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Lee H, Ahmad S, Frazier M, Dundar MM, Turkkahraman H. A novel machine learning model for class III surgery decision. J Orofac Orthop 2024; 85:239-249. [PMID: 36018345 DOI: 10.1007/s00056-022-00421-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The primary purpose of this study was to develop a new machine learning model for the surgery/non-surgery decision in class III patients and evaluate the validity and reliability of this model. METHODS The sample consisted of 196 skeletal class III patients. All the cases were allocated randomly, 136 to the training set and the remaining 60 to the test set. Using the test set, the success rate of the artificial neural network model was estimated, along with a 95% confidence interval. To predict surgical cases, we trained a binary classifier using two different methods: random forest (RF) and logistic regression (LR). RESULTS Both the RF and the LR model showed high separability when classifying each patient for surgical or non-surgical treatment. RF achieved an area under the curve (AUC) of 0.9395 on the test set. 95% confidence intervals were computed by bootstrap sampling as lower bound = 0.7908 and higher bound = 0.9799. On the other hand, LR achieved an AUC of 0.937 on the test set. 95% confidence intervals were computed by bootstrap sampling as lower bound = 0.8467 and higher bound = 0.9812. CONCLUSIONS RF and LR machine learning models can be used to generate accurate and reliable algorithms to successfully classify patients up to 90%. The features selected by the algorithms coincide with the clinical features that we as clinicians weigh heavily when determining a treatment plan. This study further supports that overjet, Wits appraisal, lower incisor angulation, and Holdaway H angle can be used as strong predictors in assessing a patient's surgical needs.
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Affiliation(s)
- Hunter Lee
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, 1121 West Michigan Street, 46202, Indianapolis, IN, USA
| | - Sunna Ahmad
- Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Michael Frazier
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, 1121 West Michigan Street, 46202, Indianapolis, IN, USA
| | - Mehmet Murat Dundar
- Department of Computer and Information Science, School of Science, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Hakan Turkkahraman
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, 1121 West Michigan Street, 46202, Indianapolis, IN, USA.
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Bravo Vallejo G, Alcaraz Ros GDD, Peloso RM, Gambardela-Tkacz CM, Cotrin P, Freitas KMS, de Freitas MR. Long-term profile attractiveness of patients with Class I and II malocclusion treated with and without extractions: A 35-year follow-up. Am J Orthod Dentofacial Orthop 2024; 165:513-519. [PMID: 38231168 DOI: 10.1016/j.ajodo.2023.11.009] [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: 06/01/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION The objective of this study was to compare the profile attractiveness in subjects treated with and without extractions after the long-term 35-year follow-up, according to laypeople, dentists, and orthodontists. METHODS A total of 40 patients with Class I and II malocclusion were divided into 2 groups, according to the treatment protocol: extraction (E) group, extractions of 4 premolars (n = 24), with mean pretreatment (T1), posttreatment (T2), and long-term posttreatment (T3) ages of 13.13, 15.50 and 49.56 years, respectively. The mean treatment time (T2 - T1) was 2.37 years, and the long-term follow-up (T3 - T2) was 34.19. Nonextraction (NE) group (n = 16), with mean ages at T1, T2, and T3 of 13.21, 15.07, and 50.32 years, respectively. The mean (T2 - T1) was 1.86 years, and the (T3 - T2) was 35.25 years. Lateral cephalograms were used to perform profile facial silhouettes, and an online evaluation was performed by 72 laypeople, 63 dentists, and 65 orthodontists, rating the attractiveness from 1 (least attractive) to 10 (most attractive). The intragroup comparison was performed with the repeated measures analysis of variance and Tukey tests. Intergroup comparison was performed with t tests, 1-way analysis of variance, and Tukey tests. RESULTS The E group had a longer treatment time than that of the NE group. In the pretreatment, posttreatment, and long-term posttreatment stages, the E and NE groups showed similar profile attractiveness. Laypersons and dentists were more critical than orthodontists. CONCLUSIONS At long-term posttreatment follow-up, profile attractiveness was similar in patients treated with and without extractions.
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Affiliation(s)
- Gabriel Bravo Vallejo
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
| | | | - Renan Morais Peloso
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Paula Cotrin
- Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Paraná, Brazil
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Gentile A, Ferrara D, Maci M, Ciavarella D. Correction of Class III Malocclusion Treated with Carriere® Motion™. Case Rep Dent 2023; 2023:8848581. [PMID: 37842329 PMCID: PMC10576646 DOI: 10.1155/2023/8848581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Class III malocclusion needs complex orthodontic treatment. This case report describes a 16-year-old male patient with skeletal class III malocclusion with a negative overjet and overbite. Upper incisors were proclined with the accentuated curve of Wilson. Treatment has changed the functional curve of Wilson that has improved functional dynamic occlusion. The patient was treated using a Carriere® Motion™ Class III (CM3) and SLX 3D Brackets system. After a 25-month treatment, the patient reached class I molars and canines relationships on both sides with good facial aesthetics and good functional occlusion. The result was also satisfactory for the patient. A one-year follow-up confirmed that the outcome was stable.
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Affiliation(s)
- Alberto Gentile
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Donatella Ferrara
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Marta Maci
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
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El Khoury K, Ghoubril J, Kassis A, Khoury E. Factors influencing the perception of profile beauty in Class III dental compensation: A comparative cross-sectional study according to three categories of assessors. Int Orthod 2023; 21:100784. [PMID: 37331196 DOI: 10.1016/j.ortho.2023.100784] [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: 03/22/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION The main objective of this study was to evaluate the different factors influencing the perception of female profile facial beauty in Class III patients with protruded mandible that can be treated with orthodontic dental compensation: (1)severity of the protrusion, (2) the upper incisors inclination and (3) the presence of jawlines. The secondary objective was to determine if the rater's gender and profession played a role in the assessment of the preferred profile. METHODS A normal and smiling photographs of a female subject with normal facial and skeletal profile criteria were digitally manipulated to obtain 3 different mandibular sagittal positions: 0mm, +4mm and +8mm. Each position of the chin was evaluated with the presence or not of jawlines. In the smiling profiles, the same chin modifications were scored, and the maxillary incisor inclination was changed from 0 to +10 degrees with 5 degrees increments. A total of 320 raters (107 dentists, 103 orthodontists and 110 laypeople) scored the attractiveness of the different images using a Visual Analogue Scale. The limit of statistical significance was P<0.05. Generalized estimating equation (GEE) models were conducted to assess the predictors of variations in ratings within each set of photos, as well as the interactions of predictors where adjusted odds ratios (aOR) and their 95% confidence intervals were calculated and reported. RESULTS In the profiles without a smile, image +4mm chin (Class III treated by compensation) and image +8-mm mandible (Class III not treated) were selected as the most and least attractive images, respectively, by almost all groups with no difference. The presence of jawlines has a positive role in facial attractiveness. In the smiling profiles, all the examiners showed a preference for image +4-mm chin and a slight protrusion of maxillary incisors (+5 degrees). No significant difference was found between genders in this study. CONCLUSIONS Class III treated by compensation (+4mm) are more attractive than non-treated Class III (+8mm) by almost all groups with no difference. The presence of jawlines has a positive role in facial attractiveness. In the smiling profiles, all the examiners showed a preference for image +4-mm chin and a slight protrusion of maxillary incisors (+5 degrees). Orthodontists older than 50 years old are aware of the difficulty to treat a skeletal Class III and tend to accept it due to their long career experience. No significant difference was found between genders in this study.
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Affiliation(s)
- Khalil El Khoury
- Saint Joseph University of Beirut, Faculty of Dental Medicine, Orthodontic Department, Beirut, Lebanon
| | - Joseph Ghoubril
- Saint Joseph University of Beirut, Faculty of Dental Medicine, Orthodontic Department, Beirut, Lebanon
| | - Adib Kassis
- Saint Joseph University of Beirut, Faculty of Dental Medicine, Orthodontic Department, Beirut, Lebanon
| | - Elie Khoury
- Saint Joseph University of Beirut, Faculty of Dental Medicine, Orthodontic Department, Beirut, Lebanon.
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Varghese C, Ramaiah PT, Setty S, Madhusudhan V, Thimmiah MK, Dakshina CK. Evaluation of stress distribution values at the temporomandibular joint and distalization of teeth during en-masse retraction of the mandibular dentition using buccal shelf bone screws: A FEM study. Int Orthod 2023; 21:100747. [PMID: 36907085 DOI: 10.1016/j.ortho.2023.100747] [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: 12/24/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Present Finite-element-method (FEM) study evaluates the stress distribution values at the Temporomandibular-Joint (TMJ) during en-masse retraction of the mandibular dentition using buccal shelf bone screws with varying magnitudes of forces. MATERIAL AND METHODS Nine replicas of a pre-existing three-dimensional finite element model of the craniofacial skeleton and articular disc from Cone-Beam-Computed-Tomography (CBCT) data and Magnetic-Resonance-Imaging (MRI) data of a patient were used. Buccal shelf (BS) bone screws were inserted buccal to the mandibular second molar region. Forces of magnitudes 250 gm, 350 gm and 450 gm were applied through NiTi coil springs along with stainless-steel archwires of sizes 0.016 × 0.022-inch, 0.017 × 0.025-inch and 0.019 × 0.025-inch. RESULTS On the articular disc, the maximum stress was observed at the inferior region and the inferior part of the anterior and posterior zone at all force levels. The stress on the articular disc and displacement of teeth increased with increase in force levels in all the 3 archwires. The maximum stress at the articular disc and displacement of teeth was observed for 450 gm force and the least for 250 gm force. No significant difference in the amount of displacement of teeth or the stresses produced at the articular disc was seen with increasing the size of the archwire. CONCLUSION With the present FEM study, we can deduce that it is better to use forces of lower levels on patients with temporomandibular-disorders (TMD) so as to reduce the stresses produced at the TMJ to avoid worsening of the TMD condition.
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Affiliation(s)
- Cilpa Varghese
- Department of Orthodontics and Dentofacial Orthopedics, Sri-Siddhartha Dental College and Hospital, Sri-Siddhartha Academy of Higher Education, Tumkur, Karnataka, India.
| | - Prasanna T Ramaiah
- Department of Dentistry, Siddaganga Medical College and Research Institute, Tumkur, Karnataka, India
| | - Suhas Setty
- Department of Oral Medicine and Radiology, Siddhartha Dental College and Hospital, Tumkur, Karnataka, India
| | - V Madhusudhan
- Department of Orthodontics and Dentofacial Orthopedics, Sri-Siddhartha Dental College and Hospital, Sri-Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
| | - Manjula K Thimmiah
- Department of Orthodontics and Dentofacial Orthopedics, Sri-Siddhartha Dental College and Hospital, Sri-Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
| | - Chethan K Dakshina
- Department of Orthodontics and Dentofacial Orthopedics, Sri-Siddhartha Dental College and Hospital, Sri-Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
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Is There Any Differences in Dento-Skeletal Stability between One Vs. Three-Screw Fixation of Mandible Following Bilateral Sagittal Split Osteotomy (BSSO)? World J Plast Surg 2022; 11:46-56. [PMID: 36117899 PMCID: PMC9446116 DOI: 10.52547/wjps.11.2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
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Araujo MTDS, Squeff LR. Orthodontic camouflage as a treatment alternative for skeletal Class III. Dental Press J Orthod 2021; 26:e21bbo4. [PMID: 34524381 PMCID: PMC8439187 DOI: 10.1590/2177-6709.26.4.e21bbo4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Skeletal Class III malocclusion is a deformity of complex treatment, with few intervention alternatives, which are further limited in nongrowing patients. In most cases, orthognathic surgery is the ideal treatment for adults, an option often refused by patients. Mild to moderate skeletal Class III malocclusions and acceptable facial esthetics can benefit from a course of treatment in which dental movements are used to compensate for the skeletal discrepancy. Objective: This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications and expected results.
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Surgical-Orthodontic Diagnosis and Treatment Planning in an Asymmetric Skeletal Class III Patient—A Case Report. Symmetry (Basel) 2021. [DOI: 10.3390/sym13071150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The skeletal Class III pattern is characterized by a sagittal intermaxillary mesial discrepancy. This discrepancy may have an unfavorable impact on function and aesthetics, which can be aggravated by the presence of facial asymmetries. This case report describes the diagnosis and treatment planning of a 19-year-old male patient with a skeletal Class III, maxillary hypoplasia, anterior crossbite, and mandibular asymmetry. When the patient reached skeletal maturity at the end of puberty, the definitive diagnosis was skeletal Class III with hyperdivergent profile and mandibular asymmetry, and a surgical-orthodontic treatment was proposed. At the end of the treatment, bimaxillary surgical correction allowed a skeletal Class I with mandibular symmetry, improving the function of the stomatognathic system and facial aesthetics.
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Möhlhenrich SC, Kötter F, Peters F, Kniha K, Chhatwani S, Danesh G, Hölzle F, Modabber A. Effects of different surgical techniques and displacement distances on the soft tissue profile via orthodontic-orthognathic treatment of class II and class III malocclusions. Head Face Med 2021; 17:13. [PMID: 33853633 PMCID: PMC8048257 DOI: 10.1186/s13005-021-00264-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background Orthognathic surgery can be carried out using isolated mandibular or maxillary movement and bimaxillary procedures. In cases of moderate skeletal malocclusion, camouflage treatment by premolar extraction is another treatment option. All these surgical procedures can have a different impact on the soft tissue profile. Methods The changes in the soft tissue profile of 187 patients (Class II: 53, Class III: 134) were investigated. The treatment approaches were differentiated as follows: Class II: mandible advancement (MnA), bimaxillary surgery (MxS/MnA), upper extraction (UpEX), or Class III: maxillary advancement (MxA), mandible setback (MnS), bimaxillary surgery (MxA/MnS), and lower extraction (LowEX) as well as the extent of skeletal deviation (moderate Wits appraisal: − 7 mm to 7 mm, pronounced: Wits <− 7 mm, > 7 mm, respectively). This resulted in five groups for Class II treatment and seven groups for Class III treatment. Results In the Class II patients, a statistically significant difference (p ≤ 0.05) between UpEX and moderate MnA was found for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), and mentolabial angle (Pog’-B′-Li). In the Class III patients, a statistically significant differences (p ≤ 0.05) occurred between LowEX and moderate MxA for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), upper and lower lip distacne to esthetic line (Ls/Li-E-line), and lower lip length (Sto-Gn’). Only isolated significant differences (p < 0.05) were recognized between the moderate surgical Class II and III treatments as well between the pronounced Class III surgeries. No statistical differences were noticed between moderate and pronounced orthognathic surgery. Conclusions When surgery is required, the influence of orthognathic surgical techniques on the profile seems to be less significant. However, it must be carefully considered if orthognathic or camouflage treatment should be done in moderate malocclusions as a moderate mandibular advancement in Class II therapy will straighten the soft tissue profile much more by increasing the facial and soft tissue profile angle and reducing the mentolabial angle than camouflage treatment. In contrast, moderate maxillary advancement in Class III therapy led to a significantly more convex facial and soft tissue profile by decreasing distances of the lips to the E-Line as well as the lower lip length. Supplementary Information The online version contains supplementary material available at 10.1186/s13005-021-00264-4.
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Affiliation(s)
- Stephan Christian Möhlhenrich
- Department of Orthodontics, University Witten/Herdecke, Alfred-Herrhausen-Straße 45, 58448, Witten, Germany. .,Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Florian Kötter
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sachin Chhatwani
- Department of Orthodontics, University Witten/Herdecke, Alfred-Herrhausen-Straße 45, 58448, Witten, Germany
| | - Gholamreza Danesh
- Department of Orthodontics, University Witten/Herdecke, Alfred-Herrhausen-Straße 45, 58448, Witten, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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