Soft-Tissue Analysis of Different Sagittal Skeletal Patterns Using the Geometric Morphometric Method.

OBJECTIVES: This study aimed to investigate the size and shape variations of soft-tissue patterns in different sagittal skeletal patterns using the geometric morphometrics method (GMM) obtained from lateral cephalograms. MATERIALS AND METHODS: This is a retrospective study, where the sample comprised of 188 Malaysian Malay subjects aged between 18 and 40 years and with different sagittal skeletal patterns. Overall, 71 males and 117 females were gathered for all size and shape analyses. This study incorporated 11 soft-tissue landmarks, which underwent landmark application using tpsDig2 software version 2.31, while the shape analysis was done using MorphoJ software version 1.07a. STATISTICAL ANALYSIS: Statistical analyses were performed using IBM SPSS Statistics 26. The result of the analysis of variance (ANOVA) test showed significant differences in some of the parameters between the landmarks. Length D, Length E, Length F, Length H, and Length I showed significant differences (p < 0.05), while other parameters showed no difference (p > 0.05). RESULTS: The shape variation of soft-tissue landmarks in different skeletal patterns existed in 18 different dimensions which showed by 18 principal components (PCs). Procrustes ANOVA and canonical variate analysis showed the size and shape differences of soft-tissue patterns between Class II and III and gender groups (p < 0.0001). In discriminant function analysis for Class II subjects, the classification accuracy was 98.4%, whereas subsequent to cross-validation, the classification accuracy was 90.6%. For Class III subjects, the classification accuracy was 96.6%, while after cross-validation, the classification accuracy was 90%. CONCLUSION: Different sagittal skeletal patterns demonstrated different soft-tissue shape variations. Class III showed the most protrusive upper and lower lips, while Class II demonstrated the most retrusive lower lip.

A geometric morphometric evaluation of facial hard tissue patterns.

OBJECTIVE: The purpose of this study was to investigate the size and shape variations of hard tissue patterns in different skeletal relations in Malaysian Malay subjects using the two-dimensional geometric morphometrics method. MATERIALS AND METHODS: A total of 188 lateral cephalograms of adult Malay subjects (aged between 18 and 40 years) with Class I, II, and III skeletal relations were collected. Ten two-dimensional hard tissue landmarks were applied on lateral cephalograms which underwent landmark application and shape analyses as Procrustes ANOVA analysis, principal component analysis, canonical variate analysis, and discriminant function analysis. Statistical analyses were performed to find the mean and variance of each landmark using one-way ANOVA. The raw data from shape analysis were used to calculate the link between landmarks. RESULTS: Skeletal relations showed 16 Principal Components which indicated that variances existed in 16 different dimensions. In Procrustes ANOVA, the Centroid size was significantly different in genders and skeletal relations (P < 0.01). Canonical variate analysis showed the highest Mahalanobis distances and Procrustes distances between Class II and III among skeletal relations and between gender groups (P < 0.0001). Discriminant function analysis showed the classification was mostly accurate, especially for Class II and Class III with success rates of 90.6% and 83.3%, respectively, after cross-validation. The statistical analysis showed significant differences (P < 0.05) in hard tissue landmarks. CONCLUSION: There were different ANB angles in different skeletal relations. The GMM could be used as an alternative tool for diagnosis and treatment planning for craniofacial shape evaluations for future orthodontists and maxillofacial surgeons.

Technique for Orthodontic Clinical Photographs Using a Smartphone.

Smartphone cameras have advanced at a rapid rate. With this advancement, it is possible to take high quality orthodontic clinical photographs using a smartphone. The aim of this article is to describe the technique to take orthodontic clinical photographs using a smartphone.

Effectiveness of microosteoperforations in accelerating alignment of maxillary anterior crowding in adults: A randomized controlled clinical trial.

INTRODUCTION: This trial aimed to investigate the effectiveness of microosteoperforations (MOPs) in overall time taken for alignment of maxillary anterior crowding and to evaluate the alignment improvement percentage within 6 months between MOPs and control groups. METHODS: Thirty adult participants (25 females and 5 males; mean age, 22.66 ± 3.27 years) with moderate upper labial segment crowding were randomly assigned into intervention and control groups using block randomization. All participants had first premolar extractions, bonded conventional fixed appliances, and 0.014-in, followed by 0.018-in nickel-titanium archwire placement for initial alignment. The intervention group received a 3-mm deep MOPs procedure under local anesthesia using a Propel device (Propel Ortho Singapore, Pte, Ltd, Winstedt Rd, Singapore) on the labial attached gingivae of maxillary incisors at monthly visits until complete alignment. Little's irregularity index was used to assess the overall changes and measure the change of tooth alignment of the 6 maxillary anterior teeth. Assessor blinding was employed. RESULTS: There was no statistically significant difference in the median overall alignment duration between MOPs and control groups (139 days [95% confidence interval, 115.32-161.83] vs 143 days [95% confidence interval, 107.12-179.74]; hazard ratio, 0.829; P = 0.467). The MOPs procedure had no significant effect on the alignment duration (P = 0.657) and no overall significant difference in alignment improvement percentage among 2 groups on the basis of time (F = 2.53; P = 0.124). No harm was encountered. CONCLUSIONS: The application of MOPs is no more effective in accelerating initial orthodontic alignment than conventional treatment. TRIAL REGISTRATION: This trial was registered at the ISRCTN registry with the study ID ISRCTN15080404. PROTOCOL: https://doi.org/10.1186/ISRCTN15080404. FUNDING: This work was supported by the Postgraduate Trust Fund, Faculty of Dentistry, Universiti Teknologi MARA.

Effect of micro-osteoperforations on external apical root resorption: A randomized controlled trial.

OBJECTIVE: This study aimed to investigate the effect of micro-osteoperforations (MOPs) on external apical root resorption (EARR) during the initial orthodontic alignment phase of maxillary anterior crowding. METHODS: Thirty patients (25 females, 5 males; mean age, 22.66 ± 3.27 years) who presented with moderate crowding of the upper labial segment and underwent extraction-based fixed appliance treatment were recruited. They were randomly allocated to receive adjunctive therapy with MOPs (n = 15) or treatment with fixed appliances only (control group; n = 15). EARR was measured from long-cone periapical radiographs taken at the start and the sixth month of treatment. A correction factor for the enlargement difference was used to calculate EARR. Data were analyzed with descriptive statistics and repeated-measures analysis of variance. RESULTS: The mean root lengths of 168 teeth were measured and showed no statistically significant difference (p > 0.05) after six months of fixed appliance treatment in the MOP (mean difference [MD] = 0.13 mm; 95% confidence interval [CI] = -0.10-0.35) and control group (MD = 0.14 mm; 95% CI = -0.10-0.37). Most of the roots in the MOP and control groups (42.86% and 52.38%, respectively) showed only mild resorption. Less than 8% of the roots in both groups (7.14% in the MOP group and 4.76% in the control group) showed moderate resorption. CONCLUSIONS: Acceleration of orthodontic tooth movement with adjunctive MOPs therapy during the alignment phase does not exacerbate EARR in patients with moderate crowding of the upper labial segment in comparison with controls.

Effects of scanning parameters reduction in dental radiographs on image quality and diagnostic performance: A randomised controlled trial.

OBJECTIVES: To investigate the effect of reducing scanning parameters of digital dental panoramic tomogram (DPT) and lateral cephalometric (LC) radiographs on quality and diagnostic performance of the images. DESIGN: Single-centre prospective two-arm parallel randomised controlled trial. SETTING: Orthodontic Clinic, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia. PARTICIPANTS: Adult orthodontic patients aged 18-35 years, indicated for DPT and LC, who were fit and healthy with a body mass index of 18.5-25.0, not contraindicated to radiographic examination, not pregnant, and did not have a history of facial or skeletal abnormalities or bone diseases were included. METHODS: Thirty-eight adult orthodontic patients were randomised into control and intervention groups. DPT and LC radiographs in the control group were obtained using standard scanning parameters as prescribed by the manufacturer using Orthopantomograph® OP300 by Instrumentarium. Scanning parameters in the intervention group were reduced by 60% for DPT (60 kV, 3.2 mA) and 30% for LC (85 kV, 8 mA). A five-point rating scale was used for the assessment of image quality. Images were evaluated for diagnostic performance by detection of anatomical landmarks. Mann-Whitney test was performed to compare the quality and diagnostic performance of the images and the observer agreement was assessed using the intraclass correlation coefficient (ICC). RESULTS: For image quality, the control group produced slightly lower median scores (DPT 2.0, LC 2.0) compared to the intervention group (DPT 2.0, LC 3.0). For diagnostic performance, both groups showed similar median scores (DPT 21.0, LC 32.0). The differences between control and intervention groups for both modalities were not statistically significant. The average scores for intra-observer agreement were excellent (ICC 0.917) and inter-observer agreement was good (ICC 0.822). CONCLUSION: Minimising radiation exposure by reducing scanning parameters on digital DPT by 60% and LC by 30% on Intsrumentarium 300 OP did not affect the quality and diagnostic performance of the images. Thus, scanning parameters on digital DPT and LC should be reduced when taking radiographs.

Pain experience with micro-osteoperforations during Initial orthodontic alignment: a randomized clinical trial / Experiencia de dolor con micro-osteoperforaciones durante la alineación ortodóncica inicial: un ensayo clínico aleatorizado

Objetive: The objective of this clinical trial was to investigate the perception of pain during initial maxillary alignment with an adjunctive procedure of micro-osteoperforations (MOPs) compared to conventional orthodontics. Material and methods: This study design was a single-centre, two-arm parallel prospective randomised clinical trial. Thirty consecutive adult subjects (25 females and 5 males; mean age ± SD, 22.66 ± 3.27 years) with 5-8mm moderate upper labial segment crowding were randomly allocated using block randomisation into intervention and control group. All subjects had first premolar extractions, bonded conventional fixed appliances and 0.014-inch nickel-titanium archwire was placed for initial alignment. The intervention group received a 3-mm deep MOPs procedure under local anaesthesia using a Propel device (PROPEL Ortho Singapore) on the labiogingival aspect between the maxillary incisors. Both groups received a set of 100 mm visual analogue scale to complete over the first week, recording pain at 24 hours, 3 days and 1 week. Data were analysed using repeated-measures analysis of variance (ANOVA). Results: There was a statistically significant difference observed in perceived pain levels between MOPs and the control group on day 1, day 3 and day 7 postoperatively. Pain perception was significantly lower in the intervention group at all time points. Conclusion: Accelerating orthodontic tooth movement with MOPs did not accentuate pain perceived during initial maxillary alignment with fixed appliances.

Objetivo: El objetivo de este ensayo clínico fue investigar la percepción del dolor durante la alineación maxilar inicial con un procedimiento adyuvante de micro-osteoperforaciones (MOP) en comparación con la ortodoncia convencional. Material y Métodos: El diseño de este estudio fue un ensayo clínico aleatorizado prospectivo paralelo de dos brazos y un solo centro. Treinta sujetos adultos consecutivos (25 mujeres y 5 hombres; edad media ± DE, 22,66 ± 3,27 años) con apiñamiento moderado del segmento labial superior de 5-8 mm se asignaron al azar mediante la asignación al azar en bloques en el grupo de intervención y de control. A todos los sujetos se les realizaron extracciones de los primeros premolares, se colocaron aparatos fijos convencionales adheridos y se colocó un arco de níquel-titanio de 0,014 pulgadas para la alineación inicial. El grupo de intervención recibió un procedimiento de MOP de 3 mm de profundidad bajo anestesia local utilizando un dispositivo Propel (PROPEL Ortho Singapore) en la cara labial de los incisivos superiores. Ambos grupos recibieron un conjunto de escala analógica visual de 100 mm para completar durante la primera semana, registrando el dolor a las 24 horas, 3 días y 1 semana. Los datos se analizaron mediante análisis de varianza de medidas repetidas (ANOVA). Resultados: Se observó una diferencia estadísticamente significativa en los niveles de dolor percibido entre los MOP y el grupo de control el día 1, el día 3 y el día 7 del postoperatorio. La percepción del dolor fue significativamente menor en el grupo de intervención en todos los momentos. Conclusión: La aceleración del movimiento dental de ortodoncia con MOP no acentuó el dolor percibido durante la alineación maxilar inicial con aparatos fijos.

Geometric morphometric analysis of malocclusion on lateral cephalograms in Malaysian population.

Geometric morphometrics is a new approach for shape identification in diagnosis of malocclusion. Lateral cephalogram is an X-ray that taken for diagnosing malocclusion in dental setting. The aim of this study was to determine the differences of craniofacial shape in malocclusion by application of two-dimensional geometric morphometrics and to compile the database of malocclusion in adult Malaysian population. Lateral cephalogram radiographs of 381 adults Malaysia (age 18-45) were retrieved retrospectively and assigned to three groups according to their occlusion: class I, class II, and class III. The geometric morphometric shape study incorporated nine landmarks and was analyzed in details using tpsUtil p software. Geometric morphometric analysis such was done using MorphoJ software. The results of the principal component's analysis (PCA) yielded 14 main components responsible for 100% of the variation exhibited by the malocclusion with three highly significant PCA. The highest Mahalanobis distances were exhibited by the malocclusion class II and III population. The Procrustes ANOVA showed that the shape effect was highly significant (P<0.01). The discriminant function analysis showed the high percentage of 80% discriminate among the malocclusions after cross-validation. There are significant differences for ANB angle (A point-Nasion-B point) in all malocclusion groups. Class II has the widest ANB angle while class III has the most acute ANB angle. Skeletal shape was clearly associated with dental malocclusion and showed considerable variation. Geometric morphometrics is an alternative research tool and can be used for diagnosing individual classification of malocclusion.

Nickel titanium springs versus stainless steel springs: A randomized clinical trial of two methods of space closure.

OBJECTIVE: To compare the clinical performance of nickel titanium (NiTi) versus stainless steel (SS) springs during orthodontic space closure. DESIGN: Two-centre parallel group randomized clinical trial. SETTING: Orthodontic Department University of Manchester Dental Hospital and Orthodontic Department Countess of Chester Hospital, United Kingdom. SUBJECTS AND METHODS: Forty orthodontic patients requiring fixed appliance treatment were enrolled, each being randomly allocated into either NiTi (n = 19) or SS groups (n = 21). Study models were constructed at the start of the space closure phase (T0) and following the completion of space closure (T1). The rate of space closure achieved for each patient was calculated by taking an average measurement from the tip of the canine to the mesiobuccal groove on the first permanent molar of each quadrant. RESULTS: The study was terminated early due to time constraints. Only 30 patients completed, 15 in each study group. There was no statistically significant difference between the amounts of space closed (mean difference 0.17 mm (95%CI -0.99 to 1.34; P = 0.76)). The mean rate of space closure for NiTi coil springs was 0.58 mm/4 weeks (SD 0.24) and 0.85 mm/4 weeks (SD 0.36) for the stainless steel springs. There was a statistically significant difference between the two groups (P = 0.024), in favour of the stainless steel springs, when the mean values per patient were compared. CONCLUSIONS: Our study shows that stainless steel springs are clinically effective; these springs produce as much space closure as their more expensive rivals, the NiTi springs.