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  Reader's Forum l 2021-03-25

  READER’S FORUM

  Nalin Katkoria Priyanka, Sekar Santhosh Kumar, Shivangi Ramteke et al.

  https://doi.org/10.4041/kjod.2021.51.2.75

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  Original Article l 2021-03-25

  Evaluation of a multi-stage convolutional neural network-based fully automated landmark identification system using cone-beam computed tomographysynthesized posteroanterior cephalometric images

  Min-Jung Kim , Yi Liu, Song Hee Oh et al.

  https://doi.org/10.4041/kjod.2021.51.2.77

  Abstract : Objective: To evaluate the accuracy of a multi-stage convolutional neural network (CNN) model-based automated identification system for posteroanterior (PA) cephalometric landmarks. Methods: The multi-stage CNN model was implemented with a personal computer. A total of 430 PA-cephalograms synthesized from cone-beam computed tomography scans (CBCT-PA) were selected as samples. Twenty-three landmarks used for Tweemac analysis were manually identified on all CBCT-PA images by a single examiner. Intra-examiner reproducibility was confirmed by repeating the identification on 85 randomly selected images, which were subsequently set as test data, with a two-week interval before training. For initial learning stage of the multi-stage CNN model, the data from 345 of 430 CBCT-PA images were used, after which the multi-stage CNN model was tested with previous 85 images. The first manual identification on these 85 images was set as a truth ground. The mean radial error (MRE) and successful detection rate (SDR) were calculated to evaluate the errors in manual identification and artificial intelligence (AI) prediction. Results: The AI showed an average MRE of 2.23 ± 2.02 mm with an SDR of 60.88% for errors of 2 mm or lower. However, in a comparison of the repetitive task, the AI predicted landmarks at the same position, while the MRE for the repeated manual identification was 1.31 ± 0.94 mm. Conclusions: Automated identification for CBCT-synthesized PA cephalometric landmarks did not sufficiently achieve the clinically favorable error range of less than 2 mm. However, AI landmark identification on PA cephalograms showed better consistency than manual identification.

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  Original Article l 2021-03-25

  Effect of micro-osteoperforations on external apical root resorption: A randomized controlled trial

  Azaitun Akma Shahrin , Sarah Haniza Abdul Ghani, Noraina Hafizan Norman

  https://doi.org/10.4041/kjod.2021.51.2.86

  Abstract : Objective: This study aimed to investigate the effect of micro-osteoperforations (MOPs) on external apical root resorption (EARR) during the initial orthodontic alignment phase of maxillary anterior crowding. Methods: Thirty patients (25 females, 5 males; mean age, 22.66 ± 3.27 years) who presented with moderate crowding of the upper labial segment and underwent extraction-based fixed appliance treatment were recruited. They were randomly allocated to receive adjunctive therapy with MOPs (n = 15) or treatment with fixed appliances only (control group; n = 15). EARR was measured from long-cone periapical radiographs taken at the start and the sixth month of treatment. A correction factor for the enlargement difference was used to calculate EARR. Data were analyzed with descriptive statistics and repeated-measures analysis of variance. Results: The mean root lengths of 168 teeth were measured and showed no statistically significant difference (p > 0.05) after six months of fixed appliance treatment in the MOP (mean difference [MD] = 0.13 mm; 95% confidence interval [CI] = −0.10–0.35) and control group (MD = 0.14 mm; 95% CI = −0.10–0.37). Most of the roots in the MOP and control groups (42.86% and 52.38%, respectively) showed only mild resorption. Less than 8% of the roots in both groups (7.14% in the MOP group and 4.76% in the control group) showed moderate resorption. Conclusions: Acceleration of orthodontic tooth movement with adjunctive MOPs therapy during the alignment phase does not exacerbate EARR in patients with moderate crowding of the upper labial segment in comparison with controls.

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  Original Article l 2021-03-25

  Full-arch accuracy of five intraoral scanners: In vivo analysis of trueness and precision

  Miran Kwon , Youngmok Cho, Dong-Wook Kim et al.

  https://doi.org/10.4041/kjod.2021.51.2.95

  Abstract : Objective: To evaluate the trueness and precision of full-arch scans acquired using five intraoral scanners and investigate the factors associated with the dimensional accuracy of the intraoral scan data. Methods: Nine adult participants (mean age, 34.3 ± 8.3 years) were recruited. Four zirconium spheres (Ø 6 mm) were bonded to the canines and the molars. Following acquisition of reference scans using an industrial-grade scanner, five intraoral scanners, namely i500, CS3600, Trios 3, iTero, and CEREC Omnicam, were used to scan the arches. Linear distances between the four reference spheres were automatically calculated, and linear mixed model analysis was performed to compare the trueness and precision of the intraoral scan data among the different scanners. Results: The absolute mean trueness and precision values for all intraoral scanners were 76.6 ± 79.3 and 56.6 ± 52.4 μm, respectively. The type of scanner and the measured linear distances had significant effects on the accuracy of the intraoral scan data. With regard to trueness, errors in the intermolar dimension and the distance from the canine to the contralateral molar were greater with Omnicam than with the other scanners. With regard to precision, the error in the linear distance from the canine to the molar in the same quadrant was greater with Omnicam and CS3600 than with the other scanners. Conclusions: The dimensional accuracy of intraoral scan data may differ significantly according to the type of scanner, with the amount of error in terms of trueness being clinically significant.

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  Original Article l 2021-03-25

  Relationship between rotational disc displacement of the temporomandibular joint and the dentoskeletal morphology

  So-Hyun Park , Won-Jeong Han, Dong-Hwa Chung et al.

  https://doi.org/10.4041/kjod.2021.51.2.105

  Abstract : Objective: The purpose of this study was to evaluate the relationship between rotational disk displacement (DD) of the temporomandibular joint (TMJ) and the dentoskeletal morphology. Methods: Women aged > 17 years were included in this study. Each subject had a primary complaint of malocclusion and underwent routine cephalometric examinations. They were divided into five groups according to the findings on sagittal and coronal magnetic resonance images of their TMJs: bilateral normal disk position, bilateral anterior DD with reduction (ADDR), bilateral rotational DD with reduction (RDDR), bilateral anterior DD without reduction (ADDNR), and bilateral rotational DD without reduction (RDDNR). Twenty-three cephalometric variables were analyzed, and the Kruskal–Wallis test was used to evaluate differences in the dentoskeletal morphology among the five groups. Results: Patients with TMJ DD exhibited a hyperdivergent pattern with a retrognathic mandible, unlike those with a normal disk position. These specific skeletal characteristics were more severe in patients exhibiting DD without reduction than in those with reduction, regardless of the presence of rotational DD. Rotational DD significantly influenced horizontal and vertical skeletal patterns only in the stage of DD with reduction, and the mandible exhibited a more backward position and rotation in patients with RDDR than in those with ADDR. However, there were no significant dentoskeletal differences between ADDNR and RDDNR. Conclusions: The results of this study suggest that rotational DD of TMJ plays an important role in the dentoskeletal morphology, particularly in patients showing DD with reduction.

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  Original Article l 2021-03-25

  Reasons influencing the preferences of prospective patients and orthodontists for different orthodontic appliances

  Guido Artemio Marañón-Vásquez , Luísa Schubach da Costa Barreto, Matheus Melo Pithon et al.

  https://doi.org/10.4041/kjod.2021.51.2.115

  Abstract : Objective: To evaluate the reasons influencing the preferences for a certain type of orthodontic appliance over another among prospective patients (PP) and orthodontists. Methods: A total of 49 PP and 51 orthodontists were asked about their preferences for the following appliances: clear aligners (CA), lingual metallic brackets (LMB), polycrystalline and monocrystalline ceramic brackets, and buccal metallic brackets (BMB). The participants rated the importance of 17 potential reasons that would explain their choices. The reasons that contributed most to these preferences were identified. Non-parametric tests (Fisher’s exact, χ² and Mann–Whitney tests) and multivariate analyses (regression and discriminant analysis) were used to assess the data (α = 0.05). Results: CA and BMB were the most chosen appliances by PP and orthodontists, respectively. LMB was the most rejected option among both groups of participants (p < 0.001). Rates of the importance of pain/discomfort, smile esthetics, finishing details, and feeding/speech impairment showed the highest differences between PP and orthodontists (p < 0.0005). Discriminant analyses showed that individuals who considered treatment time and smile esthetics as more important were more likely to prefer CA, while those who prioritized finishing details and cost were more likely to choose BMB (p < 0.05). Conclusions: Reasons related to comfort and quality of life during use were considered as more important by PP, while those related to the results and clinical performance of the appliances were considered as more relevant by orthodontists.

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  Original Article l 2021-03-25

  Differences in mandibular condyle and glenoid fossa morphology in relation to vertical and sagittal skeletal patterns: A cone-beam computed tomography study

  Kyoung Jin Noh , Hyoung-Seon Baik, Sang-Sun Han et al.

  https://doi.org/10.4041/kjod.2021.51.2.126

  Abstract : Objective: This study aimed to evaluate the following null hypothesis: there are no differences in the morphology of the temporomandibular joint (TMJ) structures in relation to vertical and sagittal cephalometric patterns. Methods: This retrospective study was performed with 131 participants showing no TMJ symptoms. The participants were divided into Class I, II, and III groups on the basis of their sagittal cephalometric relationships and into hyperdivergent, normodivergent, and hypodivergent groups on the basis of their vertical cephalometric relationships. The following measurements were performed using cone-beam computed tomography images and compared among the groups: condylar volume, condylar size (width, length, and height), fossa size (length and height), and condyle-to-fossa joint spaces at the anterior, superior, and posterior condylar poles. Results: The null hypothesis was rejected. The Class III group showed larger values for condylar width, condylar height, and fossa height than the Class II group (p < 0.05). Condylar volume and superior joint space in the hyperdivergent group were significantly smaller than those in the other two vertical groups (p < 0.001), whereas fossa length and height were significantly larger in the hyperdivergent group than in the other groups (p < 0.01). The hypodivergent group showed a greater condylar width than the hyperdivergent group (p < 0.01). The sagittal and vertical cephalometric patterns showed statistically significant interactions for fossa length and height. Conclusions: TMJ morphology differed across diverse skeletal cephalometric patterns. The fossa length and height were affected by the interactions of the vertical and sagittal skeletal patterns.

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  Brief Report l 2021-03-25

  Micro-computed tomography evaluation of general trends in aligner thickness and gap width after thermoforming procedures involving six commercial clear aligners: An in vitro study

  Mario Palone , Mattia Longo, Niki Arveda et al.

  https://doi.org/10.4041/kjod.2021.51.2.135

  Abstract : Objective: To assess the effects of thermoforming on aligner thickness and gap width in six aligner systems with the same nominal thickness. Methods: Six passive upper aligners of different brands were adapted to a single printed cast. Each sample was evaluated with high-resolution micro-computed tomography. To investigate aligner thickness and gap width, two-dimensional (2D) analysis was conducted assessing the effects of the following variables: tooth type (central incisor, canine, and first molar), 2D reference points, and aligner type. Data were analyzed and compared using analysis of variance and Tukey’s post-hoc tests (p < 0.05). Results: Tooth type, dental region, and aligner type affected both the gap width and aligner thickness. The aligner thickness remained moderately stable across the arch only in the F22. Conclusions: All thermoformed samples displayed smaller aligner thickness and gap width at anterior teeth and both gingival and coronal centers than at posterior teeth and occlusal surfaces.

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