resolution. CONCLUSIONS RME resulted in improvement of nasal skeletal parameters and simulated ventilation with the former being in favour of the HH and the latter not showing significant differences among the three appliances. LIMITATION Attrition in the K group due to blocked activation rods possibly leading to limited sample to identify any existing group differences. HARMS Replacement of blocked Keles expanders for finalizing treatment. PROTOCOL The protocol was not published before the trial commencement. REGISTRATION Australian and New Zealand Clinical Trial Registry; ACTRN12617001136392.
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Affiliation(s)
- Tomonori Iwasaki
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
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Cheung GC, Dalci O, Mustac S, Papageorgiou SN, Hammond S, Darendeliler MA, Papadopoulou AK. The upper airway volume effects produced by Hyrax, Hybrid-Hyrax, and Keles keyless expanders: a single-centre randomized controlled trial. Eur J Orthod 2021; 43:254-264. [PMID: 32377675 DOI: 10.1093/ejo/cjaa031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess upper airway volume changes after rapid maxillary expansion (RME) with three different expanders. TRIAL DESIGN Three-arm parallel randomized clinical trial. METHODS Sixty-six patients, 10-16 years old, in permanent dentition, with maxillary transverse deficiency were recruited and assigned with block randomization (1:1:1 ratio) and allocation concealment to three groups of 22 patients each (Hyrax, Hybrid-Hyrax, and Keles keyless expander). The primary outcome (overall upper airway volume change) and secondary outcomes (volume changes in the nasal cavity, nasopharynx, oropharynx, and hypopharynx) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone beam computed tomography. Differences across groups were assessed with crude or adjusted for confounders (gender, age, growth stage, skeletal pattern, baseline airway volume, and amount of expansion) linear regression models. RESULTS Fifty-one patients were analysed (19, 19, and 13 in the Hyrax, Hybrid-Hyrax, and Keles groups). Maxillary expansion resulted in considerable increases in total airway volume in the Hybrid-Hyrax group (+5902.1 mm3) and less in the Hyrax group (+2537.9 mm3) or the Keles group (+3001.4 mm3). However, treatment-induced changes for the primary and all secondary outcomes were of small magnitude and no significant difference was seen among the three expanderes in the total airway volume in either crude or adjusted analyses (P > 0.05 in all instances). Finally, among pre-peak patients (CVM 1-3), the Hybrid-Hyrax expander was associated with significantly greater increases in total airway volume compared to the Hyrax expander (P = 0.02). CONCLUSIONS RME resulted in relatively small increases in total upper airway volume and its separate compartments, with mostly no statistically significant differences across the Hyrax, Hybrid-Hyrax, and Keles groups. LIMITATIONS Significantly greater attrition was found in the Keles group due to appliance failure. The current trial might possibly be under-powered to detect differences between groups, if such exist. HARMS Keles expanders blocked during activations and required substitution for completion of treatment. PROTOCOL The protocol was not published before trial commencement. REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN12617001136392).
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Affiliation(s)
- Gordon C Cheung
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Oyku Dalci
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Simone Mustac
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shanya Hammond
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
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Leonardi R, Lo Giudice A, Farronato M, Ronsivalle V, Allegrini S, Musumeci G, Spampinato C. Fully automatic segmentation of sinonasal cavity and pharyngeal airway based on convolutional neural networks. Am J Orthod Dentofacial Orthop 2021; 159:824-835.e1. [PMID: 34059213 DOI: 10.1016/j.ajodo.2020.05.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This study aimed to test the accuracy of a new automatic deep learning-based approach on the basis of convolutional neural networks (CNN) for fully automatic segmentation of the sinonasal cavity and the pharyngeal airway from cone-beam computed tomography (CBCT) scans. METHODS Forty CBCT scans from healthy patients (20 women and 20 men; mean age, 23.37 ± 3.34 years) were collected, and manual segmentation of the sinonasal cavity and pharyngeal subregions were carried out by using Mimics software (version 20.0; Materialise, Leuven, Belgium). Twenty CBCT scans from the total sample were randomly selected and used for training the artificial intelligence model file. The remaining 20 CBCT segmentation masks were used to test the accuracy of the CNN fully automatic method by comparing the segmentation volumes of the 3-dimensional models obtained with automatic and manual segmentations. The accuracy of the CNN-based method was also assessed by using the Dice score coefficient and by the surface-to-surface matching technique. The intraclass correlation coefficient and Dahlberg's formula were used to test the intraobserver reliability and method error, respectively. Independent Student t test was used for between-groups volumetric comparison. RESULTS Measurements were highly correlated with an intraclass correlation coefficient value of 0.921, whereas the method error was 0.31 mm3. A mean difference of 1.93 ± 0.73 cm3 was found between the methodologies, but it was not statistically significant (P >0.05). The mean matching percentage detected was 85.35 ± 2.59 (tolerance 0.5 mm) and 93.44 ± 2.54 (tolerance 1.0 mm). The differences, measured as the Dice score coefficient in percentage, between the assessments done with both methods were 3.3% and 5.8%, respectively. CONCLUSIONS The new deep learning-based method for automated segmentation of the sinonasal cavity and the pharyngeal airway in CBCT scans is accurate and performs equally well as an experienced image reader.
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Affiliation(s)
- Rosalia Leonardi
- Department of Orthodontics, School of Dentistry, University of Catania, Catania, Italy.
| | - Antonino Lo Giudice
- Department of Orthodontics, School of Dentistry, University of Catania, Catania, Italy
| | - Marco Farronato
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, Milan, Italy
| | - Vincenzo Ronsivalle
- Department of Orthodontics, School of Dentistry, University of Catania, Catania, Italy
| | | | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, Italy
| | - Concetto Spampinato
- Department of Computer and Telecommunications Engineering, University of Catania, Catania, Italy
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23
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Leonardi R, Giudice AL, Isola G, Spampinato C. Deep learning and computer vision: Two promising pillars, powering the future in orthodontics. Semin Orthod 2021. [DOI: 10.1053/j.sodo.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Tepedino M, Montaruli G, Scapato F, Laurenziello M, Suriano C, Chimenti C, Ciavarella D. Long-term effect on adenoid dimensions and craniocervical angulation after maxillary expansion with fixed or functional appliances. J Clin Exp Dent 2021; 13:e594-e600. [PMID: 34188766 PMCID: PMC8223156 DOI: 10.4317/jced.58171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background Maxillary expansion is a common orthodontic procedure that could have a positive effect also on airway patency. The aim of the present study was to evaluate the long-term effects of rapid maxillary expansion (RME) on nasopharyngeal area and cranio-cervical angulation in growing patients, compared to controls treated with a function-generating bite appliance (FGB).
Material and Methods Sixty patients aged 6-14 consecutively treated with RME or FGB were selected retrospectively and divided into two groups. Lateral cephalograms taken before and after treatment were retrieved, and the nasopharyngeal area, delimited superiorly by a sella-posterior nasal spine (PNS) line and inferiorly by a basion-PNS line, and the cranio-cervical angulation were measured.
Results The mean observation time was 17.6 ± 8 months. No differences were present between the two groups regarding age and gender. The nasopharyngeal area increased significantly in both groups after treatment, but with no statistically significant difference between them. The cranio-cervical angulation showed no differences within or between groups.
Conclusions Maxillary deficiency treatment with either RME or FGB was followed by a comparable increase in nasopharyngeal area. Key words:Rapid maxillary expansion, Airway, Nasopharyngeal area, Adenoid.
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Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesco Scapato
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carmela Suriano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Cheung JL, Dreyer C, Ranjitkar S. Opening up on airways: the purported effect of nasorespiratory obstruction on dentofacial growth. Aust Dent J 2021; 66:358-370. [PMID: 34031885 DOI: 10.1111/adj.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in 'airway friendly orthodontics' among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options. These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.
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Affiliation(s)
- J-Ls Cheung
- Private Practice, Melbourne, Victoria, Australia
| | - C Dreyer
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - S Ranjitkar
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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26
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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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27
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Effectiveness of 2D radiographs in detecting CBCT-based incidental findings in orthodontic patients. Sci Rep 2021; 11:9280. [PMID: 33927309 PMCID: PMC8085218 DOI: 10.1038/s41598-021-88795-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/16/2021] [Indexed: 01/12/2023] Open
Abstract
Some craniofacial diseases or anatomical variations are found in radiographic images taken for other purposes. These incidental findings (IFs) can be detected in orthodontic patients, as various radiographs are required for orthodontic diagnosis. The radiographic data of 1020-orthodontic patients were interpreted to evaluate the rates of IFs in three-dimensional (3D) cone-beam-computed tomography (CBCT) with a large field of view (FOV) and investigate the effectiveness and accuracy of two-dimensional (2D) radiographs for detecting IFs compared to CBCT. Prevalence and accuracy in five areas was measured for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The accuracies of various 2D-radiograph were compared through a proportion test. A total of 709-cases (69.5%) of 1020-subjects showed one or more IFs in CBCT images. Nasal cavity was the most affected area. Based on the CBCT images as a gold standard, different accuracies of various 2D-radiographs were observed in each area of the findings. The highest accuracy was confirmed in soft tissue calcifications with comprehensive radiographs. For detecting nasal septum deviations, postero-anterior cephalograms were the most accurate 2D radiograph. In cases the IFs were not determined because of its ambiguity in 2D radiographs, considering them as an absence of findings increased the accuracy.
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28
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Existence of a Neutral-Impact Maxillo-Mandibular Displacement on Upper Airways Morphology. J Pers Med 2021; 11:jpm11030177. [PMID: 33806410 PMCID: PMC7999116 DOI: 10.3390/jpm11030177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
Current scientific evidence on how orthognathic surgery affects the airways morphology remains contradictory. The aim of this study is to investigate the existence and extension of a neutral-impact interval of bony segments displacement on the upper airways morphology. Its upper boundary would behave as a skeletal displacement threshold differentiating minor and major jaw repositioning, with impact on the planning of the individual case. Pre- and post-operative cone beam computed tomographies (CBCTs) of 45 patients who underwent maxillo-mandibular advancement or maxillary advancement/mandibular setback were analysed by means of a semi-automated three-dimensional (3D) method; 3D models of skull and airways were produced, the latter divided into the three pharyngeal subregions. The correlation between skeletal displacement, stacked surface area and volume was investigated. The displacement threshold was identified by setting three ∆Area percentage variations. No significant difference in area and volume emerged from the comparison of the two surgical procedures with bone repositioning below the threshold (approximated to +5 mm). A threshold ranging from +4.8 to +7 mm was identified, varying in relation to the three ∆Area percentages considered. The ∆Area increased linearly above the threshold, while showing no consistency in the interval ranging from -5 mm to +5 mm.
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29
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Rosaria B, Roberto R, Paolo B, Rosa V, Ambrosina M, Vincenzo D. Effects of surgical mandibular advancement on the upper airways of adult class II patients: A systematic review with meta-analysis. J Oral Rehabil 2021; 48:210-232. [PMID: 33377557 DOI: 10.1111/joor.13140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/21/2020] [Indexed: 01/31/2023]
Abstract
AIM To systematically review the effects of surgical mandibular advancement (SMA) regarding changes of the upper airways in adult patients with skeletal Class II malocclusion. MATERIALS AND METHODS Five electronic databases were searched up to April 2020. Human studies focusing on the morphology and dimension of the upper airways after SMA were included. 'Quality assessment for Before-After (Pre-Post) Studies' was used to assess the risk of bias of the individual studies. Standard mean differences (SMD) with 95% confidence intervals (CI) were calculated for random effect model meta-analysis. The certainty of evidence was assessed using the GRADE tool. RESULTS Twenty cohort studies of only treated patients without control group were eligible for qualitative synthesis, of which 17 were used for quantitative synthesis. Very low certainty of evidence indicated that SMA resulted in significant increase of the volume and of the smallest cross-sectional area (SMC) of the nasopharynx (volume SMD: 1.43, CI: 0.62, 2.24, P = .001, I2 = 87.8%; SMC SMD: 1.53, CI: 0.59, 2.47, P = .001, I2 = 90.5%) and oropharynx (volume SMD: 1.36, CI: 0.37,2.35, P = .007, I2 = 92.1%; SMC SMD: 1.21, CI: 0.11,2.32, P = .032, I2 = 93.1%). Significant augmentation of the distances between the posterior pharynx wall and the uvala (SMD: 0.73, CI: 0.46,0.98, P < .001, I2 = 72.7%), the posterior border of the tongue (SMD: 0.52, CI: 0.21,0.84, P = .001; I2 : 60.5%), the gonion (SMD: 1.24, CI: 0.56,1.91, P < .001; I2 = 88.8%) and the epiglottis (SMD: 0.40, CI: 0.06,0.74, P = .033; I2 = 84.8%) were observed. CONCLUSIONS Weak evidence suggests enlargement of the upper airways of adult Class II subjects following SMA, with major increases in the oropharynx.
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Affiliation(s)
- Bucci Rosaria
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Rongo Roberto
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Bucci Paolo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Valletta Rosa
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Michelotti Ambrosina
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - D'Antò Vincenzo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
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Kumar M, Madi M, Pentapati KC, Vineetha R. Reliability of Linear and Curvilinear Measurements on Cone-Beam Computed Tomography Images for the Evaluation of Implant Sites and Jaw Pathologies. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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31
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Ng JH, Song YL, Yap AUJ. Effects of bicuspid extractions and incisor retraction on upper airway of Asian adults and late adolescents: A systematic review. J Oral Rehabil 2019; 46:1071-1087. [PMID: 31281971 PMCID: PMC6851666 DOI: 10.1111/joor.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/23/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This systematic review aimed to assess the effects of bicuspid extractions and incisor retraction on airway dimension, hyoid position and breathing of adults and late adolescents. METHODS The review was conducted according to PRISMA guidelines. Eight databases including PubMed, EMBASE, Web of Science and Scopus were searched to August 2018. Minimum age of participants was 16 years. The intervention was dual-arch bicuspid extractions with incisor retraction. Outcomes were airway dimension, hyoid position and breathing assessment. RESULTS All nine publications meeting inclusion criteria were from Asia. They were divided into three Asian subregions. All East Asian lateral cephalometric studies reported anteroposterior airway narrowing at the oropharynx and sometimes the hypopharynx. However, the narrowing was small, comparable to measurement errors, and highly variable. Two out of three East Asian computed tomography (CT) studies described reductions in airway dimensions. The single functional breathing study showed increased simulated flow resistance after incisor retraction in East Asians. South Asian studies had mixed findings, with some reporting significant airway narrowing. The single study from West Asia found no significant airway or hyoid changes. CONCLUSIONS Airway response to bicuspid extractions and incisor retraction varied substantially when assessed with cephalometry. CT measurements present larger effect sizes and smaller variations, providing stronger evidence of airway narrowing. Orthodontic extractions for incisor retraction may be more frequently indicated in Asia, and East Asians seem particularly susceptible to airway narrowing and postero-inferior hyoid movement with incisor retraction. Better designed CT studies are needed for confirmation due to small effect size and large variability.
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Affiliation(s)
- Jing Hao Ng
- National Dental Centre SingaporeSingaporeSingapore
| | - Yi Lin Song
- National Dental Centre SingaporeSingaporeSingapore
| | - Adrian U. J. Yap
- National Dental Centre SingaporeSingaporeSingapore
- Department of Dentistry, Ng Teng Fong General HospitalNational University Health SystemSingaporeSingapore
- Faculty of DentistryNational University of SingaporeSingaporeSingapore
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Abdelkarim A. Cone-Beam Computed Tomography in Orthodontics. Dent J (Basel) 2019; 7:E89. [PMID: 31480667 PMCID: PMC6784482 DOI: 10.3390/dj7030089] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022] Open
Abstract
Unlike patients receiving implants or endodontic treatment, most orthodontic patients are children who are particularly sensitive to ionizing radiation. Cone-beam computed tomography (CBCT) carries risks and benefits in orthodontics. The principal risks and limitations include ionizing radiation, the presence of artifacts, higher cost, limited accessibility, and the need for additional training. However, this imaging modality has several recognized indications in orthodontics, such as the assessment of impacted and ectopic teeth, assessment of pharyngeal airway, assessment of mini-implant sites, evaluation of craniofacial abnormalities, evaluation of sinus anatomy or pathology, evaluation of root resorption, evaluation of the cortical bone plate, and orthognathic surgery planning and evaluation. CBCT is particularly justified when it brings a benefit to the patient or changes the outcome of the treatment when compared with conventional imaging techniques. Therefore, CBCT should be considered for clinical orthodontics for selected patients. Prescription of CBCT requires judicious and sound clinical judgment. The central question of this narrative review article is: when does CBCT add value to the practice of orthodontics? To answer this question, this article presents discussion on radiation dosage of CBCT and other imaging techniques used in orthodontics, limitations of CBCT in orthodontics, justifying the use of CBCT in orthodontics, and the benefits and evidence-based indications of CBCT in orthodontics. This review summarizes the central themes and topics in the literature regarding CBCT in orthodontics and presents ten orthodontic cases in which CBCT proved to be valuable.
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Affiliation(s)
- Ahmad Abdelkarim
- Department of Orthodontics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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