BACKGROUND: To support dentists with limited experience, this study trained and compared six convolutional neural networks to detect crossbites and classify non-crossbite, frontal, and lateral crossbites using 2D intraoral photographs.
METHODS: Based on 676 photographs from 311 orthodontic patients, six convolutional neural network models were trained and compared to classify (1) non-crossbite vs. crossbite and (2) non-crossbite vs. lateral crossbite vs. frontal crossbite. The trained models comprised DenseNet, EfficientNet, MobileNet, ResNet18, ResNet50, and Xception.
RESULTS: Among the models, Xception showed the highest accuracy (98.57%) in the test dataset for classifying non-crossbite vs. crossbite images. When additionally distinguishing between lateral and frontal crossbites, average accuracy decreased with the DenseNet architecture achieving the highest accuracy among the models with 91.43% in the test dataset.
CONCLUSIONS: Convolutional neural networks show high potential in processing clinical photographs and detecting crossbites. This study provides initial insights into how deep learning models can be used for orthodontic diagnosis of malocclusions based on intraoral 2D photographs.

BACKGROUND: Orthodontic education, besides some other factors, influences the confidence level of recently graduated dentists to diagnose subjects seeking orthodontic treatment and provide treatment plans. This study aims to explore the factors that influence the confidence level of undergraduate dental students to diagnose subjects seeking orthodontic treatment and provide treatment plans after graduation.
METHODS: A qualitative study was undertaken using focus groups and interviews. Purposive sampling was used, focus groups and face to face semi-structured interviews were adopted as the method of data collection. Three focus groups were evaluated including fifth-year undergraduate, postgraduate orthodontic students, and recently graduated general dentists. In addition, eleven interviews were performed with the fifth-year undergraduate students. Data collection ceased upon reaching data saturation, with thematic analysis employed for qualitative data analysis.
RESULTS: Six themes and two sub-themes were extracted from the data. More focus on the theory was highly noticed, and most of the participants exhibited a low level of self confidence in extrapolating orthodontic diagnosis and establishing treatment plans after graduation. In addition, they believed that practical teaching sessions mostly deal with wire bending and demanded to expand the clinical orthodontic knowledge to be able to indicate the right diagnosis and initiate proper treatment plans.
CONCLUSIONS: Clinical and practical training alongside theoretical foundation represent key factors in orthodontic education required to obtain confidence in orthodontic practice among dental undergraduate students and alumni. The findings help in enhancing undergraduate programs via providing a clinically oriented orthodontic education from student perceptions.

This dataset features 200 sagittal projection images derived from Cone Beam Computed Tomography (CBCT) scans, corrected according to the Natural Head Position (NHP) guidelines proposed by Fredrik Lundström and Anders Lundström. The images originate from orthodontic patients in Cali, Valle del Cauca, Colombia, encompassing both initial phases and ongoing treatments. The dataset is divided into two groups: 100 images from female subjects (CoF) and 100 from male subjects (CoM), facilitating gender-specific studies. The dataset is accompanied by an Excel file ``Data info.xlsx\'\' that details the rotation angles in the axial (Yaw), coronal (Roll), and sagittal (Pitch) planes, along with the pixel size and image dimensions. This detailed documentation supports the replication of studies and aids in the interpretation of cephalometric analyses. Corrections made to align the images with NHP standards involve adjustments in the three main anatomical planes using points from the frontozygomatic suture (Fz) in the axial and coronal planes, and sella (S) and nasion (N) for the sagittal plane.

BACKGROUND: Magnetic resonance imaging (MRI) is a non-ionizing imaging technique. Using MRI in dentistry may potentially lower the general radiation dose of the examined population, provided MRI can replace various radiation-based images. Furthermore, novel MRI imaging modalities for three-dimensional and two-dimensional cephalometrics have recently been developed for orthodontic diagnosis.
OBJECTIVE: This systematic review aimed to determine the diagnostic accuracy and reliability of MRI in orthodontic diagnosis and treatment planning.
METHODS: An electronic search was conducted on 20 November 2022 in the following databases: PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane. The search was updated on 30 August 2023. Furthermore, a grey literature search was performed in Google Scholar and Open-Grey.
METHODS: This review included descriptive, observational, cohort studies, cross-sectional, case-control studies, and randomized/non-randomized trials related to the research question. The study excluded studies related to patients with syndromes, chronic diseases, craniofacial anomalies, or bone diseases.
METHODS: The included studies were quality assessed using the \"Joanna Brigg\'s Critical Appraisal Tool for diagnostic test accuracy\". The GRADE approach for non-randomized studies was used for strength-of-evidence analysis.
RESULTS: Eight of the 10 included studies compared MRI with either cone beam computed tomography or lateral cephalogram and found a high intra- and inter-rater agreement for landmark identification. The risk of bias was high in four studies, moderate in three, and low in three studies. Homogeneity was lacking among the included studies in terms of MRI imaging parameters and sample characteristics. This should be taken into consideration by future studies where uniformity with respect to these parameters may be considered.
CONCLUSIONS: Despite dissimilarity and heterogeneity in the sample population and other methodological aspects, all the included studies concluded that MRI enjoyed considerable intra- and inter-examiner reliability and was comparable to current diagnostic standards in orthodontics. Furthermore, the studies agreed on the innovative potential of MRI in radiation-free diagnosis and treatment planning in orthodontics in the future.
BACKGROUND: CRD number: CRD420223XXXXX.

OBJECTIVE: The aim of this study was to analyze the popularity of surgery first among orthodontists as well as the protocols used for its implementation and to collect the opinions (favorable or unfavorable) of practitioners and patients regarding it.
METHODS: A questionnaire was sent to a population of dental surgeons qualified in Dentofacial Orthopedics or in the process of specialization (residents) practicing in France. The questionnaire consisted of a total of 27 questions. There were 10 open-ended questions and 17 closed-ended questions (8 binary and 9 multiple choices). The conditional pathway allows the respondent\'s path through the form to be modified based on their answers. This survey was conducted using Google Forms online survey software.
RESULTS: On average, the responding practitioners had 15.9 years of experience, and most of them (78.2%) work in private practice. Most treated between 200 and 400 cases per year, of which 7% were surgical cases. Orthodontists who are familiar with and practice the surgery first protocol use it on average for 7 cases per year. The most frequent indication for the surgery first protocol was: transverse maxillary defects.
CONCLUSIONS: Surgery first protocol is a preferred option in cases of high severity since it prevents respiratory worsening during the pre-surgical orthodontic phase. The lack of a standardized protocol for this approach, at the pre-surgical and post-surgical levels, requires an increase in the number of high-level evidence publications to clarify the methods of application of this protocol.

OBJECTIVE: To determine the habits of Orthodontists in the management of moderate skeletal class III patients by using miniplates, and to assess the relationship between the factors that may hinder the implementation of such treatment.
METHODS: A questionnaire was carried out using the Google Form® platform, which included 18 questions relating to the seniority of the practice of the orthodontists, the preferential treatment, the difficulties encountered, the results obtained, and the frequency of a relapse.
RESULTS: Experienced orthodontists (more than 10 years) treated skeletal class III malocclusion with the conventional facemask therapy, whereas orthodontists with less than 5 years of experience shifted to the miniplate technique which presented less dental effect and more skeletal correction with a decreased frequency of relapse.
CONCLUSIONS: High financial cost and increased care load were considered the main obstacles regarding the placement of the titanium miniplates in treating skeletal class III patients.

UNASSIGNED: Growth measurement has always been essential to identify the best time to employ orthopedic or orthodontic appliances. Optimal timing for orthodontic treatment is strictly linked to the identification of periods of craniofacial growth when treatment is more effective.The aim of this study was to compare two different methods, middle phalanx maturation (MPM) and cervical vertebrae maturation (CVM), used to evaluate the stage of facial growth.
UNASSIGNED: The research data was collected from July 2018 to April 2019 at the Dental Clinic of the San Gerardo Hospital in Monza. The study included a sample of 98 patients-46 males and 52 females. For each patient, a latero-lateral teleradiography of the skull and an X-ray on the middle finger of the right hand were obtained.The statistical analysis of the comparison of the stages of skeletal maturation obtained by the MPM and CVM methods was performed using the correlation coefficient for ranks of Spearman.
UNASSIGNED: A descriptive statistical analysis of the entire sample of 98 patients was performed (mean age of 12.2 years and median of 12.2 years). The average age of females in every single stage of MPM was significantly lower than the average age of males. Of the total sample, 87 patients (88.8%) showed complete agreement between the two methods.
UNASSIGNED: The results obtained from the statistical analysis of this study allowed us to confirm a satisfactory agreement between the two methods.The intermediate phalanx method is a valid and alternative indicator to CVM for the identification of the puberty growth peak. We can, therefore, consider the MPM method a valid indicator of skeletal maturity.
UNASSIGNED: Mirabelli L, Bianco E, Pigato G, et al. Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation. Int J Clin Pediatr Dent 2023;16(2):327-332.

The use of Artificial Intelligence (AI) in the medical field has the potential to bring about significant improvements in patient care and outcomes. AI is being used in dentistry and more specifically in orthodontics through the development of diagnostic imaging tools, the development of treatment planning tools, and the development of robotic surgery. The aim of this study is to present the latest emerging AI softwares and applications in dental field to benefit from.
Search strategies were conducted in three electronic databases, with no date limits in the following databases up to April 30, 2023: MEDLINE, PUBMED, and GOOGLE® SCHOLAR for articles related to AI in dentistry & orthodontics. No inclusion and exclusion criteria were used for the selection of the articles. Most of the articles included (n = 79) are reviews of the literature, retro/prospective studies, systematic reviews and meta-analyses, and observational studies.
The use of AI in dentistry and orthodontics is a rapidly growing area of research and development, with the potential to revolutionize the field and bring about significant improvements in patient care and outcomes; this can save clinicians\' chair-time and push for more individualized treatment plans. Results from the various studies reported in this review are suggestive that the accuracy of AI-based systems is quite promising and reliable.
AI application in the healthcare field has proven to be efficient and helpful for the dentist to be more precise in diagnosis and clinical decision-making. These systems can simplify the tasks and provide results in quick time which can save dentists time and help them perform their duties more efficiently. These systems can be of greater aid and can be used as auxiliary support for dentists with lesser experience.

Orthodontists often encounter significant clinical challenges in the finishing stages of treatment due to a disproportion in interarch tooth size relationships. Despite the increasing presence of digital technology and concomitant focus on customized treatment approaches, there is a gap in the knowledge of how generating tooth size data using digital versus traditional methods may impact our treatment regime.
OBJECTIVE: This study aimed to compare the prevalence of tooth size discrepancies using digital models and a digitally based cast analysis in our cohort based on (i) Angle\'s Classification; (ii) gender and (iii) race.
METHODS: The mesiodistal widths of teeth in 101 digital models were assessed using computerized odontometric software. A Chi-square test was used to determine the prevalence of tooth size disproportions among the study groups. The differences between all three groups of the cohort were analysed using a three-way analysis of variance (ANOVA).
RESULTS: An overall Bolton tooth size discrepancy (TSD) prevalence of 36.6% was observed in our study cohort; 26.7% had an anterior Bolton TSD. No differences existed in the prevalence of tooth size discrepancies between male and female subjects as well as between the different malocclusion groups (P > .05). Caucasian subjects had a statistically significant smaller prevalence of TSD compared to Black and Hispanic patients (P < .05).
CONCLUSIONS: The prevalence results in this study illuminate how relatively common TSD is and underscores the importance of proper diagnosis. Our findings also suggest that racial background may be an influential factor in the presence of TSD.

A key step prior to clear aligner therapy (CAT) is the clinical examination and case selection, which includes understanding the specific orthodontic problem to be managed and the wider evaluation of oral health. Seeking CAT may further differ along sociodemographic parameters or across countries, as may perceived orthodontic treatment needs and oral health. We aimed to characterize patients seeking CAT across five European countries. Anonymized real-life data from one large CAT provider (DrSmile, Berlin, Germany) was retrospectively sampled for the period 1 November 2021−31 December 2021. A total of 15,015 patients (68.4% females, 31.6% males, with an age range of 18−81 years, median 30.0 years) were included. The cross-national comparison revealed a significant difference in gender distribution (p < 0.001/Chi-square), with the highest proportion of males in Italy (434/1199, 36.2%) and the lowest in Poland (457/1600, 28.6%); generally, more females sought CAT. The largest motivational factor in all countries for seeking CAT was crowding, in both males and females. By and large, patients paid out of pocket for CAT. The prevalence of caries, periodontitis, and craniomandibular dysfunction as well as the numbers of missing teeth were generally low, albeit with significant differences between sociodemographic groups and countries for caries and periodontitis. Patients seeking CAT showed a low prevalence in oral conditions but differed in their sociodemographic characteristics across countries. Dentists and orthodontists should consider these country-specific differences when planning CAT.