Search Results (242)

Background/Objectives: Surgical extraction of impacted mandibular third molars is frequently associated with postoperative morbidity, including swelling, trismus, and pain. However, the extent to which osteotomy contributes to these outcomes remains unclear. The aim of this study was to evaluate osteotomy as an intraoperative determinant of early postoperative morbidity following mandibular third molar extraction. Methods: This study represents a secondary analysis of data obtained from a randomized clinical trial. Patients undergoing surgical removal of impacted mandibular third molars were categorized according to whether osteotomy was required during the procedure. Postoperative outcomes included surgical duration, facial swelling (primary outcome) assessed by linear facial measurements, maximal mouth opening (trismus), postoperative pain intensity, and early soft tissue healing evaluated using the Early Healing Index. Results: Procedures involving osteotomy were associated with significantly longer surgical duration, as well as greater postoperative swelling and trismus during the early postoperative period. The most pronounced difference in swelling was observed along facial measurement line A on postoperative day 3. Multivariable analysis confirmed that osteotomy remained independently associated with increased postoperative swelling and trismus after adjustment for age, sex, and the original six-arm treatment allocation. In contrast, no statistically significant differences were found between the groups in postoperative pain intensity or early soft tissue healing. Conclusions: Osteotomy during mandibular third molar extraction is independently associated with increased early postoperative morbidity, particularly in terms of swelling and trismus. However, bone removal does not appear to negatively affect early soft tissue healing of the surgical site. Full article

Reflective-mode photoplethysmography (PPG) potentially enables non-invasive physiological monitoring of heart rate and Peripheral Oxygen Saturation (SpO₂) from virtually any anatomical body site, but its performances are strongly affected by several parameters such as local perfusion, skin temperature, and microvascular bed and tissue optical properties. This study systematically evaluates the quality of reflective-mode PPG signals acquired at the finger, wrist, ear, nose, temple, upper lip, and lower lip, using two commercial PPG sensors. PPG signal quality was quantified via Skewness, Kurtosis, Perfusion Index, and Shannon entropy. Heart rate (HR) and pulse transit time (PTT) were also computed. Skewness and Perfusion Index were the most informative quality indices, revealing the finger as the site with the best signal quality and the wrist as the most challenging location. Several facial regions—including the lips, nose, and temple—showed signal quality comparable to the finger. HR estimation was most accurate using the GREEN wavelength, with the lower lip achieving the lowest error, followed by the upper lip and finger. PTT values reflected physiological differences in pulse propagation, being longest at the finger and wrist and shortest at the lips. These findings highlight the potential of non-conventional anatomical sites as alternatives to the finger and wrist for reflective-mode PPG acquisition. Full article

Background and Objectives: Childhood obesity is a major global health concern and is increasingly recognized as a factor influencing skeletal development. Emerging evidence suggests that excess adiposity may alter craniofacial growth patterns, with potential implications for orthodontic diagnosis and treatment planning. However, the extent to which obesity affects craniofacial morphology in growing individuals remains incompletely understood. This study aims to evaluate the association between body mass index (BMI) and craniofacial morphology in children and adolescents using selected sagittal and linear parameters, and to assess the independent effects of age and sex. Materials and Methods: This cross-sectional orthodontic study included 130 subjects aged ≤ 19 years. Anthropometric measurements were recorded, and BMI was used to classify participants as normal weight, overweight, or obese. Standardized lateral cephalometric radiographs were analyzed using skeletal and soft-tissue parameters. Statistical analyses included normality testing, one-way ANOVA with post hoc comparisons, and multivariate modeling. Results: Obesity was significantly associated with increased sagittal skeletal dimensions. Mandibular body length, mandibular unit length, SNB angle, and maxillary unit length demonstrated progressive increases across BMI categories (p < 0.05). In contrast, vertical growth parameters showed no significant differences. Soft-tissue analysis revealed reduced facial convexity and lower facial height ratios in obese subjects. Age was strongly associated with increases in linear jaw dimensions, whereas sex differences were limited primarily to skeletal size rather than morphological relationships. Conclusions: Childhood obesity is associated with enhanced sagittal craniofacial growth, particularly involving mandibular structures, while vertical skeletal patterns remain largely unaffected. These findings highlight the importance of incorporating BMI assessment into orthodontic evaluation and suggest that obesity may influence growth timing, facial morphology, and airway-related risk factors. Full article

Background: Dentofacial deformities (DFDs) comprise heterogeneous sagittal, vertical, transverse, and asymmetry components, yet clinical severity is often summarized using isolated measurements. Objectives: To operationalize a reproducible composite DFD severity score and evaluate its cross-sectional associations with quality of life, function, airway-related screening indicators, and psychosocial burden. Methods: In this single-center cross-sectional study, consecutive adults assessed in an orthognathic surgery pathway underwent a prespecified 0–100 severity scoring framework integrating sagittal discrepancy (|Wits| and |ANB deviation|), vertical pattern (SN-MP angle), and asymmetry/transverse variables (chin deviation, asymmetry index, transverse discrepancy, and absolute overjet). Outcomes included the Oral Health Impact Profile-14 (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ), FACE-Q facial appearance satisfaction scale, PHQ-9, GAD-7, STOP-Bang, functional testing, and CBCT-derived upper-airway metrics. Results: Severe DFDs had higher composite severity (62.9 ± 12.8 vs. 25.3 ± 10.9), larger sagittal discrepancy (|Wits| 6.3 ± 2.8 vs. 3.1 ± 1.8), and higher SN-MP angles (39.8 ± 7.4 vs. 34.7 ± 7.2) (all p < 0.001). Severe DFDs also had worse OQLQ (36.2 ± 6.2 vs. 24.1 ± 7.2), OHIP-14 (18.3 ± 4.2 vs. 12.4 ± 4.1), FACE-Q satisfaction (45.7 ± 10.3 vs. 67.6 ± 9.6), masticatory performance (59.4 ± 8.5 vs. 75.1 ± 7.5), and smaller airway area (126.7 ± 29.6 vs. 161.4 ± 27.7) (all p < 0.001). In multivariable logistic regression, |Wits|, SN-MP angle, asymmetry index, and lower airway area independently predicted severe status; PHQ-9 was associated with severity in unadjusted analyses but did not retain independent significance after multivariable adjustment. Model discrimination was high (AUC 0.91). Conclusions: This multidimensional severity framework captures clinically meaningful cross-sectional differences across morphologic, functional, airway-related, and psychosocial domains. Its interpretability remained stable in sensitivity analyses, but external and longitudinal validation is still required before broader implementation. Full article

Background: Functional appliance therapy is widely employed for the management of skeletal Class II malocclusion in growing patients. However, treatment outcomes are influenced by multiple biological and behavioural variables, including genetic background, craniofacial growth pattern, neuromuscular adaptability, orofacial resting postures, and patient adherence. These factors often limit direct comparison of different appliance systems. Monozygotic twin studies provide a unique biological model by minimizing genetic and environmental variability, allowing more accurate evaluation of appliance-specific effects. Methods: This case report presents a comparative evaluation of a clear functional jaw corrector and a conventional twin block appliance in two 11-year-old female monozygotic twins at cervical vertebral maturation index stage 3. Both patients exhibited similar skeletal Class II patterns, vertical growth tendencies, proclined maxillary incisors, and convex soft tissue profiles. Twin A was treated with a removable clear functional jaw corrector fabricated using mandibular advancement blocks incorporated into a 1.5-mm Essix retainer sheet, while Twin B received a conventional twin block appliance. Treatment objectives, wear protocol, and duration were identical. Neither patient received orofacial myofunctional therapy. Results: Post-treatment clinical and cephalometric evaluation demonstrated improvement in sagittal jaw relationships, facial profile, and occlusal relationships in both patients. However, differences were observed in the magnitude of skeletal correction, dentoalveolar effects, vertical control, and the extent of molar and canine relationship correction. Conclusions: Both appliance designs were effective in improving sagittal relationships under similar biological conditions, with minor differences favoring the clear functional jaw corrector. However, the findings also highlight that orthodontic appliance therapy alone does not address underlying orofacial myofunctional factors, emphasizing the importance of incorporating functional assessment and adjunctive myofunctional therapy for optimal and stable outcomes. Full article

Sustainable sourcing of bioactive ingredients is an important direction in the development of topical formulations. Fruit by-products generated during food processing such as apple pomace, represent a promising resource for skincare applications. The aim of this study was to evaluate the safety, effectiveness, and consumer perception of a three-step facial skincare regimen consisting of a cleansing gel, serum, and face cream containing upcycled apple pomace extract. Unlike most cosmetic studies focusing on single products, this research assessed a complete skincare routine to better reflect real-life usage conditions. All formulations underwent dermatological safety evaluation prior to the in vivo study. The clinical assessment was conducted on 30 healthy female volunteers aged 25–55 years. Skin hydration, pH, transepidermal water loss, sebum level, and skin gloss were measured on untreated skin, after the first use, and after four weeks. User perception was assessed using a questionnaire completed by 58 participants. Short-term changes in skin parameters were observed after application, while four weeks of use maintained them within physiological ranges. Skin gloss increased significantly by 4.2%, and no adverse reactions were reported. These results indicate that the tested skincare regimen containing apple pomace extract was well-tolerated and cosmetically acceptable under the study conditions. Full article

Vitamin D plays an important role in bone metabolism and may influence postoperative healing processes. This study evaluated the association between preoperative serum vitamin D levels and recovery after mandibular third molar extraction. This secondary exploratory analysis included 122 healthy patients undergoing surgical extraction of an impacted mandibular third molar, of whom 98 had complete datasets for clinical and radiographic evaluation. Postoperative outcomes included pain intensity, facial swelling, trismus, early soft tissue healing assessed with the Wachtel Early Healing Index, and bone regeneration evaluated four months after surgery using CBCT-based fractal dimension analysis. Serum vitamin D levels were not significantly associated with postoperative pain, trismus, or early soft tissue healing. A weak correlation was observed between lower vitamin D levels and greater swelling along the tragus–pogonion line on postoperative day 1 (ρ = −0.21, p = 0.035), with no significant associations at later time points. Fractal dimension analysis did not demonstrate significant differences between groups. Within the limitations of this secondary exploratory analysis, vitamin D levels showed limited and inconsistent associations with postoperative outcomes, and their clinical relevance remains uncertain. Full article

Background/Objectives: Preterm infants often experience impaired swallowing function, and objective assessments for this population remain limited. In this prospective single-center study, we aimed to propose and validate an automated framework that quantitatively assesses neonatal sucking behavior by tracking facial key points in bottle feeding videos. Methods: Fifty-eight preterm infants (corrected age [CA] ≤ 2 months) were enrolled, and 2 min videos of bottle-feeding were recorded. Certified therapists manually evaluated the videos using the Neonatal Oral Motor Assessment Scale (NOMAS), and an artificial intelligence (AI)-based analysis classified the videos into the following three groups: Normal, Disorganization, and Dysfunction. At 12 months CA, developmental outcomes were assessed using the Mental Development Index (MDI) and the Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development, Second Edition (BSID-II). Results: Among the 58 infants, the AI-based tool correctly classified 47 and misclassified 11. The classification accuracy was 82.76 for the Normal group, 82.76 for Disorganization, and 96.55 for Dysfunction. The mean PDI was lower in the Dysfunction group than in other groups; however, the differences were not statistically significant. Conclusions: This novel AI-based video analysis demonstrates preliminary potential as a noninvasive tool for evaluating sucking behavior in preterm infants, potentially enabling early identification of dysphagia even by non-specialists in the neonatal intensive care unit (NICU) without hazard exposure. This feasibility study demonstrates preliminary technical viability of a video-based framework for neonatal sucking behavior assessment; however, further validation is required before clinical implementation. Full article

Adolescence is a key period of significant physiological and social development, during which social anxiety symptoms often emerge and can impact academic and social functioning. Social anxiety disorder (SAD) involves heightened sensitivity to social cues and impaired social information processing, potentially contributing to persistent anxiety symptoms. However, research exploring the neural mechanisms of social information processing in adolescents with social anxiety remains limited. The investigation employed a facial dot-probe paradigm combined with EEG measurements to assess differences in attentional processing and neurophysiological activity between two adolescent groups: a high-social-anxiety (HSA) group (N = 27) and a low-social-anxiety (LSA) group (N = 18). Results showed (1) there was a significant reduction in P2 amplitudes in the HSA group compared to the LSA group. (2) A significant negative correlation between the disengagement index (DI) and P2 amplitude was found. (3) Weaker functional connectivity in the theta band was found in the HSA group. (4) In the graph theory analysis, the HSA group exhibited significantly higher node efficiency across various frequency bands compared to the LSA group. The findings suggest that socially anxious adolescents have impaired attentional control toward social cues. This difficulty may reinforce their anxiety symptoms over time. Full article

Background and Objectives: Dentofacial asymmetries are common in patients with malocclusions, while mild body postural asymmetries are frequently reported in otherwise healthy individuals. However, their interrelationship remains insufficiently investigated in adults without diagnosed spinal disorders. This study aimed to evaluate the association between dentofacial and body postural asymmetries in adults with malocclusions. Materials and Methods: A clinical cross-sectional observational study was conducted on 102 adults (18–45 years) with malocclusions and no spinal pathology. Standardized clinical morphometric examinations assessed dentofacial asymmetries (horizontal and vertical planes), dental parameters (dental midlines deviation and occlusal plane inclination), and body postural asymmetries (head, shoulder, trunk, pelvic, and lower limb alignment). Asymmetries were recorded using predefined clinical thresholds. Statistical analyses included the Wilcoxon signed-rank test, Pearson chi-square test, and Spearman’s rank correlation coefficient. Results: Dentofacial asymmetries were identified in both planes and occurred more frequently on the left side. Horizontal facial asymmetries were most common at the cheek (74.5%), nostril (66.7%), and mandibular angle levels (57.9%), and were influenced by sex, age, facial growth pattern, and facial profile (p ≤ 0.05). Mandibular dental midline asymmetry was present in 55.8% of patients. Body postural asymmetries were also frequent, particularly unilateral (60.8%) or anterior (55.9%) head inclination and shoulder asymmetries (54.9%), with a predominance on the left side and associations with age, body mass index, and postural attitude (p ≤ 0.05). Correlations were identified among facial asymmetries and among body postural asymmetries (p ≤ 0.01), indicating a bilateral distribution pattern. Additionally, right-sided facial asymmetries showed significant positive associations with right-sided body postural asymmetries (ρ = 0.197–0.229; p ≤ 0.05). Conclusions: Dentofacial and body postural asymmetries have been identified in adults with malocclusions and presented side-specific associations regarding the patterns of asymmetry. Full article

Emotional and workload-related states unfold dynamically during immersive virtual reality (VR) experiences, yet reliable physiological modeling in such environments remains challenging. We investigated whether multi-channel facial electromyography (fEMG), combined with spatio-temporal deep learning, can (i) accurately classify calibrated facial expressions across participants and (ii) transfer to spontaneous, task-elicited behavior in immersive VR. Twelve adults completed a calibration phase involving four intentional expressions (smile, frown, raised eyebrow, neutral), followed by VR scenes designed to elicit emotional, cognitive, physical, and dual task demands. After participant-level physiological normalization, a single shared Convolutional Neural Network–Temporal Convolutional Network (CNN–TCN) model was trained and evaluated using leave-one-participant-out (LOPO) validation. The model achieved strong cross-participant performance (Macro-F1 = 0.88 ± 0.13; ROC-AUC = 0.95 ± 0.06). When applied to unlabeled spontaneous VR task-elicited fEMG recordings, the trained model generated continuous expression classes. Derived static and temporal expression features showed scene-dependent modulation and False Discovery Rate (FDR)-surviving associations, primarily with perceived physical demand (NASA-TLX). The observed muscle activation patterns were physiologically plausible and aligned with Facial Action Coding System (FACS)-based interpretations of underlying muscle activity. These findings demonstrate that end-to-end spatio-temporal modeling of raw fEMG enables facial expression sensing in immersive VR using a single shared model following physiological normalization. The proposed framework bridges calibrated expression learning and spontaneous task-elicited behavior, supporting privacy-preserving, continuous and physiologically grounded monitoring in human-centered VR applications. Full article

Multimodal human–AI systems generally consider facial expressions and body motions as separate input streams, leading to disjointed interpretations and diminished emotional coherence. To overcome this issue, we offer the Engagement-Safe Expressive Alignment (ESEA) paradigm and the Unified Visual Synchrony (UVS) framework as its computational implementation. UVS models the coherence between facial expressions and gestures, offering an interpretable visual synchrony signal that can function as adaptive feedback in human–AI interactions. The framework’s key component is the Consistency Index for Affective Synchrony ($CIAS$), which correlates brief visual segments with scalar synchrony scores through a common latent representation. Facial and gestural signals are processed by modality-specific projection networks into a unified latent space, and $CIAS$ is derived from the similarity and short-term temporal consistency of these latent trajectories. The synchrony index is regarded as an estimation of affective visual coherence within the ESEA paradigm. We formalize the UVS/$CIAS$ framework and conduct a comparative experimental evaluation utilizing matched and mismatched face–gesture segments derived from rendered dialog footage. Utilizing ROC analysis, score distribution comparisons, temporal visualizations, and negative control tests, we illustrate that $CIAS$ effectively captures structured face–gesture alignment that surpasses similarity-based baselines, while also delivering a persistent, time-resolved synchronization signal. These findings establish $CIAS$ as a principled and interpretable feedback signal for future affect-aware, engagement-focused multimodal agents. Full article

Background/Objectives: This study evaluated autologous platelet concentrates (APCs), including advanced platelet-rich fibrin (A-PRF+) and concentrated growth factors (CGFs), as biologically active matrices, and photobiomodulation (PBM) as a biophysical stimulus affecting soft and hard tissue regeneration following mandibular third molar extraction. Methods: A six-arm parallel randomised controlled trial was conducted including 135 patients. A total of 122 participants completed follow-up and were analysed: control (n = 22), photobiomodulation (n = 20), A-PRF+ (n = 19), CGF (n = 20), A-PRF+ plus photobiomodulation (n = 22), and CGF plus photobiomodulation (n = 19). The primary endpoint was postoperative pain intensity assessed on postoperative day 3 using an 11-point visual analogue scale (VAS). Secondary outcomes included swelling, trismus, wound healing assessed by the early healing index, and bone regeneration assessed by CBCT-based fractal dimension analysis at 4 months. Results: On postoperative day 3, mean VAS pain was 2.95 ± 2.65 in the control group and 1.00 ± 1.65 in the photobiomodulation group, corresponding to a mean difference of 1.95 VAS points. The overall between-group difference for day 3 pain was statistically significant. In swelling outcomes, no statistically significant between-group differences were observed at days 1, 3, or 7 across facial measurement lines. In CBCT fractal analysis, a significant group effect was detected for the mid socket region, with higher fractal dimension at 4 months in the CGF plus photobiomodulation group compared with the control. Conclusions: Both APCs and PBM positively influenced postoperative healing. Their combined application, particularly CGF with PBM, showed the most consistent regenerative effects, although not all outcomes differed significantly between groups. These minimally invasive strategies may support soft and hard tissue regeneration. Full article

Background: Dental anxiety is common in pediatric dentistry and may hinder care, particularly in behaviorally challenging children. Most anxiety measures rely on verbal report, which can be unreliable in young patients. This study explored whether the Lüscher Color Test, a non-verbal psychological instrument, shows associations with established anxiety proxies in a pediatric dental sedation setting. Methods: In this single-center prospective observational study, 100 children aged 4–12 years referred for dental treatment in a conscious sedation unit were recruited; 80 completed the protocol (exclusion rate 20%). N₂O/O₂ inhalation sedation was not randomized and was selected by the clinician based on clinical judgement. Anxiety was assessed pre- and post-operative using the Lüscher Color Test, heart rate (HR) monitoring, and the Visual Facial Anxiety Scale (VFAS). The primary outcome was the pre–post change in the Lüscher anxiety index calculated as the pre-operative score minus the post-operative score (Δ = pre − post). Associations between changes in anxiety measures and demographic/clinical variables were examined. Results: Anxiety scores decreased after treatment for both the Lüscher Color Test and VFAS (both p < 0.001). Change in Lüscher scores was positively associated with HR reduction (Spearman r = 0.68; p < 0.01), whereas VFAS change showed a weaker association (r = 0.28; p < 0.05). In regression analyses, treatment-related variables were explored; however, given the observational design and subgroup imbalance, these findings should be interpreted cautiously. Conclusions: Although pre–post scores suggested a reduction in anxiety, the Lüscher Color Test should be considered an exploratory, complementary non-verbal measure rather than a validated diagnostic instrument. In the multivariable logistic regression, nitrous oxide sedation showed only a non-significant trend toward greater anxiety reduction (p = 0.07). Further studies with appropriate validation frameworks and stronger designs are needed before clinical implementation can be recommended. Full article

Background: Tracheal rupture is a rare, life-threatening condition that may follow blunt trauma, intubation, and, less commonly, esophageal instrumentation. The diagnosis may be challenging due to the subtle, delayed, and wide variety of symptoms. We present a unique case of delayed tracheal rupture secondary to iatrogenic esophageal perforation, presenting months later with a cervical neck insufflation on Valsalva, a novel clinical sign that has not been previously described in the literature. Case Presentation: A 44-year-old male initially presented with esophageal food impactation. Following endoscopic removal attempts, he developed signs consistent with esophageal perforation and was managed conservatively. In follow-up, he reported persistent neck discomfort, facial numbness, and the ability to insufflate the right side of his neck while doing a Valsalva. Flexible bronchoscopy and retrospective review of imaging revealed a proximal posterior tracheal defect, initially misinterpreted as a tracheal diverticulum. Surgical exploration confirmed a 6 cm dehiscence between the membranous trachea and the anterior wall of the esophagus. The defect was repaired using regional muscle flaps with tissue sealant reinforcement. Postoperatively, the patient had complete symptom resolution and no recurrence of neck insufflation. Conclusions: The case underscores the importance of maintaining a high index of suspicion for tracheal injury in patients with persistent or atypical symptoms following esophageal perforation or instrumentation. To our knowledge, we have described a novel clinical finding of neck insufflation upon Valsalva for diagnosing tracheal rupture. Full article