Clinical evaluation of Artificial Intelligence Driven Remote Monitoring technology for assessment of patient oral hygiene during orthodontic treatment.

INTRODUCTION: This study aimed to clinically evaluate the accuracy of Dental Monitoring's (DM) artificial intelligence (AI) image analysis and oral hygiene notification algorithm in identifying oral hygiene and mucogingival conditions. METHODS: Twenty-four patients seeking orthodontic therapy were monitored by DM oral hygiene protocol during their orthodontic treatment. During the bonding appointment and at each of 10 subsequent adjustment visits, a total of 232 clinical oral examinations were performed to assess the presence of the 3 oral hygiene parameters that DM monitors. In each clinical timepoint, the subjects took an oral DM scan and received a notification regarding their current oral status at that moment in time. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate AI and clinical assessment of plaque, gingivitis, and recession. RESULTS: A total of 232 clinical time points have been evaluated clinically and by the DM AI algorithm. For DM's AI detection of plaque and calculus, gingivitis, and recession, the sensitivity was 0.53, 0.35, and 0.22; the specificity was 0.94, 0.96, and 0.99; and the accuracy was 0.60, 0.49, and 0.72, respectively. CONCLUSIONS: DM's oral hygiene notification algorithm has low sensitivity, high specificity, and moderate accuracy. This indicates a tendency of DM to underreport the presence of plaque, gingivitis, and recession.

Comparison of light transmittance and color changes between polyurethane and copolyester retainer materials after staining and destaining.

BACKGROUND: Retainers are the only effective approach to prevent orthodontic relapse. The aim of this study was to compare the changes in color and light-transmittance of rough and smooth thermoformed polyurethane and copolymer retainer samples after staining in different solutions and destaining with different approaches. METHODS: Four hundred copolyester (Essix® ACE) and 400 polyurethane (Zendura®) samples with different surface textures, smooth and rough, were stained in 4 different solutions (n = 100 per solution) over 28 days. Each of the four groups of 100 stained samples of each material was subdivided into 5 groups of 20 samples and subjected to different destaining solutions. Light transmittance and color changes were evaluated using a spectrometer and a spectrophotometer. Mean differences were compared using a two-way analysis of variance (ANOVA) and posthoc multiple comparison tests at P = 0.05. RESULTS: No significant differences in light transmittance were found between both untreated materials. Both materials were stained in a similar fashion and showed no significant differences between two materials after staining. Coffee and tea stained both materials more significantly than wine, but there was a significant difference of changes of color and light transmittance between rough and smooth surfaces during the destaining in coffee- and tea-stained samples of copolyester material. All destaining solutions were effective at removing all stains on the samples. The surface roughness of the material plays a significant role in the ability of the materials to be destained, demonstrating a more significant greater effect on cleaning rough samples for improvements in light-transmittance and greater changes in color. CONCLUSIONS: This study concluded that the surface of materials plays a significant role in the material destaining and staining. In addition, the different polymers used for retainer fabrication exhibited different responses during the destaining process depending on types of stains.

Effectiveness of AI-driven remote monitoring technology in improving oral hygiene during orthodontic treatment.

OBJECTIVE: This study aimed to evaluate the effectiveness of Dental Monitoring™ (DM™) Artificial Intelligence Driven Remote Monitoring Technology (AIDRM) technology in improving the patient's oral hygiene during orthodontic treatment through AI-based personalized active notifications. METHODS: A prospective clinical study was conducted on two groups of orthodontic patients. DM Group: (n = 24) monitored by DM weekly scans and received personalized notifications on the DM smartphone application regarding their oral hygiene status. Control Group (n = 25) not monitored by DM. Both groups were clinically assessed using Plaque Index (OPI) and the Modified Gingival Index (MGI). DM Group was followed for 13 months and the Control Group was followed for 5 months. Student-independent t test and paired t tests were used to investigate the mean differences between study groups and between time points for each group respectively. RESULTS: At all time points, the mean differences indicated that the DM group had lower OPI and MGI values than the control group. The mean value for OPI and MGI were statistically significantly lower in the DM group (OPI = 1.96, MGI = 1.56) than in the control group (OPI = 2.41, MGI = 2.17) after 5 months. A rapid increase in mean OPI and MGI values was found between T0 and T1 for both study groups. A plateau effect for OPI scores appeared to occur from T1 to T5 for both study groups, but the plateau effect seemed to be more pronounced for the DM group than the study group. The MGI values for both study groups also increased dramatically from baseline to T5, however, a plateau effect was not observed. CONCLUSIONS: The oral hygiene of orthodontic patients rapidly worsens over the first 3 months and plateaus after about 5 months of treatment. AIDRM by weekly DM scans and personalized active notifications may improve oral hygiene over time in orthodontic patients.

Cone-beam computed tomography assessment of maxillary anterior alveolar bone remodelling in extraction and non-extraction orthodontic cases using stable extra-alveolar reference.

OBJECTIVE: To explore alveolar cortical positional change in response to tooth movement in extraction and non-extraction orthodontic cases, using cone-beam computed tomography (CBCT) and stable extra-alveolar references. MATERIALS AND METHODS: The pre-treatment (T1) and post-treatment (T2) CBCT scans of 25 extraction (EXT) and matched 25 non-extraction (Non-EXT) orthodontic cases were imported into Dolphin Imaging 3D, and oriented uniformly. Sagittal and axial CBCT cross-sections were traced using customized software-generated guides. The displacement of teeth and alveolar bone cortices were automatically measured using the palatal plane (PP) and the line perpendicular to PP and passing Sella as reference. Intra- and inter-group differences between T1 and T2 were analysed. Subjects were also superimposed three-dimensionally using Geomagic Control X for qualitative analysis of cortical remodelling. RESULTS: The EXT group showed incisor retraction, while the Non-EXT group exhibited statistically significant incisor anterior tipping (P < .05). In EXT, both the labial and palatal cortices are resorbed. Non-EXT showed labial cortex anterior modelling, and statistically significant palatal cortex resorption (P < .05). In both groups, statistically significant decrease in total and palatal alveolar widths, increase in labial widths, and palatal dehiscence were observed. Comparatively, EXT showed significantly more incisal total and palatal width decrease and palatal vertical bone loss. CONCLUSION: Labial cortical remodelling was shown to follow anterior tooth movement, but the palatal cortical response to incisor retraction and labial cortical remodelling in general remained inconclusive. Narrowing of the alveolar housing and palatal dehiscence were observed regardless of extraction following orthodontic treatment.

Novel Machine Learning Algorithms for Prediction of Treatment Decisions in Adult Patients With Class III Malocclusion.

BACKGROUND: Management of Class III (Cl III) dentoskeletal phenotype is often expert-driven. PURPOSE: The aim is to identify critical morphological features in postcircumpubertal Cl III treatment and appraise the predictive ability of innovative machine learning (ML) algorithms for adult Cl III malocclusion treatment planning. STUDY DESIGN: The Orthodontics Department at the University of Illinois Chicago undertook a retrospective cross-sectional study analyzing Cl III malocclusion cases (2003-2020) through dental records and pretreatment lateral cephalograms. PREDICTOR: Forty features were identified through a literature review and gathered from pretreatment records, serving as ML model inputs. Eight ML models were trained to predict the best treatment for adult Cl III malocclusion. OUTCOME VARIABLE: Predictive accuracy, sensitivity, and specificity of the models, along with the highest-contributing features, were evaluated for performance assessment. COVARIATES: Demographic covariates, including age, gender, race, and ethnicity, were assessed. Inclusion criteria targeted patients with cervical vertebral maturation stage 4 or above. Operative covariates such as tooth extraction and types of orthognathic surgical maneuvers were also analyzed. ANALYSES: Demographic characteristics of the camouflage and surgical study groups were described statistically. Shapiro-Wilk Normality test was employed to check data distribution. Differences in means between groups were evaluated using parametric and nonparametric independent sample tests, with statistical significance set at <0.05. RESULTS: The study involved 182 participants; 65 underwent camouflage mechanotherapy, and 117 received orthognathic surgery. No statistical differences were found in demographic characteristics between the two groups (P > .05). Extreme values of pretreatment parameters suggested a surgical approach. Artificial neural network algorithms predicted treatment approach with 91% accuracy, while the Extreme Gradient Boosting model achieved 93% accuracy after recursive feature elimination optimization. The Extreme Gradient Boosting model highlighted Wit's appraisal, anterior overjet, and Mx/Md ratio as key predictors. CONCLUSIONS: The research identified significant cephalometric differences between Cl III adults requiring orthodontic camouflage or surgery. A 93% accurate artificial intelligence model was formulated based on these insights, highlighting the potential role of artificial intelligence and ML as adjunct tools in orthodontic diagnosis and treatment planning. This may assist in minimizing clinician subjectivity in borderline cases.

In-vivo evaluation of Artificial Intelligence Driven Remote Monitoring technology for tracking tooth movement and reconstruction of 3-dimensional digital models during orthodontic treatment.

INTRODUCTION: An in-vivo evaluation of the Dental Monitoring (DM; Paris, France) Artificial Intelligence Driven Remote Monitoring technology was conducted in an active clinical setting. Our objectives were to compare the accuracy and validity of the 3-dimensional (3D) digital models remotely generated from the DM application to 3D Digital Models generated from the iTero Element 5D intraoral scanner (Align Technologies, San Jose, Calif) of patients' dentition during in-vivo fixed orthodontic treatment. METHODS: The orthodontic treatment of 24 patients (aged 14-55 years) was tracked across an average of 13.4 months. Scans of the maxillary and mandibular arches of each patient were taken by an iTero intraoral scanner and with the DM application before treatment initiation without (T0) and with (T1) the fixed orthodontic appliances and at every in-person adjustment appointment (T2-T10). The global deviation between the reconstructed digital models from the DM and iTero scans was compared at each time point using Geomagic Control-X 2020 (3D Systems, Rock Hill, SC). Descriptive analysis was conducted to determine the mean deviation at each time point for the maxillary and mandibular arches, to compare the maxilla and mandible mean deviations at each time point to the null hypothesis mean of 0 mm and the paired mean of the average at each time point between the maxilla and mandible. RESULTS: The findings revealed no clinically significant difference between the reconstructed digital models generated by the iTero IOS and the remotely reconstructed digital dental models generated by the DM application. CONCLUSION: DM artificial intelligence tracking algorithm can track tooth movement and reconstruct 3D digital models to a clinically acceptable degree for orthodontic application.

COVID-19 infection rates and mitigation strategies in orthodontic practices.

BACKGROUND: COVID-19 has impacted and increased risks for all populations, including orthodontic patients and providers. It also changes the practice management and infection control landscape in the practices. This study aimed to investigate the COVID-19 infection and vaccination status of orthodontic providers and mitigation approaches in orthodontic practices in the United States during 2021. METHODS: A validated 50-question research electronic data capture (REDCap) browser-based questionnaire was distributed to 12,393 orthodontists and pediatric dentists who reported actively providing orthodontic treatment. Questions were designed to collect demographic data of respondents, evaluate the COVID-19 mitigation approaches, and evaluate the history of COVID-19 infection and vaccination status of the orthodontic providers. Associations of demographic and the COVID-19 mitigation approaches were assessed using chi-square tests at the significance level of 0.05. RESULTS: Four hundred fifty-seven returned the survey (response rate 3.69%) for analysis. Most respondents were vaccinated, and increased infection control measures in response to the pandemic. Half of the respondents practiced teledentistry and switched to digital impression systems. Two-thirds reported difficulties in attaining PPEs due to the increased cost and scarcity of PPEs. About 6% of respondents reported a history of COVID-19 infection, and 68.9% of their staff had COVID-19 infection. Statistically significant associations were found between increased practice experience with difficulties in acquiring PPE (p = .010). There were no significant associations between races of respondents, geographic location, and years of practicing when cross-tabulated with vaccination status or COVID-19 infection rate (p > .05). CONCLUSION: Increased infection control strategies were employed in almost all orthodontic practices in addition to existing universal precaution. Most of the orthodontic providers and their staff members were vaccinated. While staff's infection rates were an issue, doctors' infection rates remained low.

The use of teleorthodontics during the COVID-19 pandemic and beyond - perspectives of patients and providers.

BACKGROUND: The COVID-19 pandemic significantly impacted dental services, resulting in reduced staff availability, limited appointments, and some dental clinics even being forced to close their doors. Despite these challenges, the need for dental consultants remained present, particularly in emergency situations. One area of orthodontics that had seen a surge in demand during the pandemic is Teleorthodontics. With the help of Teleorthodontics, orthodontic consultations, assessments, and even treatment monitoring could be conducted remotely, making it a safe and convenient option for patients during those challenging times. AIM: This survey aimed to evaluate the acceptance of patients and their orthodontists on the use of different modes of communication through Teleorthodontics during the COVID-19 pandemic and their willingness to continue using this in the future. METHODS: An online survey instrument in Qualtrics was distributed to orthodontic patients at the University of Illinois, Chicago. The survey was available on a rolling basis for up to 6 months. A total number of 364 partients voluntarily participated in the survey. The Faculty and Residents were also asked to participate in a survey through recruitment via their UIC email addresses. RESULTS: According to our survey, both patients and providers showed acceptance of Teleorthodontics and have used it in different forms during orthodontic treatment. The application is easy-to-use, convenient, and not at all time-consuming. Overall satisfaction with using this application was recorded at 92%, with 66% of patients stating that it saved them time by eliminating the need to travel to the orthodontic clinic. 30% of providers found that the interaction with patients using Teleorthodontics was a positive experience and would recommend it in future. CONCLUSION: Teleorthodontics has shown great potential, particularly in follow-up cases, and holds promise as a valuable tool for online remote dental consultations in the future.

Bimaxillary transverse constriction in adults: Short-term follow-up of non-surgical arch expansion.

OBJECTIVE: Concurrent maxillary and mandibular expansion is a treatment option for patients with maxillary and mandibular transverse constriction. These patients do not present with crossbite but require expansion due to narrow arches and associated crowding, dark buccal corridors and decreased anterior arch contour. The objective of the study is to first establish Bimaxillary Transverse Constriction as an under-recognized malocclusion and second to evaluate whether in adults the maxillary and mandibular arches can be successfully and safely expanded. SETTING AND SAMPLE POPULATION: Pre- and post-treatment study models and lateral cephalograms of 31 adults with Bimaxillary Transverse Constriction expanded non-surgically were analysed. Thirty adult orthodontic patients who did not require expansion served as a control. Expanders were turned no more frequently than every other day in the maxilla and every third day in the mandible. MATERIALS AND METHODS: Measurements in both arches made on OrthoCAD models were transarch widths, molar and premolar axial angulation, clinical crown height of posterior teeth and cuspids, and mandibular divergence. Retrospective comparison of the 2 groups used independent Student's t tests for mean differences between groups. RESULTS: At pre-treatment, the expansion group demonstrated significant transverse constriction compared with the control. Increased widths were achieved in the expansion group (4 mm in the maxilla and 2.5 mm in the mandible), while the control group was unchanged. The mandibular plane was unchanged. There was no buccal attachment loss. CONCLUSION: Non-surgical expansion in the maxilla and mandible is a viable treatment option for adult patients with Bimaxillary Transverse Constriction.

Accuracy of Dental Monitoring 3D digital dental models using photograph and video mode.

INTRODUCTION: This study aimed to test the accuracy of the 3-dimensional (3D) digital dental models generated by the Dental Monitoring (DM) smartphone application in both photograph and video modes over successive DM examinations in comparison with 3D digital dental models generated by the iTero Element intraoral scanner. METHODS: Ten typodonts with setups of class I malocclusion and comparable severity of anterior crowding were used in the study. iTero Element scans along with DM examination in photograph and video modes were performed before tooth movement and after each set of 10 Invisalign aligners for each typodont. Stereolithography (STL) files generated from the DM examinations in photograph and video modes were superimposed with the STL files from the iTero scans using GOM Inspect software to determine the accuracy of both photograph and video modes of DM technology. RESULTS: No clinically significant differences, according to the American Board of Orthodontics-determined standards, were found. Mean global deviations for the maxillary arch ranged from 0.00149 to 0.02756 mm in photograph mode and from 0.0148 to 0.0256 mm in video mode. Mean global deviations for the mandibular arch ranged from 0.0164 to 0.0275 mm in photograph mode and from 0.0150 to 0.0264 mm in video mode. Statistically significant differences were found between the 3D models generated by the iTero and the DM application in photograph and video modes over successive DM examinations. CONCLUSIONS: 3D digital dental models generated by the DM smartphone application in photograph and video modes are accurate enough to be used for clinical applications.

Effects of unilateral premolar extraction treatment on the dental arch forms of Class II subdivision malocclusions.

INTRODUCTION: A retrospective study evaluating posttreatment symmetry in dental arch form and midlines was carried out in Class II subdivision patients treated with unilateral and bilateral maxillary premolar extractions. METHODS: Using Geomagic (version 14; Geomagic, Research Triangle Park, NC) and MATLAB (version 8.4; MathWorks, Natick, Mass) software, best-fit curves expressed as quartic polynomials were generated for 13 Class II subdivisions treated with unilateral extractions and 20 treated with bilateral maxillary premolar extractions. Transverse and sagittal measurements were recorded to assess symmetry. Dental models were superimposed on constructed reference planes to generate average posttreatment arches. Statistical comparisons were performed with the significance level set at P ≤0.05. RESULTS: The unilateral extraction group showed significant differences in transverse arch forms between the right and left sides in the anterior, anterior-middle, and middle segments of the arch, and all regions other than the posterior segment in the sagittal dimension. Significant differences were found between groups in the anterior and anterior-middle segments of the arch transversely, the middle and middle-posterior segments sagittally, and the midline deviation relative to the midsagittal plane. Superimposed average arches showed similar results. CONCLUSIONS: Unilateral maxillary extraction treatment generally results in a narrower and more posteriorly displaced arch form on the extraction side, with a deviated maxillary midline toward the extraction side of the arch.

Secular trends in the timing of skeletal maturation as assessed by the cervical vertebrae maturation method.

Objective: To investigate the presence of secular trends in skeletal maturation of girls and boys as assessed by the use of cervical vertebrae bones. Materials and methods: The study compared two main groups: the first included data collected from the Denver growth study (1930s to 1960s) and the second included data collected from recent pretreatment records (1980s to 2010s) of patients from the orthodontic clinic of a North American University. The records from the two groups were all for Caucasian subjects. The sample for each group included 78 lateral cephalographs for girls and the same number for boys. The age of the subjects ranged from 7 to 18 years. Cervical vertebrae maturation (CVM) stages were directly assessed from the radiographs according to the method described by Hassel and Farman in which six CVM stages were designated from cervical vertebrae 2, 3, and 4. Results: The mean age of girls from the Denver growth study and girls from the university clinic in each of the six CVM stages was not different at P ≤0.05. However, the mean age of boys from the two groups was not different only in stage 3 (P = 0.139) and stage 4 (P = 0.211). Conclusions: The results showed no evidence to indicate a tendency for earlier skeletal maturation of girls or boys. Boys in the university group started their skeletal maturation later than boys in the Denver group and completed their maturation earlier. Gender was a significant factor affecting skeletal maturation stages in both Denver and university groups.

Assessing Collagen and Micro-permeability at the Proanthocyanidin-treated Resin-Dentin Interface.

PURPOSE: To establish a fluorescence-based method to simultaneously assess micro-permeability and collagen cross-linking induced by chemical agents at the resin-dentin interface. MATERIALS AND METHODS: Three chemical agents were investigated (proanthocyanidin-rich grape seed extract: GSE; carbodiimide hydrochloride/N-hydroxysuccinimide: EDC/NHS; glutaraldehyde: GD) along with a control (distilled water) as primers applied on flat occlusal dentin surfaces of 48 teeth and restored with two commercially available etch-and-rinse adhesives. Resin-dentin interfaces were polished and infiltrated with rhodamine-B solution for confocal laser scanning microscopy analysis. Parameters were chosen that would allow acquisition of a simultaneous appearance of collagen and interfacial micro-permeability (rhodamine-B). Fluorescence emission intensity (FEI) was converted into numerals and values were calculated for each group. Data were statistically analyzed using one-way ANOVA and post-hoc Scheffe's and multiple comparisons tests (α = 0.05). T-tests with Pearson correlations were used to investigate correlations between collagen cross-linking and micro-permeability. RESULTS: The FEI of collagen was the highest for GD, followed by GSE, with no significant differences between EDC/ NHS and the control group (p > 0.05). Micro-permeability was significantly affected by the adhesives (p < 0.05). Micro- permeability was the lowest for GSE groups, regardless of the adhesives (p < 0.001). Weak correlations were found between micro-permeability and collagen auto-fluorescence. CONCLUSIONS: Non-enzymatic collagen cross-linking induced by GSE and GD can be detected by increased collagen auto-fluorescence, and results in reduced interfacial micro-permeability. Increased collagen auto-fluorescence was correlated with fluorescent collagen cross-links and decreased micro-permeability at the resin-dentin interface. Collagen auto-fluorescence is a useful tool to detect auto-fluorescent exogenous cross links and their potential impact on the quality of the resin-dentin interface.

Demineralization of resin-sealed enamel by soft drinks in a clinically relevant pH cycling model.

PURPOSE: To compare the in vitro protective effect of orthodontic sealants on the enamel demineralization under a soft drink-induced erosive challenge. METHODS: The facial surfaces of bovine incisors were sectioned into 5 mm x 4 mm x 4 mm enamel blocks. Specimens were randomly assigned to three surface protection measures: control (exposed enamel), coating with Transbond XT (unfilled resin primer), or coating with Opal Seal (filled and fluoride releasing primer). Thermocycling was used to simulate aging. The specimens were pH cycled through an acidic buffer, test beverage and a neutral buffer for a total of 7 days. Test beverages included water, Diet Mountain Dew, and Coke Classic. Quantitative light-induced fluorescence (QLF) images were taken at baseline and after aging. Final QLF images were taken to evaluate the demineralization of enamel. Data were analyzed statistically using a two-way ANOVA to compare the interaction between enamel surface protection and beverages as well as one-way ANOVA to compare surface protection and the test beverage levels. RESULTS: A statistically significant interaction was found between the surface protected groups and the test beverage groups (P < 0.05). Statistically significant differences were found among the test beverage groups (P < 0.05) and among the surface protection groups (P < 0.05). Coke Classic went through the sealant layer resulting in high enamel demineralization. Enamel coating with Opal Seal significantly reduced the erosive attack of beverages.

Site specific properties of carious dentin matrices biomodified with collagen cross-linkers.

PURPOSE: To assess in non-cavitated carious teeth the mechanical properties of dentin matrix by measuring its reduced modulus of elasticity and the effect of dentin biomodification strategies on three dentin matrix zones: caries-affected, apparently normal dentin below caries-affected zone and sound dentin far from carious site. METHODS: Nano-indentations were performed on dentin matrices of carious molars before and after surface modification using known cross-linking agents (glutaraldehyde, proanthocyanidins from grape seed extract and carbodiimide). RESULTS: Statistically significant differences were observed between dentin zones of demineralized dentin prior to surface biomodification (P < 0.05). Following surface modification, there were no statistically significant differences between dentin zones (P < 0.05). An average increase of 30-fold, 2-fold and 2.2-fold of the reduced modulus of elasticity was observed following treatments of the three dentin zones with proanthocyanidin, carbodiimide and glutaraldehyde, respectively.

Positivity rates of SAR-CoV-2 infection in orthodontic patients at the orthodontic clinic, University of Illinois Chicago.

COVID-19 has impacted and increased risks for healthcare providers, including orthodontists. There is no information regarding the potential transmission risks in the orthodontic community. This study aims to compare the positivity rate of SARS-CoV-2 infection in orthodontic patients at the University of Illinois Chicago (UIC) orthodontic clinic to the positivity rate of the local population in Chicago. All orthodontic patients who sought treatment at the UIC orthodontic clinic from June 16 to October 31, 2021, were invited to participate in the study. Three milliliters of saliva from the participants were collected in the sample collection tubes and subjected to a polymerase chain reaction (PCR) based assay to detect SAR-CoV-2. All participants' age, sex, history of COVID-19 infection, and vaccination status were recorded. The COVID-19 positivity rates of Chicago, Cook County of Illinois, and the orthodontic clinic at UIC were compared. One thousand four hundred and thirty-seven orthodontic patients aged 6 to 70 years old (41.8% males and 58.2% females) participated in the study. Among all participants, nine participants tested positive for SARS-CoV-2 (5 males and 4 females). During the study, the average COVID-19 positivity rate at the UIC orthodontic clinic was 0.626%. All of the positive participants were asymptomatic, and two of the participants had a history of COVID-19 infection. Among all positive participants, three participants had received complete COVID-19 vaccination. An increased frequency of positive cases at the orthodontic clinic was observed during the time of high positivity rate in Chicago and Cook County. A potential risk of COVID-19 transmission from patients to orthodontic providers remains, even with asymptomatic and vaccinated patients.

Assessment of Handicapping Labio-Lingual Deviation index scoring methods and their effect on orthodontic treatment coverage by Medicaid.

BACKGROUND: The purpose of this study was to assess the validity and reliability of Handicapping Labio-Lingual Deviation index (HLDI) scoring methods as calculated by digital models (DM) and visual inspection (VI) and their agreement to either meet or fail to meet the Medicaid coverage threshold. An additional objective was to assess the agreement with Medicaid managed care organizations (MCO) coverage decisions. METHODS: The study included the orthodontic records of 401 patients who applied for Medicaid coverage. Two methods were used to calculate HLDI scores: (1) Measurements derived from DMs using OrthoCAD software; and (2) VI of intraoral photographs. The levels of agreement between the two methods and the Medicaid coverage decision by a MCO were evaluated. RESULTS: The study results show a high level of agreement between the two HLDI calculation methods, DM and VI evaluation methods(Cramer's V = 0.812). The agreement on coverage decisions (eligible/not eligible) between VI methods and the official MCO decision was Cramer's V = 0.318. The agreement on coverage decisions between the DM method and the official MCO decision was Cramer's V = 0.318. CONCLUSIONS: MCO assessment results of the patients using HLDI showed low agreement with the results obtained by DM and VI scoring methods used in this study. The Illinois Medicaid system is apparently using unknown factors other than the HLDI score when determining when approving or disapproving orthodontic coverage. PRACTICAL IMPLICATIONS: MCO decisions on eligibility for orthodontic treatment coverage were not consistent with patients' treatment needs.

Measuring progressive soft tissue change with nasoalveolar molding using a three-dimensional system.

BACKGROUND: For craniofacial orthodontics and surgery to progress, accurate temporal evaluation of soft tissue and skeletal change with treatment is necessary. Evolution in three-dimensional imaging eliminates certain inherent challenges in making such measurements in infants with facial clefts. OBJECTIVE: The aim of this pilot study was to measure progressive three-dimensional changes in nasal form in a series of infants with facial clefts during the course of presurgical nasoalveolar molding. MATERIALS AND METHODS: In 5 infants with unrepaired cleft lip and palate, three-dimensional photographs were obtained using the 3dMD system (3dMD, Inc, Atlanta, GA) at 2-week intervals during nasoalveolar molding treatment. Using the 3dMD Vultus software, temporal soft tissue changes were evaluated quantitatively based on three-dimensional linear measurements of 3 landmarks in the nasal area and qualitative changes in the surface shell. RESULTS: Increase in columellar length on the cleft side and decrease of the nostril floor on the noncleft side were observed in all subjects. Progressive changes were observed most significantly in week 4 (T3) into treatment. CONCLUSIONS: This pilot study describes an approach using the 3dMD photo system with Vultus software for measuring the progressive change in the nasal soft tissues. The 3dMD system was believed to be valuable for facial analysis in this setting.

Influence of palatal expanders on oral comfort, speech, and mastication.

INTRODUCTION: It is not known whether the design of the expander has an effect on initial adaptation, comfort level, speech, chewing, and swallowing, or whether age is a crucial aspect when dealing with speech adaptations. The objectives of this study were to assess whether patients of different age groups undergoing palatal expansion with various types of expanders experienced discomfort, speech impairment, chewing difficulty, and swallowing disturbances. METHODS: A questionnaire was developed and distributed to patients who had received palatal expanders in the preceding 3 to 12 months. RESULTS: Regardless of the type of expander, most patients initially felt oral discomfort, and had problems with speech and mastication. However, these disturbances were confined to the first week after cementation of the device. Remarkable adaptation to the device in all aspects studied was observed by the end of the first week. In addition, age did not influence the variables; younger patients and older teenagers responded similarly to the survey. In addition, the questionnaire responses did not appear to be related to the respondents' sex. CONCLUSIONS: Discomfort might not be a deciding variable when choosing an appliance. Instead, clinicians should base their decision on factors such as its biomechanics.