Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate.

OBJECTIVE: To evaluate final posttreatment occlusion in patients with complete unilateral cleft lip and palate (cUCLP) by comparing (1) 3 treatment centers, (2) males and females, (3) cleft and noncleft sides, (4) right- and left-sided clefts, and (5) orthodontic treatment with/without orthognathic surgery (OS). DESIGN: Retrospective cohort study. PATIENTS: Blinded posttreatment dental casts of 56 patients (19.4 ± 1.4 years) with cUCLP from 3 centers in Switzerland. MAIN OUTCOME MEASURE: Occlusal assessment using the modified Huddart/Bodenham (MHB) index. RESULTS: Our sample comprised 35 males and 21 females, 46 with left- and 10 with right-sided clefts, of which 32 had undergone OS. The final posttreatment occlusion showed a median MHB score of 0 (interquartile range: -1.0 to 2.0) in the total sample and did not seem to depend on treatment center, sex, or OS. The MHB scores for the anterior buccal and the buccal segments were more negative on the cleft than on the noncleft side (P = .002 and P = .006, respectively). When the cleft was on the left side, the MHB score tended to be more positive in the labial (P = .046) and anterior buccal segments (P = .034). CONCLUSIONS: This study shows a very satisfactory final posttreatment occlusion in patients with cUCLP. The more constricted buccal occlusion on the cleft side emphasizes the attention that should be given in correcting the more medially positioned lesser maxillary segment. The influence of cleft-sidedness should be analyzed further on a sample including more patients with right-sided clefts.

Quantitative analysis of facial asymmetry based on three-dimensional photography: a valuable indicator for asymmetrical temporomandibular joint affection in juvenile idiopathic arthritis patients?

BACKGROUND: Juvenile idiopathic arthritis (JIA) can cause osseous deformity in the temporomandibular joint (TMJ) and may impair mandibular growth. This study aimed to evaluate whether facial asymmetry determined clinically or by morphometric analysis of three-dimensional (3D) photographs in JIA patients is associated with an asymmetric affection of theTMJ. METHODS: Of 76 consecutive JIA patients with a mean age of 11.7 years (range: 6.3-17.9), facial asymmetry was evaluated clinically (chin asymmetry, gonion asymmetry), and stereophotogrammetrically with 3D photographs. The facial surfaces were demarcated, then mirrored, superimposed using semi-automated landmarks, and quantitatively assessed (chin asymmetry, Hausdorff distances). Clinical and digital measurements were related to the diagnosis of right and left TMJ involvement derived from magnetic resonance images (MRI). RESULTS: Twenty-seven (34%) patients had an asymmetrical osseous deformity of the TMJ. By clinical evaluation, chin asymmetry was related to asymmetrical osseous destruction (p = 0.02), but gonion asymmetry was not (p = 0.14). In regard to 3D-photograph based morphometric measurements, chin asymmetry was also related to asymmetrical osseous destruction (p = 0.01), but neither the mean (p = 0.06) nor the maximal Hausdorff distance (p = 0.67). Despite the attested significance, none of the chin asymmetry evaluation methods appeared to hold sufficient predictive value (positive predictive values ≤54%; coefficient of determination ≤7%). CONCLUSIONS: For the assessment of facial asymmetry in JIA patients, morphometric measurements originating from 3D-photographs seem to deliver results comparable to the clinical assessment methods. The asymmetry of the face, especially around the chin, appears to be related to asymmetrical TMJ destruction, but none of the investigated measurement methods of the face were able to reliably predict the TMJ affection. Thus, facial asymmetry assessments, both qualitatively in a clinical setting and quantitatively based on 3D-photographs, have limited diagnostic value for TMJ involvement in JIA patients.

Magnetic Resonance Imaging Followup of Temporomandibular Joint Inflammation, Deformation, and Mandibular Growth in Juvenile Idiopathic Arthritis Patients Receiving Systemic Treatment.

OBJECTIVE: To investigate the course of temporomandibular joint (TMJ) inflammation, osseous deformation, and mandibular ramus growth in children with juvenile idiopathic arthritis (JIA) during systemic therapy. METHODS: Longitudinal study of 38 consecutive patients with JIA (29 female, median age 9.0 yrs, interquartile range 6.2-10.7 yrs) receiving systemic therapy with TMJ involvement, with 2 TMJ magnetic resonance imaging (MRI) examinations ≥ 2 years apart and no TMJ corticosteroid injection. Clinical and MRI findings were compared between initial and followup examinations and between TMJ with and without active inflammation at baseline. RESULTS: Over a median period of 3.6 years (range, 2.0-8.7 yrs), MRI grade of TMJ inflammation improved (p = 0.009) and overall osseous deformity tended to become less severe (p = 0.114). In TMJ with arthritis at baseline (46 TMJ), both the grades of inflammation (p < 0.001) and deformity (p = 0.011) improved. In TMJ with no arthritis at baseline (30 TMJ), the frequency and grade of condylar deformation remained stable. Mandibular ramus growth rates were not significantly different between TMJ with and without arthritis at baseline (1.3 mm/yr vs 1.5 mm/yr, p = 0.273), and were not correlated with the degree of inflammation at baseline or followup. The frequency of facial asymmetry tended to be lower at followup than at initial examination (24% vs 45%, p = 0.056). CONCLUSION: Our results suggest that systemic treatment of TMJ arthritis in children with JIA decreases the degree of inflammation seen on MRI, preserves osseous TMJ morphology, and maintains normal mandibular ramus growth.

Enamel Surface Roughness after Lingual Bracket Debonding: An In Vitro Study.

The aim of the present study was to quantitatively assess changes in enamel roughness parameters before and after lingual bracket debonding. The lingual surface of 25 sound premolars extracted for orthodontic reasons was studied by 3D optical interferometric profilometry before and after debonding of lingual brackets following enamel finishing (with fine diamond) and polishing (with 12- and 20-fluted carbide burs). The roughness parameters tested were the amplitude parameters Sa and Sz, the hybrid parameter Sdr, and the functional parameters Sc and Sv. The parameter differences (after debonding-reference) were calculated, and statistical analysis was performed via a Wilcoxon signed-rank test. Statistically significantly higher values were observed in all the surface roughness parameters of enamel surfaces after finishing and polishing, with the mostly affected parameter being the Sdr. Under the conditions of the present study, the finishing and polishing instruments used after debonding of lingual noncustomized brackets created a surface texture rougher than the control in all the tested roughness parameters.

Influence of different loupe systems and their light source on the vision in endodontics

The aim of this study was to evaluate the performance of Galilean and Keplerian loupes in the endodontic lumen with and without integrated light. Although the use of an operating microscope is widely recommended in endodontics it is uncertain whether an adequate loupe system with coaxial light source might replace the microscope for some endodontic work. Twenty-four dentists (age 27­64 years) underwent a miniaturized visual test inside the endodontic lumen of a natural molar: at the canal entrance, 5 mm inside the canal, and at the apex. The tooth was mounted in a phantom head in a simulated clinical setting. The naked eye (negative) and the microscope 6× (positive) served as control groups, and Galilean loupes 2.5× and Keplerian loupes 4.3× with and without a coaxial light source as experimental groups. A structure of 0.05 mm corresponding to the smallest instrument (06) was the threshold for sufficient vision. The loupe type, coaxial light source and the dentists' age had a statistically significant influence at all locations. None of the loupes helped to visualize structures at the apex. At the canal entrance, the visual threshold was reached by dentists < 40 years with Galilean loupes, by dentists ≥ 40 years with Keplerian loupes, with and without coaxial light. Dentists < 40 years detected structures < 0.05 mm inside the root canal with Keplerian loupes and coaxial light. The microscope offered highly superior results. The naked eye was insufficient to reach the visual threshold at any location.

Facial attractiveness of cleft patients: a direct comparison between artificial-intelligence-based scoring and conventional rater groups.

OBJECTIVES: To evaluate facial attractiveness of treated cleft patients and controls by artificial intelligence (AI) and to compare these results with panel ratings performed by laypeople, orthodontists, and oral surgeons. MATERIALS AND METHODS: Frontal and profile images of 20 treated left-sided cleft patients (10 males, mean age: 20.5 years) and 10 controls (5 males, mean age: 22.1 years) were evaluated for facial attractiveness with dedicated convolutional neural networks trained on >17 million ratings for attractiveness and compared to the assessments of 15 laypeople, 14 orthodontists, and 10 oral surgeons performed on a visual analogue scale (n = 2323 scorings). RESULTS: AI evaluation of cleft patients (mean score: 4.75 ± 1.27) was comparable to human ratings (laypeople: 4.24 ± 0.81, orthodontists: 4.82 ± 0.94, oral surgeons: 4.74 ± 0.83) and was not statistically different (all Ps ≥ 0.19). Facial attractiveness of controls was rated significantly higher by humans than AI (all Ps ≤ 0.02), which yielded lower scores than in cleft subjects. Variance was considerably large in all human rating groups when considering cases separately, and especially accentuated in the assessment of cleft patients (coefficient of variance-laypeople: 38.73 ± 9.64, orthodontists: 32.56 ± 8.21, oral surgeons: 42.19 ± 9.80). CONCLUSIONS: AI-based results were comparable with the average scores of cleft patients seen in all three rating groups (with especially strong agreement to both professional panels) but overall lower for control cases. The variance observed in panel ratings revealed a large imprecision based on a problematic absence of unity. IMPLICATION: Current panel-based evaluations of facial attractiveness suffer from dispersion-related issues and remain practically unavailable for patients. AI could become a helpful tool to describe facial attractiveness, but the present results indicate that important adjustments are needed on AI models, to improve the interpretation of the impact of cleft features on facial attractiveness.

Visual acuity and magnification devices in dentistry.

This review discusses visual acuity in dentistry and the influence of optical aids. Studies based on objective visual tests at a dental working distance were included. These studies show dramatic individual variation independent of the dentists’ age. The limitations due to presbyopia begin at an age of 40 years. Dental professionals should have their near vision tested regularly. Visual deficiencies can be compensated with magnification aids. It is important to differentiate between Galilean and Keplerian loupes. The lightweight Galilean loupes allow an almost straight posture and offer improved ergonomics. Younger dentists profit more from the ergonomic aspects, while dentists over the age of 40 can compensate their age-related visual deficiencies when using this type of loupe. Keplerian loupes, with their superior optical construction, improve the visual performance for dentists of all age groups. The optical advantages come at the cost of ergonomic constraints due to the weight of these loupes. The microscope is highly superior visually and ergonomically, and it is indispensable for the visual control of endodontic treatments.

Visual acuity of dentists in their respective clinical conditions.

OBJECTIVES: This study examined the impact of age and magnification on the near visual acuity of dentists in their private practice under simulated clinical conditions. MATERIALS AND METHODS: Miniaturized visual tests were fixed in posterior teeth of a dental phantom head and brought to 31 dentists in their respective private practice. The visual acuity of these dentists (n = 19, ≥40 years; n = 12, <40 years) was measured in a clinical setting under the following conditions: (a) natural visual acuity, distance of 300 mm; (b) natural visual acuity, free choice of the distance; and (c) loupe and additional light source, if available. RESULTS: The visual acuity under the different clinical conditions varied widely between individuals. The older group of dentists had a lower median visual acuity value under all clinical conditions. This difference was highly significant for natural visual acuity at a free choice of distance (p < 0.0001). For younger dentists (<40 years), visual acuity could be significantly improved by reducing the eye-object distance (p = 0.001) or by using loupes (p = 0.008). For older dentists (≥40 years), visual acuity could be significantly improved by using loupes (p = 0.0005). CONCLUSIONS: Visual performance decreased with increasing age under the specific clinical conditions of each dentist's private practice. Magnification aids can compensate for visual deficiencies. CLINICAL RELEVANCE: The question of whether findings obtained under standardized conditions are valuable for the habitual setting of each dentist's private practice seems clinically relevant.

Facial attractiveness of patients with unilateral cleft lip and palate and of controls assessed by laypersons and professionals.

OBJECTIVES: The aim of the study was to identify differences in the aesthetic evaluation of profile and frontal photographs of (1) patients treated for complete left-sided cleft lip and palate and (2) control patients by laypeople and professionals. MATERIALS, SUBJECTS, AND METHODS: Left-side profile and frontal photographs of 20 adult patients treated for complete left-sided cleft lip and palate (10 men, 10 women, mean age: 20.5 years) and of 10 control patients with a class I occlusion (five men, five women, mean age: 22.1 years) were included in the study. The post-treatment photographs were evaluated by 15 adult laypeople, 14 orthodontists, and 10 maxillofacial surgeons. Each photograph was judged on a modified visual analogue scale (VA S, 0-10; 0 'very unattractive' to 10 'very attractive'). A four-level mixed model was fitted in which the VA S score was the dependent variable; cases, profession, view, and rater were independent variables. RESULTS: Compared with laypersons, orthodontists gave higher VA S scores (+0.69, 95% confidence interval (CI) [0.53, 0.84]; P < 0.001), followed by surgeons (+0.21, 95% CI [0.03, 0.38], P = 0.02). Controls were given significantly higher scores than patients with clefts for profile and frontal photographs (+1.97, 95% CI [1.60; 2.35], P < 0.001). No significant difference was found between the scores for the frontal and lateral views (P = 0.46). CONCLUSIONS: All the different rater panels were less satisfied with the facial aesthetics of patients with clefts compared with that of control patients. Further research should evaluate whether these findings correlate with patients' self-perception and to what extent it affects the patients' psychosocial well-being.

Visual acuity of dentists under simulated clinical conditions.

OBJECTIVES: This study examined the near visual acuity of dentists in relation to age and magnification under simulated clinical conditions. MATERIALS AND METHODS: Miniaturized visual tests were performed in posterior teeth of a dental phantom head in a simulated clinical setting (dental chair, operating lamp, dental mirror). The visual acuity of 40 dentists was measured under the following conditions: (1) natural visual acuity, distance of 300 mm; (2) natural visual acuity, free choice of distance; (3) Galilean loupes, magnification of ×2.5; (4) Keplerian loupes, ×4.3; (5) operating microscope, ×4, integrated light; (6) operating microscope, ×6.4, integrated light. RESULTS: The visual acuity varied widely between individuals and was significantly lower in the group ≥40 years of age (p < 0.001). Significant differences were found between all tested conditions (p < 0.01). Furthermore, a correlation between visual acuity and age was found for all conditions. The performance with the microscope was better than with loupes even with comparable magnification factors. Some dentists had a better visual acuity without optical aids than others with Galilean loupes. CONCLUSIONS: Near visual acuity under simulated clinical conditions varies widely between individuals and decreases throughout life. Visual deficiencies can be compensated for with optical aids. CLINICAL RELEVANCE: Newly developed miniaturized vision tests have allowed, in a clinically relevant way, to evaluate the influence of magnification and age on the near visual acuity of dentists.

Influence of loupes and age on the near visual acuity of practicing dentists.

We evaluated the near visual acuity of 40 dentists and its improvement by using different magnification devices. The acuity was tested with miniaturized E-optotype tests on a negatoscope under the following conditions: 1. natural visual acuity, 300 mm; 2. single lens loupe, 2×, 250 mm; 3. Galilean loupe, 2.5×, 380 mm; and 4. Keplerian loupe, 4.3×, 400 mm. In part 1, the influence of the magnification devices was investigated for all dentists. The Keplerian loupe obtained the highest visual acuity (4.64), followed by the Galilean loupe (2.43), the single lens loupe (1.42), and natural visual acuity (1.19). For part 2, the dentists were classified according to their age (<∕≥40 years). The younger dentists' group achieved a significantly higher visual acuity with all magnification devices (p<0.001). For part 3, the dentists were grouped according to their natural visual acuity. The group with the higher natural visual acuity achieved significantly higher visual acuity with all magnification devices than did the group of dentists with the lower natural visual acuity (p<0.01). It can be concluded that near visual acuity varies highly between individuals and decreases during the lifetime. Independent of age or natural vision, visual acuity can be significantly improved by using magnification devices.

Influence of decontamination procedures on shear forces after contamination with blood or saliva.

INTRODUCTION: Despite rapid development in adhesive technology, contamination of bonding surfaces remains a major problem. The aims of this study were to evaluate the influence of contamination on bond strength and to investigate possible decontamination procedures. METHODS: Four bonding systems were evaluated for their shear bond strengths under 5 bonding situations: control (without contamination and decontamination); contamination with blood; contamination with saliva; decontamination with water and air, and repriming after blood contamination; and decontamination with water and air, and repriming after saliva contamination. The 25 specimens of each group consisted of composite blocks bonded to bovine teeth. Shear forces were measured with a testing machine after thermocycling. RESULTS: The 3 composite primers showed similar behavior. With the exception of Transbond SEP (3M Unitek, Monrovia, Calif) with saliva contamination, all contaminated samples showed greatly reduced shear forces. The control and decontaminated groups showed shear forces about 20 MPa. The resin-modified glass ionomer, however, did not reach clinically sufficient bond strengths in either setup. CONCLUSIONS: Decontamination with water and air and repriming is sufficient after contamination with blood or saliva. Etching again is not necessary. The bond strength of Transbond SEP was not significantly altered by saliva contamination and can be recommended for conventional bonding procedures.