Artificial intelligence as a prediction tool for orthognathic surgery assessment.

INTRODUCTION: An ideal orthodontic treatment involves qualitative and quantitative measurements of dental and skeletal components to evaluate patients' discrepancies, such as facial, occlusal, and functional characteristics. Deciding between orthodontics and orthognathic surgery remains challenging, especially in borderline patients. Advances in technology are aiding clinical decisions in orthodontics. The increasing availability of data and the era of big data enable the use of artificial intelligence to guide clinicians' diagnoses. This study aims to test the capacity of different machine learning (ML) models to predict whether orthognathic surgery or orthodontics treatment is required, using soft and hard tissue cephalometric values. METHODS: A total of 920 lateral radiographs from patients previously treated with either conventional orthodontics or in combination with orthognathic surgery were used, comprising n = 558 Class II and n = 362 Class III patients, respectively. Thirty-two measures were obtained from each cephalogram at the initial appointment. The subjects were randomly divided into training (n = 552), validation (n = 183), and test (n = 185) datasets, both as an entire sample and divided into Class II and Class III sub-groups. The extracted data were evaluated using 10 machine learning models and by a four-expert panel consisting of orthodontists (n = 2) and surgeons (n = 2). RESULTS: The combined prediction of 10 models showed top-ranked performance in the testing dataset for accuracy, F1-score, and AUC (entire sample: 0.707, 0.706, 0.791; Class II: 0.759, 0.758, 0.824; Class III: 0.822, 0.807, 0.89). CONCLUSIONS: The proposed combined 10 ML approach model accurately predicted the need for orthognathic surgery, showing better performance in Class III patients.

Orthognathic Surgery Associated with Condylectomy for Treatment of Mandibular Osteochondroma: Case Report

ABSTRACT: Osteochondroma is a common benign bone tumor and although its involvement in facial bones is rare (0.6 %), it shows a strong predilection for developing in the mandibular condyle, causing occlusal changes and facial asymmetry. The aim of this study was to report a clinical case and the treatment of a 43-year-old male patient, who was diagnosed with condylar osteochondroma. Clinically, the patient presented an increase in volume in the right condylar region, deviation of the mandible to the left side and malocclusion. His main complaint was his facial asymmetry. Imaging exams showed changes in the size and morphology of the right condyle, and signs of hyper-capture on scintigraphy. The hypothesis of condylar hyperplasia and osteochondroma was raised. A virtual planning and execution of an orthognathic surgery of the jaws was performed to correct the occlusion and facial asymmetry, besides a low condylectomy to remove the lesion. Procedures such as high, low, proportional condylectomy, orthognathic surgery and TMJ reconstructive surgery are alternatives for the treatment of these pathologies. In our case, the orthognathic surgery combined with a condylectomy proved to be promising, to correct the occlusion and the facial asymmetry of the patient.

RESUMEN: El osteocondroma es un tumor óseo benigno común y aunque su afectación en los huesos faciales es rara (0,6 %), muestra una fuerte predilección por desarrollarse en el cóndilo mandibular, causando cambios oclusales y asimetría facial. El objetivo de este trabajo fue informar de un caso clínico y el tratamiento de un paciente de sexo masculino de 43 años, que fue diagnosticado con osteocondroma cóndilar. Clínicamente, el paciente presentaba un aumento en el volumen en la región condilar derecha, desviación de la mandíbula hacia el lado izquierdo y maloclusión. Su principal molestia era su asimetría facial. Los exámenes por imágenes mostraron cambios en el tamaño y la morfología del cóndilo derecho, y signos de hiper-captura en la centellografía. Se planteó la hipótesis de hiperplasia condilar y osteocondroma. Se realizó una planificación virtual y ejecución de una cirugía ortognática de la mandíbula para corregir la oclusión y la asimetría facial, además de una baja condilectomía para extirpar la lesión. Procedimientos como la condilectomía alta, baja y proporcional, la cirugía ortognática y la cirugía reconstructiva de la ATM son alternativas para el tratamiento de estas patologías. En nuestro caso, la combinación de la cirugía ortognática y una condiloectomía resultó ser prometedora, para corregir la oclusión y la asimetría facial del paciente.

Effect of surface characteristics of soft liners and tissue conditioners and saliva on the adhesion and biofilm formation.

PURPOSE: To investigate the influence of surface characteristics and saliva on the adhesion and biofilm formation of Candida glabrata and methicillin-resistant Staphylococcus aureus (MRSA) to soft liners and tissue conditioners. METHODS: For each material (Ufi Gel P - UG; Sofreliner S - SS; Trusoft - TR; Coe Comfort - CC; Softone - ST), specimens were prepared and roughness (Ra), hydrophobicity (water contact angles-WCA) and surface free energy (SFE) were measured. Surface morphology was also analyzed using scanning electron microscopy (SEM). Specimens were incubated in C. glabrata or MRSA suspensions for 90 minutes (adhesion) or 48 hours (biofilm). The absorbance (AB) was measured by XTT assay. Experiments were performed using specimens that were either uncoated or had been coated with saliva. Data were analyzed using one- or two-way ANOVAs, followed by Tukey's test (α= 0.05). RESULTS: TR exhibited the highest Ra and UG the lowest. SEM images also showed that UG and SS had smooth surfaces, while TR presented several irregularities and pores. In the absence of saliva, UG and SS presented higher WCA and lower SFE than the other materials. XTT results showed that, in the C. glabrata adhesion assay, the AB value was higher for TR followed by UG > CC> SS> ST. For the biofilm formation of C. glabrata, AB values were in the following order TR > CC = UG > ST = SS. In the adhesion assay, AB values obtained for MRSA were TR > UG = CC > ST > SS and for the biofilm formation were TR > ST > CC > UG > SS. Saliva decreased the WCA and increased the SFE for all materials. In general, the presence of saliva decreased the adhesion and biofilm formation of both microorganisms to the acrylic-based material (TR) and tissue conditioners (CC and ST), and increased for the silicone-based soft liners (UH and SS). Surface characteristics and the influence of saliva varied among materials. Roughness seemed to favor C. glabrata and MRSA adhesion and biofilm formation. CLINICAL SIGNIFICANCE: The presence of microorganisms on denture liners can irritate the oral tissues and contribute to systemic diseases. Colonization with more tolerant microorganisms such as C. glabrata and MRSA may expose patients to a greater risk of infection, mainly in immunocompromised hosts, such as aged individuals after treatment of oral cancer. For this, it is important to investigate the surface characteristics of soft liners and tissue conditioners, as well as saliva, and their influence on the adhesion and biofilm formation of C. glabrata and methicillin-resistant Staphylococcus aureus.