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Ibald LC, Witte V, Klawonn F, Conrad R, Mücke M, Sellin J, Teschke M. Suggestion of a new standard in measuring the mandible via MRI and an overview of reference values in young women. Oral Maxillofac Surg 2024; 28:373-383. [PMID: 37099046 PMCID: PMC10914874 DOI: 10.1007/s10006-023-01153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/07/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Adult idiopathic condylar resorption (AICR) mainly affects young women, but generally accepted diagnostic standards are lacking. Patients often need temporomandibular joint (TMJ) surgery, and often jaw anatomy is assessed by CT as well as MRI to observe both bone and soft tissue. This study aims to establish reference values for mandible dimensions in women from MRI only and correlate them to, e.g., laboratory parameters and lifestyle, to explore new putative parameters relevant in AICR. MRI-derived reference values could reduce preoperative effort by allowing physicians to rely on only the MRI without additional CT scan. METHODS We analyzed MRI data from a previous study (LIFE-Adult-Study, Leipzig, Germany) of 158 female participants aged 15-40 years (as AICR typically affects young women). The MR images were segmented, and standardized measuring of the mandibles was established. We correlated morphological features of the mandible with a large variety of other parameters documented in the LIFE-Adult study. RESULTS We established new reference values for mandible morphology in MRI, which are consistent with previous CT-based studies. Our results allow assessment of both mandible and soft tissue without radiation exposure. Correlations with BMI, lifestyle, or laboratory parameters could not be observed. Of note, correlation between SNB angle, a parameter often used for AICR assessment, and condylar volume, was also not observed, opening up the question if these parameters behave differently in AICR patients. CONCLUSION These efforts constitute a first step towards establishing MRI as a viable method for condylar resorption assessment.
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Affiliation(s)
- Leonie Carina Ibald
- Centre for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Veronica Witte
- Cognitive Neurology, University Medical Center Leipzig, Leipzig, Germany
- Max Planck Institute for Cognitive and Brain Sciences, Leipzig, Germany
| | - Fank Klawonn
- Biostatistics Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Department of Computer Science, Ostfalia University, Wolfenbüttel, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Martin Mücke
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, Germany
- Centre for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Sellin
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, Germany.
- Centre for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, Germany.
| | - Marcus Teschke
- Dept. of Maxillofacial Surgery, Parkklinik Manhagen, Großhansdorf, Germany
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Elrawdy AM, Amer ME, Algariah AK, Eid MH, Abu-Elsaoud AM, Ghoneim MM. Appraisal of the Accuracy and Reliability of Cone-Beam Computed Tomography and Three-Dimensional Printing for Volumetric Mandibular Condyle Measurements of a Human Condyle. Cureus 2023; 15:e46746. [PMID: 38022326 PMCID: PMC10631571 DOI: 10.7759/cureus.46746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aims to evaluate the accuracy of volumetric measurements of three-dimensional (3D)-printed human condyles from cone-beam computed tomography (CBCT) in comparison to physical condyles using a water displacement test. Methodology A sample of 22 dry condyles was separated from the mandibular body by disc, mounted on a base made of casting wax, and scanned using the SCANORA (Scanora 3DX, Soredex, Finland) CBCT scanner. Subsequently, the projection data were reconstructed with the machine-dedicated OnDemand 3D (Cybermed Co., Seoul, Korea). The Standard Tessellation Language file was prepared for 3D printing using chitubox slicing software v1.9.1. Frozen water-washable gray resin was used for 3D printing. All condyles were printed using the same parameters and the same resin. The volumetric measurements were then performed using a customized modified pycnometer based on water volume and weight displacement. Volumetric measures were performed for both the physical human condyles and the 3D-printed replicas and the measurements were then compared. Results The volume of dry condyles using the water displacement method showed an average (±SD) of 1.925 ± 0.40 cm3. However, the volume of 3D-printed replicas using the water displacement method showed an average (±SD) of 2.109 ± 0.40 cm3. The differences in measurements were insignificant (p > 0.05), as revealed by an independent t-test. Conclusions Highly precise, accurate, and reliable CBCT for volumetric mandibular condyle was applied for measurements of a human condyle and 3D-printed replica. The modified pycnometer for volumetric measurements presented an excellent volumetric measure based on a simple water displacement device. The tested modified pycnometer can be applied in volumetric measurements in both 3D-printed and mandibular condyle. For best accuracy, the highest scanning resolution possible should be used. As it directly handles irregularly shaped solid objects in a non-destructive manner with a high level of precision and reliability, this 3D scanning approach may be seen as a superior alternative to the current measurement methods.
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Affiliation(s)
- Ahmed M Elrawdy
- Department of Oral Radiology, Suez Canal University, Faculty of Dentistry, Ismailia, EGY
| | - Mohamed E Amer
- Department of Orthodontics, Zagazig University, Faculty of Dentistry, Zagazig, EGY
| | - Ahmed K Algariah
- Department of Orthodontics, Sinai University, Faculty of Dentistry, Ismailia, EGY
| | - Mohamed H Eid
- Department of Oral and Maxillofacial Surgery, Suez Canal University, Faculty of Dentistry, Ismailia, EGY
| | - Abdelghafar M Abu-Elsaoud
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
- Faculty of Science, Suez Canal University, Ismailia, EGY
| | - Mohamed M Ghoneim
- Department of Oral and Maxillofacial Surgery, Sinai University, Faculty of Dentistry, El-Arish, EGY
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Sánchez-Ayala A, Sánchez-Ayala A, Kolodzejezyk RC, Urban VM, Lagravère MÓ, Campanha NH. A three-dimensional method to calculate mechanical advantage in mandibular function : Intra- and interexaminer reliability study. J Orofac Orthop 2023; 84:321-339. [PMID: 35254453 DOI: 10.1007/s00056-022-00378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Masticatory muscles are physically affected by several skeletal features. The muscle performance depends on muscle size, intrinsic strength, fiber direction, moment arm, and neuromuscular control. To date, for the masticatory apparatus, only a two-dimensional cephalometric method for assessing the mechanical advantage, which is a measure for the ratio of the output force to the input force in a system, is available. This study determined the reliability and errors of a three-dimensional (3D) mechanical advantage calculation for the masticatory system. METHODS Using cone-beam computed tomography images from teenage patients undergoing orthodontic treatments, 36 craniofacial landmarks were identified, and the moment arms for seven muscles and their load moment arms (biomechanical variables) were determined. The 3D mechanical advantage for each muscle was calculated. This procedure was repeated by three examiners. Reliability was verified using the intraclass correlation coefficient (ICC) and the errors by calculating the absolute differences, variance estimator and coefficient of variation (CV). RESULTS Landmark coordinates demonstrated excellent intra- and interexaminer reliability (ICC 0.998-1.000; p < 0.0001). Intraexaminer data showed errors < 1.5 mm. Unsatisfactory interexaminer errors ranged from 1.51-5.83 mm. All biomechanical variables presented excellent intraexaminer reliability (ICC 0.919-1.000, p < 0.0001; CV < 7%). Interexaminer results were almost excellent, but with lower values (ICC 0.750-1.000, p < 0.0001; CV < 10%). However, the muscle moment arm and 3D mechanical advantage of the lateral pterygoid muscles had ICCs < 0.500 (p < 0.05) and CV < 30%. Intra- and interexaminer errors were ≤ 0.01 and ≤ 0.05, respectively. CONCLUSIONS Both landmarks and biomechanical variables showed high reliability and acceptable errors. The proposed method is viable for the 3D mechanical advantage measure.
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Affiliation(s)
- Alejandro Sánchez-Ayala
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Alfonso Sánchez-Ayala
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil.
| | - Rafaela Cristina Kolodzejezyk
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Vanessa Migliorini Urban
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Manuel Óscar Lagravère
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Nara Hellen Campanha
- Orthodontic Graduate Program, University of Alberta, 116 St & 85 Ave, T6G 2R3, Edmonton, Alberta, Canada
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Hill CN, Coombs MC, Cisewski SE, Durham EL, Bonthius DJ, Gardner GM, Lopez EC, Wilson MB, Cray JJ, Yao H. Structure-function relationships of TMJ lateral capsule-ligament complex. J Biomech 2022; 130:110889. [PMID: 34871896 PMCID: PMC8724391 DOI: 10.1016/j.jbiomech.2021.110889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 01/03/2023]
Abstract
The human temporomandibular joint (TMJ) lateral capsule ligament (LCL) complex is debated as a fibrous capsule with distinct ligaments or ligamentous thickening, necessitating further evaluation of the complex and its role in TMJ anatomy and mechanics. This study explores the ultrastructural arrangement, biomechanical tensile properties, and biochemical composition of the human LCL complex including region-specific differences to explore the presence of a distinct temporomandibular ligament and sex-specific differences to inform evaluations of potential etiological mechanisms. LCL complex ultrastructural arrangement, biomechanical properties, and biochemical composition were determined using cadaveric samples. Statistical modeling assessed sex- and region-specific effects on LCL complex tissue properties. Collagen fiber coherency, collagen fiber bundle size, and elastin fiber count did not differ between sexes, but females trended higher in elastin fiber count. LCL complex water and sGAG content did not differ between sexes or regions, but collagen content was higher in the anterior region (311.0 ± 185.6 μg/mg) compared to the posterior region (221.0 ± 124.9 μg/mg) (p = 0.045) across sexes and in males (339.6 ± 170.6 μg/mg) compared to females (204.5 ± 130.7 μg/mg) (p = 0.006) across regions. Anterior failure stress (1.1 ± 0.7 MPa) was larger than posterior failure stress (0.6 ± 0.4 MPa) (p = 0.024). Regional differences confirm the presence of a mechanically and compositionally distinct temporomandibular ligament. Baseline sex-specific differences are critical for etiological investigations of sex disparities in TMJ disorders. These results have important biomechanical and clinical ramifications, providing critical baseline tissue material properties, informing the development of TMJ musculoskeletal models, and identifying new areas for etiologic investigations for temporomandibular disorders.
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Affiliation(s)
- Cherice N. Hill
- Department of Bioengineering, Clemson University, Clemson, SC,Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Matthew C. Coombs
- Department of Bioengineering, Clemson University, Clemson, SC,Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Sarah E. Cisewski
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Emily L. Durham
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
| | | | | | - Ethan C. Lopez
- Department of Bioengineering, Clemson University, Clemson, SC
| | | | - James J. Cray
- Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, OH,Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC,Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
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She X, Sun S, Damon BJ, Hill CN, Coombs MC, Wei F, Lecholop MK, Steed MB, Bacro TH, Slate EH, Zheng N, Lee JS, Yao H. Sexual dimorphisms in three-dimensional masticatory muscle attachment morphometry regulates temporomandibular joint mechanics. J Biomech 2021; 126:110623. [PMID: 34311291 DOI: 10.1016/j.jbiomech.2021.110623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Temporomandibular joint (TMJ) disorders disproportionally affect females, with female to male prevalence varying from 3:1 to 8:1. Sexual dimorphisms in masticatory muscle attachment morphometry and association with craniofacial size, critical for understanding sex-differences in TMJ function, have not been reported. The objective of this study was to determine sex-specific differences in three-dimensional (3D) TMJ muscle attachment morphometry and craniofacial sizes and their impact on TMJ mechanics. Human cadaveric TMJ muscle attachment morphometry and craniofacial anthropometry (10Males; 11Females) were determined by previously developed 3D digitization and imaging-based methods. Sex-differences in muscle attachment morphometry and craniofacial anthropometry, and their correlation were determined, respectively using multivariate general linear and linear regression statistical models. Subject-specific musculoskeletal models of the mandible were developed to determine effects of sexual dimorphisms in mandibular size and TMJ muscle attachment morphometry on joint loading during static biting. There were significant sex-differences in craniofacial size (p = 0.024) and TMJ muscle attachment morphometry (p < 0.001). TMJ muscle attachment morphometry was significantly correlated with craniofacial size. TMJ contact forces estimated from biomechanical models were significantly, 23% on average (p < 0.001), greater for females compared to those for males when generating the same bite forces. There were significant linear correlations between TMJ contact force and both 3D mandibular length (R2 = 0.48, p < 0.001) and muscle force moment arm ratio (R2 = 0.68, p < 0.001). Sexual dimorphisms in masticatory muscle morphology and craniofacial sizes play critical roles in subject-specific TMJ biomechanics. Sex-specific differences in the TMJ mechanical environment should be further investigated concerning mechanical fatigue of TMJ discs associated with TMJ disorders.
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Affiliation(s)
- Xin She
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Shuchun Sun
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Brooke J Damon
- Department of Bioengineering, Clemson University, Clemson, SC, USA; Department of Oral Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Cherice N Hill
- Department of Bioengineering, Clemson University, Clemson, SC, USA; Department of Oral Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Matthew C Coombs
- Department of Bioengineering, Clemson University, Clemson, SC, USA; Department of Oral Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Feng Wei
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | | | - Martin B Steed
- Department of Oral and Maxillofacial Surgery, MUSC, Charleston, SC, USA
| | - Thierry H Bacro
- Center for Anatomical Studies and Education, MUSC, Charleston, SC, USA
| | - Elizabeth H Slate
- Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Naiquan Zheng
- Department of Mechanical Engineering and Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, USA; Department of Oral Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA.
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Delesalle Q, Lopes AM, Gawor JP, Zani D, Pereira HM, Mestrinho LA. Comparative morphometry of the temporomandibular joint in brachycephalic and mesocephalic cats using multislice CT and cone beam CT. J Feline Med Surg 2020; 23:507-512. [PMID: 33030097 DOI: 10.1177/1098612x20960657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to analyse and compare morphometric measurements of the temporomandibular joint (TMJ) in two groups of cats with brachycephalic and mesocephalic craniofacial skull conformations using multislice CT and cone beam CT. METHODS CT records of 20 cats without TMJ pathology were included in the study, and were divided into two groups according to those with mesocephalic or brachycephalic skull conformation. Width and depth of the mandibular fossa, width and height of the head of the mandible, and two different angles were measured in 40 TMJs. RESULTS TMJ conformation differed between groups: 3/6 parameters were statistically different. Brachycephalic cats had a significantly narrower mandibular fossa, a shorter head of the mandible and a wider angle of congruence (angle 2). CONCLUSIONS AND RELEVANCE The results provide morphometric measurements that can serve as a reference tool for the veterinary radiologist and surgeon when TMJ evaluation is necessary. Moreover, the study identified significant differences between the two craniofacial skull conformations.
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Affiliation(s)
| | - António M Lopes
- Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisboa, Portugal
| | | | - Davide Zani
- Department of Veterinary Radiology, Academic Veterinary Hospital, University of Milan, Lodi, Italy
| | | | - Lisa A Mestrinho
- Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisboa, Portugal
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Effects on loads in temporomandibular joints for patients with mandibular asymmetry before and after orthognathic surgeries under the unilateral molar clenching. Biomech Model Mechanobiol 2019; 19:533-541. [DOI: 10.1007/s10237-019-01227-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/07/2019] [Indexed: 11/26/2022]
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8
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Coombs MC, She X, Brown TR, Slate EH, Lee JS, Yao H. Temporomandibular Joint Condyle-Disc Morphometric Sexual Dimorphisms Independent of Skull Scaling. J Oral Maxillofac Surg 2019; 77:2245-2257. [PMID: 31125537 DOI: 10.1016/j.joms.2019.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Approximately 2 to 4% of the US population have been estimated to seek treatment for temporomandibular symptoms, predominately women. The study purpose was to determine whether sex-specific differences in temporomandibular morphometry result from scaling with sex differences in skull size and shape or intrinsic sex-specific differences. MATERIALS AND METHODS A total of 22 (11 male [aged 74.5 ± 9.1 years]; 11 female [aged 73.6 ± 12.8 years]) human cadaveric heads with no history of temporomandibular disc derangement underwent cone beam computed tomography and high-resolution magnetic resonance imaging scanning to determine 3-dimensional cephalometric parameters and temporomandibular morphometric outcomes. Regression models between morphometric outcomes and cephalometric parameters were developed, and intrinsic sex-specific differences in temporomandibular morphometry normalized by cephalometric parameters were determined. Subject-specific finite element (FE) models of the extreme male and extreme female conditions were developed to predict variations in articular disc stress-strain under the same joint loading. RESULTS In some cases, sex differences in temporomandibular morphometric parameters could be explained by linear scaling with skull size and shape; however, scaling alone could not fully account for some differences between sexes, indicating intrinsic sex-specific differences. The intrinsic sex-specific differences in temporomandibular morphometry included an increased condylar medial length and mediolateral disc lengths in men and a longer anteroposterior disc length in women. Considering the extreme male and female temporomandibular morphometry observed in the present study, subject-specific FE models resulted in sex differences, with the extreme male joint having a broadly distributed stress field and peak stress of 5.28 MPa. The extreme female joint had a concentrated stress field and peak stress of 7.37 MPa. CONCLUSIONS Intrinsic sex-specific differences independent of scaling with donor skull size were identified in temporomandibular morphometry. Understanding intrinsic sex-specific morphometric differences is critical to determining the temporomandibular biomechanics given the effect of anatomy on joint contact mechanics and stress-strain distributions and requires further study as one potential factor for the increased predisposition of women to temporomandibular disc derangement.
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Affiliation(s)
- Matthew C Coombs
- Postdoctoral Fellow, Department of Bioengineering, Clemson University, Clemson, SC; and Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Xin She
- Graduate Assistant, Department of Bioengineering, Clemson University, Clemson, SC
| | - Truman R Brown
- Professor, Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC
| | - Elizabeth H Slate
- Professor, Department of Statistics, Florida State University, Tallahassee, FL
| | - Janice S Lee
- Clinical Director, National Institutes of Health National Institute of Dental and Craniofacial Research, Bethesda, MD
| | - Hai Yao
- Professor, Department of Bioengineering, Clemson University, Clemson, SC; and Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC.
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