Stability of clockwise rotation of the maxillary occlusal plane in skeletal Class III patients treated with two-jaw surgery.

OBJECTIVE: The objective of the study was to investigate the post-surgical stability of clockwise rotation of the maxillary occlusal plane (MXOP) after Le Fort I osteotomy for posterior impaction and advancement, in skeletal Class III patients who had undergone two-jaw orthognathic surgery (2J-OGS). MATERIALS AND METHODS: The sample set consisted of 46 patients (18 males and 28 females). Using lateral cephalograms taken at the initial evaluation (T0), before 2J-OGS (T1), after 2J-OGS (T2) and at debonding (T3), the amount of MXOP change (criterion: 2° in ΔMXOP [between T2 and T3]) was used to assign patients to Group 1 (G1, high relapse, -3.09°) or Group 2 (G2, low relapse, -0.99°). Findings were statistically compared between the groups. RESULTS: Compared with G2, G1 exhibited more severe skeletal Class III relationships and a flatter MXOP at T0, a greater increase in ΔANB, and more clockwise rotation of ΔMXOP and ΔFMA between T1 and T2. G1 also showed a greater decrease in ΔANB, higher counterclockwise rotation of ΔMXOP and upward movement of U1 between T2 and T3. Regression analysis yielded the following equation: MXOP (ΔT2-T3) = -0.37 X MXOP (ΔT1-T2) -0.43. CONCLUSIONS: The higher the clockwise rotation of the MXOP during 2J-OGS in skeletal Class III patients, the greater the subsequent relapse (counterclockwise rotation) of the MXOP.

Heritability of maxillary dental cephalometric variables among monozygotic twins, dizygotic twins and their siblings.

OBJECTIVES: The purpose of this study was to investigate the heritability of dental cephalometric variables by analyzing vertical linear measurements and angular measurements of the upper incisor, canine, and first molar. MATERIALS AND METHODS: Among the 553 Korean patients who participated in twin studies conducted at Samsung Medical Center, 150 patients had their lateral cephalometric radiograph data included in this study. The group was comprised of 36 monozygotic (MZ) twins (males, 16 pairs; females, 20 pairs), 13 dizygotic (DZ) twins (males, 7 pairs; females, 6 pairs), and 26 same-sex sibling pairs (males, 11 pairs; females, 15 pairs). All patients were over 20 years old with a mean age of 39.75 years. Lateral cephalometric diagrams and linear measurements (6 vertical factors, 6 horizontal factors) were taken. Three axial planes were measured for each tooth; intraclass correlation coefficients (ICCs) were obtained for each group and heritability was calculated using Falconer's method. RESULTS: ICCs of vertical linear measurements (average 0.837, P < 0.01) and the tooth axis of the central incisor and canine (average 0.679, P < 0.001) were higher in the MZ group compared to the DZ and sibling groups; thus, these variables showed high heritability. CONCLUSIONS: Orthodontic treatment aiming to alter the tooth axis of the maxillary central incisor or canine or other vertical factors with greater heritability can be difficult, requiring strategic treatment planning to achieve desired treatment outcome and stability. CLINICAL RELEVANCE: The active early treatment to gain tooth eruption space can lead to normal tooth position.

Cone-beam computed tomography and digital model analysis of maxillary buccal alveolar bone thickness for vertical temporary skeletal anchorage device placement.

INTRODUCTION: This study aimed to quantify the buccal alveolar bone thickness (BABT) in the maxillary molar region to provide a practical guideline for vertical temporary skeletal anchorage device (TSAD) placement using cone-beam computed tomography (CBCT). It also aimed to develop a linear regression model for use in digital models to predict available BABT. METHODS: The sample for this retrospective study consisted of 31 sites (24 patients; mean age, 28.75 years; range, 18-44 years) in which vertical TSADs were placed successfully in the maxillary posterior interradicular area during the total arch distalization procedure. BABT was measured at 3 points of the interradicular space using CBCT, and the buccal alveolar region thickness (BART), which included buccal-attached gingival thickness and the buccal alveolar bone, was measured using the digital model. In CBCT, BABT was measured at the most convex point of the lamina dura of the root adjacent to the vertical TSAD mesially, at the most convex point of the lamina dura of the root adjacent to the vertical TSAD distally, and the central point between the mesial and distal points. Three linear measurements were obtained at 2, 4, and 6 mm apical to the alveolar crest: the mesial thickness, the central thickness (centralCBCT), and the distal thickness. In the digital model, the most convex points of the clinical crowns of 2 teeth adjacent to vertical TSAD and their contact point along with the corresponding Will Andrews and Lawrence Andrews ridge were identified. The horizontal distance paralleling the model base was digitally measured and recorded at 3 positions: the mesial, central, and distal points. Then, the following 3 linear measurements were taken directly on each 3-dimensional dental model: the mesial thickness, the central thickness (centralModel), and the distal thickness. RESULTS: Both BABT and BART at the central position (centralCBCT, 3.44 mm; centralModel, 6.28 mm) were thicker than at the 2 exterior positions (mesial thickness, 2.16; distal thickness, 2.59 mm; mesial thickness, 2.74 mm; distal thickness, 2.99 mm). BABT was thinnest at 2 mm from the alveolar crest, and there was no statistically significant difference between 4 mm and 6 mm. There was a strong correlation between centralModel and centralCBCT. CONCLUSIONS: The mean BABT and BART at the central position, in which we suggest placing vertical TSADs, were 3.44 ± 0.69 mm in CBCT and 6.28 ± 1.11 mm in the digital model, respectively. The minimum BABT and BART at the central position in which vertical TSAD was placed successfully were 2.38 mm in CBCT and 4.25 mm in the digital model. There was a strong correlation between centralCBCT and centralModel, and we developed a linear regression model that resulted in a useful formula for estimating the actual available BABT at the central position: centralCBCT = 0.57 × centralModel - 0.15.

Accuracy of auto-identification of the posteroanterior cephalometric landmarks using cascade convolution neural network algorithm and cephalometric images of different quality from nationwide multiple centers.

INTRODUCTION: The purpose of this study was to evaluate the accuracy of auto-identification of the posteroanterior (PA) cephalometric landmarks using the cascade convolution neural network (CNN) algorithm and PA cephalogram images of a different quality from nationwide multiple centers nationwide. METHODS: Of the 2798 PA cephalograms from 9 university hospitals, 2418 images (2075 training set and 343 validation set) were used to train the CNN algorithm for auto-identification of 16 PA cephalometric landmarks. Subsequently, 99 pretreatment images from the remaining 380 test set images were used to evaluate the accuracy of auto-identification of the CNN algorithm by comparing with the identification by a human examiner (gold standard) using V-Ceph 8.0 (Ostem, Seoul, South Korea). Pretreatment images were used to eliminate the effects of orthodontic bracket, tube and wire, surgical plate, and surgical screws. Paired t test was performed to compare the x- and y-coordinates of each landmark. The point-to-point error and the successful detection rate (range, within 2.0 mm) were calculated. RESULTS: The number of landmarks without a significant difference between the location identified by the human examiner and by auto-identification by the CNN algorithm were 8 on the x-coordinate and 5 on the y-coordinate, respectively. The mean point-to-point error was 1.52 mm. The low point-to-point error (<1.0 mm) was observed at the left and right antegonion (0.96 mm and 0.99 mm, respectively) and the high point-to-point error (>2.0 mm) was observed at the maxillary right first molar root apex (2.18 mm). The mean successful detection rate of auto-identification was 83.3%. CONCLUSIONS: Cascade CNN algorithm for auto-identification of PA cephalometric landmarks showed a possibility of an effective alternative to manual identification.

Vertical bony step between proximal and distal segments after mandibular setback is related with relapse: A cone-beam computed tomographic study.

INTRODUCTION: Vertical bony step (VBS) occurs between proximal and distal segments of the mandible during mandibular setback surgery with bilateral sagittal split ramus osteotomy. The purpose of this study was to investigate whether VBS is correlated with the relapse of mandibular setback using 3-dimensional models constructed from cone-beam computed tomography. METHODS: The subjects consisted of 30 patients who underwent bilateral sagittal split ramus osteotomy for a mandibular setback. Double jaw surgery was performed in 18 patients, and isolated mandibular setback surgery was performed in 12 patients. Cone-beam computed tomography scans were taken at pretreatment (T0), postsurgery (T1), and posttreatment (T2). Treatment changes and the correlations between measurements were evaluated. RESULTS: The mean mandibular setback was -11.9 mm, and the mean VBS was -5.6 mm. Correlations with the relapse of mandibular setback were found in the amount of mandibular setback (T1 - T0), development of VBS (T1 - T0), posterior movement of the proximal segment (T1 - T0), counterclockwise rotation of symphysis (T2 - T1), and the resolution of VBS (T2 - T1). CONCLUSIONS: The development and resolution of VBS were correlated with the relapse of mandibular setback. Minimizing VBS is recommended to reduce the relapse of mandibular setback.

Accuracy of automated identification of lateral cephalometric landmarks using cascade convolutional neural networks on lateral cephalograms from nationwide multi-centres.

OBJECTIVE: To investigate the accuracy of automated identification of cephalometric landmarks using the cascade convolutional neural networks (CNN) on lateral cephalograms acquired from nationwide multi-centres. SETTINGS AND SAMPLE POPULATION: A total of 3150 lateral cephalograms were acquired from 10 university hospitals in South Korea for training. MATERIALS AND METHODS: We evaluated the accuracy of the developed model with independent 100 lateral cephalograms as an external validation. Two orthodontists independently identified the anatomic landmarks of the test data set using the V-ceph software (version 8.0, Osstem, Seoul, Korea). The mean positions of the landmarks identified by two orthodontists were regarded as the gold standard. The performance of the CNN model was evaluated by calculating the mean absolute distance between the gold standard and the automatically detected positions. Factors associated with the detection accuracy for landmarks were analysed using the linear regression models. RESULTS: The mean inter-examiner difference was 1.31 ± 1.13 mm. The overall automated detection error was 1.36 ± 0.98 mm. The mean detection error for each landmark ranged between 0.46 ± 0.37 mm (maxillary incisor crown tip) and 2.09 ± 1.91 mm (distal root tip of the mandibular first molar). A significant difference in the detection accuracy among cephalograms was noted according to hospital (P = .011), sensor type (P < .01), and cephalography machine model (P < .01). CONCLUSION: The automated cephalometric landmark detection model may aid in preliminary screening for patient diagnosis and mid-treatment assessment, independent of the type of the radiography machines tested.

Pharyngeal Airway Morphology in Skeletal Class III With Mandibular Asymmetry is Improved After Bimaxillary Orthognathic Surgery.

PURPOSE: The relationship between pharyngeal airway morphology and jawbone movements in skeletal Class III patients with mandibular asymmetry after orthognathic surgery remains unclear. This study was to measure the changes in pharyngeal airway morphology in skeletal Class III patients with mandibular asymmetry after bimaxillary surgery and evaluate associations between changes in pharyngeal airway morphology and skeletal movements. METHODS: In this retrospective cohort study, skeletal Class III patients who underwent bimaxillary surgery were enrolled. The predictor variable was facial symmetry status divided into 2 groups, asymmetric (Group A) and symmetric (Group B). The primary outcome variables were changes in airway parameters, including cross-sectional linear distances, cross-sectional area (CSA), minimum CSA (Min-CSA), and volume; and airway asymmetry index between the preoperative and 6-month postoperative imaging studies. Correlation analysis was performed between upper airway and skeletal changes. RESULTS: Twenty-five patients were included in this study, with 15 patients in Group A (mean age: 23.00 years; BMI: 22.83) and 10 patients in Group B (mean age: 22.30 years; BMI: 22.48). Group A showed a higher asymmetry index than Group B at T0; however, no significant differences compared to Group B at T1. The airway volume was significantly decreased in the oropharynx in Group A at T1, whereas it showed no significant differences in Group B (P < .05). Lateral movement of B point and Menton showed positive correlations with changes in Min-CSA in the oropharynx and negative correlations with changes in airway asymmetry index (P < .05). CONCLUSIONS: Pharyngeal airway exhibited an asymmetrical and constricted morphology in Group A before surgery. The airway morphology in Group A showed a tendency to adopt a symmetrical and less constricted shape after surgery. The airway space was reduced in the oropharynx in Group A after surgery. Surgical correction of mandibular asymmetry correlated with the improvement of pharyngeal airway morphology.

Combination of bisacodyl suppository and 1 L polyethylene glycol plus ascorbic acid is a non-inferior and comfortable regimen compared to 2 L polyethylene glycol plus ascorbic acid.

BACKGROUND AND AIM: Appropriate bowel cleansing before colonoscopy is an important factor in increasing the detection rate of lesions. Low-volume polyethylene glycol (PEG) plus ascorbic acid (PEG-Asc) reduces the dosage of bowel preparation agent, but still presents discomfort to patients. The primary aim of the present study was to compare the efficacy of bowel cleansing between 2 L PEG-Asc (control) and 1 L PEG-Asc with bisacodyl suppository (suppository) groups, and the secondary aim was to investigate complications and tolerability between the two groups. METHODS: This was a single-center prospective randomized controlled study. We identified 168 patients scheduled for colonoscopy between August 2017 and January 2018 and randomly assigned them to the control or to the suppository groups. Efficacy of bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS), and side-effects were surveyed using questionnaires. RESULTS: No significant difference was detected in baseline characteristics including insertion and withdrawal times, and adenoma detection rates between the two groups. Total BBPS score was 7.93 ± 1.06 and 7.74 ± 1.02 in the control and suppository groups, respectively (P = 0.22). Incidence of abdominal pain and nausea was not statistically different, whereas that of sleep disturbance and anal discomfort was higher in the control group. (P = 0.00). CONCLUSIONS: One liter PEG-Asc with bisacodyl suppository resulted in an equivalent bowel-cleansing outcome with reduced patient discomfort compared to 2 L PEG-Asc. Therefore, PEG-Asc with bisacodyl suppository represents a potential alternative and increases patient compliance with bowel preparation.

Precision Analysis of Supraorbital Transcranial Exits Using Three Dimensional Multidetector Computed Tomography.

PURPOSE: Anatomical variation in supraorbital transcranial exits, which can be divided into the lateral supraorbital exit and the medial frontal exit, has been investigated in several studies during the past few decades. However, in previous studies, inconsistent criteria were used for classifying those exits. The authors analyzed variations in supraorbital transcranial exits using 3 dimensional multidetector computed tomography (3D MDCT), and present a consistent classification of the types of those exits with precise location measurements. METHODS: In 1181 patients (2362 orbits) who underwent facial 3D MDCT, the authors measured a set of qualitative and quantitative parameters. The qualitative parameters included an assessment of the location and type of the exit, and the number of accessory foramina. The quantitative parameters included various distance measurements. RESULTS: A frontal exit was present in 2071 orbits and a supraorbital exit in 953. Neither a frontal exit nor a supraorbital exit was found in 11 orbits. The most common type of frontal exit was the notch type, followed by the foramen type and none. The mean distance from the nasion to the frontal exit was 24.70 ± 3.50 mm on the right side and 23.69 ± 3.42 mm on the left side. CONCLUSION: In conclusion, various types of supraorbital transcranial exits were observed, of which the frontal notch was the most common. This is the first study to conduct a consistent analysis of a large sample of skulls to characterize the distribution of supraorbital transcranial exit types using a comprehensive and clear set of criteria.

Heritability of Facial Skeletal and Dental Characteristics of Monozygotic and Dizygotic Twins Using Cephalometric Analysis and Falconer's Method.

The purpose of this study was to investigate the heritability of facial skeletal and dental characteristics of the monozygotic (MZ) and dizygotic (DZ) twins. The samples consisted of Korean MZ and DZ twins (n = 13 pairs/each twin; 7 pairs of males and 6 pairs of females; mean age, 39 years, respectively). The linear, angular, and ratio variables, which could describe the size and shape of the facial horizontal and vertical, dental, mandible and cranial base structure, were measured. The Falconer's method was used to calculate the heritability (h; close to or below 0, low heritability; close to or above 1, high heritability). In the facial horizontal and vertical aspects, the highest h values were shown at SNA (degree, 1.53), SNB (degree, 2.12), SN-Pog (degree, 2.19), SN-palatal plane angle (degree, 1.29), SN-mandibular plane angle (degree, 1.59), N-ANS/ANS-Me (1.66), and ANS-Me/N-Me (1.62). In the dental aspects, although L1-occlusal plane angle (degree, 1.38) and SN-occlusal plane angle (degree, 2.09) showed high h values, most of the dental variables showed low h values. In the mandible and cranial base, lower gonial angle, mandibular body length, and cranial base angle showed high h values (N-Go-Gn [degree], 1.07; Go-Pog [mm], 0.92; N-S-Ba [degree], 1.51). The descending order of the overall mean h values was the facial horizontal (1.10), facial vertical (0.71), mandible (0.59), cranial base (0.37), and dental characteristics (-0.11). The shape of facial skeletal structure and location of the occlusal plane within skeletal framework was more influenced by genetic factors than environmental factors.

Odontogenic ameloblast-associated protein (ODAM) in gingival crevicular fluid for site-specific diagnostic value of periodontitis: a pilot study.

BACKGROUND: Odontogenic Ameloblast-Associated Protein (ODAM) in gingival crevicular fluid (GCF) can provide evidence of the detachment of junctional epithelium from the tooth surface by periodontitis. This study sought to investigate the ability of ODAM to reflect the severity of periodontitis at a site-specific level; thus whether there was a relationship between clinical diagnostic parameters and the value of ODAM in GCF was analyzed. METHODS: Eight periodontitis patients with various severities were enrolled, and the clinical parameters and samples of GCF were obtained from 44 to 60 sites of each subject. The ODAM concentration was quantified by enzyme-linked immunosorbent assay. Correlation analyses between clinical parameters and ODAM values and unadjusted and adjusted (linear) mixed model analyses were performed. The accuracy of ODAM to reflect sites having a probing depth (PD) ≥ 5 mm and a positive bleeding on probing (BOP) was evaluated by receiver-operating characteristic analysis. RESULTS: A total of 424 GCF samples were collected. The mean ODAM concentration from each patient varied from 0.2 to 1.52 ng/ml. Correlations between PD or clinical attachment level (CAL) and ODAM values were found (p <  0.0001). An adjusted linear mixed model showed that PD or CAL were associated with ODAM values (p <  0.05). The area under the curve of ODAM, which reflected sites with PD ≥ 5 mm and positive BOP, was 0.661 (p <  0.0001). CONCLUSION: This result shows the possibility of GCF ODAM as a site-specific biomarker for periodontal tissue destruction.

Preparation of Microstructure Molds of Montmorillonite/Polyethylene Glycol Diacrylate and Multi-Walled Carbon Nanotube/Polyethylene Glycol Diacrylate Nanocomposites for Miniaturized Device Applications.

Environmentally friendly microstructure molds with montmorillonite (MMT) or multi-walled carbon nanotube (MWCNT) reinforced polyethylene glycol diacrylate (PEGDA) nanocomposites have been prepared for miniaturized device applications. The micropatterning of MMT/PEGDA and MWCNT/PEGDA with 0.5 to 2.0 wt% of MMTs and MWCNTs was achieved through a UV curing process with micro-patterned masks. Hexagonal dot arrays and complex patterns for microstructures of the nanocomposites were produced and characterized with an optical microscope; their thermal properties were studied by thermogravimetric analysis (TGA). The TGA results showed that these nanocomposites were thermally stable up to 350 °C. Polydimethylsiloxane thin replicas with different microstructures were prepared by a casting method using the microstructured nanocomposites as molds. It is considered that these microstructure molds of the nanocomposites can be used as microchip molds to fabricate nanobio-chips and medical diagnostic chip devices.

Characteristics of the perception for unilateral facial nerve palsy.

Patients with facial nerve palsy (FNP) are actually evaluated by other people rather than doctors or the patients themselves. This study was performed to investigate the characteristics of the perception of unilateral FNP in Korean people. A questionnaire using photographs of four patients with four different grades (House-Brackmann) of FNP was given to two hundred people with no FNP. Subjects of each gender, ranging from 20 to 69 years of age, participated. The questionnaire, showing facial expressions of resting, smiling, whistling, eye closing, and frowning, consisted of questions concerning the identification and the involved side of FNP, the unnatural areas of the face, and the unnaturalness of the facial expressions. The overall identification rate of FNP was 75.0%. The identification rate increased according to the increase in the grade of the patient's FNP (p < .001). The overall detection rate of the involved side was 54.5%, and that rate decreased with increasing subject age (p < .001). The area of the most unnatural facial expression was reported to be the mouth, followed by the eyes and cheeks. The most unnatural facial expression was also reported to be smiling, followed by eye closing and whistling. There was no difference in the identification rate of FNP according to education level. However, the overall detection rate of the involved side was higher in the high-education group (p < .001). The detection rate for the involved side of FNP was lower than the rate of identification of FNP and was significantly low in the middle-aged/elderly and low-education level groups.

A smartphone-based automatic diagnosis system for facial nerve palsy.

Facial nerve palsy induces a weakness or loss of facial expression through damage of the facial nerve. A quantitative and reliable assessment system for facial nerve palsy is required for both patients and clinicians. In this study, we propose a rapid and portable smartphone-based automatic diagnosis system that discriminates facial nerve palsy from normal subjects. Facial landmarks are localized and tracked by an incremental parallel cascade of the linear regression method. An asymmetry index is computed using the displacement ratio between the left and right side of the forehead and mouth regions during three motions: resting, raising eye-brow and smiling. To classify facial nerve palsy, we used Linear Discriminant Analysis (LDA) and Support Vector Machine (SVM), and Leave-one-out Cross Validation (LOOCV) with 36 subjects. The classification accuracy rate was 88.9%.

Preparation of 3D electrode microarrays of multi-walled carbon nanotubes/nafion nanocomposites for microfluidic biofuel cells.

Three-dimensional (3D) electrode microarrays with multi-walled carbon nanotubes (MWCNTs) reinforced Nafion nanocomposites were prepared for microfluidic biofuel cells. The oxidized MWCNTs (ox-MWCNTs) were prepared using chemical reactions with 60% nitric acid solution with pristine MWCNTs at 120 degrees C for 12 hrs with a nitrogen gas flow environment. Ox-MWCNTs in the range of 1 to 20 wt.% based on the Nafion polymer weight were reinforced to Nafion nanocomposites by solution casting. The micro-porous structure of the ox-MWCNTs reinforced Nafion nanocomposites was prepared by plasma etching for 5 to 20 min. The 10 wt.% ox-MWCNTs reinforced Nafion nanocomposite produced stable micro-porous structures of 3D electrodes by 10 min plasma etching. Micro-scale 3D structures of MWCNTs reinforced Nafion nanocomposites in a diameter range of 47 to 300 µm were prepared by the micro-stencil assisted casting. To characterize the 3D electrode microarrays, the physical geometry and the reinforced MWCNT dispersion in the nanocomposite structure were examined using a scanning electron microscope (SEM) and an optical microscope. Thermal property measurements of the ox-MWCNTs reinforced Nafion nanocomposites with 10 min of plasma etching, and without plasma etching were made. Both showed stable thermal properties over 300 degrees C. The proposed 3D electrode microarray of MWCNT/Nafion nanocomposites with micro-porous structures can be applied to miniaturized fuel cell devices.

Accuracy of posteroanterior cephalogram landmarks and measurements identification using a cascaded convolutional neural network algorithm: A multicenter study.

Objective: : To quantify the effects of midline-related landmark identification on midline deviation measurements in posteroanterior (PA) cephalograms using a cascaded convolutional neural network (CNN). Methods: : A total of 2,903 PA cephalogram images obtained from 9 university hospitals were divided into training, internal validation, and test sets (n = 2,150, 376, and 377). As the gold standard, 2 orthodontic professors marked the bilateral landmarks, including the frontozygomatic suture point and latero-orbitale (LO), and the midline landmarks, including the crista galli, anterior nasal spine (ANS), upper dental midpoint (UDM), lower dental midpoint (LDM), and menton (Me). For the test, Examiner-1 and Examiner-2 (3-year and 1-year orthodontic residents) and the Cascaded-CNN models marked the landmarks. After point-to-point errors of landmark identification, the successful detection rate (SDR) and distance and direction of the midline landmark deviation from the midsagittal line (ANS-mid, UDM-mid, LDM-mid, and Me-mid) were measured, and statistical analysis was performed. Results: : The cascaded-CNN algorithm showed a clinically acceptable level of point-to-point error (1.26 mm vs. 1.57 mm in Examiner-1 and 1.75 mm in Examiner-2). The average SDR within the 2 mm range was 83.2%, with high accuracy at the LO (right, 96.9%; left, 97.1%), and UDM (96.9%). The absolute measurement errors were less than 1 mm for ANS-mid, UDM-mid, and LDM-mid compared with the gold standard. Conclusions: : The cascaded-CNN model may be considered an effective tool for the auto-identification of midline landmarks and quantification of midline deviation in PA cephalograms of adult patients, regardless of variations in the image acquisition method.

Non-covalent bonding interaction of surfactants with functionalized carbon nanotubes in proton exchange membranes for fuel cell applications.

Dispersion of functionalized multiwalled carbon nanotubes (MWCNTs) in proton exchange membranes (PEMs) was conducted via non-covalent bonding between benzene rings of various surfactants and functionalized MWCNTs. In the solution casting method, dispersion of functionalized MWCNTs in PEMs such as Nafion membranes is a critical issue. In this study, 1 wt.% pristine MWCNTs (p-MWCNTs) and oxidized MWCNTs (ox-MWCNTs) were reinforced in Nafion membranes by adding 0.1-0.5 wt.% of a surfactant such as benzalkonium chloride (BKC) as a cationic surfactant with a benzene ring, Tween-80 as a nonanionic surfactant without a benzene ring, sodium dodecylsulfonate (SDS) as an anionic surfactant without a benzene ring, or sodium dodecylben-zenesulfonate (SDBS) as an anionic surfactant with a benzene ring and their effects on the dispersion of nanocomposites were then observed. Among these surfactants, those with benzene rings such as BKC and SDBS produced enhanced dispersion via non-covalent bonding interaction between CNTs and surfactants. Specifically, the surfactants were adsorbed onto the surface of functionalized MWCNTs, where they prevented re-aggregation of MWCNTs in the nanocomposites. Furthermore, the prepared CNTs reinforced nanocomposite membranes showed reduced methanol uptake values while the ion exchange capacity values were maintained. The enhanced properties, including thermal property of the CNTs reinforced PEMs with surfactants, could be applicable to fuel cell applications.

Is second generation metal-on-metal primary total hip arthroplasty with a 28 mm head a worthy option?: a 12- to 18-year follow-up study.

To determine whether MoM THA with a small head is still worthy of use, we investigated survivorship, complications, and factors influencing failure. Of 149 consecutive patients (195 hips), 141 (180 hips) of mean age 43 (19-55) years were available for review at a mean of 14.4 years postoperatively. Survivorship for cup revision for any cause was 97.8% at 18.4 years postoperatively. Nine hips generated complaints of groin pain; six showed periacetabular osteolysis, one had pain without radiological change, and two were diagnosed as symptomatic pseudotumors. Four of six hips with periacetabular osteolysis or aseptic loosening were revised. Surgery- and patient-related factors had no effect in results. Our results are encouraging, however, further study will be necessary to determine the incidence and fates of pseudotumors after MoM THA with a small head.

The prediction of sagittal chin point relapse following two-jaw surgery using machine learning.

The study aimed to identify critical factors associated with the surgical stability of pogonion (Pog) by applying machine learning (ML) to predict relapse following two-jaw orthognathic surgery (2 J-OGJ). The sample set comprised 227 patients (110 males and 117 females, 207 training and 20 test sets). Using lateral cephalograms taken at the initial evaluation (T0), pretreatment (T1), after (T2) 2 J-OGS, and post treatment (T3), 55 linear and angular skeletal and dental surgical movements (T2-T1) were measured. Six ML modes were utilized, including classification and regression trees (CART), conditional inference tree (CTREE), and random forest (RF). The training samples were classified into three groups; highly significant (HS) (≥ 4), significant (S) (≥ 2 and < 4), and insignificant (N), depending on Pog relapse. RF indicated that the most important variable that affected relapse rank prediction was ramus inclination (RI), CTREE and CART revealed that a clockwise rotation of more than 3.7 and 1.8 degrees of RI was a risk factor for HS and S groups, respectively. RF, CTREE, and CART were practical tools for predicting surgical stability. More than 1.8 degrees of CW rotation of the ramus during surgery would lead to significant Pog relapse.

Orthognathic surgical planning using graph CNN with dual embedding module: External validations with multi-hospital datasets.

BACKGROUND AND OBJECTIVE: Despite recent development of AI, prediction of the surgical movement in the maxilla and mandible by OGS might be more difficult than that of tooth movement by orthodontic treatment. To evaluate the prediction accuracy of the surgical movement using pairs of pre-(T0) and post-surgical (T1) lateral cephalograms (lat-ceph) of orthognathic surgery (OGS) patients and dual embedding module-graph convolution neural network (DEM-GCNN) model. METHODS: 599 pairs from 3 institutions were used as training, internal validation, and internal test sets and 201 pairs from other 6 institutions were used as external test set. DEM-GCNN model (IEM, learning the lat-ceph images; LTEM, learning the landmarks) was developed to predict the amount and direction of surgical movement of ANS and PNS in the maxilla and B-point and Md1crown in the mandible. The distance between T1 landmark coordinates actually moved by OGS (ground truth) and predicted by DEM-GCNN model and pre-existed CNN-based Model-C (learning the lat-ceph images) was compared. RESULTS: In both internal and external tests, DEM-GCNN did not exhibit significant difference from ground truth in all landmarks (ANS, PNS, B-point, Md1crown, all P > 0.05). When the accumulated successful detection rate for each landmark was compared, DEM-GCNN showed higher values than Model-C in both the internal and external tests. In violin plots exhibiting the error distribution of the prediction results, both internal and external tests showed that DEM-GCNN had significant performance improvement in PNS, ANS, B-point, Md1crown than Model-C. DEM-GCNN showed significantly lower prediction error values than Model-C (one-jaw surgery, B-point, Md1crown, all P < 0.005; two-jaw surgery, PNS, ANS, all P < 0.05; B point, Md1crown, all P < 0.005). CONCLUSION: We developed a robust OGS planning model with maximized generalizability despite diverse qualities of lat-cephs from 9 institutions.