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Öğe 3D evaluation of tooth crown size in unilateral cleft lip and palate patients(Wolters Kluwer Medknow Publications, 2020) Kaplan, M.; Görgülü, Sinan; Cesur, Emre; Arslan, Can; Altuğ, Ayşe TubaAim: The aim of this retrospective study is to evaluate and compare the 3-dimensional (3D) crown sizes of the left and right sides of upper and lower dental arches in patients with unilateral cleft lip and palate (UCLP). Materials and Methods: Dental casts of 94 patients all in permanent dentition were included in this study. Dental casts were divided into three groups as 36 casts with unilateral left cleft lip and palate (ULCLP), 18 casts with unilateral right cleft lip and palate (URCLP), and 40 casts without cleft (control). Mesiodistal (MD), buccolingual (BL), and gingiva incisal (GI) values of each tooth were measured by scanning the dental models with a high-precision optical 3D scanner. Paired t-test and independent t-test were used for statistical analysis. Results: U1 MD, U6 MD (P = 0.001) and BL (P = 0.01), L3 GI (P = 0.05) were greater in UCLP patients on the non-cleft side while U1 GI, L1 BL, L5 MD (P = 0.001), L4 MD, and BL (P = 0.01) values were found to be greater on the cleft side. Comparison of the cleft-sides and the control group showed that MD, BL, and GI dimensions of teeth on the cleft sides were generally found to be smaller, excluding the UR7 GI values for URCLP group (P = 0.05). Conclusion: In the measurements of teeth size, reliable and repeatable results were acquired through 3D software. Tooth size asymmetries can occur non-syndromic UCLP patients in both jaws. MD, BL, and GI dimensions of teeth are mostly found to be smaller in patients with CLP.Öğe Applications of contemporary imaging modalities in orthodontics(Ondokuz Mayıs Üniversitesi, 2021) Cesur, Emre; Orhan, KaanThe validity of orthodontic diagnosis and treatment planning depends on the accuracy of the photos, models and radiograps to be obtained from the patient. One of the most important parts of diagnosis and treatment planning is the use of appropriate imaging method. Although lateral cephalometric radiographs are still the most preferred imaging method, other methods such as hand-wrist radiographs, panoramic radiographs, cone beam computerized tomography (CBCT), magnetic resonance imaging (MRI), and ultrasound are also frequently used. For this reason, it is important to know the advantages and disadvantages of all imaging methods for orthodontists in order to select the most suitable method for the patient. Although 2D imaging modalities are still frequently preferred in terms of their accessibility, CBCT use may come to the fore when precise imaging of hard tissues is desired. In cases where TMJ region and soft tissues are to be imaged, the use of MRI and ultrasound should be considered. Orthodontists should follow up the up-to-date usage areas of the developing imaging methods.Öğe Effect of different resin removal methods on enamel after metal and ceramic bracket debonding an in vitro micro-computed tomography study(Urban & Vogel, 2022) Cesur, Emre; Arslan, Can; Orhan, Ayşe Işıl; Bilecenoğlu, Burak; Orhan, KaanPurpose The aim of this study was to conduct an in vitro evaluation of the effects of different adhesive debonding and polishing techniques performed after metal and ceramic bracket removal on enamel using micro-computed tomography (micro-CT). Methods This study was performed on 42 extracted maxillary first premolars divided into 2 main groups and 6 subgroups as follows: metal (group 1) or ceramic (group 2) brackets were bonded to the teeth, then, after debonding, one of three different methods was used to remove the residual adhesive: tungsten carbide burs with pumice (A), fiber-reinforced composite burs and polishing paste (B), or Sof-Lex discs (C; 3M Dental, St Paul, MN, USA). The samples were evaluated by micro-CT before bracket bonding (T0) and after resin removal (T1). Demineralization area, demineralization depth, demineralization volume, mineral density, and mineral volume were measured. Results At T1, demineralization area was significantly larger in groups 1A and 2A compared to groups 1B, 1C, 2B, and 2C (P = 0.001). Group 2A (ceramic bracket/tungsten carbide-pumice) had the highest demineralization volume (P = 0.001). When the groups were compared in terms of change from T0 to T1, groups 1A and 2A showed significantly larger changes in demineralization area compared to the other 4 groups (P = 0.001). The increase in demineralization volume was larger in group 2A compared to all other groups (P = 0.001). Conclusion All resin removal methods damaged the enamel surface to varying degrees. Regardless of bracket type, the use of tungsten carbide and pumice should be avoided when cleaning the tooth surface after debonding. Use of composite burs and Sof-Lex discs in particular after the debonding of ceramic brackets will help minimize damage.Öğe Effects of surface preparation with sodium hypochlorite on shear bond strength and residual adhesive of orthodontic brackets on primary and permanent teeth(Ankara University, 2022) Arslan, Can; Üstün, Nilüfer; Cesur, EmreObjective: To investigate the effects of surface preparation with sodium hypochlorite (NaOCl) on bracket shear bond strength and amount of residual adhesive on primary and permanent teeth. Materials and Methods: 24 permanent premolars, 12 in each group (groups I and III), and 24 primary molars, 12 in each group (groups II and IV) were included. In group I and II, 37% phosphoric acid was applied to the tooth surfaces, without using any other agent. In Group III and IV, 5.25% NaOCl was first applied. Following washing and drying, surface roughening was performed with phosphoric acid. The shear bond strengths (SBS) of the brackets bonded to the tooth surfaces was measured. After debonding, the base of each bracket was examined for adhesive remnant index (ARI) scores. Results: There were no statistically significant differences in SBS values between primary and permanent teeth with and without preparation with NaOCl(P>0.05). Mean SBS(18.55±14.98 MPa) was higher in permanent premolars subjected to surface deproteinization with NaOCl (group III) when compared with other groups, but the difference was not significant. There was no significant difference in ARI scores between the groups. Conclusions: The bond strength of orthodontic brackets or the distribution of ARI scores were similar between groups with and without NaOCl pretreatment. Hence, it can be concluded that conventional bonding procedures applied without any additional preparation to primary teeth are sufficient and the debonding of brackets didn’t cause any harm to enamel surfaces.Öğe Evaluating the effects of functional orthodontic treatment on mandibular osseous structure using fractal dimension analysis of dental panoramic radiographs(Edward H. Angle Education and Research Foundation, 2020) Cesur, Emre; Bayrak, Seval; Kurşun Çakmak, Emine Şebnem; Arslan, Can; Köklü, Ayşegül; Orhan, KaanObjective: To evaluate the effects of functional appliance treatment on mandibular trabecular structure using fractal dimension (FD) analysis of dental panoramic radiographs.Materials and Methods: This study was conducted using digital panoramic radiographs of 45 patients with Class II malocclusion treated with functional appliances (treatment group, mean age: 11.39 +/- 0.97 years; 23 girls, 22 boys) acquired before (T-0) and after (T-1) treatment and the panoramic radiographs of 45 control subjects who had undergone no orthodontic treatment (control group, mean age: 11.31 +/- 0.87 years; 23 girls, 22 boys). FD values in the condylar process, mandibular corpus, and mandibular angle were analyzed from the panoramic radiographs of both groups.Results: Analysis of changes in FD between T-0 and T-1 revealed significant increases in the FD values of the right and left condylar processes and right mandibular corpus in the treatment group (P<.001) and in the right condylar process in the control group (P<.05). Between-group comparisons demonstrated that the treatment group showed greater changes in the condylar process (right, P<.001; left, P<.05) and right mandibular corpus (P<.05) compared to controls. Correlation analysis between the cephalometric and FD changes in the treatment group showed the right condylar process changes were negatively correlated with GoGn/SN angle (P<.05) and positively correlated with Co-Go (P<.05), although these correlations were weak.Conclusions: FD analysis demonstrated significant changes in trabeculation of the condyle and mandibular corpus in the treatment group compared to the control group. Functional appliance treatment may lead to skeletal correction by altering skeletal form and trabeculation of the mandibular bone.Öğe Evaluation of dental age in individuals of different ages with unilateral cleft lip and palate(AVES, 2020) Cesur, Emre; Arslan, Can; Patır Münevveroğlu, Aslı; Altuğ, Ayşe TubaObjective: This study aimed to evaluate the dental age of unilateral cleft lip and palate (UCLP) patients aged 7-12 and 12-16 years using Demirjian's method and to compare these results with a control group. Methods: We evaluated the panoramic radiographs of 54 individuals with UCLP and 54 age- and gender-matched individuals without UCLP (control). The UCLP and control groups were divided into two groups: 7-12 and 12-16 years of age. Their dental ages were determined using Demirjian's method. Dental ages of the cleft side and noncleft side were assessed separately and were also compared with those of the control group to assess potential asymmetric dental developments in the UCLP group. Results: The chronological age was lower than the dental ages on both right and left sides in the control group (p<0.01). When age groups were evaluated separately, it was found that the chronological age was lower than the dental age in 7-12 year old individuals in the UCLP group (p<0.05), whereas it was less than the left and right dental ages in 7-12 (p<0.01) and 12-16 year old individuals (p<0.05) in the control group. Conclusion: We detected no differences in dental age between UCLP patients and healthy controls, and lack of asymmetrical dental development in the mandibular teeth of either group. However, based on assessments performed using Demirjian's method, subjects' dental and chronological ages were incompatible.Öğe Evaluation of maxillofacial characteristics in individuals with anterior open bite using denture frame analysis(AVES, 2020) Cesur, Emre; Köklü, AyşegülKeywords: The aim of this study was to evaluate the effectiveness of denture frame analysis (DFA) in individuals with anterior open bite who had completed pubertal peak growth (post-peak).Methods: This retrospective study was conducted using the cephalometric radiographs and hand-wrist X-rays of 50 individuals with open bite (mean age: 17.33 +/- 3 years; 35 female, 15 male) and a control group of 50 individuals without open bite (mean age: 17.38 +/- 2.72; 35 female, 15 male). All individuals included in the study were skeletal Class I and had completed or nearly completed skeletal growth. Skeletal and dental measurements pertaining to DFA were done and the data were analyzed using independent samples t test and Mann-Whitney U test.Results: Measurements assessing the vertical dimension showed that GoGn/SN, Frankfurt horizontal (FH)/mandibular plane (MP), palatal plane (PP)/MP, occlusal plane (OP)/MP, and OP-MP/PP-MP measurements were significantly greater in the open bite group (p<0.001). AB/MP angle was significantly larger in the control group (p<0.05). The open bite group had shorter A'-P' (posterior maxillary length; p<0.05) and, therefore, higher A'-6'/A'-P' ratio (p<0.01).Conclusion: Our results suggest that there may be a close association between maxillary OP inclination and mandibular position in individuals with open bite, and that open bite may arise due to maxillary denture base deficiency, especially in the posterior region. DFA may be useful in the differential diagnosis of open bite and in treatment planning, particularly when determining the need for tooth extraction.Öğe Evaluation of temporomandibular joint, masticatory muscle, and brain cortex activity in patients treated by removable functional appliances: A prospective fMRI study(British Institute of Radiology, 2019) Özdiler, Orhan; Orhan, Kaan; Cesur, Emre; Köklü, Ayşegül; Algın, OktayObjectives: The aim of this study is to evaluate the effects of functional orthodontic appliances on the masticatory muscles, temporomandibular joint (TMJ), and brain to determine whether using functional appliances full-time or only at night yields different results. Methods: 16 patients with Class II malocclusion were included in this study. Eight patients were instructed to wear their appliances (monoblock/twinblock) full-time and the other eight patients were instructed to wear them at night while sleeping. An additional 10 patients with Class II malocclusion were later included as a pre-treatment control group. Signal intensity ratios (SIR) of TMJ structures and morphological evaluations of the masticatory muscles were done for all patients. Functional MRI (fMRI) data were also obtained from the patients while performing chewing and biting movements. Results: ANB angle was reduced significantly in both the full-time and night wear groups, by values of 1.17° and 1.35°, respectively (p < 0.05). MRI showed that SIRs were significantly increased in both groups in the masticatory muscles, retrodiscal pad, condylar process, and articular disc (p < 0.05). Both resting and task-based fMRI evaluation revealed significant increases in blood oxygen level dependent signals in several regions of the brain in both groups (p < 0.05). Conclusions: The cephalometric and MRI findings of this study indicate that the treatment effects were similar for both wear schedules. Functional appliances should be regarded not as simple devices that treat Class II malocclusion through skeletal and dental correction alone, but as exercise devices that lead to neuromuscular changes by facilitating muscle adaptation and activating various brain regions.Öğe Evaluation of the quality and reliability of youtubetm videos created by orthodontists as an information source for clear aligners(2024) Cesur, Emre; Tuncer, Koray; Sevgi, Duygu; Balaban, Barkın Cem; Arslan, CanObjective: This study aimed to evaluate the quality, reliability, and content usefulness of videos created by orthodontists on clear orthodontic aligners. Methods: Videos were screened using YouTubeTM by conducting a search for “Invisalign”. After a preliminary evaluation of the first 250 results, 61 videos that met the selection criteria were scored and their length, days since upload, and numbers of views, likes, dislikes, and comments were recorded. These data were used to calculate the interaction index and viewing rate. Video reliability was assessed using a five-item modified DISCERN index, and video quality was assessed using the Video Information and Quality Index. A 10-item content usefulness index was created to determine the usefulness of the video content. Descriptive statistics of the parameters were calculated, and correlation coefficients were calculated to evaluate the relationships between the parameters. Results: The mean reliability score was 2.75±1.02 (out of 5), and the total quality score was 11.80±3.38 (out of 20). The total content usefulness index was quite low, with a mean score of 2.52±2.14 (out of 10). Interaction index and viewing rate were positively correlated with reliability score (r=0.463, p<0.01; r=0.295, p<0.05) and total quality score (r=0.365, p<0.01; r=0.295, p<0.01, respectively). The reliability score was positively correlated with the total quality score (r=0.842, p<0.01) and total content usefulness index (r=0.346, p<0.01). Conclusion: Videos about orthodontic aligner treatment have average reliability and quality but largely insufficient content.Öğe Farklı yaş ve cinsiyete sahip bireylerin profil estetik algısının siluet görüntüleri kullanılarak değerlendirilmesi(İstanbul Medipol Üniversitesi, Sağlık Bilimleri Enstitüsü, 2022) Tuncer, Mehmet Koray; Cesur, EmreBu klinik çalışmanın amacı, farklı yaş ve cinsiyete sahip bireylerin profil estetik algılarının organik fotoğraflar aracılığıyla oluşturulmuş siluetler kullanılarak değerlendirilmesidir. Farklı yaş gruplarının profil estetik algısının ölçülebilmesi adına altı tane yaş grubu, katılımcıların yaşı <12, 12-18, 19-25, 25-40, 40-50 ve 50< olacak şekilde oluşturulmuştur. Her yaş grubundaki katılımcılar da cinsiyetlerine göre eşit olacak şekilde ikiye ayrılmıştır. Katılımcı sayısını belirleyebilmek için %90 güç oranında power analizi yapılmış ve her bir gruba 70 kişi olacak şekilde 35 erkek ve 35 kadın katılımcı yerleştirilmiştir. Katılımcılara gösterilmesi için kullanılacak fotoğraflar, İstanbul Medipol Üniversitesi Mega Hastaneler Kompleksine ortodontik tedavi için başvuran hastaların profil fotoğrafları arasından seçilmiştir. Yüz tiplerinin sınıflandırılabilmesi için Gonion Gnathion-Sella Nasion (GoGn-SN) ve A noktası-Nasion-B noktası (ANB) açıları kullanılmıştır. Bu açılara göre dokuz tane grup oluşturulmuştur. Bu gruplar sırasıyla: Sınıf I hiperdiverjan, Sınıf I hipodiverjan, Sınıf I normodiverjan, Sınıf II hiperdiverjan, Sınıf II hipodiverjan, Sınıf II normodiverjan, Sınıf III hiperdiverjan, Sınıf III hipodiverjan ve Sınıf III normodiverjandır. Bu dokuz grubun içine iki erkek ve iki kadın profili yerleştirilmiş ve toplamda 36 tane profil fotoğraflarından oluşturulmuş siluetler kullanılmıştır. Katılımcılara, bu fotoğraflar gösterilmiş ve puanlamaları istenmiştir. Toplanan anket cevaplarına göre ölçümler yapılmıştır. Bu çalışmada elde edilen veriler SPSS 22 paket programı (Delaware, Chicago, ABD) aracılığı ile analiz edilmiştir. Verilerin normal dağılmamasından dolayı, ikili gruplar arasındaki karşılaştırmalarda Mann-Whitney U testi, üç ya da daha fazla gruplar arasındaki karşılaştırmalarda Kruskall Wallis H testi kullanılmıştır. Anlamlılık seviyesi olarak 0,05 kullanılmış olup, p<0,05 olması durumunda anlamlı bir farklılığın/ilişkinin olduğu, p>0,05 olması durumunda ise anlamlı farklılığın/ilişkinin olmadığı belirtilmiştir. Yapılan ölçümler doğrultusunda en çok beğenilen profiller profil 4, profil 24, profil 9, profil 2, profil 12 olurken, en az beğenilen profiller profil 33, profil 36, profil 31, profil 34, profil 35, profil 18 ve profil 32 olmuştur. Ortalama beğeni puanı ile önceden belirlenmiş 40 adet lateral sefalometrik ölçüm arasındaki korelasyon araştırılmış ve bütün katılımcılar için Subnasale-Stomion Superior (Sn-StS) ile pozitif yönlü, dudak açısı (ULA-St-LLAº) ile negatif yönlü; erkek katılımcılar için Sn-StS ile pozitif yönlü, ULA-St-LLAº ile negatif yönlü; kadın katılımcılar için ise Sn-StS ile pozitif yönlü, üst keser açısı (U1-NAº) ile negatif yönlü bir korelasyon bulunmuştur. Cinsiyet grupları arası ortalama beğeni puanları karşılaştırıldığında, profil 12 ve profil 24'e kadın katılımcıların daha yüksek puan verdikleri gözlemlenmiştir. Yaş gruplarının profillere vermiş olduğu ortalama beğeni puanları ile profiller arasındaki ilişki araştırıldığında ise profil 1, profil 14, profil 26, profil 27, profil 28, profil 32, ve profil 36 haricindeki bütün profillerde farklı yaş gruplarının ortalama beğeni puanları arasında anlamlı bir fark olduğu ve anlamlı fark gözlenen profillerde katılımcının yaşı arttıkça profillere vermiş oldukları puanların artmış olduğu gözlenmiştir.Öğe Growth-enabling modified Groper appliance for the replacement of permanent maxillary incisors: Report of two cases(Australian Society of Orthodontists Inc, 2020) Arıkan, Volkan; Öcal, Duygu; Akçay, Merve; Altuğ, Ayşe Tuba; Özer, Levent; Cesur, EmreThe aim of this case report is to introduce a modified Groper appliance that enables transverse growth of the maxilla in addition to improving the aesthetics of patients with missing anterior teeth. Patient 1 was a 16-year-old young woman in the late stages of growth who presented with a congenitally missing maxillary lateral incisor. Patient 2 was a nine-year-old girl missing both of her maxillary central incisors due to trauma. The missing teeth were replaced by artificial acrylic teeth bonded onto growth-enabling, maxillary, fixed palatal space maintainers. A tube was soldered onto one of the arch wires of the maintainer and the opposite arch wire was threaded into this tube, allowing it to slide until the patient completed growth. Intermolar width increased by approximately 1.9 mm in Patient 1 and 2.6 mm in Patient 2 over the three-year review period. The in-tube mechanical design of the device allowed transverse growth of the maxilla without interference during and throughout long-term wear.Öğe Is it possible to protract the maxilla by surgically assisted rapid maxillary expansion and intermaxillary class III elastics?(AVES, 2019) Şahbaz, Emir Bahman; Cesur, Emre; Altuğ, Ayşe Tuba; Ergül, Kutay Can; Karasu, Hakan Alpay; Memikoğlu, Ufuk ToygarObjective: The purpose of the present study was to evaluate skeletal and soft tissue changes with surgically assisted rapid maxillary expansion (SARME) and intermaxillary Class III elastics. Methods: A total of 15 patients (mean age: 19.58 years) were included in the study. Each patient underwent SARME with the use of Class III elastics (500 g) applied through miniscrews to stimulate maxillary advancement. Lateral cephalograms and posteroanterior radiographs obtained before treatment (T1), after SARME and elastic use (T2), and after treatment (T3) were analyzed to determine the changes in each phase of treatment. Planimeter was used to evaluate facial soft tissue changes. Wilcoxon signed-rank test was used to evaluate the changes that occur during treatment. Results: SARME provided permanent and efficient maxillary expansion at both skeletal and dental levels (p<0.01). Maxillary skeletal (ANS-Ver and U1i-Ver; p<0.01) and soft tissue (Pr-Ver, Sn-Ver, and ULA-Ver; p<0.01) variables and superior upper labial area (Area 1; p<0.05) increased due to maxillary dental and skeletal changes. Superior lower labial area (Area 3; p<0.05) decreased as a result of slight increase in facial height and changes in maxillary-mandibular incisor relationship at the end of the treatment. Conclusion: The results suggest that the improvement in the facial profiles of the patients is related to the significant increase in the bony and dental support of the upper lip region together with the contribution of the superior lower lip area.Öğe Knowledge and attitudes of paediatric dentists in Turkey regarding cone beam computed tomography (CBTC)(Cumhuriyet University Faculty of Dentistry, 2021) Orhan, Ayşe Işıl; Cesur, Emre; Bezgin, Tuğba; Orhan, KaanObjectives: The use of cone-beam computed tomography (CBCT) in dental practice has increased in recent years due to the lower radiation dose, fast scanning time, and superior imaging quality compared to conventional computed tomography (CT). Although CBCT is frequently preferred for the evaluation of the craniofacial region in areas such as orthodontics, orthognathic surgery, head trauma, and implant surgery, its use is still limited in paediatric dentistry. The aim of this study was to evaluate the knowledge and attitudes of paediatric dentists in Turkey regarding CBCT. Materials and Methods: A self-administered anonymous questionnaire consisting of 17 questions was completed by 273 volunteer participants. Of these, 135 were postgraduate students in a paediatric dentistry program and 137 were PhDs or specialists. Relationships between categorical variables were evaluated using chi-square test. Results: 237 (86.8%) of the 273 participants stated that they were knowledgeable about CT/CBCT, but 81% of the respondents said the information they received during dental education was insufficient. The only significant relationship among the studied variables was between the participants’ self-rated knowledge about the use of CT and/or CBCT for the dentomaxillofacial region and the institution in which they worked (P =.001). Conclusions: Although our results indicate that paediatric dentists have high levels of knowledge and positive attitudes towards digital imaging techniques and CBCT, it would be beneficial to update the dental curricula and enable dental students to gain practical experience in addition to theoretical knowledge.Öğe Long-term effects of botulinum toxin a injection on pain and quality of life in patients with myofascial pain of masticatory muscles: A retrospective study(Termedia Publishing House Ltd., 2022) Develi, Tuba; Uzel, Tansu; Cesur, Emre; Uçkan, SinaIntroduction: Favorable effects of botulinum toxin type A (BoNT/A) on muscle hyperactivity and pain has led to its' use in the treatment of temporomandibular joint disorders, related to muscle pain and masticatory myofascial pain. Objectives: The aim of this retrospective study was to evaluate the short- and long-term effects of trigger point injections of BoNT/A in patients with myofascial pain syndrome. Material and Methods: The study included 17 individuals aged 19-57 years (mean, 33 years), with 2 years of follow-up records. Visual analogue scale (VAS), pressure-pain threshold (PPT), and maximum mouth opening (MMO) were applied to evaluate pain and dysfunction. Mood and sleep quality were assessed using Beck's depression inventory (BDI) and Pittsburgh sleep quality index (PSQI). All evaluations were repeated before (T0) as well as at 4 weeks (T1), 6 months (T2), and 2 years (T3) after BoNT/A injection. Results: VAS score was lower at all 3 post-injection time points compared to T0 (p < 0.001). Significant increases in PPT and MMO measurements were also observed at T1, T2, and T3 compared to T0. BDI scores were significantly reduced at T1 and T2 compared to T0 (p < 0.05). PSQI decreased significantly between T0 and T1 (p < 0.001), but increased at T3 (p < 0.05). Conclusions: BoNT/A injections are an effective treatment alternative that relieve myofascial pain and mouth opening restriction, and subsequently improve quality of life in both the short- and long-term.Öğe Using artificial intelligence models to evaluate envisaged points initially: A pilot study(SAGE Publications Ltd, 2023) Amasya, Hakan; Aydoğan, Turgay; Cesur, Emre; Kemaloğlu Alagöz, Nazan; Uğurlu, Mehmet; Bayrakdar, İbrahim Şevki; Orhan, KaanThe morphology of the finger bones in hand-wrist radiographs (HWRs) can be considered as a radiological skeletal maturity indicator, along with the other indicators. This study aims to validate the anatomical landmarks envisaged to be used for classification of the morphology of the phalanges, by developing classical neural network (NN) classifiers based on a sub-dataset of 136 HWRs. A web-based tool was developed and 22 anatomical landmarks were labeled on four region of interests (proximal (PP3), medial (MP3), distal (DP3) phalanges of the third and medial phalanx (MP5) of the fifth finger) and the epiphysis-diaphysis relationships were saved as "narrow,'' "equal,'' "capping'' or "fusion'' by three observers. In each region, 18 ratios and 15 angles were extracted using anatomical points. The data set is analyzed by developing two NN classifiers, without (NN-1) and with (NN-2) the 5-fold cross-validation. The performance of the models was evaluated with percentage of agreement, Cohen's (c kappa) and Weighted (w kappa) Kappa coefficients, precision, recall, F1-score and accuracy (statistically significance: p < 0.05). Method error was found to be in the range of ck: 0.7-1. Overall classification performance of the models was changed between 82.14% and 89.29%. On average, performance of the NN-1 and NN-2 models were found to be 85.71% and 85.52%, respectively. The ck and wk of the NN-1 model were changed between 20.08 (p > 0.05) and 0.91 among regions. The average performance was found to be promising except the regions without adequate samples and the anatomical points are validated to be used in the future studies, initially.Öğe Validation of cervical vertebral maturation stages: Artificial intelligence vs human observer visual analysis(Mosby-Elsevier, 2020) Amasya, Hakan; Cesur, Emre; Yıldırım, Derya; Orhan, KaanIntroduction: This study aimed to develop an artificial neural network (ANN) model for cervical vertebral maturation (CVM) analysis and validate the model's output with the results of human observers. Methods: A total of 647 lateral cephalograms were selected from patients with 10-30 years of chronological age (mean +/- standard deviation, 15.36 +/- 4.13 years). New software with a decision support system was developed for manual labeling of the dataset. A total of 26 points were marked on each radiograph. The CVM stages were saved on the basis of the final decision of the observer. Fifty-four image features were saved in text format. A new subset of 72 radiographs was created according to the classification result, and these 72 radiographs were visually evaluated by 4 observers. Weighted kappa (w kappa) and Cohen's kappa (c kappa) coefficients and percentage agreement were calculated to evaluate the compatibility of the results. Results: Intraobserver agreement ranges were as follows: w kappa = 0.92-0.98, c kappa = 0.65-0.85, and 70.8%-87.5%. Interobserver agreement ranges were as follows: w kappa = 0.76-0.92, c kappa = 0.4-0.65, and 50%-72.2%. Agreement between the ANN model and observers 1, 2, 3, and 4 were as follows: w kappa = 0.85 (c kappa = 0.52, 59.7%), w kappa = 0.8 (c kappa = 0.4, 50%), w kappa = 0.87 (c kappa = 0.55, 62.5%), and w kappa = 0.91 (c kappa = 0.53, 61.1%), respectively (P < 0.001). An average of 58.3% agreement was observed between the ANN model and the human observers. Conclusions: This study demonstrated that the developed ANN model performed close to, if not better than, human observers in CVM analysis. By generating new algorithms, automatic classification of CVM with artificial intelligence may replace conventional evaluation methods used in the future.
