Dolphin Imaging Research Articles

The hyoid bone position and upper airway morphology among children with and without adenotonsillar hypertrophy: a cross-sectional study

BackgroundAdenotonsillar hypertrophy (ATH) is a major cause of pediatric obstructive sleep apnea (OSA), potentially impacting craniofacial growth and development. Currently, whether children with ATH exhibit distinctive hyoid bone position and upper airway morphology remains uncertain. This research aimed to compare the hyoid bone position and upper airway morphology of children with and without ATH.MethodsA total of 199 children aged 6–8 years were recruited for the study, and their pre-treatment lateral cephalograms were obtained. The size of the adenoids and tonsils on the lateral cephalogram was assessed based on Fujioka’s and Baroni’s methods for classification into groups: adenoid hypertrophy only (AHO) group, tonsillar hypertrophy only (THO) group, adenoid and tonsillar hypertrophy (AH + TH) group, and control group (CG). The position of the hyoid bone and upper airway morphology was analyzed using Dolphin Image Software.ResultsThe distance between the hyoid bone and mentum was greater in the THO group compared to the AHO group (P = 0.005). Children in the AHO group exhibited a longer soft palate (SPL) compared to the THO group (P = 0.014), whereas the THO group displayed a reduced SPL in comparison to healthy controls (P = 0.008). The THO group showed a more inferior tongue position compared to children in the AHO group (P = 0.004). Subjects in the THO group exhibited significantly wider inferior airway space compared to healthy children (P < 0.001).ConclusionsAdenotonsillar hypertrophy may be associated with hyoid bone position and upper airway morphology in children seeking for orthodontic treatment. In children with enlarged tonsils, the hyoid bone was positioned farther from the mentum than in those with enlarged adenoids. Conversely, children with enlarged adenoids had a longer soft palate compared to those with enlarged tonsils.

Accuracy of web-based automated versus digital manual cephalometric landmark identification.

The purpose of this study was to assess the accuracy of two web-based automated cephalometric landmark identification and analysis programs. Manual landmark identification using Dolphin Imaging software was used as reference. 105 cephalograms were selected and divided into three groups of 35 subjects each, Class I, II and III. Radiographs were traced using Dolphin imaging software. WebCeph™ (South Korea) and Cephio™ (Poland) were used for the automated cephalometric analysis. Bland-Altman limits of agreement and the concordance correlation coefficient (CCC) were calculated. Kruskal Wallis test was used to compare the accuracy of WebCeph™ and Cephio™ measurements between the three groups. Mann-Whitney U test was used to compare the absolute difference between cephalometric measurements obtained using WebCeph™ and Cephio™. The mean difference (MD) between AI and manually-derived measurements was less than 1mm/degree and ranged from 0.01 to 0.8 except for upper lip protrusion (MD 1.35°), nasolabial angle (MD 5.01°), SN-GoGn (MD 1.41°), Ramus height (MD 1.46°), and IMPA (MD 1.94°). The mean CCC was 0.91 (range 0.60 to 0.96). No statistically significant differences were found between the three malocclusion groups for most of the measurements (P > 0.05). For most of the measurements, automated cephalometric measurements were clinically acceptable. Few differences were found between Webceph™ and Cephio™ for most measurements. Measurements including SNA, SN-PP, IMPA as well as soft tissue measurements require extra consideration and manual adjustment of respective landmarks for higher precision and improved efficiency.

COMPARATIVE ANALYSIS OF SOFT TISSUES FACIAL PROFILE CHANGES DURING ORTHODONTIC TREATMENT OF VESTIBULAR POSITIONED MAXILLARY PERMANENT CANINES WITH OR WITHOUT EXTRACTION

The aim: To improve the effectiveness of diagnosing and developing treatment strategies for patients with the vestibular position of permanent canines Material and Methods: Material for the conducted research were the database obtained during clinical examination of 7172 patients that have been referring to our clinic for the orthodontic treatment. Of these, 2,669 were male (37.21%) and 4,503 were female (62.79%). Among the total number of examined patients, 461 were found to have a vestibular position of tooth 13 (6.43±0.29%), and 357 patients had a vestibular position of tooth 23 (4.98±0.26%). A combination of vestibular positions of teeth 12 and 13 was found in 553 patients (7.71±0.31%). Simulation of various orthodontic treatment options to achieve the optimal aesthetic result using the "Dolphin Imaging 11.9" program was conducted in two scenarios: one with the removal of the first permanent premolars and the other without tooth extractions, using maxillary expansion and distalization of the posterior teeth. Two clinical cases are illustrated to demonstrate the stages of treatment in patients with vestibular positioning of maxillary canines, both with and without tooth extraction. Results: The author concludes that the use of the "Dolphin Imaging 11.9" program significantly enhances the effectiveness of diagnosing and orthodontically treating patients with vestibular positioning of permanent maxillary canines, helping to achieve harmony between skeletal and soft tissue facial relationships.

Comparative evaluation of commercially available AI-based cephalometric tracing programs

ObjectivesCompare the accuracy and diagnostic concordance of three commercially available AI-based lateral cephalometric tracing software.Materials and methodsSixty-three lateral cephalometric radiographs were analyzed using semi-automatic (Dolphin Imaging Systems LLC) and AI-based software programs (WebCeph™, Cephio, and Ceppro DDH Inc.). Intra- and inter-observer reliability were assessed for human expert measurements, and repeated-measures one-way ANOVA was used to compare the AI and human expert measurements. The diagnostic performance was evaluated using sensitivity and specificity tests.ResultsHuman expert reliability was excellent (ICC > 0.9) for most cephalometric parameters. Compared to human experts, significant differences were observed for all three AI-based cephalometric programs (WebCeph™ – 10 of 11, Cephio – 7 of 11, and Ceppro DDH Inc. – 7 of 11 cephalometric measurements). Variations exceeding two units were noted for most parameters, and differences in defining the sagittal and vertical skeletal patterns, dental, and soft tissue characteristics were observed.ConclusionAll three AI-based tracing programs showed inaccuracies compared to human expert measurements and lacked reliability in measuring key cephalometric parameters. Clinicians should exercise caution when relying solely on AI-based analyses for orthodontic treatment planning and assessment.

Evaluation Of Accuracy And Reliability Of Artificial Intelligence-Based Fully Automated And Semi-Automated Cephalometric Analysis Software In Comparison With Manual Cephalometric Analysis

Introduction: Lateral cephalometric analysis stands as a pivotal diagnostic tool within the realm of Orthodontics, often regarded as the gold standard. Over time, several computerised programs have surfaced, aiming to streamline the process of digital cephalometric analysis, thereby offering efficiency gains and time savings. The current study sought to assess the diagnostic accuracy and reliability of four computerised cephalometric analysis programs. These encompassed three digital software solutions alongside an online artificial intelligence platform. The objective was to compare the digital approaches against the traditional method of manual cephalometric tracing. Materials and methodology: This study analysed thirty pre-treatment lateral cephalometric radiographs of individuals undergoing orthodontic treatment. Four computer programs—Dolphin Imaging software, Nemoceph, and FACAD for semi-automated cephalometric analysis, and WebCeph for artificial intelligence-based cephalometric analysis—were evaluated and compared with manual cephalometric tracing. Measurements were taken for five skeletal, four dental, and one soft tissue parameters, including six angular and four linear measurements derived from Steiner, McNamara, and Tweed cephalometric analysis. Fifteen cephalometric radiographs were remeasured to assess the intra-examiner correlation coefficient. One-way ANOVA was used to compare different cephalometric points among the various tracing methods, and multiple comparisons were performed using the Post Hoc Tukey’s test. Results: No significant difference was noted in SNA, SNB, ANB, FMA, IMPA, 1 to Pt A, 1 to N-A and nasolabial angle between the software. While 1 to A Pog and 1 to N-B revealed significant differences between the software. FACAD vs. NemoCeph showed a significant difference with a mean difference of -0.30 and -0.30 and a p-value of 0.03 and 0.02 for 1 to A Pog and 1 to N-B values respectively and this variability was noted between FACAD and NemoCeph. Conclusion: Digital and AI-based software have shown accuracy comparable to manual tracing. Among the software, Dolphin Imaging proved to be the most reliable, followed by WebCeph and NemoCeph, with FACAD showing the most variability. The variability, which lacked clinical significance, was primarily due to challenges in identifying certain landmarks.

Diagnostic performance of ClinCheck, Dolphin Imaging, and 3D Slicer software for Bolton discrepancy analysis.

To evaluate the diagnostic performance of ClinCheck, Dolphin Imaging orthodontic software, and 3D Slicer for the analysis of Bolton discrepancy (BD). Fifty-five pairs of early-stage digital models of patients treated with Invisalign were printed to measure the BD by manual method with a digital caliper (gold standard). The discrepancy values calculated by ClinCheck were obtained. In addition, the sample STL files were measured using Dolphin Imaging and 3D Slicer software to obtain BD values. To assess reliability, precision, and accuracy of the methods, intraclass correlation coefficients (ICCs), Dahlberg's formula, paired t-tests, and the Bland-Altman method were used, respectively. Repeated-measures analysis of variance with Bonferroni post hoc test was used to assess the difference between groups. The three methods showed reliable measurements (ICC ≥ 0.7), with the values of anterior Bolton slightly higher than overall Bolton. Measurements for the anterior Bolton showed higher precision (Dahlberg's formula 0.65, 0.70, and 0.55) than those for the overall Bolton. For anterior Bolton, only the measurements obtained by ClinCheck and Dolphin Imaging were accurate (P > .05, no proportion bias), while for overall Bolton, all groups had a significant difference. The Bland-Altman plots demonstrated no consistency for anterior Bolton measurements when 3D Slicer was used and for the overall Bolton. ClinCheck and Dolphin Imaging showed accuracy to quantify anterior BD. For the overall Bolton measurements, ClinCheck showed a statistical difference from the manual assessment but without relevant clinical significance.

Comparative analysis of 3D tomography based soft tissue rendering and Proface facial scanning systems in orthognathic surgery

PurposeThis study aimed to investigate the linear and angular differences in the nasolabial soft tissue in patients who underwent bimaxillary orthognathic surgery using two different three-dimensional imaging methods. Furthermore, the advantages, disadvantages, and limitations of these methods were determined after comparing the data obtained from the imaging methods used in the study. Materials and MethodsPreoperative (T0) and 6-months postoperative (T1) cone-beam computed tomography (CBCT) and three-dimensional facial scanning (3DFS) data from 22 patients who underwent maxillary advancement surgery were examined. The DICOM (Digital Imaging and Communications in Medicine) data (CBCT group) and “.obj” format images (3DFS group) of the patients were analyzed using Dolphin software (Dolphin Imaging®, Version 12, Chatsworth, CA, USA). The linear and angular soft tissue measurements were calculated after determining the reference anatomical landmarks for both groups. ResultsMeasurements with CBCT and 3DFS imaging methods were compared at T0, T1, and all measurements (T0+T1). No statistically significant difference was observed between the CBCT and 3DFS groups for five measurements performed at T0 and T0+T1, but statistically significant differences were observed between the groups for the other seven measurements. There was no statistically significant difference between the CBCT and 3DFS groups for six measurements at T1, but there were statistically significant differences between the groups for the other six measurements. After reviewing the postoperative differences in the nasolabial soft tissue, a statistically significant increase in four linear and one angular measurement in the 3DFS group was observed, and there was a statistically significant increase in two linear and two angular measurements in the CBCT group. Upon comparison of postoperative differences in soft tissue alterations, no statistically significant difference between the 3DFS group and the CBCT group were observed in any of the soft tissue measurements. ConclusionOrthognathic surgery has significant effects on nose width and upper lip morphology. Although both 3DFS and CBCT methods can be used to evaluate such effects, the results of the present study revealed differences in sensitivity and limitations between the two methods. Thus, surgical outcomes should be evaluated in consideration of the abovementioned parameters.

A simple and free software-based inferior alveolar nerve protector surgical guide in bilateral sagittal split osteotomy

ObjectivesThis technical note introduces a novel concept of a alveolar inferior nerve protector guide during orthognathic surgery based on a free-software creation and printing. Technical NoteOrthognathic surgery using Virtual Surgical Planning software like Dolphin Imaging ® v 11.9 facilitated a bimaxillary procedure with mandible advancement and occlusal plane correction, later followed by 3D printing of splints. The process involved importing a composite skull with osteotomies into Blender ® software, where solids were added and edited to match Dolphin's osteotomies, ensuring bone contact without distortion. The guide creation was performed adhering to bilateral sagittal split osteotomy principles, maintaining precision, resulting in preserved inferior alveolar nerve and faster operation times compared to non-guided procedures, as demonstrated by postoperative CT scans. ConclusionsIntegrating advanced tools like Blender software into maxillofacial surgery represents a significant advancement. Despite challenges like the absence of specific manuals for this purpose in Blender, using such software offers innovative and cost-effective solutions. Developing user-friendly resources tailored to surgical applications such as a protector guide within Blender can enhance its usability and improve surgical outcomes and patient care, leading to groundbreaking advancements in maxillofacial surgery.

Mandibular response after rapid maxillary expansion in mixed dentition children with different vertical growth patterns: a retrospective study.

This study evaluated the mandibular development induced by rapid maxillary expansion (RME) therapy in mixed dentition patients with different vertical growth patterns through long-term observation. The research utilized a retrospective design that included two cohorts: a control group consisting of pediatric subjects with individualized malocclusions, and an experimental group received RME therapy. A total of 60 subjects were included; 37 in the RME group (17 males and 20 females) and 23 in the control group (13 males and 10 females). Based on mandibular plane angles, 19 pertinent cephalometric variables were quantified with Dolphin Imaging software, and participants were subclassified into high-angle and normal-angle subgroups. Changes in the groups during the observation period were statistically analyzed with a t-test. Compared to the control group, both sagittal parameters tended to decrease after treatment in the RME group (p < 0.05), and none of the vertical correlations were statistically different (p > 0.05). Within the normal-angle experimental subgroup, sagittal parameters markedly decreased when contrasted with their normal-angle control group (p < 0.05). Notably, a substantive decrease in overjet was solely observable in the sagittal dimension among the high-angle expansion subgroup when compared to the high-angle control subgroup (p < 0.05). In the vertical dimension, neither the normal-angle nor high-angle subgroups exhibited any statistically significant differences from their respective control cohorts (p > 0.05). Based on long-term observation, RME therapy promotes mandible sagittal growth of the mandible in subjects with normal-angle vertical growth patterns. A similar tendency was not observed in subjects with high-angle vertical growth patterns. In addition, the mandibular plane angle did not increase after RME in children with high-angles.

Relationship between interincisal angles and TMJ morphology/position and trabecular structure: a retrospective study

BackgroundTMJ morphology/position and trabecular structure are influenced by various factors. The role of the interincisal angle, an indicator of the anterior occlusal relationship, on TMJ remains unclear. This study aims to investigate the morphology, trabecular bone structure, and position of the condyle, as well as the glenoid fossa’s morphology in skeletal class II populations with different interincisal angles.Materials and methodsA total of 150 adult patients with normodivergent facial types and skeletal class II malocclusions were selected and divided into three groups based on their interincisal angles: normal, small, and large angle groups. The indexes of TMJ were measured using cone-beam computed tomography (CBCT) data and analyzed using Dolphin Imaging, Mimics, and ImageJ.ResultsThe small angle group had the smallest anteroposterior diameter (APD), while the large angle group had a greater mediolateral diameter (MLD). The large angle group exhibited significantly the largest maximum axial area, bone surface area, and bone volume (P < 0.05). Small and large angle groups exhibited greater bone trabeculae (Tb. N) and thinner trabecular thickness (Tb. Th). Compared to the normal angle group, the small angle group exhibited a larger horizontal condylar angle and smaller bilateral condylar angles on the axial plane, while the large angle group showed the opposite trend. Small and large angle groups showed a reduced vertical condyle angle on the coronal plane, with the largest reduction observed in the large angle group (P < 0.05). Small and large angle groups had higher heights of the glenoid fossa (GFH). The large angle group exhibited the greatest GFH and width of the glenoid fossa (GFW) (P < 0.05).ConclusionThe large angle group had elongated oval and large condyles, and deeper glenoid fossae, while a flattened-oval and smaller condyle, and wider and shallower glenoid fossae were observed in the small angle group. Small and large interincisal angle affects the structure of condylar trabeculae, resulting in thinner Tb. Th and greater Th. N. In the condylar position, small and large angle groups exhibit condylar rotation in the axial and coronal planes. Therefore, the interincisal angle affects the morphology, position, and trabecular structure of the TMJ. This implies that we must pay attention to the impact of the interincisal angle on TMJ, and it is crucial to restore the normal interincisal angle during orthodontic treatment.

A 3D-CBCT Volumetric Analysis of Cervical Vertebrae Angulation and Airway Dimensions

Aim: To evaluate the relationship between airway dimensions and cervical vertebrae angulations in dental patients using three-dimensional cone beam computed tomography (3D-CBCT) technology. Materials and Methods: Pre-treatment CBCT scans and cephalometric radiographs were measured for 59 patients (mean age 22±2.3yrs.) using the Dolphin3D software system (version 11.7; Dolphin Imaging &amp; Management Solutions, Chatworth, CA) to record airway dimensions and cervical vertebral angulations. All CBCT images were acquired using the same standard protocol for collection using the iCAT CBCT Unit (Imaging Sciences International, Hatfield, PA): 13cm field of view, 0.4mm voxel size, 8.9sec scan time. Intraclass Correlations (ICC) were performed on duplicate measurements of 10 CBCT scans after a two-week interval to assess reliability. P-value and Pearson correlation coefficients were used to statistically assess the relationship between vertebral angulations and airway dimensions. Results: ICC values from the reliability assessment were &gt;0.90. Pearson correlation coefficients were categorized based on confidence level as follows: high (&gt;0.75 or &lt;-0.75), moderate (0.5 to 0.74 or -0.5 to -0.74), or weak (0.3 to 0.49 or -0.3 to -0.49). No high/moderate correlations were observed. Weak correlations (p&lt;0.05) were observed between the nasopharyngeal volume and the soft tissue thickness at CV1(-0.47) and CV2(-0.34). A weak correlation was observed between the nasal cavity volume and S-N (+0.41) as well as ANS-PNS(+0.38). A weak correlation was observed between the total airway volume and the soft tissue thickness at CV2(-0.34). Conclusion: The soft tissue thickness of the posterior wall of the airway at the level of cervical vertebrae-2 appears to have a weak, negative correlation with several upper airway parameters and total airway volume. Soft tissue thickness of the posterior pharyngeal wall is crucial for dental clinicians to analyze prior to some procedures such as orthognathic surgery and orthodontic treatment that involve growth modification and jaw positioning, as it may have an association with decreased airway volume. Clinical Significance: The relationship between cervical vertebrae angulation, airway, and craniofacial morphology is a complex aspect of human anatomy. In dentistry, it is crucial that clinicians recognize the vital role cervical vertebrae angulation and airway interact in relation to craniofacial morphology. Knowledge of these interconnections will significantly inform treatment planning for multiple oral health conditions such as malocclusions, jaw discrepancies, and temporomandibular joint disorders.

Relation between orthodontic malocculusion and maxillary sinus volume.

This study aimed to determine maxillary sinus volume (MSV) in different skeletal malocclusion classes and the correlation between MSV and craniofacial morphology on Cone Beam Computed Tomography (CBCT). The study was performed retrospectively on CBCT images of individuals aged 12-24 years. A total of 129 patients (70 females, 59 males) with a normal vertical growth pattern (27° ≤ SNGoMe ≤ 38°) were divided into three groups according to malocclusion. Group 1 consisted of Class I (1 ≤ ANB ≤ 4) (n = 46) patients, Group 2 consisted of Class II (ANB > 4) (n = 47) patients, and Group 3 consisted of Class III (ANB < 1) (n = 36) patients. Four angular (SNA, SNB, ANB, SNGoMe) and linear (S-N, ANS-PNS, S-Ar, N-ANS) parameters were measured to evaluate craniofacial morphology. Right and left MSV were measured using Dolphin 11.0 (Dolphin Imaging, Chatsworth, CA, USA) Imaging software. Pearson's correlation analysis was performed to assess statistical correlation. MSV was larger in males than females (male AMSV = 14244.1 ± 4735.8, female AMSV = 12778.2 ± 4606.9 p = 0.011) in the general population, but just the Class II group showed this (male AMSV = 16089.6 ± 4330.4, female AMSV= 12705.9 ± 3210.2, p = 0.008). RMSV and LMSV were similar (female p = 0.181 male p = 0.097), and MSV showed no significant differences between the different malocclusion classes in both sex (female p = 0.315, male p = 0.118). In the Class III group, SNB was positively correlated with RMSV (r = 416, p = 0.012). MSV showed significant positive correlation with N-ANS in all groups (Class I r = 0.359, p = 0.014, Class II r = 0.336, p = 0.021, Cl III r = 0.387, p = 0.02). In the Class II and Cl III groups, there is a statistically significant correlation between MSV and the S-N parameter (Class II r = 0.304, p = 0.038, Class III r = 0.412, p = 0.013). ANS-PNS parameter was measured at the lowest statistically significant level (female 43.1 ± 3.9a, p < 0.001, male 43.1 ± 4.3a, p < 0.001) in the Class III group but no correlation was found with MSV. Only Class II group showed a weak positive correlation between MSV and ANS-PNS (r = 0.314, p = 0.032). There was no difference regarding MSV between malocclusion classes. Class II males exhibit significantly larger MSV compared to females. There is a correlation between MSV and SNB, S-N, N-ANS and ANS-PNS parameters for various orthodontic skeletal patterns. Further studies are needed to understand the relationship between MSV and different skeletal structures.

Measuring Accuracy of Dolphin Imaging Software in predicting upper jaw soft tissue profile changes in Class II Adult Patients treated with Extraction versus Non-Extraction

Measuring Accuracy of Dolphin Imaging Software in predicting upper jaw soft tissue profile changes in Class II Adult Patients treated with Extraction versus Non-Extraction

Accuracy of Digital Imaging Software to Predict Soft Tissue Changes during Orthodontic Treatment.

This study aimed to evaluate the accuracy of the Digital Imaging software in the prediction of soft tissue changes following three types of orthodontic interventions: non-extraction, extraction, and orthognathic surgery treatments. Ninety-six patients were randomly selected from the records of three orthodontic interventions (32 subjects per group): (1) non-extraction, (2) extraction, and (3) orthodontic treatment combined with orthognathic surgery. The cephalometric analysis of soft tissue changes in both the actual post-treatment and the predicted treatment was performed using Dolphin Imaging software version 11.9. A paired t-test was utilized to assess the statistically significant differences between the predicted and actual treatment outcomes of the parameters (p < 0.05). In the non-extraction group, prediction errors were exhibited only in the lower lip parameters. In the extraction group, prediction errors were observed in both the upper and lower lip parameters. In the orthognathic surgery group, prediction errors were identified in chin thickness, facial contour angle, and upper and lower lip parameters (p < 0.05). Digital Imaging software exhibited inaccurate soft tissue prediction of 0.3-1.0 mm in some parameters of all treatment groups, which should be considered regarding the application of Dolphin Imaging software in orthodontic treatment planning.

Comparison of craniomaxillofacial morphology in children with unilateral cleft lip and palate treated with/without presurgical nasoalveolar molding - a retrospective study with a mean age of 5 years.

To three-dimensionally assess differences in craniomaxillofacial skeletal development in patients with operated unilateral cleft lip and palate (UCLP) treated with/without presurgical nasoalveolar molding (PNAM) with a mean age of 5 years. Cone-beam CT radiographs of 30 patients with UCLP who had undergone PNAM and 34 patients with UCLP who did not receive PNAM were analyzed. The data were stored in DICOM file format and were imported into the Dolphin Imaging program for 3D image reconstruction and landmark identification. 33 landmarks, 17 linear and three angular variables representing craniofacial morphology were analyzed and compared by using the Mann-Whitney U tests. The vast majority of linear variables and 3D coordinates of landmark points reflecting craniofacial skeletal symmetry were not significantly different between the two groups. In terms of craniofacial skeletal development, the PNAM group had a significantly smaller anterior nasal spine offset in the midsagittal plane and a greater maxillary length compared to the non-PNAM group. Evaluations performed in early childhood showed that treatment with/without PNAM in the neonatal period was not a major factor influencing craniomaxillofacial hard tissue development in patients with UCLP; moreover, PNAM treatment showed significant correction of skeletal deviation at the base of the nose. Follow-up in early childhood has shown that PNAM treatment administered during the neonatal stage does not impede maxillary development and has benefits in correcting nasal floor deviation. It is a viable option for improving nasal deformity in children with unilateral cleft lip and palate.

3D analysis of upper airway morphology related to obstructive sleep apnea severity

BackgroundObstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive collapse of the upper airway during sleep. However, little evidence is available on the differences between the sub-regions of the upper airway morphology and OSA severity. Since orthodontists frequently perform cone beam computed tomography (CBCT) in the neck area, we aimed to investigate the relationship and the differences between upper airway morphology and OSA severity using CBCT. Materials and methodsThe medical records, CBCT imaging of 21 OSA patients diagnosed by polysomnography, and the apnea-hypopnea index (AHI) results were included to classify OSA severity as mild, moderate, or severe. The minimum cross-sectional areas (MCA) and volumes of the upper pharyngeal airway boundaries in four sub-regions: nasopharynx, retropalatal, retroglossal, and hypopharynx were measured. Dolphin Imaging software was used for upper airway segmentation. The correlation coefficient (r), one-way ANOVA, and the least significant difference post hoc multiple comparison test were applied to fulfill the objectives. ResultsA statistically significant relationship was found between the MCA of the nasopharynx and the AHI (r = −0.473, P < 0.05). Furthermore, a difference was found between mild and moderate and moderate and severe OSA severity in the MCA results of the retroglossal region (P < 0.05). However, no relationship was found between the upper airway volume and OSA severity. ConclusionsMCA was moderately negatively correlated to AHI only in the nasopharynx subregion. Moderate OSA presented significantly less MCA than mild and severe OSA only in the oropharynx and retroglossal subregions.

Analysis of changes and correlation in condyle-fossa relationship after maxillary skeletal expansion.

To investigate the changes in condyle-glenoid fossa relationship after maxillary skeletal expansion (MSE) and to verify the correlation between the condyle positional changes and expansion effect. In this study, 20 patients (mean age 21.1 ± 5.7 years, 8 male, 12 female) with maxillary transverse deficiency (MTD) were treated with the MSE appliance, which contained molar bands and a expander with four micro-implants. The CBCT images were taken before expansion (T0), after expansion (T1) and after 6 months of maintenance (T2). The posterior TMJ space (PS), superior TMJ space (SS), anterior TMJ space, coronal lateral TMJ space (CLS), coronal medial TMJ space (CMS), condyle axis angle, maxillary basal bone width (BWM), inter-molars width, nasal bone width, molar inclination and molar palatal cusp height (U6H) were measured using Dolphin Imaging. At T1, compared with T0, the PS and SS significantly increased by 0.41 mm (P = .008) and 0.3 mm (P = .007). But only the SS significantly increased by 0.21 mm (P = .025) at T2. There was a significant difference of 0.37 mm (left-right, P = .014) between the left and right SS at T0, but no significant difference at T1 and T2. The increased BMW showed weak positive correlations with the change of PS (P = .015) and CMS (P = .031), and the decreased U6H showed weak negative correlations with the change of PS (P = .015) and CLS (P = .031) at T1. The use of MSE led to an increase in the SS and PS, which were weakly correlated with BWM and U6H. But this effect in the TMJ space gradually diminished after 6 months of maintenance, and the symmetry of the condyle-fossa relationship was preserved.

Guidelines for a surgery-first approach using Dolphin Imaging software and the Invisalign system

Guidelines for a surgery-first approach using Dolphin Imaging software and the Invisalign system

Relationship between Bilateral Landmarks of Facial Asymmetry in Skeletal Class II and Class III in Vertical Dimension: 3D Facial Scan and Cone-Beam Computed Tomography.

Significant facial asymmetry can lead to both functional and aesthetic issues. Often, such asymmetry originates from irregularities in the jaw structure. It is critical to recognize that asymmetries can be concealed by soft tissue, which may be overlooked. The aim of this study is to investigate the relationships between bilateral landmarks in the vertical dimension of facial asymmetry among individuals with skeletal Class II and Class III malocclusions. Fifty-two adult patients with a mean age of 24.4 ± 3.79 years with facial asymmetry who underwent orthodontic and orthognathic surgery were studied. Cone-beam computed tomography and facial scans were used to create 3D virtual head models which enhanced the accuracy in addressing facial asymmetry to ensure effective treatment planning. Each landmark was measured and digitized using the Dolphin Imaging program. The findings showed a correlation between gender and type of skeletal discrepancies with the menton deviation direction. In conclusion, the vertical discrepancy between bilateral landmarks was observable in both hard and soft tissues with more pronounced expression in soft tissues. This discrepancy was characterized by an elevation on the same side as the menton deviation, which was a feature observed in both skeletal Class II and Class III individuals.

Accuracy of Dolphin Imaging software in predicting soft tissue changes of Class II Division 1 incisor relationship treated by all first premolar extraction compared with post-treatment lateral cephalogram

To quantify the accuracy of Dolphin Imaging software in predicting soft tissue changes of Class II Division 1 incisor relationship treated by all first premolar extraction compared with actual changes. Pretreatment and post-treatment lateral cephalograms of 30 young adult subjects (25 females and 5 males; age range of 16 to 21 years) were imported and traced in Dolphin Imaging software (version 11.95). Tracings of actual treatment results and the Dolphin predicted treatment outcome were superimposed to calculate the prediction errors. The mean difference for the Holdaway soft tissue analysis and at each landmark was measured in both the X and Y axes. Paired t test was used to compare the statistical differences in Holdaway soft tissue analysis parameters. There were significant differences between the predicted and actual values in three parameters of the Holdaway soft tissue analysis (P < 0.05). The overall accuracy of estimation was better in vertical direction than horizontal. Prediction of upper and lower lip landmarks was overestimated horizontally and underestimated vertically, whereas that belonging to chin was underestimated horizontally and overestimated vertically. Soft tissue nasion and soft tissue A-point were most accurately predicted, whereas the least accuracy was found in soft tissue chin region. Dolphin Imaging Software (version 11.95) can be accurate enough for use in patient communication and education but should be used with caution. It is most accurate in predicting soft tissue changes in the nasion and A-point regions, but least accurate in chin region.