• Journal of Periodontal and Implant Science
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• v.50 no.3
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• pp.146-158
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• 2020

Purpose: The aim of this study was to investigate and identify the main causes of periodontal tissue change associated with labial gingival recession by examining the anterior region of patients who underwent orthodontic treatment. Methods: In total, 45 patients who had undergone orthodontic treatment from January 2010 to December 2015 were included. Before and after the orthodontic treatment, sectioned images from 3-dimensional digital model scanning and cone-beam computed tomography images in the same region were superimposed to measure periodontal parameters. The initial labial gingival thickness (IGT) and the initial labial alveolar bone thickness (IBT) were measured at 4 mm below the cementoenamel junction (CEJ), and the change of the labial gingival margin was defined as the change of the distance from the CEJ to the gingival margin. Additionally, the jaw, tooth position, tooth inclination, tooth rotation, and history of orthognathic surgery were investigated to determine the various factors that could have affected anterior periodontal tissue changes. Results: The mean IGT and IBT were 0.77±0.29 mm and 0.77±0.32 mm, respectively. The mean gingival recession was 0.14±0.57 mm. Tooth inclination had a significant association with gingival recession, and as tooth inclination increased labially, gingival recession increased by approximately 0.2 mm per 1°. Conclusions: In conclusion, the IGT, IBT, tooth position, tooth rotation, and history of orthognathic surgery did not affect labial gingival recession. However, tooth inclination showed a significant association with labial gingival recession of the anterior teeth after orthodontic treatment.

• The korean journal of orthodontics
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• v.48 no.3
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• pp.189-199
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• 2018

For patients with bimaxillary protrusion, significant retraction and intrusion of the anterior teeth are sometimes essential to improve the facial profile. However, severe root resorption of the maxillary incisors occasionally occurs after treatment because of various factors. For instance, it has been reported that approximation or invasion of the incisive canal by the anterior tooth roots during retraction may cause apical root damage. Thus, determination of the position of the maxillary incisors is key for orthodontic diagnosis and treatment planning in such cases. Cone-beam computed tomography (CBCT) may be useful for simulating the post-treatment position of the maxillary incisors and surrounding structures in order to ensure safe teeth movement. Here, we present a case of Class II malocclusion with bimaxillary protrusion, wherein apical root damage due to treatment was minimized by pretreatment evaluation of the anatomical structures and simulation of the maxillary central incisor movement using CBCT. Considerable retraction and intrusion of the maxillary incisors, which resulted in a significant improvement in the facial profile and smile, were achieved without severe root resorption. Our findings suggest that CBCT-based diagnosis and treatment simulation may facilitate safe and dynamic orthodontic tooth movement, particularly in patients requiring maximum anterior tooth retraction.

• The korean journal of orthodontics
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• v.45 no.3
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• pp.113-120
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• 2015

Objective: This study compared occlusal contact areas of ideally planned set-up and accomplished final models against the initial in class I and II molar relationships at finishing. Methods: Evaluations were performed for 41 post-orthodontic treatment cases, of which 22 were clinically diagnosed as class I and the remainder were diagnosed as full cusp class II. Class I cases had four first premolars extracted, while class II cases had maxillary first premolars extracted. Occlusal contact areas were measured using a three-dimensional scanner and RapidForm 2004. Independent t-tests were used to validate comparison values between class I and II finishings. Repeated measures analysis of variance was used to compare initial, set up, and final models. Results: Molars from cases in the class I finishing for the set-up model showed significantly greater contact areas than those from class II finishing (p < 0.05). The final model class I finishing showed significantly larger contact areas for the second molars (p < 0.05). The first molars of the class I finishing for the final model showed a tendency to have larger contact areas than those of class II finishing, although the difference was not statistically significant (p = 0.078). Conclusions: In set-up models, posterior occlusal contact was better in class I than in class II finishing. In final models, class I finishing tended to have larger occlusal contact areas than class II finishing.

• The korean journal of orthodontics
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• v.50 no.3
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• pp.216-226
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• 2020

Root resorption can be caused by several factors, including contact with the cortical bone. Here we report a case involving a 21-year-old female with Angle Class II, division 1 malocclusion who exhibited significant root resorption in the maxillary right central incisor after orthodontic treatment. The patient presented with significant left-sided deviation of the maxillary incisors due to lingual dislocation of the left lateral incisor and a Class II molar relationship. Cephalometric analysis demonstrated a Class I skeletal relationship (A point-nasion-B point, 2.5°) and proclined maxillary anterior teeth (upper incisor to sella-nasion plane angle, 113.4°). The primary treatment objectives were the achievement of stable occlusion with midline agreement between the maxillary and mandibular dentitions and appropriate maxillary anterior tooth axes and molar relationship. A panoramic radiograph obtained after active treatment showed significant root resorption in the maxillary right central incisor; therefore, we performed cone-beam computed tomography, which confirmed root resorption along the cortical bone around the incisive canal. The findings from this case, where different degrees of root resorption were observed despite comparable degrees of orthodontic movement in the bilateral maxillary central incisors, suggest that the incisive canal could be an inducing factor for root resorption. However, further investigation is necessary to confirm this assumption.

• Imaging Science in Dentistry
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• v.45 no.3
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• pp.175-180
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• 2015

Purpose: This study was performed to evaluate the reliability of the identification of anatomical landmarks in panoramic and lateral cephalometric radiographs on a standard medical grade picture archiving communication system (PACS) monitor and a tablet computer (iPad 5). Materials and Methods: A total of 1000 radiographs, including 500 panoramic and 500 lateral cephalometric radiographs, were retrieved from the de-identified dataset of the archive of the Section of Oral and Maxillofacial Radiology of the University Of Connecticut School Of Dental Medicine. Major radiographic anatomical landmarks were independently reviewed by two examiners on both displays. The examiners initially reviewed ten panoramic and ten lateral cephalometric radiographs using each imaging system, in order to verify interoperator agreement in landmark identification. The images were scored on a four-point scale reflecting the diagnostic image quality and exposure level of the images. Results: Statistical analysis showed no significant difference between the two displays regarding the visibility and clarity of the landmarks in either the panoramic or cephalometric radiographs. Conclusion: Tablet computers can reliably show anatomical landmarks in panoramic and lateral cephalometric radiographs.

• Animal cells and systems
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• v.16 no.4
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• pp.295-301
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• 2012

Interdigital tissue regression is one of the most well-known examples of embryonic programmed cell death, providing the mechanism behind separation of developing digits. Caspases have been shown to play a key part in this process, with activated caspase-3 localized between the developing digits. In caspase-3 knock-out adult mice, however, the digits are completely separated with no webbing. In other mutants with defects in the apoptotic machinery, such as Apaf1 deficient mice, interdigital tissue regression is initially inhibited but the webbing eventually disappears as alternative/additional cell death mechanisms step in. In order to investigate whether a similar temporal effect occurs after loss of caspase-3, we have used an in vitro approach to inhibit caspase-3 at specific times during digit separation. Previous limb explant culture approaches have encountered problems with proper limb development in culture, and thus a modified technique was used. The new approach enables detailed observation of the effects of caspase-3 inhibition on interdigital regression. Using these methods, we show that caspase-3 inhibition caused a delay in the loss of interdigital tissue compared with control explants, similar to that observed in Apaf1 mutant mice. Along with immunohistochemistry, active caspase-3 positive cells of the interdigital vs. digital regions were measured by flow cytometry. Notably, activated caspase-3 in vivo was found not only in the interdigital mesenchyme but also in the TUNEL negative digit region, supporting a role for caspase-3 in nonapoptotic events.

• Imaging Science in Dentistry
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• v.51 no.3
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• pp.299-306
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• 2021

Purpose: This study aimed to propose a fully automatic landmark identification model based on a deep learning algorithm using real clinical data and to verify its accuracy considering inter-examiner variability. Materials and Methods: In total, 950 lateral cephalometric images from Yonsei Dental Hospital were used. Two calibrated examiners manually identified the 13 most important landmarks to set as references. The proposed deep learning model has a 2-step structure-a region of interest machine and a detection machine-each consisting of 8 convolution layers, 5 pooling layers, and 2 fully connected layers. The distance errors of detection between 2 examiners were used as a clinically acceptable range for performance evaluation. Results: The 13 landmarks were automatically detected using the proposed model. Inter-examiner agreement for all landmarks indicated excellent reliability based on the 95% confidence interval. The average clinically acceptable range for all 13 landmarks was 1.24 mm. The mean radial error between the reference values assigned by 1 expert and the proposed model was 1.84 mm, exhibiting a successful detection rate of 36.1%. The A-point, the incisal tip of the maxillary and mandibular incisors, and ANS showed lower mean radial error than the calibrated expert variability. Conclusion: This experiment demonstrated that the proposed deep learning model can perform fully automatic identification of cephalometric landmarks and achieve better results than examiners for some landmarks. It is meaningful to consider between-examiner variability for clinical applicability when evaluating the performance of deep learning methods in cephalometric landmark identification.

• Imaging Science in Dentistry
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• v.50 no.4
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• pp.291-298
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• 2020

Purpose: The detection and exact localization of penetrating foreign bodies are crucial for the appropriate management of patients with dentoalveolar trauma. This study compared the efficacy of cone-beam computed tomography (CBCT) and spiral computed tomography (CT) scans for the detection of different foreign bodies composed of 5 frequently encountered materials in 2 sizes. The effect of the location of the foreign bodies on their visibility was also analyzed. Materials and Methods: In this in vitro study, metal, tooth, stone, glass, and plastic particles measuring 1×1×1 mm and 2×2×2 mm were prepared. They were implanted in a sheep's head in the tongue muscle, nasal cavity, and at the interface of the mandibular cortex and soft tissue. CBCT and spiral CT scans were taken and the visibility of foreign bodies was scored by 4 skilled maxillofacial radiologists who were blinded to the location and number of foreign bodies. Results: CT and CBCT were equally accurate in visualizing metal, stone, and tooth particles of both sizes. However, CBCT was better for detecting glass particles in the periosteum. Although both imaging modalities visualized plastic particles poorly, CT was slightly better for detecting plastic particles, especially the smaller ones. Conclusion: Considering the lower patient radiation dose and cost, CBCT can be used with almost equal accuracy as CT for detecting foreign bodies of different compositions and sizes in multiple maxillofacial regions. However, CT performed better for detecting plastic particles.

• Journal of Oral Medicine and Pain
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• v.46 no.2
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• pp.21-32
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• 2021

Purpose: The purpose of the present study was to investigate the correlation between age and 34 radiomorphometric parameters on panoramic radiographs, and to provide generalized linear models (GLMs) as a non-invasive, inexpensive, and accurate method to the forensic judgement of living individual's age. Methods: The study included 417 digital panoramic radiographs of Korean individuals (178 males and 239 females, mean age: 32.57±17.81 years). Considering the skeletal differences between the sexes, GLMs were obtained separately according to sex, as well as across the total sample. For statistical analysis and to predict the accuracy of the new GLMs, root mean squared error (RMSE) and adjusted R-squared (R²) were calculated. Results: The adjusted R²-values of the developed GLMs in the total sample, and male and female groups were 0.623, 0.637, and 0.660, respectively (p<0.001), while the allowable RMSE values were 8.80, 8.42, and 8.53 years, respectively. In the GLM of the total sample, the most influential predictor of greater age was decreased pulp area in the #36 first molar (beta=-26.52; p<0.01), followed by the presence of periodontitis (beta=10.24; p<0.01). In males, the most influential factor was the presence of periodontitis (beta=9.20; p<0.05), followed by the number of full veneer crowns (beta=2.19; p<0.001). In females, the most influential predictor was the presence of periodontitis (beta=18.10; p<0.001), followed by the tooth area of the #16 first molar (beta=-11.57; p<0.001). Conclusions: We established acceptable GLM for each sex and found out the predictors necessary to age estimation which can be easily found in panoramic radiographs. Our study provides reference that parameters such as the area of tooth and pulp, the number of teeth treated, and the presence of periodontitis should be considered in estimating age.

• Journal of dental hygiene science
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• v.22 no.4
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• pp.249-255
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• 2022

Background: Sexual dimorphism is important for sex determination in the field of forensics. However, sexual dimorphism is commonly assessed using cone beam computed tomography (CBCT) rather than three-dimensional (3D) modeling software; therefore, studies using a more accurate measurement approach are necessary. This study assessed the sexual dimorphism of the MS using a 3D modeling program to obtain information that could contribute to the fields of surgery and forensics. Methods: The CBCT data of 60 patients (age, 20~29 y; 30 males and 30 females) admitted to the Department of Orthodontics at the Dankook University School of Dentistry were provided in Digital Imaging and Communications in Medicine (DICOM) format. The left MS and right MS were modeled based on the DICOM files using the Mimics (version 22; Materialise, Leuven, Belgium) 3D program and converted to stereolithography (STL) files used to measure the width, length, and height of the MS, infraorbital foramen (IOF), right MS, and left MS. The average of three repeated measurements was calculated, and a reliability test was performed to ensure data reliability (Cronbach's α=0.618). A canonical discriminant analysis was performed using a standard approach (left: Box's M=0.096; right: Box's M=0.115). Results: Males had greater values for all parameters (MS width, MS length, MS height, IOF, right MS, left MS) than females. The discriminant analysis identified six independent variables (MS width, MS height, MS length, IOF, right MS, left MS) that could identify sex. The left MS and right MS correctly identified the sex of 81.7% and 71.7% of the patients, respectively, with the left MS having higher accuracy. Conclusion: This study confirmed that, for Korean individuals, the left MS has a better ability to identify sex than the right MS. These results may contribute to sex identification in the fields of surgery and forensics.