Experienced Orthodontists Research Articles

A Novel Mathematical Method to Diagnose the Transverse Growth Deficit of the Nasomaxillary Complex.

The diagnosis of transverse growth deficit of the maxilla in daily clinical practice is carried out mainly through the experience of a well-trained clinician, which implies a lack of objective criteria applicable in a protocolized manner. The objective of this study was to establish a mathematical method to diagnose maxillary compression in relation to the dimensions of the skull and mandible. Methods: Records of 97 cases with an overall mean age of 9.8 ± 2.6 years were analyzed by three experienced orthodontists. The group of transverse compression was comprised of 62 cases and the control group of 35 cases. The main measurements of the widths were made on a frontal teleradiography of the skull (cranial, zygomatic, orbital, maxillary, bigonial and biantegonial width) and a lateral teleradiography of the skull (facial axis, mandibular plane, SNA, SNB, ANB and Wits). It was established that from the cranial width it is possible to predict the group to which each subject studied belongs—the compression group or the control group. A mathematical formula was obtained in the form of logistic regression that allows for the diagnosis of the presence of maxillary compression based on the cranial, maxillary and orbital widths with a sensitivity of 88.7% and a specificity of 77.1%.

Accuracy of two orthodontic mini-implant templates in the infrazygomatic crest zone: a prospective cohort study

BackgroundIn the clinic, most computer-aided design and manufacturing orthodontic mini-implant guides are suitable for the position between the tooth roots, and few templates are designed and used for the infrazygomatic crest zone. In this study, we took into account the structure of the infrazygomatic crest and 3D printing technology, developed two kinds of templates, and evaluated their clinical effects.MethodsSeventeen patients who accepted 30 mini-implant insertions in the infrazygomatic crest were selected. According to different implantation methods, three groups were divided. In Groups A and B, the mini-implants were positioned with an A-type or B-type template designed by EXOCAD software. In Group C, the mini-implants were inserted by an experienced orthodontist without any guides. We simulate the bucco-palatal, mesio-distal, and vertical head positions in the Segma implant guide software and measure the deviation from the virtual design position of the mini-implant. The linear deviation of the mini-implant tip and cap and the angular deviation of the long axis of the mini-implant in the bucco-palatal direction, mesio-distal direction, and vertical direction were also measured. The results were statistically analysed by SPSS software.ResultsThe deviations of Group A and Group C’s miniscrew cap in the bucco-palatal direction, Group A and Group B, Group A and Group C’s miniscrew tip in the mesio-distal direction, and Group B and Group C’s miniscrew tip and cap in the vertical direction were statistically significant (P < 0.05). There was a significant difference in the deviations of Group A and Group C’s miniscrew tip and cap in the vertical direction (P < 0.01).ConclusionsIn the vertical direction, the accuracy of implantation with the template is higher than that of the traditional method without the template to avoid piercing the maxillary sinus mucosa in the infrazygomatic crest zone.

Occlusal deviations in adolescents with idiopathic and congenital scoliosis.

ObjectiveThis cross-sectional study aimed to investigate the characteristics of malocclusions in scoliotic patients through clinical examinations.MethodsFifty-eight patients with idiopathic scoliosis (IS) and 48 patients with congenital scoliosis (CS) participated in the study. A randomly selected group of 152 orthopedically healthy children served as the control group. Standardized orthodontic and orthopedic examination protocols were used to record the occlusal patterns and type of scoliosis. Assessments were made by three experienced orthodontists and a spinal surgery team. The differences in the frequency distribution of occlusal patterns were evaluated by the chi-squared test.ResultsIn comparison with patients showing IS, patients with CS showed a higher incidence of Cobb angle ≥ 45° (p = 0.020) and included a higher proportion of patients receiving surgical treatments (p < 0.001). The distribution of the Angle Class II subgroup was significantly higher in the IS (p < 0.001) and CS (p = 0.031) groups than in the control group. In comparison with the healthy controls, the CS and IS groups showed significantly higher (p < 0.05) frequencies of asymmetric molar and asymmetric canine relationships, upper and lower middle line deviations, anterior deep overbite, unilateral posterior crossbite, and canted occlusal plane, with the frequencies being especially higher in CS patients and to a lesser extent in IS patients.ConclusionsPatients with scoliosis showed a high frequency of malocclusions, which were most obvious in patients with CS.

Use of automated artificial intelligence to predict the need for orthodontic extractions.

ObjectiveTo develop and explore the usefulness of an artificial intelligence system for the prediction of the need for dental extractions during orthodontic treatments based on gender, model variables, and cephalometric records.MethodsThe gender, model variables, and radiographic records of 214 patients were obtained from an anonymized data bank containing 314 cases treated by two experienced orthodontists. The data were processed using an automated machine learning software (Auto-WEKA) and used to predict the need for extractions.ResultsBy generating and comparing several prediction models, an accuracy of 93.9% was achieved for determining whether extraction is required or not based on the model and radiographic data. When only model variables were used, an accuracy of 87.4% was attained, whereas a 72.7% accuracy was achieved if only cephalometric information was used.ConclusionsThe use of an automated machine learning system allows the generation of orthodontic extraction prediction models. The accuracy of the optimal extraction prediction models increases with the combination of model and cephalometric data for the analytical process.

Clinical feasibility evaluation of digital dental articulation for three-piece maxillary orthognathic surgery: a proof-of-concept study

Digital dental articulation for three-piece maxillary orthognathic surgery is challenging. The purpose of this proof-of-concept study was to evaluate the clinical feasibility of a newly developed mathematical algorithm to digitally establish the final occlusion for three-piece maxillary surgery. Five patients with jaw deformities who had undergone a three-piece double-jaw surgery that was planned virtually were randomly selected for this study. The final occlusion had been hand-articulated using stone casts, scanned into the computer and used in the surgery. These hand-articulated occlusions served as the control group. To form the experimental group, the three-piece maxillary dental arch was articulated again automatically from the patient’s original occlusion using the mathematical algorithm. The hand- and algorithm-articulated occlusions were then evaluated qualitatively by two experienced orthodontists. A quantitative evaluation was also performed. The results of the qualitative evaluation showed that all of the three-piece occlusions, hand- and algorithm-articulated, were clinically acceptable based on the American Board of Orthodontics grading system. When compared, two of the algorithm-articulated occlusions were clearly better (40%), one was the same (20%), and two were slightly worse (40%) than the hand-articulated occlusions. All of the quantitative measurements were comparable between the two articulation methods. In conclusion, the results of this study demonstrate that it is clinically feasible to digitally articulate the three-piece maxillary arch to the intact mandibular dental arch.

Reporting Sample Size Calculation in Randomized Clinical Trials Published in 4 Orthodontic Journals.

The purpose of this study was to describe sample size calculations in randomized clinical trials (RCTs) published in four orthodontic journals. This cross-sectional study evaluated 142 RCTs published from 2015 to 2019 in the four journals with the highest impact factor in orthodontics according to SCIMAGO 2018 ranking. Two trained and experienced orthodontists assessed if the RCTs evaluated reported their sample size calculations, and if they adequately described the criteria for the calculations, including the level of significance, test power, precision or effect size (clinically relevant difference), and expected variability. The reporting of sample size calculation was considered adequate when the above four criteria were described. We identified 120 publications (84.5%) reporting the sample size calculation, but only 70 (58.3%) fully described the above parameters. Inadequate calculation included failure to report the confidence level (ranging from 0% to 12.9%), test power (ranging from 0% to 20%), effect size (ranging from 0% to 22.5%) and expected variability (ranging from 22.6% to 80%). According to the journal, some parameters of sample size calculation were more frequently reported. RCTs published in four leading orthodontic journals frequently do not report the parameters used for sample size calculations.

Evaluation of the distortion of photographs using various focal lengths.

It is of interest to evaluate the distortion of intraoral frontal photographs using various focal lengths. Intra-oral frontal view pictures of 20 subjects were taken using a standard 18-55mm lens of a DSLR camera at three different focal lengths (18mm, 35mm, 55mm). 52 experienced orthodontists were chosen and they were asked to assess the photographs and choose the one with the least amount of distortion. Majority of the orthodontists selected the frontal photograph taken at a focal length of 35mm as the best photo with the least distortion among the three photographs. The photos taken at a focal length of 35 mm showed the least amount of distortion.

Predictability of overbite control with the Invisalign appliance

Control of overbite is considered essential in achieving ideal orthodontic outcomes. Questions have been raised regarding the accuracy of ClinCheck software (AlignTechnology, Santa Clara, Calif) in predicting posttreatment outcomes with Invisalign, with the paucity of well-researched literature available on this topic. This research aimed to investigate and determine the accuracy of Invisalign (Align Technology) in correcting a deep overbite by comparing the outcomes predicted by ClinCheck with achieved posttreatment outcomes. A retrospective study was conducted using pretreatment and posttreatment intraoral scans and predicted outcome (ClinCheck) stereolithography files of 42 adult patients consecutively treated with Invisalign from January 2014 and completed before July 2018, selected from the files of 1 experienced orthodontist. Patients included in the study were treated without extractions and with a minimum of 14 dual arch Invisalign aligners using a 2-weekly aligner change protocol. The pretreatment, posttreatment, and predicted outcome stereolithography files for each patient were imported into Geomagic Control X (3D Systems, Rock Hill, SC) software to measure overbite. The deeper the patient's initial overbite and the greater the amount of programmed reduction in overbite according to ClinCheck, the greater the discrepancy in overbite expression posttreatment. ClinCheck over-predicted overbite reduction in 95.3% of patients in which, on average, only 39.2% of the prescribed overbite reduction was expressed. Overbite reduction may result in suboptimal outcomes when using the Invisalign appliance unless remedial measures are employed. The deeper the initial overbite, the more challenging it is to achieve the prescribed posttreatment overbite.

A Novel Frontal Sinus Index Protocol for Gender Determination: A Retrospective Lateral Cephalometric Study for Egyptians

Abstract Aim: To develop and assess a new protocol proposed for sex determination using frontal sinus index measured from two dimensional lateral cephalometric radiographs Materials & Methods: The frontal sinus index was measured by two experienced radiologists and one experienced orthodontist on two hundred and one digital lateral cephalometric scans (Ninety-three males & One hundred and eight females). The maximum height and width of the sinus were measured, after that the height to width ratio was calculated. The mean height to width ratio of the sinus were tabulated and subjected to statistical analysis to determine the correlation to gender. Results: There was a high statistically significant difference between the frontal sinus index measured between males and females' groups. Conclusion: Frontal sinus index measured on lateral cephalometric radiographs by the developed novel protocol can be an indicator for gender identification in adult Egyptians and a larger sample multi-centric study is recommended.

Evaluation of the quality of information on the internet about 2019 coronavirus outbreak in relation to orthodontics.

This study aims to evaluate the content of information in three different search engines in terms of orthodontics as the source of information at the current stage of the COVID-19 outbreak.An internet search was conducted on April 10th, 2020, using the most popular search engines: GoogleTM, BingTM, and Yahoo!® with the keyword “coronavirus orthodontics”. Top 10 websites were evaluated for each search engine. After excluding duplicates the remaining 23 sites were saved in Microsoft Excel programme and evaluated by two independent researchers (HKO and RSO; both experienced orthodontists) using the modified DISCERN tool and JAMA benchmarks. The websites were also classified as "useful, misleading and news updates".Sixty one percent of the websites were classified as useful, 26% as misleading, and 13% as news updates. Most of the authors of the websites were unknown (35%) and followed by orthodontists (30%). The DISCERN and JAMA scores of the four websites were excellent and their target audience were orthodontists. The average modified DISCERN score of 23 websites was moderate (average score 2,8). Useful websites had a significantly higher number of DISCERN and JAMA scores than the misleading websites (p < 0.05).Most of the information available in three different search engines about orthodontics related to COVID-19 were useful. The most reliable websites belonged to American Association of Orthodontists (AAO), Australian Society of Orthodontists (ASO), and British Orthodontic Society (BOS), and they appeared on the first page of the GoogleTM.

Changes of epiglottis and hyoid bone position after orthodontic treatment with cast splint fixed functional appliances.

Angle Class II malocclusions including a retrognathic mandible are the most frequent orthodontic problems. Both removable and fixed functional appliances can be used for mandibular advancement. Mandibular advancement after treatment with any fixed functional appliance has numerous therapeutic effects, such as stretching of masticatory muscles, ligaments, membranes and surrounding soft tissues, thus causing positional changes of the hyoid bone and epiglottis. This retrospective study investigates and compares treatment effects upon epiglottis- and hyoid bone position and posterior airway space in class II patients who received mandibular advancement through two different cast splint fixed functional appliances. Two groups of 21 patients each ('Functional Mandibular Advancer' (FMA) and Herbst appliance) were investigated. The same experienced orthodontist performed the treatment in all patients, employing a single-step advancement protocol. The mandible always received initial protrusion into an edge-to-edge position. Conventional lateral cephalograms were available pre-treatment (T1) and immediately after appliance removal (T2) for all patients. The measurements comprised (I) hyoid bone, (II) epiglottis or (III) posterior airway space. Treatment-related changes were analysed with one-sample Student's t tests for intragroup comparisons and independent Student's t tests for intergroup comparisons. Statistical significance was set at p < 0.05. Measurements of the hyoid bone showed mostly increases for both appliances after treatment. Intergroup comparisons were not significant for FMA patients but significant for selected measurements in Herbst appliance patients. Intergroup comparisons showed insignificant changes. The posterior airway space was always insignificantly increased after treatment. The greatest increase was found caudally. Intergroup comparisons showed insignificant changes. Both fixed functional appliances cause an anterior and caudal displacement of epiglottis and hyoid bone and enlarge the posterior airway space. The therapeutic effects of the Herbst appliance are slightly larger, although not significantly. Treatment with either Herbst appliance of FMA alters the hyoid bone position and enlarges the posterior airway space. Still, long-term data are as yet unavailable; it remains unknown if the effects upon posterior airway space remain stable, and if a resulting posterior airway space enlargement may have clinical influence upon obstructive sleep apnoea syndrome.

Development and comparison of the new index with DAI for evaluating orthodontic treatment need in high caries prevalence community: A diagnostic test study

Aim: The aim of this study was to develop an index for evaluating orthodontic treatment need called “Community Orthodontic Treatment Need Index (COTN)” and to preliminarily compare its accuracy and reliability with Dental Aesthetic Index (DAI). Materials and Methods: This diagnostic test study includes three steps. First and second steps were related to develop the index (COTN) and assessing its accuracy and reliability in dental models. The 110 orthodontic dental models were randomly selected from the pooled dental models of 12–14-year-old children who came for orthodontic screening at the University Orthodontic Clinic. Seven experienced orthodontists assessed orthodontic treatment needs in all 110 dental models (gold standard). Eighty dental models were randomly selected from these 110 models to develop the index by creating algebraic equations using discriminant analysis. Another 30 dental models were evaluated for accuracy and intra-examiner reliability of the two indexes. The last step compared reliability and time consuming of indices in the community. Two examiners assessed 28 schoolchildren aged 12–14 years who were purposively selected using two indices at school. Kappa coefficient, sensitivity, specificity, and paired t test were calculated. Results: COTN contains both anterior and posterior teeth components. It was more likely to have better accuracy and intra-examiner reliability in evaluating orthodontic treatment needs in dental models than DAI (sensitivity + specificity = 1.67 vs. 1.56, kappa = 0.811 vs. 0.689, respectively). Nevertheless, COTN was comparable to DAI for reliability and time consuming when used in the community. Conclusion: This new index (COTN) could be an alternative index for evaluating orthodontic treatment need in high caries prevalence community.

Clinical outcomes of lingual fully customized vs labial straight wire systems : Assessment based on American Board of Orthodontics criteria.

To evaluate orthodontic treatment outcome in patients treated with alingual appliance (Incognito™ Appliance System, 3MUnitek, Monrovia, CA, USA) versus patients treated with alabial appliance (Victory series™, 3MUnitek, Monrovia, CA, USA). Atotal of 72patients were retrospectively analyzed. The complexity of each case was evaluated using the American Board of Orthodontics (ABO) Discrepancy Index (DI), and orthodontic clinical outcomes were evaluated using the ABO Objective Grading System (cast-radiograph evaluation: C‑REval). The mean total ABO C‑REval score was 16 ± 9.1 in the labial appliance group and 12.7 ± 5.4 in lingual appliance group (p = 0.152). The mean total ABO-DI scores were 16.3 ± 7.3 and 15.4 ± 6.6 in the labial and lingual appliance groups, respectively (p = 0.445). A significant correlation was observed between the total DI and total C‑REval scores. In this particular study and in the hands of two experienced orthodontists, no differences in the finishing quality of orthodontic treatments using the lingual technique or the buccal appliance technique were found. However, further prospective studies with larger sample sizes are necessary in order to generalize these results.

Prevalence of Body Dysmorphic Disorder among patients seeking orthodontic treatment

BackgroundBody Dysmorphic Disorder (BDD) is a psychiatric disorder with delusions about defects in appearance for which patients seek various treatments. Patients with BDD often seek cosmetic procedures, and orthodontic treatment is one among them. This is the first Indian study to determine the prevalence of BDD in an orthodontic outpatient department.Materials and methodA total of 1184 patients with varying degrees of malocclusion completed the BDD-YBOCS questionnaire, while an experienced orthodontist assessed the severity of malocclusion with a rating scale.ResultsSixty-two patients (5.2%) were screened positive for BDD. Most of the BDD-positive patients were single (p value of 0.02) and had multiple previous consultations for orthodontic treatment (p value of < 0.00**) with a gender predilection toward males (p value of 0.00**), and age was not statistically significant with a p value of 0.3.ConclusionFrom our study, the prevalence of BDD among orthodontic patients was 5.2%. The orthodontist should be aware of the high prevalence of BDD among orthodontic patients and identify the expectations of the patient at the time of history taking and refer the patient to a psychiatrist for diagnosis and appropriate management.

Clinical Evaluation of Digital Dental Articulation for One-Piece Maxillary Surgery

Methods for digital dental alignment are not readily available to automatically articulate the upper and lower jaw models. The purpose of the present study was to assess the accuracy of our newly developed 3-stage automatic digital articulation approach by comparing it with the reference standard of orthodontist-articulated occlusion. Thirty pairs of stone dental models from double-jaw orthognathic surgery patients who had undergone 1-piece Le Fort I osteotomy were used. Two experienced orthodontists manually articulated the models to their perceived final occlusion for surgery. Each pair of models was then scanned twice-while in the orthodontist-determined occlusion and again with the upper and lower models separated and positioned randomly. The separately scanned models were automatically articulated to the final occlusion using our 3-stage algorithm, resulting in an algorithm-articulated occlusion (experimental group). The models scanned together represented the manually articulated occlusion (control group). A qualitative evaluation was completed using a 3-point categorical scale by the same orthodontists, who were unaware of the methods used to articulate the models. A quantitative evaluation was also completed to determine whether any differences were present in the midline, canine, and molar relationships between the algorithm-determined and manually articulated occlusions using repeated measures analysis of variance (ANOVA). Finally, the mean±standard deviation values were computed to determine the differences between the 2 methods. The results of the qualitative evaluation revealed that all the algorithm-articulated occlusions were as good as the manually articulated ones. The results of the repeated measures ANOVA found no statistically significant differences between the 2 methods [F(1,28)=0.03; P=.87]. The mean differences between the 2 methods were all within 0.2mm. The results of our study have demonstrated that dental models can be accurately, reliably, and automatically articulated using our 3-stage algorithm approach, meeting the reference standard of orthodontist-articulated occlusion.

Orientation of Cone-Beam Computed Tomography Image: Pursuit of Perfect Orientation Plane in Three Dimensions—A Retrospective Cross-Sectional Study

Abstract Objective This study aimed to evaluate the reproducibility of nine reference planes used in orientation of as-received cone-beam computed tomography (CBCT) images in all three dimensions. Materials and Methods The study was conducted on CBCT images of 15 adult subjects (mean age 21.2 ± 5.8 years). The anonymized CBCT images were oriented using five different methods created from nine reference planes by two experienced orthodontists. For each subject, pitch, yaw, and roll changes with five orientation methods were recorded twice by each observer. Statistical Analysis The inter- and intraobserver agreement was tested using intraclass correlation (ICC) and Bland–Altman plot. The intra- and interobserver error was analyzed using paired t-test. Analysis of variance and paired t-test were used to analyze the differences among the various pitch, roll, and yaw orientation planes. Results Inter- and intraobserver agreement (ICC, 0.9) was excellent for all the nine reference planes. The interobserver reliability showed statistically significant differences for four planes namely Frankfort horizontal plane constructed on right side (p = 0.014) and left side (p = 0.000), transorbital plane (p = 0.001), and midsagittal plane on top view (p = 0.036); however, the mean differences were clinically insignificant. Conclusion The landmark-based nine reference planes used in this study to orient CBCT images showed good reproducibility. Therefore, these reference planes can be used to orient CBCT images and can be incorporated into automated software.

Evaluation of a Fluorescence-aided Identification Technique (FIT) to assist clean-up after orthodontic bracket debonding

To compare a fluorescence-aided identification technique (FIT) with a conventional light source (CLS) for removing composite during debonding of brackets with respect to time needed, composite remnants, and tooth substance loss. Twelve maxillary models with 10 bovine teeth each were digitally surface-scanned and metal brackets were bonded on each tooth with Opal Seal and Opal Bond. Two operators: an experienced orthodontist (A) and an undergraduate student (B) received six models each and were asked to remove the composite remnants with a tungsten carbide bur and Sof-Lex discs by both a conventional light source (CLS group, n = 3), and fluorescent inducing light (FIT group, n = 3). The time taken was recorded, and a postoperative scan was digitally superimposed on the preoperative scan to quantify number of teeth with composite remnants and volume and thickness of enamel loss and composite remnants. Chi-square test and independent t-tests were performed to compare methods with a significance level of 5%. Compared to CLS, both operators needed significantly less time when using the FIT method and degree of enamel loss, height, and volume of composite remnants and total remaining composite remnants were significantly reduced. By FIT, the volume of enamel loss was significantly reduced for operator A only. Operator B removed the same enamel volume with either method. Cleanup after orthodontic debonding with the FIT was superior regarding time needed and removal of composite remnants. Total enamel loss reduction was operator-dependent.

Craniofacial morphology and soft tissue profile outcomes for complete unilateral and complete bilateral cleft lip and palate in New Zealand.

(a) To establish baseline lateral craniofacial morphology and soft tissue profile outcomes for New Zealand children with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) and determine differences in relation to demographic characteristics including cleft type, sex and ethnicity and (b) To compare these outcomes to similar international studies. Nation-wide prospective and retrospective cephalometric analysis of 76 patients with CUCLP and 23 patients with CBCLP pre-secondary alveolar bone graft. Assessment was undertaken by three experienced orthodontists blinded to patient identity. A total of 13 hard tissue and 8 soft tissue landmarks were identified allowing for an assessment of 16 angular, three linear and one ratio variables. Inter-assessor reliability was determined by pre-defined measurement error thresholds. Inter-assessor reliability of cephalometric landmarks restricted reporting to 10 hard tissue, four soft tissue and one ratio variables. CUCLP had greater midface and mandibular retrusion than CBCLP. Females had greater midface and mandibular prominence and smaller nasal projections. The Pacific and Māori groups had more retrusive midfacial profiles, and the Pacific group had more prominent mandibles. A sub-analysis of New Zealand European CUCLP results found they were closely aligned to Eurocleft and Americleft study centres with less favourable outcomes. The reliability of a number of cephalometric measurements was poor. Lateral craniofacial morphology and soft tissue profile outcomes varied between CUCLP/CBCLP, sex and ethnicity. The New Zealand European outcomes are similar to or less favourable to other studies.

Reliability of different radiographic methods for the localization of displaced maxillary canines.

The purpose of this study was to evaluate the reliability of the radiographic images of the main conventional x-ray techniques compared with the information from cone-beam computed tomography (CBCT). Twenty patients with unilateral or bilateral impaction of the maxillary canines had radiographic examinations by means of periapical x-rays, occlusal x-rays, panoramic x-rays, and CBCT scans. Three experienced orthodontists examined all x-rays from each patient and evaluated the radiographic images of the impacted canines. The examiners were asked to detect resorption in adjacent teeth and the buccal-palatal position of the impacted canines. Agreement between examiners was statistically tested. Different diagnoses were produced by the 3 examiners regarding localization of the impacted canines and the presence or absence of root resorption of the adjacent teeth in conventional radiographic images. It appears that whereas panoramic x-ray is more sensitive in detecting resorption and tooth position, occlusal and periapical imaging have higher specificity and positive predictive value. The examiners were in good or excellent agreement when occlusal and periapicals were used for the definite diagnosis of resorption and tooth position. There was no disagreement of the examiners in CBCT images, which were used as the gold standard. Conventional radiographic methods demonstrated a more subjective diagnostic procedure compared with CBCT images. CBCT is a more accurate and precise examination method compared with conventional radiography for the localization of impacted teeth and root resorption of the adjacent teeth.

The 5-year-olds' index, the GOSLON Yardstick index, and the modified Huddart/Bodenham index among children with complete unilateral cleft lip and palate: A methodological study

Background: The function of many orthodontic indices is to assess occlusion in patients born with a cleft. The aim of this study was to assess the intra- and interexaminer reliability for the 5-year-olds' (5YO) index, the GOSLON Yardstick index, and the modified Huddart/Bodenham (MHB) index in dental casts of children with complete unilateral cleft lip and palate (UCLP); a further aim is to compare the indices to each other. Methods: Forty dental casts from 5-year-old nonsyndromic patients with complete UCLP who had undergone primary surgery at Skane University Hospital in Malmo, Sweden, were examined by two examiners: one orthodontic specialist and one general dentist. Results: Intraexaminer reliability for 5YO and MHB had a substantial (κ: 0.61–0.80) to almost perfect agreement ( κ: 0.81–1.00) and GOSLON Yardstick moderate (κ: 0.41–0.60) to almost perfect agreement. Grouped teeth or single-tooth MHB had an almost perfect agreement for both examiners. Interexaminer reliability for 5YO had a moderate agreement, whereas GOSLON Yardstick and MHB had a fair agreement (κ: 0.21–0.40). Grouped teeth or single-tooth MHB had an almost perfect agreement. Conclusions: The 5YO index illustrates the occlusion and has a high degree of reliability for an experienced orthodontist. The GOSLON Yardstick also illustrates the occlusion, but reliability between assessments is lower. MHB index can be used with a high degree of reliability when categorized as grouped or single tooth, but the judgment of total occlusion is more uncertain.