Intraoral Photographs Research Articles

The Reliability and Validity of Intraoral Photographs in Assessing Orthodontic Treatment Need.

Orthodontic treatment need has commonly been assessed using treatment need indices during clinical examinations or using photographs in combination with plaster casts. Recently, the use of intraoral photographs alone to screen malocclusions has increased. This study aimed to validate intraoral photographs for the assessment of orthodontic treatment need. The study sample consisted of case files from 30 pre-orthodontic patients aged 12-19 years. Each case file included intraoral photographs and casts. The cases were consecutively recruited from two orthodontic treatment waiting lists: 15 from the Department of Orthodontics at Folktandvården Eastmaninstitutet, Stockholm, Sweden and 15 from the Center for Orthodontics and Pediatric Dentistry, Norrköping, Public Dental Service Östergötland. Their orthodontic treatment need was assessed by four raters (calibrated orthodontists) using the indices IOTN-AC, IOTN-DHC, ICON, and DAI. The four raters individually assessed the 30 cases on three occasions: (1) photos only, (2) photos and casts, and (3) photos only. Finally, the four raters jointly made a consensus assessment using both photos and casts. For IOTN-AC and IOTN-DHC, interrater agreement was assessed with Fleiss' kappa, and validity with the Wilcoxon signed-rank test. For ICON and DAI, interrater agreement was assessed with Intra Class Correlation (ICC) (1, 2) and validity with a paired t-test. Interrater agreement for IOTN-AC was slight (0.14-0.18) and moderate for IOTN-DHC (0.51-0.57), regardless of whether photographs were used alone or combined with casts. ICON demonstrated moderate interrater agreement (0.57-0.72), while DAI showed moderate to excellent (0.70-0.91), similarly unaffected by the use of photographs alone or in combination with casts. The validity analysis, which compared the individual assessments to the consensus one, revealed equivalent differences whether the assessment involved intraoral photographs alone or in combination with casts. Intraoral photographs are sufficient for assessing orthodontic treatment need because interrater agreement and validity are similar whether photos are used alone or with casts. However, interrater variability was substantial for both assessment methods. ClinicalTrial.gov. identifier: NCT05038865.

Prevalence of hypomineralised second primary molars and molar incisor hypomineralisation in patients with cleft lip and/or palate.

This study aimed to determine the prevalence of hypomineralised second primary molars (HSPM) and molar incisor hypomineralisation (MIH) in cleft lip and/or palate (CL/P) patients. A retrospective analysis of intraoral photographs of CL/P patients was done. All patients born between 2000 and 2011, and visiting the cleft team of the Erasmus Medical Center in Rotterdam, The Netherlands, were included. Their photos were scored on the presence and severity of HSPM and MIH using criteria formulated by the European Academy of Pediatric Dentistry. The outcomes were compared with data of the general population, extracted from the Generation R study. The photos of 535 CL/P patients were evaluated. The overall prevalence of HSPM in CL/P patients was 15.2%, of MIH 12.8%. HSPM and MIH prevalence was significantly higher (both p < 0.001) compared to prevalence inthe general population. No significant differences were found in prevalence of HSPM nor of MIH in CL/P patients based on gender (p = 0.891 resp. p = 0.405), cleft type (p = 0.282, resp. p = 0.415), Pierre Robin (p = 0.837, resp. p = 0.169) or other comorbidities (p = 0.553, resp. p = 0.617). CL/P patients with HSPM were almost 3 times more likely diagnosed with MIH than CL/P patients without HSPM (OR = 2.57, p = 0.002). The prevalence of HSPM and MIH is higher in patients with CL/P than in the general population.

The Occurrence and Risk Factors of Black Triangles Between Central Incisors After Orthodontic Treatment.

To assess the incidence of and risk factors for black triangles between the central incisors after orthodontic treatment; Methods: Ninety-seven post-treatment patients (29 men and 68 women; mean age, 22.7 years) were retrospectively divided into two groups based on the presence or absence of black triangles, using intraoral photographs. Based on the Jemt Index, the black triangle occurrence group was further classified into mild, moderate, and severe groups. Parameters from periapical radio graphs, lateral cephalograms, and study models were compared between the occurrence and the non-occurrence groups by using independent t-tests. Logistic regression analysis was performed to identify the risk factors for black triangles; Results: The incidence of black triangles between the central incisors was 51% and 64% in the maxilla and in the mandible, respectively. The factors significantly associated with the occurrence of black triangles were age, treatment duration, the lingual inclination of the maxillary incisors in the maxilla, and age in the mandible (p < 0.05); Conclusions: This study showed the diverse risk factors associated with black triangles between central incisors after orthodontic treatment and revealed that the formation of black triangles is relatively common. Considering these risk factors during orthodontic diagnosis and treatment planning can help minimize the occurrence of black triangles.

Effects of extraoral storage time on autologous gingival graft early healing: A split-mouth randomized study.

Despite the established use of palatal tissue grafts for mucogingival procedures, there are no studies on the effect of extraoral storage time on graft outcomes. This prospective split-mouth randomized experimental clinical trial aimed to assess whether gingival graft extraoral storage time affects graft healing. Standardized grafts were harvested from the palate and stored extraorally for 2 (Control) or 40 (Test) minutes before being placed at recipient beds. Intraoral scans, clinical photographs, and tissue blood perfusion were obtained preoperatively, postoperatively, and at follow-up visits (Days 2 (PO2), 3 (PO3), 7 (PO7), and 14 (PO14)). Healing Score Index (HSI) and wound fluid (WF) biomarkers (angiogenin, IL-6, IL-8 (CXCL8), IL-33, VEGF-A, and ENA-78 (CXCL5)) were also assessed. Twenty-three participants completed all study visits. Extraoral storage time was 2.3 ± 1.1 min and 42.8 ± 3.4 min for C and T grafts, respectively (p < .0001). Recipient beds remained open for 21.4 ± 1.7 min. No graft underwent necrosis or failed to heal by PO14. Minimal volumetric changes were observed, without significant intergroup differences (p ≥ .11). Graft perfusion initially decreased post-harvesting before peaking on PO7 for both C and T grafts, with no significant intergroup differences (p ≥ .14). HSI values progressively increased, with no significant intergroup differences (p ≥ .22). WF analysis revealed detectable levels for all biomarkers tested, without significant intergroup differences (p ≥ .23). Extraoral storage time of 40 min has neither statistically significant nor clinically discernible effects on autologous graft revascularization, early healing, or survival, as determined by physiological, wound healing, and molecular parameters.

Use of artificial intelligence to detect dental caries on intraoral photos.

Dental caries is one of the most common diseases globally and affects children and adults living in poverty who have limited access to dental care the most. Left unexamined and untreated in the early stages, treatments for late-stage and severe caries are costly and unaffordable for socioeconomically disadvantaged families. If detected early, caries can be reversed to avoid more severe outcomes and a tremendous financial burden on the dental care system. Building upon a dataset of 50,179 intraoral tooth photos taken by various modalities, including smartphones and intraoral cameras, this study developed a multi-stage deep learning-based pipeline of AI algorithms that localize individual teeth and classify each tooth into several classes of caries. This study initially assigned International Caries Detection and Assessment System (ICDAS) scores to each tooth and subsequently grouped caries into two levels: Level-1 for white spots (ICDAS 1 and 2) and level-2 for cavitated lesions (ICDAS 3-6). The system's performance was assessed across a broad spectrum of anterior andposterior teeth photographs. For anterior teeth, 89.78% sensitivity and 91.67% specificity for level-1 (white spots) and 97.06% sensitivity and 99.79% specificity for level-2 (cavitated lesions) were achieved, respectively. For the more challenging posterior teeth due to the higher variability in the location of white spots, 90.25% sensitivity and 86.96% specificity for level-1 and 95.8% sensitivity and 94.12% specificity for level-2 were achieved, respectively. The performance of the developed AI algorithms shows potential as a cost-effective tool for early caries detection in non-clinical settings.

A Pilot Investigation Into the Use of Teledentistry and Artificial Intelligence to Assess Dental Erosion in Competitive Swimmers.

The aim of the study was to assess the prevalence of dental erosion in competitive swimmers using teledentistry and artificial intelligence. An opportunistic sample of 20 competitive swimmers was recruited. The participants reported that they carried out an average of 2.40 h of training per day, 4.45 days per week. Data gathering was carried out remotely. The subjects completed a digital questionnaire and uploaded three photos of their mouth. Intraoral photographs were analyzed using the "Intact-Tooth" application to assess dental erosion. A statistical analysis was carried out to verify a possible correlation between the collected data. The average calculated Basic Erosive Wear Examination (BEWE) index was 13.95, and 11 subjects (55%) had a severe BEWE (≥ 14). More than 40% of the participants disagreed about having social issues related to tooth hypersensitivity. Considering only subjects with a severe total BEWE value, we have observed an indirect correlation between the degree of dental erosion and diet (Pearson coefficient r = -0.57), whereas a direct correlation was observed between dental erosion and age (r = 0.493) and between BEWE and weekly training hours (r = 0.217). Because of their lifestyle, competitive swimmers can be considered at a higher risk of developing dental erosion. In this context, teledentistry and AI tools can be effectively used to intercept those at the highest risk and prevent the occurrence of conditions. Dental erosion assessment in competitive swimmers using teledentistry and AI.

Developing an AI-based application for caries index detection on intraoral photographs.

This study evaluates the effectiveness of an Artificial Intelligence (AI)-based smartphone application designed for decay detection on intraoral photographs, comparing its performance to that of junior dentists. Conducted at The Aga Khan University Hospital, Karachi, Pakistan, this study utilized a dataset comprising 7,465 intraoral images, including both primary and secondary dentitions. These images were meticulously annotated by two experienced dentists and further verified by senior dentists. A YOLOv5s model was trained on this dataset and integrated into a smartphone application, while a Detection Transformer was also fine-tuned for comparative purposes. Explainable AI techniques were employed to assess the AI's decision-making processes. A sample of 70 photographs was used to directly compare the application's performance with that of junior dentists. Results showed that the YOLOv5s-based smartphone application achieved a precision of 90.7%, sensitivity of 85.6%, and an F1 score of 88.0% in detecting dental decay. In contrast, junior dentists achieved 83.3% precision, 64.1% sensitivity, and an F1 score of 72.4%. The study concludes that the YOLOv5s algorithm effectively detects dental decay on intraoral photographs and performs comparably to junior dentists. This application holds potential for aiding in the evaluation of the caries index within populations, thus contributing to efforts aimed at reducing the disease burden at the community level.

Dental photography using DSLR cameras vs smartphones

Background: Smartphone photography has increased in quality with the advancement of technology. Dental photography using a digital single-lens reflex (DSLR) camera has been a critical tool for patient education, treatment planning, self-evaluation, and research in the orthodontic profession. This study aims to determine if there is a significant difference in quality between facial and intraoral photographs taken with DSLR cameras and smartphones.Method: Dental students and practicing orthodontists took an 18-question survey to compare facial and intraoral photographs taken with a DSLR camera and a smartphone. Participants evaluated the photographs based on color, sharpness, depth of field, and overall quality. Chi-square analyses and Fisher's exact tests were used to evaluate potential differences across image sources and respondent types.Results: Three hundred twenty-nine participants completed this survey with an overall response rate of 74.9%. Facial photographs taken with a DSLR had significantly superior overall quality, sharpness, and depth of field compared to smartphone facial photographs (P<0.05). Intraoral photographs taken with a smartphone had significantly superior overall quality, color, sharpness, and depth of field compared to DSLR photographs (P< 0.01).Conclusions: This study suggests that intraoral photographs taken with a smartphone could provide a superior image quality compared to those taken by a DSLR camera, but not for facial photographs. As smartphone cameras continue to evolve, they have the potential to provide superior photographic quality for intraoral photographs compared to DSLR cameras.

Comparing the Existence of Golden Proportion Using Maxillary Anterior Teeth Dimensions in Primary and Permanent Dentition: A Cross-sectional Study.

The golden proportion is based on the premise that there is a link between natural beauty and mathematics. The study aimed to analyze the mesiodistal width of maxillary anterior teeth in primary and permanent dentition to determine whether a golden proportion exists among them. Sixty subjects were randomly selected in accordance with inclusion and exclusion criteria. Participants were divided into two groups, each comprising 30 children with primary dentition between 3 and 6 years old, and 30 children with permanent dentition between 12 and 13 years old. Intraoral photographs were taken using a smartphone (in-built sensor: Sony IMX890, focal length: 24 mm, aperture: f/1.8) and a cheek retractor, with the head upright and the occlusal plane parallel to the floor. The distance between the participant and the camera was fixed at 4 cm. The digital photographic images were transferred to a computer, and the perceived mesiodistal width was measured for anterior teeth using Adobe Photoshop CS (version 8) software. The ratio of lateral incisor to central incisor was not found to differ significantly between permanent and primary dentition (p-value > 0.05). However, the ratio of canine to lateral incisor was significantly greater in primary dentition compared to permanent dentition (p-value < 0.05). The study revealed that the golden proportion was inconsistent in terms of relative tooth width in primary dentition. The golden proportion existing in permanent dentition serves as a guide for restoring severely mutilated anterior teeth, so it is important to assess whether the golden proportion exists in primary dentition. Pursnani RA, Saxena A, Parihar A, et al. Comparing the Existence of Golden Proportion Using Maxillary Anterior Teeth Dimensions in Primary and Permanent Dentition: A Cross-sectional Study. Int J Clin Pediatr Dent 2024;17(11):1206-1210.

The 2018 Classification of Periodontal Diseases: An Observational Study on Inter-examiner Agreement among Undergraduate Students.

The objective of the present observational study was to assess the inter-examiner agreement for the diagnosis of periodontitis using the 2018 CPD among fourth and fifth year undergraduate students. It is hypothesised that there is no difference in the inter-examiner relaibility between fourth- and fifth-year undergraduate students regarding staging and grading periodontal disease using the 2018 Classification of Periodontal Diseases (CPD). All participants received training on the 2018 CPD scheme through a mandatory periodontics course conducted by a periodontist. Documentation for seven deidentified periodontitis patients, comprising medical history, dental history including tooth loss, intra-oral photographs and radiographs, periodontal charts reporting probing depth, plaque and bleeding on probing scores, furcation involvement and clinical attachment loss, was sent via e-mail to undergraduate students. The cases consisted of one sextant, and the participants were instructed to assume the sextant to be a true representation of the entire dentition. Power analysis was done on pilot data, and the level of significance was set at p0.05. The percentage of undergraduate students in the fourth and fifth year that correctly identified the stage of periodontitis according to the 2018 CPD ranged between 28% and 72% and 18.5% and 77.8%, respectively. The percentage of undergraduate students in the fourth and fifth year that correctly identified the grade of periodontitis ranged between 40% and 88% and 51.8% and 92.5%, respectively. The overall staging and grading ranged between 22.8% and 74.1%, and 45.66% and 87.4%, respectively. There was no statistically significant difference between fourth- and fifth-year undergraduate students with regards to assigning the correct diagnoses to case documentation in terms of either stage or grade. Fourth- and fifth-year undergraduate students demonstrated high inter-examiner agreement using the 2018 CPD.

Molar Incisor Hypomineralization: Etiology, Correlation with Tooth Number Anomalies and Implications for Comprehensive Management Strategies in Children from Transylvania.

This study investigates the etiology of enamel developmental defects, specifically Molar Incisor Hypomineralization (MIH), and explores correlations between MIH and dental anomalies such as hypodontia to improve interdisciplinary restorative and orthodontic treatments. Additionally, it assesses the influence of stress factors on the development of enamel defects. Conducted from July to September 2024, this study involved 57 patients aged 6 to 11 from an urban setting, divided into two groups: 32 with MIH and 25 controls, selected based on criteria of mixed dentition without systemic pathology or chronic medication. Clinical evaluations, including intraoral photographs and panoramic radiographs, were performed alongside a detailed questionnaire addressed to the mothers covering prenatal, perinatal, and postnatal factors. The average age of children with MIH was 7.5 years, in contrast to 7.04 years in the control group (p = 0.17). Significant differences were noted in maternal age, with MIH mothers older (35.56 years) than controls (29.36, p = 0.0001). The prevalence of MIH was higher in boys (66.7%) compared to girls (38.1%, p = 0.036). Factors such as prolonged labor, medication during birth, and early postnatal medication were significantly linked to MIH. The study shows a strong correlation with hypodontia, with a significantly higher incidence of tooth number anomalies (p = 0.009) in the study group. Overall, the study emphasizes the association of MIH with various maternal and birth-related factors and with hypodontia, highlighting the need for a comprehensive, multidisciplinary approach to diagnosis and treatment. Further research is recommended to investigate the relationship between stress factors and MIH.

Effect of endodontically treated teeth on prosthetically guided orthodontics with clear aligners: a case series

BackgroundProsthetically guided orthodontics (PGO) can correct the malocclusion for better prosthetic rehabilitation in esthetic rehabilitation. Unlike conventional orthodontic treatment, only minor tooth movement is designed in PGO according to the requirement of subsequent restoration. For better appearance during the treatment, PGO is often performed with clear aligners, which have no metal brackets. It has been proven that the PGO with clear aligners can achieve generally satisfactory outcomes. However, its risk has not been fully known due to the paucity of relevant studies.Case presentationThree patients who needed esthetic rehabilitation with mild malocclusion were included in this study. After evaluation, a prosthetic solution alone was considered insufficient to provide optimal outcomes. Thus, they were treated using PGO with clear aligners (Invisalign Go, Align Technology, Santa Clara, California, USA) and accomplished prosthetic rehabilitation subsequently. Dental history and X-ray examination revealed that endodontically treated teeth (ETT) existed in all the cases. Intraoral photographs were collected to compare the pre-treatment and post-treatment dentition. After PGO, posterior ETT did not maintain their position as scheduled and lost occlusal contacts, while all the anterior teeth, including anterior ETT, were moved to the designed position. Corresponding prosthetic rehabilitation was used to solve it after consulting with the patients.ConclusionsOcclusal contact loss of posterior ETT is a potential risk in PGO with clear aligners, affecting the orthodontic result.

Publicly Available Dental Image Datasets for Artificial Intelligence

The development of artificial intelligence (AI) in dentistry requires large and well-annotated datasets. However, the availability of public dental imaging datasets remains unclear. This study aimed to provide a comprehensive overview of all publicly available dental imaging datasets to address this gap and support AI development. This observational study searched all publicly available dataset resources (academic databases, preprints, and AI challenges), focusing on datasets/articles from 2020 to 2023, with PubMed searches extending back to 2011. We comprehensively searched for dental AI datasets containing images (intraoral photos, scans, radiographs, etc.) using relevant keywords. We included datasets of >50 images obtained from publicly available sources. We extracted dataset characteristics, patient demographics, country of origin, dataset size, ethical clearance, image details, FAIRness metrics, and metadata completeness. We screened 131,028 records and extracted 16 unique dental imaging datasets. The datasets were obtained from Kaggle (18.8%), GitHub, Google, Mendeley, PubMed, Zenodo (each 12.5%), Grand-Challenge, OSF, and arXiv (each 6.25%). The primary focus was tooth segmentation (62.5%) and labeling (56.2%). Panoramic radiography was the most common imaging modality (58.8%). Of the 13 countries, China contributed the most images (2,413). Of the datasets, 75% contained annotations, whereas the methods used to establish labels were often unclear and inconsistent. Only 31.2% of the datasets reported ethical approval, and 56.25% did not specify a license. Most data were obtained from dental clinics (50%). Intraoral radiographs had the highest findability score in the FAIR assessment, whereas cone-beam computed tomography datasets scored the lowest in all categories. These findings revealed a scarcity of publicly available imaging dental data and inconsistent metadata reporting. To promote the development of robust, equitable, and generalizable AI tools for dental diagnostics, treatment, and research, efforts are needed to address data scarcity, increase diversity, mandate metadata completeness, and ensure FAIRness in AI dental imaging research.

Morphometric measurements of intraoral anatomy in children with Beckwith-Wiedemann syndrome: a novel approach

BackgroundAn easy-to-use tool to objectively measure intraoral anatomy with meaningful clinical correlations may improve care for patients with Beckwith-Wiedemann syndrome (BWS), who commonly have symptomatic macroglossia.MethodsChildren aged 2–17 years with BWS were enrolled between 12/2021 and 01/2024. Digital intraoral photographs with a laser ruler were taken, and morphometric measurements were made using ImageJ software. Relationships between morphometrics and outcomes including BWS clinical score, percentage mosaicism, and incidence of tongue reduction surgery were examined using t-tests and multivariate linear models.ResultsPharyngeal morphometric measurements were obtained in 49 patients with BWS. Mouth area, width, and height differed significantly across BWS molecular subtypes. Right-to-left tongue width and mouth width were larger in those with loss of methylation at imprinting control region 2 (IC2 LOM) than other BWS variants. Patients with paternal uniparental isodisomy of chromosome 11p15 (pUPD11) had narrower mouths than others. Those with tongue reduction surgery had more tongue ridging than those without surgery. There were correlations between mouth area and BWS clinical score, tongue width and BWS clinical score, and tongue length and percentage mosaicism.ConclusionIntraoral morphometric measurements are associated with phenotypic burden in BWS. Tongue morphology varies across the BWS spectrum, with IC2 LOM having wider tongues and mouths, and pUPD11 having narrower mouths. Tongue ridging is more common in those selected for surgery. Intraoral morphometric measurements may be safely obtained at low costs across centers caring for children with BWS or others at risk of upper airway obstruction.

The perspectives of laypeople, prosthodontists, orthodontists, and general dentists regarding the efficacy of different types of photographs in revealing the orthodontic treatment results

Aim: This study assessed the perspectives of laypeople, prosthodontists, orthodontists, and general dentists regarding the efficacy of different photographs in revealing the orthodontic treatment results. Methods: In this cross-sectional study, one Cl I and one Cl III orthodontic patient were selected by consensus of several orthodontists, and their preoperative and postoperative photographs were shown to 125 raters in 4 groups of laypeople, prosthodontists, orthodontists, and general dentists. The raters were asked to rate the clarity of the impact of treatment shown on each photograph using a 100-mm visual analog scale (VAS). Results: In the Cl I malocclusion patient, the frontal smiling view acquired the highest score among extraoral photographs, followed by the profile view and frontal view at rest (P&lt;0.001). Of intraoral photographs, the frontal view of occlusion acquired the highest score, followed by the maxillary occlusal view, mandibular occlusal view, and left and right views of occlusion (P&lt;0.001). In the Cl III patient (orthosurgery), the profile view acquired the highest score among extraoral photographs, followed by the frontal smiling view and frontal view at rest (P&lt;0.001). Of intraoral photographs, the frontal view of occlusion acquired the highest score, followed by the left and right occlusal views, maxillary occlusal view, and mandibular occlusal view (P&lt;0.001). Conclusion: For patients with intraoral intra-arch changes, the frontal smiling view extraoral photograph and frontal occlusal view intraoral photograph best revealed the results. In patients with additional facial and extraoral changes, the extraoral profile view and intraoral frontal occlusal view best revealed the treatment results.

Poverty Dynamics and Caries Status in Young Adolescents.

To investigate whether timing, accumulation and trajectories of poverty are associated with dental caries in young adolescents. The study was conducted within the Generation R Study, which is an ongoing population-based prospective cohort study conducted in Rotterdam, the Netherlands. This study included 2653 children. Information about household income and number of children and adults living in a household at six time points from pregnancy to 13 years old was retrieved from parental questionnaires to construct the poverty variable. Dental caries was assessed with the decayed, missing and filled teeth index through intraoral photographs at the age of 13 years. Sociodemographic and oral health-related characteristics were included as possible confounders. The association between poverty and dental caries was analysed on the basis of the three lifecourse theories, that is, critical period, cumulative risk and social mobility model. For the latter, we used latent class growth analysis (LCGA) to identify poverty trajectories over time. Next, the associations were studied with Hurdle Negative Binomial Models. Poverty at birth and intermittent poverty up to the age of 13 were significantly associated with dental caries at 13 years of age (OR 1.41, 95% CI 1.01-1.99; OR 1.36, 95% CI 1.01-1.83 respectively) and with an increased mean number of decayed teeth by 34% (95% CI 1.02-1.76; 95% CI 1.05-1.71, respectively). LCGA showed four trajectories for the probabilities of poverty. All trajectories were significantly associated with dental caries at 13 years of age, with the 'downward mobility' trajectory showing the strongest association with dental caries (OR 1.55, 95% CI 1.05-2.29) and an increasing mean number of decayed teeth by 58% (95% CI 1.18-2.12) than the 'stable absent' trajectory. Poverty at birth, intermittent poverty and downward poverty trajectory were associated with higher odds and higher mean number of decayed teeth at 13 years of age. The three lifecourse models influenced dental caries status during adolescence, hence strategies and policies targeted to improve socioeconomic conditions on deprived children should be implemented.

Gender Determination Through Dental Morphology: A Cross-Sectional Study.

Microesthetics portrays the tooth morphology, shape, size, shade, and color. The debate of whether microesthetics may or may not be related to gender is the main focus or interest of our study. The aim of our study is to assess if dentists are able to identify the gender of the patient by evaluating the dental morphology using intraoral photographs only (retracted lips and cheeks). This study was a retrospective cross-sectional survey among general dentists and dental specialists practicing in Kuwait. A sample of 151 participants was approached through a multi-stage random sampling method. Data were collected through personal visits to each of the public dental centers. Of these 151 selected, a sample of 10 participants was randomly selected to repeat their participation and answer the questionnaire a second time 2 months after their initial partaking. The statistical analysis for the study was conducted using chi-square tests of goodness of fit and Pearson chi-square. The objectives of this were to compare the dentists' current performance to the task to see if it was due to chance, to compare their previous performance to chance, and to compare their previous and current performances using the McNemar test to determine if any significant differences existed. In our study, tooth morphology was linked to gender significantly by the participants, which showed that despite some differences, it may still be identified. However, orthodontists did not perform significantly better than other specialties. In conclusion, our study showed that dentists are able to identify or determine gender based on photographs, which is inconsistent with our starting hypothesis. Overall, the study's findings suggest that both orthodontists and dentists from other specialties could identify an individual's gender based on smiling photographs.

Clinical Observations of Soft Tissue Dimensions Around Teeth and Implants After Free Gingival Graft

Introduction and aimsThe histological and morphological differences in soft tissue between natural teeth and peri-implant may result in different clinical effectiveness to free gingival graft (FGG). This research aims to investigate the different efficacy of FGG in augmenting keratinized tissue width (KTW) between tooth and implant sites while evaluating its medium-term stability over a 2- to 5-year follow-up. MethodsIn this study, 29 patients underwent FGG to address insufficient clinical scenarios when KTW <2 mm at the buccal aspect, including 37 implant sites and 33 natural teeth sites both in posterior regions were included. The KTW and gingival margin position (GMP) of these sites was assessed by measuring the intra-oral photographs which were taken at 0 days (T0), 3-month (T1), 6-month (T2), 12-month post-surgery (T3), and 2 to 5 years follow-up (T4). ResultsThe results revealed that KTW increased significantly in both groups. However, the natural teeth group showed significantly less graft shrinkage (GS) than the implants group. (Teeth: 2.05 ± 0.51 mm and 25.42% ± 6.45%; Implants: 3.18 ± 0.65 mm and 38.92% ± 5.39%, P <.01). From T1 to T4. The gingival margin coronally advanced by 0.47 ± 0.51 mm and 0.18 ± 0.43 mm for the natural teeth and implants group, respectively (P<.05). ConclusionsA greater KTW reduction after FGG was observed at implants versus natural teeth. And, the graft surrounding implants after crown restoration was stable for up to 2 to 5 years. Clinical relevanceBy comparing the changes in KTW around natural teeth and implants following FGG to investigate whether there are differences between them and the degree of differences. Additionally, this allows us to explore whether the restorations impact the effect of FGG. This research can assist clinicians in selecting an appropriate amount of soft tissue during surgery to achieve treatment goals, reduce postoperative discomfort for patients, and enhance predictability in clinicians' ability to increase keratinized tissue. Furthermore, by observing changes in the position of GMP around natural teeth and implants, the effectiveness of FGG in root coverage can be understood, thus improving the predictability of FGG for root coverage.

Is occlusal contact re-established within 6 months after bonding of a fixed anterior bite plane in adolescents with a Class II division 2 incisor relationship? A randomised controlled trial.

To determine if re-establishment of occlusal contact was achieved within 6 months after insertion of a fixed anterior bite plane in individuals with Class II division 2 incisor relationship, and to evaluate the occlusal and vertical skeletal changes and acceptance of the intra-oral scanner and bite plane. Single-centre two-arm parallel group randomised controlled trial with 1:1 allocation to intervention and control groups. Dundee Dental Hospital and Research School, UK. A total of 38 participants aged 9-16 years (11 males, 27 females) with Class II division 2 incisor relationship and increased overbite (greater than one-third incisor overlap). Participants were randomised to intervention (n = 19) and control (n = 19) groups using block randomisation. The intervention group had a fixed anterior bite plane, and the occlusion and vertical facial dimensions were monitored with intra-oral scans, lateral cephalograms and photographs. The control group received no treatment and occlusal and vertical facial dimensions were monitored with scans and photographs. Questionnaires were completed by participants and parents/carers. An intention-to-treat analysis was planned. The overbite reduced in all participants in the intervention group (mean initial overbite: 5.07 mm, 95% confidence interval [CI] = 4.15-6.00; mean overbite after 6 months: 2.45 mm, 95% CI = 1.93-2.96). There was a mean incisor intrusion of 0.29 mm (95% CI = 0.17-0.42) and mean eruption of the first molars of 0.23 mm (95% CI = 0.09-0.37). There was no significant change in incisor inclination or vertical skeletal change. Feedback from participants and their parents/carers were generally positive. Fixed anterior bite planes effectively reduce an increased overbite in adolescents with a Class II division 2 incisor relationship, due to a combination of incisor intrusion and molar eruption with no change in incisor inclination or vertical skeletal change. Intra-oral scanning and fixed anterior bite planes are acceptable in adolescents.

Reliability of the Assessment of Tooth Wear Severity on Dental Hard Tissues and Dental Restorations, Using the TWES 2.0, by Nonexperts.

Tooth wear is a multifactorial process resulting in the loss of dental hard tissues. For its assessment, the tooth wear evaluation system (TWES) 2.0 has been published. Previous studies on the TWES involved well-trained practitioners, rather than nonexperts. The first aim of this study was to investigate the reliability of the assessment of tooth wear severity on dental hard tissues, using the TWES 2.0, by nonexperts. The second aim was to investigate the reliability of assessment of wear severity on dental restorations, using a third scale. Forty-seven dental students evaluated at least 9 of 14 possible patient cases on dental casts and intraoral photographs. Cohen's kappa (agreement with sample solution) and Fleiss' kappa (Inter-rater reliability) were calculated. The agreements of the operators' ratings compared to the sample-solution resulted in Cohen's kappa between 0.02 and 0.9. The agreements were 0.34 for occlusal; 0.43 for vestibular; 0.57 for oral surfaces. Inter-rater reliability (Fleiss' kappa) was 0.35 for occlusal, 0.17 for vestibular and 0.24 for oral assessment. The inter-rater reliability of the ratings on tooth surfaces with restorations was lower with 0.21 (occlusal), 0.14 (vestibular) and 0.39 (oral). The agreement on different restorations differed tremendously. The ability to correctly assess the cases varied considerably between individual examiners. Within the limits of this study, assessment of restorations was slightly more challenging compared to natural teeth, particularly in occlusal regions or when the restorative material is gold. Subsequent studies should address whether enhanced training and improved definition of tooth wear grades result in higher reliability scores.