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

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

A Novel Algorithm for Forensic Identification Using Geometric Cranial Patterns in Digital Lateral Cephalometric Radiographs in Forensic Dentistry.

Lateral cephalometric radiographs are crucial in dentistry and orthodontics for diagnosis and treatment planning. However, their use in forensic identification, especially with burned bodies or in mass disasters, is challenging. AM (antemortem) and PM (postmortem) radiographs can be compared for identification. This study introduces and evaluates a novel algorithm for extracting cranial patterns from digital lateral cephalometric radiographs for identification purposes. Due to the unavailability of AM cephalograms from deceased individuals, the algorithm was tested using pre- and post-treatment cephalograms of living individuals from an orthodontic archive, considered as AM and PM data. The proposed algorithm encodes cranial patterns into a database for future identification. It matches PM cephalograms with AM records, accurately identifying individuals by comparing cranial features. The algorithm achieved an accuracy of 97.5%, a sensitivity of 97.7%, and a specificity of 95.2%, correctly identifying 350 out of 358 cases. The mean similarity score improved from 91.02% to 98.10% after applying the Automatic Error Reduction (AER) function. Intra-observer error analysis showed an average Euclidean distance of 3.07 pixels (SD = 0.73) for repeated landmark selections. The proposed algorithm shows promise for identity recognition based on cranial patterns and could be enhanced with artificial intelligence (AI) algorithms in future studies.

Cephalometric Analysis of Maxillary Sinus for Gender Determination Using Lateral Cephalogram: A Novel Retrospective Study in the North Indian Population.

BACKGROUND: Underlying disorders of the maxillary sinus (MS), including a history of sinus surgeries, chronic sinusitis, or congenital anomalies can potentially impact sinus function and structure, necessitating careful evaluation and management. Moreover, intact sinuses are crucial in gender determination in forensic anthropology. The present study was undertaken to check the accuracy and reliability of MS in gender determination using morphometric parameters. MATERIALS AND METHODS: This retrospective study was carried out on 74 lateral cephalograms (37 males and 37 females) aged between 18 to 50 years from the North Indian population. The MS area was measured using a NewTom CBCT machine (NewTom, Imola, Italy) with slicer software. The anatomical landmarks for the sinus were identified, and the area was calculated in square millimeters (mm2). RESULTS: In terms of surface area, females had a mean of 13,210.40 mm2 with a standard error of 713.46. Males, however, exhibited a higher mean surface area of 18,713.82 mm2, but with a significantly larger standard error of 3,371.70. The difference in MS area between males and females was statistically significant (p<0.01). In the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was 0.77, suggesting good discriminative ability. CONCLUSION: The MS area on lateral cephalograms shows significant sexual dimorphism. Overall, the findings suggest that the MS surface area can be a useful anatomical feature for distinguishing between male and female North Indian subjects, given the statistically significant difference and the good discriminative performance indicated by the ROC curve analysis.

Craniofacial Cephalometric Morphology in Polish Adolescents with Cleft Palate Only.

Background: Cephalometric studies indicate that craniofacial morphology in patients with cleft palate only (CPO) differs from other forms of orofacial clefts and healthy patients. Planning orthodontic treatment for patients with different craniofacial deformities requires knowledge on the craniofacial complex. The aim of the present study was to describe the cephalometric craniofacial morphology in adolescents with cleft palate only compared to generally healthy orthodontic patients. Methods: The study comprised 100 lateral cephalograms (taken in the years 2003-2020) of Polish patients with cleft palate only aged from 11.1 to 14.2 (mean age 12.43 y) and a matched control group of 100 children without orofacial clefts aged 12-14 (mean age 12.25). All digital images were analyzed in specialized cephalometric software. Results: Statistically significantly lower values of both SNA (p < 0.001) and ANB (p < 0.001) were found in the study group versus the control group. Mandibular line to cranial base angle (ML-NSL) as well as maxillary base to cranial base (NL-NSL) were significantly higher in the CPO group. Both the maxilla and mandible were rotated distally in CPO. Moreover, the intermaxillary vertical angle (ML-NL) was reduced in CPO. Mandibular angle in CPO was significantly higher (p = 0.005), reflecting posterior mandibular rotation. Conclusions: In adolescents with CPO, maxillary deficiency is found, without a severe sagittal jaw discrepancy, with a slight compensatory lingual inclination of the lower incisors. Mandibular deficiency in CPO is concurrent with posterior rotation and an increased mandibular angle.

Assessment of Sexual Dimorphism Through Lateral Cephalogram in Children Aged 10-12 Years.

INTRODUCTION: Forensic dentistry integrates interdisciplinary scientific knowledge to produce accurate and reliable forensic statements. Anthropometry, essential since its introduction by Alphonse Bertillon in 1882, describes human body shapes and has significant forensic applications. This study focuses on sexual dimorphism, phenotypic differences between males and females, using lateral cephalometric measurements to determine sex in children aged 10-12 years from the Chengalpattu population. MATERIALS AND METHODS: The cross-sectional study included 80 participants (40 boys and 40 girls). Lateral cephalograms were analyzed using Ceph Ninja Pro software to obtain 15 cephalometric measurements. Statistical analysis using SPSS Software (Version 22.0) involved t-tests to identify significant differences (P<0.05). Discriminant function analysis assessed the predictive power of these variables. RESULTS: Seven variables showed significant differences between sexes. Discriminant models based on these variables determined sex with varying reliability. Ramus length was the most reliable predictor (81%), while maxillary length had the lowest reliability (62%). DISCUSSION: The study's findings align with existing literature, indicating the robustness of ramus length for sex determination. However, the low reliability of maxillary length contrasts with studies that found it useful for sex differentiation, suggesting variability across populations and age groups. Combining multiple cephalometric variables improved accuracy, consistent with previous research. CONCLUSION: Lateral cephalograms are effective for assessing sexual dimorphism in children. The study supports the forensic and clinical utility of cephalometric measurements and calls for further research with diverse populations and advanced imaging techniques to enhance method reliability and applicability.

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

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

Accuracy of Artificial Intelligence for Cervical Vertebral Maturation Assessment-A Systematic Review.

Background/Objectives: To systematically review and summarize the existing scientific evidence on the diagnostic performance of artificial intelligence (AI) in assessing cervical vertebral maturation (CVM). This review aimed to evaluate the accuracy and reliability of AI algorithms in comparison to those of experienced clinicians. Methods: Comprehensive searches were conducted across multiple databases, including PubMed, Scopus, Web of Science, and Embase, using a combination of Boolean operators and MeSH terms. The inclusion criteria were cross-sectional studies with neural network research, reporting diagnostic accuracy, and involving human subjects. Data extraction and quality assessment were performed independently by two reviewers, with a third reviewer resolving any disagreements. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool was used for bias assessment. Results: Eighteen studies met the inclusion criteria, predominantly employing supervised learning techniques, especially convolutional neural networks (CNNs). The diagnostic accuracy of AI models for CVM assessment varied widely, ranging from 57% to 95%. The factors influencing accuracy included the type of AI model, training data, and study methods. Geographic concentration and variability in the experience of radiograph readers also impacted the results. Conclusions: AI has considerable potential for enhancing the accuracy and reliability of CVM assessments in orthodontics. However, the variability in AI performance and the limited number of high-quality studies suggest the need for further research.

Evaluating the long-term stability of a predefined palatal region for tooth movement analysis.

OBJECTIVES: We conducted a three-dimensional (3D) analysis of orthodontic tooth movement (TM) using digital dental models (DMs), focusing on the palatal region of interest (PROI), aiming to evaluate the long-term stability of the PROI, validate the 3D TM analysis with PROI registration, and compare it with conventional lateral cephalometric analyses. METHODS: Twenty adult patients treated with a multibracket appliance were evaluated at their first visit (T0) and at least 5 years later (T1) using DMs and lateral cephalograms (LCs). The long-term stability of PROI was assessed by calculating the point cloud distances between DM-T0 and DM-T1. TM analysis using DM with PROI registration for the maxillary central incisors was assessed through linear and angular measurements in the sagittal view and subsequently compared with the LCs. RESULTS: The average point cloud distance of the PROI between DM-T0 and DM-T1 was 0.21 mm (standard deviation, 0.13 mm). TM analysis using DMs demonstrated excellent reproducibility for both linear and angular measurements (intra-rater correlation coefficient, > 0.99). The 95 % limits of agreement between the DM and LC measurements were < 5.14° for angular change, 3.53 mm for horizontal displacement, and 0.98 mm for vertical displacement. No significant differences were observed in the angular and linear measurements when the TM was compared using the DMs and LCs. CONCLUSIONS: The PROI remained stable for over 5 years, supporting the reproducibility and accuracy of TM assessment using PROI registration in orthodontic clinical practice. CLINICAL SIGNIFICANCE: DM analysis lacks the risks associated with X-ray exposure and can be easily performed in daily clinical practice, indicating its potential for future clinical applications. These findings further support the use of DM with PROI registration for TM analysis in orthodontic clinical practice, emphasizing its long-term stability and reproducibility.

Artificial intelligence in age and sex determination using maxillofacial radiographs: A systematic review.

In the past few years, there has been an enormous increase in the application of artificial intelligence and its adoption in multiple fields, including healthcare. Forensic medicine and forensic odontology have tremendous scope for development using AI. In cases of severe burns, complete loss of tissue, complete or partial loss of bony structure, decayed bodies, mass disaster victim identification, etc., there is a need for prompt identification of the bony remains. The mandible, is the strongest bone of the facial region, is highly resistant to undue mechanical, chemical or physical impacts and has been widely used in many studies to determine age and sexual dimorphism. Radiographic estimation of the jaw bone for age and sex is more workable since it is simple and can be applied equally to both dead and living cases to aid in the identification process. Hence, this systematic review is focused on various AI tools for age and sex determination in maxillofacial radiographs. The data was obtained through searching for the articles across various search engines, published from January 2013 to March 2023. QUADAS 2 was used for qualitative synthesis, followed by a Cochrane diagnostic test accuracy review for the risk of bias analysis of the included studies. The results of the studies are highly optimistic. The accuracy and precision obtained are comparable to those of a human examiner. These models, when designed with the right kind of data, can be of tremendous use in medico legal scenarios and disaster victim identification.

Assessing the Accuracy of Lateral Cephalogram in Quantifying Three-Dimensional Pharyngeal Airway Morphology Compared to Cone-Beam Computed Tomography.

BACKGROUND: When it comes to orthodontic diagnosis and treatment planning, the structures of the upper and lower airway space are crucial because of the role they play in craniofacial development. AIM: The major objective of this study was to evaluate the accuracy of lateral cephalogram in the evaluation of upper and lower pharyngeal space by comparing it to clinical usage of cone-beam computed tomography (CBCT) in quantifying the 3D morphology of the pharyngeal airway. METHODS AND MATERIALS: In total, 70 patients were included in the study. They had both a CBCT scan and a lateral cephalogram performed within a week of each other. Different cephalometric landmarks have been utilized to estimate linear and area dimensions for use in lateral cephalogram airway investigations. By superimposing the lateral cephalogram measurement of the vertical height of the pharyngeal airway over axial CBCT slices of 0.8 to 1 mm in thickness, airway volumes were calculated. For this study, we measured the pharyngeal airway space in each patient in two dimensions (2D) using the airway area from the lateral cephalogram and in three dimensions (3D) using the airway volume from the CBCT scan over the same region of interest, using a uniform scale and magnification throughout all split 3D volumes. RESULTS:  The mean value of the area of pharyngeal space calculated by lateral cephalograph analysis (LCA) was 336.35 ± 86.49 mm2. The maximum value was 551.234 mm2. The minimum value was 206.32 mm2. The mean value of the volume of the same area calculated using CBCT was 3409.11 ± 1237.96 mm3. The maximum value was 5887.23 mm3. When the area calculated using LCA was compared with the volume calculated using CBCT, the correlation between them was significant statistically (r=0.831, p-value =0.000). The mean values of volume evaluated in 3D CBCT in males were 4198±1008 mm3 while for females it was 2980±1134.5 mm3. During the statistical analysis, these observations were found to have a positive correlation with increased volume of pharyngeal space in males as compared to that of females (p=0.006). The values of the area of pharyngeal space calculated using LCA in males was 370.1±60.9 mm2. while it was 301.9±88 mm2  in females. CONCLUSION: The area estimated for the pharyngeal airway on LCA correlates strongly with the volume determined by a CBCT scan. Since we have considered pharyngeal space analysis using CBCT to be a reliable and standard methodology, therefore a positive correlation of area calculated using LCA with volume calculated using CBCT shows that the analysis made by LCA can be reliable.

Mapping an intelligent algorithm for predicting female adolescents' cervical vertebrae maturation stage with high recall and accuracy.

BACKGROUNDS AND OBJECTIVES: The present study was designed to define a novel algorithm capable of predicting female adolescents' cervical vertebrae maturation stage with high recall and accuracy. METHODS: A total of 560 female cephalograms were collected, and cephalograms with unclear vertebral shapes and deformed scales were removed. 480 films from female adolescents (mean age: 11.5 years; age range: 6-19 years) were used for the model development phase, and 80 subjects were randomly and stratified allocated to the validation cohort to further assess the model's performance. Derived significant predictive parameters from 15 anatomic points and 25 quantitative parameters of the second to fourth cervical vertebrae (C2-C4) to establish the ordinary logistic regression model. Evaluation metrics including precision, recall, and F1 score are employed to assess the efficacy of the models in each identified cervical vertebrae maturation stage (iCS). In cases of confusion and mispredictions, the model underwent modification to improve consistency. RESULTS: Four significant parameters, including chronological age, the ratio of D3 to AH3 (D3:AH3), anterosuperior angle of C4 (@4), and distance between C3lp and C4up (C3lp-C4up) were administered into the ordinary regression model. The primary predicting model that implements the novel algorithm was built and the performance evaluation with all stages of 93.96% for accuracy, 93.98% for precision, 93.98% for recall, and 93.95% for F1-score were obtained. Despite the hybrid logistic-based model achieving high accuracy, the unsatisfactory performance of stage estimation was noticed for iCS3 in the primary cohort (89.17%) and validation cohort (85.00%). Through bivariate logistic regression analysis, the posterior height of C4 (PH4) was further selected in the iCS3 to establish a corrected model, thus the evaluation metrics were upgraded to 95.83% and 90.00%, respectively. CONCLUSIONS: An unbiased and objective assessment of the cervical vertebrae maturation (CVM) method can function as a decision-support tool, assisting in the evaluation of the optimal timing for treatment in growing adults. Our novel proposed logistic model yielded individual formulas for each specific CVM stage and attained exceptional performance, indicating the capability to function as a benchmark for maturity evaluation in clinical craniofacial orthopedics for Chinese female adolescents.

Is Incisor Compensation Related to Skeletal Discrepancies in Skeletal Class III? A Retrospective Cephalometric Study.

This study investigated compensation in skeletal Class III subjects to compare various severities of abnormal jaws. A retrospective analysis of 137 skeletal Class III cephalograms (63 males and 74 females) was conducted, with cephalometric assessments determining skeletal and dental values. The results were compared with Class I cephalograms. Incisor compensation was examined by pairing normal jaws with varied abnormal jaws, classified by severity using one standard deviation (SD). Statistical analyses included Kruskal-Wallis tests, Bonferroni tests, Spearman's correlations, and multiple linear regression. Four skeletal Class III groups were identified: OMx+PMd, RMx+OMd, OMx+OMd, and PMx+PMd (P = prognathic; O = orthognathic; R = retrognathic; Mx = maxilla; Md = mandible.). The upper central incisor (U1) showed proclination, and the lower central incisor (L1) showed retroclination across all groups except for U1 in PMx+PMd and L1 in OMx+OMd, which exhibited normal inclination. U1 exhibited limited compensation even with progressive maxillary retrognathism, while L1 showed limited compensation after one SD of mandibular prognathism. Maxilla (SNA) and jaw discrepancy (ANB) were inversely related to the U1 degree, whereas only jaw discrepancy (ANB) was positively related to the L1 degree. U1 in PMx+PMd and L1 in OMx+OMd showed no incisor compensation. U1 had limited compensation even with progressive maxillary retrognathism while L1 showed limited compensation after one SD mandibular prognathism.

Sex estimation from maxillofacial radiographs using a deep learning approach.

The purpose of this study was to construct deep learning models for more efficient and reliable sex estimation. Two deep learning models, VGG16 and DenseNet-121, were used in this retrospective study. In total, 600 lateral cephalograms were analyzed. A saliency map was generated by gradient-weighted class activation mapping for each output. The two deep learning models achieved high values in each performance metric according to accuracy, sensitivity (recall), precision, F1 score, and areas under the receiver operating characteristic curve. Both models showed substantial differences in the positions indicated in saliency maps for male and female images. The positions in saliency maps also differed between VGG16 and DenseNet-121, regardless of sex. This analysis of our proposed system suggested that sex estimation from lateral cephalograms can be achieved with high accuracy using deep learning.

Morphometric Analysis of Sella Turcica and a Proposed Novel Sella Turcica Index - A Digital Lateral Cephalometric Study.

Background: The sella turcica is a structure readily seen on lateral cephalograms and sella point is routinely traced for various cephalometric analyses. The aim of the present study was to evaluate the morphometric variation in size and shape of sella turcica via lateral cephalogram. The objectives were to introduce a novel sella turcica index (STI) and assess its reliability that could be helpful in gender determination. Materials and Methods: A total of 80 lateral cephalograms of the patients of age group 10-30 years were included for the study. The morphological variations of the sella turcica was done based on the classification given by Axelsson et al. (2004). The length, depth and perimeter of the sella turcica was measured and STI derived and calculated. The data was further subjected to discriminant analysis to validate the gender outcome. Reliability of the novel index was determined by calculating the sensitivity and specificity. Results: The overall most common morphological type of sella turcica was Type A (56.25%) followed by Type B (18.75%) and Type E (13.75%). The mean perimeter and depth of sella turcica was higher in females whereas the mean length of sella turcica was higher in males. The mean STI was higher in males and statistically highly significant. The sensitivity and specificity of this index was 72.5% and 90% respectively. Conclusion: A significant relationship was observed between the morphometric measurements of sella turcica and gender. STI could be of great help as a reliable tool for personal identification in forensic sciences. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04082-9.

Accuracy and tracing time of cephalometric analyses on a tablet or desktop computer : A prospective study.

BACKGROUND: This prospective study aimed to evaluate the influence of the computer type (tablet or desktop) on accuracy and tracing time of cephalometric analyses. METHODS: Dental students used a web-based application specifically developed for this purpose to perform cephalometric analyses on tablet and desktop computers. Landmark locations and timestamps were exported to measure the accuracy, successful detection rate and tracing time. Reference landmarks were established by six experienced orthodontists. Statistical analysis included reliability assessment, descriptive statistics, and linear mixed effect models. RESULTS: Over a period of 8 semesters a total of 277 cephalometric analyses by 161 students were included. The interrater reliability of the orthodontists establishing the reference coordinates was excellent (ICC > 0.9). For the students, the mean landmark deviation was 2.05 mm and the successful detection rate for the clinically acceptable threshold of 2 mm suggested in the literature was 68.6%, with large variations among landmarks. No effect of the computer type on accuracy and tracing time of the cephalometric analyses could be found. CONCLUSION: The use of tablet computers for cephalometric analyses can be recommended.

Reliability and safety of miniscrew insertion planning with the use of lateral cephalograms assessed on corresponding cone-beam computer tomography images.

BACKGROUND/OBJECTIVES: Recently, lateral cephalograms have been proposed for guided miniscrew insertion planning. Therefore, the aim was to assess the reliability and safety of such planning on corresponding cone-beam computer tomography (CBCT) images. MATERIALS/METHODS: Intraoral scans, lateral cephalograms, and CBCT images of 52 subjects (even sexes distribution), aged 15.1 ±â€…2.5 years, were included. Miniscrew (n = 104) insertion planning was performed using lateral cephalograms superimposed on the maxillary intraoral scans, while the assessment of their bicortical placement, length in bone, contact with adjacent teeth, incisive canal, and nasal floor perforation was done on corresponding superimposed CBCT images. Moreover, maxillary incisor inclination, crowding, and the maxillary intercanine width were measured. RESULTS: The overall miniscrew length in bone was 7.2 ±â€…1.3mm. Bicortical placement was seen in 58.7% of the sample (38.5% of subjects). Incisive canal and nasal floor perforation was seen in 25% and 21.2% of subjects, respectively. No contact of the miniscrew with adjacent teeth was recorded. A negative significant interaction was seen between the miniscrew length in bone, the percentage of total miniscrew length and maxillary anterior teeth crowding (ß, -0.10, P = .047 and ß, -0.90, P = .006, respectively). Moreover, a positive significant interaction was seen between the incisive canal perforation and maxillary anterior teeth crowding (OR = 1.32, P = .021). LIMITATIONS: Exclusion of subjects with impacted teeth. CONCLUSIONS: Miniscrew insertion planning using lateral cephalograms, despite being safe in preventing contact with adjacent teeth, is limited in achieving bicortical placement and insufficient in completely avoiding incisive canal and nasal floor perforation.

Comparative manual and digital analysis of gonial angle in lateral cephalograms for gender determination.

Human skull has always been used for victim identification in forensic odontology. The gender-dimorphic bone of the skull is the mandible. The gonial angle has frequently been investigated for gender estimation with variable results and requires further exploration. We aim to compare the efficacy of gonial angle estimation by ancient methods of lateral cephalometric tracing compared with more recent digital analysis methods for gender estimation in the Indian population. Lateral cephalograms of 191 (96 M and 95F) cases above the age of 17 years were retrieved. Cephalometric analysis of gonial angle on radiographs was done using both manual cephalometric tracing method and digitally using Adobe Photoshop software. The results were subjected to statistical analysis for evaluation. The mean gonial angle was higher in females (125.05; 123.77 and 125.28) than in males (122.583; 121.715 and 122.008) using both manual and digital methods. On applying the logistical regression analysis (LRA), the digital method showed the highest gender estimation accuracy of 60.7% followed by Burstone's analysis (57.1%) and manual conventional analysis (56.5%). Burstone's analysis (57.9%) correctly identified increased females, whereas digital analysis (62.5%) and manual conventional analysis (59.4%) accurately recognised increased males. The present study showed a higher gender estimation accuracy using digital methods as compared to manual methods, but it still lacks the credibility to be used as a sole factor for predicting the gender of an individual. Hence, a cumulative factor must be taken into consideration for gender identification which would provide more promising results.

Effects of Twin-Block with an expanding device on the upper airway in growing children with skeletal class II malocclusion-a retrospective study based on the consistency of three-dimensional and two-dimensional data.

OBJECTIVES: Skeletal class II malocclusion is one of the most common malocclusions. Among the functional appliances for skeletal class II malocclusion, the Twin-Block appliance with a maxillary expander is effective in repositioning the mandible forward. In this study, we focused our efforts on investigating the effects of Twin-Block appliances with maxillary expanders on the upper airway in growing children with skeletal class II malocclusion by tracing and measuring lateral cephalograms after evaluating the consistency of three-dimensional CBCT data and two-dimensional lateral cephalogram data. MATERIALS AND METHODS: A total of 102 patients ranging from 9 to 15 years old (11.37 ± 2.80, male/female ratio = 1:1) with skeletal class II malocclusion were selected to evaluate the consistency of CBCT data and lateral cephalogram data. The strongly and moderately correlated segments were then selected to study the effects of Twin-Block with a maxillary expander on the upper airway in 66 growing children with skeletal class II malocclusion (11.31 ± 1.23 years old, male/female ratio = 1:1) by lateral cephalograms. RESULTS: The results showed a strong significant correlation in the nasopharynx (r = 0.708) and moderate significant correlations in the overall upper airway (r = 0.641), palatopharynx (r = 0.553), and glossopharynx (r = 0.575) but a weak correlation in the hypopharynx (r = 0.323). The corresponding determination coefficient (R2) was also determined by scatter plot analysis. Moreover, compared with the pretreatment data (T1), the total area of the upper airway and the areas of the nasopharynx, palatopharynx, and glossopharynx after functional treatment (T2) increased statistically and significantly. CONCLUSIONS: Lateral cephalograms can reflect the volume of the nasopharynx and oropharynx in skeletal class II children to a certain extent, while Twin-Block appliances with maxillary expanders can widen the volume of the nasopharynx and oropharynx significantly. CLINICAL RELEVANCE: The lateral cephalogram is reliable for analyzing the nasopharynx, palatopharynx, and glossopharynx in orthodontic clinical practice. Twin-Block appliances with maxillary expanders have a positive effect on skeletal class II patients with airway stenosis.

Role of the tonsil-oropharynx ratio on lateral cephalograms in assessing tonsillar hypertrophy in children seeking orthodontic treatment.

OBJECTIVES: To analyze the diagnostic value of the tonsil-oropharynx (T/O) ratio on lateral cephalograms for evaluating tonsillar hypertrophy (TH). METHODS: A cross-sectional study was performed on 185 consecutive children (101 males, 84 females; mean age 7.3 ± 1.4 years) seeking orthodontic treatment. The T/O ratios on lateral cephalograms were calculated following Baroni et al.'s method. Tonsil sizes were clinically determined according to the Brodsky grading scale. Spearman correlation coefficients between the T/O ratio and clinical tonsil size were calculated with the total sample and subgroups and then compared between subgroups. Diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values, and accuracy. RESULTS: There was a strong correlation between the T/O ratio and clinical tonsil size in children (ρ = 0.73; P < 0.001). A significantly higher correlation coefficient was found in the Class III children. The ROC curve revealed an area under the curve of 0.90 (95% CI, 0.86-0.94; P < 0.001). The optimal cutoff value of the T/O ratio for predicting TH was 0.58, with a sensitivity of 98.7% and specificity of 64.2%. Employing the cutoff value of 0.5, the sensitivity was 100% and the specificity was 45.9%. CONCLUSIONS: Measurement of the T/O ratio on lateral cephalograms may be helpful to initial screening in children for TH. Practitioners may combine the clinical examination of tonsil size with the cephalometric findings for a more comprehensive evaluation.

Correlation of "K" plane to occlusal plane and three different ala-tragal lines in dentulous subjects with different skeletal forms: A cephalometric study.

Aim: Orientation of the occlusal plane is an important clinical procedure for complete denture fabrication. An attempt had been made to reconstruct the occlusal plane using a different reference plane. The aim of this study was to find the correlation of the "K" plane to the occlusal plane and to assess the angular deviation between the K-plane to the occlusal plane (KO) with different skeletal forms. Settings and Design: An in vivo observational study was conducted on dentulous subjects having Class I dental occlusion with different skeletal forms undergoing orthodontic treatment. Materials and Methods: The study was conducted on 54 subjects aged 18-30 years. Metallic balls (3 mm in diameter) were attached to the desired landmarks, and a lateral cephalogram was taken for each subject. Cephalometric analysis was done using the Dolphin Imaging software, and the values obtained were recorded and subjected to statistical analysis. Statistical Analysis Used: The values obtained were recorded and subjected to statistical analysis using simple descriptive analysis, Shapiro-Wilk test, Mann-Whitney U-test, and Pearson's correlation. Results: A positive correlation was found between KO with a mean angular deviation of 8.59° ± 3.05°. The angle was found to be steeper in skeletal Class II subjects. Conclusions: Clinical application of the K-plane to use as a reference plane to orient the posterior occlusal plane can enhance the treatment outcome for a removable prosthesis. The results of this study provide a theoretical foundation for the practical restoration of the occlusal plane in different skeletal forms.