Lateral Cephalometric Radiographs Research Articles

Soft tissue paradigm based Treatment planning in skeletal class III.

This study aimed to propose guidelines for the indications of non-extraction, extraction camouflage treatment, and orthognathic surgery by comparing the degree of soft tissue improvement effects. This comparison focused on changes in CKHA, a soft tissue indicator corresponding to the major hard tissue indicator, ANB. Sixty-six patients, 25 males and 41 females, aged between 18 and 50 years and diagnosed with skeletal Class III malocclusion (ANB < 0°), were enrolled in the study. Participants were categorized into three groups based on the treatment approach: G1, non-extraction (n = 20); G2, extraction (n = 20); and G3, orthognathic surgery (n = 26). To assess variations in treatment outcomes, measurements derived from lateral cephalometric radiographs obtained before and after treatment were analyzed and compared across the different treatment methods. Significant differences were observed in the ANB between the G1 and G2/G3 groups. However, no significant differences were observed in CKHA levels after treatment. Furthermore, in G2, the CKHA approached the normal range at -1.8° (normal range: -2.0°), suggesting that soft tissue responses can normalize despite minimal changes in the skeletal structure. Although surgery resulted in the most significant skeletal changes, both camouflage groups demonstrated distinct advantages in the soft tissue paradigm. In G2, a noticeable posterior movement of the lower lip was observed along with a corresponding posterior shift in the soft tissue B point. This study provides guidelines for non-extraction, extraction and surgical treatment selection aimed at achieving soft tissue objectives.

Radiological assessment of Sella Turcica morphology correlates with skeletal classes in an Austrian population: an observational study.

This study aimed to analyze variations in the sella turcica (ST) concerning its size, shape, and bridging, providing first reference values in Austrian individuals. Additionally, it assessed associations between these morphological and demographic parameters and their correlation with patients' skeletal class. 208 lateral cephalometric radiographs (154 female, 54 male; age 8-58 years) from DPU Dental Clinic (Austria) were included. Size, skeletal class, shape, age, and gender of ST were tested for significance in correlation using, (M)ANOVA, and chi-square. Linear dimensions of ST ranged from 11.1 to 12.9mm across readers, with a standard deviation of 2.0-2.2mm. Normal ST (49.76%) and round ST (58.77%) were the most frequent. ST bridging was detected in 6.97%. Skeletal class I appeared most frequently (54.8%). Statistical significance was observed between age, gender, and ST length, with further significant age effects on ST shape. Moreover, age showed significant modification of ST shape, while skeletal parameters appeared unaffected by other ST parameters. These preliminary findings define normal ST dimensions in an Austrian population, offering reference values for clinical interpretation and broadening the available European data. Clear associations between morphological and demographic parameters were detected. Additionally, these findings may contribute to diagnostic and therapeutic strategies in orthodontics and craniofacial pathology. Future studies employing cone beam computed tomography (CBCT) along a larger sample size could enhance the generalizability of these findings.

Validation of 2D lateral cephalometric analysis using artificial intelligence-processed low-dose cone beam computed tomography

ObjectivesTraditional cephalometric radiographs depict a three-dimensional structure in a two-dimensional plane; therefore, errors may occur during a quantitative assessment. Cone beam computed tomography, on the other hand, minimizes image distortion, allowing essential areas to be observed without overlap. Artificial intelligence can be used to enhance low-dose cone beam computed tomography images. This study aimed to clinically validate the use of artificial intelligence-processed low-dose cone beam computed tomography for generating two-dimensional lateral cephalometric radiographs by comparing these artificial intelligence-enhanced radiographs with traditional two-dimensional lateral cephalograms and those derived from standard cone beam computed tomography. MethodsSixteen participants who had previously undergone both cone beam computed tomography and plain radiography were selected. Group I included standard lateral cephalometric radiographs. Group II included cone beam computed tomography-produced lateral cephalometric radiographs, and Group III included artificial intelligence-processed low-dose cone beam computed tomography-produced lateral cephalometric radiographs. Lateral cephalometric radiographs of the three groups were analyzed using an artificial intelligence-based cephalometric analysis platform. ResultsA total of six angles and five lengths were measured for dentofacial diagnosis. There were no significant differences in measurements except for nasion-menton among the three groups. ConclusionsLow-dose cone beam computed tomography could be an efficient method for cephalometric analyses in dentofacial treatment. Artificial intelligence-processed low-dose cone beam computed tomography imaging procedures have the potential in a wide range of dental applications. Further research is required to develop artificial intelligence technologies capable of producing acceptable and effective outcomes in various clinical situations. Clinical significanceReplacing standard cephalograms with cone beam computed tomography (CBCT) to evaluate the craniofacial relationship has the potential to significantly enhance the diagnosis and treatment of selected patients. The effectiveness of low-dose (LD)-CBCT was assessed in this study. The results indicated that lateral cephalograms reconstructed using LD-CBCT were comparable to standard lateral cephalograms.

Evaluation of automated photograph-cephalogram image integration using artificial intelligence models.

To develop and evaluate an automated method for combining a digital photograph with a lateral cephalogram. A total of 985 digital photographs were collected and soft tissue landmarks were manually detected. Then 2500 lateral cephalograms were collected, and corresponding soft tissue landmarks were manually detected. Using the images and landmark identification information, two different artificial intelligence (AI) models-one for detecting soft tissue on photographs and the other for identifying soft tissue on cephalograms-were developed using different deep-learning algorithms. The digital photographs were rotated, scaled, and shifted to minimize the squared sum of distances between the soft tissue landmarks identified by the two different AI models. As a validation process, eight soft tissue landmarks were selected on digital photographs and lateral cephalometric radiographs from 100 additionally collected validation subjects. Paired t-tests were used to compare the accuracy of measures obtained between the automated and manual image integration methods. The validation results showed statistically significant differences between the automated and manual methods on the upper lip and soft tissue B point. Otherwise, no statistically significant difference was found. Automated photograph-cephalogram image integration using AI models seemed to be as reliable as manual superimposition procedures.

The reliability of a modified three-stage cervical vertebrae maturation method for estimating skeletal growth in males and females.

Reliability of the six-stage cervical vertebrae maturation method to evaluate skeletal growth was evaluated on the combined male and female samples and revealed diverse results. The current study aimed to determine the reliability of the modified three-stage cervical vertebrae maturation method for estimating the skeletal growth of males and females. Pretreatment lateral cephalometric radiographs of 137 orthodontic patients were utilized to evaluate the intra- and inter-observer reliability of a modified cervical vertebrae maturation method. Four independent examiners categorized each radiograph into one of the three skeletal growth stages according to the cervical vertebrae morphology: (1) a pre-peak group (combining the CS1 and CS2 stages), (2) a peak group (combining the CS3 and CS4 stages), and (3) a post-peak group (combining the CS5 and CS6 stages). The Kappa index and the Fleiss multirater Kappa test were carried out to determine the reproducibility of this method. The studied sample included cephalometric radiographs of 68 males (49.6%) and 69 females (50.4%) aged between 7 and 58 years; no significant age difference was found between the sexes (p = 0.189). The overall inter-observer reliability was 0.689 (p < 0.001), and the inter-observer reliability for the post-peak stage showed only Kappa = 0.896 (p < 0.001). The Kappa values were significantly greater in males than in females during the peak stage (0.626 and 0.488, respectively). A modified three-stage cervical vertebrae maturation method showed substantial overall inter-examiner agreement; however, differential reliability for diverse skeletal maturation stages and sexes was found.

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.

Evaluation of Upper Airway Growth Patterns With Cephalometric Analysis Based on Cervical Vertebral Maturation in the Japanese: A Cross-Sectional Study.

Objective This study aims to establish standard values for the upper airway cross-sectional area and evaluate growth patterns using the cervical vertebral maturation stage (CVMS) in a Japanese population. Methods A cross-sectional sample of 400 patients, aged 6-20 years, was selected randomly from the Orthodontic Clinic at Tokyo Medical and Dental University (TMDU) dental hospital. Cervical vertebral maturation stages (CVMS I-V) guided the classification of participants into five equal groups. Lateral cephalometric radiographs taken prior to orthodontic treatment were used to measure the upper airway's cross-sectional area. The growth spurt and sex differences in growth patterns were assessed through these measurements. Results Standard values for the upper airway dimensions at each CVMS stage were established. Significant growth spurts were noted between CVMS II-III and CVMS III-IV in males and at CVMS II-III in females. The weighted kappa coefficient (κ) demonstrated almost perfect intra- and inter-evaluator agreement, confirming the reliability of CVMS in growth assessment. Conclusion CVMS provides a reliable framework for assessing growth patterns of the upper airway, with distinct variations between sexes noted. These findings support the utility of CVMS in clinical growth evaluation and orthodontic treatment planning.

A Novel Approach for Improving Midface Aesthetics: A Pilot Study.

Asian individuals often seek solutions to address midface depression and enhance nasal alar base morphology to achieve Western facial aesthetics. Current treatment options, including injections and invasive procedures, have limited efficacy and safety. To address these challenges, we introduced the "modified A-10 surgery," which integrates the Point A-Koji method, titanium plates, and artificial dermis insertion. The efficacy of the modified A-10 surgery was illustrated using a case study of a 22-year-old woman. Surgical planning was based on dental cone-beam computed tomography data, with lateral cephalometric radiographs used to determine the titanium plate dimensions. The surgery involved customized plate alignment, fixation, and artificial dermis insertion. The modified A-10 surgery substantially improved facial aesthetics and structural parameters. Facial convexity increased from 15.5 degrees to 23.2 degrees, enhancing the 3-dimensionality. The nasolabial angle shifted from 91.9 degrees to 110.2 degrees, achieving the desired mouth projection. Other measurements, such as the E-line to the lower lip and the distance from point A to the subnasal point, contributed to refined aesthetics. The nasal alar base thickness increased by 2.2 mm (19.5%), correcting the depression. The modified A-10 surgery represents a minimally invasive and comprehensive solution for midface depression and nasal alar base enhancement. By combining the Point A-Koji method, titanium plates, and artificial dermis insertion, this surgery successfully achieved improved facial aesthetics and contours. The results validate its potential as a long-term solution, with implications for antiaging interventions and promising avenues for future research.

A Cephalometric Study Of Vertical Skeletal Changes After Extraction And Non-Extraction Fixed Orthodontic Treatment Of Class I Malocclusion In North Indian Population

Background: Orthodontic treatments frequently involve tooth extractions to address crowding and protrusion, but the effects of these extractions on vertical skeletal changes are still debated. Research has extensively covered aspects like soft tissue response and smile aesthetics, yet there is no consensus on their impact on vertical dimensions. This issue is particularly pertinent for hyperdivergent individuals, who make up about 22% of orthodontic patients. A proposed technique for such cases includes counterclockwise rotation of the lower jaw and advancement of posterior teeth to manage open bites or excessive vertical facial height. This study aims to compare vertical skeletal changes in Class I malocclusion patients undergoing extraction versus non-extraction fixed orthodontic treatments. Material and Methods: We analysed pre- and post-treatment lateral cephalometric radiographs from 60 Class I crowding patients, evenly split into extraction and non-extraction groups. Eight vertical skeletal parameters were assessed and compared statistically between the two groups. Superimposition analysis of radiograph tracings was used to explore vertical changes related to molar mesialization, particularly in the extraction group. Results: The extraction group demonstrated significant reductions in vertical skeletal dimensions compared to the non-extraction group. Measurements including FMA, SN-GoGn, Y-axis, SN-PP, and PP-MP showed significant differences, with reductions in the extraction group (P = 0.001). Procrustes superimposition indicated effective molar mesialization in the extraction group, which was not observed in the non-extraction group. Conclusion: Extraction of first premolars in fixed orthodontic treatment leads to a notable decrease in vertical skeletal dimensions, in contrast to the slight increase seen with non-extraction treatments. This reduction is largely due to molar mesialization, which enhances vertical skeletal dimensions and treatment stability in Class I crowding cases.

Skeletal and dental features of class II malocclusion among Palestinian population: a retrospective cephalometric study

Aim. This study aims to assess the dentofacial characteristics for a sample of palestinian population with skeletal Class II malocclusion. Methods. A total of 170 lateral cephalograms for non-growing patients (age ranged between 19 and 32 years) with skeletal Class II malocclusion were retrieved. The lateral cephalograms were analyzed using virtual cephalometric analysis software - WeDoCeph® (Audax®, Ljubljana, Slovenia) to assess sagittal and vertical Skeletal parameters including SNA, SNB, ANB, SN/Mandibular Plane angle SN/Go-Gn, FMA and the Y axis angle were measured. Moreover, the upper and lower dental angular parameters (Maxillary incisor long axis with Sella - Nasion line (U1-SN), Maxillary incisor long axis with Nasion - point A angular (U1-A Point), Mandibular incisor long axis with mandibular plane (L1-MP), Mandibular incisor with nasion-point B (L1- NB) angular were also measured. The mean and standard deviation for each measurement were calculated using the Statistical Package for Social Sciences (Minitab) for Windows. Gender differences were analyzed using the independent t-test. Results. One-hundred and seventy lateral cephalometric radiographs were retrieved and analyzed. The Class II skeletal value (ANB value of 6.7 degrees) was mainly due to retrognathic mandible (SNB 75.5 degrees) rather than prognathic maxilla (SNA 82.2 degrees). In the vertical dimension, the Y axis angle, SN/Go-Gn angle, and FMA were generally increased. Regarding the dental parameters, the upper incisors were mostly retroclined, while the lower incisors were mostly proclined. There was a significant gender difference in two parameters (SN/Go-Gn and the L1-MP), where females showed more vertical growth and more lower incisors proclination. Conclusions. Skeletal class II malocclusion in the studied sample was characterized by retrognathic mandible, increased vertical growth, and compensated upper and lower incisors. Compared with male subjects, females significantly had more vertical growth and more lower incisor proclination.

Comparison of semi and fully automated artificial intelligence driven softwares and manual system for cephalometric analysis

BackgroundCephalometric analysis has been used as one of the main tools for orthodontic diagnosis and treatment planning. The analysis can be performed manually on acetate tracing sheets, digitally by manual selection of landmarks or by recently introduced Artificial Intelligence (AI)-driven tools or softwares that automatically detect landmarks and analyze them. The use of AI-driven tools is expected to avoid errors and make it less time consuming with effective evaluation and high reproducibility.ObjectiveTo conduct intra- and inter-group comparisons of the accuracy and reliability of cephalometric tracing and evaluation done manually and with AI-driven tools that is WebCeph and CephX softwares.MethodsDigital and manual tracing of lateral cephalometric radiographs of 54 patients was done. 18 cephalometric parameters were assessed on each radiograph by 3 methods, manual method and by using semi (WebCeph) and fully automatic softwares (Ceph X). Each parameter was assessed by two investigators using these three methods. SPSS was then used to assess the differences in values of cephalometric variables between investigators, between softwares, between human investigator means and software means. ICC and paired T test were used for intra-group comparisons while ANOVA and post-hoc were used for inter-group comparisons.ResultsTwelve out of eighteen variables had high intra-group correlation and significant ICC p-values, 5 variables had relatively lower values and only one variable (SNO) had significantly low ICC value. Fifteen out of eighteen variables had minimal detection error using fully-automatic method of cephalometric analysis. Only three variables had lowest detection error using semi-automatic method of cephalometric analysis. Inter-group comparison revealed significant difference between three methods for eight variables; Witts, NLA, SNGoGn, Y-Axis, Jaraback, SNO, MMA and McNamara to Point A.ConclusionThere is a lack of significant difference among manual, semiautomatic and fully automatic methods of cephalometric tracing and analysis in terms of the variables measured by these methods. The mean detection errors were the highest for manual analysis and lowest for fully automatic method. Hence the fully automatic AI software has the most reproducible and accurate results.

Predicting Mandibular Growth Potential Based on Cervical Vertebral Bone Age Using Lateral Cephalometric Radiographs in a Sample of the Saudi Population

Background: This study estimated the predictive accuracy of the mandibular growth potential based on cervical vertebral bone age using digital lateral cephalograms in a sample of the Saudi population. Methods: This study included digital lateral cephalograms of eighty subjects aged 10–21 years divided into adult and young groups. Cervical vertebral age was calculated by tracing and measuring the third and fourth cervical vertebrae on lateral cephalograms, and the mandibular growth potential was estimated using the Mito et al. regression equation. The accuracy of the calculated CVB age was verified via comparison with the chronological age. The data analyses included independent sample t-tests for testing the differences in mean values and Pearson correlation coefficients to examine the relationship between dependent and independent variables. Results: A significant difference was noted between the mean cervical vertebral age and chronological age in the young group for both males (p = 0.0003) and females (p = 0.033). The correlation coefficient between cervical vertebral age and chronological age in the young male group was higher (r = 0.934) than that in the young females (r = 0.254). Conclusions: The mandibular growth potential prediction based on CVB age using the regression equation of Mito et al. was applicable only to the young Saudi males. Further studies are needed to develop new multiple regression models to obtain cervical vertebral age more accurately for both genders in the Saudi population.

Assessment of Zygomaticomaxillary Suture Maturation in Patients With Unilateral Cleft Lip and Palate: Implications for Orthodontic Treatment Planning.

Introduction The zygomaticomaxillary suture (ZMS) is vital for craniofacial development and orthodontic treatment planning. Located at the junction of the zygomatic and maxillary bones, the ZMS undergoes significant changes during growth, affecting midfacial morphology and stability. Understanding ZMS maturation is essential for optimizing orthodontic interventions, especially in patients with cleft lip and palate (CLP), who often exhibit altered craniofacial growth patterns due to congenital deformities and surgical interventions. Methodology A retrospective analysis was conducted with 50 participants, including 25 patients with unilateral CLP and 25 age-matched controls. Clinical and radiographic data, including lateral cephalometric radiographs and cone-beam computed tomography (CBCT) scans, were collected to assess ZMS maturation stages. The stages, ranging from immature (stage 0) to fully mature (stage 4), were evaluated using established radiographic criteria. Statistical analyses, including Chi-square tests and logistic regression, were performed to compare the distribution of maturation stages between groups. Results Significant differences were observed in ZMS maturation stages between the cleft side, non-cleft side, and control group. The cleft side exhibited a higher prevalence of immature (stage 0) and early maturation (stage 1) stages compared to the control group, with mean values of 4 ± 1.2 and 5 ± 1.3, respectively. The control group showed a higher prevalence of fully mature (stage 4) sutures, with a mean value of 8 ± 1.4. The p-values for stages 0, 1, and 4 were 0.045, 0.034, and 0.039, respectively, indicating statistical significance. The findings highlight distinct maturation patterns in CLP patients, with delayed ZMS maturation on the cleft side. This suggests the need for tailored orthodontic interventions to accommodate prolonged growth phases in CLP patients. The study underscores the importance of detailed ZMS assessments for personalized treatment planning. Future research should focus on longitudinal studies to further understand CLP's impact on craniofacial development. Conclusion Assessing ZMS maturation provides critical insights for optimizing orthodontic and surgical treatment outcomes in CLP patients. By identifying specific developmental delays and tailoring interventions accordingly, clinicians can improve the effectiveness and stability of treatments. This study contributes to the growing body of evidence supporting individualized treatment plans based on precise developmental assessments.

Runx2 gene single nucleotide polymorphism in Class II and Class III malocclusions

To assess the prevalence of RUNX2 gene polymorphism in skeletal class II and class III malocclusions. : Unstimulated salivary samples of 36 patients (18- 30 years of age group), comprising 18 with skeletal class II and 18 with skeletal class III were collected from a tertiary care hospital in Mangalore. Salivary DNA samples were collected and analyzed using Sanger sequencing. Digital tracing was performed on lateral cephalometric radiographs by using AutoCAD software for digitization to assess the anterio-posterior and vertical relationship of the maxillary and mandibular arch.When polymorphism of 36 samples comprised of 18 Class II and 18 Class III were assessed, 83.3% Class III malocclusion and 5.6% Class II showed RUNX2 gene polymorphism in the population. Chi Square test which indicated that the results are statistically significant in Class III malocclusion for RUNX2 single nucleotide polymorphism (p&amp;#60;0.001). RUNX2 gene polymorphism was statistically significant in skeletal Class III malocclusion when compared to skeletal Class II malocclusion. This is a preliminary study done on a smaller sample, we need a larger sample size to confirm our findings.

A RETROSPECTIVE LATERAL CEPHALOMETRIC STUDY ON FRONTAL SINUS HEIGHT AND WIDTH MEASUREMENT PROTOCOL FOR GENDER DETERMINATION

Aim: To develop and assess a protocol proposed for sex determination using frontal sinus height and width measured from two dimensional lateral cephalometric radiographs. Material and Methods: The frontal sinus index was measured on sixty-four cephalometric scans (32 males &amp; 32 females). The maximum height and width of the sinus were measured. The data was tabulated and independent t test was done to determine the correlation to gender. Results: There was a high statistically significant difference between the frontal sinus width measured between male and female groups. The p value for width was found to be 0.02 which is significant. Conclusion: Measuring the frontal sinus height and width by the proposed protocol is promising. Multicentric study is recommended to reach a solid evidence-based result. Also testing the reliability of the standardization protocol is recommended by applying it on multiple drawn sinus borders by multiple experienced radiologists.

A comparative study of the efficacy of customized titanium plates versus conventional maxillary protraction in the treatment of skeletal class Ⅲ patients

Objective: To compare the clinical efficacy of customized titanium plate and conventional maxillary protraction treatment in patients with skeletal class Ⅲ malocclusion during growth spurt. Methods: During growth spurt, skeletal class Ⅲ patients with maxillary hypoplasia who were treated in the Department of Orthodontics, Capital Medical University School of Stomatology from August 2018 to July 2021 were prospectively enrolled. They were treated with maxillary protraction using customized titanium plates (customized titanium plate group) and conventional methods (conventional protraction group), respectively. Lateral cephalometric radiographs were collected before and after treatment for conventional cephalometric analysis, including SNA angle (angle between Sella, Nasion and A point), ANB angle (angle between A point, Nasion, and B point), FH-MP angle (mandibular plane angle), Y-axis angle, U1-L1 angle (upper to lower central incisor angle), U1-SN angle (upper incisor to SN plane angle), anterior and lower height, maxillary length, etc. The stable basicranial line (SBL) was used as the reference line to measure the distance from each reference point (ANS point, A point, Prn point, Sn point, UL point etc.) to the stable basicranial vertical line (VerT, the perpendicular line of the skull base line at the intersection point of the anterior wall of the sella image and the inferior edge of the anterior bed process). Paired t-tests were performed on the cephalometric data before and after maxillary protraction treatment in the two groups, and two independent samples t-tests were performed to compare the differences in the efficacy of the two maxillary protraction methods. Results: A total of 20 patients (9 males and 11 females), aged (10.8±1.3) years, were included in the personalized titanium plate group. A total of 20 patients (8 males and 12 females), aged (10.5±1.1) years, were included in the conventional protraction group. The SNA angle, ANB angle, FH-MP angle, Y-axis angle, anterior lower height, maxillary length, ANS-VerT distance, A-VerT distance, Prn-VerT distance, Sn-VerT distance, and UL-VerT distance were significantly higher than those before treatment in the two groups (P<0.05). The changes of SNA angle, ANB angle and A-VerT before and after treatment in the personalized titanium plate group [3.15°±2.28°, 4.64°±1.40°, (4.41±3.43) mm, respectively] were significantly higher than those in the traditional group [2.13°±2.69°, 2.81°±1.10°, (3.13±4.76) mm, respectively](P<0.05), and the changes of U1-L1 angle and U1-SN angle before and after treatment (-0.76°±7.42° and 1.74°±6.38°, respectively) was significantly lower than that of the control group (-5.14°±6.62° and 4.57°±5.24°, respectively, P<0.05). Conclusions: Maxillary protraction can effectively improve skeletal class Ⅲ relationships in growing patients. The linear measurements using the SBL line as a reference plane visualize the sagittal improvement in sagittal relationship after maxillary protraction. The customized titanium plate maxillary protraction treatment has a clear therapeutic effect on patients with skeletal class Ⅲ deformities, and its dental effect is relatively small.

Determination of orthodontic anomaly patterns in patients in the Thrace region and assessment of the relationship between orthodontic anomalies and DMFT indices: a retrospective study

OBJECTIVE: The aim of this study was to investigate the prevalence of dental and skeletal anomalies that could be a cause of malocclusion and their relationship with caries distribution in the western region of Türkiye. MATERIALS AND METHOD: A retrospective study was conducted with 1815 digital panoramic and lateral cephalometric radiographs taken from patients, age ranging between 6 and 47 years, who applied for orthodontic treatment. The lateral cephalometric radiographs, panoramic radiographs, and dental records were reviewed according to skeletal anomaly, dental malocclusion (Angle classification), and decay-missing- filling teeth (DMFT) index. Kruskal Wallis test was used in intergroup comparisons of variables that did not show normal distribution, and Dunn’s multiple comparison test was used in subgroup comparisons. The chi-square test and Yates correction were used in comparisons of qualitative data. RESULTS: The mean DMFT of the dental Class I malocclusion group was statistically and significantly lower than Class II division 1 and Class III malocclusion groups (p &amp;lt; 0.05). The mean DMFT index of Class II subdivision malocclusion group was statistically and significantly lower than that of Class III malocclusion group (p &amp;lt; 0.05). The DMFT index was significantly lower in the skeletal Class I group compared to the skeletal Class II and Class III anomaly groups (p &amp;lt; 0.05). CONCLUSION: There is a correlation between DMFT indices and dental malocclusions as well as skeletal anomalies. By correcting dental malocclusions and skeletal anomalies with orthodontic treatment and providing ideal occlusion, it becomes easier for patients to maintain oral hygiene and DMFT indices might decrease.

Construction of virtual airway model to assist surgical correction of velopharyngeal insufficiency with posterior pharyngeal flap

ObjectivePosterior pharyngeal flap (PPF) is one of the most common surgical technique to correct velopharyngeal insufficiency(VPI), during which controlling the sizes of the lateral pharyngeal ports(LPP) is the key to outcomes. One innovative procedure was developed to well control the size of LPP. Materials and methods40 patients with repaired cleft palate were collected from June 2022 to August 2023. All patients were diagnosed with VPI, and treated with modified PPF surgery. For each patient, upper airway model was reconstructed, and the virtual airway model of PPF was designed. The nasal valve area was measured as it was considered to be the narrowest part of the upper airway. The upper airway resistances under different sizes of LPP was predicted through computational fluid dynamics analysis. The minimum size of each lateral pharyngeal port without obviously increase of upper airway resistance was calculated through effect of lateral pharyngeal ports’ size on upper airway resistance. Postoperative follow-up was 6–18 months, including speech outcome and respiration outcome. Resting soft palate length (RVL), effective working length of soft palate (EWL) and angle of soft palate elevation (AVL) were measured and compared according to the lateral cephalometric radiograph. ResultsThere was a linear relationship between the threshold value and nasal valve (R = 0.62). Among the forty patients, the average size of nasal valve was 47.81 mm2, the average size of the threshold value of LPP was 31.63mm2. The proportion of velopharyngeal closure competence after surgery was 95 %. Compared with the preoperative measurements, there were significantly increase of RVL, EWL and AVL (P < 0.05). There were significantly difference in the nasal obstruction symptom evaluation score in long-term follow-up compared to short-term follow-up (P < 0.05), and no one needed flap revision. There was no significant difference in nasal respiration and nasal resistance before and after surgery (P > 0.05). ConclusionWith the help of computer fluid dynamics analysis, it is possible to predict the threshold size of lateral pharyngeal port without obviously increasing upper airway resistance and reduce the risk of suffering from airway obstruction for patients undergoing PPF surgery.

Factors influencing craniofaciadental changes in skeletal Class III orthognathic surgery by using machine learning

Background/purposeIn skeletal Class III patients, treatment options include camouflage and orthognathic surgery. This study used machine learning to investigate factors influencing dental, skeletal, and soft tissue morphological changes following skeletal Class III orthognathic surgery. Materials and methodsA retrospective analysis was conducted at Taipei Medical University Hospital. The study analyzed the lateral cephalometric radiographs of 58 patients with skeletal Class III who underwent orthognathic surgery. Web-based cephalometric software was used to obtain cephalometric tracing measurements, including dental, skeletal, and soft tissue parameters at pretreatment (T0) and posttreatment (T1), and assess postsurgical changes (T1−T0). Conventional statistical models were used for data analysis, followed by the application of machine learning–based random forest regression to identify influencing factors, as characterized by the feature of importance (FI). ResultsAll cephalometric variables except SNA, A to NP, overbite, and lower lip to E-plane differed significantly between T0 and T1. ANB was significantly influenced by surgery type (P = 0.045), whereas IMPA and lower lip to E-plane were significantly influenced by sex (IMPA P = 0.029; lower lip to E-plane P = 0.033). According to machine learning results on the influence of pretreatment conditions, overjet was a key factor influencing several dependent variables, namely, changes in ANB (FI = 0.226), B to N-Perp (FH) (FI = 0.259), and Pog to N-Perp (FH) (FI = 0.257). ConclusionMachine learning revealed the overjet plays a dominant role in several dependent variables, including changes in ANB, B to N-Perp (FH), and Pog to N-Perp (FH). Future studies should use a larger dataset and three-dimensional data.