Surgical-orthodontic with atypical extraction pattern as a treatment for an anterior open bite: A case report.

This case report described th e surgical- orthodontic interdisciplinar y t reatment of a patie nt with skeletal anterior open bite, class III skelet al pa ttern, steep mandibular plane, increa sed lower face heigh t, and thin mandibular sym physis. The or thodontic p reparation included an unusual extraction pattern (maxillary right first molar, maxillary left second premolar, and mandibular right central incisor), combined with two-jaw surger y comprised of maxillar y advancement and d ifferential impac tion, b ilateral malarplasty augme ntation and man dib ula r asymmetric bilateral sagittal split osteotomy setback. The follow-up of a rare complication of surgical hooks breakage during surgery is reported. Guided by 3- dimesional digital platforms, treatment planning and execution, resulted in a more ba lan ced a nd proportionate face with functional occlusion, and the case stability is shown i n a 32-m onth follow-up.

The utility of adaptive eLearning data in predicting dental students' learning performance in a blended learning course.

Objectives: To examine the impact of dental students' usage patterns within an adaptive learning platform (ALP), using ALP-related indicators, on their final exam performance. Methods: Track usage data from the ALP, combined with demographic and academic data including age, gender, pre- and post-test scores, and cumulative grade point average (GPA) were retrospectively collected from 115 second-year dental students enrolled in a blended learning review course. Learning performance was measured by post-test scores. Data were analyzed using correlation coefficients and linear regression tests. Results: The ALP-related variables (without controlling for background demographics and academic data) accounted for 29.6% of student final exam performance (R2=0.296, F(10,104)=4.37, p=0.000). Positive significant ALP-related predictors of post-test scores were improvement after activities (ß=0.507, t(104)=2.101, p=0.038), timely completed objectives (ß=0.391, t(104)=2.418, p=0.017), and number of revisions (ß=0.127, t(104)=3.240, p=0.002). Number of total activities, regardless of learning improvement, negatively predicted post-test scores (ß= -0.088, t(104)=-4.447, p=0.000). The significant R2 change following the addition of gender, GPA, and pre-test score (R2=0.689, F(13, 101)=17.24, p=0.000), indicated that these predictors explained an additional 39% of the variance in student performance beyond that explained by ALP-related variables, which were no longer significant. Inclusion of cumulative GPA and pre-test scores showed to be the strongest and only predictors of post-test scores (ß=18.708, t(101)=4.815, p=0.038) and (ß=0.449, t(101)=6.513, p=0.038), respectively. Conclusions: Track ALP-related data can be valuable indicators of learning behavior. Careful and contextual analysis of ALP data can guide future studies to examine practical and scalable interventions.

Utilizing Evaluation and Development Frameworks to Engineer a College-Wide Evaluation and Reform of an Undergraduate Dental Curriculum.

Purpose: To operationalize and analyze a college-wide evaluation of an undergraduate dental curriculum. Materials and Methods: A descriptive case study design was used with extensive multiple data collection methods that included literature review, document review of existing data, survey questionnaires, focus group semi-structured interviews and observation of clinical and laboratory tasks. This approach was based on Kern's curriculum development model and Fitzpatrick's practical guidelines and evaluation standards. Results: The evaluation outcomes indicated that a significant curricular change is needed. In hindsight, a thorough reflection on the evaluation strategy is provided highlighting several contextual factors. Actionable recommendations and comparisons are also drafted to shape a coherent curriculum reform implementation. Conclusion: The process by which the evaluation was conducted, and the reform implementation is being instituted, while unique to this college, may offer insights for change at other dental colleges. In that, greater emphasis is placed on the general principles that remain applicable to other comparable contexts regardless of the distinctiveness in specificities.

Sleep-Disordered Breathing among Saudi Primary School Children: Incidence and Risk Factors.

This study aimed to identify the incidence and risk factors of sleep-disordered breathing (SDB) using an Arabic version of the pediatric sleep questionnaire (PSQ). A total of 2000 PSQs were circulated to children aged 6-12 years who were randomly selected from 20 schools in Al-Kharj city, Saudi Arabia. The questionnaires were filled out by the parents of participating children. The participants were further divided into two groups (younger group: 6-9 years and older group: 10-12 years). Out of 2000 questionnaires, 1866 were completed and analyzed (93.3% response rate), of which 44.2% were from the younger group and 55.8% were from the older group. Among all the participants, a total of 1027 participants were female (55%) and 839 were male (45%) with a mean age of 9.67 ± 1.78 years. It showed that 13% of children were suffering from a high risk of SDB. Chi-square test and logistic regression analyses within this study cohort showed a significant association between SDB symptoms (habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting) and risk of developing SDB. In conclusion: habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting strongly contribute the to development of SDB.

Comparison between two asynchronous teaching methods in an undergraduate dental course: a pilot study.

BACKGROUND: Properly designed and implemented eLearning can lead to improvement of dental teaching quality. Various strategies have been proposed to increase the effectiveness of eLearning in dental education, however, there is a lack of research to assess the effectiveness of these strategies. OBJECTIVE: To investigate dental students' learning performance and perception of a virtual flipped learning format compared to a virtual traditional learning method. METHODS: A crossover pilot study was conducted at the College of Dentistry, Princes Sattam Bin Abdulaziz University, Saudi Arabia. Computer-generated randomization, blinded from researchers who analyzed the results, was performed to allocate 32 participants (aged 23.27 ± 0.86 years) to one of two groups. Participants in the control group were taught through the virtual traditional learning method (VTL) using live video lectures. In contrast, participants in the intervention group were taught through the virtual flipped learning method (VFL) using recorded online lectures and post-lecture virtual discussions. Learning gain and preference were measured by pre- and post-test average score differences and a modified validated survey, respectively. RESULTS: There was no significant difference in learning performance between VFL and VTL groups (P > 0.05). However, students preferred VFL over VTL and the differences were significant among all survey items, except for the opportunity to ask questions. CONCLUSION: Health professions educators are encouraged to carefully design online curricula with efficient learning strategies that help students improve learning performance and foster self-directed learning skills while valuing active learning in an online environment. TRIAL REGISTRATION: NCT04692142 , 31/12/2020.

Comparing two pediatric sleep questionnaires: The Pediatric Sleep Questionnaire (PSQ) and a set of 6 hierarchically arranged questions (6Q).

OBJECTIVE: To compare the Pediatric Sleep Questionnaire (PSQ) and a less time-consuming set of 6 hierarchically arranged questions (6Q) as they relate to the pre-test probability for sleep apnea in pediatric patients. METHODS: Parents of 116 subjects between the ages of 7 and 17 answered two sleep questionnaires (the PSQ and the 6Q) distributed in random order before the subjects had sleep studies. Correlation coefficients were used for apnea-hypopnea index (AHI) prediction, while the area under the curve (AUC) was calculated for sleep apnea classification prediction. RESULTS: The 6Q showed statistical significance, while the more commonly used PSQ did not, both in terms of correlating with AHI (rho = 0.294, p = 0.001) and predicting moderate and severe sleep apnea (AUC = 0.650 and 0.788, respectively). CONCLUSION: Although additional field validation is required, these pediatric sleep questionnaires are sensitive and easy-to-use screening tools that can greatly help in the screening for pediatric sleep apnea.

Parental Satisfaction with Their Children's Rapid Palatal Expansion Treatment Provided by Orthodontists and Pediatric Dentists.

BACKGROUND: Dentofacial problems have a definitive impact on patients' psychological well-being, quality of life, and satisfaction. Therefore, patients' satisfaction with their dentition should be an essential goal for dental caregivers. AIM: To compare parental satisfaction with their children's rapid palatal expansion treatment outcome provided by orthodontists and pediatric dentists. MATERIALS AND METHODS: The authors reviewed 605 medical records and contacted 134 parents whose children received early orthodontic treatment from orthodontists and pediatric dentists using a rapid palatal expander. Eighty-eight parents (65.7%) responded to a validated questionnaire about patients' satisfaction with orthodontic treatment outcomes. RESULTS: At baseline; there were no significant differences in relation to parent-related demographic variables. However, there were statistically significant differences between patients' ages and treatment duration (p < 0.001). Independent t-tests showed statistically significant differences in the means for the subscales of doctor-patient relationship and situational aspects (p < 0.05). Spearman's rho correlation coefficients and multivariate linear regression analysis showed that the overall satisfaction is significantly related to, and can be predicted by, parents' educational level, child's gender, and the specialty of the dentist who provided the treatment (p < 0.05). CONCLUSION: Overall parental satisfaction with their children's rapid palatal expansion treatment is significantly higher when provided by pediatric dentists as compared with orthodontists. Factors related to doctor-patient relationship and situational aspects (ie, office location and design, appointment waiting, and treatment duration) significantly impacted parental satisfaction.

Relating three-dimensional airway measurements to the apnea-hypopnea index in pediatric sleep apnea patients.

OBJECTIVES: (a) To evaluate three-dimensional radiographic airway analysis as it relates to the pre-test probability for sleep apnea in pediatric patients, and (b) to develop cut-off values for measurements showing promising results. SETTING AND SAMPLE POPULATION: A consecutive series of pediatric patients between the ages of 7 and 17 years, referred for a sleep study were recruited. Cone beam computed tomography (CBCT) scans were acquired for 103 subjects within one month following the sleep study. METHODS: Three-dimensional airway analysis was performed including volumetric, area and linear measurements. Correlations with the apnea-hypopnea index (AHI) and receiver operating characteristic (ROC) curves were constructed. Sensitivity and specificity were calculated for prediction of AHI ≥ 5 and AHI ≥ 10. RESULTS: 99 CBCT scans were included (median age = 11 years). The nasopharyngeal volume (NPV) significantly correlated with AHI (rho≈-0.4, P < .05). In subjects aged 7-11 years, proposed cut-off values for NPV are 2400mm3 and 1600mm3 for AHI ≥ 5 and AHI ≥ 10, respectively. In subjects aged 12-17 years, proposed cut-off values for NPV are 3500mm3 and 2700mm3 for AHI ≥ 5 and AHI ≥ 10, respectively. Oropharyngeal cross-sectional area (OCSA) demonstrated significant predictive value in ROC curve analysis, and cut-off values for this airway measure are also proposed. CONCLUSIONS: Contrary to findings in adults, the NPV shows promise when screening for sleep apnea in children when CBCT scans are available. The OCSA might also be of value when screening for sleep apnea especially in older children.

Effectiveness of an adaptive eLearning intervention on dental students' learning in comparison to traditional instruction.

There is a great deal of excitement in higher education about the value of adaptive learning to personalize learning paths according to students' individual needs. The authors explored the impact of an Adaptive Learning Platform (ALP) on learning, by comparing learning effectiveness between dental students who used the ALP in a blended learning environment formatively and summatively compared with students who did not use the ALP (i.e., face-to-face), as measured by students' performance on the final exam in a single review preparatory course during the academic years 2013-2018. Paired t-tests showed significant improvement in post-test scores across different course instructional modalities (P < 0.01). The learning gain was greater for students who studied using the ALP summatively (t = 26.20) than those who used it formatively or studied using a face-to-face format (t = 13.10 and 14.13, respectively). Controlling for pre-test scores, analysis of covariance tests indicate that: (1) intervention groups (formative and summative ALP) scored significantly higher than the traditional group (B = 9.34 points, P < 0.01, for summative ALP group) and (B = 4.47 points, P < 0.05, for formative ALP group), and (2) summative ALP group scored significantly higher than formative ALP group (B = 4.84 points, P < 0.05). This study provides empirical evidence that an adaptive learning intervention can have a significant impact on student learning performance. The success of any adaptive learning system relies mainly on sound instructional design. Technology will continue to grow at an overwhelming pace; the cautionary note the authors highlight is that conceptions of pedagogy, complemented by technology, must guide the development of adaptive learning systems.

Developing pediatric three-dimensional upper airway normative values using fixed and interactive thresholds.

OBJECTIVE: To develop and compare pediatric upper airway three-dimensional normative values using the two most commonly used cone beam computed tomography (CBCT) software: Invivo5 (fixed threshold) and Dolphin 3D (interactive threshold). STUDY DESIGN: Out of 3738 CBCT scans, scans of 81 pediatric patients were utilized after applying strict exclusion criteria. The sample was grouped into two age groups (7-11 and 12-17 years). Intra-class correlation coefficient was used to test intra-rater and inter-rater reliability and showed coefficients greater than 0.9 indicating good reliability of the methods used. RESULTS: Paired t tests showed that volumetric and area measurements obtained using Dolphin 3D were significantly larger than those obtained using Invivo5 (p < 0.05). The mean minimal cross-sectional areas (MCSA) for Dolphin 3D were 151 mm2 and 177 mm2 for age groups 1 and 2, respectively. The mean MCSA values for Invivo5 for age groups 1 and 2 were 120 mm2 and 145 mm2, respectively. CONCLUSION: Pediatric upper airway volumetric, area, and linear measurements were reported after applying strict exclusion criteria including a validated sleep questionnaire. Our goal is that clinicians utilize the proposed-here normative values for screening and assist in the timely diagnosis and management of pediatric sleep apnea.

Computerized measurement of the location and value of the minimum sagittal linear dimension of the upper airway on reconstructed lateral cephalograms compared with 3-dimensional values.

INTRODUCTION: Identifying the location and value of the smallest airway dimension can be useful in screening and planning treatment for patients with obstructive sleep apnea. Our objectives in this study were to (1) objectively identify the vertical location and value of the minimum sagittal linear dimension (MSLD) on 2-dimensional reconstructed lateral cephalograms (RLCs), (2) compare the location and value of the MSLD on RLCs with the vertical location and sagittal dimension of the minimum cross-sectional area (MCSA), and (3) investigate the association between the MSLD on RLCs and both the MCSA and the airway volume. METHODS: Cone-beam computed tomography (CBCT) scans of 91 patients, in 3 age groups (<20, 20-40, and >40 years), were used to perform 3-dimensional assessments of the upper airway and reconstruct lateral cephalograms. Airway volume, MCSA, vertical level, and sagittal dimension of MCSA on the CBCT scans were obtained using Dolphin 3D software (version 11.7; Dolphin Imaging, Chatsworth, Calif). Customized software was used to objectively obtain the location and value of the MSLD of the airway on RLCs. RESULTS: In all age groups, correlation tests showed significant correlations between the MSLD on RLCs and both the MCSA (rs ≥0.59; P <0.001) and the airway volume (rs ≥0.37; P <0.05). Additionally, there were significant correlations between the vertical location of the MSLD and the vertical location of the MCSA (rs ≥0.41; P <0.05) and between the MSLD and the sagittal dimension of the MCSA (r ≥0.61; P <0.001). Bland-Altman plots for the MSLD and the sagittal dimension of the MCSA showed much narrower 95% limits of agreement compared with the Bland-Altman plots for the vertical locations of the MSLD and the MCSA. CONCLUSIONS: Two-dimensional images may be used as a screening tool and to identify the sagittal dimension of the smallest airway dimension. However, comprehensive assessment of airway characteristics is better achieved with CBCT-based 3-dimensional evaluation.