Jason P. Carey

Three-dimensional accuracy of measurements made with software on cone-beam computed tomography images.

INTRODUCTION The purpose of this article was to evaluate the accuracy of measurements made on 9- and 12-in cone-beam computed tomography (CBCT) images compared with measurements made on a coordinate measuring machine (CMM), which is the gold standard. METHODS Ten markers were placed on a synthetic mandible, and landmark coordinates and linear and angular measurements were determined with the CMM. Three-dimensional CBCT images, measuring 9 and 12 in, were taken of the mandible with a CBCT machine (NewTom 3G, Aperio Services, Verona, Italy), and landmark coordinates and linear and angular measurements were obtained with AMIRA (Mercury Computer Systems, Berlin, Germany) software. RESULTS The coordinate intrareliability correlation coefficient was almost perfect between the 3-dimensional CBCT images and the CMM measurements. With the Student t test, we found no significant statistical difference between linear and angular measurements from the CMM and the NewTom 3G images, which differed less than 1 mm and 1 degrees , respectively. CONCLUSIONS The NewTom 3G produces a 1-to-1 image-to-reality ratio.

Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: A randomized clinical trial

INTRODUCTION The purpose of this study was to compare the transverse, vertical, and anteroposterior skeletal and dental changes in adolescents receiving expansion treatment with tooth-borne and bone-anchored expanders. Immediate and long-term changes were measured on cone-beam computed tomography (CBCT) images. METHODS Sixty-two patients needing maxillary expansion were randomly allocated to 1 of 3 groups: traditional hyrax tooth-borne expander, bone-anchored expander, and control. CBCT images were taken at baseline, immediately after expansion, after removal of the appliance (6 months), and just before fixed bonding (12 months). Repeated measures multivariate analysis of variance (MANOVA) was applied to the distances and angles measured to determine the statistical significance in the immediate and long time periods. Bonferroni post-hoc tests were used to identify significant differences between the treatment groups. RESULTS Immediately after expansion, the subjects in the tooth-borne expander group had significantly more expansion at the crown level of the maxillary first premolars (P = 0.003). Dental crown expansion was greater than apical expansion and skeletal expansion with both appliances. The control group showed little change (growth) over the 6-month interval. At 12 months, no group had a statistically significant difference in angle changes, suggesting symmetric expansion. Both treatment groups had significant long-term expansion at the level of the maxillary first molar crown and root apex, first premolar crown and root, alveolus in the first molar and premolar regions, and central incisor root. Tooth-borne expansion resulted in significantly more long-term expansion at the maxillary premolar crown and root than did bone-borne expansion. CONCLUSIONS Both expanders showed similar results. The greatest changes were seen in the transverse dimension; changes in the vertical and anteroposterior dimensions were negligible. Dental expansion was also greater than skeletal expansion.

Three-dimensional orthodontic force measurements

INTRODUCTION Until recently, much of the orthodontic biomechanics literature was restricted to 2-dimensional experimental studies and, more recently, to assumption-based 3-dimensional computer modeling. There is little evidence in the literature regarding 3-dimensional experimental measurements and analysis of orthodontic force systems. METHODS The purpose of this study was the design, construction, and validation of a laboratory-based human mouth model capable of accurately measuring forces and moments applied by orthodontic fixed appliances on all teeth in 1 arch. A high canine malocclusion was simulated, and forces and moments acting on the canine, lateral incisor, and premolar were measured with passive and conventional ligation. RESULTS We were successful in building this human mouth model. The error in force measurements of the 14 transducers was 1.54%. The force system resulting from passive ligation brackets was considerably different from that of conventional ligation. CONCLUSIONS This method will allow us, for the first time in the history of our specialty, to determine with great accuracy the forces acting on orthodontically treated teeth. Future research will focus on simulating many types of orthodontic clinical applications of full-fixed or partial-fixed appliances.

Online human training of a myoelectric prosthesis controller via actor-critic reinforcement learning

As a contribution toward the goal of adaptable, intelligent artificial limbs, this work introduces a continuous actor-critic reinforcement learning method for optimizing the control of multi-function myoelectric devices. Using a simulated upper-arm robotic prosthesis, we demonstrate how it is possible to derive successful limb controllers from myoelectric data using only a sparse human-delivered training signal, without requiring detailed knowledge about the task domain. This reinforcement-based machine learning framework is well suited for use by both patients and clinical staff, and may be easily adapted to different application domains and the needs of individual amputees. To our knowledge, this is the first my-oelectric control approach that facilitates the online learning of new amputee-specific motions based only on a one-dimensional (scalar) feedback signal provided by the user of the prosthesis.

Torque expression of self-ligating brackets

INTRODUCTION The labiolingual inclination of maxillary and mandibular incisors is considered by many orthodontists to be an important determinant of pleasing dental esthetics and ideal stable occlusion. In contemporary fixed appliances, attaching a rectangular orthodontic archwire to a bracket with a rectangular slot makes third-order control possible. The purpose of this study was to measure the difference in third-order moments that can be delivered by engaging 0.019 x 0.025-in stainless steel archwires to 2 active self-ligating brackets (In-Ovation, GAC, Bohemia, NY; Speed, Strite Industries, Cambridge, Ontario, Canada) and 2 passive self-ligating brackets (Damon2, Ormco, Orange, Calif; Smart Clip, 3M Unitek, Monrovia, Calif). METHODS A bracket/wire assembly torsion device was developed. This novel apparatus can apply torsion to the wire while maintaining perfect vertical and horizontal alignment between the wire and the bracket. A multi-axis force/torque transducer was used to measure the moment of the couple (torque), and a digital inclinometer was used to measure the torsion angle. Fifty maxillary right central incisor brackets from each of the 4 manufacturers were tested. RESULTS There was a significant difference in the engagement angle between the 2 types of brackets; on average, torque started to be expressed at 7.5 degrees of torsion for the active self-ligating brackets and at 15 degrees of torsion for the passive self-ligating brackets. The torque expression was higher for the active self-ligating brackets up to 35 degrees of torsion. Torsion of the wire past this point resulted in a linear increase of the measured torque for the Damon2, the Smart Clip, and the In-Ovation brackets. The torque was relatively constant past 35 degrees of torsion for the Speed bracket. CONCLUSIONS We conclude that active self-ligating brackets are more effective in torque expression than passive self-ligating brackets.

Intraexaminer and interexaminer reliabilities of landmark identification on digitized lateral cephalograms and formatted 3-dimensional cone-beam computerized tomography images

INTRODUCTION The purposes of this study were to determine and compare the intraexaminer and interexaminer reliabilities of commonly used cephalometric landmarks identified on digitized lateral cephalograms and formatted cone-beam computerized tomography (CBCT) images. METHODS CBCT images from 10 randomly selected adolescent patients were obtained from the orthodontic records of a private practice. Measurement errors, and intraexaminer, and interexaminer reliability correlation coefficients (ICC) were obtained for all landmark coordinates. RESULTS Intraexaminer and interexaminer reliabilities for all coordinates for most landmarks on the digital lateral cephalograms and CBCT images were greater than 0.9 (ICC value). The means of landmark locations differed by approximately 1 mm in most coordinates from the lateral cephalograms and were predominantly higher than 1 mm for all coordinates from the CBCT images. CONCLUSIONS Intraexaminer and interexaminer reliabilities were high for most landmarks. Coordinates with greater measurement errors in the lateral cephalograms (condylion, gonion, porion, mandibular incisor apex, and posterior nasal spine) were in structures without clearly defined borders. In the CBCT images, gonion, condylion, and porion were located on surfaces that were flat or curved, making it difficult to recognize a specific reference point. Other less reliable landmarks (anterior nasal spine, posterior nasal spine, mandibular incisor apex) were located in structures with lower densities and could not be visualized with 3-dimensional reconstruction; thus, they had high measurement errors.

Effect of object location on the density measurement and Hounsfield conversion in a NewTom 3G cone beam computed tomography unit

OBJECTIVES The purpose of this study was to determine the effect of an objects location in a cone beam CT imaging chamber (CBCT-NewTom 3G) on its apparent density and to develop a linear conversion coefficient for Hounsfield units (HU) to material density (g cm(-3)) for the NewTom 3G Scanner. METHODS Three cylindrical models of materials with different densities were constructed and scanned at five different locations in a NewTom 3G Volume Scanner. The average HU value for each model at each location was obtained using two different types of software. Next, five cylinders of different known densities were scanned at the exact centre of a NewTom 3G Scanner. The collected data were analysed using the same two types of software to determine a standard linear relationship between density and HU for each type of software. RESULTS There is no statistical significance of location of an object within the CBCT scanner on determination of its density. A linear relationship between the density of an object and the HU of a scan was rho = 0.001(HU)+1.19 with an R2 value of 0.893 (where density, rho, is measured in g cm(-3)). This equation is to be used on a range between 1.42 g cm(-3) and 0.4456 g cm(-3). CONCLUSIONS A linear relationship can be used to determine the density of materials (in the density range of bone) from the HU values of a CBCT scan. This relationship is not affected by the objects location within the scanner itself.

Experimentally Determined Mechanical Properties of, and Models for, the Periodontal Ligament: Critical Review of Current Literature

Introduction. This review is intended to highlight and discuss discrepancies in the literature of the periodontal ligaments (PDL) mechanical properties and the various experimental approaches used to measure them. Methods. Searches were performed on biomechanical and orthodontic publications (in databases: Compendex, EMBASE, MEDLINE, PubMed, ScienceDirect, and Scopus). Results. The review revealed that significant variations exist, some on the order of six orders of magnitude, in the PDLs elastic constants and mechanical properties. Possible explanations may be attributable to different experimental approaches and assumptions. Conclusions. The discrepancies highlight the need for further research into PDL properties under various clinical and experimental loading conditions. Better understanding of the PDLs biomechanical behavior under physiologic and traumatic loading conditions might enhance the understanding of the PDLs biologic reaction in health and disease. Providing a greater insight into the response of the PDL would be instrumental to orthodontists and engineers for designing more predictable, and therefore more efficacious, orthodontic appliances.

Analytically determined mechanical properties of, and models for the periodontal ligament: Critical review of literature

OBJECTIVE This review is intended to highlight and discuss discrepancies in the literature of the periodontal ligaments (PDL) mechanical properties and the various analytical models, approaches and assumptions used in simulating its behaviour. The present study then offers to propose a model development that allows for a better phenomenological description of PDL behaviour under static, near clinical, orthodontic loading conditions. METHODOLOGY Searches were performed on biomechanical and orthodontic publications (in databases: Compendex, EMBASE, MEDLINE, PubMed, ScienceDirect and Scopus). RESULTS The review revealed that significant variations exist, some on the order of six orders of magnitude, in the PDLs elastic constants and mechanical properties. Possible explanations may be attributable to different modelling approaches and behavioural assumptions. SIGNIFICANCE The discrepancies highlight the need for further research into determining what the key factors that contribute to tooth movement are, their correlations and their degree of impact. Despite the PDLs definitive role in orthodontic tooth movement, proposed models of the PDLs mechanical behaviour thus far have been unsatisfactorily inadequate. Hence, there is a need to develop a robust PDL model that more accurately simulates the PDLs biomechanical response to orthodontic loads. Better understanding of the PDLs biomechanical behaviour under physiologic and traumatic loading conditions might enhance the understanding of the PDLs biologic reaction in health and disease. Providing a greater insight into the response of the PDL would be instrumental to orthodontists and engineers for designing more predictable, and therefore more efficacious, orthodontic appliances.

Reliability of traditional cephalometric landmarks as seen in three-dimensional analysis in maxillary expansion treatments.

OBJECTIVE To evaluate intra-examiner and inter-examiner reliability of 3D CBCT-generated landmarks previously used in traditional 2D cephalometry. MATERIALS AND METHODS Twenty-four CBCTs NewTom 3G (Aperio Services, Verona, Italy) were randomly selected from patients participating in a clinical trial involving maxillary expansion treatments. The principal investigator located the landmarks five times, and four other investigators located the same landmarks once. Intra-examiner and inter-examiner reliability values were determined using intraclass correlation coefficients (ICCs). To assist in interpretation of the clinical significance of landmark identification differences, average mean differences for x, y, and z landmark coordinates were determined from the repeated assessments. Landmarks then were separated into groups with respect to the region they represented and then were compared via repeated measures ANOVA and multiple comparisons via Bonferroni corrected alpha. RESULTS Intra-examiner and inter-examiner reliability for x, y, and z coordinates for all landmarks were acceptable, all being greater than 0.80. Most of the mean measurement differences obtained from trials within the principal investigator in all three axes were less than 1.5 mm. Inter-examiner mean measurement differences generally were larger than the intra-examiner differences. CONCLUSIONS Based on this, the best landmarks for use in verifying expansion treatment results are Ekm, buccal surface, and apexes of upper molars, upper premolars and upper canines, and buccal surfaces of lower molars and lower canines. Foramen Spinosum, ELSA, Auditory External Meatus, and Dorsum Foramen Magnum demonstrated adequate reliability for determining a standardized reference system.