Inter-examiner Reliability of Two Methods for Scoring Post-Orthodontic White Spot Lesions from Digital Photographs.

Objective: To compare the reliability of two scoring systems for detecting white spot lesions (WSLs) from clinical photographs captured during debonding of fixed orthodontic appliances. Methods: Digital images of 58 healthy adolescents (34 females and 24 males) were examined, depicting 384 buccal surfaces of maxillary incisors, canines, and first premolars. Three trained examiners (E1, E2 and E3) independently evaluated the fully anonymized photos in a randomized order using the Gorelick index (GI) and the modified International Caries Detection and Assessment System (ICDAS II). A 1-2-week interval separated the scorings. Spearman's rank correlation coefficient, Fisher's z-test, and the interclass correlation coefficient (ICC) were applied to compare the scoring methods and express examiner agreement. Results: The two scoring systems showed a moderate to strong positive relationship, but inter-examiner variations were significant (p<0.05). We found moderate to good reliability (ICC 0.60 to 0.84) with the ICDAS II system and good to excellent values with the GI (ICC 0.72 to 0.94), depending on the examiner. The agreement concerning the sound surfaces and the most severe WSLs was perfect, whereas the scoring of the milder lesion stages appeared more uncertain. Conclusion: A moderate to strong positive relationship was demonstrated between the two methods when scoring the presence and severity of WSLs from digital images. Significant inter-examiner variations affected reliability.

Investigation of the Mechanical Properties of Thermoplastic Materials Influenced by Different Chemicals.

Objective: The quality of orthodontic forces in aligners is mainly influenced by their mechanical properties. At present, there is insufficient information on how environmental factors affect the mechanical function of aligners, and studies have shown that patients do not pay enough attention to removing aligners while eating and drinking. Therefore, in this study, we investigated the effect of different chemicals on the mechanical properties of thermoplastic materials. Methods: In this study, 175 thermoplastic samples from Easy-Vac gasket (3A Medes, Korea) were prepared, and their chemical composition, tensile strength, and hardness before and after exposure to solutions of orange juice, Cola, chlorhexidine mouthwash, and distilled water were measured. One-Way analysis of variance (ANOVA), Tamhane's test, and Tukey's test were used for statistical analysis. Results: The tensile strength of the sheets increased with continuous exposure to orange juice and chlorhexidine mouthwash, and their hardness decreased with continuous exposure to carbonated beverages. There was no change in the chemical composition of the samples after exposure to different chemicals. Conclusion: Although these changes are statistically significant, they do not have a significant effect on the result of aligner performance. Therefore, the only concern is the cariogenicity of orange juice and Cola during treatment with aligners and the administration of chlorhexidine mouthwash.

Correlation between oral muscle pressure and malocclusion in mixed dentition: a cross-sectional study.

OBJECTIVE: To investigate the relationship between oral muscle pressure and malocclusion in the mixed dentition. MATERIALS AND METHODS: Maximum tongue, lip and cheek pressure was measured using the Iowa Oral Performance Instrument (IOPI) in 3 patient cohorts: patients with (1) posterior crossbite, (2) class II relationship and (3) a control group of patients without malocclusion. Linear models were used to compare the mean differences in muscle pressure between groups, with correction for age and gender. The imbalance between lips and tongue and between lips and cheeks was calculated by the Delta z-scores of each group. RESULTS: A total of 146 participants were included, 46 (mean age 8.71±0.85), 41 (mean age 11.74±1.17) and 35 (mean age 10.71±1.92) in groups 1, 2 and 3 respectively. Patients with malocclusion showed significantly higher lip and lower cheek pressure and imbalance favouring the lips over the tongue compared to controls. Class II,1 patients showed significantly higher tongue pressure than Class II,2. No differences were found in muscle pressure or imbalance between crossbite and Class II nor between crossbite types. CONCLUSION AND CLINICAL RELEVANCE: These findings suggest that oral muscle pressure may be associated with malocclusion. This highlights the importance of functional diagnosis and its implications on the prevention and treatment of malocclusion, as well as on orthodontic stability.

Evaluating malocclusion patterns in children with autism spectrum disorder using the index of complexity, outcome and need: a cross-sectional study.

BACKGROUND: The purpose of this study was to evaluate the complexity of malocclusion and existing patterns in children with autism spectrum disorders (ASD) using the index of complexity, outcome and need (ICON). METHODS: This cross-sectional study included children diagnosed with ASD, aged 9-15 years. A group of healthy children with the same demographic characteristics was randomly selected as the control group. Malocclusion was assessed according to ICON scoring protocol. The following parameters were recorded: dental aesthetics, upper arch crowding/spacing, presence of crossbite, anterior-vertical relationship (open and deep bite) and buccal segment anterior-posterior relationship. Finally, an overall ICON score was derived and reported for each patient. Descriptive analysis was performed for all investigated variables. Significance level was set at p < 0.05. RESULTS: A total of 324 children, divided into ASD (162) and control (162) groups, comprised the study population. Our results demonstrated that the average overall ICON score was significantly higher in the ASD group compared to the control group (38.77 vs. 27.43, p < 0.001). ASD children also obtained significantly higher scores regarding the dental aesthetics component (3.84 vs 2.78, p < 0.001). Study groups were significantly different in terms of the prevalence of incisor overbite and open bite (p = 0.002 and p < 0.001, respectively). Patients in the ASD group showed a higher prevalence of Class II and Class III malocclusions (p < 0.001). CONCLUSION: ASD children obtained significantly higher overall ICON scores, indicating more complex and severe malocclusions. These children also exhibited a greater tendency towards Class II and III malocclusions.

Clear aligner therapy practices among orthodontists practicing in Canada.

BACKGROUND: The acceptability and preference for clear aligner therapy (CAT) has been increasing among orthodontists, but there is still a lack of consensus regarding CAT best practices. Consequently, this study aimed to investigate CAT practices among orthodontists practicing in Canada. METHODS: The survey was conducted among orthodontists practicing in Canada using a modified previously published survey. Sixty orthodontists participated (6.1% response rate). It consisted of 11 sections with open and closed questions related to demographic information and particularities about using or not using CAT. The survey responses were exported from REDCap to a Microsoft Excel (Microsoft, Redmond, Wash) spreadsheet, then statistically analyzed using SPSS software (SPSS for Windows, version 21.0; IBM Inc., Armonk, NY, USA). The comments were categorized under themes and subthemes. Data were organized in descriptive statistics, expressing frequencies and percentages. RESULTS: Almost 30% of the orthodontist's annual caseload was treated with CAT, most frequently prescribed to adult patients. Case complexity and patient cooperation were the factors that most influenced the decision to prescribe CAT. Almost half of orthodontists reported sometimes combining CAT with adjunctive fixed appliances. CONCLUSIONS: Most orthodontists prescribe CAT, and its use is based on the malocclusion's complexity. Orthodontists who do not prescribe CAT believe that fixed appliance therapy has superior treatment outcomes.

Post-condylectomy orthodontic treatment for a severe asymmetrical open bite in a condylar hyperplasia patient.

A satisfactory treatment of an 18-year-old lady was reported with right combination-type condylar hyperplasia (CH) in active phase. The chin severely deviated to the left, with the right gonial angle locating at a lower level. Intraorally, the lower centre line shifted to the left, the scale of which reached the width of one lower incisor. The right molar relation was mesial. Right maxillary second molar over-erupted without contact to lower teeth. There had been 2.5-mm anterior open bite (AOB) before surgery (T1) due to the tongue-spitting habit. After judging the benefits and disadvantages of all treatment alternatives, the decision was made to perform a right condylectomy and post-surgery orthodontics. Before orthodontics (T2) when the chin was positioned centred, an asymmetrical open bite occurred, caused by pre-contact between the right maxillary and mandibular second molars. Meanwhile, the AOB at T2 became 11.5mm. Orthodontic-related treatment included four premolars extraction and intrusion of bilateral maxillary molars using four miniscrews. Finally, this treatment achieved a clinically centred chin with two gonial angles at the same level. Post-condylectomy, the large AOB was resolved, together with a bilateral neutral molar relationship and alignment of the incisor midlines. Besides, the resected right condyle was covered by a continuous cortex bone and returned to the glenoid fossa. In sum, a high-challenging combined-type CH case was accomplished with impressive improvement in facial and occlusal symmetry, thanks to condylectomy and post-surgery miniscrew-assisted orthodontics.

A digitalized analysis of incisal changes among orthodontically treated patients: A retrospective comparative study.

Background: To compare incisor angulation and/or position changes among orthodontically treated patients with metal brackets and clear aligners. Methods: A total of sixty-two participants of both sexes, aged-16-40 years old, with CL I skeletal pattern and mild crowding following strict eligibility criteria were included. The patients were divided into two groups based on their treatment approach. Pre and post lateral cephalograms were collected from Riyadh Elm University (REU) and then digitally analyzed using WEBCEPH (Medical Image Analysis) software. Eight angular and two linear measurements were used for the assessment. Results: The upper incisor angulation and position showed statistically significant differences when orthodontic clear aligners were used. In contrast, no significant difference was observed with the conventional orthodontic treatment. However, the upper incisal palatal root torque decreased after clear aligner therapy compared to conventional treatment. The inter-incisal angle demonstrated a significant increase with clear aligners compared to conventional treatment. Conclusions: The current study revealed the importance of definitive guidelines upon and after treatment, in addition to determining incisor changes. Orthodontic clear aligners are distinct from conventional treatments in controlling the incisors' angulation and position. The expansion treatment modality precedes Interproximal reduction in increasing the arch perimeter.

The Future of Orthodontics: Deep Learning Technologies.

Deep learning has emerged as a revolutionary technical advancement in modern orthodontics, offering novel methods for diagnosis, treatment planning, and outcome prediction. Over the past 25 years, the field of dentistry has widely adopted information technology (IT), resulting in several benefits, including decreased expenses, increased efficiency, decreased need for human expertise, and reduced errors. The transition from preset rules to learning from real-world examples, particularly machine learning (ML) and artificial intelligence (AI), has greatly benefited the organization, analysis, and storage of medical data. Deep learning, a type of AI, enables robots to mimic human neural networks, allowing them to learn and make decisions independently without the need for explicit programming. Its ability to automate cephalometric analysis and enhance diagnosis through 3D imaging has revolutionized orthodontic operations. Deep learning models have the potential to significantly improve treatment outcomes and reduce human errors by accurately identifying anatomical characteristics on radiographs, thereby expediting analytical processes. Additionally, the use of 3D imaging technologies such as cone-beam computed tomography (CBCT) can facilitate precise treatment planning, allowing for comprehensive examinations of craniofacial architecture, tooth movements, and airway dimensions. In today's era of personalized medicine, deep learning's ability to customize treatments for individual patients has propelled the field of orthodontics forward tremendously. However, it is essential to address issues related to data privacy, model interpretability, and ethical considerations before orthodontic practices can use deep learning in an ethical and responsible manner. Modern orthodontics is evolving, thanks to the ability of deep learning to deliver more accurate, effective, and personalized orthodontic treatments, improving patient care as technology develops.

Association between orthodontic treatment and upper airway changes in children assessed with cone-beam computed tomography (CBCT): A systematic review.

BACKGROUND: Some orthodontic devices used in children share similar design principles to appliances used to treat obstructive sleep apnoea in adults. As well as treating malocclusion, orthodontic appliances used in children may therefore also have effects on the upper airway. OBJECTIVE: A review of the literature to assess the effects of orthodontic treatment on the upper airway dimensions in children assessed on CBCT. MATERIALS AND METHODS: Following registration of the protocol (PROSPERO CRD42023439056), a systematic electronic search of published studies was performed using several databases (PubMed; Scopus, Web of Science and Science Direct) in accordance with the PRISMA guidelines. Inclusion criteria were as follows: age under 18 years, orthodontic treatment with any appliance, a control group who received no treatment or a non-active alternative treatment and airway measurement using CBCT. RoB-2 and ROBINS-I tools were used to assess risk of bias and quality of the evidence. RESULTS: In total, 341 studies were identified following the initial search. Title and abstract screening resulted in 45 studies for further full-text analysis. On completion of the screening process, a total of 23 studies met the inclusion criteria. Study interventions included functional appliances (10 studies), rapid maxillary expansion (RME) (9 studies), reverse-pull headgear (1 study) and 4 premolar dental extractions (3 studies). The included studies had moderate to high risk of bias, and the quality of evidence was low. CONCLUSION: The scientific evidence shows that functional appliances are associated with significant improvements in both upper airway volume and constriction when used in children however, the effects on the nasal cavity are limited. RME was associated with a significant increase in nasal cavity and nasopharyngeal dimensions, but not the upper pharyngeal airway. Neither reverse-pull headgear nor dental extractions were associated with any change in airway dimensions; however, the evidence is limited. Functional appliances may reduce the severity of obstructive sleep apnoea (OSA) in children.

A Comparative Evaluation of Frictional Resistance of Various Lingual Brackets With Nitinol (NiTi) Archwires of Different Dimensions: An In Vitro Study.

Introduction Orthodontic mechanics involves transferring some of the applied force to the tooth's supporting components via friction, which in turn allows the tooth to move more easily. Aim The purpose of this in vitro experiment was to examine the frictional resistance (FR) of different lingual brackets utilizing Instron universal testing machines and nitinol (NiTi) archwires of varying sizes. Materials and methods Twenty-four sectional anterior die stones were replicated from a study model. They were categorized into eight categories, with the Libral lingual bracket and the JJ lingual bracket having 0.012" and 0.014" inch NiTi archwire, which were further subdivided into six subgroups. Three brackets were bonded to the anterior teeth of the upper and lower segments and replicated on other models with the help of silicon putty. Elastomeric modules were ligated to two diameters of NiTi wire (0.012" and 0.014") in each model. An Instron universal testing machine was used to measure the frictional force. Numerical data and descriptive statistics such as mean and standard deviation have been shown. Results In the overall analysis, it was observed that among JJ Orthodontics samples using 0.012" NiTi archwires, the maxilla exhibited a higher FR (4.205N) compared to the mandible (4.092N). Similarly, in the case of Libral Orthodontics samples with 0.012" NiTi archwires, the maxilla also demonstrated a higher FR (5.10N) than the mandible (4.97N). However, this trend did not hold for samples using 0.014" NiTi archwires. There was a statistically nonsignificant difference (p > 0.05) in the values between all the pairs of groups. Conclusion The present study concludes that Libral lingual brackets produced overall more FR than JJ lingual brackets.

Why does maxillary skeletal expansion work with some adults and fail with Others?: A narrative review.

Maxillary skeletal expansion is considered a challenging treatment modality in adult ages. Mini-screw-assisted rapid palatal expansion (MARPE) is considered a pioneer in providing a solution for maxillary deficiency in adults away from any surgical interventions. If we consider patient cooperation and motivation, together with operator skills, as constant factors during MARPE, and exclude all hygiene and soft tissue complications that jeopardise the appliance's stability, there is a percentage of expansion failure recorded in different studies with no emphasis on what makes mid-facial diastema appear in some, rather than others. Electronic databases including PubMed, Scopus, Google Scholar, and Web of Science, were searched for literature published in English till 2023. Failure was related in some literature to different criteria, as of yet, no verifiable indicators would allow us to determine success or failure in advance. This review highlighted the most common reasons for failure discussed in different literature: Chronological Age, Mid-palatal suture maturation, Bone density, Sex, Race, Appliance design, and Expansion technique used. This study could be considered an attempt to make candidate selection for non-surgical maxillary skeletal expansion at this old age easier, time-saving, and cost less.

Comparative Evaluation of the Effect of Different Types of Bleaching Dentifrices on Shear Bond Strength of Orthodontic Metal Brackets Bonded by Conventional Composite to Human Teeth: An In Vitro Study.

AIM: This study aims to evaluate and compare the effect of different types of bleaching dentifrices on the shear bond strength of orthodontic metal brackets bonded by light-cured composite adhesive to human teeth. MATERIALS AND METHODS: Forty-five human premolar teeth were randomly divided into three groups, receiving the following treatments: Group 1 (control group; teeth in this group were not bleached), Group 2 (teeth in this group were treated with active oxygen bleaching dentifrice), and Group 3 (teeth in this group were treated with peroxide bleaching dentifrice). Orthodontic brackets were bonded using a light-cured composite adhesive. A universal measuring device was used to assess the shear bond strength with a crosshead speed of 0.5 mm/min. One-way ANOVA, post hoc Tukey tests, and an independent t-test were used to analyse the data. RESULTS: There was a highly significant difference (p≤0.001) in the mean shear bond strength of orthodontic brackets bonded to untreated teeth as compared to teeth treated with bleaching dentifrice. There was no significant difference in the mean shear bond strength of orthodontic brackets bonded to teeth treated with peroxide bleaching dentifrice or active oxygen bleaching dentifrice. CONCLUSION: There was a significant reduction in the mean shear bond strength of orthodontic metal brackets when bonded to human teeth treated with bleaching dentifrices.

Patients' and Parents' Concerns over Orthodontic Treatment during the COVID - 19 Pandemic.

Objective: We aimed to assess the impact of the COVID-19 pandemic on the concern of adolescents in orthodontic treatment, and to determine whether personality traits and parental perception were predictors of adolescent patients' concerns. Participants and methods: The sample consisted of 229 adolescent patients (57.2% female) and 223 parents (65.1% female). Questionnaires included items about the importance of infection control and concern about treatment duration and results. Their latent structure was determined using exploratory factor analysis. The Big Five Inventory was used for assessing personality traits. Predictors of patients' and parental orthodontic concern and awareness of the importance of infection control measures were tested by the hierarchical multiple regression analysis. Results: Two factors were revealed for the patient questionnaire, Treatment concern (TC) and Awareness of the importance of measures (AM), and four factors for the parent questionnaire, Parents' treatment concern (PTC), Parents' awareness of the importance of measures (PAM), Parents' concern about the pandemic (PCP) and Parents' concern about their child with regards to the pandemic (PCC). Adolescents' personality traits were not predictors of either TC or AM. PTC was a predictor of TC (p<0.001), accounting for 28% of the variance. PAM and the patient's following of the news were predictors of AM (p≤0.022), accounting for 24% and 2% of the variance, respectively. Conclusion: Parental concern and awareness of measures had an important role in attitudes of adolescent orthodontic patients during the COVID-19 pandemic, while personality traits did not. The clinician should put additional emphasis on communication with the parent.

Thickness Variations of Thermoformed and 3D-Printed Clear Aligners.

Objective: To assess thickness variations of thermoformed and 3D-printed clear aligners. Materials and Methods: Six different thermoplastic materials with different initial thicknesses were used for aligner thermoforming using Biostar® device (Biostar®, SCHEU-DENTAL GmbH, Iserlohn, Germany). Also, two different dental resins were used to create the printed aligners in three digitally designed thicknesses using IZZI Direct printer (3Dtech, Zagreb, Croatia). The aligners were measured using an electronic micrometer (ELECTRONIC UNIVERSAL MICROMETER, Schut Geometrical Metrology, Groningen, The Netherlands, accuracy: 0.001 mm) on a total of 20 points per aligner. Statistical analysis was performed using the JASP program (JASP, University of Amsterdam, Amsterdam, The Netherlands). Results: The difference between the thermoformed and printed groups was statistically significant. Significant differences between different thermoformed materials and between 3D-printed materials were found. The thickness of thermoformed aligners deviated more in the upper jaw, whereas the thickness of printed aligners deviated more in the lower jaw. Both differences were statistically significant. The greatest average deviation from the initial thickness was found in Duran 0.75; Erkodur 0.6; Erkoloc-Pro 1.0; IZZI 0.5; NextDent 0.6 and NextDent A 0.6. NextDent group had the lowest deviations for all teeth of both jaws, except for upper and lower first molar where NextDent A group was more accurate. Conclusions: Thermoformed aligners showed decreased values, while printed ones showed mostly increased values compared to the original material thickness. The highest mean deviation belonged to IZZI group, and the NextDent group had the lowest mean deviation. The thickness of both aligners was thinner at the edges compared to the thickness at cusps and fissures.

The effect of antimicrobial peptide-added adhesive resins on shear bond strength and the adhesive remnant index of orthodontic brackets.

OBJECTIVES: The aim of this study was to evaluate the effect of in-vivo produced Nisin which is an antimicrobial peptide (AMP) added to adhesive resin on shear bond strength (SBS) and the adhesive remnant index (ARI) of orthodontic brackets. METHODS: Bacterial AMP was produced by fermentation and the ideal AMP/Bond concentration and antimicrobial efficacy of the mixture were tested. To evaluate the SBS and ARI scores of AMP-added adhesive resins, 80 maxillary premolar teeth extracted for orthodontic purposes were used and randomly assigned into 2 groups (n = 40). Group 1: Control Group (teeth bonded with standard adhesive resin); Group 2: Experimental Group (teeth bonded with AMP-added adhesive resin). Statistical analysis was performed using the SPSS package program and applying the Mann-Whitney U and Fisher's exact tests. P < 0.05 was considered as statistically significant. RESULTS: Nisin synthesized in-vivo from Lactococcus lactis (L. lactis) (ATCC 7962) bacteria was provided to form a homogenous solution at an ideal concentration To find the minimum AMP/Bond mixture ratio that showed maximum antimicrobial activity, AMP and Bond mixtures were tested at various concentration levels between 1/160 and 1/2 (AMP/Bond). As a result, the optimum ratio was determined as 1/40. The antimicrobial efficacy of Nisin-added adhesive resin was tested against Streptococcus mutans (S. mutans) (ATCC 35,688) and Lactobacillus strains (cariogenic microorganisms). AMP formed a 2.7 cm diameter zone alone, while 1/40 AMP-bond mixture formed a 1.2 cm diameter zone. SBS values of the teeth bonded with Nisin added adhesive (17.49 ± 5.31) were significantly higher than the control group (14.54 ± 4.96) (P = 0.004). According to the four point scale, Nisin added adhesive provided a higher ARI score in favour of the adhesive and tooth compared to the control group (ARI = 3, n = 20). CONCLUSIONS: Nisin produced from L. lactis (ATCC 7962) had greater antimicrobial effects after mixing with adhesive bond against cariogenic microorganisms S. mutans (ATCC 35,688) and Lactobacillus strains. Nisin added adhesive increased shear bond strength (SBS) of orthodontic brackets and ARI scores in favor of adhesive & teeth. CLINICAL RELEVANCE: Clinicians should take into account that using Nisin-added adhesive resin in orthodontic treatments can provide prophylaxis against tooth decay, especially in patients with poor oral hygiene.

Mapping the evolving trend of research on Class III malocclusion: a bibliometric analysis.

OBJECTIVES: This study aimed to provide visualized knowledge maps to show the evolving trends and key focal points of Class III malocclusion research through a comprehensive bibliometric analysis. MATERIALS AND METHODS: Class III malocclusion research published between 2000 and 2023 was retrieved from the Web of Science Core Collection. VOSviewer was utilized to count the citation and publication number of authors, institutions, countries and journals. Co-occurrence, co-citation, and cluster analyses and burst detection were conducted using CiteSpace. RESULTS: A total of 3,682 publications on Class III malocclusion were included in the bibliometric analysis. During 2000-2023, both the annual publication count and citation frequency exhibited a gradual upward trajectory, with a noticeable surge in recent years. In terms of production and citation counts of Class III malocclusion research, the core journal is the American Journal of Orthodontics and Dentofacial Orthopedics. Furthermore, apart from the primary keyword 'Class III malocclusion', 'orthognathic surgery' was identified as keyword with the most frequency. The cluster analysis of cited references reveals that the research focal points have shifted to 'skeletal anchorage' and 'surgery-first approach'. Furthermore, the burst detection identified 'quality of life' as a potential research hotspot since it has recently gained increasing scholarly attention. CONCLUSIONS: The current study provides scholars with the knowledge maps of evolving trends and prominent topics of Class III malocclusion research and a summary of research progress on various priorities during different periods. These findings are expected to provide a valuable guidance to facilitate the future research on Class III malocclusion.

Impact of concentrated growth factor (CGF) injection on acceleration of orthodontic tooth movement in rabbits.

BACKGROUND: The present study aimed to assess how a concentrated growth factor (CGF) injection affects the rate of orthodontic tooth movement in rabbits. METHODS: This experimental investigation employed a split-mouth configuration. Before orthodontic mesialization of the maxillary first molars, CGF was prepared and administered using submucosal injections on the buccal and palatal sides of the maxillary first molars in one randomly assigned quadrant. The opposite quadrant was used as a control. The study examined four time points:1, 2, 3, and 4 weeks. The measurement of tooth movement was conducted at each follow-up point using a digital caliper. The rabbits were euthanized, and their maxillary segments, specifically the maxillary first molars, were studied histologically to identify any alterations occurring on both the tension and compression sides. RESULTS: Significant tooth movement was observed in the experimental sides versus control sides in the second, third, and fourth week of follow-up periods (p ≤ 0.05). Histologically, on the compression side, the CGF group showed bone resorption and periodontal ligament active reactions from the first week and continued throughout the next three weeks. Also, on the tension side, the CGF group depicted cementoblastic and osteoblastic activities from the first week followed by fibroblastic activities from the second week and all activities continued till the fourth week. CONCLUSIONS: CGF has the potential to effectively enhance orthodontic tooth movement without adverse clinical or histological effects.

Predicting Outcome in Clear Aligner Treatment: A Machine Learning Analysis.

Background/Objectives: Machine learning (ML) models predicting the risk of refinement (i.e., a subsequent course of treatment being necessary) in clear aligner therapy (CAT) were developed and evaluated. Methods: An anonymized sample of 9942 CAT patients (70.6% females, 29.4% males, age range 18-64 years, median 30.5 years), as provided by DrSmile, a large European CAT provider based in Berlin, Germany, was used. Three different ML methods were employed: (1) logistic regression with L1 regularization, (2) extreme gradient boosting (XGBoost), and (3) support vector classification with a radial basis function kernel. In total, 74 factors were selected as predictors for these methods and are consistent with clinical reasoning. Results: On a held-out test set with a true-positive rate of 0.58, the logistic regression model has an area under the ROC curve (AUC) of 0.67, an average precision (AP) of 0.73, and Brier loss of 0.22; the XGBoost model has an AUC of 0.67, an AP of 0.74, and Brier loss of 0.22; and the support vector model has a recall of 0.61 and a precision of 0.64. The logistic regression and XGBoost models identify predictors influencing refinement risk, including patient compliance, interproximal enamel reduction (IPR) and certain planned tooth movements, for example, lingual translation of maxillary incisors being associated with the lowest risk of refinement and rotation of mandibular incisors with the highest risk. Conclusions: These findings suggest moderate, well-calibrated predictive accuracy with both regularized logistic regression and XGBoost and underscore the influence the identified factors have on the risk of refinement in CAT, emphasizing their importance in the careful planning of orthodontic treatment and the potential for shorter treatment times, less patient discomfort, and fewer clinic visits. Identification of at-risk individuals could support tailored clinical decision-making and enable targeted interventions.

Comparison of Three Commercially Available, AI-Driven Cephalometric Analysis Tools in Orthodontics.

Background: Cephalometric analysis (CA) is an indispensable diagnostic tool in orthodontics for treatment planning and outcome assessment. Manual CA is time-consuming and prone to variability. Methods: This study aims to compare the accuracy and repeatability of CA results among three commercial AI-driven programs: CephX, WebCeph, and AudaxCeph. This study involved a retrospective analysis of lateral cephalograms from a single orthodontic center. Automated CA was performed using the AI programs, focusing on common parameters defined by Downs, Ricketts, and Steiner. Repeatability was tested through 50 randomly reanalyzed cases by each software. Statistical analyses included intraclass correlation coefficients (ICC3) for agreement and the Friedman test for concordance. Results: One hundred twenty-four cephalograms were analyzed. High agreement between the AI systems was noted for most parameters (ICC3 > 0.9). Notable differences were found in the measurements of angle convexity and the occlusal plane, where discrepancies suggested different methodologies among the programs. Some analyses presented high variability in the results, indicating errors. Repeatability analysis revealed perfect agreement within each program. Conclusions: AI-driven cephalometric analysis tools demonstrate a high potential for reliable and efficient orthodontic assessments, with substantial agreement in repeated analyses. Despite this, the observed discrepancies and high variability in part of analyses underscore the need for standardization across AI platforms and the critical evaluation of automated results by clinicians, particularly in parameters with significant treatment implications.

Pyogenic granuloma of the hard palate leading to alveolar cleft: a case report.

This case report describes a rare occurrence of pyogenic granuloma (PG) in the hard palate deviating from its typical gingival location that led to the formation of an alveolar cleft. The aggressive growth pattern of the lesion, with atypical progression from a pedunculated nodule to an alveolar cleft, raised concern. The diagnosis was based on magnetic resonance imaging and computed tomography findings, which revealed a tadpole-shaped lesion originating from the midline hard palate. The differential diagnosis included a minor salivary gland tumor. Surgical excision was performed under general anesthesia and resulted in a mucosal defect without nasolabial fistula formation or bone exposure. The palatal defect was packed with oxidized regenerated cellulose and closed with Vicryl Rapide sutures, both of which contributed to the patient's successful outcomes. Our comprehensive approach, extending across the stages of surgical planning, execution, and postoperative care, demonstrated the advantages of a multidisciplinary strategy for the accurate diagnosis and effective treatment of palatal PGs. This report makes a meaningful contribution to the existing literature on common oral lesions by emphasizing the importance of a broad differential diagnosis and a systematic approach to oral pathologies. It also raises clinical awareness of PGs with atypical presentations and the diagnostic challenge that they pose.