Evaluation of the Quality and Reliability of YouTubeTM Videos Created by Orthodontists as an Information Source for Clear Aligners.

Objective: This study aimed to evaluate the quality, reliability, and content usefulness of videos created by orthodontists on clear orthodontic aligners. Methods: Videos were screened using YouTubeTM by conducting a search for "Invisalign". After a preliminary evaluation of the first 250 results, 61 videos that met the selection criteria were scored and their length, days since upload, and numbers of views, likes, dislikes, and comments were recorded. These data were used to calculate the interaction index and viewing rate. Video reliability was assessed using a five-item modified DISCERN index, and video quality was assessed using the Video Information and Quality Index. A 10-item content usefulness index was created to determine the usefulness of the video content. Descriptive statistics of the parameters were calculated, and correlation coefficients were calculated to evaluate the relationships between the parameters. Results: The mean reliability score was 2.75±1.02 (out of 5), and the total quality score was 11.80±3.38 (out of 20). The total content usefulness index was quite low, with a mean score of 2.52±2.14 (out of 10). Interaction index and viewing rate were positively correlated with reliability score (r=0.463, p<0.01; r=0.295, p<0.05) and total quality score (r=0.365, p<0.01; r=0.295, p<0.01, respectively). The reliability score was positively correlated with the total quality score (r=0.842, p<0.01) and total content usefulness index (r=0.346, p<0.01). Conclusion: Videos about orthodontic aligner treatment have average reliability and quality but largely insufficient content.

Using artificial intelligence models to evaluate envisaged points initially: A pilot study.

The morphology of the finger bones in hand-wrist radiographs (HWRs) can be considered as a radiological skeletal maturity indicator, along with the other indicators. This study aims to validate the anatomical landmarks envisaged to be used for classification of the morphology of the phalanges, by developing classical neural network (NN) classifiers based on a sub-dataset of 136 HWRs. A web-based tool was developed and 22 anatomical landmarks were labeled on four region of interests (proximal (PP3), medial (MP3), distal (DP3) phalanges of the third and medial phalanx (MP5) of the fifth finger) and the epiphysis-diaphysis relationships were saved as "narrow,""equal,""capping" or "fusion" by three observers. In each region, 18 ratios and 15 angles were extracted using anatomical points. The data set is analyzed by developing two NN classifiers, without (NN-1) and with (NN-2) the 5-fold cross-validation. The performance of the models was evaluated with percentage of agreement, Cohen's (cκ) and Weighted (wκ) Kappa coefficients, precision, recall, F1-score and accuracy (statistically significance: p < 0.05). Method error was found to be in the range of cκ: 0.7-1. Overall classification performance of the models was changed between 82.14% and 89.29%. On average, performance of the NN-1 and NN-2 models were found to be 85.71% and 85.52%, respectively. The cκ and wκ of the NN-1 model were changed between -0.08 (p > 0.05) and 0.91 among regions. The average performance was found to be promising except the regions without adequate samples and the anatomical points are validated to be used in the future studies, initially.

Effect of different resin removal methods on enamel after metal and ceramic bracket debonding : An in vitro micro-computed tomography study.

PURPOSE: The aim of this study was to conduct an in vitro evaluation of the effects of different adhesive debonding and polishing techniques performed after metal and ceramic bracket removal on enamel using micro-computed tomography (micro-CT). METHODS: This study was performed on 42 extracted maxillary first premolars divided into 2 main groups and 6 subgroups as follows: metal (group 1) or ceramic (group 2) brackets were bonded to the teeth, then, after debonding, one of three different methods was used to remove the residual adhesive: tungsten carbide burs with pumice (A), fiber-reinforced composite burs and polishing paste (B), or Sof-Lex discs (C; 3M Dental, St Paul, MN, USA). The samples were evaluated by micro-CT before bracket bonding (T0) and after resin removal (T1). Demineralization area, demineralization depth, demineralization volume, mineral density, and mineral volume were measured. RESULTS: At T1, demineralization area was significantly larger in groups 1A and 2A compared to groups 1B, 1C, 2B, and 2C (P = 0.001). Group 2A (ceramic bracket/tungsten carbide-pumice) had the highest demineralization volume (P = 0.001). When the groups were compared in terms of change from T0 to T1, groups 1A and 2A showed significantly larger changes in demineralization area compared to the other 4 groups (P = 0.001). The increase in demineralization volume was larger in group 2A compared to all other groups (P = 0.001). CONCLUSION: All resin removal methods damaged the enamel surface to varying degrees. Regardless of bracket type, the use of tungsten carbide and pumice should be avoided when cleaning the tooth surface after debonding. Use of composite burs and Sof-Lex discs in particular after the debonding of ceramic brackets will help minimize damage.

Evaluating the effects of functional orthodontic treatment on mandibular osseous structure using fractal dimension analysis of dental panoramic radiographs.

OBJECTIVE: To evaluate the effects of functional appliance treatment on mandibular trabecular structure using fractal dimension (FD) analysis of dental panoramic radiographs. MATERIALS AND METHODS: This study was conducted using digital panoramic radiographs of 45 patients with Class II malocclusion treated with functional appliances (treatment group, mean age: 11.39 ± 0.97 years; 23 girls, 22 boys) acquired before (T0) and after (T1) treatment and the panoramic radiographs of 45 control subjects who had undergone no orthodontic treatment (control group, mean age: 11.31 ± 0.87 years; 23 girls, 22 boys). FD values in the condylar process, mandibular corpus, and mandibular angle were analyzed from the panoramic radiographs of both groups. RESULTS: Analysis of changes in FD between T0 and T1 revealed significant increases in the FD values of the right and left condylar processes and right mandibular corpus in the treatment group (P < .001) and in the right condylar process in the control group (P < .05). Between-group comparisons demonstrated that the treatment group showed greater changes in the condylar process (right, P < .001; left, P < .05) and right mandibular corpus (P < .05) compared to controls. Correlation analysis between the cephalometric and FD changes in the treatment group showed the right condylar process changes were negatively correlated with GoGn/SN angle (P < .05) and positively correlated with Co-Go (P < .05), although these correlations were weak. CONCLUSIONS: FD analysis demonstrated significant changes in trabeculation of the condyle and mandibular corpus in the treatment group compared to the control group. Functional appliance treatment may lead to skeletal correction by altering skeletal form and trabeculation of the mandibular bone.

Cone beam computed tomography evaluation of the relationship between atlantodental interval and skeletal facial morphology in adolescents / Avaliação por tomografia computadorizada de feixe cônico da relação entre o intervalo atlantodental e a morfologia esquelética facial em adolescentes

Abstract Introduction: In the pediatric population, computed tomography examination of the upper cervical spine plays an important role in the diagnosis of neurological injuries involving that region. Due to the interconnected nature of the craniofacial structures, a structural change in one is expected to also cause changes in the other structures. Objective: The aim of this study was to evaluate relationships between atlantodental interval, cervical vertebral morphology, and facial structure in healthy adolescents using cone beam computed tomography. Methods: Thirty subjects aged 14-20 years (10 males, mean age: 17.2 years; 20 females, mean age: 17.9 years) were included in the study. The anterior, lateral and posterior atlantodental intervals, and vertical and anteroposterior dimensions of the first and second cervical vertebrae were evaluated from cone beam computed tomography images. Facial morphology was evaluated using 7 parameters on lateral cephalometric cone beam computed tomography images and 6 parameters on posteroanterior images. The Mann-Whitney U test and Wilcoxon test were used for statistical analyses. Results: Comparisons between males and females showed that most parameters were larger in males, with significant differences in vertical facial dimensions (anterior lower face height: p= 0.05; anterior upper face height: p= 0.001), (distance between the most internal point of the frontozygomatic suture and midsagittal reference plane; p= 0.01), (the distance between the deepest point of the right alveolar maxillar process and midsagittal reference plane; p= 0.001), and C2 vertebral dimensions. The anterior and lateral atlantodental interval values correlated with maxilla position relative to the mandible angle, and the anterior atlantodental interval correlated with lower anterior facial height (p= 0.05). Dimensional measurements of the C1 and C2 vertebrae were correlated with both anterior facial heights and some posteroanterior parameters. Conclusion: Sagittal, vertical, and transverse facial dimensions and positions were strongly associated with C1 and C2 vertebral dimensions, and the maxillomandibular relationship may affect atlantodental interval. Therefore, including craniofacial features in assessment of the atlantodental area and vertebral distances in adolescents may be beneficial.

Resumo Introdução: Na população pediátrica, a tomografia computadorizada da coluna cervical alta tem um importante papel no diagnóstico de lesões neurológicas que envolvem essa região. Devido à natureza interconectada das estruturas craniofaciais, espera-se que uma mudança estrutural em uma delas também cause alterações nas outras estruturas. Objetivo: Avaliar as relações entre o intervalo atlantodental, a morfologia vertebral cervical e a estrutura facial em adolescentes saudáveis com a tomografia computadorizada de feixe cônico. Método: Trinta indivíduos entre 14 e 20 anos (10 homens, média de 17,2 anos; 20 mulheres, média de 17,9 anos) foram incluídos no estudo. O intervalo atlantodental anterior, lateral e posterior e as dimensões vertical e anteroposterior da primeira e segunda vértebras cervicais foram avaliados a partir de imagens de tomografia computadorizada de feixe cônico. A morfologia facial foi avaliada utilizando-se sete parâmetros em imagens de tomografia computadorizada de feixe cônico cefalométricas laterais e seis parâmetros em imagens posteroanteriores. O teste U de Mann-Whitney e o teste de Wilcoxon foram utilizados para as análises estatísticas. Resultados: As comparações entre homens e mulheres mostraram que em sua maioria os parâmetros foram maiores no sexo masculino, com diferenças significantes nas dimensões faciais verticais (altura facial anterior inferior: p = 0,05; altura facial anterior superior: p = 0,001), distância entre o ponto mais interno da sutura fronto-zigomática e plano de referência médio-sagital; p = 0,01distância entre o ponto mais profundo do processo alveolar do maxilar direito e o plano de referência médio-sagital; p = 0,001) e as dimensões do corpo vertebral C2. O intervalo atlantodental anterior e lateral correlacionaram-se com o ângulo da posição da maxila em relação à mandíbula e o intervalo atlantodental anterior correlacionou-se com altura facial anterior inferior (p = 0,05). Medidas das dimensões das vértebras C1 e C2 foram correlacionadas com as alturas faciais anteriores e alguns parâmetros póstero-anteriores. Conclusão: As dimensões e posições faciais sagitais, verticais e transversais foram fortemente associadas às dimensões dos corpos vertebrais C1 e C2 e a relação maxilomandibular pode afetar o intervalo atlantodental. Portanto, incluir características craniofaciais na avaliação da área atlantodental e das distâncias vertebrais em adolescentes pode ser benéfico.

Validation of cervical vertebral maturation stages: Artificial intelligence vs human observer visual analysis.

INTRODUCTION: This study aimed to develop an artificial neural network (ANN) model for cervical vertebral maturation (CVM) analysis and validate the model's output with the results of human observers. METHODS: A total of 647 lateral cephalograms were selected from patients with 10-30 years of chronological age (mean ± standard deviation, 15.36 ± 4.13 years). New software with a decision support system was developed for manual labeling of the dataset. A total of 26 points were marked on each radiograph. The CVM stages were saved on the basis of the final decision of the observer. Fifty-four image features were saved in text format. A new subset of 72 radiographs was created according to the classification result, and these 72 radiographs were visually evaluated by 4 observers. Weighted kappa (wκ) and Cohen's kappa (cκ) coefficients and percentage agreement were calculated to evaluate the compatibility of the results. RESULTS: Intraobserver agreement ranges were as follows: wκ = 0.92-0.98, cκ = 0.65-0.85, and 70.8%-87.5%. Interobserver agreement ranges were as follows: wκ = 0.76-0.92, cκ = 0.4-0.65, and 50%-72.2%. Agreement between the ANN model and observers 1, 2, 3, and 4 were as follows: wκ = 0.85 (cκ = 0.52, 59.7%), wκ = 0.8 (cκ = 0.4, 50%), wκ = 0.87 (cκ = 0.55, 62.5%), and wκ = 0.91 (cκ = 0.53, 61.1%), respectively (P <0.001). An average of 58.3% agreement was observed between the ANN model and the human observers. CONCLUSIONS: This study demonstrated that the developed ANN model performed close to, if not better than, human observers in CVM analysis. By generating new algorithms, automatic classification of CVM with artificial intelligence may replace conventional evaluation methods used in the future.

Evaluation of Maxillofacial Characteristics in Individuals with Anterior Open Bite Using Denture Frame Analysis.

KEYWORDS: The aim of this study was to evaluate the effectiveness of denture frame analysis (DFA) in individuals with anterior open bite who had completed pubertal peak growth (post-peak). METHODS: This retrospective study was conducted using the cephalometric radiographs and hand-wrist X-rays of 50 individuals with open bite (mean age: 17.33±3 years; 35 female, 15 male) and a control group of 50 individuals without open bite (mean age: 17.38±2.72; 35 female, 15 male). All individuals included in the study were skeletal Class I and had completed or nearly completed skeletal growth. Skeletal and dental measurements pertaining to DFA were done and the data were analyzed using independent samples t test and Mann-Whitney U test. RESULTS: Measurements assessing the vertical dimension showed that GoGn/SN, Frankfurt horizontal (FH)/mandibular plane (MP), palatal plane (PP)/MP, occlusal plane (OP)/MP, and OP-MP/PP-MP measurements were significantly greater in the open bite group (p<0.001). AB/MP angle was significantly larger in the control group (p<0.05). The open bite group had shorter A'-P' (posterior maxillary length; p<0.05) and, therefore, higher A'-6'/A'-P' ratio (p<0.01). CONCLUSION: Our results suggest that there may be a close association between maxillary OP inclination and mandibular position in individuals with open bite, and that open bite may arise due to maxillary denture base deficiency, especially in the posterior region. DFA may be useful in the differential diagnosis of open bite and in treatment planning, particularly when determining the need for tooth extraction.

Evaluation of Dental Age in Individuals of Different Ages with Unilateral Cleft Lip and Palate.

OBJECTIVE: This study aimed to evaluate the dental age of unilateral cleft lip and palate (UCLP) patients aged 7-12 and 12-16 years using Demirjian's method and to compare these results with a control group. METHODS: We evaluated the panoramic radiographs of 54 individuals with UCLP and 54 age- and gender-matched individuals without UCLP (control). The UCLP and control groups were divided into two groups: 7-12 and 12-16 years of age. Their dental ages were determined using Demirjian's method. Dental ages of the cleft side and noncleft side were assessed separately and were also compared with those of the control group to assess potential asymmetric dental developments in the UCLP group. RESULTS: The chronological age was lower than the dental ages on both right and left sides in the control group (p<0.01). When age groups were evaluated separately, it was found that the chronological age was lower than the dental age in 7-12 year old individuals in the UCLP group (p<0.05), whereas it was less than the left and right dental ages in 7-12 (p<0.01) and 12-16 year old individuals (p<0.05) in the control group. CONCLUSION: We detected no differences in dental age between UCLP patients and healthy controls, and lack of asymmetrical dental development in the mandibular teeth of either group. However, based on assessments performed using Demirjian's method, subjects' dental and chronological ages were incompatible.

Cone beam computed tomography evaluation of the relationship between atlantodental interval and skeletal facial morphology in adolescents.

INTRODUCTION: In the pediatric population, computed tomography examination of the upper cervical spine plays an important role in the diagnosis of neurological injuries involving that region. Due to the interconnected nature of the craniofacial structures, a structural change in one is expected to also cause changes in the other structures. OBJECTIVE: The aim of this study was to evaluate relationships between atlantodental interval, cervical vertebral morphology, and facial structure in healthy adolescents using cone beam computed tomography. METHODS: Thirty subjects aged 14-20 years (10 males, mean age: 17.2 years; 20 females, mean age: 17.9 years) were included in the study. The anterior, lateral and posterior atlantodental intervals, and vertical and anteroposterior dimensions of the first and second cervical vertebrae were evaluated from cone beam computed tomography images. Facial morphology was evaluated using 7 parameters on lateral cephalometric cone beam computed tomography images and 6 parameters on posteroanterior images. The Mann-Whitney U test and Wilcoxon test were used for statistical analyses. RESULTS: Comparisons between males and females showed that most parameters were larger in males, with significant differences in vertical facial dimensions (anterior lower face height: p = 0.05; anterior upper face height: p = 0.001), (distance between the most internal point of the frontozygomatic suture and midsagittal reference plane; p = 0.01), (the distance between the deepest point of the right alveolar maxillar process and midsagittal reference plane; p = 0.001), and C2 vertebral dimensions. The anterior and lateral atlantodental interval values correlated with maxilla position relative to the mandible angle, and the anterior atlantodental interval correlated with lower anterior facial height (p = 0.05). Dimensional measurements of the C1 and C2 vertebrae were correlated with both anterior facial heights and some posteroanterior parameters. CONCLUSION: Sagittal, vertical, and transverse facial dimensions and positions were strongly associated with C1 and C2 vertebral dimensions, and the maxillomandibular relationship may affect atlantodental interval. Therefore, including craniofacial features in assessment of the atlantodental area and vertebral distances in adolescents may be beneficial.

Effects of wear time differences of removable functional appliances in class II patients: prospective MRI study of TMJ and masticatory muscle changes.

OBJECTIVES: The aim of this prospective study was to evaluate the short-term effects of full-time and night-time wear of functional appliances on the temporomandibular joint (TMJ) and masticatory muscles and to compare the differences in craniofacial structures, TMJ, and masticatory muscles with magnetic resonance imaging (MRI). METHODS: The study was carried out using cephalometric radiographs and MRI of 20 Class II patients who were treated with monoblock/twin-block appliances. The patients were divided into 2 groups: ten patients in Group 1 used their appliances all day, while ten patients in Group 2 were instructed to wear the appliances during sleep. After at least 6 months of uninterrupted treatment, post-treatment cephalograms and MRI were obtained for patients whose molar relationship improved by at least a half cusp width. Signal intensity ratios (SIR) of TMJ structures and morphological evaluations of masticatory muscles were done for all patients. RESULTS: It was found a significant increase in SIR values of the condylar process, articular disc, retrodiscal tissue, and masticatory muscles for all treatment groups. Length of the masseter and medial pterygoid muscles increased to varying degrees which left side of Group 2 was significantly increased (P < 0.05). The volume of all muscles also increased to varying degrees. CONCLUSIONS: The cephalometric and MRI findings of this study show that the treatment effects were similar for both wear schedules.

Is It Possible to Protract the Maxilla by Surgically Assisted Rapid Maxillary Expansion and Intermaxillary Class III Elastics?

OBJECTIVE: The purpose of the present study was to evaluate skeletal and soft tissue changes with surgically assisted rapid maxillary expansion (SARME) and intermaxillary Class III elastics. METHODS: A total of 15 patients (mean age: 19.58 years) were included in the study. Each patient underwent SARME with the use of Class III elastics (500 g) applied through miniscrews to stimulate maxillary advancement. Lateral cephalograms and posteroanterior radiographs obtained before treatment (T1), after SARME and elastic use (T2), and after treatment (T3) were analyzed to determine the changes in each phase of treatment. Planimeter was used to evaluate facial soft tissue changes. Wilcoxon signed-rank test was used to evaluate the changes that occur during treatment. RESULTS: SARME provided permanent and efficient maxillary expansion at both skeletal and dental levels (p<0.01). Maxillary skeletal (ANS-Ver and U1i-Ver; p<0.01) and soft tissue (Pr-Ver, Sn-Ver, and ULA-Ver; p<0.01) variables and superior upper labial area (Area 1; p<0.05) increased due to maxillary dental and skeletal changes. Superior lower labial area (Area 3; p<0.05) decreased as a result of slight increase in facial height and changes in maxillary-mandibular incisor relationship at the end of the treatment. CONCLUSION: The results suggest that the improvement in the facial profiles of the patients is related to the significant increase in the bony and dental support of the upper lip region together with the contribution of the superior lower lip area.

Evaluation of temporomandibular joint, masticatory muscle, and brain cortex activity in patients treated by removable functional appliances: a prospective fMRI study.

OBJECTIVES: The aim of this study is to evaluate the effects of functional orthodontic appliances on the masticatory muscles, temporomandibular joint (TMJ), and brain to determine whether using functional appliances full-time or only at night yields different results. METHODS: 16 patients with Class II malocclusion were included in this study. Eight patients were instructed to wear their appliances (monoblock/twinblock) full-time and the other eight patients were instructed to wear them at night while sleeping. An additional 10 patients with Class II malocclusion were later included as a pre-treatment control group. Signal intensity ratios (SIR) of TMJ structures and morphological evaluations of the masticatory muscles were done for all patients. Functional MRI (fMRI) data were also obtained from the patients while performing chewing and biting movements. RESULTS: ANB angle was reduced significantly in both the full-time and night wear groups, by values of 1.17° and 1.35°, respectively (p < 0.05). MRI showed that SIRs were significantly increased in both groups in the masticatory muscles, retrodiscal pad, condylar process, and articular disc (p < 0.05). Both resting and task-based fMRI evaluation revealed significant increases in blood oxygen level dependent signals in several regions of the brain in both groups (p < 0.05). CONCLUSIONS: The cephalometric and MRI findings of this study indicate that the treatment effects were similar for both wear schedules. Functional appliances should be regarded not as simple devices that treat Class II malocclusion through skeletal and dental correction alone, but as exercise devices that lead to neuromuscular changes by facilitating muscle adaptation and activating various brain regions.