Orthodontic Extraction Research Articles

Effect of orthodontic extraction of mandibular premolars on third molar angulation after treatment with fixed appliances : Across-sectional study.

Orthodontic treatment involving premolar extractions might improve the angulation of lower third molars, which are the teeth most often impacted. This study analyzes the impact of first/second lower premolar extraction during orthodontic therapy on the angulation of mandibular third molars. A total of 120patients treated non-extraction (n = 40), with extraction of first (n = 40), or second lower premolars (n = 40) were included. The mesiodistal angulation of lower third molars relative to the adjacent tooth and their developmental stage were evaluated from posttreatment orthopantomograms. Between-group differences were statistically evaluated at asignificance level of 0.05. The orthopantomograms of 120patients (51% female) with amedian age of 15.2years at the time of debonding were evaluated after amean treatment duration time of 2.9years. No difference (P > 0.05) was seen between the average angulation of the lower third molars of the right (mean = 24.4°, standard deviation [SD] 13.6°) and the left side (mean = 23.6°, SD 14.1°). No differences in the angulation of the lower third molar were found between the non-extraction and extraction groups for the right (P = 0.44) or the left side (P = 0.22). Likewise, no differences were found when comparing the first and second premolars for the right (P = 0.26) or the left side (P = 0.10). Premolar extraction was associated with an advanced root development stage of the right third molar (odds ratio 7.1; 95% confidence interval 1.1-48.1; P = 0.04), with no differences between extraction of the first or second premolar (P = 0.10). Orthodontic treatment involving premolars extractions might be associated with asmall acceleration in root development, but not with the angulation, of lower third molars.

Evaluation of artificial intelligence model for crowding categorization and extraction diagnosis using intraoral photographs

Determining the severity of dental crowding and the necessity of tooth extraction for orthodontic treatment planning are time-consuming processes and there are no firm criteria. Thus, automated assistance would be useful to clinicians. This study aimed to construct and evaluate artificial intelligence (AI) systems to assist with such treatment planning. A total of 3,136 orthodontic occlusal photographs with annotations by two orthodontists were obtained. Four convolutional neural network (CNN) models, namely ResNet50, ResNet101, VGG16, and VGG19, were adopted for the AI process. Using the intraoral photographs as input, the crowding group and the necessity of tooth extraction were obtained. Arch length discrepancy analysis with AI-detected landmarks was used for crowding categorization. Various statistical and visual analyses were conducted to evaluate the performance. The maxillary and mandibular VGG19 models showed minimum mean errors of 0.84 mm and 1.06 mm for teeth landmark detection, respectively. Analysis of Cohen’s weighted kappa coefficient indicated that crowding categorization performance was best in VGG19 (0.73), decreasing in the order of VGG16, ResNet101, and ResNet50. For tooth extraction, the maxillary VGG19 model showed the highest accuracy (0.922) and AUC (0.961). By utilizing deep learning with orthodontic photographs, dental crowding categorization and diagnosis of orthodontic extraction were successfully determined. This suggests that AI can assist clinicians in the diagnosis and decision making of treatment plans.

Can we predict orthodontic extraction patterns by using machine learning?

To investigate the utility of machine learning (ML) in accurately predicting orthodontic extraction patterns in a heterogeneous population. The material of this retrospective study consisted of records of 366 patients treated with orthodontic extractions. The dataset was randomly split into training (70%) and test sets (30%) and was stratified according to race/ethnicity and gender. Fifty-five cephalometric and demographic input data were used to train and test multiple ML algorithms. The extraction patterns were labelled according to the previous treatment plan. Random Forest (RF), Logistic Regression (LR), and Support Vector Machine (SVM) algorithms were used to predict the patient's extraction patterns. The highest class accuracy percentages were obtained for the upper and lower 1st premolars (U/L4s) (RF: 81.63%, LR: 63.27%, SVM: 63.27%) and upper 1st premolars only (U4s) extraction patterns (RF: 61.11%, LR: 72.22%, SVM: 72.22%). However, all methods revealed low class accuracy rates (<50%) for the upper 1st and lower 2nd premolars (U4/L5s), upper 2nd and lower 1st premolars (U5/L4s), and upper and lower 2nd premolars (U/L5s) extraction patterns. For the overall accuracy, RF yielded the highest percentage with 54.55%, followed by SVM with 52.73% and LR with 49.09%. All tested supervised ML techniques yielded good accuracy in predicting U/L4s and U4s extraction patterns. However, they predicted poorly for the U4/L5s, U5/L4s, and U/L5s extraction patterns. Molar relationship, mandibular crowding, and overjet were found to be the most predictive indicators for determining extraction patterns.

Correction: Diagnostic accuracy of AI in orthodontic extraction decisions: “Are we ready to let Mr. Data run our Enterprise?” A commentary on a systematic review

Correction: Diagnostic accuracy of AI in orthodontic extraction decisions: “Are we ready to let Mr. Data run our Enterprise?” A commentary on a systematic review

Efficacy of various Platelet concentrates on the rate of Orthodontic tooth movement – A Systematic Review and Meta-Analysis.

With increased interest in reducing the average duration of Orthodontic treatment, various techniques for accelerating tooth movement have been extensively researched. Studies have shown conflicting results with various Platelet Concentrates (PCs). Hence this review aimed to evaluate and gather evidence of the effectiveness of Platelet concentrates (PRP/PRF) during orthodontic extraction space closure about the space closure rate and the time required for and the angular measurements of the tooth movement during space closure. The electronic databases of Cochrane CENTRAL, PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched up to June 2021. The criteria for selection were Randomised Controlled Trials (RCTs) comparing the use of PCs with that of no intervention/placebo during canine retraction or retraction of anterior teeth. All other studies were excluded. Two reviewers performed the entire process of study selection, extraction of data, and quality assessment independently. Cochrane's ROB2 tool was used for quality assessment in the studies selected. The quantitative analysis of the studies was performed with the use of Review Manager (RevMan5). Eight RCTs met the inclusion criteria and were included for the qualitative synthesis in this review. Of these, five RCTs were included in the quantitative analysis. The results indicated an insignificant increase in the rate of tooth movement with the administration of the PCs (0.13 mm more Tooth movement; 95% CI = -0.17 – 0.43; p = 0.40). No differences were also found in the change of canine inclination and amount of canine rotation. Quantitative synthesis of the selected five studies (3 studies had a low Risk of Bias) reveals no statistically significant difference in the rate of tooth movement with the use of PCs. The results of this analysis should be interpreted with caution owing to the existence of heterogeneity. Limited evidence suggests an actual reduction in the overall treatment duration. Future studies should be aimed at standardizing the protocol for preparing and administering the PCs. This review did not receive any funding.Trial registration number: PROSPERO CRD42021241221

Longitudinal behavior of orthodontic extraction spaces: A retrospective dental cast analysis

This retrospective study aimed to qualitatively and quantitatively evaluate orthodontic extraction space behavior and size at the end of treatment and the short- and long-term stages in Class I, II, and III malocclusions. The sample comprised records of 1283 orthodontic patients treated with extractions (cross-sectional group). From these patients, 1- and 5-year posttreatment records of 214 patients were additionally evaluated (longitudinal group). Orthodontic extraction sites of immediate (end of treatment), short-term (1-year posttreatment), and long-term (5-year posttreatment) stage dental casts were measured with a digital caliper. Extraction spaces were classified according to their qualitative behavior in the open, closed, reopened, and recently closed spaces. Space qualitative longitudinal behavior was compared among the malocclusion types with chi-square tests. Kolmogorov-Smirnov normality tests were performed to check the variable's distribution. All variables showed normal distribution, except the malocclusion group ages. Therefore, parametric tests were used for all comparisons between the malocclusion groups, except for age comparisons in each stage, which were compared with the Kruskal-Wallis tests. Thus, space size and its reduction were compared among the 3 stages, in general, and between the maxillary and mandibular arches, with analysis of variance followed by Tukey tests and t tests, respectively. Classes I, II, and III malocclusion patients presented similar ages at each stage. At the end of treatment, 71.4% and 65.1% of the quadrants were closed in the cross-sectional and longitudinal groups, respectively, and 43.6% and 38.2% of patients presented all quadrants closed at this same stage in both groups. The reopening and late closure tendencies were 2.9 and 2.3 times greater in the short term than in the long term. Reopening tendency in the short-term was greater in Class II than in Class I malocclusion. Of the quadrants closed at the end of treatment, 87% were stable in the long term. From the quadrants with residual spaces at the end of treatment, 28.4% persisted openly in the long term. Residual space size reduced significantly in the short and long term, primarily in the mandibular arch. The percentage of patients with residual spaces at the end of treatment was 56.4%. Space reopening and late closure occur mainly in the first year after treatment. There was long-term stability in 87% of the quadrants closed at the end of treatment. There was a significant reduction in orthodontic extraction space size in the short and long term, especially in the mandibular arch.

Effectiveness of micro-implant in vertical control during orthodontic extraction treatment in class II adults and adolescents after pubertal growth peak: a systematic review and meta-analysis.

To compare the effectiveness of micro-implant (MI) and conventional anchorage (CA) in vertical control during orthodontic extraction treatment of class II adults and adolescents after pubertal growth peak. Literature search was conducted through Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine (CBM), and other sources, from inception to December 2021. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Mean differences (MDs) with 95% confidence intervals (CIs) were conducted. A meta-analysis concerning change of mandibular plane, vertical change of upper and lower molar, change of occlusal plane, SNB, chin position, and profile was carried out. A total of 10,669 records were identified in the database search, and 19 studies (10 RCTs and 9 CCTs) were included in the final analysis. Compared with CA, MI significantly decreased mandibular plane angle and intruded upper molars. No significant difference was found in vertical change of lower molars, occlusal plane, SNB, chin position, and profile. MI seems to be more effective than CA in vertical control during orthodontic extraction treatment of class II adults and adolescents after pubertal growth peak. MI should be given priority when considering the vertical control of class II patients, which is beneficial to the counterclockwise rotation of mandible or at least prevention of deterioration of the profile.

Bilateral orthodontic extractions using physics versus conventional forceps among Indian patients.

It is of interest to assess whether or not physics forceps are superior to traditional forceps for the extraction of premolar teeth in orthodontic procedures. Tooth and buccal bone fractures, as well as extraction time, lacerated gingiva, postoperative discomfort, and infection, were all measured in this research of both types of forceps extraction. Twenty individuals who need orthodontic extraction on both jaws were enrolled in the research. One arch's premolars were removed in two appointments, the first using Physics forceps and the second using conventional ones. The subsequent assignment included extraction from the obverse arch. Intraoperative evaluations included assessments of factors such as tooth and buccal bone fractures, surgical time, and gingival lacerations; postoperative assessments of pain and infection were conducted on days 1, 3, and 7. With physics forceps, the average time to remove a patient's mandible was 86.55 seconds, whereas traditional forceps required just 35.70 seconds. Using traditional forceps, the average pain score was 0.865 on day one after surgery, but with physics forceps, it was 3.30. The use of physics forceps resulted in one buccal bone fracture out of twenty premolar extractions. That so, no meaningful statistical change was seen. There was no tooth damage or post-operative infection with either set of forceps, it was found. Each forceps caused a Grade I laceration to the gingiva. The average time required removing a maxillary using physics forceps was 224.05 seconds, whereas the time required doing it with conventional forceps was 141.50 seconds. On a Visual Analogue Scale (VAS), the average first-day pain after surgery using physics forceps was 4.90, whereas using traditional forceps resulted in just 3.15. The difference between using physics forceps and regular forceps was statistically significant by the third postoperative day (2.05 vs 0.75). There was a statistically insignificant increase in the occurrence of buccal bone fracture and tooth fracture while using physics forceps. Both forceps and scissors caused just grade I lacerations, and there was no postoperative infection. These findings suggest that the use of physics forceps, as opposed to conventional forceps, may significantly lengthen the time required to remove orthodontic premolars on both sides of the mouth. Non-significant results were also found for additional criteria such as buccal bone fracture, tooth fracture, gingival laceration, and post-operative discomfort. When it comes to orthodontic premolar extraction, this research found that traditional forceps performed better than modern forceps across a range of measures, including intraoperative time and postoperative discomfort.

Sedative Agents in Minor Paediatric Oral Surgical ProceduresA Narrative Review

Sedation in pediatric dentistry reduces anxiety during surgical procedures and also helps cope with very stressful events encountered during dental treatment. Various sedative agents like Nitrous oxide, diazepam, midazolam, Ketamine, propofol, fentanyl, and dexmedetomidine have been administered through several sedation routes including oral, nasal, inhalation, intramuscular, and sub-mucosal to attain active sedation. However, it is evident that the sesedative drugs also have the prospective to causelethal complications. Aim: The present review was carried out to brief the clinical aspects of various sedative agents currently available in pediatric practices based on the existing literature with special emphasis on their role in minor pediatric oral surgical procedures. Discussion: Nitrous oxide is frequently used in combination with complextime-consuming procedures and dental extractions, particularly for young and anxious patients undergoing orthodontic extractions. Fentanyl decreases pain and anxiety but causes respiratory distress. Oral ketamine is a potent dissociative drug often combined with midazolam produces excellent analgesic and sedative effects. None the less, the most common combinations include sedatives with ketamine/opioids or dexmedetomidine to maintain the airway reflexes if given in small doses with precautions. Sometimes a combination of inhaled gases especially short-acting sevoflurane along with Diazepam is favored. Conclusion: Within the limitation, it is evident that a clear understanding of the proper selection of sedative agents, awareness of the intended level of sedation or route of drug administration, and knowledge of adverse responses during and after sedation are essential to achieve appropriate sedation levels during minor oral surgical procedures.

Influence of resin infiltration pretreatment on the microleakage under orthodontic bracket (an in vitro study).

In order to assess the changes in tooth orthodontic adhesive interface microleakage after applying a caries resin penetrated to the sound enamel tooth surface in different storage media. A total of 60 human maxillary first premolars (orthodontic extraction) were collected by random separation of the teeth into two equal groups. The control group was classified into three subgroups (n = 10) (control in deionized water, control in milk, and control in energy drink), while the experimental one (treated with ICON) was categorized into three subgroups (n = 10) (ICON in deionized water, ICON in milk, and ICON in energy drink) incubation phase lasted three weeks in total. A one-way analysis of variance (ANOVA) yielded a significant difference between all experimental subgroups (ICON in deionized water, ICON in milk, and ICON in energy drink) and control subgroups (control in deionized water, control in milk, and control in energy drink). The control group in the energy drink subgroup had the highest mean microleakage value when compared to the other subgroups, whereas the resin-infiltrated group in deionized water had the lowest mean value. According to the results of the T-test, ICON pre-treatment tooth samples had significantly lower mean values of microleakage than non-ICON tooth samples. The adhesive system (control group) revealed that a resin infiltrate on a sound enamel surface prior to orthodontic bracket bonding reduced bracket tooth interface microleakage in all examined samples. The ICON-infiltrated surface was discovered to provide a secondary preventive strategy against white spot lesion development by reducing microleakage under brackets.

Influence of varying dry air temperatures on postoperative sensitivity, penetration depth, and push-out bond strength of an ethanol/water-based adhesive: An in vivo double-blind clinical trial and in vitro analysis.

Incomplete monomer infiltration into the etched dentin causes postoperative sensitivity (POS) with total-etch adhesives. Increasing the temperature of the air to dry the adhesive has shown to improve its infiltration into the dentin. The aim of this research is to evaluate the effectiveness of dry air temperatures of 15°C ± 5°C and 50°C ± 5°C on the POS, depth of penetration, and bond strength of an ethanol/water-based etch-and-rinse (ER) adhesive under in vivo and in vitro conditions. Forty-four premolars from 11 patients scheduled for orthodontic extraction were allocated into cold air (Group 1) and warm air (Group 2) groups using a split-mouth design. A 2 mm × 2 mm × 2 mm cavity was prepared on the middle third of the buccal surface of the teeth, acid etched, and two coats of an ethanol/water-based adhesive resin mixed with 0.1% rhodamine B was applied for 10 s. A dental air gun customized to deliver warm and cold air was used to dry the adhesive prior to its light polymerization. The cavities were restored with resin composite incrementally. POS was assessed using visual analog scale at 24 and 72 h using cold test. The teeth were atraumatically extracted and analyzed for depth of adhesive penetration using confocal laser scanning microscope (n = 11) and push-out bond strength (n = 11). The data were analyzed using sample t-test and Wilcoxon signed-rank test (P < 0.05). A significantly lower POS and greater adhesive penetration into the dentin was observed in the warm air group compared to cold air (P < 0.05). No significant difference could be elicited between the push-out bond strength of both the groups (P > 0.05). Warm air alleviated POS and improved the penetration of an ethanol/water-based ER adhesive into the dentin.

Comparative Evaluation of Efficacy of Physics Forceps Versus Conventional Forceps in Orthodontic Extractions

Objective: To comparative evaluation of efficacy of physics forceps versus conventional forceps in orthodontic extractions. Design of the Study: It was a cross-sectional survey. Place and Duration of Study: This study was carried at Department of Maxillofacial Surgery Mufti Mehmood Teaching Hospital Dera Ismail Khan from January 2022 to June 2022. Patients and Methods: Total 300 healthy patients reporting to our department and who were indicated for removal of tooth with ideal extraction indications and conditions, and consenting for the same were taken up for the study. Patients were divided into 2 groups: Group-1 consisted of a split mouth study with 100 patients and Group-2 consisted of 200 patients consecutively selected and further categorised randomly, were subdivided into 2 subgroups, Group-2A (Conventional forceps group) and Group-2B (Physics forceps group) with 100 patients each. All the extraction procedures were done by 2 operators namely A and B &amp; an experienced observing assistant was used for the assessment of Operative complications. Every patient underwent an adequate pre-surgical preparation consisting of adequate case history, gross scaling, blood test where indicated and radiographic examination. Results of the Study: In Group-1 the average time taken with physics forceps was 33.14 seconds with a SD of 12.272 seconds and the average time taken with conventional forceps was 53.86 seconds with a SD of 24.985 seconds. In Group-2 the average time taken with physics forceps was 24.77 seconds with a SD of 9.878 seconds and the average time taken with conventional forceps was 34.78 seconds with a SD of 8.693 seconds. In Group-1 on 3rd post-operative day, with Conventional forceps the mean pain score was 6.45 and with Physics forceps the mean pain score was 4.15. In Group-2, on 3rd post-operative day, with Conventional forceps the mean pain score was 6.46 and with Physics forceps the mean pain score was 3.75. Conclusion: Physics forceps are comparatively superior to conventional extraction forceps in terms of lesser time taken for the procedure, lesser tendency to induce trauma to both hard and soft tissue and have been found to induce comparatively lesser pain post extraction. Keywords: Bone loss, Extraction forceps, Physics forceps, Soft tissue loss

Mesial movement of maxillary first molars and vertical dimensional changes in orthodontic extraction treatment for patients with different facial morphology

Objectives: Primarily, to compare anchorage loss and changes in mandibular plane (MP) angle, overbite, and amount of horizontal, vertical, and angular movements of maxillary incisors in groups of hypodivergent, hyperdivergent, and normodivergent patients. Secondarily, to analyze the relationship between those factors. Methods: Pre- and post-treatment cephalograms of 89 patients treated with extraction of four bicuspids or two maxillary bicuspids were analyzed. The sample was divided into three groups based on their facial pattern measured by SN-MP angle (hypodivergent: &lt; 270, hyperdivergent: &gt;380, and normodivergent: 270-380). Linear and angular measurements included the distances of U1 tip and U6 mesial height of contour to Y-axis (i.e., line perpendicular to the X-axis, passing through Sella turcica), distance of U1 tip to Sella on X-axis, overbite, angulation of U1 to palatal plane, and SN-MP and ANB angles. Inferential statistics included one-way ANOVA, Chi-square test, independent t-test, and Pearson’s correlation coefficients. Results: Facial morphology did not primarily affect anchorage loss, because other factors such as crowding, severity of Class II molar relationship, and extraction modality played more impactful role (P&lt; 0.01). Change in mandibular plane angle was neither influenced by, nor correlated with, initial facial morphology or anchorage loss (P&gt; 0.05). Positive change in overbite was significantly correlated with facial pattern, incisor extrusion and retroclination (r= 0.30, 0.44, and -0.35, respectively, P&lt; 0.01). Conclusion: Anchorage loss in extraction orthodontic treatment is not influenced primarily by initial facial morphology. Anchorage loss is not significantly associated with MP angle reduction. Change in overbite can be achieved through incisor extrusion and retroclination.

Implant or Tooth?-A Prospective Clinical Study on Oral Health-Related Quality of Life for Patients with "Unrestorable" Teeth.

In cases of severely compromised teeth, dental practitioners are confronted with the therapeutic decision of whether to restore a tooth or replace it with an implant. Comparative scientific evidence on patient perception of both treatment approaches is scarce. The subject of this prospective clinical study was to compare oral health-related quality of life (OHRQoL) between two treatment groups: restoration of severely destroyed teeth after orthodontic extrusion (FOE) versus tooth extraction and implant-supported single crown restoration (ISC). A self-selected trial was performed with 21 patients per group. OHRQoL was assessed with the aid of the Oral Health Impact Profile (OHIP-G49) at different time intervals: before treatment (T1), after treatment (T2), after restoration (T3) and at recall (T4). Overall, OHIP scores improved from baseline to follow-up for both concepts with no significant differences between groups. There were no significant differences in subscales between FOE and ISC at T1, T3 and T4. In terms of functional limitations (p = 0.003) and physical disability (p = 0.021), patients in the FOE group temporarily exhibited lower OHRQoL at T2 in comparison to the ISC group. However, at baseline, after final restoration and at recall, the study demonstrates the same level of OHRQoL for both treatment concepts.

Detailed Correlation between Central Incisor Movement and Alveolar Bone Resorption in Adults with Orthodontic Premolar Extraction Treatment: A Retrospective Cohort CBCT Study.

This study aims to explore the detailed correlation between the movement of maxillary and mandibular central incisors and alveolar bone resorption in adults who had orthodontic premolar extraction treatment. A total of 63 adult patients (mean age, 24.41 years) who received orthodontic treatment with the extraction of four first premolars were included in this study. CBCT images were obtained before and after treatment. Three-dimensional evaluations of the movement of 252 central incisors (126 maxillary and 126 mandibular incisors) and alveolar bone changes were conducted. Four points were used to describe the incisor movement: C (cusp point), R (root apex point), M (mid-point of root neck), and L (labial cementoenamel junction point). The thickness of labial and palatal alveolar bone was assessed at the crestal, mid-root, and apical levels of incisors. The results were analyzed with Spearman's correlation and multilinear regression. Matching the measurements of central incisor movement and alveolar bone resorption, significant correlations could be observed. For maxillary central incisors, the labial alveolar bone resorption at the crestal level was correlated with the movement of Point L (r = 0.290, p &lt; 0.05), and the labial alveolar bone resorption at the apical level was correlated with Point M (r = 0.387, p &lt; 0.05). For mandibular central incisors, the labial alveolar bone resorption at the apical level was correlated with the movement of Point M (r = 0.493, p &lt; 0.05) and R (r = 0.498, p &lt; 0.01); the palatal alveolar bone resorption at the mid-root level with Point M (r = -0.170, p &lt; 0.01); and the palatal alveolar bone resorption at the apical level with Point R (r = 0.177, p &lt; 0.01). This study investigated the concrete correlations between central incisor movement and alveolar bone resorption in adults after orthodontic treatment with premolar extraction. It is potentially helpful for orthodontists to have a relatively accurate prediction of alveolar bone resorption based on the specific movements of central incisors and to reduce the risk of alveolar bone resorption by better adjusting the three-dimensional movement types of incisors.

Trends and Application of Artificial Intelligence Technology in Orthodontic Diagnosis and Treatment Planning—A Review

Artificial intelligence (AI) is a new breakthrough in technological advancements based on the concept of simulating human intelligence. These emerging technologies highly influence the diagnostic process in the field of medical sciences, with enhanced accuracy in diagnosis. This review article intends to report on the trends and application of AI models designed for diagnosis and treatment planning in orthodontics. A data search for the original research articles that were published over the last 22 years (from 1 January 2000 until 31 August 2022) was carried out in the most renowned electronic databases, which mainly included PubMed, Google Scholar, Web of Science, Scopus, and Saudi Digital Library. A total of 56 articles that met the eligibility criteria were included. The research trend shows a rapid increase in articles over the last two years. In total: 17 articles have reported on AI models designed for the automated identification of cephalometric landmarks; 12 articles on the estimation of bone age and maturity using cervical vertebra and hand-wrist radiographs; two articles on palatal shape analysis; seven articles for determining the need for orthodontic tooth extractions; two articles for automated skeletal classification; and 16 articles for the diagnosis and planning of orthognathic surgeries. AI is a significant development that has been successfully implemented in a wide range of image-based applications. These applications can facilitate clinicians in diagnosing, treatment planning, and decision-making. AI applications are beneficial as they are reliable, with enhanced speed, and have the potential to automatically complete the task with an efficiency equivalent to experienced clinicians. These models can prove as an excellent guide for less experienced orthodontists.

Manual and mechanical stripping-induced enamel roughness and elemental composition in vivo.

Interproximal enamel reduction (IPR) is routinely used in orthodontics to generate small to moderate amounts of space within the dental arch. Aim of this ex vivo study was to evaluate the effect of two different IPR systems on the enamel surface's waviness, roughness, and elemental composition after 6 months of intraoral exposure. Fifteen orthodontic extraction patients were included in the present study. The 39 healthy premolars, which were scheduled to be extracted, were subjected to IPR at least 6 months before their extraction. IPR was performed on their mesial side with two different methods: (1) instrumented method with the Ortho-Strips system (on handpiece) and (2) manually with the Intensiv ProxoStrip (strips)-each with four different grits for contouring, finishing, and polishing. The distal side of each premolar served as its own internal control. Treated and untreated tooth surfaces were evaluated by optical profilometry, Raman, and scanning electron microscope/X-ray energy-dispersive (EDX) analyses. Data were analysed with descriptive statistics and generalized linear models at alpha = 5%. Both IPR methods significantly reduced the waviness of the enamel surface (P < 0.001), with manual IPR leading to smaller waviness reductions than the instrumented IPR (P ≤ 0.001). On the other side, both IPR methods led to a significant increase in enamel surface roughness (P < 0.001), with no significant differences between IPR methods. EDX and Raman analyses did not demonstrate any alterations on elemental composition of enamel after at least 6 months of intraoral exposure. Both stripping systems led to a flatter but rougher enamel surface. Further polishing is needed to restore the initial enamel smoothness. The elemental composition of the stripped enamel returns to the baseline level after 6 months of intraoral exposure.

Patients Knowledge and Perception about Orthodontic Extraction of Sound Permanent Teeth

BACKGROUND&#x0D; There are many beliefs &amp; misconceptions of patients associated with the orthodontic extraction of sound teeth. The decision to extract creates a cycle of doubts in the patients' minds. So, the purpose of this study was to assess the knowledge and perception of patients undergoing extractions of sound permanent teeth for orthodontic reasons in a dental teaching institute.&#x0D; METHODS&#x0D; This prospective study involved patients who were advised and indicated for orthodontic extraction of sound permanent teeth. A questionnaire which was content, and face validated was used to measure the patients’ responses, which included questions about the knowledge and perception of patients regarding the extraction of sound permanent teeth for orthodontic reason. The returned questionnaires were analysed, and responses were tabulated and subjected to various statistical tests.&#x0D; RESULTS&#x0D; The overall level of knowledge was 38.18 % above average and the level of perception was 45.45 % above average. There was no statistically significant association between age groups with the level of knowledge (P=0.4980). Percentagewise: higher the age group, the higher the knowledge. While there was a statistically significant association (P=0.0490) between age groups with the level of perception. Percentagewise in ≤19 yrs. it was 38.10 % as compared to 69.23 % in ≥20 yrs. age who had an above average level of perception. A statistically significant association between the ANOVA test (F=8.0794, P=0.0009) and Tukey's post hoc test was seen between education level with mean perception level. Subjects with a higher degree had above-average perception levels followed by secondary and higher secondary education levels. Knowledge level was significantly higher in subjects residing in an urban area as compared to rural area (t=-2.9097, P=0.0053), percentage wise also urban area had more level of mean knowledge (53.33 %) as compared to rural area (20 %).&#x0D; CONCLUSIONS&#x0D; The overall level of knowledge and perception in patients reporting for orthodontic extraction of sound teeth was less. The study concluded the need for more awareness about the orthodontic extraction of sound teeth which can lead to more satisfaction and less anxiety, especially in lower age groups and rural populations.

Accuracy of artificial intelligence for tooth extraction decision-making in orthodontics: a systematic review and meta-analysis.

This study aimed to analyze the accuracy of artificial intelligence (AI) for orthodontic tooth extraction decision-making. PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, Computers & Applied Science, ACM Digital Library, Compendex, and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Three independent reviewers selected the studies and extracted and analyzed the data. Risk of bias, methodological quality, and certainty of evidence were assessed by QUADAS-2, checklist for AI research, and GRADE, respectively. The search identified 1810 studies. After 2 phases of selection, six studies were included, showing an unclear risk of bias of patient selection. Two studies showed a high risk of bias in the index test, while two others presented an unclear risk of bias in the diagnostic test. Data were pooled in a random model and yielded an accuracy value of 0.87 (95% CI = 0.75-0.96) for all studies, 0.89 (95% CI = 0.70-1.00) for multilayer perceptron, and 0.88 (95% CI = 0.73-0.98) for back propagation models. Sensitivity, specificity, and area under the curve of the multilayer perceptron model yielded 0.84 (95% CI = 0.58-1.00), 0.89 (95% CI = 0.74-0.98), and 0.92 (95% CI = 0.72-1.00) scores, respectively. Sagittal discrepancy, upper crowding, and protrusion showed the highest ranks weighted in the models. Orthodontic tooth extraction decision-making using AI presented promising accuracy but should be considered with caution due to the very low certainty of evidence. AI models for tooth extraction decision in orthodontics cannot yet be considered a substitute for a final human decision.

Efficacy of Diclofenac Transdermal Patch in Therapeutic Extractions: A Literature Review.

Diclofenac sodium is a nonsteroidal anti-inflammatory drug that effectively manages pain following therapeutic extractions. Post-extraction pain is commonly treated with non-steroidal anti-inflammatory drugs (NSAIDs). In addition to their high bioavailability and long duration of action, transdermal NSAIDS have several other advantages. The review tries to understand and elucidate the use of transdermal patches, here Diclofenac, as a postoperative pain management modality. Drug delivery is one of the essential aspects of drug administration where transdermal patches are to be found equally effective when compared to oral administration of drugs. Various analgesics can be administered as patches, for example, ketoprofen, diclofenac, etc. There are also comparative studies between diclofenac and ketoprofen to see and understand the efficacy of transdermal patches compared with oral administration. Compared to oral administration, transdermal patches offer numerous benefits. These include avoidance of first-pass metabolism, sustained and non-rapid absorption, steady plasma levels that remain for prolonged periods, lack of patient dependence on drugs, prevention of gastric distress, and flexibility of stopping delivery of medications by simply removing the patch. This review aims to examine the diclofenac transdermal patch's effectiveness in reducing postoperative pain after orthodontic extraction.