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Background Despite the integral role of cephalometric analysis in orthodontics, there have been limitations regarding the reliability, accuracy, etc. of cephalometric landmarks tracing. Attempts on developing automatic plotting systems have continuously been made but they are insufficient for clinical applications due to low reliability of specific landmarks. In this study, we aimed to develop a novel framework for locating cephalometric landmarks with confidence regions using Bayesian Convolutional Neural Networks (BCNN). Methods We have trained our model with the dataset from the ISBI 2015 grand challenge in dental X-ray image analysis. The overall algorithm consisted of a region of interest (ROI) extraction of landmarks and landmarks estimation considering uncertainty. Prediction data produced from the Bayesian model has been dealt with post-processing methods with respect to pixel probabilities and uncertainties. Results Our framework showed a mean landmark error (LE) of 1.53 ± 1.74 mm and achieved a successful detection rate (SDR) of 82.11, 92.28 and 95.95%, respectively, in the 2, 3, and 4 mm range. Especially, the most erroneous point in preceding studies, Gonion, reduced nearly halves of its error compared to the others. Additionally, our results demonstrated significantly higher performance in identifying anatomical abnormalities. By providing confidence regions (95%) that consider uncertainty, our framework can provide clinical convenience and contribute to making better decisions. Conclusion Our framework provides cephalometric landmarks and their confidence regions, which could be used as a computer-aided diagnosis tool and education.

IntroductionOral health research provides evidence for policy and practice, yet no study has comprehensively mapped the scope of oral health research in Malaysia. The COVID-19 pandemic has also created a great impact on oral healthcare in Malaysia, including the dental care delivery. Additionally, there is a notable lack of research focusing on oral health during and after the COVID-19 pandemic. Therefore, this scoping review will aim to map the landscape of oral health research conducted in Malaysia and identify key topics, study designs, populations studied and gaps in the literature, in order to inform future research priorities and policy, particularly in the post-COVID-19 era.Methods and analysisThe methodology draws on Arksey and O’Malleys’ seminal framework for the scoping review and will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. We will search five major electronic databases—PubMed, Scopus, ProQuest, Cochrane and Web of Science—as well as selected grey literature sources (eg, theses, dissertations and conference proceedings) for studies published in English from January 2014 to December 2024. Studies of any design related to oral health in Malaysia will be included. Two reviewers will be performing title and abstract screening, in which they will be working independently. The included publication will undergo a full-text review, and references cited in these studies will be examined following the inclusion criteria. The PRISMA-ScR flow diagram will be used as a guide throughout the process. Data will be extracted, analysed and charted according to key categories identified in the included publications. A narrative synthesis and descriptive statistics will be presented.Ethics and disseminationThe results of this scoping review will illustrate an overview and provide a better understanding regarding the oral health research in the Malaysian context; whether research has already been conducted, is currently ongoing and is still needed; and which areas should be prioritised for future investigation. As this review will use publicly available literature, formal ethics approval will not be required. The findings will be submitted for publication in an open-access peer-reviewed journal, presented at national and regional conferences and shared with Malaysian dental professional bodies and relevant stakeholders.Trial registration numberThe protocol of this scoping review is registered with the Open Science Framework and is available at osf.io/hjq6m.

ObjectivesSpeech problems in patients with a cleft palate are often complex and multifactorial. Finding the optimal way of monitoring these problems is challenging. The International Consortium of Health Outcomes Measurement (ICHOM) has developed a set of standardised outcome measures at specific ages for patients with a cleft lip and/or palate, including measures of speech assessment. This study evaluates the type and timing of speech outcome measures currently included in this ICHOM Standard Set. Additionally, speech assessments in other cleft protocols and initiatives are discussed.Design, setting and participantsAn international, multicentre study was set up including centres from the USA and the Netherlands. Outcomes of clinical measures and Patient Reported Outcome Measures (PROMs) were collected retrospectively according to the ICHOM set. PROM data from a field test of the CLEFT-Q, a questionnaire developed and validated for patients with a cleft, were collected, including participants from countries with all sorts of income statuses, to examine the value of additional moments of measurement that are used in other cleft initiatives.Data from 2500 patients were included. Measured outcomes contained univariate regression analyses, trend analyses, t-tests, correlations and floor and ceiling effects.ResultsPROMs correlated low to moderate with clinical outcome measures. Clinical outcome measures correlated low to moderate with each other too. In contrast, two CLEFT-Q Scales correlated strongly with each other. All PROMs and the Percent Consonants Correct (PCC) showed an effect of age. In patients with an isolated cleft palate, a ceiling effect was found in the Intelligibility in Context Scale.ConclusionRecommendations for an optimal speech outcome assessment in cleft patients are made. Measurement moments of different cleft protocols and initiatives are considered in this proposition. Concerning the type of measures, adjustment of the current PCC score outcome seems appropriate. For centres with adequate resources and specific interest in research, translation and validation of an upcoming tool, the Cleft Audit Protocol for Speech Augmented, is recommended.

ObjectivesThe objective of this study was to evaluate the effectiveness of a modified pulpotomy (MP) procedure in immature permanent teeth with apical periodontitis (AP).DesignRandomised controlled trial.SettingOne public hospital in Shanghai, ChinaParticipantsA total of 33 teeth (31 patients) with a definitive diagnosis of AP with radiographic periapical radiolucency were recruited in this study. All the patients (teeth) completed the study accordingly.Methods and interventionPatients were randomly assigned to either MP or apexification treatment groups and were followed up for 12 months. Clinical symptoms and complications were recorded, and parallel periapical radiographic images were used to measure changes in root length and apical diameter. Wilcoxon’s rank sum test and Fisher’s exact test were used to compare the clinical and radiographic outcomes between MP and apexification, and analysed with analysis of variance.Main outcome measureThe primary outcome was increase in root length at 12 months. The secondary outcomes included tooth survival, clinical success and decrease in apical diameter.ResultsMP group showed a significant increase in root length (10.05%±2.14% vs 1.16%±0.79%, p<0.05) at 12 months and a decrease in apical diameter (48.88%±10.42% vs 15.90%±8.88%, p<0.05) as compared with the apexification group. The tooth survival rate was 100%, and 90.91% (30/33) of teeth were asymptomatic with apical healing in both treatment groups (p>0.05).ConclusionsMP can be an option for treating immature permanent teeth with AP. MP showed better performance in terms of continued root maturation than apexification. MP and apexification achieved comparable outcomes with regard to the resolution of clinical symptoms and apical healing.Trial registration numberChiCTR-INR-17012169.

IntroductionAnkyloglossia is a situation where the tongue tip cannot go beyond the mandibular incisor because the frenulum linguae is short. It could affect children’s health by interfering with their ability to talk, breast feeding and dental development. The most effective measure to control ankyloglossia is the surgical method. However, which surgical procedure is the best one is still controversial. Thus, this protocol aims to assess the effectiveness of different surgical interventions in children with ankyloglossia.Methods and analysisPubMed, EMBASE, Cochrane Library, Web of Science and OVID will be searched for relevant information from inception to 31 May 2022. Observational studies in English that investigate the association between surgical methods and ankyloglossia will be included in this protocol. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The Critical Appraisal Checklist for Analytical Cross-Sectional Studies and the Newcastle–Ottawa Quality Assessment Scale for longitudinal studies will be used to assess the included studies. The improvement of breast feeding and nipple pain will be the primary outcome. STATA V.15.1 will do the statistical analysis in the meta-analysis. Subgroup and meta-regression will be carried out based on the characteristics of included studies.Ethics and disseminationThis systematic review and meta-analysis will summarise relevant information on the effects of different surgical treatments on patients with ankyloglossia. The results will be disseminated through peer-reviewed publications. The data included in this study will be extracted from the published original studies. Thus, ethical approval and informed consent will not be required.PROSPERO registration numberCRD42022323350.

IntroductionClass II treatment with mandibular retrusion often involves the Herbst appliance due to its efficiency and low requirement of cooperation. Despite its advantages, it causes side effects concerning the occlusal plane and pogonion in terms of clockwise rotation that hinder the desired mandibular advancement for hyperdivergent patients. In this study, we will use a newly designed Herbst appliance, and a protocol that is accompanied by TADs for vertical control to avoid maxillary clockwise rotation. We hypothesise that the effect of the Herbst appliance with the vertical control approach will be beneficial for maintaining or even decreasing the skeletal divergence in hyperdivergent class II patients compared with conventional Herbst treatment.Methods and analysisThis study is a randomised, parallel, prospective controlled trial that will study the efficacy of Herbst with or without vertical control in children with hyperdivergent skeletal class II malocclusion. A total of 44 patients will be enrolled and randomised in a ratio of 1:1 to either Herbst treatment or Herbst treatment with vertical control. Participants will be recruited at the Shanghai Stomatological Hospital, Shanghai, China. The primary endpoint is the change in the angle indicating the occlusal plane and Sella-Nasion plane from baseline (T0) to the primary endpoint (T2) on cephalometric measurements by lateral X-ray examination. Important secondary outcomes include the root length of the anterior teeth, and the assessment score of the Visual Analogue Scale Questionnaire, etc. Safety endpoints will also be evaluated.Ethics and disseminationThis study has been approved by the ethics committee of the Shanghai Stomatological Hospital (Approval No. (2021) 012). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals.Trial registration numberChiCTR2100049860, Chinese Clinical Trial Registry

Oral and maxillofacial surgery has seen various advancements throughout years. From dental implants to 3D printing, every advancement this field has witnessed has taken it one step ahead into the future. Reconstructive surgeries in oral and maxillofacial surgery have evolved drastically over the years. Till now, autografts are considered the best possible alternative to soft tissue or hard tissue defects. The advent of 3D bioprinting has not only broadened the vision of surgeons, physicians, and bioengineers but also enkindled the hope for a better future in reconstructive surgeries. All in all, the facial structures are full of complexities and loss of tissues in maxillofacial area is much common. 3D bioprinting with the ability to print a tissue with pre-defined arrangement of cells having its own vascularization can prove to be a valuable tool in the field of maxillofacial surgeries. Although still it has a long way to go to make it accessible for all, 3D bioprinting can be considered an asset for the field of oral and maxillofacial surgery. This article throws some light on the applications of 3D bioprinting in the field of oral and maxillofacial surgery and the promising future it holds in reconstructive surgeries.Structured abstract is required. Please provide.Respected sir/madam, This is a mini review article and as per the submission guidelines for abstract in the Journal of Maxillofacial and Oral Surgery, no instructions were given about the structured abstract for mini review. But, with due respect, if we are mistaken, then kindly guide us regarding the same and give us couple of days more to rectify this mistake. Regards.Kindly check and confirm whether the corresponding author and mail gigiid is correctly identified.Yes, the corresponding author and mail id is correctly identified.Journal standard instruction requires a structured abstract; however, none was provided. Please supply an Abstract with subsections \"supply required Abstract sections separated by ;\".Respected sir/madam, This is a mini review article and as per the submission guidelines for abstract in the journal of maxillofacial and oral surgery, no instructions were given about the structured abstract for mini review. But, with due respect if we are mistaken kindly guide us regarding the same and give us couple of days more to rectify this mistake. Regards.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 3 Given name: [Gurinder Bir Singh] Last name [Thind]. Also, kindly confirm the details in the metadata are correct.Yes, Author 3 given name is in correct order. Given name : Gurinder Middle Name : Bir Singh Last Name: Thind Yes, details are correct.As per the instruction, other language titles like ……….. are required, but are not provided. Could you please provide the missing titles?There are no other language titles in this mini review article.As per the instruction, other language abstracts like ……….. are required, but are not provided. Could you please provide the other language abstracts?There are no other language abstract in this article.

Background The aim of this study was to evaluate the cost-effectiveness of extraction compared with restorative treatment of first permanent molars (FPMs) affected by Molar–Incisor Hypomineralisation (MIH) in 11-year-olds in Sweden. Methods Seventy-five patients from the GuREx-MIH project were included. Of these, 43 were randomised to the Restorative treatment group (ReTG) and 32 to the Extraction treatment group (ExTG). Healthcare costs were calculated from dental records, while non-healthcare costs, were collected through surveys. Effectiveness was measured using the Child Perceptions Questionnaire (CPQ11-14) and the proportion of patients achieving a minimally important difference (MID). Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in effectiveness between groups. Results The ExTG incurred higher mean healthcare (€1,417 vs. €1,051; p  = 0.029) and total costs (€2,950 vs. €2,161; p  = 0.029) compared with the ReTG, almost entirely due to general anaesthesia (GA), while non-healthcare costs were (€1,531 vs. €1,111; p  = 0.117). When patients treated under GA were excluded, the ExTG became less costly, with lower healthcare costs (€868 vs. €1,051; p  = 0.039), fewer visits (9.2 vs. 11.4; p  = 0.025), and shorter chair time (324 vs. 401 min; p  = 0.040). ICERs showed that with GA, extraction was associated with higher incremental costs per MID responder (€2,593 healthcare; €6,110 total). Without GA, extraction was either dominant when only healthcare costs were considered or showed a cost of €4,201 per MID responder when considering total costs. Conclusions Compared with restorative treatment, extraction was associated with higher healthcare and total costs, primarily due to general anaesthesia, but also linked with a greater proportion of patients achieving clinically meaningful improvements in oral health-related quality of life at the age of 11 years. Trial registration The study was retrospectively registered on ClinicalTrials.gov 29th of January 2024, registration number: NCT06228989.

Oral squamous cell carcinoma (OSCC) develops on the mucosal epithelium of the oral cavity. It accounts for approximately 90% of oral malignancies and impairs appearance, pronunciation, swallowing, and flavor perception. In 2020, 377,713 OSCC cases were reported globally. According to the Global Cancer Observatory (GCO), the incidence of OSCC will rise by approximately 40% by 2040, accompanied by a growth in mortality. Persistent exposure to various risk factors, including tobacco, alcohol, betel quid (BQ), and human papillomavirus (HPV), will lead to the development of oral potentially malignant disorders (OPMDs), which are oral mucosal lesions with an increased risk of developing into OSCC. Complex and multifactorial, the oncogenesis process involves genetic alteration, epigenetic modification, and a dysregulated tumor microenvironment. Although various therapeutic interventions, such as chemotherapy, radiation, immunotherapy, and nanomedicine, have been proposed to prevent or treat OSCC and OPMDs, understanding the mechanism of malignancies will facilitate the identification of therapeutic and prognostic factors, thereby improving the efficacy of treatment for OSCC patients. This review summarizes the mechanisms involved in OSCC. Moreover, the current therapeutic interventions and prognostic methods for OSCC and OPMDs are discussed to facilitate comprehension and provide several prospective outlooks for the fields.

Background Vinyl polysiloxane (VPS) index is the most commonly used tool of guided composite resin injection (G-CRI) technique. Understanding the mechanical and optical properties of various transparent VPS materials is vital for determining optimal G-CRI parameters and identifying the best material. Still, existing literature on this topic is limited. This study aimed to compare the mechanical and optical properties of various VPS materials used for G-CRI technique, and to evaluate the effect of material thickness on optical properties. Methods Four transparent VPS materials (OKVD, DELIAN, HUGE, and ZHERMACK) were evaluated. Shore A hardness was measured on cylindrical specimens (Ø25 × 6 mm, n  = 9) using a portable Shore durometer, and compression modulus was measured on specimens (Ø10 × 6 mm, n  = 9) using a universal testing machine. For optical properties, cylindrical specimens (Ø12 mm, n  = 5 per thickness) at five thickness (2, 4, 6, 8, and 10 mm) were fabricated. Translucency parameter was calculated from color measurements taken with a portable spectroradiometer against black and white backgrounds. Light irradiance transmitted through specimens was measured using a dental radiometer. Statistical analysis was performed using analysis of variance, and Pearson’s correlation was used to correlate the compressive modulus with Shore A hardness, and the light irradiance with translucency (α = 0.05). Results The trend of changes in Shore A hardness and compressive modulus of VPS materials is consistent, with ZHERMARK > OKVD > DELIAN > HUGE. Both translucency and light irradiance decreased significantly with increasing thickness for all materials. DELIAN exhibited the highest optical properties across all thickness, while HUGE showed the lowest. Strong positive correlations were observed between Shore A hardness and compressive modulus ( r  = 0.93) and between translucency and light irradiance ( r  = 0.96–0.98). Conclusions Significant variations exist in the mechanical and optical properties of transparent VPS materials, with ZHERMACK exhibiting superior mechanical properties and DELIAN superior optical properties. The optical properties declined significantly with increasing thickness. Transparent VPS material with higher mechanical properties can enhance the restoration accuracy of G-CRI technique, while thicker index or that fabricated using lower translucent materials necessitate longer exposure times for complete polymerization. Additionally, compressive modulus and light irradiance can be predicted using Shore A hardness and translucency, respectively.