Cephalometric measurements performed on CBCT and reconstructed lateral cephalograms: a cross-sectional study providing a quantitative approach of differences and bias

Background: Cephalometric analysis is traditionally performed on skull lateral teleradiographs for orthodontic diagnosis and treatment planning. However, the skull flattened over a 2D film presents projection distortions and superimpositions to various extents depending on landmarks relative position. When a CBCT scan is indicated for mixed reasons, cephalometric assessments can be performed directly on CBCT scans with a distortion free procedure. The aim of the present study is to compare these two methods for orthodontic cephalometry. Methods: 114 CBCTs were selected, reconstructed lateral cephalometries were obtained by lateral radiographic projection of the entire volume from the right and left sides. 2D and 3D cephalometric tracings were performed. Since paired t-tests between left and right-side measurements found no statistically significant differences, mean values between sides were considered for both 2D and 3D values. The following measurements were evaluated: PNS-A; S-N; N-Me; N-ANS; ANS-Me; Go-Me; Go-S; Go-Co; SNA, SNB, ANB; BaŜN; S-N^PNS-ANS; PNS-ANS^Go-Me; S-N^Go-Me. Intraclass correlation coefficients, paired t-test, correlation coefficient and Bland-Altman analysis were performed to compare these techniques. Results: The values of intra- and inter-rater ICC showed excellent repeatability and reliability: the average (± SD) intraobserver ICCs were 0.98 (± 0.01) and 0.97(± 0.01) for CBCT and RLCs, respectively; Inter-rater reliability resulted in an average ICC (± SD) of 0.98 (± 0.01) for CBCT and 0.94 (± 0.03) for RLC. The paired t-tests between CBCT and reconstructed lateral cephalograms revealed that Go-Me, Go-S, PNS-ANS^Go-Me and S-N^Go-Me measurements were statistically different between the two modalities. All the evaluated sets of measurements showed strong positive correlation; the bias and ranges for the 95% Limits of Agreement showed higher levels of agreement between the two modalities for unpaired measurements with respect to bilateral ones. Conclusion: The cephalometric measurements laying on the mid-sagittal plane can be evaluated on CBCT and used for orthodontic diagnosis as they do not show statistically significant differences with those measured on 2D lateral cephalograms. For measurements that are not in the mid-sagittal plane, the future development of specific algorithms for distortion correction could help clinicians deduct all the information needed for orthodontic diagnosis from the CBCT scan

3D Cephalometric Normality Range: Auto Contractive Maps (ACM) Analysis in Selected Caucasian Skeletal Class I Age Groups

The objective of this paper is to define normal values of a novel 3D cephalometric analysis and to define the links through an artificial neural network (ANN)

Incidental Finding in Pre-Orthodontic Treatment Radiographs of an Aural Foreign Body: A Case Report

The presence of foreign bodies in the external auditory canal of young patients may cause, if left untreated, severe permanent damage to the adjacent anatomical structures, and infections. A 10‐year‐old patient with an intellectual disability underwent orthodontic evaluation. An aural radiopaque finding was visible in the lateral cephalogram and in the orthopantomography. The patient’s mother reported that her son never showed any ear discomfort, except for a mild hearing impairment that was never investigated. The patient was referred to an ear, nose and throat (ENT) specialist that removed the foreign body located in the left external auditory meatus. The careful evaluation of dental radiographs, including pre‐orthodontic and interim orthodontic radiographs, may help to identify silent incidental findings that may otherwise lead to severe complications if left untreated

Cone-Beam Computed Tomographic Assessment of the Mandibular Condylar Volume in Different Skeletal Patterns: A Retrospective Study in Adult Patients

The aim of this study was to assess the condylar volume in adult patients with different skeletal classes and vertical patterns using cone‐beam computed tomography (CBCT). CBCT scans of 146 condyles from 73 patients (mean age 30   12 years old; 49 female, 24 male) were selected from the archive of the Department of Dentistry and Maxillofacial Surgery of Fondazione IRCCS Ca’ Granda, Milan, Italy, and retrospectively analyzed. The following inclusion criteria were used: adult patients; CBCT performed with the same protocol (0.4 mm slice thickness, 16   22 cm field of view, 20 s scan time); no systemic diseases; and no previous orthodontic treatments. Three‐dimensional cephalometric tracings were performed for each patient, the mandibular condyles were segmented and the relevant volumes calculated using Mimics Materialize 20.0  software (Materialise, Leuven, Belgium). Right and left variables were analyzed together using random‐intercept linear regression models. No significant association between condylar volumes and skeletal class was found. On the other hand, in relation to vertical patterns, the mean values of the mandibular condyle volumes in hyperdivergent subjects (688 mm3) with a post‐rotation growth pattern (625 mm3) were smaller than in hypodivergent patients (812 mm3) with a horizontal growth pattern (900 mm3). Patients with an increased divergence angle had smaller condylar volumes than subjects with normal or decreased mandibular plane divergence. This relationship may help the clinician when planning orthodontic treatment

Dental and Dental Hygiene Students' Knowledge and Capacity to Discriminate the Developmental Defects of Enamel: A Self-Submitted Questionnaire Survey.

Background: A prompt and accurate diagnosis of developmental defects of enamel (DDE) is mandatory for proper treatment management. This cross-sectional survey, designed and carried out using anonymous self-administered questionnaires, aimed to assess dental and dental hygiene students' knowledge and their capability to identify different enamel development defects. Methods: The questionnaire consisted of twenty-eight closed-ended questions. Two different samples of undergraduate students were selected and enrolled: a group of dental hygiene (GDH) students and a group of dental (GD) students. A multivariate logistic regression was performed by adopting the correct answers as explanatory variables to assess the difference between the two groups. Results: Overall, 301 completed questionnaires were analyzed: 157 from the GDH and 144 from the GD. The dental student group showed better knowledge than the GDH of enamel hypomineralization and hypoplasia (p = 0.03 for both). A quarter (25.25%) of the total sample correctly identified the period of development of dental fluorosis with a statistically significant difference between the groups (p < 0.01). Amelogenesis imperfecta (AI) was identified as a genetic disease by 64.45% of the sample, with a better performance from the GD (p = 0.01), while no statistical differences were found between the groups regarding molar incisor hypomineralization. Multivariate analysis showed that AI (OR = 0.40, [0.23;0.69], p < 0.01) and caries lesion (OR = 0.58, [0.34;0.94], p = 0.03) were better recognized by the GD. Conclusions: Disparities exist in the knowledge and management of DDE among dental and dental hygiene students in Italy; however, significant knowledge gaps were found in both groups. Education on the diagnosis and treatment of DDE during the training for dental and dental hygiene students needs to be strongly implemented

Assessment of facial asymmetry using stereophotogrammetry

Asymmetry in the dimensions and spatial position of facial structures is a common finding in healthy individuals and in esthetically pleasing faces (1). Additionally, a variety of craniofacial anomalies are characterized by severe hard- and soft-tissue asymmetry (2). Facial asymmetry can impair the affected people from both aesthetical and functional points of view. Currently, facial asymmetry is mainly evaluated using the entire facial surface, thus providing measurements that give only general information about facial morphology. In contrast, several pathologies affecting facial appearance are localized in selected parts of the face, and a local assessment can provide helpful information for clinical decisions. For these reasons a detailed, focused and objective evaluation of facial asymmetry is advised, both for surgical planning and treatment evaluation. In this study we present a new quantitative method to assess symmetry in different facial thirds, objectively defined on the territories of distribution of trigeminal branches. Forty healthy young adults (21 women; 19 men; average age 39 ± 12 years) were acquired with a stereophotogrammetric system and the level of asymmetry of their hemi-facial thirds was evaluated, comparing the root mean square of the distances (RMSD) between their original and mirrored facial surfaces. The method resulted highly reproducible (Bland and Altman coefficient of reproducibility for area selection, 98.8%). In the upper facial third, median asymmetry was 0.726 mm (IQ range: 0.579-0.954 mm); in the middle facial third, median asymmetry was 0.739 mm (IQ range: 0.558-0.887 mm); in the lower facial third, median asymmetry was 0.679 mm (IQ range: 0.552-0.907 mm). No significant differences in RMSD values among the facial thirds were found (ANOVA, p>0.05). The presented method provides an accurate, reproducible and local facial symmetry analysis, that can be used for different conditions, especially when only part of the face is asymmetric.This work was supported by grants from University of Milan (Grant for Research 2015-2017)

Comparison of direct linear measurements on dental plaster cast and digital measurements obtained from laser scanner and Cone-Beam CT dental models

Different dental imaging technologies are now daily used in clinical practice to evaluate oral anatomy. These new techniques allow to replace dental plaster casts with digital models that are easier to manage and store. Such models can be acquired with optical methods like laser scanner, stereophotogrammetry and intraoral scanner or reconstructed by 3D CT or CBCT images [1]. Since these digital casts are used in clinical routine, it is important to evaluate accuracy and reliability of measurements taken from them, in relation to traditional methods [2]. We wanted to compare linear measurements taken on digital models obtained from CBCT images and laser scanner surfaces, with direct measurements obtained with digital calliper on dental plaster casts. Data from 6 adult Caucasian subjects with full dentition, no history of implant surgery and without dental filling were obtained. The absence of implants and metal fillings was selected as inclusion criterion to reduce the presence of metal artefacts that can affect the measurement process. All patients were retrospectively selected from a clinical database and underwent CBCT examination for clinical reasons uncorrelated with this study. Six dental distances in the upper and six in the lower jaw were examined: the mesio-distal distance of teeth 21, 23, 24 and 26, the palatal-vestibular distance of teeth 24 and 26, and the corresponding distances on teeth 41, 43, 44 and 46. All measurements were performed using: 1) a digital calliper on dental plaster casts; 2) a virtual calliper on digital models obtained from CBCT images; and 3) a virtual calliper on laser scanner surfaces. Kruskal-Wallis test compared measurements performed with the 3 different techniques. There was no statistical significant difference among different techniques for all measurements (p>0.05) except for one distance, the mesio-distal distance of tooth 24 (

The Gaseous Ozone Therapy as a Promising Antiseptic Adjuvant of Periodontal Treatment: A Randomized Controlled Clinical Trial

Background: the establishment of periodontitis is regulated by the primary etiological factor and several individual conditions including the immune response mechanism of the host and individual genetic factors. It results when the oral homeostasis is interrupted, and biological reactions favor the development and progression of periodontal tissues damage. Different strategies have been explored for reinforcing the therapeutic effect of non-surgical periodontal treatment of periodontal tissue damage. Gaseous ozone therapy has been recognized as a promising antiseptic adjuvant, because of its immunostimulating, antimicrobial, antihypoxic, and biosynthetic effects. Then, we hypothesized that the adjunct of gaseous ozone therapy to standard periodontal treatment may be leveraged to promote the tissue healing response. Methods: to test this hypothesis, we conducted a prospective randomized study comparing non-surgical periodontal treatment plus gaseous ozone therapy to standard therapy. A total of 90 healthy individuals with moderate or severe generalized periodontitis were involved in the study. The trial was conducted from September 2019 to October 2020. Forty-five patients were randomized to receive scaling and rootplanning (SRP) used as conventional non-surgical periodontal therapy plus gaseous ozone therapy (GROUP A); forty-five were allocated to standard treatment (GROUP B). The endpoint was defined as the periodontal response rate after the application of the ozone therapy at 3 months and 6 months, defined as no longer meeting the criteria for active periodontitis. Statistical analysis was performed employing SPSS v.18 Chicago: SPSS Inc. Results: periodontal parameters differed significantly between patients treated with the two distinct procedures at 3 months (p ≤ 0.005); a statistically significant difference between groups was observed from baseline in the CAL (p ≤ 0.0001), PPD (p ≤ 0.0001) and BOP (p ≤ 0.0001) scores. Conclusions: The present study suggests that SRP combined with ozone therapy in the treatment of periodontitis revealed an improved outcome than SRP alone

Evaluation of accuracy and reproducibility in manual point picking during 3D cephalometry on CBCT data

Three-dimensional cephalometry is currently emerging as an innovative diagnos- tic tool, due to accessibility and radiation low dose of Cone Beam CT (CBCT) scan ners (1). Despite annotation made by specialists is now considered the gold standard in clinical practice and research, reliability of manual point picking can be biased by intra and inter-operator differences (2). In order to estimate the variability of the manual procedure, in this study an evaluation of accuracy, precision and reproducibility was performed. Three experienced operators analyzed ten CBCT images, retrospectively selected from the SST Dentofacial Clinic database. They annotated 9 chosen landmarks on all the images for three times, under the same conditions and at least one week of distance. Accuracy and precision were calculated as the median and the interquartile range of the distances from each landmark to the corresponding barycenter, calculated as the mean of all operator annotations. Kruskal-Wallis test was performed to evaluate reproducibility, and post-hoc tests were carried out to assess whether the significance depended from operators. A remarkable difference was found in accuracy between anatomic and geometrical landmarks, in both the intra and inter-operator repetitions. The intra-operator analysis showed higher accuracy and precision values than the inter-operator one. Statistical analyses revealed significant differences in reproducibility (p<0.05) for all landmarks except for Sella turcica, but the post-hoc tests did not show a clear pattern between operators. Results demonstrate that both accuracy and reproducibility may vary, depending on the operators, suggesting the need for automatic or semiautomatic tools that will help the operator during annotation

Dietary supplements for the management of COVID-19 symptoms

SARS-CoV-2, the etiological agent of COVID-19, caused a pandemic in 2020, which is only recently slowing down. The symptoms of COVID-19 range from cough to fever and pneumonia and may persist beyond the active state of the infection, in a condition called post-COVID syndrome. The aim of this paper is to review the relationship between COVID-19 and nutrition and to discuss to most up-to-date dietary supplements proposed for COVID-19 treatment and prevention. Nutrition and nutritional dysregulations, such as obesity and malnutrition, are prominent risk factors for severe COVID-19. These factors exert anti-inflammatory and proinflammatory effects on the immune system, thus exacerbating or reducing the immunological response against the virus. As for the nutritional habits, the Western diet induces a chronic inflammatory state, whereas the Mediterranean diet exerts anti-inflammatory effects and has been proposed for ameliorating COVID-19 evolution and symptoms. Several vaccines have been researched and commercialized for COVID-19 prevention, whereas several drugs, although clinically tested, have not shown promising effects. To compensate for the lack of treatment, several supplements have been recommended for preventing or ameliorating COVID-19 symptoms. Thus, it is critical to review the dietary supplements proposed for COVID-19 treatment. Supplements containing α-cyclodextrin and hydroxytyrosol exhibited promising effects in several clinical trials and reduced the severity of the outcomes and the duration of the infection. Moreover, a supplement containing hydroxytyrosol, acetyl L-carnitine, and vitamins B, C, and D improved the symptoms of patients with post-COVID syndrome