Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis.

Objective: : This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. Methods: : The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). Results: : Forty-nine articles met the inclusion criteria. The meta-analysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. Conclusions: : Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

Novel Procedure for Automatic Registration between Cone-Beam Computed Tomography and Intraoral Scan Data Supported with 3D Segmentation.

In contemporary practice, intraoral scans and cone-beam computed tomography (CBCT) are widely adopted techniques for tooth localization and the acquisition of comprehensive three-dimensional models. Despite their utility, each dataset presents inherent merits and limitations, prompting the pursuit of an amalgamated solution for optimization. Thus, this research introduces a novel 3D registration approach aimed at harmonizing these distinct datasets to offer a holistic perspective. In the pre-processing phase, a retrained Mask-RCNN is deployed on both sagittal and panoramic projections to partition upper and lower teeth from the encompassing CBCT raw data. Simultaneously, a chromatic classification model is proposed for segregating gingival tissue from tooth structures in intraoral scan data. Subsequently, the segregated datasets are aligned based on dental crowns, employing the robust RANSAC and ICP algorithms. To assess the proposed methodology's efficacy, the Euclidean distance between corresponding points is statistically evaluated. Additionally, dental experts, including two orthodontists and an experienced general dentist, evaluate the clinical potential by measuring distances between landmarks on tooth surfaces. The computed error in corresponding point distances between intraoral scan data and CBCT data in the automatically registered datasets utilizing the proposed technique is quantified at 0.234 ± 0.019 mm, which is significantly below the 0.3 mm CBCT voxel size. Moreover, the average measurement discrepancy among expert-identified landmarks ranges from 0.368 to 1.079 mm, underscoring the promise of the proposed method.

Three-Dimensional Quantitative Assessment of Condylar Displacement and Adaptive Remodeling in Asymmetrical Mandibular Prognathism Patients After Sagittal Split Ramus Osteotomy.

This study was performed to evaluate the condylar displacement and associated condylar remodeling in class III patients following mandibular setback surgery via sagittal split ramus osteotomy (SSRO). The sample comprised of 26 condyles of 13 subjects (mean age of 21.2±2.6 y). We evaluated patients with mandibular prognathism and facial asymmetry who had undergone SSRO for mandibular setback at Korea University Hospital between January 2016 and December 2018. Three-dimensional segmentation of the mandibular condyles was done using the initial cone-beam computed tomography scan and scan taken 12 months postoperatively or later. Quantitative assessments of the 3-dimensional condylar displacement from T0 to T1 and bony remodeling of 8 regions of the condylar head were performed. The correlation between the condylar displacement and condylar head remodeling on the deviated (D) and nondeviated (ND) sides was analyzed. Significant correlations between condylar displacement and surface remodeling were observed in both D and ND condyles. The anteroposterior condylar displacement was significantly different between the D and ND sides (P=0.007). There was no significant difference in condylar remodeling between the 2 sides. Condylar displacement and adaptive remodeling after SSRO varied greatly among individuals. Compared with displacement in the ND condyle, displacement in the D condyle has a greater association with condylar remodeling in both D and ND condyles. There is no significant difference in condylar head remodeling between D and ND condyles.

Fully automated condyle segmentation using 3D convolutional neural networks.

The aim of this study was to develop an auto-segmentation algorithm for mandibular condyle using the 3D U-Net and perform a stress test to determine the optimal dataset size for achieving clinically acceptable accuracy. 234 cone-beam computed tomography images of mandibular condyles were acquired from 117 subjects from two institutions, which were manually segmented to generate the ground truth. Semantic segmentation was performed using basic 3D U-Net and a cascaded 3D U-Net. A stress test was performed using different sets of condylar images as the training, validation, and test datasets. Relative accuracy was evaluated using dice similarity coefficients (DSCs) and Hausdorff distance (HD). In the five stages, the DSC ranged 0.886-0.922 and 0.912-0.932 for basic 3D U-Net and cascaded 3D U-Net, respectively; the HD ranged 2.557-3.099 and 2.452-2.600 for basic 3D U-Net and cascaded 3D U-Net, respectively. Stage V (largest data from two institutions) exhibited the highest DSC of 0.922 ± 0.021 and 0.932 ± 0.023 for basic 3D U-Net and cascaded 3D U-Net, respectively. Stage IV (200 samples from two institutions) had a lower performance than stage III (162 samples from one institution). Our results show that fully automated segmentation of mandibular condyles is possible using 3D U-Net algorithms, and the segmentation accuracy increases as training data increases.

Diagnosis of temporomandibular disorders using artificial intelligence technologies: A systematic review and meta-analysis.

BACKGROUND: Artificial intelligence (AI) algorithms have been applied to diagnose temporomandibular disorders (TMDs). However, studies have used different patient selection criteria, disease subtypes, input data, and outcome measures. Resultantly, the performance of the AI models varies. OBJECTIVE: This study aimed to systematically summarize the current literature on the application of AI technologies for diagnosis of different TMD subtypes, evaluate the quality of these studies, and assess the diagnostic accuracy of existing AI models. MATERIALS AND METHODS: The study protocol was carried out based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA). The PubMed, Embase, and Web of Science databases were searched to find relevant articles from database inception to June 2022. Studies that used AI algorithms to diagnose at least one subtype of TMD and those that assessed the performance of AI algorithms were included. We excluded studies on orofacial pain that were not directly related to the TMD, such as studies on atypical facial pain and neuropathic pain, editorials, book chapters, and excerpts without detailed empirical data. The risk of bias was assessed using the QUADAS-2 tool. We used Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to provide certainty of evidence. RESULTS: A total of 17 articles for automated diagnosis of masticatory muscle disorders, TMJ osteoarthrosis, internal derangement, and disc perforation were included; they were retrospective studies, case-control studies, cohort studies, and a pilot study. Seven studies were subjected to a meta-analysis for diagnostic accuracy. According to the GRADE, the certainty of evidence was very low. The performance of the AI models had accuracy and specificity ranging from 84% to 99.9% and 73% to 100%, respectively. The pooled accuracy was 0.91 (95% CI 0.76-0.99), I2 = 97% (95% CI 0.96-0.98), p < 0.001. CONCLUSIONS: Various AI algorithms developed for diagnosing TMDs may provide additional clinical expertise to increase diagnostic accuracy. However, it should be noted that a high risk of bias was present in the included studies. Also, certainty of evidence was very low. Future research of higher quality is strongly recommended.

Three-Dimensional Changes in the Mandibular Proximal Segment After Using a Surgery-First Approach in Patients With Class III Malocclusion and Facial Asymmetry.

ABSTRACT: This study was performed to evaluate condylar position and angulation after asymmetric mandibular setback between a conventional (CA) and surgery-first approach (SFA) using three-dimensional analysis. The condylar positions of 30 patients with skeletal Class III malocclusion and facial asymmetry who underwent 1-jaw (sagittal split ramus osteotomy) or 2-jaw orthognathic surgery (Le Fort I osteotomy and sagittal split ramus osteotomy) with CA (n = 18) or SFA (n = 12) from 2 university hospitals were studied. The three-dimensional assessment of condylar changes was performed using computed tomography images at the initial time point (T0) and at least 6 months after surgery (T1). Segmentation of condyles and cranial base assessment from cone-beam computed tomography images were performed using ITK-SNAP software (version 3.4.0). Condylar position and angulation changes were calculated using 3D Slicer software (version 4.10.2), and statistical analysis was performed. No significant translational or rotational condylar changes were observed between the deviated and non-deviated sides in each group or between the CA and SFA groups except yaw ( p = 0.014). Linear mixed-model analysis and multi-variate analysis showed no significant difference between the CA and SFA groups. Surgery-first approach might not be associated with more harmful effects on the condylar position and angulation changes as compared with CA.

Risk factor assessments of temporomandibular disorders via machine learning.

This study aimed to use artificial intelligence to determine whether biological and psychosocial factors, such as stress, socioeconomic status, and working conditions, were major risk factors for temporomandibular disorders (TMDs). Data were retrieved from the fourth Korea National Health and Nutritional Examination Survey (2009), with information concerning 4744 participants' TMDs, demographic factors, socioeconomic status, working conditions, and health-related determinants. Based on variable importance observed from the random forest, the top 20 determinants of self-reported TMDs were body mass index (BMI), household income (monthly), sleep (daily), obesity (subjective), health (subjective), working conditions (control, hygiene, respect, risks, and workload), occupation, education, region (metropolitan), residence type (apartment), stress, smoking status, marital status, and sex. The top 20 determinants of temporomandibular disorders determined via a doctor's diagnosis were BMI, age, household income (monthly), sleep (daily), obesity (subjective), working conditions (control, hygiene, risks, and workload), household income (subjective), subjective health, education, smoking status, residence type (apartment), region (metropolitan), sex, marital status, and allergic rhinitis. This study supports the hypothesis, highlighting the importance of obesity, general health, stress, socioeconomic status, and working conditions in the management of TMDs.

Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment.

OBJECTIVE: To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults. METHODS: We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1-3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients. RESULTS: For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period. CONCLUSIONS: The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.

Antimicrobial activity of NO-releasing compounds against periodontal pathogens.

This study describes the successful synthesis of nitric oxide (NO)-releasing compounds with biodegradable and injectable properties and demonstrates that the kinetics of NO release vary according to the type of NO donor. The antimicrobial activity of NO-releasing compounds against three common periodontal pathogens, i.e., Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Actinomyces israelii, was investigated using a susceptibility assay. Human gingival fibroblasts were treated with NO-releasing compounds at the minimum concentrations required for bacterial growth and cytotoxicity was evaluated using the MTT cell proliferation assay. Our results suggest that NO-releasing compounds can be used topically to treat both gram-negative and gram-positive periodontal pathogens. Comparison of the antimicrobial activity and cytotoxicity assay results between the NO-releasing compounds revealed that an NO donor comprising a macromolecule without surface charge, a lower instantaneous NO concentration, and an adequate supply of NO were associated with a strong bactericidal effect and low cytotoxicity. NO-releasing compounds with these properties may be suitable for treatment of periodontitis.

Biological and medical applications of plasma-activated media, water and solutions.

Non-thermal atmospheric pressure plasma has been proposed as a new tool for various biological and medical applications. Plasma in close proximity to cell culture media or water creates reactive oxygen and nitrogen species containing solutions known as plasma-activated media (PAM) or plasma-activated water (PAW) - the latter even displays acidification. These plasma-treated solutions remain stable for several days with respect to the storage temperature. Recently, PAM and PAW have been widely studied for many biomedical applications. Here, we reviewed promising reports demonstrating plasma-liquid interaction chemistry and the application of PAM or PAW as an anti-cancer, anti-metastatic, antimicrobial, regenerative medicine for blood coagulation and even as a dental treatment agent. We also discuss the role of PAM on cancer initiation cells (spheroids or cancer stem cells), on the epithelial mesenchymal transition (EMT), and when used for metastasis inhibition considering its anticancer effects. The roles of PAW in controlling plant disease, seed decontamination, seed germination and plant growth are also considered in this review. Finally, we emphasize the future prospects of PAM, PAW or plasma-activated solutions in biomedical applications with a discussion of the mechanisms and the stability and safety issues in relation to humans.

Generation and Role of Reactive Oxygen and Nitrogen Species Induced by Plasma, Lasers, Chemical Agents, and Other Systems in Dentistry.

The generation of reactive oxygen and nitrogen species (RONS) has been found to occur during inflammatory procedures, during cell ischemia, and in various crucial developmental processes such as cell differentiation and along cell signaling pathways. The most common sources of intracellular RONS are the mitochondrial electron transport system, NADH oxidase, and cytochrome P450. In this review, we analyzed the extracellular and intracellular sources of reactive species, their cell signaling pathways, the mechanisms of action, and their positive and negative effects in the dental field. In dentistry, ROS can be found-in lasers, photosensitizers, bleaching agents, cold plasma, and even resin cements, all of which contribute to the generation and prevalence of ROS. Nonthermal plasma has been used as a source of ROS for biomedical applications and has the potential for use with dental stem cells as well. There are different types of dental stem cells, but their therapeutic use remains largely untapped, with the focus currently on only periodontal ligament stem cells. More research is necessary in this area, including studies about ROS mechanisms with dental cells, along with the utilization of reactive species in redox medicine. Such studies will help to provide successful treatment modalities for various diseases.

Types of devices used in ridge split procedure for alveolar bone expansion: A systematic review.

The aim of this systematic review was to evaluate instrumentation procedures of the alveolar ridge expansion technique (ARST) with or without Guided Bone Regeneration (GBR) and to identify the most used instruments for successful outcome. An electronic as well as manual literature search was conducted in several databases including Medline, Embase, and Cochrane Central Register of Controlled Trials, for articles written in English up to September 2016. The question in focus was to identify the type of device for ridge expansion that is most frequently used and provides adequate bone expansion and implant success rate. To meet the inclusion criteria, the studies were analysed for the following parameters: prospective or retrospective studies, cohort or case studies/series, cases with 5 or more human subjects, type of device used for surgery, location of defect, and minimum follow up period. The frequency of osteotome usage in this study was approximately 65%, and on average, the implant success was 97%. The motorized expanders and ultrasonic surgery system are easier to use and cause less trauma to the bone compared to the traditional/conventional instruments like mallets and osteotomes. However, their cost is a limiting factor; hence, osteotomes remain a popular mode of instrumentation.

Polymerization Mode of Self-Adhesive, Dual-Cured Dental Resin Cements Light Cured Through Various Restorative Materials.

OBJECTIVE: The aim of this study was to investigate the polymerization mode of self-adhesive, dual-cured resin cements light-cured through overlying materials with different degree of translucency by measuring the degree of conversion (DC). MATERIALS AND METHODS: Three kinds of self-adhesive, dual-cured resin cements (G-CEM LinkAceTM , Maxcem EliteTM , and BisCem® ) were light-cured through three different restorative materials that included porcelain-fused metal (PFM), zirconia, and lithium disilicate. Polymerization kinetics were continuously evaluated using infrared spectroscopy after 0, 5, 10, and 30 min and 2 weeks of mixing. Data were statistically analyzed using two-way analysis of variance (ANOVA), one-way ANOVA, and Tukey's multiple-comparison test (α = 0.05). RESULTS: Regardless of the kind of resin cement, the light-cured groups showed higher DC than did the autopolymerization group under PFM at any point of time (p < 0.05). The time taken by the cements to achieve statistically similar DC between the zirconia and lithium disilicate groups increased in the following order: G-CEM LinkAceTM , BisCem® , and Maxcem EliteTM (p < 0.05). CONCLUSIONS: The degree of translucency of the restorative material can be a significant variable determining the polymerization aspects of self-adhesive, dual-cured resin cements. The resin cements light-cured through lithium disilicate and zirconia showed higher DC than that shown by cements cured under PFM at any measurement time. The lithium disilicate and zirconia groups showed differences in the early stage of polymerization for G-CEM LinkAceTM and BisCem® ; however, the differences diminished at 2 weeks. CLINICAL SIGNIFICANCE: Chemical polymerization is not sufficient to cause the resin cement to achieve the highest polymerization not only in early stage, but also in late stage of polymerization. The sensitivity to the intensity of the light was different for each resin cement. Special clinical steps to compensate for the attenuated light intensity seem to be necessary for the resin cements which are susceptible to light intensity. (J Esthet Restor Dent 29:209-214, 2017).

Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: An introductory review.

Gingival hyperpigmentation and the condition known as gummy smile are very common dental cosmetic problems. Gingival hyperpigmentation arises due to the excess presence of melanin in certain regions of the gums. In the case of gummy smile, more than the required amount of gingival tissue is exposed upon smiling. An aesthetically pleasing smile should expose only a negligible amount of gingival tissue. Gummy smile and gingival hyperpigmentation can have detrimental effects on the aesthetic quality of a smile, and thereby a wide variety of treatment options must be taken into consideration depending patient outcome objectives. The use of a laser as a treatment modality is considered to be a promising option for such cases. We aim to explain the effects of using a laser on the gingiva and discuss the advantages and disadvantages of this type of treatment and the resulting alteration of the genetic composition of the gingival tissue. This article reviews the histological aspects and biological effects of a laser treatment for oral hyperpigmentation and gummy smile and analyzes the use of the laser as a modality to improve the smiles of people with hyperpigmentation and excessive gingival display. We also attempt to provide insight into the use of plasma as a novel technology for medical and dental research and its future implications with regard to, dental soft tissue procedures.