Implications of occlusal plane in diagnosis and treatment of malocclusion / 浙江大学学报·医学版

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.

Accuracy of eyes of AITM artificial intelligence-driven platform for lateral cephalometric analysis

Aim: The objective of this prospective study was to evaluate the accuracy of cephalometric analyses acquired through manualtracing and the Eyes of AITM AI-driven web-based program.Materials and Methods: This prospective study employed randomization conducted via computer software, with a determinedsample size of 150 cases. Inclusion criteria encompassed good quality lateral cephalograms available in both digital and printformats, absence of artifacts that might hinder anatomical point location, and presence of a clear calibration ruler for magnificationdetermination. Exclusion criteria included lateral cephalograms with identifiable motion artifacts, resolution disparity, orcontrast, as well as those exhibiting positional errors indicated by ear rod markers. Each lateral cephalogramunderwent tracing and analysis using the manual method, as well as Eyes of AITM software. Following landmark plotting, linearand angular measurements of Steiner, Downs, McNamara, and Jefferson analyses were calculated.Results: A comparison of thirty-six cephalometric measurements of Steiner, Downs, McNamara, and Jefferson analyses obtainedfrom manual tracing and AI-driven Eyes of AITM revealed a Concordance Correlation Coefficient (CCC) value above 0.76 for all parameters, indicating strong agreement between manual and AI-driven cephalometric measurements. Furthermore, a CCC valueexceeding 0.9 was observed for twenty-eight parameters, indicative of very strong agreement. Conclusion: Automated lateral cephalometric measurements obtained from Eyes of AITM are accurate when compared to manualmeasurements.

Progress on application of artificial intelligence technology in orthodontic diagnosis and treatment / 口腔疾病防治

@#In recent years, artificial intelligence technology has developed rapidly and has been gradually applied to the fields of clinical image data processing, auxiliary diagnosis and prognosis evaluation. Research has shown that it can simplify doctors’ clinical tasks, quickly provide analysis and processing results, and has high accuracy. In terms of orthodontic diagnosis and treatment, artificial intelligence can assist in the rapid fixation of two-dimensional and three-dimensional cephalometric measurements. In addition, it is also widely used in the efficient processing and analysis of three-dimensional dental molds data, and shows considerable advantages in determining deciding whether orthodontic treatment needs tooth extraction, thus assisting in judging the stage of growth and development, orthodontic prognosis and aesthetic evaluation. Although the application of artificial intelligence technology is limited by the quantity and quality of training data, combining it with orthodontic clinical diagnosis and treatment can provide faster and more effective analysis and diagnosis and support more accurate diagnosis and treatment decisions. This paper reviews the current application of artificial intelligence technology in orthodontic diagnosis and treatment in the hope that orthodontists can rationally treat and use artificial intelligence technology in the clinic, and make artificial intelligence better serve orthodontic clinical diagnosis and treatment, so as to promote the further development of intelligent orthodontic diagnosis and treatment processes.

Application of digital technology in orthodontic clinic / 口腔疾病防治

@#The rapid development of digital technology has made the processes of orthodontic data collection, diagnosis, design and treatment more accurate, comprehensive, convenient and safe and has improved the clinical efficiency of orthodontists. Safe, non-invasive, rapid three-dimensional facial imaging and digital dental models have enabled orthodontists to collect accurately visualized case data. In addition, during diagnosis and design, orthodontists can comprehensively analyze teeth, jaws, and cranial surfaces in 3 dimensions. Through advances that range from digitized whole-dentition information to computer-replicated design and computer-aided manufacturing, invisible orthodontic technology without brackets has become one of the best manifestations of the combination of digital technology and oral orthodontics. In addition, individualized fixed orthodontic devices have become widely used in orthodontic clinics. In this paper, the applications of digital technology in orthodontic clinics is described. It is hoped that orthodontists will be able to use digital technology rationally to benefit increasing numbers of patients with orthodontic demands.

Concordância dos ortodontistas no diagnóstico do padrão facial / Agreement among orthodontists regarding facial pattern diagnosis

OBJETIVO: avaliar a concordância de ortodontistas treinados no diagnóstico do Padrão Facial, por meio da avaliação morfológica da face. MÉTODOS: foram utilizadas fotografias faciais de frente, perfil e sorriso de 105 indivíduos selecionados aleatoriamente entre pacientes que procuraram tratamento ortodôntico, as quais foram enviadas a ortodontistas treinados na classificação do Padrão Facial. A concordância intraexaminador, dos examinadores com o Padrão-Ouro e interexaminadores foi avaliada por meio do Índice Kappa. RESULTADOS: a concordância na avaliação intraexaminador foi quase perfeita, com Índice Kappa 0,85. A concordância entre os examinadores e o Padrão-Ouro foi moderada (Kappa 0,48), sendo mais alta no Padrão I (Kappa 0,62) e mais baixa no Padrão Face Curta (Kappa 0,33). A concordância entre os examinadores foi substancial (Kappa 0,61), mais alta que a concordância com o Padrão-Ouro em todos os Padrões. CONCLUSÃO: os critérios utilizados pelos examinadores para determinação do Padrão Facial foram os mesmos na primeira e na segunda avaliação. A concordância entre os examinadores e o Padrão-Ouro é moderada, e eles apresentam maior concordância entre si que com o Padrão-Ouro.

OBJECTIVE To assess agreement among orthodontists trained in facial pattern diagnosis through the morphological evaluation of the face. METHODS: Facial photographs were taken in front and side view, as well as photos of the smiles of 105 individuals randomly selected among patients seeking orthodontic treatment. The photos were sent to orthodontists trained in facial pattern classification. Intra-rater agreement, agreement between raters and the Gold Standard, as well as inter-rater agreement were assessed using the Kappa index. RESULTS: Intra-rater agreement was almost perfect, with Kappa index reaching 0.85. Agreement between raters and the Gold Standard was moderate (Kappa = 0.48), higher for Pattern I (Kappa = 0.62) and lower for the short face pattern (Kappa = 0.33). Agreement between raters was significant (Kappa = 0.61) and even higher than agreement with the Gold Standard for all patterns. CONCLUSIONS: The criteria used by raters to determine the facial pattern were the same in the first and second evaluation. Agreement between raters and the Gold Standard was moderate, with raters exhibiting greater agreement between them than with the Gold Standard.

Avaliação dos fatores determinantes da estética do perfil facial / Evaluation of the determinants of facial profile aesthetics

OBJETIVO: avaliar a influência da idade, do sexo, da relação oclusal sagital, do Padrão Facial e de 8 medidas do perfil facial sobre a estética do perfil. MÉTODOS: foram utilizadas tabelas de contingência, o Teste Qui-quadrado e o coeficiente de Cramér para avaliar a possível associação entre a nota dada por 32 avaliadores (14 ortodontistas, 12 leigos e 6 artistas) para a estética do perfil de 100 brasileiros - adultos, leucodermas, portadores de selamento labial passivo - e a idade, o sexo, a relação oclusal sagital, o Padrão Facial e as variáveis da análise facial numérica do perfil. RESULTADOS: não foi observada associação entre a idade, o sexo e a relação oclusal sagital e a estética do perfil facial. A associação foi observada entre a nota recebida para a estética do perfil e o Padrão Facial, o ângulo de convexidade facial e o ângulo do terço inferior da face. CONCLUSÃO: o Padrão Facial, definido na avaliação do perfil pela convexidade do perfil facial, e a projeção anterior do mento foram, entre os fatores avaliados, os determinantes para a estética do perfil facial.

OBJECTIVE: To evaluate the influence of age, gender, sagittal occlusal relationship, facial pattern and 8 facial profile measures on profile aesthetics. METHODS: Contingency tables, chi-square test and Cramer's coefficient were used to evaluate the possible association between the scores assigned by 32 examiners (14 orthodontists, 12 laypeople and 6 artists) to the aesthetics of the profile of 100 Brazilian Caucasian adults, all patients with lip seal competence, and age, gender, sagittal occlusal relationship, facial pattern and the variables of the numerical analysis of the facial profile. RESULTS: No association was found between age, gender and sagittal occlusal relationship and the aesthetics of facial profile. An association was observed between profile scores and facial pattern, facial convexity angle and lower face angle. CONCLUSIONS: Among the factors evaluated in this study, facial profile convexity and anterior chin projection were the key determinants of facial profile aesthetics.

Avaliação do espaço na dentição mista por meio da análise de Moyers e de Tanaka-Johnston / Evaluation of the space in the mixing dentition based on the analysis of Moyers and Tanaka-Johnston

A análise do espaço na dentição mista é um aspecto importante no diagnóstico e planejamento ortodôntico, permitindo determinar se o tratamento irá envolver extrações seriadas, orientação quanto à sequência de erupção, manutenção de espaço, recuperação de espaço, ou apenas observação periódica do paciente. Em vista, disto inúmeros métodos têm sido propostos visando à previsão da largura mesiodistal de caninos e pré-molares não irrompidos, dentre eles, e talvez os mais utilizados recentemente, estão os métodos de Moyers e de Tanaka-Johnston. Esta pesquisa teve a finalidade de avaliar a aplicabilidade destes dois métodos em uma população de adolescentes brasileiros da região de Piracicaba (SP) verificando qual seria a melhor maneira de previsão nesse caso. Foram realizadas mensurações diretas dos incisivos centrais e laterais inferiores, caninos e pré-molares de ambas as arcadas em modelos de gesso de 40 pacientes com idade média de 12 anos, provenientes de arquivos da área de Ortodontia da FOP/Unicamp. Tendo-se em mãos tais medidas, foram calculadas as respectivas diferenças entre a largura mesiodistal real dos caninos permanentes e pré-molares e a prevista segundo as análises de Moyers e de Tanaka-Jhonston. A análise de Tanaka-Johnston mostrou que essa pode ser utilizada nessa população, exceto para a arcada inferior do gênero feminino onde superestimou os resultados em cerca de 0,8mm; além disso, a análise de Moyers demonstrou que os níveis de probabilidade a serem utilizados para essa população são os de 75% para a arcada inferior e 95% para a arcada superior, em ambos os gêneros.

The analysis of the space in the mixing dentition is an important aspect in the diagnosis and orthodontic planning, allowing to determine if the treatment will go to involve serial extractions, orientation of eruption, maintenance of space, recovery of space, or only periodic comment of the patient. In sight of this innumerable method they have been considered aiming at the forecast of the mesiodistal width of tooth’s and premolars not burst, amongst them, and perhaps the most used recently, they are the methods of Moyers and Tanaka- Johnston. This research had as purpose to evaluate the applicability of these two methods in a population of Brazilian adolescents of the region of Piracicaba (SP) and to determine which would be better way of forecast in this case. Direct measurements of the incisors had been carried through inferior, canine and premolars of both the arches in plaster models of 40 patients with average age of 12 years, proceeding from archives of the Orthodontics Department of the FOP/Unicamp. Having in hands these measures, the respective differences between real the mesiodistal width of the permanent and daily pay-molar teeth according to the analyses of Moyers and Tanaka-Johnston had been calculated. The analysis of Tanaka-Johnston showed that this can be used in this population, except for the lower arches of the female group where it overestimated the results in about 0,8mm; moreover, the analyses of Moyers had demonstrated that the probability levels that must be used for this population are of 75% for inferior arches and 95% for the superior arches, in both sexes.

Estudo comparativo entre avaliações esqueléticas e do perfil tegumentar utilizadas no diagnóstico ortodôntico sagital / Comparative study between skeletal and tegumental measurements used in sagital orthodontic diagnosis

OBJETIVO: este trabalho objetivou comparar o diagnóstico de grandezas cefalométricas angulares e lineares rotineiramente utilizadas na determinação da posição sagital das bases ósseas, comparando-as com o diagnóstico de medidas lineares de tecido tegumentar, verificando a possibilidade ou não de concordância entre elas. METODOLOGIA: analisou-se 30 telerradiografias, obtidas em norma lateral e em posição natural da cabeça (PNC), de jovens do gênero feminino, entre 20 e 26 anos de idade (média de 21,3 anos). Comparou-se os diagnósticos das medidas cefalométricas sagitais (SNA, SNB, profundidade facial, profundidade maxilar, Nperp-A e Nperp-P) entre si e com os das medidas sagitais tegumentares (Snvert-Ls, Snvert-Li e Snvert-Pog'). Resultados e CONCLUSÃO: os resultados permitiram concluir que ocorreu uma fraca concordância entre os diagnósticos sugeridos pelas medidas esqueléticas e tegumentares, bem como aquele sugerido pelas diferentes medidas esqueléticas, quando comparados entre si.

AIM: This study aimed to evaluate skeletal measures used in sagital diagnosis of both jaws in comparison with tegumental measures, verifying the agreement between themselves. METHODS: Cephalometric radiographs in natural head position were obtained from 30 white females, between 20 and 26 years of age, mean 21,3 years. Cephalometric tracings were taken and the following measurements recorded: SNA, SNB, Facial depth, Maxillary depth, Nperp-A, Nperp-Pog, and then compared to the tegumental measurements Snvert-Ls, Snvert-Li Snvert-Pog'. Results and CONCLUSIONS: The results showed low agreement between the diagnosis proposed by different hard tissue and soft tissue analysis, as well as the different hard tissue measures when compared to themselves.

Proposta para classificação, segundo a severidade, dos indivíduos portadores de más oclusões do Padrão Face Longa / Proposal for classification of individuals with long face pattern malocclusions according to severity

OBJETIVO: o presente estudo teve como objetivo propor um método para classificação, segundo a severidade, dos indivíduos Padrão Face Longa, avaliando sua confiabilidade e reprodutibilidade. METODOLOGIA: foram utilizadas fotografias faciais (frontal, perfil e frontal sorrindo) de 125 crianças Padrão Face Longa (54 do gênero feminino e 71 do gênero masculino), selecionadas apenas considerando-se a morfologia facial, com idades entre 10 anos e 6 meses e 15 anos e 2 meses. As fotografias foram avaliadas, separadamente, por três examinadores, sendo reavaliadas após três semanas, em uma nova disposição aleatória. Os indivíduos foram graduados em três subtipos, de acordo com a severidade: moderado, médio e severo. Para avaliar as concordâncias intra e interexaminadores, foi utilizada a estatística Kappa (k). RESULTADOS: na avaliação intra-examinador, todos os examinadores obtiveram concordâncias substanciais, com o valor de Kappa variando de 0,64 a 0,66, havendo em todos os examinadores 80 por cento ou mais de concordância. Quando comparadas as avaliações interexaminadores, as freqüências de concordância diminuíram, variando de 67,2 por cento a 70,4 por cento. A partir dos valores de Kappa, que variaram de 0,41 a 0,46, a interpretação foi considerada moderada. CONCLUSÕES: com base nesses resultados, o método foi considerado aplicável, com necessidade de complemento de informações provenientes de outros exames rotineiramente aplicados em Ortodontia. A aplicação clínica será demonstrada com intuito de evidenciar os níveis diferentes de severidade das más oclusões do Padrão Face Longa e as características do protocolo de tratamento recomendado.

AIM: The present study aimed to propose a method for classification of long-face patients according to severity, evaluating its reliability and reproducibility. METHODS: The study was conducted on facial photographs (frontal, profile and smiling frontal) of 125 long-face children (54 females and 71 males) aged 10 years and 6 months to 15 years and 2 months, selected only on the basis of facial morphology. The photographs were separately evaluated by three examiners and re-evaluated after three weeks in a different random order. The individuals were divided into three subtypes according to severity as mild, moderate and severe. Intra- and inter-examiner agreement was assessed by Kappa (k) statistics. RESULTS: Intra-examiner evaluation revealed substantial agreement, with Kappa values ranging from 0.64 to 0.66 and 80 percent or more agreement for all examiners. Evaluation of inter-examiner agreement revealed lower values, ranging from 67.2 percent to 70.4 percent, with Kappa values of 0.41 to 0.46, thus indicating moderate agreement. CONCLUSIONS: Based on these results, the method was regarded as applicable, yet it should be complemented with further information from other examinations routinely applied in Orthodontics. Clinical application will be demonstrated to highlight the different degrees of severity of long face pattern malocclusions and the characteristics of the recommended treatment protocol.