Short-term effects of microimplant-assisted rapid palatal expansion on the circummaxillary sutures in skeletally mature patients: A cone-beam computed tomography study.

INTRODUCTION: This study aimed to investigate the short-term effects on the circummaxillary sutures induced by microimplant-assisted rapid palatal expansion (MARPE) in skeletally mature patients. METHODS: Cone-beam computed tomography (CBCT) images of preexpansion (T0) and postexpansion (T1) of 23 patients (mean age, 20.9 ± 3.65 years) treated with MARPE were evaluated. The T0 and T1 CBCT images were reoriented and superimposed on the basis of the anterior cranial base, using OnDemand3D software (Cybermed, Seoul, Korea). Then, width changes of 9 circummaxillary sutures (frontonasal, frontomaxillary, frontozygomatic, nasomaxillary, zygomaticomaxillary, intermaxillary, midpalatal, zygomaticotemporal, and pterygopalatine sutures) were measured on 1 section of each patient's T0 and T1 CBCT images. In addition, correlation coefficients between changes in the midpalatal sutures, the amount of appliance activation, age, and the changes in other circummaxillary sutural widths were also calculated. RESULTS: Statistically significant (P <0.05) width increases were found in all 9 circummaxillary sutures. The changes in midpalatal suture at the maxillary central incisor level positively correlated with the intermaxillary sutures at the anterior nasal spine level, midpalatal sutures at the posterior nasal spine level, and frontomaxillary sutures (P <0.05). In addition, the changes in the midpalatal sutures at the posterior nasal spine level also positively correlated with the changes in the intermaxillary sutures at the anterior nasal spine level, frontomaxillary sutures, and medial pterygopalatine sutures (P <0.05). CONCLUSIONS: All 9 circummaxillary sutural widths increased in skeletally mature patients immediately after MARPE. The greatest increases in width were measured in the midpalatal sutures and the intermaxillary sutures, followed by the frontomaxillary sutures.

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.

N-linked glycosylation restricts the function of Short gastrulation to bind and shuttle BMPs.

Disorders of N-linked glycosylation are increasingly reported in the literature. However, the targets that are responsible for the associated developmental and physiological defects are largely unknown. Bone morphogenetic proteins (BMPs) act as highly dynamic complexes to regulate several functions during development. The range and strength of BMP activity depend on interactions with glycosylated protein complexes in the extracellular milieu. Here, we investigate the role of glycosylation for the function of the conserved extracellular BMP antagonist Short gastrulation (Sog). We identify conserved N-glycosylated sites and describe the effect of mutating these residues on BMP pathway activity in Drosophila Functional analysis reveals that loss of individual Sog glycosylation sites enhances BMP antagonism and/or increases the spatial range of Sog effects in the tissue. Mechanistically, we provide evidence that N-terminal and stem glycosylation controls extracellular Sog levels and distribution. The identification of similar residues in vertebrate Chordin proteins suggests that N-glycosylation may be an evolutionarily conserved process that adds complexity to the regulation of BMP activity.

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.

Three-dimensional changes of the zygomaticomaxillary complex after mini-implant assisted rapid maxillary expansion.

INTRODUCTION: The aim of this study was to investigate 3-dimensional changes of the zygomaticomaxillary complex (ZMC) after mini-implant assisted rapid maxillary expansion (MARME). METHODS: A total of 15 pairs of cone-beam computed tomography 3-dimensional images taken before expansion (T0) and after expansion (T1) were analyzed by measuring changes in the coordinates of the landmarks of the ZMC. RESULTS: Changes in the x coordinates of the landmarks showed significant expansion (P <0.01) and greater expansion at the lower than upper portion of the ZMC (P <0.05) in the transverse dimension. All y coordinates of the landmarks except the jugal point (J) showed forward displacement (P <0.05), and the z coordinates of ANS, PNS, Alare, A, and ectocanine showed downward displacement (P <0.01) in the sagittal and vertical dimensions. Also, z coordinates of the landmarks that were closer to the midsagittal plane and in a more posterior portion of the ZMC displaced further downward (P <0.05). SNA and ANB angles increased (P <0.05 and P <0.001, respectively) and the SNB angle decreased (P <0.01). There was a significant correlation between changes in the x coordinates of the ectomolare and ectocanine and the amount of expansion measured from the center of resistance of the maxillary first molars (CR6; P <0.05). There was no significant correlation between the amount of CR6 expansion and changes in y and z coordinates of the landmarks. CONCLUSIONS: 3-Dimensional changes of the ZMC after MARME showed expansion in a pyramidal shape from the coronal view, downward and forward displacement from the sagittal view, and parallel palatal expansion from the axial view. These findings might be useful for understanding skeletal expansion patterns using MARME.

Effects of acid etching and calcium chloride immersion on removal torque and bone-cutting ability of orthodontic mini-implants.

INTRODUCTION: The 2-fold purpose of this study was to evaluate the effects of acid etching and calcium chloride immersion on removal torque and the bone-cutting ability of orthodontic mini-implants (OMIs). METHODS: For the removal torque part of the study, 3 types of OMIs (titanium alloy) were evaluated in a rabbit model: OMIs with acid surface etching with and without calcium chloride immersion (ECG and EG, respectively) and a control group (CG), in which the OMIs had an untreated, machined surface. We inserted 126 OMIs (42 OMIs per type) into both tibias of 21 male rabbits (5 months of age) with body weights of 3.0 to 3.5 kg. Removal torque was evaluated after 1, 4, and 7 weeks. To determine the OMIs' bone-cutting ability, total insertion time to place an OMI 6 mm into artificial bone was measured (6 OMIs per group). RESULTS: Removal torque values for the EG (3.97 ± 0.52 Ncm) and ECG (4.21 ± 0.44 Ncm) were statistically and significantly higher than those of the CG (3.02 ± 0.53 Ncm) 1 week after implantation (P <0.05). The ECG (6.54 ± 0.50, 6.61 ± 0.66 Ncm) showed the highest removal torque value followed by the EG (5.68 ± 0.58, 5.89 ± 0.70 Ncm) and CG (3.43 ± 0.62, 3.38 ± 0.54 Ncm) at 4 and 7 weeks after implantation (P <0.05). Removal torque did not change over time with the CG, but with the ECG and EG, it was significantly higher in weeks 4 and 7 than in week 1 (P <0.05). Total insertion time was significantly greater for the EG than for the ECG and CG (P <0.05). CONCLUSIONS: Treating OMIs with a calcium chloride solution improved the initial bone reaction by preventing contamination of the implant surface, and increasing the surface roughness of OMIs by acid etching enhanced their stability without decreasing the bone-cutting ability compared with OMIs without surface treatment.

Effectiveness of pulsed electromagnetic field for pain caused by placement of initial orthodontic wire in female orthodontic patients: A preliminary single-blind randomized clinical trial.

INTRODUCTION: The purpose of this 2-arm parallel trial was to assess the effects of pulsed electromagnetic field (PEMF) on the reduction of pain caused by initial orthodontic tooth movement. METHODS: Thirty-three female patients (mean age, 16.8 ± 3.8 years) who began orthodontic treatment using fixed appliances were examined. In the pilot study, male patients were less likely to use the PEMF device (epatchQ; Speed Dental, Seoul, Korea) and answer a survey consistently, so eligibility criteria were female patients who were periodontally and systemically healthy at the initiation of treatment and had no history of dental pain in the prior 2 weeks or who used no medications (anti-inflammatory or analgesic drugs) during the experiment period. Each patient had brackets bonded on the maxillary teeth, and a 0.014-in nickel-titanium archwire was tied with elastomeric rings. Their maxillary arches were randomly divided into left and right sides in a split-mouth design: a normal PEMF device (experimental group) was used on 1 side, and a PEMF device with an inversely inserted battery (placebo group) was used on the opposite side of the arch for 7 hours on 3 consecutive nights. A Google survey link was sent to the patients' mobile phones via text message, and they were instructed to record their current pain on the survey. The survey was sent a total of 6 times after insertion of the initial archwire at 0 (T0), 2 (T1), 6 (T2), 24 (T3), 48 (T4), and 72 (T5) hours. Patients recorded the degree of pain in resting and clenching states using a numeric rating scale (NRS) from 1 (no pain) to 10 (worst pain). PEMF devices were used after T2. Generalized linear mixed models, along with ancillary pairwise analyses, were used to model and evaluate the differences in pain reported over 72 hours. RESULTS: The NRS scores did not differ across the groups during the before-PEMF phase for resting (mean difference, -0.07; 95% confidence interval [CI], -0.73 to 0.59; P = 0.842) and clenching (mean difference, -0.28; 95% CI, -1.11 to 0.56, P = 0.513). During the after-PEMF phase, NRS scores in the experimental group were significantly lower than those in the placebo group during both resting (mean difference, -1.46; 95% CI, -2.06 to -0.85; P = <0.001) and clenching (mean difference, -1.88; 95% CI, -2.74 to -1.02, P = <0.001). The NRS scores did not differ across the groups during the before-PEMF phase for either state but were significantly lower in the experimental group than in the placebo group at T3, T4, and T5 (P <0.01). The average NRS score in the clenching state was significantly greater than in the resting state. CONCLUSIONS: PEMF was effective in reducing orthodontic pain caused by initial archwire placement. REGISTRATION: The trial was not registered. PROTOCOL: The protocol was not published before trial commencement.

Pten coordinates retinal neurogenesis by regulating Notch signalling.

Development of nervous tissue is a coordinated process of neural progenitor cell (NPC) proliferation and neuronal differentiation. Intracellular signalling events that regulate the balance between NPC proliferation and neuronal differentiation, therefore, determine the size and composition of nervous tissues. Here, we demonstrate that negative regulation of phosphoinosite 3-kinase (PI3K)-Akt signalling by phosphatase tensin homologue (Pten) is essential for maintaining NPC population in mouse retina. We found that mouse retinal progenitor cells (RPCs) lacking the Pten gene complete neurogenesis earlier than their normal developmental schedule, resulting in their premature depletion in the mature retina. We further discover that Notch intracellular domain (NICD) fails to form transcription activator complex in Pten-deficient RPCs, and thereby unable to support RPC maintenance. Taken together, our results suggest that Pten plays a pivotal role in retinal neurogenesis by supporting Notch-driven RPC maintenance against neurogenic PI3K-Akt signalling.

Bone density effects on the success rate of orthodontic microimplants evaluated with cone-beam computed tomography.

INTRODUCTION: The purpose of this study was to evaluate the effect of bone densities on the success rate of orthodontic microimplants with cone-beam computed tomography images. METHODS: We examined 127 orthodontic microimplants implanted into the maxillary buccal alveolar bone of 71 patients (53 female, 18 male; mean age, 19.2 years) with malocclusion. The cortical, cancellous, and total bone densities were measured with Simplant Pro 2011 software (version 13; Materialise, Leuven, Belgium), and the correlations between these measurements and the orthodontic microimplant success rates were evaluated with cone-beam computed tomography. RESULTS: The overall success rate was 85.0% (108 of 127). Sex, age, and side of placement were not significant factors for success in the results (P >0.05). The density of the cortical bone increased apically (3, 5, and 7 mm) from the alveolar crest, but in the cancellous bone it decreased. Whereas the orthodontic microimplant success rates significantly increased as cancellous bone density and total bone density increased (P <0.01), cortical bone density did not have a significant effect on the success rate (P >0.05). CONCLUSIONS: The success rate of orthodontic microimplants significantly increased with higher cancellous and total bone densities, whereas cortical bone density did not have a significant effect.

Forced eruption of impacted maxillary central incisors with severely dilacerated roots.

Treatment of impacted dilacerated incisors is challenging for clinicians because of the prominent position of the teeth and the abnormality of their roots. We report on 2 patients who had horizontally upward impacted and severely dilacerated maxillary central incisors. The first patient's root perforated the labial plate without significant resorption, and the second patient's root was resorbed. Both patients were treated by a surgical-orthodontic approach, and the crowns of the impacted teeth were brought into the arches by closed forced eruption. Therefore, if impacted teeth have dilacerated roots, patients should be told of the possibility of root resorption.

Control of neural stem cell self-renewal and differentiation in Drosophila.

The neural stem cells of Drosophila, called neuroblasts, have the ability to self-renew and at the same time produce many different types of neurons and glial cells. In the central brain and ventral ganglia, neuroblasts are specified and delaminate from the neuroectoderm during embryonic development under the control of proneural and neurogenic genes. In contrast, in the optic lobes, neuroepithelial cells are transformed into neuroblasts postembryonically by a spatial wave of proneural gene expression. Central brain and ventral nerve cord neuroblasts manifest a short embryonic proliferation period followed by a stage of quiescence and then undergo a prolonged postembryonic proliferation period during which most of the differentiated neurons of the adult CNS are generated. While most neuroblasts belong to a type I class that produces neuronal lineages through non-self-renewing ganglion mother cells, a small subset of type II neuroblasts generates exceptionally large neuronal lineages through self-renewing intermediate progenitor cells that have a transit amplifying function. All neuroblasts in the CNS generate their neural progeny through an asymmetric cell division mode in which the interplay of apical complex and basal complex molecules in the mitotically active progenitor results in the segregation of cell fate determinants into the smaller more differentiated daughter cell. Defects in this molecular control of asymmetric cell division in neuroblasts can result in brain tumor formation. Proliferating neuroblast lineages in the developing CNS utilize transcription factor cascades as a generic mechanism for temporal patterning and birth order-dependent determination of differential neural cell fate. This contributes to the generation of a remarkable diversity of cell types in the developing CNS from a surprisingly small set of neural stem cell-like precursors.

Anti-inflammatory effects of Hwang-Heuk-San, a traditional Korean herbal formulation, on lipopolysaccharide-stimulated murine macrophages.

BACKGROUND: Hwang-Heuk-San (HHS), a Korean traditional herbal formula comprising four medicinal herbs, has been used to treat patients with inflammation syndromes and digestive tract cancer for hundreds of years; however, its anti-inflammatory potential is poorly understood. The aim of the present study was to investigate the anti-inflammatory effects of HHS using a lipopolysaccharide (LPS)-activated RAW 264.7 macrophage model. METHODS: The inhibitory effects of HHS on LPS-induced nitric oxide (NO), interleukin-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α) production were examined using Griess reagent and enzyme-linked immunosorbent assay (ELISA) detection kits. The effects of HHS on the expression of inducible NO synthase (iNOS), IL-1ß and TNF-α, their upstream signal proteins, including nuclear factor κB (NF-κB), mitogen-activated protein kinases (MAPKs), and activator protein (AP-1), were also investigated. RESULTS: A noncytotoxic concentration of HHS significantly reduced the production of NO, IL-1ß and TNF-α in LPS-stimulated RAW 264.7 cells, which was correlated with reduced expression of iNOS, IL-1ß and TNF-α at the mRNA and protein levels. HHS efficiently blocked the phosphorylation of MAPKs, especially that of extracellular signal-regulated kinase (ERK) and c-Jun NH2-terminal kinase (JNK) but not that of the p38 MAPK. The reduced production of inflammatory molecules by HHS was followed by decreased activity of NF-κB and AP-1. CONCLUSIONS: These results suggest that HHS may offer therapeutic potential for treating inflammatory diseases accompanied by macrophage activation.

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.

Placement angle effects on the success rate of orthodontic microimplants and other factors with cone-beam computed tomography.

INTRODUCTION: The purpose of this study was to evaluate the effect of placement angles on the success rate of orthodontic microimplants and other factors with cone-beam computed tomography images. METHODS: We examined 228 orthodontic microimplants implanted into the maxillary buccal alveolar bone of 130 patients (33 men, 97 women) with malocclusion. Vertical placement angle, horizontal placement angle, root proximity, and cortical bone thickness were measured, and the correlations between these measurements and orthodontic microimplant success rates and the correlations among the measurements were evaluated. RESULTS: The overall success rate was 87.7% (200 of 228). The orthodontic microimplant success rate statistically significantly increased as root proximity (distance from the orthodontic microimplant to the root surface) increased (P <0.05), but there were no statistical significances between placement angles and success rates, and cortical bone thickness and success rate (P >0.05). Correlations between placement angles and root proximity showed no statistical significance (P >0.05), but correlations between vertical placement angle and cortical bone thickness (P <0.001) and between horizontal placement angle and cortical bone thickness (P <0.01) showed statistical significance. A statistically significant (negative) correlation was found between vertical and horizontal placement angles (P <0.001). CONCLUSIONS: The success rate of orthodontic microimplants is not affected by placement angles and is more significantly affected by root proximity than by cortical bone thickness. Cortical bone thickness is affected by placement angles, but root proximity is not affected by placement angles.

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.

Accuracy of artificial intelligence-assisted landmark identification in serial lateral cephalograms of Class III patients who underwent orthodontic treatment and two-jaw orthognathic surgery.

Objective: To investigate the pattern of accuracy change in artificial intelligence-assisted landmark identification (LI) using a convolutional neural network (CNN) algorithm in serial lateral cephalograms (Lat-cephs) of Class III (C-III) patients who underwent two-jaw orthognathic surgery. Methods: A total of 3,188 Lat-cephs of C-III patients were allocated into the training and validation sets (3,004 Lat-cephs of 751 patients) and test set (184 Lat-cephs of 46 patients; subdivided into the genioplasty and non-genioplasty groups, n = 23 per group) for LI. Each C-III patient in the test set had four Lat-cephs: initial (T0), pre-surgery (T1, presence of orthodontic brackets [OBs]), post-surgery (T2, presence of OBs and surgical plates and screws [S-PS]), and debonding (T3, presence of S-PS and fixed retainers [FR]). After mean errors of 20 landmarks between human gold standard and the CNN model were calculated, statistical analysis was performed. Results: The total mean error was 1.17 mm without significant difference among the four time-points (T0, 1.20 mm; T1, 1.14 mm; T2, 1.18 mm; T3, 1.15 mm). In comparison of two time-points ([T0, T1] vs. [T2, T3]), ANS, A point, and B point showed an increase in error (p < 0.01, 0.05, 0.01, respectively), while Mx6D and Md6D showeda decrease in error (all p < 0.01). No difference in errors existed at B point, Pogonion, Menton, Md1C, and Md1R between the genioplasty and non-genioplasty groups. Conclusions: The CNN model can be used for LI in serial Lat-cephs despite the presence of OB, S-PS, FR, genioplasty, and bone remodeling.

Comparison of one-jaw and two-jaw orthognathic surgery in patients with skeletal Class III malocclusion using data from 10 multi-centers in Korea: Part I. Demographic and skeletodental characteristics.

OBJECTIVE: To investigate demographic and skeletodental characteristics of one-jaw (1J-OGS) and two-jaw orthognathic surgery (2J-OGS) in patients with skeletal Class III malocclusion. METHODS: 750 skeletal Class III patients who underwent OGS at 10 university hospitals in Korea between 2015 and 2019 were investigated; after dividing them into the 1J-OGS (n = 186) and 2J-OGS groups (n = 564), demographic and skeletodental characteristics were statistically analyzed. RESULTS: 2J-OGS was more frequently performed than 1J-OGS (75.2 vs. 24.8%), despite regional differences (capital area vs. provinces, 86.6 vs. 30.7%, p < 0.001). Males outnumbered females, and their mean operation age was older in both groups. Regarding dental patterns, the most frequent maxillary arch length discrepancy (ALD) was crowding in the 1J-OGS group (52.7%, p < 0.001) and spacing in the 2J-OGS group (40.4%, p < 0.001). However, the distribution of skeletal pattern was not significantly different between the two groups (all p > 0.05). The most prevalent skeletal patterns in both groups were hyper-divergent pattern (50.0 and 54.4%, respectively) and left-side chin point deviation (both 49.5%). Maxillary spacing (odds ratio [OR], 3.645; p < 0.001) increased the probability of 2J-OGS, while maxillary crowding (OR, 0.672; p < 0.05) and normo-divergent pattern (OR, 0.615; p < 0.05) decreased the probability of 2J-OGS. CONCLUSIONS: In both groups, males outnumbered females, and their mean operation age was older. The most frequent ALD was crowding in the 1J-OGS group, and spacing in the 2J-OGS group, while skeletal characteristics were not significantly different between the two groups.

Accuracy of one-step automated orthodontic diagnosis model using a convolutional neural network and lateral cephalogram images with different qualities obtained from nationwide multi-hospitals.

OBJECTIVE: The purpose of this study was to investigate the accuracy of one-step automated orthodontic diagnosis of skeletodental discrepancies using a convolutional neural network (CNN) and lateral cephalogram images with different qualities from nationwide multi-hospitals. METHODS: Among 2,174 lateral cephalograms, 1,993 cephalograms from two hospitals were used for training and internal test sets and 181 cephalograms from eight other hospitals were used for an external test set. They were divided into three classification groups according to anteroposterior skeletal discrepancies (Class I, II, and III), vertical skeletal discrepancies (normodivergent, hypodivergent, and hyperdivergent patterns), and vertical dental discrepancies (normal overbite, deep bite, and open bite) as a gold standard. Pre-trained DenseNet-169 was used as a CNN classifier model. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis, t-stochastic neighbor embedding (t-SNE), and gradientweighted class activation mapping (Grad-CAM). RESULTS: In the ROC analysis, the mean area under the curve and the mean accuracy of all classifications were high with both internal and external test sets (all, > 0.89 and > 0.80). In the t-SNE analysis, our model succeeded in creating good separation between three classification groups. Grad-CAM figures showed differences in the location and size of the focus areas between three classification groups in each diagnosis. CONCLUSIONS: Since the accuracy of our model was validated with both internal and external test sets, it shows the possible usefulness of a one-step automated orthodontic diagnosis tool using a CNN model. However, it still needs technical improvement in terms of classifying vertical dental discrepancies.