Novel methodology for measuring intraoral wear in enamel and dental restorative materials.

OBJECTIVES: To test the hypotheses that (a) the chairside/handheld dental scanner combined with a metrology software will measure clinical wear in vivo in agreement with measurements from X-ray computed microtomography and; (b) polished monolithic zirconia does not cause accelerated wear of opposing enamel. MATERIALS AND METHODS: Thirty single crowns were randomized to receive a monolithic zirconia or metal-ceramic crown. Two non-restored opposing teeth in the same quadrants were identified to serve as enamel controls. After cementation, quadrants were scanned using an intraoral dental scanner. Patients were recalled at 6-months and 1-year for re-scanning. Scanned images were compared using a metrology software to determine maximum vertical wear of teeth. The accuracy of the scanning measurements from this new method was compared with X-ray computed microtomography (micro-CT) measurements. Statistical analysis was performed using Mann-Whitney U test to determine significant differences between wear of enamel against zirconia, metal-ceramic or enamel. Linear regression analysis determined agreement between measurements obtained using intraoral scanning and micro-CT. RESULTS: Regression analysis demonstrated that there is a quantitative agreement between depth and volume measurements produced using intraoral scanning and the micro-CT methodologies. There was no significant difference between the wear of enamel against polished monolithic zirconia crowns and enamel against enamel. CONCLUSIONS: Intraoral scanning combined with a matching software can accurately quantify clinical wear to verify that monolithic zirconia exhibited comparable wear of enamel compared with metal-ceramic crowns and control enamel. Agreement between the intraoral scanner and the micro-CT was 99.8%. Clinical Trials.gov NCT02289781.

A comparison of visual identification of dental radiographic and nonradiographic images using eye tracking technology.

OBJECTIVES: Eye tracking has been used in medical radiology to understand observers' gaze patterns during radiological diagnosis. This study examines the visual identification ability of junior hospital dental officers (JHDOs) and dental surgery assistants (DSAs) in radiographic and nonradiographic images using eye tracking technology and examines if there is a correlation. MATERIAL AND METHODS: Nine JHDOs and nine DSAs examined six radiographic images and 16 nonradiographic images using eye tracking. The areas of interest (AOIs) of the radiographic images were rated as easy, medium, and hard, and the nonradiographic images were categorized as pattern recognition, face recognition, and image comparison. The participants were required to identify and locate the AOIs. Data analysis of the two domains, entire slide and AOI, was conducted by evaluating the eye tracking metrics (ETM) and the performance outcomes. ETM consisted of six parameters, and performance outcomes consisted of four parameters. RESULTS: No significant differences were observed for ETMs for JHDOs and DSAs for both radiographic and nonradiographic images. The JHDOs showed significantly higher percentage in identifying AOIs than DSAs for all the radiographic images (72.7% vs. 36.4%, p = .004) and for the easy categorization of radiographic AOIs (85.7% vs. 42.9%, p = .012). JHDOs with higher correct identification percentage in face recognition had a shorter dwell time in AOIs. CONCLUSIONS: Although no significant relation was observed between radiographic and nonradiographic images, there were some evidence that visual recognition skills may impact certain attributes of the visual search pattern in radiographic images.

Dental hard tissue morphological segmentation with sparse representation-based classifier.

In the field of dental image processing and analysis, automatic segmentation results of dental hard tissue can provide a useful reference for the clinical diagnosis and treatment process. However, the segmentation accuracy is greatly affected due to the limitation of imaging conditions in the oral environment, as well as the complexity of dental hard tissue topology. To further improve the precision of dental hard tissue segmentation, a novel algorithm was presented by using the sparse representation-based classifier and mathematical morphology operations. First, the captured dental image was preprocessed to eliminate the impact of imbalance local illumination. Then, the preliminary dental hard tissue areas were calculated as the initial marker regions based on color characteristics analysis, and the sparse representation-based classifier was applied sequentially to optimize the initial marker regions combined with certain morphological operations. Finally, a modified marker-controlled watershed transform was employed to segment dental hard tissue regions on the basis of the optimized marker regions, and the final results were obtained after homogeneous region merging. The experimental results show that our method has better adaptability and robustness than existing state-of-the-art methods. Graphical abstract.

Efeito da exposição gengival na estética do sorriso / Effect of gingival exposure on smile aesthetics

Objetivo: avaliar a influência da exposição na percepção da atratividade do sorriso entre ortodontistas, clínicos gerais, leigos, acadêmicos veteranos e calouros em Odontologia, na cidade de Imperatriz-MA. Material e métodos: através de fotografias da face de dois indivíduos, de gênero masculino e feminino, agrupadas, digitalmente alteradas, com cinco níveis distintos de exposição gengival, sendo eles: cobertura dos incisivos superiores em 4 mm, incisivos superiores pelo lábio superior em 2 mm, positivos e negativos em relação à margem gengival. As imagens foram avaliadas por 30 indivíduos de cada grupo: ortodontistas, clínicos gerais, leigos, acadêmicos do 1o e 2o períodos (calouros) e 8o e 9o períodos (veteranos). Resultados: segundo os resultados para o indivíduo do sexo masculino, o sorriso mais atrativo, na opinião de ortodontistas, clínicos, acadêmicos veteranos e calouros é aquele cujo lábio superior repousa sobre o zênite gengival (p < 0,05), entretanto, na opinião dos leigos, o sorriso mais satisfatório está na cobertura dos incisivos superiores em 2 mm (p < 0,05). Para o indivíduo do sexo feminino, leigos, clínicos gerais e acadêmicos calouros consideraram esteticamente mais atrativo o sorriso em que o lábio superior recobriu os incisivos superiores em 2 mm (p < 0,05), enquanto ortodontistas e acadêmicos veteranos consideraram o sorriso no qual o lábio superior toca a margem cervical dos incisivos superiores (p < 0,05). Conclusão: a atratividade do sorriso é influenciada pela quantidade de exposição gengival, havendo divergências de opinião.

Objectives: to evaluate the influence of smile exposure on the perception of attractiveness among orthodontists, general dentists, laypersons, and dental students at the city of Imperatriz-MA. Material and methods: digitally-altered, facial photographs of two male and female individuals, with five levels of gingival exposure were presented as follows: 4 mm and 2 mm upper incisor coverage by the upper lip being positive or negatively related to their gingival margin levels. The images were evaluated by 30 persons from each group: orthodontists, general dentists, laypersons, fresh and almost graduate dental students. Results: for males, the most attractive smile according to professionals and students is that where the upper lip is at the gingival zenith (p < 0.05); however, for laypersons, the most attractive smile covers the upper incisors by 2 mm (p < 0.05). For females, the situation of 2 mm coverage was considered the most attractive (p < 0.05) by laypersons, general clinicians and dental students, whereas orthodontists and veterans the upper lip must touch the cervical margins of the central incisors (p < 0.05). Conclusion: smile attractiveness is influenced by lip exposure with varied opinions on this subject.

Dental erosion: Prevalence and severity among 16-year-old adolescents in Troms, Norway.

AIM: To study the prevalence, distribution and severity of dental erosion among 16-year-old adolescents in the Troms region of Norway. MATERIALS AND METHODS: Study design: The participants were recruited through the Tromsø-study ("Fit Futures"), and 392 16-year-olds were examined for dental erosion using clinical intraoral photographs. Three calibrated clinicians used the Visual Erosion Dental Examination (VEDE) system to register and grade the dental erosive wear. RESULTS: More than one third (38%) of the participants showed dental erosion on at least one tooth surface, 18% were limited to the enamel, while 20% of the adolescents showed erosive wear extending into the dentine. The occlusal surfaces of the lower first molars, and the palatal surfaces of the maxillary incisors were the most often and most severely affected. Of the participants showing dental erosion, 93% exhibited "cuppings" on the molars, with 48% limited to the enamel and 52% extending into the dentine. The highest prevalence of "cuppings" (73%) was found on the first lower molars, especially the mesiobuccal cusp of the teeth. The prevalence and severity of dental erosion was found to be higher in male than in female participants (p < 0.0001). CONCLUSION: The results from this study indicate a high prevalence and severity of dental erosion among adolescents in Troms and stress the importance of information, early and effective diagnostics and implementation of prevention strategies.

Are Carious Lesions in Previously Sealed Occlusal Surfaces Detected as well on Colour Photographs as by Visual Clinical Examination?

PURPOSE: To compare the level of agreement between carious lesion assessments according to the visual clinical examination and the colour photograph methods. MATERIALS AND METHODS: Data on the presence of enamel/dentin carious lesions in previously sealed occlusal surfaces in first molars were obtained by two trained and calibrated examiners through visual clinical examination and from colour photographs 4 years after sealing. Kappa statistics were applied to calculate agreement between assessment methods. Data analysis was performed using sign, Bowker symmetry and McNemar's tests. RESULTS: The prevalence of dentin carious lesions was very low. The kappa coefficients for detecting enamel/dentin carious lesions using the two assessment methods were 0.65 (CI: 0.56-0.74) for examiner 1 and 0.70 (CI: 0.62-0.78) for examiner 2. Examiner 2 observed more enamel/dentin carious lesions on colour photographs than did examiner 1 (p = 0.008). Sensitivity analyses did not confirm this outcome. CONCLUSIONS: There was no difference in the detection of enamel/dentin carious lesions in previously sealed occlusal surfaces using colour photographs vs visual clinical examination. The colour photograph method is therefore equivalent to the visual clinical examination in detecting enamel/dentin carious lesions. More studies are required.

How orthodontic records can influence torque choice decisions?

INTRODUCTION: The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. METHODS: Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. RESULTS: The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. CONCLUSIONS: This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.

Hypodontia and supernumerary and impacted teeth in children with various types of clefts.

INTRODUCTION: The purpose of this study was to determine the prevalence of hypodontia, hyperdontia, and impacted teeth in children with various types of clefts. METHODS: This study sample consisted of 201 cleft patients including 131 male subjects with a mean age of 12.3 ± 4 years and 70 female subjects with a mean age of 12.6 ± 3.9 years. Charts, models, radiographs, and intraoral photographs were used for the study. t tests, chi-square tests, and binomial tests were used for assessment of the data. RESULTS AND CONCLUSIONS: Hypodontia was found in 129 subjects (64.1%). The chi-square test showed no statistically significant difference between the type of cleft and hypodontia (P <0.319). The binomial test showed that the frequencies of subjects with hypodontia were significantly higher in both unilateral and bilateral cleft lip and palate patients (P <0.015 and P <0.001, respectively). Hyperdontia and impacted teeth were also found to occur mostly in the maxillary arch, and maxillary canines were the most commonly impacted teeth in both unilateral and bilateral cleft lip and palate patients.

Evaluation of a photographic method to measure dental angulation.

OBJECTIVE: To analyze the reliability and reproducibility of a simplified method for analysis of dental angulation using digital photos of plaster dental casts. METHODS: Digital and standardized photographs of plaster casts were performed and posteriorly imported to an angle reading graphic program in order to have measurements obtained. Such procedures were repeated to evaluate the random error and to analyze reproducibility through intraclass correlation. The sample consisted of 12 individuals (6 male and 6 female) with full permanent dentition and not orthodontically treated. The analyses were bilaterally carried out, and generated 24 measurements. RESULTS: The random error showed variation of 0.77 to 2.55 degrees for teeth angulation. The statistical analysis revealed that the method presents excellent reproducibility (p < 0.0001) for all teeth, except for the upper premolars. In spite of that, it is still considered statistically significant (p < 0.001). CONCLUSION: The proposed method presents enough reliability that justifies its use in the development of scientific research as well as in clinical practice.

Sealant retention is better assessed through colour photographs than through the replica and the visual examination methods.

The aim of this study was to test the hypothesis that the colour photograph method has a higher level of validity for assessing sealant retention than the visual clinical examination and replica methods. Sealed molars were assessed by two evaluators. The scores for the three methods were compared against consensus scores derived through assessing retention from scanning electron microscopy images (reference standard). The presence/absence (survival) of retained sealants on occlusal surfaces was determined according to the traditional and modified categorizations of retention. Sensitivity, specificity, and Youden-index scores were calculated. Sealant retention assessment scores for visual clinical examinations and for colour photographs were compared with those of the reference standard on 95 surfaces, and sealant retention assessment scores for replicas were compared with those of the reference standard on 33 surfaces. The highest mean Youden-index score for the presence/absence of sealant material was observed for the colour photograph method, followed by that for the replica method; the visual clinical examination method scored lowest. The mean Youden-index score for the survival of retained sealants was highest for the colour photograph method for both the traditional (0.882) and the modified (0.768) categories of sealant retention, whilst the visual clinical examination method had the lowest Youden-index score for these categories (0.745 and 0.063, respectively). The colour photograph method had a higher validity than the replica and the visual examination methods for assessing sealant retention.

Evaluation of a photographic method to measure dental angulation

Objective: To analyze the reliability and reproducibility of a simplified method for analysis of dental angulation using digital photos of plaster dental casts. Methods: Digital and standardized photographs of plaster casts were performed and posteriorly imported to an angle reading graphic program in order to have measurements obtained. Such procedures were repeated to evaluate the random error and to analyze reproducibility through intraclass correlation. The sample consisted of 12 individuals (six male and six female) with full permanent dentition orthodontically untreated. The analyses were bilaterally carried out, and generated 24 measurements. Results: The random error showed variation of 0.77 to 2.55 degrees for teeth angulation. The statistical analysis revealed that the method presents excellent reproducibility (p < 0.0001) for all teeth, except for the upper premolars. In spite of that, it is still considered statistically significant (p < 0.001). Conclusion: The proposed method presents enough reliability that justifies its use in the development of scientific research as well as in clinical practice. .

Objetivo: analisar a confiabilidade e reprodutibilidade de um método simplificado para análise da angulação dentária que faz uso de fotografias digitalizadas de modelos de gesso. Métodos: foram realizadas fotografias digitalizadas e padronizadas de modelos de gesso, posteriormente transportadas para um programa gráfico de leitura de ângulos, para a obtenção das medidas. Tais procedimentos foram repetidos para avaliação do erro do método casual e para a análise da reprodutibilidade por meio da Correlação Intraclasse. A amostra constituiu-se de 12 indivíduos com dentição permanente completa e não tratados ortodonticamente, sendo seis do sexo masculino e seis do feminino. As análises foram feitas bilateralmente, gerando 24 medidas. Resultados: o erro casual mostrou uma variação de 0,77 a 2,55º para a angulação dos dentes. A análise estatística revelou que o método apresenta uma excelente reprodutibilidade (r = 0,65 - 0,91; p < 0,0001) para todos os dentes, exceto para os pré-molares superiores, mas ainda assim estatisticamente significativa (p < 0,001). Conclusão: o método proposto apresenta confiabilidade suficiente para justificar seu uso no desenvolvimento de pesquisas científicas, bem como na prática clínica. .

Influence of lateral cephalometric radiographs on extraction decision in skeletal class I patients.

BACKGROUND: Radiographic examination is considered 'justified' only when detection of a condition that would change the mechanisms and timing of treatment is possible. Radiographic safety guidelines have restricted the indication of lateral cephalometric radiographs (LCRs) to presence of distinct skeletal Class II or Class III. However, they are taken routinely in clinical practice and considered to be part of the 'gold' standard for orthodontic diagnosis. Therefore, the aim of this study was to test the null hypothesis that lateral cephalometric radiograph (LCR) evaluation would not alter the extraction/non-extraction decision in orthodontic treatment planning of skeletal Class I patients. MATERIALS AND METHODS: Intraoral and extraoral photographs, dental casts and extraoral radiographs of 60 skeletal Class I patients were prepared digitally for assessment using a presentation software. One experienced (EO) and inexperienced orthodontist (IO) was asked to decide on extraction or non-extraction on a Likert-type linear scale for treatment planning. This procedure was repeated 4 weeks later with a mixed order of patients and the LCRs being omitted. Kappa, Weighted Kappa (WK) and McNemar scores were computed to test decision consistency and Bland-Altman plots together with 95% limits of agreement were used to determine measurement accuracy and presence of systematic bias. RESULTS: Both EO (WK = 0.67) and IO (WK = 0.64) had good level of decision agreement with and without LCR evaluation. EO did not present a shift towards extraction nor non-extraction with LCR evaluation (McNemar = 0.999) whereas IO showed a tendency to extraction (McNemar = 0.07) with LCR data. Including LCR evaluation created a systematic inconsistency between EO and IO (Line of equality = 0.8, Confidence interval = 0.307-0.707). CONCLUSIONS: Lateral cephalometric radiograph evaluation did not influence the extraction decision in treatment planning of skeletal Class I patients. Reconsidering the necessity of lateral cephalograms in orthodontic treatment of skeletal Class I patients may reduce the amount of ionizing radiation. Key words: Lateral cephalometric radiograph, extraction, treatment planning, skeletal Class I.

The views of examiners on the use of intra-oral photographs to detect dental caries in epidemiological studies.

AIM: The aim of the study was to obtain the views of examiners on their experience of using intra-oral photographs as a means of detecting caries in epidemiological studies compared to an established visual examination method. METHOD: A focus group discussion was conducted with five examiners experienced in an established visual examination method after they had performed visual dental examinations of a sample of children as well as assessed intra-oral photographs of the same children. RESULTS: The time taken by examiners to assess intraoral photographs becomes extended when compared to performing a visual examination. The ability to assess intra-oral photographs on a screen at a convenient time and place was considered advantageous. The examiners found it easier to make caries detection decisions on intra-oral photographs of primary teeth than permanent teeth. Adequate removal of debris and moisture control prior to obtaining the photographs were considered important. CONCLUSION: The views of examiners in this study suggest that to improve the utility of photographic method, further research is needed to determine adequate drying methods for use in the field. Consideration should be given to a time-limited, standardised presentation of the photographs including the size and resolution. Specific training on caries detection from photographs is also required.

Prevalence of white spot lesion formation during orthodontic treatment.

PURPOSE: To quantify the prevalence of white spot lesions (WSLs) on the anterior teeth and, secondarily, to evaluate risk factors and predictors. MATERIALS AND METHODS: Digital photographs and records of 885 randomly chosen patients were evaluated before and after treatment. Chart information included gender, age, as well as banding and debanding dates. Fluorosis and oral hygiene before and after treatment were also evaluated. Preexisting and posttreatment WSLs were recorded and compared for all 12 anterior teeth. Risk ratios (RR) and absolute risk (AR) were calculated to determine the likelihood and risk of WSL formation. RESULTS: Overall, 23.4% of the patients developed at least one WSL during their course of treatment. Maxillary anterior teeth were affected more than mandibular teeth. The maxillary laterals and canines and the mandibular canines were the most susceptible. There was no significant difference in WSLs between genders. Fluorosis, treatment time in excess of 36 months, poor pretreatment hygiene, hygiene changes during treatment, and preexisting WSLs were all significantly (P < .05) related to the development of WSLs. The highest risk of developing WSLs was associated with preexisting WSLs (RR = 3.40), followed by declines in oral hygiene during treatment (RR = 3.12) and poor pretreatment oral hygiene (RR = 2.83). CONCLUSIONS: Nearly 25% of the patients developed WSLs while in treatment, depending on fluorosis, treatment time, preexisting WSLs, and oral hygiene. Orthodontists need to be mindful of these risk factors when making treatment decisions.

In vitro performance of different methods in detecting occlusal caries lesions.

UNLABELLED: Early caries detection is essential for the implementation of preventive, therapeutic and intervention strategies within general dental practice. OBJECTIVE: The aim of this study was to compare the in vitro performance of the International Caries Detection and Assessment System (ICDAS), digital photographs scored with ICDAS (ICDAS photographs), fibre-optic transillumination (FOTI), optical coherence tomography (OCT), SoproLife(®) camera and two implementations of quantitative light-induced fluorescence a commercial (QLF-Inspektor Research systems) and a custom (QLF-Custom) system, to detect early and intermediate occlusal lesions. METHODS: One hundred and twelve permanent extracted teeth were selected and assessed with each detection method. Histological validation was used as a gold standard. The detection methods were compared by means of sensitivity, specificity, areas under receiver operating characteristic (AUROC) curves for enamel and dentine levels and with the Spearman's rank correlation coefficient against histology. RESULTS: For any enamel or dentine caries detection, the AUROC curves ranged from 0.86 (OCT) to 0.98 (ICDAS and ICDAS photographs, SoproLife(®) camera) and at the dentine level from 0.83 (OCT) to 0.96 for FOTI. The correlations with histology ranged between 0.65 (OCT) and 0.88 (ICDAS and FOTI). Under in vitro conditions, the assessed detection methods showed excellent intra-examiner reproducibility. All the methods were strongly correlated with histology (p<0.01) except OCT which showed a moderate correlation (0.65). CONCLUSION: Even though all methods present similar performance in detecting occlusal caries lesions, visual inspection seems to be sufficient to be used in clinical practice for detection and assessment of lesion depth. Other methods may be useful in monitoring caries lesion behaviour.

Assessment of the reliability and repeatability of landmarks using 3-D cephalometric software.

The aim of this study was to analyze the reliability and repeatability of identification landmarks using 3-D cephalometric software. Ten orthognathic patients were selected for this study and underwent the following protocol: 1. radiographic evaluation (CBCT technique); 2. stone casts; 3. photos; and 4. 3-D cephalometric evaluation. Twenty-one hard tissue landmarks and 14 cephalometric measurements were taken three times (T1, T2, and T3) on each patient, with an interval of one week by two experts in orthodontics (A, B). Standard deviation and Pearson's correlation coefficient were calculated to evaluate intra- and inter-observer repeatability. The results showed a strong correlation for both intra- and inter-observer Pearson's correlation coefficient (>0.7). The current preliminary study showed that the reliability and repeatability of the identification landmarks were very high if the 3-D cephalometric landmarks are defined correctly in the three planes of the space. Further evaluation is necessary to better define the 3-D cephalometric system.

Need for greater consensus on protection of patient anonymity and rights in facial photographs: a survey of international and domestic oral surgery journals.

Although the International Committee of Medical Journal Editors has announced that masking the eye area in clinical photographs is inadequate for protection of patient anonymity, such examples can frequently be found in the field of oral surgery, indicating a large gap between the ideal and reality. In this study, two internationally and one domestically distributed journal published between 2009 and 2011 were analyzed. All articles containing clinical photographs of a patient's facial area were extracted and assessed based on 3 criteria: 1) extent of facial area visible, 2) necessity of showing eye area, and 3) presence or absence and form of eye masking. Showing the eye area was judged necessary in a total of 69.7% and 72.4% of photographs in the international journals, but in only 34.4% in the domestic journal. No eye masking was observed in 46.0% of photographs in one international journal and in only 4.7% in the domestic journal. Inappropriate masking occurred in 57.8% in the domestic journal. These results indicate that usage of eye masking reflects the editorial policy of a journal, influencing both author and reader consciousness. Although there may be problems in adhering to privacy regulations in a clinical setting, more needs to be done to ensure patient privacy in both journals and an educational setting.

Prevalence and distribution of hypodontia in a Turkish orthodontic patient population: results from a large academic cohort.

AIM: Purpose of this study is to investigate the prevalence and distribution of congenitally missing permanent teeth (CMT) in a Turkish orthodontic patient population. MATERIALS AND METHODS: Panoramic radiographs, intraoral photographs and dental casts of 2761 patients (females 1677, males 1084) aged from 9 to 46 who underwent orthodontic treatment at Selcuk University Department of Orthodontics from 1990 to 2005 were retrospectively reviewed for CMT. A comprehensive chart review was conducted in all subjects. Patient and treatment-related data were registered in a computer database for comparative analysis. RESULTS: When missing third molar data were included, prevalence of CMT in the overall population was 30.64% with no significant differences between male and female patients (p=0.546). On the other hand, prevalence of CMT excluding third molars was 6.77% with a significantly higher prevalence in females compared to male patients (7.63% vs. 5.44%, p=0.030). The most commonly congenitally missing tooth types in decreasing order were the third molars followed by maxillary lateral incisors and mandibular second premolars. The majority of missing third molars were located in the maxilla (55.7%) with no significant gender differences (p=0.334). 58.4% of CMT excluding third molars in females were located in the maxilla compared to only 40.8% in males (p=0.001). In both gender groups, majority of CMT excluding third molars were located in the anterior segment (55.6% and 58.4% in male and female patients respectively, p=0.713). CONCLUSION: The most commonly congenitally missing tooth type is third molars followed by maxillary lateral incisors and mandibular second premolars in our population. Although there were no gender differences in prevalence and anatomical distribution of missing third molars, CMT excluding third molars was significantly more prevalent in females with predominantly maxillary distribution in our population.

The configuration of clinics and the use of biopsy and photography in oral premalignancy: a survey of consultants of the British Association of Oral and Maxillofacial Surgeons.

Oral dysplastic lesions may have an increased chance of becoming oral squamous cell carcinoma, but to date their management remains controversial. The aim of this survey was to explore the current practical aspects of the management of patients with dysplasia by oral and maxillofacial consultants in the UK. In the survey we asked consultants about the numbers of patients they see with oral premalignant lesions, the frequency and specialty of designated hospital clinics, their use of photographs and biopsy, factors that influence their decision whether to biopsy a lesion at the first appointment, the procedure for treatment and follow-up and their use (if any) of chemopreventive agents. We found a wide variation in the practical aspects of managing patients with dysplasia, and the lack of consistency among clinicians supports the idea of an initiative to establish more robust national guidelines to use as a gold standard in the future.

Little's irregularity index: photographic assessment vs study model assessment.

INTRODUCTION: The aim of this study was to investigate whether photographic images are accurate and reliable to assess Little's irregularity index (LII) compared with study model measurements. METHODS: Ten plastic models with different levels of incisor irregularity were photographed occlusally at 9 angulations ranging from 70° to 110° on 3 occasions. Clinical occlusal photographs and study models of 72 dental arches were selected from 16 patients participating in a study of incisor alignment. LII was measured from the models by using digital calipers and from the digital images with ImageJ software (Rasband WS, National Institutes of Health, Bethesda, Md; http://rsb.info.nih.gov/ij/, 1997-2006). RESULTS: Photographs of the plastic models and the direct measurements of the models showed high levels of reliability and repeatability (intraclass correlation coefficients [ICC], 0.999 and 0.983). Validity was shown by the limits of agreement between the plastic models and the photographs at 90°, 70°, and 110°, which were -0.2621 to 0.9547, -0.1961 to 1.3205, and -0.7399 to 2.0405, respectively, and the ICC were 0.993, 0.983, and 0.969, respectively. The intraexaminer and interexaminer ICC for the clinical photographs were 0.997 and 0.987, and intraexaminer agreement for the study models was 0.995. The limits of agreement and the ICC between the photographic method and study model method were -1.9656 to 1.2861 and 0.986. CONCLUSIONS: LII can be measured from photographs with good reliability and repeatability. The limits of agreement indicate that, for the mean value of a group of subjects, the photographic method is valid, but care is needed in interpreting an individual measurement.