• 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.

• The korean journal of orthodontics
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• v.51 no.6
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• pp.407-418
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• 2021

Objective: To investigate differences in the heritability of skeletodental characteristics between twin pairs with skeletal Class I and Class II malocclusions. Methods: Forty Korean adult twin pairs were divided into Class I (C-I) group (0° ≤ angle between point A, nasion, and point B [ANB]) ≤ 4°; mean age, 40.7 years) and Class II (C-II) group (ANB > 4°; mean age, 43.0 years). Each group comprised 14 monozygotic and 6 dizygotic twin pairs. Thirty-three cephalometric variables were measured using lateral cephalograms and were categorized as the anteroposterior, vertical, dental, mandible, and cranial base characteristics. The ACE model was used to calculate heritability (A > 0.7, high heritability). Thereafter, principal component analysis (PCA) was performed. Results: Twin pairs in C-I group exhibited high heritability values in the facial anteroposterior characteristics, inclination of the maxillary and mandibular incisors, mandibular body length, and cranial base angles. Twin pairs in C-II group showed high heritability values in vertical facial height, ramus height, effective mandibular length, and cranial base length. PCA extracted eight components with 88.3% in the C-I group and seven components with 91.0% cumulative explanation in the C-II group. Conclusions: Differences in the heritability of skeletodental characteristics between twin pairs with skeletal Class I and II malocclusions might provide valuable information for growth prediction and treatment planning.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.2
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• pp.313-318
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• 2008

Dens invaginatus is a rare malformation resulting from invagination of the enamel before calcification has occurred. It is mostly found in permanent maxillary lateral incisors and mandibular teeth are rarely affected by this anomaly. The malformation is estimated to affect between 0.04 % and 10 % of people and has been associated with other abnormalities such as taurodontism, microdontia, gemination and dentinogenesis imperfecta. Dens invaginatus is classified in three types with respect to the depth of invaginatus and has a broad spectrum of morphologic variations. Invagination frequently allows the entry of irritants and microorganism, which usually lead to caries, pulp infection and pulp necrosis. Root canal treatment on such invaginatus tooth may present severe problems because of its complex anatomy of the tooth. Therefore, the early diagnosis of such malformation is crucial and preventive approach is strongly recommended.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.4
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• pp.644-648
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• 2005

Supernumerary tooth was resulted from excessive proliferation of dental lamina and associated with familial tendency and a congenital syndrome such as Cleidocranial dysostosis or Gardner's syndrome. Incidence reports identify a range of $0.3{\sim}0.8%$ in primary dentition, $1.0{\sim}3.5%$ in permanent dentition with males being affected twice as frequently as females, maxilla nine times as frequently as mandible. The most common supernumerary tooth is the mesiodens, which located between the maxillary central incisors, and the next common site is the fourth molar and lateral incisors. Supernumerary teeth are uncommon in the mandible, but premolars are the most common supernumerary teeth and occurrence is very rare in the incisor region of the mandible and the incidence is 2%. We need a early diagnosis and appropriate treatment plan because of possiblilty of diastema and eruption failure displacement, rotation of the associated permanent teeth, root resorption and dentigerous cyst with presence of the supernumerary teeth. In this two case, one supernumerary tooth located in the mandibular incisor region, the other supernumerary tooth located in premolar region. We could get normal alignment of mandibular dentition by extraction and orthodontic treatment.

• Korean Journal of Cleft Lip And Palate
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• v.6 no.1
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• pp.1-15
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• 2003

Cleft lip and palate deformity have unknown patterns of maxillofacial growth and development. The maxillofacial growth can be affected either by congenital or environmental factors such as infection and trauma. Surgical repair of cleft lip and palate may interfere the subsequent growth and development of maxillofacial region. The purpose of this study is to evaluate the characteristics of development of maxillofacial region in adult cleft lip and palate patients and to compare post-treat-ment craniofacial morphology between cleft lip and palate patients with secondary alveolar bone graft group and normal group. The material for this study consisted of 20 adult male patients with cleft lip and palate(mean 22.5, range 18-31) visited in Yeungnam University medical center. Cephalometric tracing and measurements were done by one investigator. Results were followed: The values of Na. perpendicular to point A, SNA angle and Pogonion to Na. perpendicualrwere -4.93±5.70, 76.45±4.69, and -6.38±6.73. The values of effective maxillary length, effective mandibular length, mandibular plane angle and facial axis angle were 85.6±4. 42, 123.88±7.10, 29.9±5.09 and 5.53±2.03. The value of upper incisors to point A was 3.95±2.74.

• The korean journal of orthodontics
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• v.31 no.1 s.84
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• pp.1-13
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• 2001

The extraction lot orthodontic treatment can be adopted for aligning crowded dentition, improving facial esthetics and solving a skeletal discrepancy as alternative for a surgical option. Mandibular second premolar extraction was often selected as treatment plan when there we very little or no space shortage in lower arch or limited retraction of the lower incisors was required. The primary object of this study was evaluate a pretreatment condition and examine the amount of tooth movement ior a mandibular second premolar extraction in growing patients. Pretreatment and posttreatment lateral cephalograms of 14 cases that had their four first premolar extracted (4/4 group), 15 cases with upper first and lower second premolar extraction (4/5 group) were selected. Structural method superimposition was conducted to evaluate a difference of dental change between 4/4 and 4/5 group. The results were as follows, 1. Pretreatment factor for 4/4 extraction or 4/5 extraction choice included maxillary incisor axis to occlusal plane, Class II molar relationship, IMPA and interincisal angle. 2. The amount of molar anterior movement in 4/5 group was greater than that of 4/4 group(p<0.05). 3. There was no significant difference between 4/4 group and 4/5 group in aspects of maxillary tooth movement(p<0.05).

• The korean journal of orthodontics
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• v.40 no.2
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• pp.106-114
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• 2010

Objective: The aim of this experimental study was to evaluate the effects of direct electrical current stimulation (DECS) on bone regeneration in response to an expansion of the inter-premaxillary suture in the rat. Methods: Sixteen 50 - 60 days old Wistar male rats were separated into two equal groups (control and experimental). Both groups were subjected to expansion, and 30-gram of force was applied to the maxillary incisors with helical-spring. In the experimental group, two metallic-screws were placed at lateral parts of the maxillary segments. Electrodes were connected to the screws. The device was activated with current adjustment to measure $10{\mu}A$ continuously and the current was monitored daily during the expansion and early-retention phase. Bone regeneration in the sutural area was histomorphometrically evaluated including new-bone area (${\mu}m^2$), bone perimeter (${\mu}m$), feret's diameter (${\mu}m$) and newly formed bone (%) parameters. Kruskal-Wallis rank and Mann-Whitney U tests were used for statistical evaluation at p < 0.05 level. Results: Statistical analysis showed significant differences between groups for all investigated histomorphometric parameters. New bone area (p = 0.002), bone perimeter (p = 0.004), feret's diameter (p = 0.002) and newly formed bone percentage (p = 0.002) measurements were significantly higher in the experimental group than the control group. Bone histomorphometric measurements revealed that bone architecture in the DECS group was improved. Conclusions: The application of DECS to an orthopedically expanded inter-premaxillary suture area during the early retention phase stimulated the formation of new bone.

• The korean journal of orthodontics
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• v.25 no.4
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• pp.453-463
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• 1995

Most commonly used axis for central incisors in lateral cephalometric radiographs is the line connecting root apex and incisor edge. However, crown axis and root axis do not always coincide in cases of malocclusion patients. The angle created by these axis are called the collum angle, which should be considered in orthodontic diagnosis and treatment. In this study, 31 Class I malocclusion, 30 Class II division 1 malocclusion, 31 Class II division 2 malocclusion, and 31 Class m malocclusion patients were selected and their collum angles were measured. Correlation between these angles and malocclusions was investigated, and the correlation analysis with other parameters in cephalometrics was done. The results were as follows ; 1. The mean collum angles according to the types of malocclusions are ; $3.11^{\circ}{\pm}3.54^{\circ}$ for Class I, $1.23^{\circ}{\pm}2.41^{\circ}$ for Class II division 1, $3.77^{\circ}{\pm}4.39^{\circ}$ for Class II division 2, and $3.90^{\circ}{\pm}4.08^{\circ}$ for Class III malocclusion. 2. Statistically significant differences in collum angles were noted between Class II division 1 group and Class II division 2 and Class III group. 3. Significant correlations were found between collum angles and other parameters used in cephalometrics, namely IMPA for Class I, Wits for Class II division 1, Overbite for Class II division 2 and for ClassIII.

• The korean journal of orthodontics
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• v.26 no.5 s.58
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• pp.547-556
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• 1996

The purpose of this study was to evaluate the skeletal, dental and soft tissue profile changes following the face mask therapy in growing skeletal class III malocclusion patients. The fifteen patients with the good results were selected among the patients who visited the Department of Orthodontics in Seoul National University Hospital. The mean age was 10.63(range 7.25-13.25) years and the mean treatment duration was 9.84(range 2.00-27.00) months. Lateral cephalograms were taken just before and after face mask application. After tracing the cephalograms, thirty five items(twety angular and fifteen linear) were measured. The differences before and after the face mask therapy were compared statistically by the paired t-test(p<0.05). The results were as follows : SNA and Co-A(effective maxillary length) increased significantly after using the face mask(p<0.001), which reflects the orthopedic changes of maxilla. SNB and Co-Gn(effective mandibular length) also showed an increase(p<0.01), which may be a result of the strong growth trends of the samples. FMA, SN-GoGn and Y-axis angle increased significantly(p<0.01), which means the backward and downward rotation of the mandible. This positional change seemed to have compensated an increase of effective mandibular length. There was no statistically significant difference in angulation of upper and lower incisors between pre-treatment and post-treatment(p>0.05). In soft tissue profile, the upper lip was positioned anteriorly(p<0.01) after treatment and approximated to the normal standards.

• Journal of Oral Medicine and Pain
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• v.34 no.3
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• pp.247-256
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• 2009

The purpose of this study was to investigate the changes of the pharyngeal space when the following appliances were inserted: the mandibular advancement appliance (MAA), tongue retaining appliance (TRA), and mandibular advancement-tongue retaining appliance (MATRA). Nine male dental students exhibiting Class I occlusion, normal body mass index (BMI), and no signs and symptoms of snoring were selected for this study. The three kinds of snoring appliances (MAA, TRA and MATRA) were fabricated for each subject. The mandibular advancement of the MAA and MATRA was set at a distance of 5 mm, and the TRA and MATRA were made to hold the tongue in front of the maxillary incisors by 10 to 20 mm. Lateral cephalometric radiographs of the following four states - with no appliance, MAA, TRA, and MATRA - were taken to examine any anatomical changes resulting from the application of the appliances. All four radiographs were traced and analyzed for twenty selected variables related to the pharyngeal space, cranio-cervical posture, and position of the soft palate and hyoid bone. According to the results of this study, there were significant increases in both the upper and lower oropharyngeal spaces when the mandible and tongue were protruded simultaneously, although there was a significant increase only in upper oropharyngeal space when the mandible or tongue was advanced separately. In conclusion, it is suggested that the MATRA may result in more positive effect on the control of snoring and OSA compared to a single use of the MAA or TRA, especially for the patients whose upper airway obstruction occurs in the lower oropharynx.