Landmark annotation through feature combinations: a comparative study on cephalometric images with in-depth analysis of model's explainability.

OBJECTIVES: The objectives of this study are to explore and evaluate the automation of anatomical landmark localization in cephalometric images using machine learning techniques, with a focus on feature extraction and combinations, contextual analysis, and model interpretability through Shapley Additive exPlanations (SHAP) values. METHODS: We conducted extensive experimentation on a private dataset of 300 lateral cephalograms to thoroughly study the annotation results obtained using pixel feature descriptors including raw pixel, gradient magnitude, gradient direction, and histogram-oriented gradient (HOG) values. The study includes evaluation and comparison of these feature descriptions calculated at different contexts namely local, pyramid, and global. The feature descriptor obtained using individual combinations is used to discern between landmark and nonlandmark pixels using classification method. Additionally, this study addresses the opacity of LGBM ensemble tree models across landmarks, introducing SHAP values to enhance interpretability. RESULTS: The performance of feature combinations was assessed using metrics like mean radial error, standard deviation, success detection rate (SDR) (2 mm), and test time. Remarkably, among all the combinations explored, both the HOG and gradient direction operations demonstrated significant performance across all context combinations. At the contextual level, the global texture outperformed the others, although it came with the trade-off of increased test time. The HOG in the local context emerged as the top performer with an SDR of 75.84% compared to others. CONCLUSIONS: The presented analysis enhances the understanding of the significance of different features and their combinations in the realm of landmark annotation but also paves the way for further exploration of landmark-specific feature combination methods, facilitated by explainability.

Lateral Cephalometric Landmark Annotation Using Histogram Oriented Gradients Extracted from Region of Interest Patches.

Introduction: Two-dimensional cephalometric image analysis plays a crucial role in orthodontic diagnosis and treatment planning. While deep learning-based algorithms have emerged to automate the laborious task of anatomical landmark annotation, their effectiveness is hampered by the challenges of acquiring and labelling clinical data. In this study, we propose a model that leverages conventional machine learning techniques to enhance the accuracy of landmark detection using limited dataset. Materials and methods: Our methodology involves coarse localization through region of interest (ROI) extraction and fine localization utilizing histogram-oriented gradient (HOG) feature. The image patch containing landmark pixels is classified using the light gradient boosting machine (LGBM) algorithm. To evaluate our model's performance, we conducted rigorous tests on the ISBI Cephalometric dataset and Dental Cepha dataset, aiming to achieve accuracy within a 2 mm radial precision range. We also employed cross-validation to assess our approach, providing a robust evaluation. Results: Our model's performance on the ISBI Cephalometric dataset showed an accuracy rate of 77.11% within the desired 2 mm radial precision range. The cross-validation results further confirmed the effectiveness of our approach, yielding a mean accuracy of 78.17%. Additionally, we applied our model to the Dental Cepha dataset, where we achieved a remarkable landmark detection accuracy of 84%. Conclusion: The results demonstrate that traditional machine learning techniques can be effective for accurate landmark detection in cephalometric images, even with limited data. Our findings highlight the potential of these techniques for clinical applications, where large datasets of labelled images may not be available.

Effect of Neonatal Factors on the Eruption of Primary Teeth in Children: A Longitudinal Prospective Cohort Study.

Introduction: Eruption of first primary teeth is a normal physiological process. Antenatal nutritional deficiency and prenatal and neonatal factors play an important role in eruption of primary teeth. Neonatal factors, such as gestational age (GA), degree of prematurity, severity of neonatal illness, and birth weight are primarily related to eruption of primary teeth. The relation between neonatal factors and the timing of eruption of primary teeth has not been studied prospectively among Indian preterm infants. Aims: To evaluate the influence of neonatal factors on the eruption of primary teeth in children born preterm. Materials and methods: A prospective longitudinal cohort study design was adopted. A total of 150 subjects were recruited by simple random sampling. Each child was followed up from birth up to 36 months. Intraoral examination was done and the teeth present in each visit were recorded. Data were statistically analyzed and interpreted. Statistical analysis used: Descriptive statistics, t-tests for independent sample, and Pearson's chi-squared tests were applied. Tooth showing statistically significant difference in mean age of eruption between term and preterm categories was studied for the effect of maternal and neonatal characteristics on eruption using multivariate regression analysis. Results: The mandibular central incisor was the first tooth to erupt. Significant determinant of eruption of mandibular incisor in term children was found to be parity, weight for GA, and complementary feeding, whereas for preterm children, significant determinants were parity, birth weight birth length, weight for GA, and complementary feeding. Conclusion: Neonatal factors, such as birth weight, birth length, weight for GA, and introduction of complementary feeding have a strong significant association with the eruption of primary teeth. Clinical significance: The findings of this study will guide in the preventive management of oral health in preterm children. How to cite this article: Indira MD, Nandlal B, Narayanappa D, et al. Effect of Neonatal Factors on the Eruption of Primary Teeth in Children: A Longitudinal Prospective Cohort Study. Int J Clin Pediatr Dent 2023;16(2):321-326.

Establishing Cephalometric Norms in Primary Dentition Using Comprehensive Craniofacial Growth Analysis - A Digital Cephalometric Study

ABSTRACT Objective: To establish cephalometric norms in primary dentition among males and females using novel customized Comprehensive Cephalometric Growth (CCG) Analysis. Material and Methods: The study was conducted on 67 subjects with a mean age of 5.5 yrs. Digital lateral cephalometric radiographs were obtained using Planmeca Pro One. The digital images were then transferred to Nemoceph software. Craniofacial Growth (CCG) Analysis was configured in the software with five sub-groups. This sub-grouping was done such that related components were grouped together and comprehensively; it would provide an assessment of every component of the craniofacial region that could be affected either by treatment maneuver or growth process. The same was used for the cephalometric analysis and to determine the cephalometric norms in the primary dentition. Results: Certain linear measurements were higher among males when compared to females. However, most measurements remained similar among males and females during this age group. The CCG analysis provided a comprehensive knowledge of the craniofacial parameters during the growth process. Conclusion: The cephalometric norms during primary dentition thus established using Comprehensive Craniofacial Growth analysis would provide the data for early diagnosis and treatment planning in interceptive orthodontic treatment procedures.

Virtual Reality as parent education tool in pre-surgical management of cleft lip and palate affected infants-A pilot study.

AIM: To assess the influence of virtual reality (VR) in parent acceptance of the pre-surgical nasoalveolar molding (PNAM) as a pre surgical care to the cleft lip and palate affected infants. MATERIAL AND METHODS: Descriptive Cross sectional pilot study design was planned to assess the pre surgical management of the cleft lip and palate. Twenty parents/caregivers of the infants were randomly divided into two groups. Twelve participants received education through conventional education module (Group I) using verbal explanation supported by the photographs. Another 12 participants received education through customized VR based educational video (Group II). After the education, the parents were provided with questionnaire to assess the acceptance of the treatment procedure. The survey response rate was represented in percentage. RESULTS: The results of the study indicated that most of the parents were aware of the feeding plate or obturators as an aid in assisting feeding practices among cleft lip and palate affected infants. However, only 33% of participants in Group I were able to understand the doctor's explanation regarding the PNAM whereas 100% of participants in Group II were able to visualize the benefits of PNAM. These participants were willingly accepting PNAM as essential pre-surgical care. CONCLUSION: Innovative approaches are essential in patient education modalities as the success of any treatment outcome largely depends on the patient acceptance. Within the limits of this study, VR has been successful in the educating the parents and caregivers regarding the acceptance of PNAM therapy in cleft affected infants.

Assisted breastfeeding technique to improve knowledge, attitude, and practices of mothers with cleft lip- and palate-affected infants: A randomized trial.

BACKGROUND: Cleft lip and palate is one of the most common developmental anomalies affecting the craniofacial region leading to an array of problems including the inability to feed properly. OBJECTIVES: This study aimed to compare the effectiveness of specially designed audio-visual module over traditional instructional module in improving the assisted breastfeeding habits. METHODOLOGY: Sixteen patients received training regarding the feeding practices through the traditional instructional method, and 16 subjects received training through audio-visual module. Infants in both the groups received the standard care. These infants were followed up longitudinally for 6 months. During the follow up period, the growth parameters were recorded monthly. The knowledge, attitude, and practices of the mothers regarding feeding practices were assessed using KAP questionnaire. RESULTS: There was significant improvement in the knowledge of the mothers from baseline to 6 months, however, the practices indicated that the mothers belonging to the audio-visual module group showed better understating of the condition and earlier adaptation of the breastfeeding practices. Correspondingly, the growth parameters also showed significant difference. CONCLUSION: The custom-made audio-visual module would help the mothers adapt better to the stressful situation following the birth of the infant affected with cleft lip and palate.

Comparison of Antimicrobial Efficacy of Cinnamon Bark Oil Incorporated and Probiotic Blend Incorporated Mucoadhesive Patch against Salivary Streptococcus mutans in Caries Active 7-10-year-old Children: An In Vivo Study.

INTRODUCTION: Among the various plants studied, cinnamon has emerged as a potential herbal antimicrobial agent. Besides the medicinal plants, recently probiotics have also been recognized to affect cinnamon bark oil Streptococcus mutans (S. mutans) and other harmful oral and gut microflora. AIM AND OBJECTIVE: This placebo-controlled study aims to compare the antimicrobial potential of cinnamon bark oil incorporated and probiotic blend [Lactobacillus plantarum (TSP-Lp1), and Lactobacillus rhamnosus (TSP-Lrh1)] incorporated mucoadhesive patch against salivary S. mutans in caries active 7-10-year-old children. DESIGN: It was a double-blinded placebo-controlled study with n = 60. They were randomly allotted into three groups-Group I: Cinnamon patch, group II: probiotic patch, and group III: control patch (placebo) with n = 20 in each group. MATERIALS AND METHODS: The study was carried out in three phases. In the first phase, the minimal inhibitory concentration (MIC) of cinnamon bark oil was determined against S. mutans followed by the formulation of cinnamon and probiotic patches. After a washout period of 2 weeks and a collection of baseline saliva samples, these patches were tested on the subjects from respective groups for 14 days with twice a day placement protocol. On the 15th day, saliva samples were collected and cultured, CFU/mL of the saliva of S. mutans for each subject was recorded and compared with baseline samples. Feedback in the form of a questionnaire was obtained from the patients. STATISTICAL ANALYSIS: Descriptive statistics, paired t-test for intragroup comparison, unpaired t-test for intergroup comparison, analysis of variance (ANOVA) for intergroup comparison, and post hoc Scheffe's. RESULTS: The results showed that both cinnamon patch and probiotic patch were comparable to each other in terms of their anti-S. mutans activity. The intragroup comparison of the CFU/mL count showed a highly significant reduction from baseline to post-intervention for both the groups (p = 0.001). CONCLUSION: Both cinnamon and probiotic blend have a strong antimicrobial property owing to their ability to cause significant reduction in salivary S. mutans and both the patches showed good patient acceptance. HOW TO CITE THIS ARTICLE: Gandhi HA, Srilatha KT, Deshmukh S, et al. Comparison of Antimicrobial Efficacy of Cinnamon Bark Oil Incorporated and Probiotic Blend Incorporated Mucoadhesive Patch against Salivary Streptococcus mutans in Caries Active 7-10-year-old Children: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(5):543-550.

Clinical Evaluation of Preventive Effect of Fissure Sealants on Initial Carious Lesion of Permanent Mandibular Molars Pretreated with and without Fluoride Varnish by Fluorescence Camera.

The important armamentarium in the present day scenario against caries prevention is considered to be a combination of preventive methods. The present study was conducted to evaluate the preventive effect of pit and fissure sealant pretreated with fluoride varnish on initial carious lesion by fluorescence camera (FC). How to cite this article: Lakshmi MS, Srilatha KT, Nandlal B, Deshmukh S. Clinical Evaluation of Preventive Effect of Fissure Sealants on Initial Carious Lesion of Permanent Mandibular Molars Pretreated with and without Fluoride Varnish by Fluorescence Camera. Int J Clin Pediatr Dent 2018;11(2):89-93.

Effectiveness of Plaque Control with Novel Pediatric Oral Hygiene Need Station (Modified Oral Irrigation Device) as Compared with Manual Brushing and Flossing: Randomized Controlled Pilot Trial.

BACKGROUND: Establishing good hygiene habits are valuable for present and future oral health. Below 6 years, tooth brushing should be performed by parents, as increasing dexterity and cognition may permit supervised brushing until the child is capable of independent brushing. AIM AND OBJECTIVES: The aim of the present study was to evaluate the effectiveness of modified oral irrigation device in children in terms of plaque control and to compare the effectiveness of plaque control with manual brushing with the modified oral irrigation device in children. MATERIALS AND METHODS: A randomized clinical trial was performed on 12 subjects who were allocated to the two study groups. After obtaining the consent, the control group was instructed tooth brushing with regular pediatric commercially available toothbrush and the intervention group with modified oral irrigation device. Plaque scores in both groups were assessed pre- and post-brushing using modified navy plaque index. RESULTS: The data were subjected to Descriptive statistics and Paired t-test using SPSS version 22. Intragroup comparison of mean difference of plaque score in control group and intervention group pre- and post-brushing was statistically significant. Intergroup comparison of manual brushing group with modified oral irrigation group shows P < 0.05 was statistically significant. CONCLUSION: Within the limitation of the present study, it has been found novel pediatric oral hygiene need Station is more effective than manual brushing since it combined the effect of brushing, flossing (water floss), and rinsing in children simultaneously and at the same time did not demand any special motor skill.

A comparative study to associate the presence of neonatal line in deciduous teeth of infants with the occurrence of live birth.

CONTEXT: The prominent striae of retzius corresponding to the occurrence of live birth is known as the neonatal line (NNL). The very presence of this line indicates the exposure of the infant to the stressful event of birth. AIMS: The study was aimed at locating the NNL in the developing primary teeth of the neonate and associating the presence of NNL to the occurrence of live birth. MATERIALS AND METHODS: The donated bodies of the neonates were taken, and a surgical incision was made along the crest of the alveolar ridge in the maxillary anterior region, enabling the careful removal of the tooth germs from within the jaw segment. The maxillary central incisor tooth germs were embedded in acrylic and viewed under the stereomicroscope, polarized microscope, and scanning electron microscope (SEM). STATISTICAL ANALYSIS: This being a pilot observational study, no statistical analysis methods were employed. RESULTS: The NNL was best visualized under polarized microscopy and was clearly appreciated in the control samples and faintly seen in the 10-day-old neonate. No evidence of the line was present in the tooth germ of the stillborn child. CONCLUSION: The very presence of the NNL indicates that the infant was alive during the stressful process of birth. This can be used as substantial evidence in infanticide cases brought before the law.

Modified Esthetic Splint Design for Management of Multiple Traumatic Injuries in Children: A Case Report.

Traumatic injuries to the dento-alveolar structures are emergencies that compromise the quality of life of the patients. In addition to symptomatic management, definitive functional restoration and suitable rehabilitation becomes a major treatment objective in such cases. The dynamics of the traumatic forces may cause multiple injuries of different grades to the oral and para-oral structures, which makes comprehensive management a greater challenge to the dentist. The present case report elaborates a modified esthetic splint designed to treat multiple dental injuries in children, which can promote healing, restore optimal functionality along with esthetic rehabilitation to psychologically benefit the child during the time of recovery.

Guided bone regeneration: A novel approach in the treatment of pediatric dentoalveolar trauma.

Traumatic injuries in the primary dentition pose major challenges for management. This emergency treatment requires proper planning so as to achieve favorable results. Trauma causing severe dentoalveolar injuries, especially in children, needs an interdisciplinary approach so as to retain normal functional anatomy for that age. This article describes a clinical innovative technique, which utilizes a resorbable membrane in management of pediatric dentoalveolar trauma. The membrane was shaped to cover the multiple alveolar bone fracture, thereby favoring the healing of the bone defects. The use of this resorbable membrane maintained a secluded space for the bone growth and prevented overgrowth of the soft tissue in the region of the defect. This resulted in uneventful healing leading to well-maintained functional bone contour, which further favored the esthetic rehabilitation as well as protected the underlying permanent tooth buds.

Pre surgical nasoalveolar molding: changing paradigms in early cleft lip and palate rehabilitation.

BACKGROUND: Alveolar and nasal reconstruction for patients with cleft lip and palate is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap so as to obtain esthetic results post surgically. Yet there is need of continuous exploration of newer and better methods. Rehabilitation of cleft lip and palate generally requires a team approach with paedodontists playing a major role of performing nasoalveolar molding. Presurgical Nasoalveolar Molding (PNAM) was introduced to reshape the alveolar and nasal segments prior to surgical repair. Over the time there have been changes in the concepts of the same. To assess these changing concepts a pubmed search was performed with different related terminologies and articles over a period of 30 years were obtained. Among the articles retrieved, studies performed over different concepts in early management of cleft lip and palate was selected for the systematic review. Aims This paper describes the changing paradigms in the management of patients with cleft lip and palate, focuses on the current concept of Presurgical nasoalveolar molding(PNAM) and discusses the long term benefits of the same. Conclusion The concept of the management of cleft lip and palate has changed over the time with more emphasis on the nasal and alveolar molding prior to the primary lip repair. This molding reduces the number reconstructive surgeries performed later for the purpose of esthetics. KEYWORDS: Cleft lip and palate, Nasal molding, Gingivoperiosteoplasty, Infant Orthopedics. How to cite this article: Murthy P S, Deshmukh S, Bhagyalakshmi A, Srilatha K T. Pre Surgical Nasoalveolar Molding: Changing Paradigms in Early Cleft Lip and Palate Rehabilitation. J Int Oral Health 2013; 5(2):76-86.

Evaluation of the shear bond strength of nanocomposite on carious and sound deciduous dentin.

AIM: The aim of the study was to evaluate and compare the shear bond strength of conventional composites with nanocomposites in carious and sound deciduous dentin with the use of self-etching adhesive. METHODOLOGY: Human primary molars were ground to obtain flat dentin surfaces and divided into two groups: Carious dentin and sound dentin group. The carious teeth specimens were prepared by removing infected dentin and area with affected dentin was used for bonding composite. Teeth with carious and sound dentin were subdivided in two groups (n = 15) based on the type of the composite into conventional composite group and nanocomposite group. The composite was bonded to the teeth with self-etching adhesive. All the bonded specimens were stored in distilled water for 24 hours at 37°C before shear bond testing. Independent t-test and analysis of variance were applied to the results. RESULTS: The results indicated that the nanocomposite offered significantly higher bond strength compared to conventional composite. In addition presence of affected dentin significantly reduced the bond strength of both the composite types. How to cite this article: Deshmukh S, Nandlal B. Evaluation of the Shear Bond Strength of Nanocomposite on Carious and Sound Deciduous Dentin. Int J Clin Pediatr Dent 2012;5(1): 25-28.

Ectodermal dysplasia: a genetic review.

Ectodermal dysplasia is a rare hereditary disorder with a characteristic physiognomy. It is a genetic disorder affecting the development or function of the teeth, hair, nails and sweat glands. Depending on the particular syndrome ectodermal dysplasia can also affect the skin, the lens or retina of the eye, parts of the inner ear, the development of fingers and toes, the nerves and other parts of the body. Each syndrome usually involves a different combination of symptoms, which can range from mild to severe. The history and lessons learned from hypohidrotic ectodermal dysplasia (HED) may serve as an example for unraveling of the cause and pathogenesis of other ectodermal dysplasia syndromes by demonstrating that phenotypically identical syndromes can be caused by mutations in different genes (EDA, EDAR, EDARADD), that mutations in the same gene can lead to different phenotypes and that mutations in the genes further downstream in the same signaling pathway (NEMO) may modify the phenotype quite profoundly. The aim of this paper is to describe and discuss the etiology, genetic review, clinical manifestations and treatment options of this hereditary disorder. How to cite this article: Deshmukh S, Prashanth S. Ectodermal Dysplasia: A Genetic Review. Int J Clin Pediatr Dent 2012; 5(3):197-202.