Mandibular Radiomorphometric Characteristics of Individuals with Bilateral or Unilateral Cleft Lip and Palate.

OBJECTIVE: This study aimed to investigate and compare the mandibular radiomorphometric characteristics of patients with unilateral or bilateral cleft lip and palate (CLP) with those of individuals without CLP and to determine whether there was a difference. DESIGN: Retrospective cohort study. SETTING: Orthodontic Department in Faculty of Dentistry. PATIENTS AND INTERVENTIONS: Mandibular cortical bone thickness was measured on high-quality panoramic radiographs taken from 46 patients with unilateral or bilateral CLP aged 13-15 years and 21 control patients. MAIN OUTCOME MEASURES: Three radiomorphometric indices [antegonial index (AI), mental index (MI), and panoramic mandibular index (PMI)] were measured bilaterally. AutoCAD software was used for MI, PMI, and AI measurements. RESULTS: Left MI values were significantly lower in individuals with unilateral cleft lip and palate (UCLP; 0.029 ± 0.04) than in individuals with bilateral cleft lip and palate (BCLP; 0.033 ± 0.07). In addition, right MI values of individuals with right UCLP (0.26 ± 0.06) were significantly lower than those of individuals with left UCLP (0.34 ± 0.06) or BCLP (0.32 ± 0.08). No difference was observed between individuals with BCLP and left UCLP. These values did not differ between groups. CONCLUSIONS: Antegonial index and PMI values did not differ between individuals with different types of CLP or when compared with control patients. In patients with UCLP, cortical bone thickness was found to be reduced on the cleft side compared to the intact side. Patients with UCLP with a right-sided cleft had a more substantial decrease in cortical bone thickness.

Evaluation of trabecular changes following advancement genioplasty combined with or without bilateral sagittal split osteotomy by fractal analysis: a retrospective cohort study.

BACKGROUND: It is aimed to investigate whether there was a difference in radiographic changes in the operational areas between genioplasty alone and genioplasty combined with mandibular advancement and to evaluate the fractal dimension (FD) to assess trabecular changes after genioplasty surgery. METHODS: Preoperative-(T0) and postoperative-(T1) panoramic radiographs of 26 patients without any complications who underwent genioplasty combined with bilateral sagittal osteotomy and mandibular advancement or genioplasty alone were selected. In the panoramic radiographs of both groups, the genial segment, mandibular angulus, and surgical osteotomy line were examined using FD. The box-counting method was used for FD evaluation. RESULTS: It was determined that FD values before and after treatment were similar in both groups for all regions where measurements were made. After surgery, the FD values of the middle region of the genial segment were found to be significantly lower than the other regions. At T1, the FD values at the osteotomy area were found to be significantly higher than those in the middle region of the genial segment. CONCLUSION: Trabecular structure does not differ in patients undergoing genioplasty alone or in combination with mandibular advancement osteotomy. The middle region of the genial segment heals later than other regions.

The Effects of Occlusal Plane Inclination and Dental Decompensation on the Overall Result of Surgical Correction of Class II Malocclusion.

PURPOSE: To evaluate the effects of upper occlusal plane (UOP) inclination and incisor decompensations on the outcome of surgical Class II patients. MATERIALS AND METHODS: Pretreatment (T0), preoperative (T1), and posttreatment (T2) cephalograms of 30 surgical Class II patients were included. Cephalometric measurements were performed using the Dolphin Imaging Software in this retrospective study. The differences between time points were analyzed with repeated measures ANOVA. Spearman correlation test was used to determine any correlations between either the UOP alterations or incisor decompensations and the cephalometric variables. RESULTS: A significant improvement was obtained in the sagittal skeletal, dental variables, and soft tissue B point. Significant correlations were found between the decompensation achievement ratio and the change of the convexity angle. The relative percentage ratio (RPR) of the lower incisor was correlated with Wits appraisal, ANB, and Convexity Angle at the T2 stage. The RPR of the upper incisor was found to be correlated with lip strain. The relative surgical correction ratio of the UOP angle was found to be correlated with the surgical change of Wits appraisal and convexity angle. The RPR of the UOP angle was correlated with the SNB, ANB, and SN-GOGN angles at the T2 stage. CONCLUSIONS: Significant improvement in the incisor inclinations was achieved, but the incisors were inadequately decompensated at the preoperative phase. Surgical correction was limited by the inadequate presurgical decompensation. The surgical alteration of the UOP should be taken into consideration for the surgical planning to obtain better outcomes for Class II patients.

YouTube as a Source of Information for Craniofacial Distraction Osteogenesis.

OBJECTIVE: The aim of this study was to evaluate the content and quality of YouTube videos about distraction osteogenesis (DO) in the craniofacial region. METHODS: The term "distraction osteogenesis" was searched on YouTube. After sorting by relevance, 80 videos were selected from 128 search results for analysis of general characteristics, primary purpose, information reliability, audiovisual quality, global quality scale (GQS), and viewers' interaction index. Viewing rate formulae were calculated for each YouTube video. The Mann-Whitney U test and Spearman correlation coefficient were used for statistical analysis. RESULTS: We classified 22 (27.5%) of the 80 videos as moderate/high-content and 58 (72.5%) as low-content. Most YouTube videos about DO were uploaded by doctors (45%) and information about DO was the most covered topic (61%). Videos from commercial companies had significantly higher GQS scores than videos uploaded by other groups (P = 0.040). In low-information content videos, GQS was highly correlated with the number of likes, whereas in moderate/high-content videos it was highly correlated with viewing rates. CONCLUSIONS: YouTube is insufficient source of information about DO and academic institutions have more responsibility in developing this situation and directing patients to reliable social media or Internet sources.

Exploring discrimination and racism in healthcare: a qualitative phenomenology study of Dutch persons with migration backgrounds.

OBJECTIVE: To explore and characterise the discrimination and racism experienced in healthcare from the perspective of Dutch patients with a migration background. DESIGN: This was a qualitative phenomenological study incorporating an inductive thematic analysis of the answers provided to a free form online survey. Descriptive and differential analyses were conducted for the closed-ended questions. SETTING: This study used an online survey distributed in Dutch about experiences of discrimination and racism in healthcare to the general population in the Netherlands. PARTICIPANTS: The survey was completed by 188 participants (Mage=39.89, SDage=10.2). Of whom 80 (Mage=37.92, SDage=10.87) met the eligibility criteria for thematic analysis (ie, has a migration background or a relative with a migration background and experienced discrimination in healthcare based on their background) and were thus included in the analysis. RESULTS: From the total sample, women, relative to men, were 2.31 times more likely to report experiencing healthcare discrimination (OR=2.31; 95% CI 1.23 to 4.37). The majority of the participants (60.1%) had a Moroccan or Turkish background. Six themes were identified relating to experienced discrimination in healthcare based on one's migration background: (1) explicit discrimination, (2) prejudice, (3) not being taken seriously, (4) discriminatory behaviour, (5) language barriers and (6) pain attribution to cultural background. Some participants reported that their attire or religion was linked to their migration background, thus contributing to their experiences of discrimination. CONCLUSION: Dutch patients with a migration background may experience discrimination based on their ethnic identity or other factors related to their backgrounds, such as their faith, culture and skin colour. Discrimination manifests as intersectional and may take different forms (eg, discrimination based on the intersection between race and gender). Therefore, healthcare discrimination may increase health inequities and lead to unequal access to healthcare services. Implicitly or explicitly discriminating against patients is immoral, unethical, illegal and hazardous for individual and public health. Further research on the magnitude of discrimination in healthcare and its relation to health is needed.

Effects of maxillary expansion and protraction on pharyngeal airway dimensions in relation to changes in head posture and hyoid position : A retrospective cohort study.

PURPOSE: To assess changes in pharyngeal airway dimensions, head posture and hyoid position after maxillary expansion and face mask (FM) treatment compared to untreated class III patients. METHODS: This study examined 24 class III patients (10 girls, 14 boys, mean age: 10.97 ± 0.88 years) treated with expansion and a petit-type FM appliance and 24 untreated class III patients (16 girls, 8 boys, mean age: 10.50 ± 1.06 years). Pre- and posttreatment cephalometric radiographs were digitally analysed. Parametric data were analysed with paired and independent-samples t­tests, nonparametric data were analysed with Wilcoxon signed-rank and Mann-Whitney U tests. Spearman's correlation analysis was used to examine the relationship between dental/skeletal treatment changes and those of craniocervical postural position, pharyngeal airway dimension and hyoid position. RESULTS: With respect to the hypopharyngeal airway dimension, the hypopharyngeal sagittal length (CV3'-LPW), velar angle (HRL/U-PNS) and velar length (U-PNS) significantly increased in the treatment group. All the parameters describing head posture and those describing the distances of the hyoid bone to the HRL changed significantly after treatment, but these changes were not significantly different from the control group. In the treatment group, there also occurred a significant increase in the sagittal growth of the maxilla (SNA, Co­A, Na-Perp A, Wits), vertical growth of the maxillomandibular complex (SN-GoGN, N­ANS, N­Me), counterclockwise rotation of the maxilla (SN-PP) and overjet, while a clockwise rotation (y-axis) and a nonsignificant inhibition of the sagittal growth (Co-Gn) of the mandible were observed. The treatment induced increases of hypopharyngeal sagittal length (CV3'-LPW), soft palate thickness and anteroposterior movement of hyoid bone (H-CV3) demonstrated a positive correlation with changes of craniocervical angles (NSL/OPT, NSL/CVT) and a negative correlation with craniohorizontal angles (OPT/HOR, CVT/HOR). The change of the anteroposterior movement of hyoid bone (H-CV3) was also positively correlated with oropharyngeal sagittal length (CV2'-MPW), the hypopharyngeal sagittal length (CV3'-LPW) and the minimal dimension of the pharyngeal airway space (PASmin). CONCLUSION: While expansion and FM treatment did not affect the head posture and hyoid bone position, positive effects were observed in the hypopharyngeal airway region.

Evaluation of external apical root resorption caused by fixed functional treatment of class II malocclusion : Cast splint Herbst appliance vs. Forsus fatigue resistant device.

INTRODUCTION: The aim of this study was to evaluate and compare the effects of class II fixed functional treatment with a cast splint Herbst appliance (HA; Herbst Set I, Dentaurum, Ispringen, Germany) and Forsus fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA) on external apical root resorption (EARR) in posterior teeth. METHODS: In all, 40 patients (15 male and 25 female) with class II division 1 malocclusion were treated with two fixed functional appliances: HA (20 patients, mean age 14.60 ± 1.14 years) and FRD (20 patients, mean age 14.15 ± 1.28 years). The vestibular lengths of the first molars and premolars were measured on panoramic radiographs and converted to actual tooth length using the magnification coefficient (MC), which was calculated using dental models. Intragroup comparisons of pre- and posttreatment tooth lengths were performed with the paired t­test and Wilcoxon signed-rank test, while intergroup comparisons were performed with the Mann-Whitney U test. RESULTS: Pretreatment tooth length values decreased significantly with HA and FRD therapies for all posterior teeth. The maximum resorption was observed in the mandibular first premolar with a mean of 0.81 mm following HA and 1.55 mm following FRD treatment. While no significant difference existed between the EARR values of the HA and FRD groups for maxillary teeth, the amount of EARR of mandibular posterior teeth in the FRD group was significantly higher than in the HA group. CONCLUSIONS: In patients treated with HA or FRD, the tooth length of posterior teeth decreased to a clinically minor but statistically significant degree. The root resorption effect of FRD therapy in mandibular posterior teeth was significantly higher than that of HA therapy.

Sleep disordered breathing and oral health-related quality of life in children with different skeletal malocclusions.

OBJECTIVE: To evaluate the relationship among different skeletal malocclusion patterns, sleep-disordered breathing (SDB) and children's oral health-related quality of life (OHRQoL). METHODS: Two hundred-five patients were divided into three groups, considering skeletal malocclusion. Parents completed the Pediatric Sleep Questionnaire (PSQ) on behalf of the patients, who completed the 14-question version of the Oral Health Impact Profile (OHIP-14). RESULTS: SDB was observed in 10.7% of children. The overall prevalence of snoring, difficulty breathing during sleeping, mouth breathing, and dry mouth on awakening was 8.78%, 7.31%, 36.09%, and 37.07%, respectively. However, there was no significant difference in OHIP-14 parameters among the skeletal groups. A positive correlation was found between OHIP-14 and PSQ and was significant in Class I and III. CONCLUSION: Although there was no significant difference, SDB risk and sleep quality were found as most to least problematic, in the following sequential order: Class II > Class III > Class I.

Comparison between cephalometric measurements using digital manual and web-based artificial intelligence cephalometric tracing software.

OBJECTIVE: The aim of this study was to compare the measurements performed with digital manual (DM) cephalometric analysis and automatic cephalometric analysis obtained from an online artificial intelligence (AI) platform, according to different sagittal skeletal malocclusions. METHODS: Cephalometric radiographs of 105 randomly selected individuals (mean age: 17.25 ± 1.87 years) were included in this study. Dolphin Imaging software was used for DM cephalometric analysis, and the WebCeph platform was used for AI-based cephalometric analysis. In total, 10 linear and 12 angular measurements were evaluated. The paired t-test, one-way ANOVA test, and intraclass correlation coefficient tests were used to evaluate the differences between the two methods. The level of statistical significance was set at p< 0.05. RESULTS: Except for SNB, NPog, U1.SN, U1.NA, L1-APog, I/I, and LLE parameters, all other parameters presented significant differences between the two methods (p< 0.05). While there was no difference (p> 0.05) in both SNA and SNB measurements between the two methods in the Class I malocclusion group, there was a difference between both methods in the Class II malocclusion group. Meanwhile, only the SNA in the Class III malocclusion group was different (p< 0.05). The ANB angle differed significantly in all three malocclusion groups. For both methods, all parameters except CoA and CoGn were found to have good correlation. CONCLUSION: Although significant differences were detected in some measurements between the two cephalometric analysis methods, not all differences were clinically significant. The AI-based cephalometric analysis method needs to be developed for more specific malocclusions.

Three-dimensional palatal morphology and upper arch changes following nonsurgical and surgical maxillary expansion in adults.

OBJECTIVE: The objective of this study was to evaluate the effects of nonsurgical rapid maxillary expansion (RME) and surgically assisted RME (SARME) on palatal morphology and upper arch dimensions using three-dimensional (3D) models in skeletally mature patients. STUDY DESIGN: Thirty-eight skeletally mature patients with a maxillary transverse deficiency were divided into RME and SARME groups. Nineteen patients in the RME group (mean age, 19.16 ± 2.25 years) were treated using a full-coverage bonded acrylic splint expander; 19 patients in the SARME group (mean age, 20.38 ± 3.36) were treated using the banded palatal expansion appliance with hyrax screws. The 3D models were obtained before and after expansion. The maxillary dental arch widths, maxillary first molar angulation, palatal area, and palatal volume were calculated on the 3D models. RESULTS: All variables showed statistically significant changes after the retention period (P < .001). The maxillary arch width between first premolars (P < .05), the palatal area (P < .01), and the palatal volume (P < .05) significantly increased in the SARME group compared to the RME group. The maxillary first molar tipping in the RME group was significantly higher than that in the SARME group (P < .01). CONCLUSIONS: Although SARME has more positive effects in skeletally mature patients, nonsurgical RME can be considered as an alternative by evaluating surgical risks, periodontal status, and the need for skeletal expansion.

Three-dimensional changes in the location of soft tissue landmarks following bimaxillary orthognathic surgery.

OBJECTIVES: We sought to determine the amount of three-dimensional (3D) movement of soft tissue landmarks in patients who underwent bimaxillary orthognathic surgery. MATERIALS AND METHODS: We recruited 28 patients (11 women and 17 men), who had received one-piece Le Fort I osteotomy with maxillary advancement and impaction, and bilateral sagittal split ramus osteotomy for mandibular setback. The 3D images were acquired 1-7 days before surgery and at least 6 months after surgery using stereophotogrammetry. We recorded 50 coordinate measurements and correlated the movements between soft and hard tissues. Paired samples t­test, independent samples t­test, and Pearson's correlation analysis were used for statistical analysis. RESULTS: Patients' ages ranged from 17-31 years (mean 20.4 ± 3.0 years). The mean advancement and impaction of the maxilla was 4.7 ± 1.2 and 2.2 ± 1.0 mm, respectively. The mean setback of the mandible was 4.2 ± 1.6 mm. Menton (Me) moved significantly closer to the midsagittal plane, and the bilateral alare (Al) and alar curvature (Ac) moved laterally. In addition, pronasale (Prn), bilateral Al, Ac, subnasale (Sn), subspinale (Ss), labiale superior (Ls), sublabiale (Sl), pogonion (Pog), and Me moved upwards. The bilateral cheek bone (Cbp), Al, Ac, Prn, Sn, Ss, Ls, and stomion (Sto) moved forward. Li, Sl, Pog, and Me moved backward. Interestingly, poor correlation was found between soft tissue landmarks and hard tissue movements. CONCLUSION: We observed 3D coordinate changes in several soft tissue landmarks in the middle and lower thirds of the face. The results of this study may be useful for estimating postoperative changes in similar patients.

Three-dimensional assessment of nasal changes after maxillary advancement with impaction using stereophotogrammetry.

OBJECTIVE: To evaluate the changes in the nose in three dimensions after Le Fort I osteotomy in patients with skeletal Class III malocclusion. METHODS: The subjects were 40 adult patients (20 females and 20 males; mean age, 20.3 ± 3.0 years; range, 17.0 to 31.1 years) who underwent one-piece Le Fort I osteotomy with maxillary advancement and impaction treatment for maxillary hypoplasia. The mean maxillary advancement was 4.56 ± 1.34 mm, and the mean maxillary impaction was 2.03 ± 1.04 mm. Stereophotogrammetry was used to acquire three-dimensional images before and at least 6 months after surgery. RESULTS: Alare (Al) and alare curvature (Ac) points had moved vertically and anterolaterally postoperatively. A significant increase was observed in the nasal ala width and alar base width, and no changes were noted in the columellar length, nasolabial angle, and nasal area. There was a significant relationship between maxillary impaction and nasal ala width and horizontal and sagittal positions of the bilateral Al and Ac. The only relationship found was between maxillary advancement and postoperative sagittal location of the subnasale and pronasale. CONCLUSIONS: Nasal soft tissues were highly affected by the vertical movement of the maxilla; however, the soft tissue responses were individual-dependent.

Comparison between cephalometric measurements using digital manual and web-based artificial intelligence cephalometric tracing software

ABSTRACT Objective: The aim of this study was to compare the measurements performed with digital manual (DM) cephalometric analysis and automatic cephalometric analysis obtained from an online artificial intelligence (AI) platform, according to different sagittal skeletal malocclusions. Methods: Cephalometric radiographs of 105 randomly selected individuals (mean age: 17.25 ± 1.87 years) were included in this study. Dolphin Imaging software was used for DM cephalometric analysis, and the WebCeph platform was used for AI-based cephalometric analysis. In total, 10 linear and 12 angular measurements were evaluated. The paired t-test, one-way ANOVA test, and intraclass correlation coefficient tests were used to evaluate the differences between the two methods. The level of statistical significance was set at p< 0.05. Results: Except for SNB, NPog, U1.SN, U1.NA, L1-APog, I/I, and LLE parameters, all other parameters presented significant differences between the two methods (p< 0.05). While there was no difference (p> 0.05) in both SNA and SNB measurements between the two methods in the Class I malocclusion group, there was a difference between both methods in the Class II malocclusion group. Meanwhile, only the SNA in the Class III malocclusion group was different (p< 0.05). The ANB angle differed significantly in all three malocclusion groups. For both methods, all parameters except CoA and CoGn were found to have good correlation. Conclusion: Although significant differences were detected in some measurements between the two cephalometric analysis methods, not all differences were clinically significant. The AI-based cephalometric analysis method needs to be developed for more specific malocclusions.

RESUMO Objetivo: Comparar as medidas realizadas usando análise cefalométrica digital-manual (DM) e análise cefalométrica automatizada por meio de uma plataforma online de inteligência artificial (IA), segundo as diferentes más oclusões esqueléticas sagitais. Métodos: Foram incluídas radiografias cefalométricas de 105 indivíduos selecionados aleatoriamente (idade média: 17,25 ± 1,87 anos). O software Dolphin Imaging foi utilizado para análise cefalométrica DM, e a plataforma WebCeph foi utilizada para análise cefalométrica baseada em IA. No total, foram avaliadas 10 medidas lineares e 12 angulares. O testet pareado, a ANOVA de uma via e o coeficiente de correlação intraclasse foram utilizados para avaliar as diferenças entre os dois métodos. O nível de significância foi estabelecido em p<0,05. Resultados: Com exceção dos parâmetros SNB, NPog, U1.SN, U1.NA, L1-APog, I/I e LIE, todos os outros parâmetros apresentaram valores significativamente diferentes entre os dois métodos (p<0,05). Enquanto não foi encontrada diferença (p>0,05) nas medidas SNA e SNB entre os dois métodos no grupo má oclusão de Classe I, foi encontrada diferença entre os métodos no grupo má oclusão de Classe II. Entretanto, no grupo má oclusão de Classe III somente o SNA foi diferente (p<0,05). O ângulo ANB diferiu significativamente em todos os três grupos de más oclusões. Foi encontrada boa correlação entre os dois métodos para todos os parâmetros, exceto para CoA e CoGn. Conclusão: Embora para algumas medidas tenham sido detectadas diferenças significativas entre os dois métodos de análise cefalométrica, nem todas as diferenças foram clinicamente significativas. O método de análise cefalométrica baseado em IA precisa ser aperfeiçoado, com maior especificidade para cada má oclusão.