Agreement test of P value versus Bayes factor for sample means comparison: analysis of articles from the Angle Orthodontist journal.

BACKGROUND: Researchers are cautioned against misinterpreting the conventional P value, especially while implementing the popular t test. Therefore, this study evaluated the agreement between the P value and Bayes factor (BF01) results obtained from a comparison of sample means in published orthodontic articles. METHODS: Data pooling was undertaken using the modified PRISMA flow diagram. Per the inclusion criteria applied to The Angle Orthodontist journal for a two-year period (November 2016 to September 2018), all articles that utilised the t test for statistical analysis were selected. The agreement was evaluated between the P value and Bayes factor set at 0.05 and 1, respectively. The percentage of agreement and Kappa coefficient were calculated. Plotting of effect size against P value and BF01 was analysed. RESULTS: From 265 articles, 82 utilised the t test. Of these, only 37 articles met the inclusion criteria. The study identified 793 justifiable t tests (438 independent-sample and 355 dependent-sample t tests) for which the agreement percentage and Kappa coefficient were found to be 93.57% and 0.87, respectively. However, when anecdotal evidence (1/3 < BF01 < 3) was considered, almost half of the studies missed statistical significance. Furthermore, two-thirds of the significantly reported P values (0.01 < P < 0.05; 30 independent-sample and 20 dependent-sample t tests) showed only anecdotal evidence (1/3 < BF01 < 1). Moreover, BF01 indicated moderate evidence (BF01 > 3) for approximately one-third of the total studies, with nonsignificant P values (P > 0.05). Furthermore, accompanying the P values, the effect sizes, especially for studies with independent-sample t tests, were very high with a strong potential to show substantive significance. Although it is best to extend the statistical calculation of a doubted P value (just below 0.05), especially for orthodontic innovation, orthodontists may reach a balanced decision relying on cephalometric measurements. CONCLUSIONS: The Kappa coefficient indicated perfect agreement between the two methods. BF01 restricted this judgement to approximately half of them, with two-thirds of these studies showing nonsignificant P values. Simple extensions of statistical calculations, especially effect size and BF01, can be useful and should be considered when finalising statistical analyses, especially for orthodontic studies without cephalometric analysis.

Agreement of the Newly Developed Moyers' Equations and Moyers' Tables.

OBJECTIVE: This study aimed to develop the Moyers' prediction equation to be used with tooth widths predicting app on smartphone. MATERIALS AND METHODS: Four equations were developed separately for sex and dental arches. Internal validation with Moyers' table was finished. External validation on 37 subjects with agreement test of both Moyers' prediction equations and Moyers' prediction tables was performed. STATISTICAL ANALYSIS: A general linear model procedure was used to create four prediction equations. Internal validation was evaluated using the coefficient of determination. External validation was performed using Bland and Altman (BA) test. RESULTS: Four equations were developed for OrthoAnalysis app on smartphone. The overall coefficient of determination of all equations and prediction table was 0.998 (p < 0.05) indicating good agreement of the two methods. The agreement test on the 37 subjects was that the BA test revealed the BA limits of agreement between the residuals of two predictions was -0.001 mm and ranged from -0.143 to 0.140 mm with almost all plots lying inside this difference interval. CONCLUSIONS: In summary, four novel estimation equations were developed and showed very low difference to the well accepted original Moyers' prediction tables. Therefore, the equations used in the orthodontic app for predicting unerupted tooth width were verified and valid for clinical use.

Preferences and Satisfaction Toward an Orthodontic Clinical App.

OBJECTIVES: To promote the development of professional orthodontic apps and to grow app engagement, many contributing factors should first be scrutinized. The main purpose of this research was to assess whether gap analysis facilitates strategic app design. MATERIALS AND METHODS: Gap analysis was first conducted to reveal users' preferences. Then, the OrthoAnalysis app was developed on an Android operating system using Java programming language. Finally, a self-administered survey was issued to 128 orthodontic specialists to assess their satisfaction toward usage of the app. STATISTICAL ANALYSIS: The content validity of the questionnaire was ascertained using an index of Item-Objective Congruence of more than 0.5. The reliability of the questionnaire was also analyzed with Cronbach's Alpha reliability coefficient (ɑ = 0.87). RESULTS: Besides the most important factor, "content," many issues were listed, and all were required to engage users. A strong and engaging app should show accurate, trustworthy, and practical clinical analysis that operates smoothly and fast with ease, along with a user-friendly, appealing, and trustworthy interface. In short, because of the preliminary gap analysis that was done to evaluate the potential app engagement power prior to app design, the result of the satisfaction assessment showed that nine traits including overall satisfaction were of high levels. CONCLUSIONS: Orthodontic specialists' preferences were assessed using gap analysis and an orthodontic app was designed and appraised. This article presents the orthodontic specialists' preferences and summarizes the process of achieving app satisfaction. Therefore, to create a clinical app with strong engagement power, a strategic initial plan using gap analysis can be recommended.

Computerized three-dimensional cephalometric template for Thai adults.

Cephalometry is essential in several fields of study. These include health science, anthropology, and forensic studies. Furthermore, cephalometric norms are essential for numerous disciplines in the health sciences, such as clinical anatomy, plastic surgery, pediatrics, pediatric dentistry, orthodontics, oral and maxillofacial surgery, and forensic medicine. Three-dimensional (3D) cephalometric templates offer an advanced but simple method for these specialties. This study aimed to establish cephalometric norms by developing 3D templates for Thai adults, based on cephalometric landmark coordinates obtained from skull cone-beam computed tomography (CBCT) scans of individuals with normal skeletal patterns. Full-head CBCT scans of 45 individuals (20 men and 25 women) were obtained from the archive. All had a Class I molar relationship with minor crowded teeth. The scans were captured in a normal head position, and the coordinates of 21 important cephalometric landmarks were identified using Slicer 4.10.2 software. Manual affine transformation of all landmarks was used to transfer medical image coordinates (Digital Imaging and Communications in Medicine [DICOM] or Right-Anterior-Superior [RAS] systems) to Cartesian universal coordinates. Intraclass correlation coefficients (ICC) and Bland-Altman (BA) plots were used to assess inter- and intra-examiner reliability (ICC = 0.961-1.000, BA mean errors = -0.1 mm). Important cephalometric measurements were compared to the most relevant and recent study with a sample size of 200. Most measurements showed no statistical difference (one-sample t-test, p > 0.05). Independent samples t-tests revealed that there was no statistically significant difference in the X and Y axes; however, most mean coordinates between men and women in the Z-axis coordinates were statistically significant. Consequently, 3D cephalometric templates were generated separately for adult Thai men and women using landmark coordinates. Although they are available for all disciplines at no cost through QR codes, these templates should be used with care, especially for the upper and lower incisor angulation. The application and future development of each specialty are also described here.

Xerostomia, hyposalivation and oral microbiota in patients using antihypertensive medications.

OBJECTIVE: Oral dryness can contribute to several diseases in the oral cavity. The objective of the present study was to compare the subjective oral dryness, salivary flow rates, the number of oral microbiota, and the dental status between medicated hypertensive patients and control subjects. MATERIAL AND METHOD: Four hundred subjects including 200 ambulatory hypertensive patients who were taking antihypertensive medications and 200 control subjects were included. Each subject's medical history was reviewed. The subject's oral health status, salivary flow rate, and the number of oral microbiota were also evaluated. RESULTS: The prevalence rate of xerostomia in the medicated hypertensive group was 50% whereas only 25.5% of the control group had xerostomia (p < 0.05). Using modified Schirmer test (MST), the mean unstimulated salivary flow rate of the medicated hypertensive group (23.11 +/- 6.08 mm/3 min) was significantly lower than that of the control group (31.30 +/- 3.36 mm/3 min) (p < 0.05). In addition, the mean stimulated salivary flow rate of the medicated hypertensive group (0.73 +/- 0.30 ml/min) was also significantly lower than that of the control group (1.31 +/- 0.34 mi/min) (p < 0.05). The strongest associated factor for dry mouth was the use of antihypertensive medications (OR = 6.28). The mean levels of mutans streptococci, Lactobacilli spp. and Candida spp. in the medicated hypertensive group were significantly higher than in the control group (p < 0.05). Furthermore, medicated hypertensive patients were more likely to have missing teeth compared to control subjects. CONCLUSION: Xerostomia, hyposalivation, and increasing number of oral microbiota were more prevalent in hypertensive patients taking antihypertensive medications.

Effectiveness of miniscrew assisted rapid palatal expansion using cone beam computed tomography: A systematic review and meta-analysis.

Objective: This study aims to examine the effectiveness of miniscrew assisted rapid palatal expansion (MARPE) treatment in late adolescents and adult patients using cone-beam computed tomography (CBCT). Methods: Literature search was conducted in five electronic databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) based on the PICOS keyword design focusing on MARPE. Out of the 18 CBCT screened outcomes, only nine parameters were sufficient for the quantitative meta-analysis. The parameters were classified into three main groups: 1) skeletal changes, 2) alveolar change, and 3) dental changes. Heterogeneity test, estimation of pooled means, publication bias, sensitivity analysis and risk of bias assessment were also performed. Results: Upon database searching, only 14 full-text articles were qualified from the 364 obtained results. Heterogeneity test indicated the use of the random-effects model. The pooled mean estimate were as follows: 1) Skeletal expansion: zygomatic width, 2.39 mm; nasal width, 2.68 mm; jugular width, 3.12 mm; and midpalatal suture at the posterior nasal spine and anterior nasal spine, 3.34 mm and 4.56 mm, respectively; 2) Alveolar molar width expansion, 4.80 mm; and 3) Dental expansion: inter-canine width, 3.96 mm; inter-premolar width, 4.99 mm and inter-molar width, 5.99 mm. The percentage of expansion demonstrated a skeletal expansion (PNS) of 55.76%, alveolar molar width expansion of 24.37% and dental expansion of 19.87%. Conclusions: In the coronal view, the skeletal and dental expansion created by MARPE was of the pyramidal pattern. MARPE could successfully expand the constricted maxilla in late adolescents and adult patients.

Accidental Swallowing of Dental Objects During Pediatric Dental Care in Thailand.

AIM: Accidental swallowing of dental objects can occur at any time during dental treatment, especially in child patients. Its severity and sequelae can range from minor to life-threatening. The study aimed to find out the occurrence of accidental swallowing and type of swallowed objects regarding pediatric dental treatment in Thailand. MATERIALS AND METHODS: A nationwide questionnaire survey was performed among Thai dentists to anonymously report child patients' accidental swallowing throughout their working experience for up to 10 years. Percentage and frequencies of accidental swallowing in child patients, as well as types of dental objects swallowed, were investigated. Association between factors of the respondents and their experiences was assessed by the logistic regression analysis. RESULTS: Among 408 respondents, 99 respondents [24.26%, 95% confidence interval (CI): 20.10-28.42] had experienced accidental swallowing during pediatric dental treatment. All of them reported ingestion with only one respondent reporting aspiration. Extracted teeth, stainless steel crowns, and rubber cups were top on the list of swallowed items experienced by 11.52%, 8.33%, and 3.92% of respondents, respectively. Dental sharps such as endodontic files and orthodontic wires were reported as well. Dentists with higher educational backgrounds, mostly exposed to more complicated cases, were more likely to experience accidental swallowing (odds ratio of 2.90, 95% CI: 1.61-5.21). CONCLUSION: Our results indicate that accidental swallowing in child patients appeared to occur more frequently than anticipated. Awareness on patient safety of dental professionals and preventive measures against accidental swallowing when dealing with child patients should be greatly emphasized.

Comprehensive intermaxillary tooth width proportion of Bangkok residents.

Proper occlusion depends on the correct width ratio between upper and lower teeth, known as Bolton's ratio. In fact, this ratio can be calculated for each pair of teeth from the central incisor to the first permanent molar. This set of ratios, known as comprehensive cumulative percentage ratios (CPRs), can be used not only to determine which tooth or teeth have a tooth width discrepancy, but can also enable the partial graphical analysis of tooth width discrepancy when there is agenesis of certain permanent teeth. Although CPRs have been calculated for Caucasians, tooth width is known to vary depending on racial origin. Therefore, a test of differences between racial groups should be carried out. If these ratios of the Caucasians and Bangkokians are significantly different, the ratio of the Bangkokians is recommended. The objective of this study was to measure tooth size disproportion for Thai patients and to calculate a corresponding set of CPRs. Thirty-seven pairs of dental models were made from a group of Bangkok residents with normal occlusion. Mesiodistal tooth width was measured for each model. The intra- and inter-examiner measurement errors were ascertained as insignificant (p > 0.05). CPRs were then calculated and compared to those derived from other studies. Ten of thirteen CPRs were significantly different from corresponding values derived from Caucasians. We conclude that tooth width ratios vary between different racial groups, and therefore that these should be calculated specifically for each patient racial group.

Comprehensive intermaxillary tooth width proportion of Bangkok residents

Proper occlusion depends on the correct width ratio between upper and lower teeth, known as Bolton's ratio. In fact, this ratio can be calculated for each pair of teeth from the central incisor to the first permanent molar. This set of ratios, known as comprehensive cumulative percentage ratios (CPRs), can be used not only to determine which tooth or teeth have a tooth width discrepancy, but can also enable the partial graphical analysis of tooth width discrepancy when there is agenesis of certain permanent teeth. Although CPRs have been calculated for Caucasians, tooth width is known to vary depending on racial origin. Therefore, a test of differences between racial groups should be carried out. If these ratios of the Caucasians and Bangkokians are significantly different, the ratio of the Bangkokians is recommended. The objective of this study was to measure tooth size disproportion for Thai patients and to calculate a corresponding set of CPRs. Thirty-seven pairs of dental models were made from a group of Bangkok residents with normal occlusion. Mesiodistal tooth width was measured for each model. The intra- and inter-examiner measurement errors were ascertained as insignificant (p > 0.05). CPRs were then calculated and compared to those derived from other studies. Ten of thirteen CPRs were significantly different from corresponding values derived from Caucasians. We conclude that tooth width ratios vary between different racial groups, and therefore that these should be calculated specifically for each patient racial group.