Craniofacial Research Research Articles

Assessing Appearance, Speech, and Hearing (dis)Satisfaction in Individuals with Cleft Lip and/or Palate: A Contribution to General Population Norms.

Individuals with cleft lip and/or palate (CL/P) may grow up with a visible facial difference, alongside speech and/or hearing challenges. Self-perceptions are stronger predictors of psychosocial adjustment than objective assessments, highlighting the importance of patient-reported outcome measures. Previously titled the Satisfaction with Appearance (SwA) questionnaire, the Cleft Hearing, Appearance and Speech Questionnaire (CHASQ) has been used in several countries to assess patient satisfaction, guide clinical decision-making, and conduct craniofacial research, but has lacked general population norms from which to draw comparisons. The aim of this study was to contribute to the development of norms by utilising existing data collected in the United Kingdom (UK) in 2004 using the original SwA. SwA data collected from school pupils (n = 761) aged 10-16 years were analysed across age and gender. Hair, Eyes and Ears received the highest ratings, while Teeth received the lowest ratings. Those who were younger, and those who were male, generally rated their appearance more favourably. Thresholds are proposed to identify young people in need of clinical monitoring (10%) and intervention (5%). This study supports the potential of the CHASQ as a clinically useful outcome measure and research tool with the ability to identify appearance concerns in relation to specific facial features, as well as overall appearance satisfaction in young people with and without CL/P. Further validation of its use in the CL/P population and other patient groups, as well as countries outside the UK would add additional weight to the CHASQ's utility.

Clinical Research Fellowship Fosters Mentorship, Teamwork, and Productivity: Our 11-Year Experience With a Craniofacial Research Fellowship.

This study describes the development and explores the academic impact of a cleft and craniofacial research fellowship. Research and career outcomes from 3 cleft and craniofacial surgeons, 14 clinical fellows, and 25 research fellows between 2010 and 2023 were examined. Academic productivity was measured by the number of peer-reviewed publications indexed in PubMed and podium presentations at national/international meetings. Residency match statistics were recorded for eligible research fellows. Over this 14-year period (11 with research fellows), the team produced 500 publications in 96 peer-reviewed journals, with 153 (31%) in Plastic and Reconstructive Surgery, 117 (23%) in the Journal of Craniofacial Surgery, and 32 (6%) in The Cleft Palate-Craniofacial Journal. Yearly publications increased from 15.3±7.6 per year (before fellowship) to 23.0±5.3 (with 1 fellow) to 38.3±12.9 (2 fellows) to 81.0±5.7 (3 fellows; P<0.001). There was a strong annual linear growth in publications since the beginning the research fellowship position (r=0.88, P<0.001). All (100%) clinical research fellows developed strong relationships with senior surgeons, and all who applied to plastic surgery residency matched a significantly higher success rate than the national average (P<0.05). Implementing a structured cleft and craniofacial clinical research fellowship was associated with a broad impact across all cleft and craniofacial team members, as reflected by increased academic output and high match rates among fellows. The fellowship also strengthens the talent pipeline into plastic surgery by fostering meaningful mentor/mentee relationships and provides a model that can be adopted in both surgical and nonsurgical fields.

Retrospective Cohort Studies in Craniofacial Outcomes Research: An Epidemiologist's Approach to Mitigating Bias.

Retrospective cohort studies, defined as a follow-up study in which outcome occurred prior to study onset, are common in craniofacial outcomes research and will continue to be prevalent given the increasing availability of secondary datasets and inherent prospective study limitations. However, if available data are not adequately measured, or necessary variables are absent, retrospective cohort studies can be particularly prone to bias. This brief communication aims to highlight the primary sources of bias, including measurement error, selection bias, and confounding. Each source is clearly defined, examples pertinent to craniofacial outcomes are provided, and mitigation strategies are discussed.

Identifying Socially Optimal Equilibria Using Combinatorial Properties of Nash Equilibria in Bimatrix Games

Nash equilibrium is arguably the most fundamental concept in game theory, which is used to analyze and predict the behavior of the players. In many games, there exist multiple equilibria, with different expected payoffs for the players, which in turn raises the question of equilibrium selection. In this paper, we study the [Formula: see text]-hard problem of identifying a socially optimal Nash equilibrium in two-player normal-form games (called bimatrix games), which may be represented by a mixed integer linear program (MILP). We characterize the properties of the equilibria and develop several classes of valid inequalities accordingly. We use these theoretical results to provide a decomposition-based reformulation of the MILP, which we solve by a branch-and-cut algorithm. Our extensive computational experiments demonstrate superiority of our approach over solving the MILP formulation through feeding it into a commercial solver or through the “traditional” Benders’ decomposition. Of note, our proposed approach can find provably optimal solutions for many instances. History: Accepted by Andrea Lodi, Area Editor for Design &amp; Analysis of Algorithms. Funding: This work was supported by the National Institute of Dental and Craniofacial Research [Grant R01DE028283]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2022.0072 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2022.0072 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .

Frontiers in Three-Dimensional Surface Imaging Systems for 3D Face Acquisition in Craniofacial Research and Practice: An Updated Literature Review.

Digitalizing all aspects of dental care is a contemporary approach to ensuring the best possible clinical outcomes. Ongoing advancements in 3D face acquisition have been driven by continuous research on craniofacial structures and treatment effects. An array of 3D surface-imaging systems are currently available for generating photorealistic 3D facial images. However, choosing a purpose-specific system is challenging for clinicians due to variations in accuracy, reliability, resolution, and portability. Therefore, this review aims to provide clinicians and researchers with an overview of currently used or potential 3D surface imaging technologies and systems for 3D face acquisition in craniofacial research and daily practice. Through a comprehensive literature search, 71 articles meeting the inclusion criteria were included in the qualitative analysis, investigating the hardware, software, and operational aspects of these systems. The review offers updated information on 3D surface imaging technologies and systems to guide clinicians in selecting an optimal 3D face acquisition system. While some of these systems have already been implemented in clinical settings, others hold promise. Furthermore, driven by technological advances, novel devices will become cost-effective and portable, and will also enable accurate quantitative assessments, rapid treatment simulations, and improved outcomes.

Comparison of intelligent development (IQ &amp; EQ) of children with cleft lip and palate

Background: Attention to the issue of intelligence and its promotion in children with cleft lip and cleft palate (CL and CP) is necessary to reduce their injuries in life. This study aimed to determine the intelligence quotient (IQ) and emotional intelligence (EQ) in children with CL and CP in comparison to healthy children. Materials and Methods: In this descriptive study, 140 children, including 70 children with CL and CP, were selected from the Children treated in Craniofacial and Cleft Research Center, Spearman correlation, ANOVA and 70 healthy children were selected from the Pediatric Dentistry Department of Isfahan University, in the age range of 5–9 years. After obtaining the consent of the children's parents, the Raven IQ questionnaire and the Mayer and Salovey EQ questionnaire were given to the children. Data were analyzed by the Pearson correlation coefficient tests (α =0.05). Results: EQ score in healthy children was significantly higher than in children with CL and CP (P &lt; 0.001). The percentage of IQ cognitive intelligence in healthy children and children with CL and CP was not significantly different (P = 0.641). In healthy children, no significant relationship was observed between cognitive intelligence IQ and EQ (r = 0.018, P = 0.882). However, among children with CL and CP, there was a significant inverse relationship between cognitive intelligence IQ and EQ (P &lt; 0.001, r = −0.526). Conclusion: CL and CP have no effect on IQ in children, but it does affect EQ.

Cost-effectiveness analysis design for interventions to prevent children's oral disease.

In 2015, the National Institute of Dental and Craniofacial Research (NIDCR) launched the Multidisciplinary Collaborative Research Consortium to Reduce Oral Health Disparities in Children, supporting four randomized trials testing strategies to improve preventive care. A Coordinating Center provides scientific expertise, data acquisition and quality assurance services, safety monitoring, and final analysis-ready datasets. This paper describes the trials' economic analysis strategies, placing these strategies within the broader context of contemporary economic analysis methods. The Coordinating Center established a Cost Collaborative Working Group to share information from the four trials about the components of their economic analyses. Study teams indicated data sources for their economic analysis using a set of structured tables. The Group meets regularly to share progress, discuss challenges, and coordinate analytic approaches. All four trials will calculate incremental cost-effectiveness ratios; two will also conduct cost-utility analyses using proxy diseases to estimate health state utilities. Each trial will consider at least two perspectives. Key process measures include dental services provided to child participants. The non-preference-weighted Early Childhood Oral Health Impact Scale (ECOHIS) will measure oral health-related quality of life. All trials are measuring training, implementation, personnel and supervision, service, supplies, and equipment costs. Consistent with best practices, all four trials have integrated economic analysis during their planning stages. This effort is critical since poor quality or absence of essential data can limit retrospective analysis. Integrating economic analysis into oral health preventive intervention research can provide guidance to clinicians and practices, payers, and policymakers.

Application of Machine Learning in Orthodontics: A Bibliometric Analysis

Background: Machine learning (ML), a facet of artificial intelligence, utilizes algorithms to learn from data without explicit programming. In orthodontics, ML offers advantages like tailoring personalized treatment plans for patients. Despite its potential, there hasn’t been a bibliometric analysis of ML studies in orthodontics. This study aims to fill that gap. Types of studies reviewed: Articles on ML in orthodontics were reviewed from Web of Science Core Collection, Embase, Scopus, and PubMed. Data on journal details, country of origin, publication month, citations, keywords, and co-authorship were extracted. Results: The search retrieved a total of 1478 articles, of which 701 were excluded. American Journal of Orthodontics and Dentofacial Orthopedics has published the most articles (3.6%), followed by the seminars in Orthodontics Journal (1.6%), and Orthodontics and Craniofacial Research Journal (1.6%). Most of the articles were from researchers from China (n = 156), the United States (n = 107), and South Korea (n = 70). The number of citations of the published articles ranged from 0 to 702, with most articles (75.54%) having at least one citation. Science Mapping analysis revealed that the most used keywords were Human(s) (n = 484), Artificial intelligence (n = 194), Female (n=169), Male (n = 161), and Cephalometry (n = 151). Clinical implications: Clinicians should be aware of the emerging global collaborative landscape in machine learning trends, stay informed about technological advancements, and consider the potential impact of ML on patient care and treatment outcomes in their practices.

Impact of Specialized Pro-Resolving Lipid Mediators on Craniofacial and Alveolar Bone Regeneration: Scoping Review.

Craniofacial bone defects caused by tumors, trauma, long-term tooth loss, or periodontal disease are a major challenge in the field of tissue engineering. In periodontitis and peri-implantitis, reconstructive therapy is also a major challenge for the dental surgeon. Lipoxins, resolvins, protectins, and maresins, known as specialized pro-resolving lipid mediators (SPMs), have been widely studied in the field of dental, oral, and craniofacial research for bone regeneration for their actions in restoring tissue homeostasis and promoting tissue healing and regeneration. Therefore, this study focuses on a survey of the use of SPMs for craniofacial and alveolar bone regeneration. Thus, electronic searches of five databases were performed to identify pre-clinical studies that evaluated the actions of SMPs on craniofacial and alveolar bone regeneration. Of the 523 articles retrieved from the electronic databases, 19 were included in the analysis. Resolvin (Rv) E1 was the mostly assessed SPM (n=8), followed by maresins (Ma) R1 (n=3), lipoxins (Lx) A4 (n=3), RvD1 (n=3), RvD2 (n=1), LxB4 (n=1), and maresin (M)-CTR3 (n=1). Meta-analysis showed that SPMs increased the newly formed bone by 14.85% compared to the control group (p<0.00001), decreased the area of the remaining defect by 0.35 mm2 (p<0.00001), and decreased the linear distance between the defect to the bone crest by 0.53 mm (p<0.00001). RvE1 reduced inflammatory bone resorption in periodontal defects and calvarial osteolysis and enhanced bone regeneration when RvE1 was combined with a bovine bone graft. RvD2 induced active resolution of inflammation and tissue regeneration in periapical lesions, while RvD1 controlled the inflammatory microenvironment in calvarial defects in rats, promoting bone healing and angiogenesis. MaR1 induced the proliferation and migration of mesenchymal stem cells, osteogenesis, and angiogenesis in calvarial defects, and benzo (b)-LxA4 and LxA4 promoted bone regeneration calvarial and alveolar bone defects in rats, inducing regeneration under inflammatory conditions. In summary, SPMs have emerged as pivotal contributors to the resolution of inflammation and the facilitation of bone neoformation within craniofacial and alveolar bone defects. These results are based on pre-clinical studies, in vivo and in vitro, and provide an updated review regarding the impact of SPMs in tissue engineering.

The Potential Role of Ionic Liquid as a Multifunctional Dental Biomaterial.

In craniofacial research and routine dental clinical procedures, multifunctional materials with antimicrobial properties are in constant demand. Ionic liquids (ILs) are one such multifunctional intelligent material. Over the last three decades, ILs have been explored for different biomedical applications due to their unique physical and chemical properties, high task specificity, and sustainability. Their stable physical and chemical characteristics and extremely low vapor pressure make them suitable for various applications. Their unique properties, such as density, viscosity, and hydrophilicity/hydrophobicity, may provide higher performance as a potential dental material. ILs have functionalities for optimizing dental implants, infiltrate materials, oral hygiene maintenance products, and restorative materials. They also serve as sensors for dental chairside usage to detect oral cancer, periodontal lesions, breath-based sobriety, and dental hard tissue defects. With further optimization, ILs might also make vital contributions to craniofacial regeneration, oral hygiene maintenance, oral disease prevention, and antimicrobial materials. This review explores the different advantages and properties of ILs as possible dental material.

Geroscience: Aging and Oral Health Research.

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the "hallmarks of aging"), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session "Geroscience: Aging and Oral Health Research," held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers' topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer's disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical-dental integration of electronic health records. Research to improve the "oral health span," reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies.

Application and funding status of oral and craniofacial sciences research projects funded by National Natural Science Foundation of China from 2010 to 2021

Objective: Based on the application and funding status of National Natural Science Foundation of China (NSFC) in the field of oral and craniofacial sciences (H15), we analyzed the current status of basic research of the Oral and Craniofacial Sciences (OCS) in China, and provided the references for the sustainable and efficient funding of basic research and scientific frontier exploration in the field, supporting the construction of talents and teams, and enhancing the development of OCS in China. Methods: The data of both applied and funded grants of H15 in NSFC from 2010 to 2021 were analyzed, including the number of applications and funding, the amount of funding, the funding rate, the research direction and the supporting units. The status of basic research of H15 was summarized. Results: From 2010 to 2021, H15 received 15 060 applications and funded 2 569 grants. The overall funding rate of H15 was 17.06%, and the total funding amount was 114.030 5 million yuan. The applications and funded projects of H15 were mainly focused on the General Projects and Youth Science Fund Projects, accounting for 90.33% (13 604/15 060) and 88.71% (2 279/2 569) of the total number of applications and funded projects, and 78.05% 89 002.5/114 030.5 of the total funding amount. In terms of talent training, the National Science Foundation for Distinguished Young Scholars received 65 applications, and 6 were founded, with a funding rate of 9.23%. The National Science Foundation for Outstanding Young Scholars received 85 applications, and 13 were founded, with a funding rate of 15.29%. In recent years, the number of applications has gradually increased and the number of grants has remained relatively stable. Among the nine sub-categories of H15, the top three in terms of the number of applications and grants were H1502, H1504, and H1507. H1502 (repair and regeneration of oral and craniofacial tissue and organ defects) received 2 760 applications, and 510 were funded. H1504 (periodontal and oral mucosal diseases) received 2 475 applications, and 419 were funded. H1507 (restoration of tooth defects and loss, and correction of dental deformities) received 2 270 applications, and 367 were funded. Peking University and Sichuan University ranked first and second with 1 092 and 1 001 applications, respectively. The top five recipients were Sichuan University (327 items), Peking University (260 items), Wuhan University (204 items), Shanghai Jiao Tong University (198 items) and the Fourth Military Medical University of the People's Liberation Army (193 items). The funding rates were 32.67%, 23.81%, 23.02%, 21.69% and 29.11%, respectively. Conclusions: Under the support of NSFC, the basic research of oral and craniofacial sciences has been developed in an all-round way. In recent years, the talent training of all echelons has increased year by year, the research direction and geographical coverage is comprehensive, and project support organization has its own research focus and discipline advantages, making contributions to the realization of the goal of healthy China and the progress of world medicine.

Using Geometric Morphometric Analysis of Magnetic Resonance Imaging to Assess the Anatomy of the Eustachian Tube in Children with and without Otitis Media.

Otitis media (OM) is among the most common of childhood illnesses. It has long been hypothesized that children under age two are predisposed to OM due to differences in the anatomy of the Eustachian tube (ET), including the angle of the ET. OM in later childhood is less common but does occur, begging the question, are there shape differences in the ET that persist underlying later occurrences of OM? To answer this question, a novel method, which applied geometric and morphometric shape analysis to landmarks obtained from MRI data, was used. MRI scans were performed on 16 children (5 control, 3 cOME, and 8 rAOM) between 2011 and 2015. Sixteen landmarks representing the shape of the ET, cranial base, and palate were analyzed. The results of a Procrustes ANOVA indicate that the shape of the ET varies significantly (p < 0.01) between the OM and control groups. The shape differences between the OM group and the control are a medial and low attachment site of the tensor veli palatini (TVP) muscle, a posterior and high torus tubarius, and an anteriorly projected palate. These results support previous findings that a relatively horizontal ET is associated with a predisposition for OM. This study used a novel approach to examine anatomical differences in children with and without OM. First, the data set is unique in that it includes MRI scans of children with a confirmed OM diagnosis. Second, the use of MRI scans in craniofacial anatomy OM research is novel and allows for the collection of soft tissue landmarks and the visualization of soft tissue structures. Third, geometric morphometric shape analysis is a statistical method that captures shape differences, offering a more universal picture of nuanced changes within the entire set of landmarks, in contrast to more traditional linear and angular measurements used in prior OM studies examining craniofacial anatomy.

Three-Dimensional (3D) Analysis of Orbital Morphometry in Healthy Anatolian Adults: Sex, Side Discrepancies, and Clinical Relevance.

Background and objective The complex structural integrity of the orbit is crucial for visual functions. Three-dimensional (3D) reconstructions from radiological images have revolutionized anatomical understanding, eliminating the limitations of two-dimensional (2D) imaging and offering intricate spatial details for complex structures. The aim of this study was to analyze the detailed morphometry of the orbit in healthy Anatolian adults, considering sex, side discrepancies, and clinical relevance using 3D models reconstructed from multidetector computed tomography (MDCT) images. Materials and methods Fifty-six (44.44%) males and 70 (55.56%) females (total: 126, mean age: 48.62) MDCT images were randomly selected and 3D skull models were reconstructed using 3D Slicer software. Measurements were conducted in millimeters (mm) for transverse and vertical diameters, circumference of the orbital opening, orbital wall lengths, as well as intraorbital and extraorbital distances. Results The method of measurements showed high reproducibility of results. The mean values for transverse and vertical diameters, circumference of the orbital opening, medial and lateral wall lengths, roof and floor lengths, and intraorbital and extraorbital distances were 40.23±2.12 mm (p<0.001), 34.94±2.16 mm (p=0.365), 44.74 ±3.02 mm (p<0.001), 46.30±2.69 mm (p<0.001), 51.26±2.91 mm (p<0.001), 49.01±3.22 mm (p<0.001), 126.10±5.71 mm (p<0.001), 19.63±2.35 mm (p=0.026), and 94.09±4.84 mm (p<0.001), respectively. Conclusion The study's high measurement reproducibility contributes significantly to the existing literature and clinical practice. These findings offer specific insights into Anatolian orbital morphometry, aiding in surgical planning, implant placement, and diagnostic assessments. The precise measurement values serve as a reliable reference for clinicians, facilitating the identification of normal and abnormal orbital anatomy and enhancing patient care. We believe this study provides valuable data for craniofacial and ophthalmological research, benefiting both clinical practice and future research endeavors in these fields.

Timing of Primary Surgery for Cleft Palate

BackgroundAmong infants with isolated cleft palate, whether primary surgery at 6 months of age is more beneficial than surgery at 12 months of age with respect to speech outcomes, hearing outcomes, dentofacial development, and safety is unknown.MethodsWe randomly assigned infants with nonsyndromic isolated cleft palate, in a 1:1 ratio, to undergo standardized primary surgery at 6 months of age (6-month group) or at 12 months of age (12-month group) for closure of the cleft. Standardized assessments of quality-checked video and audio recordings at 1, 3, and 5 years of age were performed independently by speech and language therapists who were unaware of the trial-group assignments. The primary outcome was velopharyngeal insufficiency at 5 years of age, defined as a velopharyngeal composite summary score of at least 4 (scores range from 0 to 6, with higher scores indicating greater severity). Secondary outcomes included speech development, postoperative complications, hearing sensitivity, dentofacial development, and growth.ResultsWe randomly assigned 558 infants at 23 centers across Europe and South America to undergo surgery at 6 months of age (281 infants) or at 12 months of age (277 infants). Speech recordings from 235 infants (83.6%) in the 6-month group and 226 (81.6%) in the 12-month group were analyzable. Insufficient velopharyngeal function at 5 years of age was observed in 21 of 235 infants (8.9%) in the 6-month group as compared with 34 of 226 (15.0%) in the 12-month group (risk ratio, 0.59; 95% confidence interval, 0.36 to 0.99; P=0.04). Postoperative complications were infrequent and similar in the 6-month and 12-month groups. Four serious adverse events were reported (three in the 6-month group and one in the 12-month group) and had resolved at follow-up.ConclusionsMedically fit infants who underwent primary surgery for isolated cleft palate in adequately resourced settings at 6 months of age were less likely to have velopharyngeal insufficiency at the age of 5 years than those who had surgery at 12 months of age. (Funded by the National Institute of Dental and Craniofacial Research; TOPS ClinicalTrials.gov number, NCT00993551.)

A Tribute to Dr. William D. McHugh (May 8, 1929–October 6, 2022)

The 12th president of the American Association for Dental Research (now the American Association for Dental, Oral, and Craniofacial Research) and the 65th president of the International Association for Dental Research, Dr. William D. McHugh was one of the longest-serving directors of the Eastman Institute for Oral Health in Rochester, New York. His exceptional leadership was evident throughout his career, and he continually strived to strengthen the science base of the future dentist.

Seeking adverse effects in systematic reviews of orthodontic interventions: a cross-sectional study (part 1)

BackgroundSystematic reviews that assess the benefits of interventions often do not completely capture all dimensions of the adverse effects. This cross-sectional study (part 1 of 2 studies) assessed whether adverse effects were sought, whether the findings on these effects were reported, and what types of adverse effects were identified in systematic reviews of orthodontic interventions.MethodsSystematic reviews of orthodontic interventions on human patients of any health status, sex, age, and demographics, and socio-economic status, in any type of setting assessing any type of adverse effect scored at any endpoint or timing were eligible. The Cochrane Database of Systematic Reviews and 5 leading orthodontic journals were manually searched for eligible reviews between August 1 2009 and July 31 2021. Study selection and data extraction was conducted by two researchers independently. Prevalence proportions were calculated for four outcomes on seeking and reporting of adverse effects of orthodontic interventions. Univariable logistic regression models were used to determine the association between each one of these outcomes and the journal in which the systematic review was published using the eligible Cochrane reviews as reference.ResultsNinety-eight eligible systematic reviews were identified. 35.7% (35/98) of reviews defined seeking of adverse effects as a research objective, 85.7% (84/98) sought adverse effects, 84.7% (83/98) reported findings related to adverse effects, and 90.8% (89/98) considered or discussed potential adverse effects in the review. Reviews in the journal Orthodontics and Craniofacial Research compared with Cochrane reviews had approximately 7 times the odds (OR 7.20, 95% CI 1.08 to 47.96) to define seeking of adverse effects in the research objectives. Five of the 12 categories of adverse effects accounted for 83.1% (162/195) of all adverse effects sought and reported.ConclusionsAlthough the majority of included reviews sought and reported adverse effects of orthodontic interventions, end-users of these reviews should beware that these findings do not give the complete spectrum on these effects and that they could be jeopardized by the risk of non-systematically assessing and reporting of adverse effects in these reviews and in the primary studies that feed them. Much research is ahead such as developing core outcome sets on adverse effects of interventions for both primary studies and systematic reviews.

Cleft Lip and/or Palate: Children's Experiences of Stigma in Colombia.

Given prior craniofacial research reporting higher risk for negative social interactions, this study aimed to explore experiences of stigma described by children with cleft lip and/or palate (CL/P). Qualitative interviews were conducted with children in three sessions (totaling 90-180 min) using creative activities in their homes and/or and walking interviews in their neighborhood. Interview transcriptions were interpreted primarily with thematic analysis following theoretical frameworks of the stigmatization process and self-stigma concept. Participants were recruited through Operation Smile Colombia. Interviews took place at children's homes and neighborhoods within three Colombian regions (Boyacá, Bogotá and Cundinamarca). Children (N = 12) with CL/P aged between 6-12 years were interviewed. Themes fit within the stigmatization process, starting with labeling and stereotyping, such as a range of mockery, and group separation by peers highlighting their not belonging and being socially 'other'. Status loss themes included negative appraisals of cleft-related differences and being perceived as 'ill' and 'imperfect'. Social exclusion themes reflected limited social interactions and loneliness. Self-stigma themes included shame about speaking with peers and anticipation of negative social interactions. The study results suggest that the process of stigmatization and self-stigma adversely affect social interactions for children with a cleft in multiple ways. Healthcare practitioners and policy makers can help address the potential consequences of stigma by implementing interventions at micro, meso and macro levels.

Preface to the 9th Biennial COAST Conference: Harnessing Technology and Biomedicine for Personalized Orthodontics.

The Consortium on Orthodontic Advances in Science and Technology (COAST) convened for its 9th biennial conference titled 'Harnessing Technology and Biomedicine for Personalized Orthodontics' to explore cutting-edge craniofacial research towards building the foundations for precision care in orthodontics. Seventy-five faculty, scholars, private practitioners, industry, residents and students met at the UCLA Arrowhead Lodge on 6-9 November 2022 for networking, scientific presentations and facilitated discussions. Thirty-three speakers provided state-of-the-art, evidence-based scientific and perspective updates in craniofacial and orthodontic-related fields. The overall format included an Education Innovation Award Faculty Development Career Enrichment (FaCE) workshop focused on faculty career development, three lunch and learns, keynote or short talks and poster presentations. The 2022 COAST Conference was organized thematically to include (a) genes, cells and environment in craniofacial development and abnormalities; (b) precision modulation of tooth movement, retention and facial growth; (c) applications of artificial intelligence in craniofacial health; (d) precision approaches to Sleep Medicine, OSA and TMJ therapies; and (e) precision technologies and appliances. The collective advances in orthodontics and science represented in the manuscripts of this issue fulfil our goal of laying solid foundations for personalized orthodontics. Participants elevated the need for stronger industry-academic research partnerships to leverage knowledge gained from large datasets with treatment approaches and outcomes; systematizing the potential of big data including through multi-omics and artificial intelligence approaches; refining the genotype: phenotype correlation to create biotechnology that will rescue inherited dental and craniofacial defects; evolving studies of tooth movement, sleep apnoea and TMD treatment to accurately measure dysfunction and treatment successes; and maximizing the integration of newer orthodontic devices and digital workflows. Technological advances combined with those in biomedicine and machine learning are rapidly changing the delivery of health care including that in orthodontics. These advances promise to lead to enhanced customization, efficiencies and outcomes of patient care in routine orthodontic problems and in severe craniofacial problems, OSA and TMD.

Oral and craniofacial research in the Generation R study: an executive summary

ObjectivesOral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood.MethodsWithin the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants.Research outcomesIn total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health–related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements.ConclusionsSeveral research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study.Clinical relevanceBeing embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population.