American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection in the orthodontic literature—use and trends: A systematic review

Visual assessment for frontal sinus radiographic identifications: Documenting accuracy and exploring the effects of experience

Decedent positive identification via visual comparisons of frontal sinus radiographs is commonly used in the medicolegal field; however, only a handful of studies have empirically tested this method. This study aimed to test the accuracy of visual assessment in frontal sinus identifications across a large and experientially diverse participant sample. A Qualtrics survey presented participants with 25 pairs of cropped frontal sinus radiographs, asking them to determine if they matched and their confidence level. Radiographs were from the American Association of Orthodontics Legacy Collection. Eighteen radiographic pairs were of the same individual taken a year or more apart. Seven pairs were from different individuals (nonmatches). Euclidean distances were used to select challenging nonmatches with similar outlines. Participants were also asked questions about their profession, training, and experience. The overall accuracy of the 145 respondents (3625 comparisons) was 89.9%, with a median accuracy of 92.0%. The majority of respondents (64.58%) report zero radiographic identification experience. Incorrect responses were biased, with only 3.6% of nonmatches wrongly reported as matches (false positives). Statistical analyses revealed significant effects of profession, radiographic experience, and training on match accuracies and confidence levels (p < 0.05), with a significant correlation between accuracy and confidence level (rs = 0.302, p < 0.001). These results support the use of frontal sinus visual comparisons in forensic identifications but highlight the importance of training and experience. In practice, accuracy rates are expected to exceed those reported here, given that identifications are made by medicolegal personnel using higher quality radiographs of the entire cranium.

AI-based open-source software for cephalometric analysis from limited FOV radiographs

BACKGROUND

Artificial Intelligence (AI) in dental diagnostics is evolving, offering innovative approaches for conducting cephalometric analysis with less manual input and overcoming the limitations of traditional imaging methods. To enhance the diagnostic processes in dentistry, an open-source software that utilises AI to improve the extraction of cephalometric values from limited field of view (FOV) images was created.

MATERIAL AND METHODS

Reduced FOV images lack several vital cephalometric landmarks, prompting the creation of predictive models to estimate missing values. The GridSearchCV algorithm and other algorithms were used to construct predictive models using software and to select the best models. The software was validated by comparing the predicted values with the actual measurements and calculating the mean squared error using Excel. Further validation involved a randomly selected cohort of 25 untreated orthodontic cases.

RESULTS

Evaluation of the software showed that it was effective in accurately predicting key cephalometric measurements, suggesting that it could be a reliable tool for clinical use. However, some variations were noted in its predictive accuracy across different measurements, indicating areas that could benefit from further development. The software could align closely with the actual cephalometric measurements through detailed statistical analysis.

CONCLUSIONS

The integration of AI into cephalometric analysis with the software could represent progress, potentially leading to more efficient dental diagnostics and a reduction in the need for additional X-rays. This study aimed to advance the integration and refinement of AI in healthcare, focusing on minimising bias and understanding its impact on clinical decisions. In future studies, the application of AI in dental practice should be expanded to address these challenges.

CLINICAL SIGNIFICANCE STATEMENT

This software integrates AI into clinical practice to enhance the diagnostic and therapeutic phases for patient benefit. It enables precise and comprehensive cephalometric analyses using data previously considered insufficient, thereby reducing the need for X-rays and improving patient care.

The effect of vertical skeletal proportions on overbite changes in untreated adolescents: a longitudinal evaluation

OBJECTIVES

To evaluate the change in overbite within an untreated cohort from 9 to 18 years of age and to compare age-related changes in overbite depth based on vertical skeletal proportion.

MATERIALS AND METHODS

Lateral cephalograms were obtained from the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collection Project. All cephalometric outcome measures were assessed at ages 9-11 (T1), 13-15 (T2), and 17-19 (T3) years. Generalized estimating equation (GEE) regression models were fit to examine the effect of MP-SN on overbite adjusted for age and gender.

RESULTS

A total of 130 subjects from the Denver, Bolton Brush, and Oregon Growth Studies were included. Overbite was relatively constant from T1 to T3 irrespective of facial type, with a minor decrease (0.15 mm) being observed overall. There was a transient increase between T1 and T2 (0.31 mm) that was canceled out by changes during later adolescence. Based on the GEE regression model adjusted for time and gender, a minor but statistically significantly greater reduction in overbite arose as MP-SN increased (coefficient = -0.080; 95% confidence interval -0.12, -0.04; P < .01).

CONCLUSIONS

In hyperdivergent subjects, a marginal decrease in overbite was observed from 9 to 18 years of age, with a transient increase from the period spanning 9-11 years to 13-15 years, which was negated in later adolescence. There are limited data to suggest that observation of vertical growth is required in most patients with marginally increased vertical facial proportions in the juvenile and pubertal phases.

Craniofacial growth and SITAR growth curve analysis

BACKGROUND

SITAR (SuperImposition by Translation And Rotation) is a shape invariant growth curve model that effectively summarizes somatic growth in puberty.

AIM

To apply the SITAR model to longitudinal mandibular growth data to clarify its suitability to facial growth analysis.

SUBJECTS AND METHODS

2D-cephalometric data on two mandibular measurements (AP: articulare-pogonion; CP: condylion-pogonion) were selected from the Denver Growth Study, consisting of longitudinal records (age range: 7.9-19.0 years) of females (sample size N: 21; number of radiographs n: 154) and males (N: 18; n: 137). The SITAR mixed effects model estimated, for each measurement and gender separately, a mean growth curve versus chronological age, along with mean age at peak velocity (APV) and peak velocity (PV), plus subject-specific random effects for PV and mean size. The models were also fitted versus Greulich-Pyle bone age.

RESULTS

In males, mean APV occurred at 14.6 years (AP) and 14.4 years (CP), with mean PV 3.1 mm/year (AP) and 3.3 mm/year (CP). In females, APV occurred at 11.6 years (AP and CP), with mean PV 2.3 mm/year (AP) and 2.4 mm/year (CP). The models explained 95-96 per cent of the cross-sectional variance for males and 92-93 per cent for females. The random effects demonstrated standard deviations (SDs) in size of 5.6 mm for males and 3.9 mm for females, and SDs for PV between 0.3 and 0.5 mm/year. The bone age results were similar.

CONCLUSION

The SITAR model is a useful tool to analyse epidemiological craniofacial growth based on cephalometric data and provides an array of information on pubertal mandibular growth and its variance in a concise manner.

Development of dentofacial characteristics related to Incontinentia Pigmenti syndrome: A repeated cross-sectional study

INTRODUCTION

This research aimed to investigate the dentofacial characteristics of patients with Incontinentia Pigmenti (IP) (or Bloch-Sulzberger) syndrome in childhood, juvenile, and adulthood developmental stages.

METHODS

Fifteen female patients with a clinical diagnosis of IP, genetically confirmed by molecular testing, were included in this study. The records of 25 nonsyndromic females with Class I occlusion and lateral cephalograms obtained at similar developmental stages were selected from the American Association of Orthodontists Foundation Legacy Collection as a control group. Dentofacial features of subjects with IP and those in the control group were compared statistically using t test and Mann-Whitney rank-sum test (significance was defined as P <0.05).

RESULTS

In general, patients with IP had shorter maxillary and mandibular length, straight skeletal profile, hypodivergent growth pattern with a tendency to mandibular protrusion, shorter anterior facial height, Class III compensatory positioning of incisors, more retruded lips, and smaller maxillary incisor exposure. The degree of hypodontia severity had a significant impact on skeletal, dental, and soft-tissue features in patients with IP.

CONCLUSIONS

The results of this study showed that, since childhood, the dentofacial characteristics of patients with IP were progressively distancing from those of nonsyndromic patients with Class I occlusion, presenting their own orthodontic needs.

Occipital hemi-bun development and shape covariation in a longitudinal extant human growth sample

OBJECTIVES

Although the homology of the Neanderthal occipital bun and anatomically modern human "hemi-bun" has long been debated, little is known about the developmental timing and patterning of these two patterns of prominent occipital squama convexity. In this study, occipital hemi-bun ontogeny and cranial shape covariation are assessed in a comparative extant human sample.

MATERIALS AND METHODS

Two-dimensional geometric morphometric methods were used to investigate hemi-bun development in a longitudinal sample of growth study cephalograms representing extant human subjects predominantly of European ancestry. Subjects were each measured at three distinct age points, ranging from 3.0 to 20.4 years, and two-block partial least squares analysis was used to assess patterns of covariation between midsagittal occipital bone morphology and other aspects of craniofacial shape.

RESULTS

Occipital hemi-bun morphology, when present, was found to develop early in ontogeny, in association with anteroposterior elongation of the frontal and parietal bones. No significant pattern of covariation was found between occipital hemi-bun shape and cranial/basicranial breadth, basicranial length, basicranial angle, or midfacial prognathism.

DISCUSSION

This study suggests that the occipital hemi-bun, at least in this extant human population, should not be considered an independent trait, as its development is closely linked to shape variation in the frontal and parietal bones. Importantly, these results suggest that occipital hemi-bun morphology is not significantly influenced by basicranial morphology during development, but instead covaries with changes in midsagittal neurocranial vault shape.

Botulinum toxin A injection into the anterior belly of the digastric muscle increased the posterior width of the maxillary arch in developing rats

Background

The purpose of this study was to evaluate the effects of botulinum toxin A (BTX) injection into the anterior belly of the digastric muscle on a growing rat.

Methods

Ten Sprague Dawley rats were used in this study. When the rats were 13 days old, 0.5 units of BTX was injected into the anterior belly of the digastric muscle for the experimental group (n = 5). For the control, the same volume of normal saline was injected (n = 5). The rats were sacrificed at 60 days old, and the skulls were harvested for micro-computed tomography (μCT) analysis.

Results

In anthropometric analysis, the zygomatic arch and mandibular bi-condylar width were significantly lower in the experimental group than those in the control group (P = 0.025 and 0.027, respectively). The maxillary point width was significantly higher in the experimental group than that in the control group (P = 0.020).

Conclusion

BTX injection into the anterior belly of the digastric muscle had effects on the maxillofacial bony width in growing rats.

Systematic review versus structured critical analysis

Objective: This analysis discusses common problems with systematic reviews (SRs) and presents a novel solution, the structured critical analysis (SCA) that can be incorporated into a SR or used as an alternative literature review design.Methods: A cross-sectional survey of current SRs related to interdisciplinary restorative dentistry was obtained by evaluating 100 current SRs for their self-reported methodological quality and its effect on scientific validity.Results: The preferred reporting items for systematic reviews and meta-analyses protocol (PRISMA) was used in 99/100 SRs, but only 8/100 reported a low risk of bias. High statistical heterogeneity precluding meta-analysis was found in 44/100 SRs. Only 94 paragraphs/100 SRs provided critical analysis.Discussion: Significant problems were found with current SRs that can compromise their reliability as the premier level of evidence for clinical science research. The reader must be aware of these deficiencies to correctly interpret the SR and cannot rely on the format alone.