To evaluate the accuracy of three fully automated software systems compared to nonautomated cephalometric analysis software tested using cephalograms featuring correct and incorrect head positions. The study sample consisted of 40 lateral cephalograms retrieved retrospectively from a larger pool of pretreatment orthodontic records. Cephalograms were recruited and divided into correct head posture group (CHP) and incorrect head posture group (IHP). Cephalometric data were obtained by manual landmarking (Dolphin software), which served as a reference, and by fully automated AI software (WebCeph, Ceph Assistant, and AudaxCeph). Intraclass correlation coefficients (ICC) and paired t-tests were used for intragroup comparisons, whereas analysis of variance and post-hoc analysis were used to compare performance among artificial intelligence (AI) based software applications. The tested software exhibited a good level of consistency for angular measurements whereas linear measurements were more error-prone. AudaxCeph demonstrated the most consistent accuracy, achieving excellent agreement (ICC > 0.90) for several skeletal parameters; however, it failed in detecting soft tissue accurately. WebCeph and Ceph Assistant showed greater variability, especially for linear measurements (ICC < 0.50). Positional errors drastically reduced measurement accuracy, with linear parameters such as Go-Me showing the poorest agreement across all software. AI-based cephalometric software demonstrated variable accuracy depending on the cephalometric measurement, and this pattern was exacerbated under conditions involving positional errors in cephalograms. Accordingly, oversight by expert clinicians is still required to minimize marginal error.ABSTRACT
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To evaluate and compare the validity and reliability of different artificial intelligence (AI) chatbots in answering queries about potential orthodontic risks. Answers to 20 frequently asked questions about the potential risks of orthodontics were derived from daily consultations with experienced orthodontists and AI chatbots (ChatGPT 4o, Claude 3.5 Sonnet, and Gemini 1.5 Pro). The questions were repeated three times and submitted to the AI chatbots to assess the reliability of their answers. The answers from AI chatbots were scored using a modified Global Quality Scale (GQS). Low- and high-threshold validity tests were used to determine validity, and Cronbach's alpha was used to evaluate the consistency of the three responses to each of the 20 questions. In the low-threshold validity test, Gemini exhibited the highest overall performance. In the high-threshold validity test, Gemini also showed the highest overall effectiveness, but there was no significant difference observed among the three chatbots. All three chatbots demonstrated satisfactory levels of reliability, with Gemini having the highest consistency. AI chatbots have some potential in providing orthodontic risk information, but they must be used cautiously and further optimized to improve their effectiveness in clinical practice.ABSTRACT
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To evaluate the influence of lip protrusion and thickness on the perception of facial profile attractiveness among subjects with different ethnic backgrounds. 424 participants were divided into four groups (European, Black African, Far Eastern, and Middle Eastern) and further subdivided into two subgroups according to age (18 to 40 and 41 to 60 years). An idealized female profile silhouette image was manipulated to generate 18 images with three different lip thicknesses and six sagittal lip positions. To assess perception of facial profile attractiveness, participants completed the developed questionnaire. Statistically significant differences were found among subjects with different ethnic backgrounds for all images (P < .01). Percent agreement averaged 13.89%. Within each group, scores varied with lip thickness and protrusion, with significant interaction between the two factors. Gender and age had a significant impact on profile attractiveness mean scores. Ricketts norms for the most favorable lip position to E-line need to be updated. Middle Eastern and Europeans regarded lips positioned + 1 mm to the norm in relation to E-line as the most attractive. Thick lips that were mildly protruded were preferred by Africans. Far Eastern participants preferred normal thickness and thin lips that were protrusive; thick lips were ranked lowest. Among the thick lips, protrusive lips were ranked higher. More personalized and culturally sensitive orthodontic treatment planning is needed to help patients achieve their desired facial esthetic outcome.ABSTRACT
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To compare and validate two tridimensional diagnostic methods for quantifying and categorizing external root resorption using an artificial intelligence (AI)-aided, automatic, or manual digital segmentation process. 40 teeth were segmented from 10 cone beam computed tomography (CBCT) records from five patients. Stereolithographic files were created, and automatic, manual, or AI-aided segmentation of each incisor was performed by two double-blinded operators. Two quantification methods were used and compared by analyzing final segmented regions of the tooth. This study followed QAREL (Quality Appraisal of Diagnostic Reliability) and COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines. Reproducibility was assessed using the Dahlberg formula, coefficient of variation, and intraclass correlation coefficient (ICC) (P value < .05). Intra- and interobserver correlations were high (ICC: > 0.736; P < .01). Statistically significant differences were found between the two measurement methods for high-quality CBCT images of central incisors, mainly at the level of the apical third. Specific differences were found between methods when root resorption was evaluated in the middle and apical thirds using AI segmentation of the central incisor (P = .043). When referring to total volume loss of the lateral incisor, differences (P = .021) were observed between methods when segmented by manual or AI-aided procedures. Highest specificity (100%) was observed for AI-aided segmentation and Method 2 for evaluation of root resorption at the apical third volume. Assessment of root resorption with CBCT is highly dependent on CBCT definition, type of segmentation, and measurement method. Three-dimensional (3D) measurement method described by three landmark points yielded satisfactory results using any tested segmentations.Objectives
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To examine how defects in alveolar bone affect movement of teeth during orthodontic treatment. Pretreatment cone-beam computed tomography images from 26 patients: 15 females and 11 males, with a mean age of 21.5 years (SD ± 3.7 years), were used to evaluate the buccal alveolar bone on the maxillary canine. Maxillary canines (n = 52) were subsequently categorized into three groups: control or no bone defects (n = 17), fenestration (n = 20), and quasidefect (n = 15). Each canine was displaced distally for 16 weeks using nickel-titanium closed coil springs (50 g) and segmental archwire mechanics. The rate and amount of tooth movement were evaluated using superimposition of lateral cephalograms and three-dimensional digital dental models between before and after canine retraction. Rate of tooth movement was evaluated among different bone defect groups. Rate of movement was significantly decreased in the fenestration (0.87 ± 0.23 mm/mo) and quasidefect groups (0.62 ± 0.14 mm/mo) compared to the control group (1.17 ± 0.40 mm/mo). Also, 85% of all subjects exhibited an evident asymmetric pattern of tooth movement, and 77% of these subjects presented with unilateral bone defects. The type and existence of alveolar bone defects have a substantial effect on rate of tooth movement. Therefore, when conducting orthodontic tooth movement investigations and planning orthodontic treatment, it is important to consider the existence of alveolar bone defects.ABSTRACT
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To analyze and summarize the current scientific evidence regarding the clinical predictability of mesiodistal movements of upper and lower molars in patients treated with clear aligners without auxiliary aid. This review followed PRISMA guidelines and was registered in PROSPERO (CRD42022357639). Databases were searched up to September 2024. Data extraction was performed independently by two reviewers, risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was evaluated qualitatively using the GRADE tool. 919 articles were identified, and six prospective and retrospective studies met the inclusion criteria, predominantly using the Invisalign system. Upper molar predictability was 61.1 ± 9.1% for movements ranging from 0.45 to 3.2 mm. Lower molar distalization showed lower predictability and molar mesial movement had median predictability rates of 85.6 ± 1.1%. Moderate to serious risk of bias and very low quality of evidence was found. Upper molar distalization using clear aligners appears to be predictable for distalization from 1.5 to 3.2 mm. Anchorage reinforcement or overcorrection should be considered when planning mesiodistal movements. Standardization of the measurement method is necessary to improve efficacy of these systems.ABSTRACT
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In this case report, we present the treatment of a 28-year-old patient with lip incompetence and vertical maxillary excess (VME), using a combination of a midpalatal miniscrew-anchored cantilever clip appliance and submerged buccal shelf miniscrews. The patient exhibited a convex profile, long face, gummy smile, and protrusion, with a Class II skeletal relationship and mentalis strain. The patient declined conventional orthognathic surgery, leading to an orthodontic camouflage treatment plan involving extraction of four first premolars, maximum retraction, and active vertical control with skeletal anchorage devices. Treatment included the use of infrazygomatic crest miniscrews, anterior subapical miniscrews, and a cantilever clip appliance for molar intrusion, resulting in significant improvement in facial profile, reduction of gummy smile, resolution of lip incompetence, and alleviation of mentalis strain. This case demonstrates the effectiveness of a nonsurgical orthodontic intervention in managing a complex case of VME and lip incompetence.ABSTRACT
To evaluate changes in glenoid fossa morphology before, during, and after orthodontic treatment with extractions. Eighty-four cone-beam computed tomograms from 28 adult female patients with Angle Class II, division 1 malocclusion, who underwent orthodontic treatment involving premolar extraction and mini-implant insertion, were collected at three time points: before treatment (T0), during treatment (just before extraction space closure, T1), and after treatment (T2). Changes in the morphology of the glenoid fossa and the relationship of the anterior teeth among T0, T1, and T2 were recorded. Inclination of the articular eminence (AEI-BFL and AEI-TRL) increased from T1 to T2 and from T0 to T2, whereas the width of the glenoid fossa (GFW) decreased from T1 to T2 and from T0 to T2. Changes in depth of the glenoid fossa (GFD) and the ratio of GFW to GFD were observed only in T0–T2. The height of the articular eminence (AEH) showed no significant differences among the three time points. Except for incisor overbite, which decreased from T0 to T1 and then to T2, all other dental parameters showed differences only in T1–T2 and T0–T2. Orthodontic treatment with extractions can induce adaptive morphological changes in the glenoid fossa, primarily during the stage of extraction space closure. These changes are mainly characterized by a steeper AEI and a reduction in GFW.ABSTRACT
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To compare orthodontic treatment cooperation between Generation Y and Generation Z teenagers and evaluate influence of age on compliance. This was a retrospective cohort study analyzing records of 124 patients (62 from each generation) treated at Tel Aviv University Dental School between 2007 and 2021. Patient cooperation was assessed through weighted noncompliance scores incorporating elastic or headgear wear, oral hygiene, appointment attendance, appliance breakage, and new caries development. Each noncompliance incident was weighted (1.0 point for major incidents, 0.5 for minor) and standardized by treatment duration. Multiple regression analysis accounted for age differences. Mean age differed significantly between Generation Y (15.5 ± 1.7 years) and Generation Z (13.1 ± 1.6 years; P < .001). Initial noncooperation scores were similar (Generation Y: 36.8% ± 16.4%; Generation Z: 35.8% ± 15.8%; P = .732). After age adjustment, regression analysis revealed significantly higher noncooperation in Generation Y (B = 8.29; P = .014). Age independently influenced cooperation, with each year increase associated with a 3% decrease in noncooperation scores (B = −3.04; P < .001). Generation Z teenagers exhibited better orthodontic treatment cooperation than Generation Y after age adjustment. Age independently predicted cooperation, with older teenagers showing better compliance regardless of generation. Treatment planning should consider both generational differences and individual patient factors when selecting compliance-dependent treatment options.ABSTRACT
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To compare a slow, rapid activation protocol for miniscrew-assisted maxillary expansion in adults. Fifteen consecutive adult patients underwent miniscrew-assisted slow palatal expansion (MASPE) using a bone borne device. A control group treated with miniscrew-assisted rapid palatal expansion (MARPE) was matched for initial demographic data and expansion need. No statistically significant differences in bispinal expansion were observed between the MASPE and MARPE groups at the anterior, middle, or posterior levels. MASPE successfully achieved skeletal expansion of the maxilla in 86.7% of adult patients treated. The expansion pattern and results were comparable to MARPE.ABSTRACT
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To evaluate the influence of personalized aligner replacement, with or without physical methods of acceleration using low-frequency vibration combined with a low-level laser, on the tooth movement rate and accuracy of clear aligners. Forty participants were randomly allocated to three groups. Fourteen participants used the standard replacement protocol in Group A, Group B included 14 participants using a personalized replacement protocol, and 12 participants in Group C followed the personalized replacement protocol and used a physical device that combined low-frequency vibration and low-level laser. Aligner replacement cycles of the first 12 steps were recorded, and GOM inspect suite software 2022 (GOM; Braunschweig, Germany) was used to evaluate maxillary molar movement accuracy using digital models collected before treatment and at the end of the 12th step. No significant difference was found in the accuracy of maxillary molar movement between Groups A and B, but the tooth movement rate in Group B was significantly greater. The accuracy of maxillary molar movement was similar in Groups B and C, and the tooth movement rate in Group C was significantly increased. The personalized replacement protocol decreased the number of aligner replacement cycles without impacting the accuracy of tooth movement. With personalized replacement, a physical method of acceleration combining low-level laser and low-frequency vibration significantly accelerated orthodontic tooth movement and had little influence on the accuracy of tooth movement.ABSTRACT
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To compare mandibular incisor root length (RL) and root volume (RV) changes after 6 months of wearing either a removable anterior bite plane (RABP) during meals (F + M) or not during meals (F − M). Additionally, changes in incisal maximum bite force (IMBF) and their correlation with RL and RV changes were assessed. Thirty-six children with deep bite using RABPs full time were randomly assigned in equal numbers to either the F + M group or F − M group. Cone-beam computed tomographic radiographs and IMBF were recorded at baseline (CT0) and after 6 months (CT1). Within and between group comparisons of RL and RV were performed (P = .05) with Bonferroni correction applied for segmental RV differences (P = .008). Relationships between IMBF changes and RL and RV changes were analyzed (P = .05). Both groups showed significant reductions in RL and RV. RL decrease in the F + M group (0.25 ± 0.14 mm) was significantly greater than in the F − M group (0.21 ± 0.14 mm). Reduction in RV was not significantly different between the groups, but IMBF significantly increased in both groups. Significant correlations were observed between IMBF changes and RL (r = 0.56) and RV (r = 0.86) changes. Deep bite correction using RABPs for 6 months with F + M protocol resulted in a greater decrease in mandibular incisor RL compared to the F − M protocol. However, RV changes were comparable between protocols. IMBF may influence the degree of RL and RV changes.ABSTRACT
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To evaluate root development after forced eruption of impacted maxillary canines before or after complete root development of the contralateral canine. A total of 50 patients (21 male, 29 female; mean age: 12.4 years) with unilateral impaction of maxillary canines were classified to “Immature group” with incomplete root development of the contralateral canine or “Mature group” with complete root development of the contralateral canine. Volume, total length, crown length, root length, and root/crown ratio (R/C) of the impacted canine and the contralateral canine were measured in the posttreatment cone-beam computed tomography images. In the immature group, total length and root length of impacted canines were 0.68 mm and 0.51 mm shorter than contralateral canines, respectively (P < .05). In the mature group, volume, total length, root length, and R/C of impacted canines were 37.90 mm3, 2.43 mm, 2.53 mm, and 0.26 smaller, respectively, than contralateral canines (P < .001). Crown length also showed a statistically significant difference between impacted canines and contralateral canines (P < .05). When differences between impacted canines and contralateral canines were compared between the immature and mature groups, all variables showed statistically significant differences, with the mean difference in total length and root length being 1.75 mm and 2.02 mm larger, respectively, in the mature group, (P < .001). Regardless of treatment timing, total length and root length of impacted canines were shorter than those of contralateral canines. Forced eruption of the impacted canine undertaken before root development of the contralateral canine showed better root development in both linear and volumetric measurements.ABSTRACT
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To investigate the possible association between the presence of extreme premolar rotations (135° to 180° rotated premolars) and other dental anomalies within the dental anomaly pattern (DAP). Thirty-two healthy subjects exhibiting at least one premolar rotated 135° to 180° were identified from the archives of a university orthodontic clinic. Inclusion criteria were: presence of a rotated premolar, availability of panoramic radiographs, dental study casts, and intraoral photographs. The concomitant occurrence of additional dental anomalies was evaluated based on the DAP, including tooth agenesis, infraocclusion of deciduous molars, peg-shaped lateral incisors, palatally-displaced canines and transpositions. Comparisons were made to a randomly selected control group (n = 96) without this anomaly, using chi-square statistics. The experimental group displayed a higher prevalence of dental anomalies compared to the control group. Forty-seven percent of patients in the experimental group exhibited dental agenesis, whereas only 8% of the control group had dental agenesis (P < .001). Infraocclusion of deciduous molars (22% vs 5%; P = .005) and canine impaction (16% vs 3%; P = .035) were also observed more frequently in patients in the experimental group. These findings reveal significant associations between the presence of extreme premolar rotations and the occurrence of other dental anomalies, namely dental agenesis, infraocclusion of deciduous molars, and palatally-displaced canines. These observations suggest a shared genetic origin for these anomalies.ABSTRACT
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To analyze, appraise, and synthesize papers in which authors have compared the effects of chemotherapeutic toothpaste (CTP) and regular toothpaste (RTP) on plaque scores (PSs), gingival scores (GSs), and bleeding scores (BSs) in orthodontic patients wearing fixed appliances (FAs). PubMed-MEDLINE, Cochrane-CENTRAL, and Embase databases were searched with predefined search terms until April 2024 for controlled or randomized controlled clinical trials aligning with the aim. In the eligible papers, risk of bias was evaluated, data of interest were extracted, and a descriptive analysis was performed. If possible, meta-analyses and subanalyses on specific factors were conducted. The quality of evidence and strength of the recommendation were rated. In our search and selection, we obtained five papers describing eight comparisons. Potential risk of bias was assessed as some concerns to high, and heterogeneity was considered substantial. Descriptive analysis revealed no significant difference in PS and BS, with an improvement in GS favoring CTP. Meta-analyses of the end scores showed CTP significantly reduced PS (standardized mean difference [SMD] = −0.26; 95% confidence interval [CI] = −0.52, −0.01; P = .04). However, no significant effects were observed on GS and BS. These findings were supported by the subanalyses on CTP with chlorhexidine (CHX; PS: mean difference [MD] = −5.12; 95% CI = −10.08, −0.15; P = .04). The quality of evidence was graded as very low, and strength of the recommendation was judged as very weak. For orthodontic patients with FAs, very weak certainty exists in recommending CTP (eg, with CHX) over RTP for use with toothbrushing. CTP may have a very small effect on PS and a small effect on GS.ABSTRACT
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A 26-year-old woman came for orthodontic treatment to improve her profile with protrusive lips. Diagnosed as bimaxillary protrusion, extraction followed by anterior retraction was indispensable for the case. However, her left upper lateral incisor was absent, the left upper canine had moved mesially and replaced the adjacent incisor, and the original canine location was restored with a long implant, which was in good condition. Surgical removal of the implant would be tricky and might lead to atrophy of the alveolar bone. In addition, the upper left central incisor had a short, curved root, which could not undergo significant movement. After crucial discussion between orthodontists and implantologists, based on digital setup, an innovative treatment plan was developed. Four incisors were extracted followed by clear aligner therapy for anterior retraction. An individualized zirconia abutment was installed on the upper left implant in a retroclined direction, cemented with a zirconia crown to replace the upper lateral incisor. Minimally invasive veneers were made to reshape the other upper incisors for better esthetics. Finally, the patient had her profile greatly improved and the teeth well aligned without removal of the implant. Thus, the seemingly mission impossible was accomplished with a satisfactory outcome, thanks to imaginative treatment planning and delicate interdisciplinary collaboration based on digital simulation.Objective
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In this case report, we show a strategic approach to prolonging the lifespan of pathologically migrated maxillary canines with a hopeless prognosis in a 57-year-old female patient, highlighting the potential of orthodontic management for middle-aged patients to enhance both occlusion and facial esthetics while minimizing the need for extensive prosthetic treatment. According to the visual treatment objective, the nonextraction treatment plan showed advantages in the type of orthodontic tooth movement and final occlusal relationship. Therefore, considering the favorable periodontal treatment results and single-root teeth, the hopelessly migrated maxillary canines were relocated, eliminating the existing trauma from occlusion. Segmental tooth movement was performed, and orthodontic temporary skeletal anchorage devices were used to support strategic orthodontic tooth movement. After 27 months of treatment, proper occlusion was established with a significant improvement in facial esthetics. The periodontally compromised teeth were preserved with adequate periodontal support. The patient expressed satisfaction with the results, and the 30-month follow-up records confirmed the stability of treatment outcomes.ABSTRACT
Class III malocclusion due to a retrognathic maxilla is common in patients with cleft lip and palate. Skeletally anchored maxillary protraction using screw-anchored mini-plates combined with intraoral elastics has shown promising results in achieving orthopedic changes and maintaining the outcome until the completion of the growth. This case report presents the course of treatment in a patient with unilateral cleft lip and palate and multiple congenitally missing teeth treated with bone-anchored maxillary protraction until the end of growth. Four mini-plates (Bollard plates) were used during comprehensive fixed orthodontic treatment to protract the dentition and close the space where teeth were missing, extrude the canine, and force eruption of the second premolar using extension arms and cantilevers. A 2-year follow-up at age 17 showed stable occlusion and maintenance of soft tissue results. Bone-anchored maxillary protraction treatment in a patient with cleft lip and palate demonstrates proper orthopedic results and could be a viable alternative to orthognathic surgery.ABSTRACT
Early versus late intermaxillary elastics in patients with Class II malocclusion: a randomized clinical trial
Transverse decompensation in surgery-first approach vs conventional orthognathic surgery in mandibular prognathism patients
Influence of attachment position and torque overcorrection on arch expansion in clear aligner treatment: a three-dimensional finite element analysis
Class III correction and enhanced periodontal health with aligner treatment in a 53-year-old patient
Parent perspectives on effective patient-provider communication during orthodontic consultations: a qualitative description study
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