Utilising massive open online courses to enhance global learning dissemination in cleft lip and palate: a case report of penta helix collaboration.

BACKGROUND: Educating and raising awareness in cleft lip and palate future generations is one vital effort to ensure the improvement of cleft care and research in the future. This study reported the overview in organising and evaluating the Massive Open Online Course (MOOC) in Cleft Lip and Palate as the alternative way for students' capacity building outside their study program whilst also earning credits towards their studies. METHODS: Smile Train cleft charity generously donated recorded lectures from cleft experts around the world in which each of the experts agreed to provide one-hour live discussion sessions. The learning activities ranging from lectures, pre- and post-course evaluation, forum, live discussion sessions, virtual visits to Indonesian Cleft Centre, self-reflection assignments and final project. A survey was released to the participants to collect their feedback. RESULTS: The course mainly attracted dental students, and several allied health professional students. In total, 414 out of 717 participants registered for this MOOC managed to finish the course and received a certificate of completion which was run between August-October 2021. In general, participants positively received the course. CONCLUSIONS: The MOOC model and its objective of disseminating widespread information across geographical boundaries to enhance learning about cleft lip and palate treatment was achieved. This report serves as an example for other educational institutions and stakeholders who plan to use online educational engagement platforms to provide high-quality education and capacity building to participants in lower-middle income countries.

Scoping review of outcome measures in cleft care used in research and reports.

Treatment outcome measures are critical in the decision making of best practices in the OFC field. OFC consortium working groups provided standardization of outcome measures based on previous treatment outcome studies. However, the implementation of such standardization in OFC centres worldwide is unknown. This study presented mapped outcome measures in cleft care using a structured review method complemented by quantitative overview of the relevant published research to provide initial guidelines for the implementation of treatment outcome standardization. A scoping review of the literature of treatment outcomes in cleft care following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines was performed. The selected indexed paper in outcome measures mapped following the international consortium in standard set of outcome measures in cleft care. Three hundred and sixty-five articles were filtered. The most discussed domains of cleft care were dental and oral health, appearance and speech/communication. Overall, the majority of publications were produced in high-income countries. The current review indicates that there are inequalities of treatment outcome studies among the domain of cleft care. In addition, there are also inequalities of published articles from HIC versus LMIC in treatment outcomes. This information can be used to develop targeted interventions aimed at encouraging cleft centres worldwide to adapt standardized outcome measures.

Caries in children with and without orofacial clefting: A systematic review and meta-analysis.

This systematic review compared children's primary dentition caries experience for those with cleft lip and/or palate (CL/P) and without. Four databases were searched without date restriction for; cross-sectional studies comparing caries experience for children with CL/P to those without. Screening, data extraction and risk assessment were carried out independently (in duplicate). Meta-analyses used a random-effects model. Twenty studies (21 reports) fitting the inclusion criteria comprised 4647 children in primary dentition from 12 countries. For dmft (n = 3016 children; 15 groups), CL/P mean = 3.2; standard deviation = 2.22 and no CL/P mean dmft = 2.5; sd 1.53. For dmfs (n = 1095 children; 6 groups), CL/P mean = 4; sd = 3.5 and no CL/P mean = 3; sd = 2.8. For % caries experience (n = 1094 children; 7 groups), CL/P mean = 65%; sd = 20.8 and no CL/P mean = 52%; sd = 28.1. Meta-analysis showed higher caries experience in children with CL/P, standardised mean difference = 0.46; 95% CI = 0.15, 0.77. Studies' risk of bias was high (n = 7), medium (n-10) and low (n = 3). Children with CL/P had higher caries experience compared to those without CLP.

Facial Anthropometry Measurements Using Three-Dimensional Stereophotogrammetry Analysis Among Nigerians.

ABSTRACT: This study aimed to determine the normative facial anthropometry measurement among Nigerians using three-dimensional stereophotogrammetry analysis.This study was carried out in Lagos, Nigeria over a period of 3 years. The sample population was Nigerians of diverse ethnic groups, age 16 and above with no history of congenital or acquired craniofacial deformities.A total of 452 subjects participated in the study with 56.2% males and 43.8% females. Most of the participants were between the ages of 25 to 49 (54.4%), 40.7% were less than 25 years of age and only 4.4% were more than 50 years old. The mean body mass index (BMI) for males was 22.7 and 23.4 for females. Mean values of upper facial height, midfacial height, lower facial height, intercanthal distance, interpupillary distance, upper facial width, and lower facial width are 69.13 ±â€Š5.91, 49.89 ±â€Š3.56, 67.85 ±â€Š6.12, 35.19 ±â€Š3.20, 67.04 ±â€Š3.67, 139.43 ±â€Š7.11, and 124.29 ±â€Š9.72 mm, respectively. The upper facial height, commissure width, upper lip length, and lower jaw width were significantly affected by age, while the BMI of an individual was a determinant of the interpupillary distance, facial width, and lower jaw width.This study demonstrated that there was a statistically significant difference in the facial dimensions of males when compared to females across all ages among the study population. The authors also observed that age and BMI are significant predictors of variations in some of the measurements.

Development of intra-oral automated landmark recognition (ALR) for dental and occlusal outcome measurements.

BACKGROUND: Previous studies embracing digital technology and automated methods of scoring dental arch relationships have shown that such technology is valid and accurate. To date, however there is no published literature on artificial intelligence and machine learning to completely automate the process of dental landmark recognition. OBJECTIVES: This study aimed to develop and evaluate a fully automated system and software tool for the identification of landmarks on human teeth using geometric computing, image segmenting, and machine learning technology. METHODS: Two hundred and thirty-nine digital models were used in the automated landmark recognition (ALR) validation phase, 161 of which were digital models from cleft palate subjects aged 5 years. These were manually annotated to facilitate qualitative validation. Additionally, landmarks were placed on 20 adult digital models manually by 3 independent observers. The same models were subjected to scoring using the ALR software and the differences (in mm) were calculated. All the teeth from the 239 models were evaluated for correct recognition by the ALR with a breakdown to find which stages of the process caused the errors. RESULTS: The results revealed that 1526 out of 1915 teeth (79.7%) were correctly identified, and the accuracy validation gave 95% confidence intervals for the geometric mean error of [0.285, 0.317] for the humans and [0.269, 0.325] for ALR-a negligible difference. CONCLUSIONS/IMPLICATIONS: It is anticipated that ALR software tool will have applications throughout clinical dentistry and anthropology, and in research will constitute an accurate and objective tool for handling large datasets without the need for time intensive employment of experts to place landmarks manually.

Nose profile morphology and accuracy study of nose profile estimation method in Scottish subadult and Indonesian adult populations.

This study investigated nose profile morphology and its relationship to the skull in Scottish subadult and Indonesian adult populations, with the aim of improving the accuracy of forensic craniofacial reconstruction. Samples of 86 lateral head cephalograms from Dundee Dental School (mean age, 11.8 years) and 335 lateral head cephalograms from the Universitas Padjadjaran Dental Hospital, Bandung, Indonesia (mean age 24.2 years), were measured. The method of nose profile estimation based on skull morphology previously proposed by Rynn and colleagues in 2010 (FSMP 6:20-34) was tested in this study. Following this method, three nasal aperture-related craniometrics and six nose profile dimensions were measured from the cephalograms. To assess the accuracy of the method, six nose profile dimensions were estimated from the three craniometric parameters using the published method and then compared to the actual nose profile dimensions.In the Scottish subadult population, no sexual dimorphism was evident in the measured dimensions. In contrast, sexual dimorphism of the Indonesian adult population was evident in all craniometric and nose profile dimensions; notably, males exhibited statistically significant larger values than females. The published method by Rynn and colleagues (FSMP 6:20-34, 2010) performed better in the Scottish subadult population (mean difference of maximum, 2.35 mm) compared to the Indonesian adult population (mean difference of maximum, 5.42 mm in males and 4.89 mm in females).In addition, regression formulae were derived to estimate nose profile dimensions based on the craniometric measurements for the Indonesian adult population. The published method is not sufficiently accurate for use on the Indonesian population, so the derived method should be used. The accuracy of the published method by Rynn and colleagues (FSMP 6:20-34, 2010) was sufficiently reliable to be applied in Scottish subadult population.

The validity and reliability of an automated method of scoring dental arch relationships in unilateral cleft lip and palate using the modified Huddart-Bodenham scoring system.

OBJECTIVE: To evaluate an automated software tool for the assessment of dental arch relationships using the modified Huddart and Bodenham (MHB) index. DESIGN: Cohort of 43 models of subjects aged 9-21 with UCLP and the ten GOSLON reference models sets. METHOD: The 53 sets of plaster models were scored using the MHB index and scanned with a benchtop scanner. The digital models were MHB scored visually using a commercial software program and landmarked for automatic scoring using a software plug-in. Scoring/landmarking was undertaken by three observers and repeated after 1 month. Intra- and inter-observer reproducibility were tested using Cronbach's alpha and intraclass correlation coefficients (ICC) (threshold > 0.9). Bland-Altman plots demonstrated inter-observer agreement for each model format. Random and systematic error with digital landmark identification error were determined using the x, y, and z co-ordinates for 28 models digitized twice 1 month apart using Cronbach's alpha and a t-test, respectively. RESULTS: Intra-operator landmark identification was excellent (Cronbach's alpha = 0.933) with no differences between sessions (P > 0.05). Intra-observer reproducibility was excellent for all examiners (Cronbach's alpha and ICC 0.986-0.988). Inter-observer reproducibility was highest for the software plug-in (0.991), followed by plaster (0.989) and OrthoAnalyzer (0.979) and Bland-Altman plots confirmed no systematic bias and greater consistency of scores with the automated software. CONCLUSION: The automated MHB software tool is valid, reproducible, and the most objective method of assessing maxillary arch constriction for patients with UCLP. CONFLICT OF INTEREST STATEMENT: The authors declare no conflict of interest or financial relationship with any organization or software used within the study.

Orthodontic scanners: what's available?

The popularity and availability of virtual technology in orthodontics for the replacement of hard-copy records with electronic records is growing rapidly, with a move towards a 'digital' patient for diagnosis, treatment planning, monitoring of treatment progress and outcome. As part of this ongoing development, three-dimensional digital models of the dental arches have the potential to replace traditional plaster models and their associated limitations for treatment planning, appliance construction and simulated treatment outcomes. This article provides the reader with a summary of the currently available benchtop model scanners and intraoral scanners. It is likely that this technology will become increasingly common-place within the orthodontic profession over the next decade.

FAF1, a gene that is disrupted in cleft palate and has conserved function in zebrafish.

Cranial neural crest (CNC) is a multipotent migratory cell population that gives rise to most of the craniofacial bones. An intricate network mediates CNC formation, epithelial-mesenchymal transition, migration along distinct paths, and differentiation. Errors in these processes lead to craniofacial abnormalities, including cleft lip and palate. Clefts are the most common congenital craniofacial defects. Patients have complications with feeding, speech, hearing, and dental and psychological development. Affected by both genetic predisposition and environmental factors, the complex etiology of clefts remains largely unknown. Here we show that Fas-associated factor-1 (FAF1) is disrupted and that its expression is decreased in a Pierre Robin family with an inherited translocation. Furthermore, the locus is strongly associated with cleft palate and shows an increased relative risk. Expression studies show that faf1 is highly expressed in zebrafish cartilages during embryogenesis. Knockdown of zebrafish faf1 leads to pharyngeal cartilage defects and jaw abnormality as a result of a failure of CNC to differentiate into and express cartilage-specific markers, such as sox9a and col2a1. Administration of faf1 mRNA rescues this phenotype. Our findings therefore identify FAF1 as a regulator of CNC differentiation and show that it predisposes humans to cleft palate and is necessary for lower jaw development in zebrafish.

Could retaining the dental recall interval save NHS dentistry?

The World Health Assembly in May 2021 was a watershed moment in oral health, with the landmark resolution that designated oral diseases as non-communicable diseases (NCDs). This was strongly supported by a host of other NCDs in recognition of the common risk factor principle and acknowledgement of the fact that oral diseases do not occur in isolation from other NCDs, but are commonly associated with cardiovascular disease, diabetes/obesity, respiratory diseases, metabolic syndrome, a range of other inflammatory disorders and cancers. Regular monitoring and early detection would potentially intercept these NCDs and this could form a central plank of a revamped holistic 'health'- as opposed to 'disease'-oriented health care system.Consultation with patients and dentists reveals strong support for maintaining regular recall intervals, which maintains trust and optimises motivation and compliance. In-person visits could be minimised by using technology, such as remote consultations and longitudinal monitoring systems, making it adaptable to different health care settings and equitable, affordable, cost-effective and sustainable.A new paradigm with dentists as oral health professionals, and the mainstreaming of oral health and population-level prevention, means the future of health care can be guided by integration and workforce modification producing a surveillance-based, early interceptive, preventive model of care.

Global perspectives in orofacial cleft management and research.

Orofacial clefts (OFCs) refer to clefts of the lip and palate, a heterogeneous group of relatively common congenital conditions that can cause mortality and significant disability if untreated, and residual morbidity even when treated with multidisciplinary care. Contemporary challenges in the field include: lack of awareness of OFCs in remote, rural and impoverished populations; uncertainties due to lack of surveillance and data gathering infrastructure; inequitable access to care in some parts of the world; and lack of political will combined with lack of capacity to prioritise research.OFCs present clinically as either syndromic or non-syndromic, with the latter either being isolated or in conjunction with other malformations; however, many registries still do not differentiate between these fundamentally different entities and lump a spectrum of cleft types and sub-phenotypes together. This has implications for treatment, research and ultimately, quality improvement.This paper deals with the challenges in contemporary management in terms of care and the prospects and possibilities for primary prevention of non-syndromic clefts. In terms of management and optimal care, there are also challenges in the provision of multi-disciplinary treatment and management of the consequences of being born with OFCs, such as dental caries, malocclusion and psychosocial adjustment.

Dental education at Dundee Dental Hospital and School - a notable past and inspiring future.

Dundee Dental Hospital and School has been present on Park Place, Dundee for over 100 years. During this time, it has been at the forefront of dental care and education, first as part of the University of St Andrews and subsequently the University of Dundee. This innovation continues with novel undergraduate curricula for dental and dental therapy students, providing early clinical experience and integrating clinical teaching with the appropriate sciences. We also offer several taught postgraduate programmes, popular particularly with international students. Dundee was at the forefront of the response to the COVID-19 pandemic, with the Scottish Dental Clinical Effectiveness Programme leading the world on guidance for safe clinical practice. Innovative solutions for the ongoing delivery of teaching and assessment also were developed. Research underpins teaching and the delivery of dental care and Dundee has an international reputation for its research portfolio. All of the above can only be achieved by close working relationships between the University and NHS, which will be strengthened further by the creation of the Dundee Dental Research Hospital and School. Our international reputation will continue to attract students and staff from across the world.

Automatic recognition of landmarks on digital dental models.

Fundamental principle in improving Dental and Orthodontic treatments is the ability to quantitatively assess and cross-compare their outcomes. Such assessments require calculating distances and angles from 3D coordinates of dental landmarks. The costly and repetitive task of hand-labelling dental models hinder studies requiring large sample size to penetrate statistical noise. We have developed techniques and a software implementing these techniques to map out automatically, 3D dental scans. This process is divided into consecutive steps - determining a model's orientation, separating and identifying the individual tooth and finding landmarks on each tooth - described in this paper. The examples to demonstrate the techniques, software and discussions on remaining issues are provided as well. The software is originally designed to automate Modified Huddard Bodemham (MHB) landmarking for assessing cleft lip/palate patients. Currently only MHB landmarks are supported, however it is extendable to any predetermined landmarks. The software, coupled with intra-oral scanning innovation, should supersede the arduous and error prone plaster model and calipers approach to Dental research, and provide a stepping-stone towards automation of routine clinical assessments such as "index of orthodontic treatment need" (IOTN).

The parental dentocraniofacial phenotype-an orofacial clefting microform.

OBJECTIVE: Using the systematic review method, (1) to identify the investigations of the parental dentocraniofacial phenotype in orofacial clefting, (2) synthesize the data to derive a model of the phenotypic features that will assist in the identification of cleft morphogenes, and (3) make recommendations for the future global strategy for researching the parental craniofacial phenotype in orofacial clefting. SEARCH STRATEGY: The Cochrane, Medline (via PubMed and OVID platforms [1966 to December 2006]), Embase, CINAHL, and ASKSAM Orthodontic Reference Database (1950-1997) databases were searched using a combination of the following keywords: microform, parent, craniofacial, dental, and cleft. All published articles were reviewed. There were no exclusions of non-English reports. Of the 36 studies identified using this strategy, 26 met the inclusion criteria. DATA ABSTRACTION/SYNTHESIS: The statistically significant data were abstracted using a pro forma, and the methodological quality of the selected studies was evaluated using a checklist. There was considerable heterogeneity among the studies, and therefore it was not possible to synthesize the data. We were, however, able to collate the data. RESULTS/CONCLUSIONS: (1) The craniofacial phenotype possessed by parents of children with orofacial clefting is distinctive when compared with that of the noncleft population. (2) There is insufficient evidence to produce a model of the phenotypic features to assist in the search for orofacial clefting morphogenes. (3) The pattern of expression of the phenotypic features identified to date supports the contention that there are differences in the inheritance of cleft lip with or without cleft palate and isolated cleft palate. Progress in this field is affected by extreme heterogeneity in etiology of cleft lip with or without cleft palate, as well as heterogeneity in study design. (4) Subphenotyping using features such as microforms should be employed to reduce the heterogeneity and to improve the power of future genetic investigations and will also assist in clinical management and genetic counseling for families.

Facial average soft tissue depth variation based on skeletal classes in Indonesian adult population: A retrospective lateral cephalometric study.

OBJECTIVE: To understand the influence of three types of skeletal classes (Class I, Class II and Class III) on midline average soft tissue depth (ASTD). METHODS: Lateral cephalograms of 335 pre-treatment orthodontic patients were obtained from the archive of Radiology Clinic Universitas Padjadjaran Dental Hospital Bandung Indonesia. The linear measurements of 10 midline facial landmarks ASTD and angular measurement of ANB were extracted and analysed statistically. RESULTS: A database of ASTD grouped by skeletal classes, specific for the Indonesian population, within the South East Asian ancestry group was obtained. CONCLUSIONS: A generic pattern of deeper upper lip than lower lip in class III compared to class II and conversely, deeper lower lip than upper lip in class II compared to class III, was visible in both male and female groups.

Forensic dental identification using two-dimensional photographs of a smile and three-dimensional dental models: A 2D-3D superimposition method.

Photographs of a person smiling may provide valuable information about their anterior dentition. These images can be an alternative ante-mortem (AM) dental source in cases with no dental records, which gives the forensic odontologist a significant opportunity for comparative dental analysis. There are no reported studies that have investigated the reliability of a superimposition technique using 2D photographs of a smile and 3D dental models in dental identification. The aim of this study was to explore novel odontological methods by combining 2D photographs with 3D dental models, simulating a dental identification scenario. The objective was to increase the accuracy of dental identification using an AM photograph with the aid of 3D imaging as an alternative to post-mortem (PM) photographs. The study comprised of 31 3D dental models (simulating PM information) and 35 digital photographs (simulating AM information). The data was analysed in two phases: Phase I- Visual Comparison of 2D-3D images and Phase II- 2D-3D superimposition after a wash out period. Both methods were analysed by the principal investigator. Further, one-third (ten) of the sample was evaluated by six raters (three experienced forensic odontologists and three forensic odontology MSc. students). The inter-rater agreement was assessed using intra-class correlation (ICC 2, 1, absolute). The results of the study suggest that the inter-rater and intra-rater reliability using 3D superimposition was highest (ICC ≈ 1.0). In summary, there was an increase in match rates and higher certainty among the opinions reached when using the 2D-3D superimposition method. The procedure attempted to reduce the limitations of previously existing 2D methods and is intended to assist forensic experts with an alternative method in dental identification when expressing conclusions on a case using photographs.

Automated Identification from Dental Data (AutoIDD): A new development in digital forensics.

There has been a significant expansion in the use of 3-dimensional (3D) dental images in recent years. In the field of forensic odontology, an automated 3D dental identification system could enhance the identification process. This study presents a novel method for automated human dental identification using 3D digital dental data by utilising a dental identification scenario. The total study sample was divided into two groups: Group A (120 dental models) and Group B (120 Intra-oral scans-IOS). Group A data was composed of 3D scanned dental models of post-orthodontic treated patients (30 maxillary and 30 mandibular). This data was considered as AM digital data. To generate an identical sample, the dental casts (60) of the same patients were retrieved and laser scanned. These models were considered as PM digital data. Group B data (IOS) was obtained from 30 study participants. To reconstruct a dental identification scenario 30 maxillary and 30 mandibular IOS were obtained from 30 participants and were considered as IOS-AM. After one year, another set of IOS (60) were acquired from the same participants and were considered as IOS-PM. The results showed that the AutoIDD (Automated Identification from Dental Data) software was consistent in accuracy; capable of differentiating "correct matches" (high match percentage) from "non-matches" (very low percentage) by 3D image superimposition. The match percentage of the maxillary and mandibular IOS ranged from 64 to 100% and 81-100 %, with a mean distance (mm) of 0.094 and 0.093 respectively. This study demonstrated the feasibility of using 3D scans through a new automated software - AutoIDD in digital forensics to assist the forensic expert in confirming the identity of a deceased individual from the available AM dental records.

Management of hypodontia: orthodontic considerations (II).

Patients with congenitally missing teeth (hypodontia) present with complex problems. Meeting their treatment needs requires a joint effort between the disciplines of orthodontics and restorative dentistry. There are a number of options available to restore space generated by missing teeth. In the majority of patients orthodontic treatment will be required before this space can be restored satisfactorily. The second part of this series reviews the orthodontic considerations for various options.

Hypodontia--a retrospective review of prevalence and etiology. Part I.

A retrospective literature review was carried out to determine the prevalence of hypodontia and current knowledge of associated etiological factors. Reported studies vary widely in their reports of prevalence. The majority are retrospective radiographic studies, and reported rates vary from 2.6% to 11.3%. Racial differences have been determined: in Caucasian studies the mandibular second premolars and maxillary lateral incisors were the most frequently recorded absent and in Asian studies, the mandibular incisor was the most frequently recorded absent. Prevalence rates are higher in females compared to males (3:2, respectively). The association of hypodontia with other systemic conditions and dental anomalies is widely reported. Hypodontia can be regarded as a multifactorial condition. Recent developments in molecular genetics have established the importance of the muscle specific homeobox genes (Msx1 and Msx2) in dental development. Specific genes that are responsible for the more severe types of hypodontia, including ectodermal dysplasia, have been identified by linkage analysis. However, variable expression of the trait suggests a polygenic mode of inheritence with epistatic genes and environmental factors interacting.

Management of hypodontia: restorative considerations. Part III.

This paper, the third in the series, initially details the role of the restorative dentist in treating patients with hypodontia. (See Quintessence Int 2005;36:263-270 and 345-353 for the first two papers.) A range of treatment options, including implants, adhesive techniques, and removable prostheses, are covered. The investigators have detailed the clinical indications, and noted their relative advantages and disadvantages.