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Tao B, Yu X, Wang W, Wang H, Chen X, Wang F, Wu Y. A deep learning-based automatic segmentation of zygomatic bones from cone-beam computed tomography images: A proof of concept. J Dent 2023:104582. [PMID: 37321334 DOI: 10.1016/j.jdent.2023.104582] [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: 02/03/2023] [Revised: 05/28/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES To investigate the efficiency and accuracy of a deep learning-based automatic segmentation method for zygomatic bones from cone-beam computed tomography (CBCT) images. METHODS One hundred thirty CBCT scans were included and randomly divided into three subsets (training, validation, and test) in a 6:2:2 ratio. A deep learning-based model was developed, and it included a classification network and a segmentation network, where an edge supervision module was added to increase the attention of the edges of zygomatic bones. Attention maps were generated by the Grad-CAM and Guided Grad-CAM algorithms to improve the interpretability of the model. The performance of the model was then compared with that of four dentists on 10 CBCT scans from the test dataset. A p value <.05 was considered statistically significant. RESULTS The accuracy of the classification network was 99.64%. The Dice coefficient (Dice) of the deep learning-based model for the test dataset was 92.34 ± 2.04%, the average surface distance (ASD) was 0.1 ± 0.15 mm, and the 95% Hausdorff distance (HD) was 0.98 ± 0.42 mm. The model required 17.03 seconds on average to segment zygomatic bones, whereas this task took 49.3 minutes for dentists to complete. The Dice score of the model for the 10 CBCT scans was 93.2 ± 1.3%, while that of the dentists was 90.37 ± 3.32%. CONCLUSIONS The proposed deep learning-based model could segment zygomatic bones with high accuracy and efficiency compared with those of dentists. CLINICAL SIGNIFICANCE The proposed automatic segmentation model for zygomatic bone could generate an accurate 3D model for the preoperative digital planning of zygoma reconstruction, orbital surgery, zygomatic implant surgery, and orthodontics.
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Affiliation(s)
- Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xinbo Yu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wenying Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Haowei Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room 805, Dongchuan Road 800, Minhang District, Shanghai, 200240, China..
| | - Feng Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China..
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China..
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Fleming PPS, Andrews DJ. Orthodontic Treatment: Getting the timing right. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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3D Printed Customized Facemask for Maxillary Protraction in the Early Treatment of a Class III Malocclusion: Proof-of-Concept Clinical Case. MATERIALS 2022; 15:ma15113747. [PMID: 35683044 PMCID: PMC9181288 DOI: 10.3390/ma15113747] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 01/27/2023]
Abstract
In order to improve fit and comfort, a maxillary protraction facemask customized to the patient’s anatomy was produced by means of 3D face scanning, digital design and additive manufacturing. An 8-year-old patient in need of early treatment for the Class III malocclusion received a rapid palatal expander and a Petit-type facemask, whose components were digitally designed on a 3D scan of the patient’s face. For face scanning, the iPad Pro 2018 tablet (Apple, Cupertino, CA, USA) with the Bellus3D DentalPro application (Bellus3D, Campbell, CA, USA) was used. Facemask components were modelled with 3D Blender software. The rests were 3D printed in BioMed Clear biocompatible resin (Formlabs, Somerville, MA, USA), and the bar in stainless steel. For greater comfort, the internal surface of the rests was lined with a polymer gel pad (Silipos, Niagara Falls, NY, USA). The manufacturing procedure of the customized facemask is patented. The patient wore the facemask at night for a period of 9 months. The patient’s experience was evaluated with a questionnaire at 1 week, 3, 6, and 10 months of treatment. The customized facemask was well accepted by the patient and obtained the expected treatment outcome. Furthermore, 3D face scanning, 3D modelling and 3D printing allow for the manufacturing of customized facemasks with improved fit and comfort, favoring patient compliance and treatment success.
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Zygomaticomaxillary suture maturation evaluation in patients with and without cleft lip and palate. Am J Orthod Dentofacial Orthop 2022; 162:162-172. [DOI: 10.1016/j.ajodo.2021.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/24/2022]
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刘 伟, 王 怡, 王 雪, 周 彦. [A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:346-355. [PMID: 35435203 PMCID: PMC9069022 DOI: 10.19723/j.issn.1671-167x.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask. METHODS In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis. RESULTS Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R2=42.5%. CONCLUSION RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.
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Affiliation(s)
- 伟涛 刘
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 怡然 王
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 雪东 王
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 彦恒 周
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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刘 伟, 王 怡, 王 雪, 周 彦. [A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:346-355. [PMID: 35435203 PMCID: PMC9069022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask. METHODS In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis. RESULTS Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R2=42.5%. CONCLUSION RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.
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Affiliation(s)
- 伟涛 刘
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 怡然 王
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 雪东 王
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 彦恒 周
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Age-Dependent Three-Dimensional Evaluation of Circummaxillary Sutures Maturation in Normal Population Using Cone-Beam Computed Tomography. J Craniofac Surg 2022; 33:e733-e735. [DOI: 10.1097/scs.0000000000008652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022] Open
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Abstract
SUMMARY Facial sutures contribute significantly to postnatal facial development, but their potential role in craniofacial disease is understudied. Since interest in their development and physiology peaked in the mid-twentieth century, facial sutures have not garnered nearly the same clinical research interest as calvarial sutures or cranial base endochondral articulations. In addition to reinforcing the complex structure of the facial skeleton, facial sutures absorb mechanical stress and generally remain patent into and beyond adolescence, as they mediate growth and refine the shape of facial bones. However, premature closure of these sites of postnatal osteogenesis leads to disrupted growth vectors and consequent dysmorphologies. Although abnormality in individual sutures results in isolated facial deformities, we posit that generalized abnormality across multiple sutures may be involved in complex craniofacial conditions such as syndromic craniosynostosis. In this work, the authors comprehensively review 27 key facial sutures, including physiologic maturation and closure, contributions to postnatal facial development, and clinical consequences of premature closure.
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A retrospective long-term comparison of early RME-facemask versus late Hybrid-Hyrax, alt-RAMEC and miniscrew-supported intraoral elastics in growing Class III patients. Int Orthod 2021; 20:100603. [PMID: 34972642 DOI: 10.1016/j.ortho.2021.100603] [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: 05/16/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the long-term dentoskeletal effects of early treatment with banded or bonded RME (Rapid Maxillary Expansion)-Face Mask (RME-FM) versus late treatment with bonded Hybrid-Hyrax, alt-RAMEC (Alternate Rapid Maxillary Expansion and Contraction) and intraoral Class III elastics anchored to miniscrew-reinforced-Lower-lingual-Arch (alt-RAMEC-HH-LLA) in growing, maxillary retrognathic patients. MATERIALS AND METHODS Two groups were matched at long-term follow-up retrospectively. Patients received either early RME-FM (n=16, 5 males, 11 females, age T1: 6.5±0.9 years, age T2: 15.8±2.5 years) or late alt-RAMEC-HH-LLA (n=15, 7 males, 8 females, age T1: 12.52±0.94 years, age T2: 16.8±0.9 years). Total follow-up was 9.2±2.3 years and 4.2±0.2 years respectively, including fixed appliances to compete treatment. RESULTS Both treatments resulted in Class III correction except one unsuccessful case of alt-RAMEC-HH-LLA. Active maxillary protraction was 1.6±0.5years with RME-FM and 0.5 years with alt-RAMEC-HH-LLA being significantly shorter (P<0.001). Values at T2 estimation with multivariate linear regression for correlated multiple outcomes, conditional on baseline estimates, age and sex showed alt-RAMEC-HH-LLA inducing significantly more retroclined lower incisors (mean: -6.11°; 95%CI: -10.66, -1.57; P=0.01), less overbite (mean: -1.28mm; 95%CI: -1.79, -0.761; P<0.001), less maxillo (Co-A)- (mean: -4.54mm; 95%CI: -7.91, -1.16; P=0.01) mandibular (Co-Gn) (mean: -10.5mm; 95%CI: -17.45, -3.55; P=0.003) projections/size, more open gonial angle (mean: 4.93°; 95%CI: 2.27, 7.59; P<0.001), and less S-N length (mean: -5.04mm; 95%CI: -6.57, -3.51; P<0.001). CONCLUSIONS Patients treated with either early RME-FM or late Alt-RAMEC-HH-LLA had comparable overall post-pubertal skeletal and overjet corrections. However, the late Alt-RAMEC-HH-LLA showed less correction of dentoalveolar compensations and in particular of the mandibular incisors. The overbite, maxillary and mandibular projection and size were lower and the gonial angle was more open.
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Mehta S, Chen PJ, Upadhyay M, Yadav S. Intermaxillary elastics on skeletal anchorage and MARPE to treat a class III maxillary retrognathic open bite adolescent: A case report. Int Orthod 2021; 19:707-715. [PMID: 34452857 DOI: 10.1016/j.ortho.2021.08.001] [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] [Received: 07/02/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Class III malocclusion when accompanied with transverse and vertical maxillomandibular discrepancies such as posterior crossbite and vertical open bite leads to complicated orthodontic treatment. Proper diagnosis and treatment planning are important in such patients for a successful orthodontic outcome. A common treatment approach for patients with class III malocclusion is to wait for the completion of growth and plan orthognathic surgery in conjunction with orthodontic treatment. However, performing no treatment and waiting for growth to be completed during teen years could lead to negative effects on the patient's self-esteem. In such cases, a non-surgical option with skeletal anchorage could be used to correct the malocclusion without surgical intervention. This case report shows that in patients with severe class III malocclusion, skeletal anchorage can be used for the correction of anterior crossbite with intermaxillary elastics.
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Affiliation(s)
- Shivam Mehta
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA.
| | - Po-Jung Chen
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
| | - Madhur Upadhyay
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
| | - Sumit Yadav
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
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Ok G, Sen Yilmaz B, Aksoy DO, Kucukkeles N. Maturity evaluation of orthodontically important anatomic structures with computed tomography. Eur J Orthod 2021; 43:8-14. [PMID: 32006443 DOI: 10.1093/ejo/cjaa009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES The success of the orthopaedic treatment is closely related to the patient's skeletal maturation. This study aimed to evaluate the midpalatal suture (MPS), the zygomaticomaxillary suture (ZMS) maturation, and the closure degree of the spheno-occipital synchondrosis (SOS) in patients of different age groups. The presence of a correlation between these parameters and the palatal dimensions was also verified. SUBJECTS/METHODS The study was based on computed tomography images of 314 patients between 7 and 30 years of age with no orthodontic treatment history. The images were retrieved from the archive of the Radiology Department of Bezmialem Vakif University Hospital and divided into six groups according to the patient's age: 7-10, 11-13, 14-16, 17-20, 21-25, and 26-30 years. The maturation scores of ZMS, SOS, and MPS were determined, and palatal thickness and length were recorded. The data were analysed by using Statistical Package for Social Sciences for Windows 22.0. RESULTS A positive relationship was found between SOS closure degree and MPS/ZMS maturation (MPS-ZMS: r = 0.816, MPS-SOS: r = 0.736, ZMS-SOS: r = 0.868, P = 0.000). The degrees of ZMS and MPS maturation were significantly increased as the SOS closure degree increased. The MPS maturation score was significantly lower in patients with a short and thick palate (MPS-palatal thickness: r = 0.405, MPS-palatal length: r = 0.387, P = 0.000). CONCLUSIONS A positive correlation indicated the simultaneous progress in the maturation of the SOS, MPS, and ZMS. Moreover, the ANS-PNS length increase was found to be correlated with the increase of the MPS, ZMS, and SOS maturation scores. In contrast, a negative correlation was observed between the palatal thickness and the maturation stage of these structures.
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Affiliation(s)
- Gokcen Ok
- Private Practice, Neo Golpark Villaları, Kocayusuf Cad., Bolluca, Istanbul, Turkey
| | - Berza Sen Yilmaz
- Department of Orthodontics, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - Direnc Ozlem Aksoy
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Nazan Kucukkeles
- Department of Orthodontics, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Kakali L, Christopoulou I, Tsolakis IA, Sabaziotis D, Alexiou A, Sanoudos M, Tsolakis AI. Mid-term follow up effectiveness of facemask treatment in class III malocclusion: A systematic review. Int Orthod 2021; 19:365-376. [PMID: 34305011 DOI: 10.1016/j.ortho.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This systematic review aims to investigate and summarize the mid-term effects and stability of the treatment with facemask appliance. METHODS Search without restrictions in five databases (Pubmed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials) since inception and hand searching until March 2021 was conducted. Detailed search strategies were based on the PubMed strategy and adapted accordingly. Studies assessing the mid-term effects of facemask appliance, with a follow-up post-treatment period of more than 6 years or after the peak of pubertal growth, were to be included. The risk of bias in individual studies was assessed using the Cochrane guidelines for the RCT and the ROBINS-I tool for the non-RCT studies. RESULTS Five studies were finally considered eligible for inclusion (one RCT and four CCTs). According to the reported evidence, the mid-term success rate ranged from 62.7% to 100%. Mid-term success was identified with positive overjet as well as acceptable aesthetic and functional characteristics. CONCLUSIONS Class III malocclusion treated with facemask presents a high percentage of success in the mid-term follow-up period. The mid-term effects of facemask were stable for the maxilla, in terms of sagittal and anteroposterior dentoskeletal dimensions, and any kind of relapse is attributed to uncontainable residual growth of the mandible. However, considering the high risk of bias and the follow-up period limitations, more high-quality studies are necessary in order to achieve further clarification. Future research should be based also on identifying biomarkers to indicate likely treatment responses. REGISTRATION NUMBER PROSPERO: CRD42020179402.
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Affiliation(s)
- Lydia Kakali
- University of Athens, School of Dentistry, Department of Orthodontics, Athens, Greece
| | - Isidora Christopoulou
- University of Athens, School of Dentistry, Department of Orthodontics, Athens, Greece.
| | - Ioannis A Tsolakis
- University of Athens, School of Dentistry, Department of Orthodontics, Athens, Greece
| | - Dimitris Sabaziotis
- University of Athens, School of Dentistry, Department of Orthodontics, Athens, Greece
| | - Antigoni Alexiou
- University of Athens, School of Dentistry, Department of Orthodontics, Athens, Greece
| | - Mattheos Sanoudos
- University of Athens, School of Dentistry, Department of Orthodontics, Athens, Greece
| | - Apostolos I Tsolakis
- University of Athens, School of Dentistry, Department of Orthodontics, Athens, Greece; Case Western Reserve University, School of Dental Medicine, Department of Orthodontics, Cleveland, OH, USA
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Vracar TR, Claro W, Vracar ME, Jenkins RS, Bland L, Dayeh AA. Sutural deformation during bone-anchored maxillary protraction. J Oral Biol Craniofac Res 2021; 11:447-450. [PMID: 34094844 DOI: 10.1016/j.jobcr.2021.05.008] [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: 03/05/2021] [Revised: 04/16/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction Bone-anchored maxillary protraction (BAMP) is an emerging treatment option for orthopedic correction of maxillary deficiency in young patients. Compared to reverse pull headgear (RPHG), it is believed that forces generated during BAMP result in greater circum-maxillary sutural separation, mandibular retrusion, and improved maxillary protraction. Mechanical loading of the circum-maxillary sutures during BAMP is still poorly understood. Methods 20 ex-vivo pig heads were used. Miniplates and molar tubes were installed like clinical procedures. A series of five 200 g-force (gf) elastics were applied on the right and left side until 1000gf were reached. Strain gauges were installed across the zygomatico-maxillary (ZMS), zygomatico-temporal (ZTS), and nasofrontal suture (NFS). Differential variable reluctance transducers (DVRTs) were installed across the ZTS. Deformation of the sutures during BAMP and RPHG was measured and compared. Results Higher average sutural deformation of the ZTS and ZMS was seen in BAMP than RPHG: 36.6 ± 20.6με vs 18.0 ± 12.4με and 54.7 ± 28.5με vs 12.5 ± 14.8με, respectively. Similarly, higher NFS deformation was seen in BAMP (18.4 ± 12.9με vs. -0.8 ± 12.0με). DVRT data showed higher ZTS separation in BAMP than RPHG (6.3 ± 5.2 μm vs. 1.7 ± 2.1 μm). These differences were all statistically significant using the Wilcoxon-signed rank test. Conclusion Both RPHG and BAMP forces separate the ZTS and ZMS. BAMP resulted in higher levels of sutural separation at the ZTS and ZMS by 2- and 5-fold, respectively.
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Affiliation(s)
- Taylor Rae Vracar
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Wanda Claro
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Michael Eli Vracar
- Department of General Dentistry, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Randall Stetson Jenkins
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Lane Bland
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Ayman Al Dayeh
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
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Skeletal Changes in Growing Cleft Patients with Class III Malocclusion Treated with Bone Anchored Maxillary Protraction-A 3.5-Year Follow-Up. J Clin Med 2021; 10:jcm10040750. [PMID: 33668503 PMCID: PMC7918916 DOI: 10.3390/jcm10040750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023] Open
Abstract
This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. Subjects and Method: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography (CBCT) scans were taken before the start of BAMP (T0), 1.5-years after (T1) and 3.5 y after (T2). Seventeen age- and malocclusion-matched, untreated cleft subjects with cephalograms available at T0 and T2 served as the control group. Three dimensional skeletal changes were measured qualitatively and quantitatively on CBCT scans. Two dimensional measurements were made on cephalograms. Results: Significant positive effects have been observed on the zygomaticomaxillary complex. Specifically, the A-point showed a displacement of 2.7 mm ± 0.9 mm from T0 to T2 (p < 0.05). A displacement of 3.8 mm ± 1.2 mm was observed in the zygoma regions (p < 0.05). On the cephalograms significant differences at T2 were observed between the BAMP and the control subjects in Wits, gonial angle, and overjet (p < 0.05), all in favor of the treatment of Class III malocclusion. The changes taking place in the two consecutive periods (ΔT1-T0, ΔT2-T1) did not differ, indicating that not only were the positive results from the first 1.5-years maintained, but continuous orthopedic effects were also achieved in the following 2-years. Conclusions: In conclusion, findings from the present prospective study with a 3.5-years follow-up provide the first evidence to support BAMP as an effective and reliable treatment option for growing cleft subjects with mild to moderate Class III malocclusion up to 15-years old.
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Martina R, D'Antò V, De Simone V, Galeotti A, Rongo R, Franchi L. Cephalometric outcomes of a new orthopaedic appliance for Class III malocclusion treatment. Eur J Orthod 2020; 42:187-192. [PMID: 31314883 DOI: 10.1093/ejo/cjz037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate dental and skeletal effects of a new orthopaedic appliance for the treatment of Class III malocclusion in growing patients. MATERIAL AND METHODS This retrospective cephalometric study was performed on a sample of 18 patients with a skeletal Class III malocclusion (4 males; 14 females; mean age 8.8 ± 1.5 years) treated with the Pushing Splints 3 (PS3) protocol. The control group consisted of 18 subjects (5 males; 13 females; mean age 9.1 ± 1.8 years) selected from a database of subjects with untreated Class III malocclusion. The cephalometric analysis was performed at the beginning (T0) and the end of the orthopaedic therapy (T1). Significant differences between the treated and control groups were assessed with independent samples t-test (P < 0.05). RESULTS In the PS3 group, the post-treatment cephalometric values showed a forward displacement of the maxilla, resulting in a statistically significant increase of the SNA angle. ANPg and Wits appraisal improved significantly compared with the control group. Lingual inclination of mandibular incisors and buccal inclination of the upper incisors were significantly increased in comparison with the control group. No significant differences were recorded for backward mandibular rotation. LIMITATIONS This study presents a short-term evaluation of the treatment and the use of a historical control group. CONCLUSIONS The PS3 was effective for the treatment of Class III malocclusion in growing patients, with favourable maxillary advancement and control of the vertical skeletal relationships.
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Affiliation(s)
- Roberto Martina
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples 'Federico II' Children's Hospital, Rome
| | - Vincenzo D'Antò
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples 'Federico II' Children's Hospital, Rome
| | - Vittoria De Simone
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples 'Federico II' Children's Hospital, Rome
| | - Angela Galeotti
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome
| | - Roberto Rongo
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples 'Federico II' Children's Hospital, Rome
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Orthopaedic and orthodontic treatment with hyrax, Class III elastics on mandibular miniplates, maxillary mini-implants in a Class III adolescent: A case report. Int Orthod 2020; 18:827-838. [PMID: 32654977 DOI: 10.1016/j.ortho.2020.06.001] [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] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The treatment of Skeletal Class III malocclusion continues to be considered as one of the biggest challenges in orthodontics as the success of its correction is largely unpredictable. Early diagnosis and treatment are highly recommended to eliminate primary etiological factors and prevent an increase in severity of the existing malocclusion. However, if the diagnosis is delayed until adulthood, treatment becomes restricted to orthognathic surgery due to limited or no remaining growth potential left. The inherent risks involved with the surgical procedures often preclude the patients from opting for it, thus leaving the orthodontist with no option but to perform possible compensatory treatments to improve facial aesthetics and restore functional occlusion. OBJECTIVE To report the case of a 15-year old boy (adolescent) with Skeletal Class III malocclusion, a concave facial profile with an anterior crossbite and no incisor visibility during smile. METHODS Intra-oral skeletally anchored maxillary protraction (I-SAMP) and mini-implants associated with fixed appliance to aid in the correction of the skeletal bases and subsequently relieve the dental crowding. RESULTS After 36 months of treatment, functional normal occlusion with a Class I molar and canine relation was achieved. The consequential increase in upper lip thickness and decrease in lower lip fullness alongwith an increased exposure of maxillary incisors during smile resulted in a significant improvement of the patient's facial profile and an aesthetically pleasing smile.
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Andrucioli MCD, Matsumoto MAN. Transverse maxillary deficiency: treatment alternatives in face of early skeletal maturation. Dental Press J Orthod 2020; 25:70-79. [PMID: 32215481 PMCID: PMC7077945 DOI: 10.1590/2177-6709.25.1.070-079.bbo] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 12/04/2022] Open
Abstract
Transverse deficiencies should be a priority in orthodontic treatment, and should be corrected as soon as diagnosed, to restore the correct transverse relationship between maxilla and mandible and, consequently, normal maxillary growth. Corrections may be performed at the skeletal level, by opening the midpalatal suture, or by dentoalveolar expansion. The choice of a treatment alternative depends on certain factors, such as age, sex, degree of maxillary hypoplasia and maturation of the midpalatal suture. Thus, the present study discusses different treatment approaches to correct maxillary hypoplasia in patients with advanced skeletal maturation.
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Affiliation(s)
- Marcela Cristina Damião Andrucioli
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Curso de Especialização em Ortodontia (Ribeirão Preto / SP, Brasil)
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Deformation of the zygomaticomaxillary and nasofrontal sutures during bone-anchored maxillary protraction and reverse-pull headgear treatments: An ex-vivo study. Am J Orthod Dentofacial Orthop 2019; 156:745-757. [PMID: 31784008 DOI: 10.1016/j.ajodo.2018.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/01/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Bone-anchored maxillary protraction (BAMP) is an emerging treatment that involves applying a protraction load to the maxillary bone. Although it is believed that such an approach results in better sutural separation, this has not been investigated. This study aimed to assess and compare the deformation of 1 circumaxillary suture (zygomaticomaxillary suture [ZMS]) and 1 facial suture (nasofrontal suture [NFS]) during BAMP and reverse-pull headgear (RPHG) treatment. METHODS The study was performed ex vivo on 15 pig heads. Miniplates were placed in the maxillary bone and the body of the mandible. A molar tube was bonded to the maxillary first molars. Six single-element strain gauges and 3 differential variable reluctance transducers were installed across the ZMS and NFS bilaterally. Each head underwent BAMP and RPHG unilaterally and bilaterally. RESULTS In unilateral experiments, both BAMP and RPHG resulted in tension on the ipsilateral ZMS and NFS and compression on the contralateral side, with higher magnitude in the BAMP group. In bilateral experiments, both modalities resulted in tension at the ZMS, with higher magnitude in the BAMP group. Deformation of the NFS was different between the 2 groups: tension in majority of the BAMP and compression in most of the RPHG heads. CONCLUSIONS Our study shows a higher magnitude of sutural separation in BAMP than in RPHG. The pattern of sutural deformation is consistent with a forward displacement of the midface in BAMP compared with an upward and backward rotation in the RPHG. Rotation of the maxilla was also present in some of the subjects who underwent BAMP.
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Kajii TS, Sakaguchi Y, Sawa Y, Tamaoki S. Maxillofacial morphological factors related to acceleration of maxillary growth attributed to facial mask treatment: a structural superimposition study. Prog Orthod 2019; 20:2. [PMID: 30637515 PMCID: PMC6330553 DOI: 10.1186/s40510-018-0254-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022] Open
Abstract
Background Anatomical textbooks mention that the contact between the pterygoid process and the palatine’s pyramidal process is not a “suture” but “conjugation.”.The aim was to evaluate the maxillofacial morphological factor responding most to the orthopedic force of facial mask treatment, using the structural superimposition analysis. Methods Thirty-one girls with Angle Class III malocclusion treated using a facial mask (FM group) and 11 girls with pseudo-Class III malocclusion (pseudo-III group) were examined. Lateral cephalograms at pre- and posttreatment were analyzed to evaluate maxillofacial changes. Cephalometric structural superimposition analysis originating with Björk and Skieller was also performed. Results In the FM group, a multiple linear regression model showed that maxillary sutural growth was significantly associated with counter-clockwise rotation of the maxilla and treatment changes in the anteroposterior distance from the pterygomaxillary fissure to the maxillary anterior alveolus, not changes in the distance from the nasion to the maxillary anterior alveolus. Conclusions Structural superimposition analysis showed that counter-clockwise rotation of the maxilla and changes in the distance from the pterygomaxillary fissure to the maxillary anterior alveolus responded most to the orthopedic force of facial mask treatment. The analysis implicated that the pterygoid fissure–palatine’s pyramidal process conjugation responds most to facial mask treatment among maxillofacial sutures and conjugation, and that the difference in the response induces maxillary counter-clockwise rotation. Electronic supplementary material The online version of this article (10.1186/s40510-018-0254-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takashi S Kajii
- Section of Orthodontics, Department of Oral Growth and Development, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan.
| | - Yui Sakaguchi
- Section of Orthodontics, Department of Oral Growth and Development, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Yoshihiko Sawa
- Department of Oral Function & Anatomy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sachio Tamaoki
- Section of Orthodontics, Department of Oral Growth and Development, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
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