Mandibular advancement device in obstructive sleep apnea treatment: what happens to the condyle position and patient response?

BACKGROUND: This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS: 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS: The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION: MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

Anthropometric measures and obstructive sleep apnea in children and adolescents: a systematic review of the literature and meta-analysis.

BACKGROUND: Anthropometric measurements can be used to identify children at risk of developing obstructive sleep apnea (OSA). The study aimed to assess which anthropometric measurements (AMs) are most associated with an increased predisposition to develop OSA in healthy children and adolescents. METHODS: We performed a systematic review (PROSPERO #CRD42022310572) that searched eight databases and gray literature. RESULTS: In eight studies with low-to-high risk of bias, investigators reported the following AMs: body mass index (BMI), neck circumference, hip circumference, waist-to-hip ratio, neck-to-waist ratio, waist circumference, waist-to-height ratio, and facial AMs. The meta-analysis showed that the OSA group had an average of 1.00 cm greater for the neck circumference (p < 0.001; Cohen's d = 2.26 [0.72, 5.23]), 3.07 cm greater for the waist circumference (p = 0.030; Cohen's d = 0.28 [0.02, 0.53]), 3.96 cm greater for the hip circumference (p = 0.040; Cohen's d = 0.28 [0.02, 0.55]), 5.21° greater for the cervicomental angle (p = 0.020; Cohen's d = 0.31 [0.03, 0.59]), and 1.23° greater for maxillary-mandibular relationship angle (p < 0.001; Cohen's d = 0.47 [0.22, 0.72]) than the control group. The mandibular depth angle had a reduction of 1.86° (p = 0.001; Cohen's d = -0.36° [-0.65, -0.08]) in control than in patients with OSA. The BMI (p = 0.180), waist-to-hip ratio (p = 0.280), neck-to-waist ratio (p = 0.070), maxillary depth angle (p = 0.250), and upper/lower face height ratio (p = 0.070) showed no significant differences between groups. CONCLUSIONS: Compared to the control group, the OSA group exhibited a greater mean difference in neck circumference, the only anthropometric measurement with high certainty of evidence.

3D analysis of maxillomandibular morphology in hyperdivergent and hypodivergent individuals: A cross-sectional study.

INTRODUCTION: The aim of this cross-sectional study was to investigate maxillomandibular morphology in hyperdivergent and hypodivergent individuals, using 3D surface models generated by cone-beam computed tomography (CBCT). METHODS: The sample consisted of 60 CBCTs (30 males, 30 females) patients aged 12-30 years, divided into two groups comprising hyperdivergent (≥35°) and hypodivergent (≤30°) individuals, according to the mandibular plane (MP) angle. Multiplanar reconstructions were used to mark the landmarks, and 3D surface models were created to evaluate structures of the maxillomandibular complex, including condyle, ramus, symphysis and palatal height. Intergroup comparisons were performed by independent t-test. Pearson's correlation test was used (P < .05) to evaluate the correlation of the MP angle with the angles and linear measurements of other structures. RESULTS: Significant differences were found between the groups regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. No differences (P > .05) were found for the condylar height, symphysis inclination angle or palatal height. Correlations (P < .05) were found between the MP angle and structures of the maxillomandibular complex. CONCLUSIONS: Hyperdivergent (MP ≥ 35°) and hypodivergent (MP ≤ 30°) individuals present different skeletal morphology regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. There is a significant correlation between MP angle and morphological structures such as condyle, ramus, symphysis, palatal plane angle and palatal-mandibular angle.

Methodological parameters for upper airway assessment by cone-beam computed tomography in adults with obstructive sleep apnea: a systematic review of the literature and meta-analysis.

BACKGROUND: A reliable method for analyzing the upper airway (UA) remains a challenge. This study aimed to report the methods for UA assessment using cone-beam computed tomography (CBCT) in adults with obstructive sleep apnea (OSA). METHODS: We performed a systematic review (PROSPERO #CRD42021237490 and PRISMA checklist) that applied a search strategy to seven databases and grey literature. RESULTS: In 29 studies with moderate-to-high risk of bias, investigators mostly reported the body position during CBCT (upright or supine) and hard tissue references, diverging in UA delimitation and terminologies. The meta-analysis showed two subgroups (upright and supine), and no statistical differences were identified (p = 0.18) considering the UA area. The volume in the OSA group was smaller than that in the control group (p < 0.003 and Cohen's d = - 0.81) in the upright position. Patients with OSA showed smaller anteroposterior dimensions than the control group and were not affected by the position during image acquisition (p = 0.02; Cohen's d = - 0.52). The lateral measurements were also lower in the OSA group (supine) (p = 0.002; Cohen's d = - 0.6). CONCLUSIONS: Patients with OSA showed smaller UA measurements in the upright (volume) and supine (lateral dimension) positions. The anteroposterior dimension was also reduced in patients with OSA compared to the control group, regardless of the position during CBCT acquisition.

Temporomandibular joint articular disc position and shape in skeletal Class III.

OBJECTIVE: To compare the position and shape of the temporomandibular joint (TMJ) articular disc among the sagittal and vertical skeletal patterns in Angle Class III, Class III subdivision malocclusion and normal occlusion. The null hypothesis was that there was no difference in disc position and shape in different (1) malocclusions and (2) skeletal patterns. METHODS: This cross-sectional observational study evaluated 105 patients divided into 3 groups: Class III (33, 9.39 ± 1.96 years), Class III subdivision (45, 9.51 ± 1.59 years) and a normal occlusion (27, 10.24 ± 0.87 years) was included as healthy control. Severity of the maxilla-mandibular anteroposterior discrepancy and vertical facial pattern were determined using 2D cephalometry, and the position and shape of the articular discs were evaluated in magnetic resonance images. Statistical parametric and non-parametric tests and Kappa analysis for intra-observer and inter-observer assessment were used (p ≤ .05). RESULTS: Significant between-group differences were found in articular disc position. In the normal occlusion group, all the articular discs were well positioned. In Class III and Class III subdivision, the discs were displaced in 30.3% and 12.2% of the TMJs, respectively. Sagittal and vertical skeletal patterns did not affect the findings significantly. The Class III subdivision malocclusion group is probably different from the other groups, showing 97.7% of biconcave discs in both TMJs. CONCLUSION: The longitudinal follow-up of this sample becomes relevant as the two groups with malocclusion in the pre-peak phase of pubertal growth showed differences in the prevalence of displacement and form of the articular disc, with no association with their vertical facial characteristics.

Accuracy of artificial intelligence for tooth extraction decision-making in orthodontics: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to analyze the accuracy of artificial intelligence (AI) for orthodontic tooth extraction decision-making. MATERIALS AND METHODS: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, Computers & Applied Science, ACM Digital Library, Compendex, and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Three independent reviewers selected the studies and extracted and analyzed the data. Risk of bias, methodological quality, and certainty of evidence were assessed by QUADAS-2, checklist for AI research, and GRADE, respectively. RESULTS: The search identified 1810 studies. After 2 phases of selection, six studies were included, showing an unclear risk of bias of patient selection. Two studies showed a high risk of bias in the index test, while two others presented an unclear risk of bias in the diagnostic test. Data were pooled in a random model and yielded an accuracy value of 0.87 (95% CI = 0.75-0.96) for all studies, 0.89 (95% CI = 0.70-1.00) for multilayer perceptron, and 0.88 (95% CI = 0.73-0.98) for back propagation models. Sensitivity, specificity, and area under the curve of the multilayer perceptron model yielded 0.84 (95% CI = 0.58-1.00), 0.89 (95% CI = 0.74-0.98), and 0.92 (95% CI = 0.72-1.00) scores, respectively. Sagittal discrepancy, upper crowding, and protrusion showed the highest ranks weighted in the models. CONCLUSIONS: Orthodontic tooth extraction decision-making using AI presented promising accuracy but should be considered with caution due to the very low certainty of evidence. CLINICAL RELEVANCE: AI models for tooth extraction decision in orthodontics cannot yet be considered a substitute for a final human decision.

Prevalence of mandibular asymmetry in different skeletal sagittal patterns.

OBJECTIVES: To analyze the prevalence of mandibular asymmetry in skeletal sagittal malocclusions. MATERIALS AND METHODS: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Two independent investigators selected the eligible studies, and assessed risk of bias and certainty of evidence (GRADE). One reviewer independently extracted the data and the second reviewer checked this information. Any disagreement between the reviewers in each phase was resolved by discussion between them and/or involved a third reviewer for final decision. RESULTS: Electronic search identified 5,132 studies, and 5 observational studies were included. Risk of bias was low in two studies, moderate in one, and high in two. The studies showed high heterogeneity. Mandibular asymmetry ranged from 17.43% to 72.95% in overall samples. Horizontal chin deviation showed a prevalence of 17.66% to 55.6% asymmetry in Class I malocclusions, and 68.98% in vertical asymmetry index. In Class II patients, prevalence of mandibular asymmetry varied from 10% to 25.5% in horizontal chin deviation, and 71.7% in vertical asymmetry index. The Class III sample showed a prevalence of mandibular asymmetry ranging from 22.93% to 78% in horizontal chin deviation and 80.4% in vertical asymmetry index. Patients seeking orthodontic or orthognathic surgery treatment showed greater prevalence of mandibular asymmetry. CONCLUSIONS: Skeletal Class III malocclusion showed the greatest prevalence of mandibular asymmetry. Mandibular vertical asymmetry showed a marked prevalence in all malocclusions. However, conclusions should be interpreted with caution due to use of convenience samples and low-quality study outcomes.

Orthodontists' criteria for prescribing cone-beam computed tomography-a multi-country survey.

OBJECTIVES: This study aimed to describe and compare CBCT imaging prescription in clinical practice among orthodontists from five countries in Europe and America. Additionally, it investigated factors associated with the prescribing and the use of guidelines for CBCT imaging. MATERIALS AND METHODS: A cross-sectional survey was carried out using an online questionnaire sent to all registered orthodontists in Belgium, Brazil, Canada, Romania, and the United States of America (USA). The data were analyzed by descriptive statistics, bivariate tests, and Poisson regression. RESULTS: The final sample consisted of 1284 participants. CBCT was prescribed by 84.4% of the participants for selected cases (84.9%), mainly for impacted teeth (92.4%), presurgical planning (54.1%), and root resorption (51.9%). High cost was most frequently the limiting factor for CBCT prescription (55.4%). Only 45.2% of those who were using CBCT imaging reported adhering to guidelines. CBCT imaging prescription was associated with the orthodontists' countries (p < .009, except for Belgium, p = .068), while the use of guidelines was associated with the respondents' country and additional training on CBCT imaging (p < .001). CONCLUSIONS: Orthodontists refer patients for CBCT for selected indications (impacted teeth, root resorption, presurgical planning, dentofacial deformities, as suggested by the international guidelines, and also for upper airway and temporomandibular joint evaluation). Many do not adhere to specific guidelines. There are substantial variations between the countries about the orthodontists' referral for CBCT and guideline usage, irrespective of gender. CBCT prescription may be limited by financial barriers, adhering to specific guidelines and prior CBCT training. CLINICAL RELEVANCE: CBCT prescription among orthodontists must be based on prescription criteria and current guidelines. It is advised to improve CBCT education and training to enhance CBCT selection, referral, analysis, and interpretation in orthodontic practice.

Radiographic interpretation using high-resolution Cbct to diagnose degenerative temporomandibular joint disease.

The objective of this study was to use high-resolution cone-beam computed images (hr- CBCT) to diagnose degenerative joint disease in asymptomatic and symptomatic subjects using the Diagnostic Criteria for Temporomandibular Disorders DC/TMD imaging criteria. This observational study comprised of 92 subjects age-sex matched and divided into two groups: clinical degenerative joint disease (c-DJD, n = 46) and asymptomatic control group (n = 46). Clinical assessment of the DJD and high-resolution CBCT images (isotropic voxel size of 0.08mm) of the temporomandibular joints were performed for each participant. An American Board of Oral and Maxillofacial Radiology certified radiologist and a maxillofacial radiologist used the DC/TMD imaging criteria to evaluate the radiographic findings, followed by a consensus of the radiographic evaluation. The two radiologists presented a high agreement (Cohen's Kappa ranging from 0.80 to 0.87) for all radiographic findings (osteophyte, erosion, cysts, flattening, and sclerosis). Five patients from the c- DJD group did not present radiographic findings, being then classified as arthralgia. In the asymptomatic control group, 82.6% of the patients presented radiographic findings determinant of DJD and were then classified as osteoarthrosis or overdiagnosis. In conclusion, our results showed a high number of radiographic findings in the asymptomatic control group, and for this reason, we suggest that there is a need for additional imaging criteria to classify DJD properly in hr-CBCT images.

Directions of mandibular canal displacement in ameloblastoma: A computed tomography mirrored-method analysis.

PURPOSE: This study was performed to investigate mandibular canal displacement in patients with ameloblastoma using a 3-dimensional mirrored-model analysis. MATERIALS AND METHODS: The sample consisted of computed tomographic scans of patients with ameloblastoma (n=10) and healthy controls (n=20). The amount of mandibular canal asymmetry was recorded as a continuous variable, while the buccolingual (yaw) and supero-inferior (pitch) directions of displacement were classified as categorical variables. The t-test for independent samples and the Fisher exact test were used to compare groups in terms of differences between sides and the presence of asymmetric inclinations, respectively (P<0.05). RESULTS: The length of the mandibular canal was similar on both sides in both groups. The ameloblastoma group presented more lateral (2.40±4.16 mm) and inferior (-1.97±1.92 mm) positions of the mental foramen, and a more buccal (1.09±2.75 mm) position of the middle canal point on the lesion side. Displacement of the mandibular canal tended to be found in the anterior region in patients with ameloblastoma, occurring toward the buccal and inferior directions in 60% and 70% of ameloblastoma patients, respectively. CONCLUSION: Mandibular canal displacement due to ameloblastoma could be detected by this superimposed mirrored method, and displacement was more prevalent toward the inferior and buccal directions. This displacement affected the mental foramen position, but did not lead to a change in the length of the mandibular canal. The control group presented no mandibular canal displacement.

Three-dimensional evaluation of dental decompensation and mandibular symphysis remodeling on orthodontic-surgical treatment of Class III malocclusion.

INTRODUCTION: The purposes of this research were to identify the buccolingual inclinations of the mandibular teeth and the mandibular symphysis remodeling that result from the orthodontic decompensation movement. METHODS: The sample consisted of 30 adults with Class III dentofacial deformity, who had presurgical orthodontic treatment. Three-dimensional images were generated by cone-beam computed tomography scans at 2 different times (initial and before orthognathic surgery). Three-dimensional virtual models were obtained and superimposed using automated voxel-based registration at the mandible to evaluate B-point displacement, mandibular molar and incisor decompensation movement, and symphysis inclination and thickness. The 3-dimensional displacements of landmarks at the symphysis were quantified and visualized with color-coded maps using 3D Slicer (version 4.0; www.slicer.org) software. RESULTS: The measurements showed high reproducibility. The patients presented mandibular incisor proclination, which was consistent with the movement of tooth decompensation caused by the presurgical orthodontic treatment. Statistically significant correlations were found between the inclination of the mandibular incisors, symphysis inclination, and B-point displacement. Regarding the thickness of the symphysis and the inclination of the incisors, no statistically significant correlation was found. CONCLUSIONS: The buccolingual orthodontic movement of the mandibular incisors with presurgical leveling is correlated with the inclination of the mandibular symphysis and repositioning of the B-point but not correlated to the thickness of the symphysis.

Osteoarthritis of the Temporomandibular Joint can be diagnosed earlier using biomarkers and machine learning.

After chronic low back pain, Temporomandibular Joint (TMJ) disorders are the second most common musculoskeletal condition affecting 5 to 12% of the population, with an annual health cost estimated at $4 billion. Chronic disability in TMJ osteoarthritis (OA) increases with aging, and the main goal is to diagnosis before morphological degeneration occurs. Here, we address this challenge using advanced data science to capture, process and analyze 52 clinical, biological and high-resolution CBCT (radiomics) markers from TMJ OA patients and controls. We tested the diagnostic performance of four machine learning models: Logistic Regression, Random Forest, LightGBM, XGBoost. Headaches, Range of mouth opening without pain, Energy, Haralick Correlation, Entropy and interactions of TGF-ß1 in Saliva and Headaches, VE-cadherin in Serum and Angiogenin in Saliva, VE-cadherin in Saliva and Headaches, PA1 in Saliva and Headaches, PA1 in Saliva and Range of mouth opening without pain; Gender and Muscle Soreness; Short Run Low Grey Level Emphasis and Headaches, Inverse Difference Moment and Trabecular Separation accurately diagnose early stages of this clinical condition. Our results show the XGBoost + LightGBM model with these features and interactions achieves the accuracy of 0.823, AUC 0.870, and F1-score 0.823 to diagnose the TMJ OA status. Thus, we expect to boost future studies into osteoarthritis patient-specific therapeutic interventions, and thereby improve the health of articular joints.

Measurement error and reliability of three available 3D superimposition methods in growing patients.

INTRODUCTION: Cone-Beam Computed Tomography (CBCT) images can be superimposed, allowing three-dimensional (3D) evaluation of craniofacial growth/treatment effects. Limitations of 3D superimposition techniques are related to imaging quality, software/hardware performance, reference areas chosen, and landmark points/volumes identification errors. The aims of this research are to determine/compare the intra-rater reliability generated by three 3D superimposition methods using CBCT images, and compare the changes observed in treated cases by these methods. METHODS: Thirty-six growing individuals (11-14 years old) were selected from patients that received orthodontic treatment. Before and after treatment (average 24 months apart) CBCTs were analyzed using three superimposition methods. The superimposed scans with the two voxel-based methods were used to construct surface models and quantify differences using SlicerCMF software, while distances in the landmark-derived method were calculated using Excel. 3D linear measurements of the models superimposed with each method were then compared. RESULTS: Repeated measurements with each method separately presented good to excellent intraclass correlation coefficient (ICC ≥ 0.825). ICC values were the lowest when comparing the landmark-based method and both voxel-based methods. Moderate to excellent agreement was observed when comparing the voxel-based methods against each other. The landmark-based method generated the highest measurement error. CONCLUSIONS: Findings indicate good to excellent intra-examiner reliability of the three 3D superimposition methods when assessed individually. However, when assessing reliability among the three methods, ICC demonstrated less powerful agreement. The measurements with two of the three methods (CMFreg/Slicer and Dolphin) showed similar mean differences; however, the accuracy of the results could not be determined.

Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study.

OBJECTIVES: To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients. SETTING AND SAMPLE POPULATION: A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2). MATERIALS AND METHODS: Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05). RESULTS: Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups. CONCLUSIONS: The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.

Condyle-glenoid fossa relationship after Herbst appliance treatment during two stages of craniofacial skeletal maturation: A retrospective study.

OBJECTIVES: To perform a three-dimensional evaluation of the position of the condyles in patients treated with Herbst appliance (HA) in two stages of cervical vertebral maturation. SETTING AND SAMPLE POPULATION: Retrospective case-control study. Pubertal Herbst group (PHG; n = 24, mean age 14.5 years, CS 3 and CS 4) and pre-pubertal Herbst group (PPHG; n = 17, mean age 9.9 years, CS 1 and CS 2) were contrasted with comparison groups of non-orthopaedically treated Class II patients in pubertal (PCG; n = 17, mean age 13.9 years) and pre-pubertal maturational stages (PPCG; n = 18, mean age 10.6 years). MATERIALS AND METHODS: Cone-beam computer tomography scans were taken before treatment (T0) and at T1 after 8 to 12 months. Point-to-point measurements of the displacement of the condyles between T0 and T1, relative to the glenoid fossae, were performed in the X, Y, Z and 3D perspectives. Qualitative assessments using semi-transparent overlays and colour mapping also were produced. RESULTS: The displacement of the condyles within the glenoid fossae in the treated groups was small (<0.75 mm; P > .05). Relative to the glenoid fossa, condylar position at T1 was similar to T0 in pre-pubertal and pubertal groups (P > .05). Similar condylar rotations from T0 to T1 were observed in Herbst and comparison groups, and no significant difference was found between pre-pubertal and pubertal patients. CONCLUSIONS: Regardless the stage of skeletal maturation, HA treatment did not change the condyle-glenoid fossa relationship.

Software comparison to analyze bone radiomics from high resolution CBCT scans of mandibular condyles.

OBJECTIVES: Radiomics refers to the extraction and analysis of advanced quantitative imaging from medical images to diagnose and/or predict diseases. In the dentistry field, the bone data from mandibular condyles could be computationally analyzed using the voxel information provided by high-resolution CBCT scans to increase the diagnostic power of temporomandibular joint (TMJ) conditions. However, such quantitative information demands innovative computational software, algorithm implementation, and validation. Our study's aim was to compare a newly developed BoneTexture application to two-consolidated software with previous applications in the medical field, Ibex and BoneJ, to extract bone morphometric and textural features from mandibular condyles. METHODS: We used an imaging database of HR-CBCT TMJs scans with an isotropic voxel size of 0.08 mm3 . A single group with 66 distinct mandibular condyles composed the final sample. We calculated 18 variables for bone textural features and 5 for bone morphometric measurements using the Ibex, BoneJ and BoneTexture applications. Spearman correlation and Bland-Altman plot analyses were done to compare the agreement among software. RESULTS: The results showed a high Spearman correlation among the software applications ( r = 0.7-1), with statistical significance for all variables, except Grey Level Non-Uniformity and Short Run Emphasis. The Bland-Altman vertical axis showed, in general, good agreement between the software applications and the horizontal axis showed a narrow average distribution for Correlation, Long Run Emphasis and Long Run High Grey Level Emphasis. CONCLUSIONS: Our data showed consistency among the three applications to analyze bone radiomics in high-resolution CBCT. Further studies are necessary to evaluate the applicability of those variables as new bone imaging biomarkers to diagnose bone diseases affecting TMJs.

Three-dimensional assessment of the middle cranial fossa and central skull base following Herbst appliance treatment.

OBJECTIVES:: The purpose of this three-dimensional (3D) study was to assess retrospectively the middle cranial fossa and central skull base of patients treated with the Herbst appliance (HA). MATERIALS AND METHODS:: 3D surface virtual models of 40 Class II, division 1 malocclusion patients were generated from cone-beam computed tomography (CBCT) acquired before treatment (T0) and after 8 months of HA treatment (T1). T0 and T1 3D models were superimposed volumetrically at the anterior cranial fossa. Twenty subjects who had been treated with the Herbst appliance (HAG) were compared to 20 subjects who were not treated orthopedically. The latter group served as a comparison control group (CG). Quantitative assessments of the location and directional changes were made with linear and angular measurements between anatomical landmarks. Qualitative assessments of the spatial behavior of the middle cranial fossa and central skull base relative to the anterior cranial fossa were displayed graphically for visualization with color maps and semitransparent overlays. Non-parametric tests were performed to compare the between the HAG and CG. RESULTS:: Point-to-point linear measurements and skeletal rotation (pitch, roll, and yaw) changes were very small along the observational period and were not significantly different between HAG and CG. Visual analysis of color maps and overlays confirmed that no changes in the cranial base were associated with HA. CONCLUSIONS:: HA therapy did not produce clinically significant changes in the middle cranial fossa and central skull base.

3D Comparison of Mandibular Response to Functional Appliances: Balters Bionator versus Sander Bite Jumping.

AIM: To assess the three-dimensional (3D) maxillomandibular and dental response to Balters Bionator (BB) and the Sander Bite Jumping Appliance (SBJA) in growing patients. MATERIALS AND METHODS: Twenty-seven Class II division 1 patients (13 males, 14 females), consecutively treated with either the BB (9 females, 7 males; 10.1 ± 1.6 years) or SBJA (5 females, 6 males; 11 ± 1.9 years), were collected from a single orthodontic practice. All patients presented overjet ≥5 mm, full Class II or end-to-end molar relationship, mandibular retrusion. CBCT scans were available at T1 and after removal of the functional appliances (T2) with a mean interval of 18 months. The 3D location and direction of skeletal and dental changes with growth and treatment were quantitatively assessed. Statistical analysis was performed by means of Mann-Whitney U test (p < 0.05). RESULTS: Patients treated with the SBJA and BB orthopedic appliances presented, respectively, 4.7 mm and 4.5 mm of 3D displacement of the chin, with marked ramus growth of, respectively, 3.7 mm and 2.3 mm. While the mandible and maxilla grew downward and forward, no opening of the mandible plane was observed. Both appliances adequately controlled labial inclination of lower incisors (1.3° and 0.3°, for the SBJA and BB groups, resp.). No significant between-group differences were found for the T2-T1 changes for any of the variables, with the exception of molar displacements (significantly greater in the SBJA group than in the BB group, 1.2 mm and 0.9 mm, resp.). CONCLUSIONS: The maxillomandibular and dental growth responses to BB and SBJA therapies are characterized by vertical ramus growth and elongation of mandible that improve the maxillomandibular relationship with adequate control of lower incisor position.

Three-dimensional dental and craniofacial manifestations in patients with late diagnosis of mucopolysaccharidosis type II: report of 2 cases.

The objective of this study was to report the clinical evaluation results and 3-dimensional (3-D) dental and craniofacial characteristics observed in 2 male patients with mucopolysaccharidosis type II. The patients were evaluated clinically (soft tissue evaluation, evaluation of occlusion, periodontal and dental examinations) and by using craniofacial computed tomography, with evaluation of 3-D images in ITK-Snap v. 2.2 (Penn Image Computing and Science Laboratory, Philadelphia, PA; http://www.itksnap.org/) and 3-D Slicer (http://www.slicer.org/) software. Mandibular 3-D volumetric label maps were built from computed tomography scans of both patients and compared through superimposition on a healthy patient's mandibular images. Clinically, the patients presented the following oral manifestations: macroglossia, total open bite and generalized diastemas, and absence of caries. Patient 1 showed dental calculus and bleeding at the gingival margin. Patient 2 showed bleeding at the gingival margin, a permanent maxillary left central incisor missing as a result of trauma, and impacted permanent mandibular left and right second molars. 3-D images showed wide arches, prominent antegonial notches, a narrow mandibular body in the region of the antegonial notches, bilateral severe condylar hypoplasia, and enlarged coronoid processes. 3-D imaging and superimpositions revealed oral and skeletal displacements, contributing to the identification of changes in the course of mucopolysaccharidosis type II in patients with a late diagnosis.

Reliability of three-dimensional anterior cranial base superimposition methods for assessment of overall hard tissue changes: A systematic review.

OBJECTIVE: The purpose of this systematic review was to synthesize the available literature concerning the reliability of three-dimensional superimposition methods when assessing changes in craniofacial hard tissues. MATERIALS AND METHODS: Four electronic databases were searched. Two authors independently reviewed potentially relevant articles for eligibility. Clinical trials, cohort, case-control, and cross-sectional studies that evaluated the reliability of three-dimensional superimposition methods on the anterior cranial base were included. RESULTS: Six studies fulfilled the inclusion criteria. Four studies used the voxel-based registration method, one used the landmark-based method and one used the surface-based method. Regarding reliability, the voxel-based studies showed on average a difference of 0.5 mm or less between images. The optimized analysis using a six-point correction algorithm in the landmark-based method showed 1.24 mm magnitude of error between images. CONCLUSIONS: Although reliability appears to be adequate, the small sample size and high risk of bias among studies make available evidence still insufficient to draw strong conclusions.