This study demonstrates the functionality and clinical value of magnetic resonance imaging (MRI) to cone-beam computed tomography (CBCT) registration using a new open-source artificial intelligence (AI) model called MR2CBCT. We present five clinical cases in which the AI-based method was used to register CBCT and MRI images. For comparison, manual registration was also performed. Qualitative inspection revealed that manual alignment often showed errors that could compromise diagnostic accuracy. In contrast, the AI-based approach consistently corrected these discrepancies, producing more anatomically coherent fused images to better support clinical decision-making. Our findings highlight MR2CBCT as a reliable and accessible tool for multimodal integration in temporomandibular joint (TMJ) assessment in orthodontics and general dentistry.

Practice-Based Research Networks (PBRN) are optimal settings for research to be conducted in the real world of clinical practice where the majority of care is provided. In this narrative review, we provide an overview of the National Dental Practice-Based Research Network (Network), which is one of the largest and most successful Dental PBRNs, and its impact on orthodontics. The Network is currently in its third seven-year round of funding and has conducted 58 studies to date. There are over 8,000 members enrolled in the Network. The largest prospective cohort study on anterior open bites was conducted through the Network. The Network provides resources and opportunities to engage clinicians in practice-based participatory research where clinical studies with direct impact on clinical outcomes are conducted.

We sought the perspectives of fourteen orthodontics educators on emerging trends and themes in the orthodontics educational landscape. The focus of this article was on four overarching areas: technology, workforce, research and clinical practice. Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis showed that infusion of newer technologies is poised to change the way we train the next generation of orthodontists, open up new lines of enquiry, and alter the way we render clinical care. Areas of weakness include lack of adequate numbers of orthodontics faculty and lack of progress in Orthodontics research when compared to medical research. Our educational set up is at crucial juncture. We have to make sure that the pipeline of Orthodontics educators is well developed and our new-gen educators have the tools and skillset to adapt to the rapidly evolving healthcare landscape.

The field of orthodontics has seen a recent increase in the number of patients over the age of 50 seeking treatment and also an increase in the use of cone beam technology. Similar to other joints in the body, the temporomandibular joint (TMJ) is associated with age-related degeneration. However, unlike other joints, degeneration of the TMJ is rarely symptomatic and when there is pain, it is usually self-limiting. In this article, we will review: a) the incidence and prevalence of TMJ degenerative diseases, b) similarities and differences of TMJ vs knee degenerative diseases, and c) current treatment recommendations for TMJ degenerative diseases. In the vast majority of people, radiographic evidence of TMJ degeneration is an incidental finding. Future longitudinal research is needed to follow the natural course of TMJ degenerative patients.

With the exponential growth of computational systems and increased patient data acquisition, dental research faces new challenges to manage a large quantity of information. For this reason, data science approaches are needed for the integrative diagnosis of multifactorial diseases, such as Temporomandibular joint (TMJ) Osteoarthritis (OA). The Data science spectrum includes data capture/acquisition, data processing with optimized web-based storage and management, data analytics involving in-depth statistical analysis, machine learning (ML) approaches, and data communication. Artificial intelligence (AI) plays a crucial role in this process. It consists of developing computational systems that can perform human intelligence tasks, such as disease diagnosis, using many features to help in the decision-making support. Patient's clinical parameters, imaging exams, and molecular data are used as the input in cross-validation tasks, and human annotation/diagnosis is also used as the gold standard to train computational learning models and automatic disease classifiers. This paper aims to review and describe AI and ML techniques to diagnose TMJ OA and data science approaches for imaging processing. We used a web-based system for multi-center data communication, algorithms integration, statistics deployment, and process the computational machine learning models. We successfully show AI and data-science applications using patients' data to improve the TMJ OA diagnosis decision-making towards personalized medicine.

To state that the new coronavirus SARS-CoV-2 has broadly and deeply impacted our lives is an understatement. Since it first showed up on our radar in December 2019, the new coronavirus has wreaked havoc on virtually all businesses and industries across the globe. The impact is equally felt in developing, developed, industrialized, rural, rich, and poor countries and communities, irrespective of how well-prepared those countries and communities felt they were 9 months ago. To this day we are still learning to prepare for, respond to, and adapt to the broad and deep impact of this virus. This essay presents different perspectives on the impact of the novel coronavirus to dentistry, through the lenses of a private practice-based general dentist, a nursing home-based public health dentist, and a school of dentistry clinical director. The goal of the essay is to share our experiences and challenges, as well as highlight our capacity to respond to a crisis with resilience, determination, creativity, inventivity, and, most importantly, humility and altruism.

Placebo and nocebo effects are present within every treatment and intervention, and can be purposefully enhanced and reduced, respectively, in order to improve patients' clinical outcomes. A plethora of research has been conducted on the mechanisms of placebo hypoalgesia and nocebo hyperalgesia in experimental and clinical settings. However, its implications in particular clinical settings such as orthodontic pain management remain underexplored. We conducted a search of the literature regarding placebo analgesia, orthodontic pain management, and orofacial and dental pain. Articles were qualitatively assessed and selected based on the scope of this narrative review. Although no studies investigating the extent of the implications of the placebo and nocebo phenomena in the orthodontic clinical setting were found, we herein present a comprehensive review on the influences of placebo and nocebo effects in experimental and clinical pain management, as well as on the potential for engaging placebo-related endogenous pain modulation for orthodontic pain management. Ethical considerations for the clinical application of placebos are discussed, and future research directions are presented.

Uncovering the genetic factors that correlate with a clinical deviation of previously unknown etiology helps to diminish the unknown variation influencing the phenotype. Clinical studies, particularly those that consider the effects of an appliance or treatment regimen on growth, need to be a part of these types of genetic investigations in the future. While the day-to-day utilization of "testing" for genetic factors is not ready for practice yet, genetic testing for monogenic traits such as Primary Failure of Eruption (PFE) and Class III malocclusion is showing more promise as knowledge and technology advances. Although the heterogeneous complexity of such things as facial and dental development, the physiology of tooth movement, and the occurrence of External Apical Root Resorption (EARR) make their precise prediction untenable, investigations into the genetic factors that influence different phenotypes, and how these factors may relate to or impact environmental factors (including orthodontic treatment) are becoming better understood. The most important "genetic test" the practitioner can do today is to gather the patient's individual and family history. This would greatly benefit the patient, and augment the usefulness of these families in future clinical research in which clinical findings, environmental, and genetic factors can be studied.

Orthodontists need to know the effectiveness, efficiency and predictability of treatment approaches and methods, which can be learned only by carefully studying and evaluating treatment outcomes. The best data for outcomes come from randomized clinical trials (RCTs), but retrospective data can provide satisfactory evidence if the subjects were a well-defined patient group, all the patients were accounted for, and the percentages of patients with various possible outcomes are presented along with measures of the central tendency and variation. Meta-analysis of multiple RCTs done in a similar way and systematic reviews of the literature can strengthen clinically-useful evidence, but reviews that are too broadly based are more likely to blur than clarify the information clinicians need. Reviews that are tightly focused on seeking the answer to specific clinical questions and evaluating the quality of the evidence available to answer the question are much more likely to provide clinically useful data.

The success of cranio-maxillofacial (CMF) surgery depends not only on surgical techniques, but also upon an accurate surgical plan. Unfortunately, traditional planning methods are often inadequate for planning complex cranio-maxillofacial deformities. To this end, we developed 3D computer-aided surgical simulation (CASS) technique. Using our CASS method, we are able to treat patients with significant asymmetries in a single operation which in the past was usually completed in two stages. The purpose of this article is to introduce our CASS method in evaluating craniofacial deformities and planning surgical correction. In addition, we discuss the problems associated with the traditional surgical planning methods. Finally, we discuss the strength and pitfalls of using three-dimensional measurements to evaluate craniofacial deformity.

This paper describes the protocols used at Childrens Hospital Los Angeles (CHLA) to protract the maxilla during early adolescence. It is a modification of techniques introduced by Eric Liou with his Alternate Rapid Maxillary Expansion and Constriction (ALT-RAMEC) technique. The main differences between the CHLA protocol and previous maxillary protraction protocols are the age the protraction is attempted, the sutural loosening by alternating weekly expansion with constriction and the use of Class III elastics to support and redirect the protraction by nightly facemask wear. The CHLA protocol entirely depends on patient compliance and must be carefully taught and monitored. In a cooperative patient, the technique can correct a Class III malocclusion that previously would have been treated with LeFort 1 maxillary advancement surgery. Thus, it is not appropriate for patients requiring 2 jaw surgeries to correct mandibular prognathism, occlusal cants or facial asymmetry. The maxillary protraction appears to work by a combination of skeletal advancement, dental compensation and rotation of the occlusal planes. Microscrew/microimplant/temporary anchorage devices have been used with these maxillary protraction protocols to assist in expanding the maxilla, increasing skeletal anchorage during protraction, limiting dental compensations and reducing skeletal relapse.

This paper outlines the clinical application of CBCT for assessment of treatment outcomes, and discusses current work to superimpose digital dental models and 3D photographs. Superimposition of CBCTs on stable structures of reference now allow assessment of 3D dental, skeletal and soft tissue changes for both growing and non-growing patients. Additionally, we describe clinical findings from CBCT superimpositions in assessment of surgery and skeletal anchorage treatment.

The purpose of this study was to determine whether cone beam digital models are as accurate as OrthoCAD (Cadent, Inc, Carlstadt, NJ) digital models for the purposes of orthodontic diagnosis and treatment planning. Digital records of 30 subjects were retrospectively reviewed, and the digital models were obtained as OrthoCAD and InVivoDental (San Jose, CA) digital models. Seven parameters indicating linear measurements from predetermined landmarks were measured and analyzed. The analysis of variance and Bland and Altman Analysis were used to compare and evaluate measurements made from the study models generated from cone beam computed tomography (CBCT) and InVivoDental software. The mean difference between the maxillary InVivoDental models and the maxillary OrthoCAD models ranged from -0.57 to 0.44 mm. The analysis of variance for repeated measures (P < 0.001) was applied to all data obtained from the CBCT and OrthoCAD models. The results indicated a mean score of 35.12 and 35.12 mm, respectively. The mean difference of all values was -7.93 × 10[-3] mm. The range of these values at the 95% confidence interval was -0.14 and 0.12 mm for the lower and upper limits, respectively. The results were not statistically significant for both groups. The Bland and Altman analysis was also applied to the data. In the maxilla, the results indicated that the mean difference between InVivoDental and OrthoCAD was -0.01 ± 1.24 mm. The range of the analysis indicated a spread of -2.40 mm and +2.40 mm. In the mandible, the results indicated that the mean difference between InVivoDental and OrthoCAD was -0.01 ± 1.21 mm. The range of the analysis indicated a spread of -2.36 mm and +2.37 mm. The results showed that the linear measurements obtained from CBCT image casts indicated a good level of accuracy when compared with OrthoCAD models. The accuracy was considered adequate for initial diagnosis and treatment planning in orthodontics.

The clinical spectrum of tooth eruption disorders includes both syndromic and non-syndromic problems ranging from delayed eruption to a complete failure of eruption. A defect in the differential apposition/resorption mechanism in alveolar bone can cause conditions such as tooth ankylosis, primary failure of eruption, failure of eruption due to inadequate arch length and canine impaction. As our knowledge of the molecular events underlying normal tooth eruption has increased, so too has our understanding of clinical eruption disorders. The recent finding that one gene, parathyroid hormone receptor 1 (PTH1R), is causative for familial cases of primary failure of eruption (PFE) suggests that other disturbances in tooth eruption may have a genetic etiology. In this report, we evaluated the current terminology (ankylosis, PFE, secondary retention, etc.) used to describe non-syndromic eruption disorders, in light of this genetic discovery. We observed that some individuals previously diagnosed with ankylosis were subsequently found to have alterations in the PTH1R gene, indicating the initial misdiagnosis of ankylosis and the necessary re-classification of PFE. We further investigated the relationship of the PTH1R gene, using a network pathway analysis, to determine its connectivity to previously identified genes that are critical to normal tooth eruption. We found that PTH1R acts in a pathway with genes such as PTHrP that have been shown to be important in bone remodeling, hence eruption, in a rat model. Thus, recent advances in our understanding of normal and abnormal tooth eruption should allow us in the future to develop a clinical nomenclature system based more on the molecular genetic cause of the eruption failures versus the clinical appearance of the various eruption disorders.

The profession of orthodontics is projected to face a multitude of challenges. Do cyclic forces accelerate the rate of tooth movement and hence the speed of orthodontic treatment? Would bioengineered cementum and dentine be a solution to root resorption? What would orthodontics be like when bioengineered periodontal ligament and alveolar bone become clinical practice, or one day, entire teeth are bioengineered? Would it be possible to selectively differentiate stem cells into osteoblasts or osteoclasts by either static or cyclic forces? What is the new demand on orthodontic expertise with increasingly automated appliances? What will be the impact of the next generation of dental implants or rapid prototyped crowns on orthodontics? A century ago, Edward Angle's practice of fixed appliances, along with other seminal contributions, such as functional appliances, established the profession of orthodontics. Today, the biophysical principles of orthodontics remain largely unchanged from Angle's era, despite incremental refinements of brackets and wires. The paucity of fundamental innovations in orthodontics for decades presents intrinsic risks for the profession. This review will identify challenges for contemporary orthodontics and delineate strategies for the profession to evolve in an era of unprecedented scientific and technological advances, and serve as a call to action for the orthodontic profession.