Harnessing the Power of Artificial Intelligence in Cleft Lip and Palate: An In-Depth Analysis from Diagnosis to Treatment, a Comprehensive Review.

Cleft lip and palate (CLP) is the most common craniofacial malformation, with a range of physical, psychological, and aesthetic consequences. In this comprehensive review, our main objective is to thoroughly examine the relationship between CLP anomalies and the use of artificial intelligence (AI) in children. Additionally, we aim to explore how the integration of AI technology can bring about significant advancements in the fields of diagnosis, treatment methods, and predictive outcomes. By analyzing the existing evidence, we will highlight state-of-the-art algorithms and predictive AI models that play a crucial role in achieving precise diagnosis, susceptibility assessment, and treatment planning for children with CLP anomalies. Our focus will specifically be on the efficacy of alveolar bone graft and orthodontic interventions. The findings of this review showed that deep learning (DL) models revolutionize the diagnostic process, predict susceptibility to CLP, and enhance alveolar bone grafts and orthodontic treatment. DL models surpass human capabilities in terms of precision, and AI algorithms applied to large datasets can uncover the intricate genetic and environmental factors contributing to CLP. Additionally, Machine learning aids in preoperative planning for alveolar bone grafts and provides personalized treatment plans in orthodontic treatment. In conclusion, these advancements inspire optimism for a future where AI seamlessly integrates with CLP management, augmenting its analytical capabilities.

Development of occlusal canting identifying tool: verification, reliability and validation assessment.

INTRODUCTION: Occlusal cant (OC) is a malocclusion trait that lacks accurate clinical assessment methods. The occlusal canting identifying tool (OCIT) was invented and patented as a clinical tool to accurately identify and quantify the degree of maxillary OC. This study aimed to 1) develop a prototype of the OCIT, 2) verify the functionality of the OCIT and 3) assess the validity and reliability of the OCIT. MATERIALS AND METHODS: A patented OCIT design was revised, and the dimensions were finalized, followed by a three-dimensional conceptual prototype design that was reviewed and approved by the inventors. Verification was performed using a digital angle gauge to determine the accuracy of the bubble level as well as the angle between the bite plate and the protractor. For laboratory validation, 40 orthodontists measured the simulated OC at (0°, 2°, 4°, 6° and 8°) on five phantom heads using the OCIT. A reliability assessment of the tool was performed in three occasions by one orthodontist using the same laboratory settings. RESULTS: The OCIT was prototyped from a medical-grade stainless steel alloy (316 L). Verification assessment revealed that the accuracy error of the bubble level (0.316° ± 0.028°) was statistically significant but clinically insignificant, while that of the angle between the bite plate and protractor (0.100° ± 0.050°) was statistically insignificant. Validation assessment showed high validity of the OCIT with no statistically significant difference between the OCIT and the reference values, having more errors in identifying smaller OC degrees compared to larger OC degrees. The intraclass correlation coefficient indicated the high reliability of the OCIT. CONCLUSION: The OCIT was verified and proven to be a valid and reliable clinical tool that accurately evaluates the degree of OC.

Criterion Validity of the Newly Developed Occlusal Cant Index.

OBJECTIVES: To assess the criterion-related (concurrent) validity of the newly developed occlusal cant index (OCI). MATERIALS AND METHODS: Four standardized posterior-anterior (PA) cephalometric radiographs of four patients were obtained at a 0° occlusal cant (OC) and manipulated to create various degrees of OC from 1° to 4° on the right and left sides, with a total of 36 PA images. The angle between the actual horizontal line and the occlusal plane was manually drawn on each PA radiographic image. The set of radiographic images was displayed to 36 orthodontists, who were asked to measure the drawn angle and apply the OCI to each PA radiographic image. RESULTS: The overall criterion-related validity of the OCI was statistically significant among all grades. CONCLUSION: The OCI is highly valid and recommended for clinical consideration.

Needle-Stick and Sharp Injuries among Hospital Healthcare Workers in Saudi Arabia: A Cross-Sectional Survey.

Needle-stick or sharp injuries (NSIs) are critical occupational hazards for healthcare workers. Exposure to blood and body fluids through NSIs increases the risk of transmission of blood-borne pathogens among them. The objectives of this study were to estimate the annual incidence of NSIs and investigate the associated factors of NSIs among the healthcare workers in Saudi Arabia. A cross-sectional online survey was conducted between October and November 2021. A total of 361 healthcare workers participated in the survey from all over Saudi Arabia. The one-year incidence of at least one event of NSIs among the healthcare workers is estimated at 22.2% (95% CI: 18.0, 26.8). More than half of the injury events (53.8%) were not reported to the authority by the healthcare workers. Incidence of NSIs was highest among the physicians (36%) and was followed by nurses (34.8%), dentists (29.2%), and medical technologists (21.1%). The odds of NSIs was higher among the healthcare workers aged 26-30 years compared to the 20-25 years age group (OR: 2.51; 95% CI: 1.04, 6.03), as well as among the workers who directly dealt with needles or other sharp objects while working compared to those who did not (OR: 5.9; 95% CI: 2.69, 12.97). The high incidence and low rate of reporting of NSIs highlights the need of education and awareness raising programs targeting healthcare providers with higher risk of injury.

Development and validation of an occlusal cant index.

BACKGROUND: Occlusal cant (OC) is a malocclusion trait lacking indexing or classification that describes the extent and severity of tilt in the occlusal plane. The aims of this study were to develop an occlusal cant index (OCI) based on the degree of OC detection among orthodontists and laypeople and to validate the newly developed OCI by a panel of experts using content validity. METHODS: The ability to perceive OC was assessed in 134 participants (orthodontists = 67 and laypeople = 67). A frontal photograph of a model with an ideal smile with 0° of OC was obtained and manipulated to create various degrees of OC from 1-5° at the right and left sides. A set of 11 electronic photographs was displayed to the participants. The participants were asked to report whether they detected an OC in each photograph. The collected data was used as a baseline to develop an OCI. Then, a content validation of the OCI was performed using a questionnaire provided to a panel of experts comprising ten orthodontists. RESULTS: The OCI was designed based on the threshold of OC detection. In both orthodontists and laypeople, the accuracy of OC detection increased as the amount of tilt increased. The threshold point of OC detection in orthodontists was at 2°, while in laypeople it was at 4°. There was a significant difference between orthodontists and laypeople in their ability to detect OC at 2-3° of tilt. The content validity index (CVI) showed excellent validity between the item-level CVI and the scale-level CVI of the OCI. CONCLUSION: The OCI was developed and implemented for diagnostic, communication, and research purposes. The index showed strong evidence supporting content validity.

Evaluation of the airway space changes after extraction of four second premolars and orthodontic space closure in adult female patients with bimaxillary protrusion - A retrospective study.

BACKGROUND & OBJECTIVES: Previous studies have found that first premolar extractions during orthodontic treatment may alter the upper airway dimensions. The objective of this study is to investigate the effects of second premolar extraction during orthodontic treatment on the dimensions of the upper airway in a sample of female adults. METHODS: Twenty-nine female adult patients with ages between 18 and 30 years old and incisor bimaxillary protrusion were included in this study. They were treated with comprehensive orthodontic treatment which included the extraction of four second premolars. Pre and post cephalometric radiographs were analyzed using Dolphin imaging software for changes in tongue length and height, soft palate thickness and length, the superior, middle, and inferior airway space, and vertical airway length. Descriptive statistics were used to characterize measurements. Student's paired t-test was preformed to compare the pre- and post-test mean values of the dimensions. RESULTS: A significant increase in the vertical airway length was observed after the extraction of the second premolars (p = 0.02). The soft palate length showed a tendency towards an increase that did not reach statistical significance (p = 0.053). No other significant changes in the airway soft tissue measurements were observed. The proclination and protrusion of the upper and lower incisors were significantly decreased compared to pre-treatment measurements.Interpretation & conclusions.Orthodontic treatment involving the extraction of all four second premolars in females with bimaxillary protrusion increases the vertical airway length, which is the amount of distance between base of the tongue and posterior nasal spine. No other significant alterations in the upper airway measurements were observed.

Dento-skeletal characteristics of cleft patients with missing teeth.

OBJECTIVE: The objective of this study was to compare the cephalometric skeletal and dental characteristics of unilateral complete cleft lip and palate (UCCLP) subjects with and without missing teeth. DESIGN: A retrospective records review was conducted for patients who are being treated at the cleft lip and palate (CLP) clinics in the College of Dentistry. METHODS: Ninety-six consecutive records of non-syndromic UCCLP subjects were recruited (33 subjects without missing teeth, 50 subjects with only one missing tooth, and 13 subjects with two or more missing teeth). Skeletal and dental characteristics were assessed using lateral cephalometric radiographs in UCCLP subjects with missing teeth and compared to the group with no missing teeth. A total of 25 linear and angular measurements were analyzed and compared between the sample groups. RESULTS: Of the dental variables tested, overjet was significantly different between the three groups. The UCCLP subjects with multiple missing teeth had the smallest overjet (-3.89±2.75 mm; P=0.015) among the three groups. None of the skeletal characteristics reached statistical significance. CONCLUSION: Missing teeth influence the dental but not skeletal characteristics of UCCLP. Overjet is significantly reduced in UCCLP subjects with multiple missing teeth. Future studies with larger sample sizes are warranted.

Effects of vibrational devices on orthodontic tooth movement: A systematic review.

INTRODUCTION: The aim of this systematic review was to investigate the ability of vibrational devices to increase the rate of orthodontic tooth movement or reduce pain associated with orthodontic treatment. METHODS: An electronic search for relevant randomized controlled trials (RCTs) was conducted using Medline via OVID (January 1, 1966, through March 30, 2018), and EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials until August 2017. Hand searching of selected orthodontic journals was also undertaken. RESULTS: Through the electronic searches, 152 titles and abstracts were identified. From these, 10 articles were retrieved for review, and 4 of these met the inclusion criteria. Two additional articles were identified by hand searching. This resulted in 6 studies from 5 separate randomized controlled trials that were included in this systematic review. One RCT reported increased tooth movement with vibrational devices, but the other 4 RCTs reported no difference. Three studies investigated the effect of vibrational devices on pain reduction and found no effect. CONCLUSIONS: The ability of vibrational forces to increase the rate of tooth movement and reduce pain in orthodontic patients has been studied in several RCTs. The results from all but 1 of the included studies indicate no advantage from the use of vibrational devices during orthodontic treatment. Future studies should focus on total treatment duration, the mechanism by which vibration may speed up tooth movement, and the use of vibration with aligners. FUNDING: No funding was received for this review.

Vitamin D and orthodontics: an insight review.

Vitamin D is known as the oldest of all hormones. 7-Dehydrocholesterol is converted to previtamin D3. It becomes a secosteroid when it is later converted to 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). A number of factors influence vitamin D3 production, including skin pigmentation, the use of sunscreen lotions, season, latitude, and altitude. Vitamin D is important for bone metabolism and calcium hemostasis. Researchers have linked a deficiency in vitamin D levels to a number of systemic complications, including cardiovascular disease, diabetes, immune deficiency, and infectious diseases. In orthodontics, laboratory studies have revealed some evidence that vitamin D enhances tooth movement and the stability of the tooth position. This review is an attempt to understand the role and systemic consequences of vitamin D deficiency and to examine its relevance to orthodontics.

The Difference in Cervical Vertebral Skeletal Maturation between Cleft Lip/Palate and Non-Cleft Lip/Palate Orthodontic Patients.

OBJECTIVE: The aim was to evaluate differences in the cervical vertebral skeletal maturity of unilateral cleft lip and palate (UCLP) and non-cleft lip/palate (non-CLP) Saudi male orthodontic patients. METHOD: This cross-sectional multicenter study took place at the dental school, King Saud University and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between October 2014 and September 2015. The records of Saudi male orthodontic patients with UCLP (n = 69) were collected. Cervical vertebral maturation was assessed using their cephalometric radiographs. The records of 138 age-matched non-CLP Saudi male orthodontic patients served as controls. RESULTS: There was a significant difference in skeletal maturity between the UCLP and non-CLP groups, as evident in the delayed skeletal development among the UCLP participants. Moreover, pubertal growth spurt onset was significantly earlier in the non-cleft participants in comparison with the UCLP participants (p = 0.009). CONCLUSIONS: There is delayed skeletal maturity among the UCLP Saudi male population in comparison with their non-CLP age-matched peers.

Learning preferences among dental students using the VARK questionnaire: A comparison between different academic levels and gender.

OBJECTIVE: To examine the learning style preferences of undergraduate dental students and determine the influence of gender on their selection. METHODS: This descriptive, cross-sectional study was conducted at the College of Dentistry, King Saud University, in Riyadh, Saudi Arabia, from September 2016 to January 2017.The Arabic version of visual, audio, read/write, and kinaesthetic questionnaire was administered to students from the first to the fifth academic year. Data was analysed using SPSS 21. P<0.05 was considered significant. RESULTS: Of the 491 students, 368(75.1%) completed the questionnaire. Of them, 269(73.1%) were males and 99(26.9%) were females. Significant differences were found when learning styles were compared (p<0.05). No significant differences could be found when the models were assessed as in the unimodal, bimodal, trimodal or quadmodal methods (p>0.05). A significant difference was found between genders when learning styles were compared (p=0.05). Males preferred the unimodal style, while females preferred the bimodal and quadmodal styles almost equally (p<0.05). CONCLUSIONS: Most dental undergraduate students preferred multi-modal learning.

Cephalometric Soft Tissue Characteristics of Unilateral Cleft Lip and Palate Patients in Relation to Missing Teeth.

OBJECTIVE: This study aimed to evaluate cephalometric soft tissue characteristics in individuals with unilateral complete cleft lip and palate (UCCLP) both with and without missing teeth. DESIGN: A retrospective investigation of patient records, who are being treated at the cleft lip and palate (CLP) clinics at the College of Dentistry. Ninety-six consecutive records of nonsyndromic UCCLP subjects were recruited (33 subjects without missing teeth and 63 subjects with missing teeth). Linear and angular soft tissue measurements obtained from lateral cephalometric radiographs were evaluated and compared among the studied samples. RESULTS: Lower lip was significantly retruded and shorter (p = 0.037), p = 0.015, respectively; in addition to the fact that shallower mentolabial sulcus (p = 0.05) was found in the subjects with missing teeth, the rest of the soft tissue was not significantly different between the two groups. CONCLUSION: In subjects with a UCCLP anomaly, missing teeth have an effect on lower lip position and length, which influenced the mentolabial sulcus. Lower lip position and length differ between cleft patients who present with either multiple missing teeth or with no missing teeth, and this needs to be considered during orthodontic treatment planning and surgical management for the cleft defect.

Color stability and force decay of clear orthodontic elastomeric chains: An in vitro study.

OBJECTIVE: To compare the percentage force decay of clear and semi-clear elastomeric chain products from eight different manufacturers and to evaluate the amount of discoloration after immersion in colored dietary media of the same elastomeric chain products. MATERIAL AND METHODS: An in vitro study was designed using an electronic force gauge to measure six samples from each of 19 types of elastomeric chains stretched for a period of four weeks. A spectrophotometer was used to measure the color of each specimen (10 of each type) at baseline and after being soaked in a dietary medium (coffee, tea, cola, and wine in 250 ml amounts) for 72 h. RESULTS: There was a significant difference in the percentage of the lost initial force between all the tested E-chains (P<0.001). ANOVA shows a significant difference in the amount of discoloration between the E-chain types (P<0.001). Semi-clear (tooth-color/pearl/obscure) E-chain types (TP-ToothC, OrthO-Pearl, GAC-SiliPearl, 3M-Obscure) present significantly less change in color than clear E-chains of the same brand (TP-Clear, OrthoO-Clear, GAC-SiliClear, 3M-Clear). CONCLUSIONS: Significant differences in the mean percentage force decay between the 19 studied clear elastomeric chain types were present. AO-Memory and Ormco maintained most of their original force at the end of the four-week interval. Significant differences in discoloration also exist between the various types of E-chains. TP Orthodontics (Tooth-Colored, SuperSlick, Clear) and Ortho Organizers (Pearl) showed the least discoloration.

Validity of moyers mixed dentition analysis for Saudi population.

OBJECTIVES: To evaluate the applicability of Moyers probability tables and to formulate more accurate mixed dentition prediction tables in the Saudi population. METHODS: A cross-sectional study was conducted at the College of Dentistry, Kind Saud University, Saudi Arabia. The data were collected from 410 (203 males and 207 females) orthodontic study models, which had erupted mandibular permanent incisors, maxillary, mandibular canines and premolars. The mesiodistal widths were measured using a digital caliper with an accuracy of 0.01 mm. Student's paired t-test was used to compare the mean width values derived from this study with the values derived using the Moyers table. Simple linear regression was used to evaluate the linear relationship between the combined mesiodistal widths of the mandibular permanent incisors and the canine-premolar segments in each dental arch. RESULTS: The regression equations for the maxillary canine-premolar segment (males: Y=10.27+0.48X; females: Y=11.71 + 0.39X) and the mandibular canine-premolar segment (males: Y=9.71 + 0.40X; females: 11.28 + 0.39X) were used to formulate new probability tables on the Moyers pattern. Statistically significant differences were observed between predicted widths in our subjects and the widths obtained using Moyers tables. CONCLUSIONS: The new prediction tables derived in this study provided a more precise mixed dentition space analysis than Moyers prediction tables in estimating tooth dimensions in the Saudi population.