This study compares the prevalence of orofacial signs and symptoms of temporomandibular disorder (TMD) in children with juvenile idiopathic arthritis (JIA) and controls at two study visits two years apart. We also examine the prevalence of TMD diagnoses and their association with general disease activity in children with JIA. In the NorJIA cohort study, children with JIA aged 4 to 16 years were recruited consecutively from three pediatric rheumatology clinics in Norway and together with an age- and sex-matched non-JIA control group from public dental health service clinics. Children with JIA were classified into temporomandibular joint (TMJ) involvement and no TMJ involvement groups on the basis of magnetic resonance imaging findings. An adapted version of the Diagnostic Criteria for TMD protocol was applied to assess myalgia, arthralgia, headache attributed to TMD, and disc displacement in all children at both visits. Fifty-five children with JIA and TMJ involvement, 132 with JIA without TMJ involvement, and 189 controls completed TMD examinations at both visits. At Visit I, at least one TMD diagnosis was present in 49

OBJECTIVE:Unilateral craniofacial microsomia (UCM) presents varying unilateral deficiencies of the temporomandibular joint, mandibular ramus, masticatory muscles, and adjacent soft tissues and ear. Reduced mandibular and maxillary dimensions may decrease upper airway volume and may increase the risk of sleep-disordered breathing (SDB). This retrospective pilot study aimed to evaluate a novel three-dimensional (3D) method for assessing nasal cavity (NC) and pharyngeal airway (PA) dimensions in growing patients with UCM compared with healthy controls, and to explore the potential associations between airway dimensions and SDB risk using the pediatric Sleep Questionnaire (PSQ). MATERIAL AND METHODS:This retrospective case-control pilot study analysed Cone-beam computed tomography (CBCT) scans from 11 patients with UCM (mean age 12.7 ± 4.4 years) and 11 age-matched controls (mean age 12.1 ± 1.1 years). Two calibrated investigators performed airway measurements, including total and partial NC and PA volumes, minimal cross-sectional area (MCS), and hydraulic diameter. SDB risk in the UCM group was assessed using PSQ scores. Reliability was evaluated with intra-class correlation coefficients and Dahlberg's formula. Group differences were tested using unpaired t-tests. RESULTS:Patients with UCM showed significantly smaller NC volume (9714.9 ± 3032 mm3) than controls (12773.9 ± 1963 mm3; p < 0.0001). PA volume and MCS did not differ significantly. Four of the eleven patients with UCM showed a high PSQ-based risk of SDB and tended to have smaller airway dimensions. Measurement reliability was acceptable. CONCLUSIONS:CBCT-based 3D assessment of upper airway morphology was feasible in patients with UCM. Patients with UCM demonstrated significantly reduced nasal cavity volume compared with controls. Exploratory analysis suggested that some patients may be at increased risk of SDB; however, these findings require confirmation in larger studies.

This study examines the nocebo effect in orthodontics by assessing how parental orthodontic experiences and attitudes toward dental care influence children's pain and discomfort at treatment onset. Consecutive orthodontic patients aged 12-18 years were included in this prospective observational cohort study. Parents' prior orthodontic experiences, perceptions of dental care, and pain expectations were assessed by questionnaire. Children completed the Pain Catastrophizing Scale (PCS) and the Spielberger State Trait Anxiety Inventory for Children (STAIC) before fixed appliance bonding. Follow-up questionnaires 3-5 days post-bonding assessed pain, dysfunction, medication use, and oral health impact (OHIP-14). Non-parametric tests and regression analyses were used to assess associations between parental expectations and patient-reported outcomes. Seventy patients (mean age 14.1 ± 1.7 years; 51.3% females) were included. Greater pain medication use was reported among patients whose parents had prior orthodontic experience (p = 0.038). Parental associations of orthodontic care with pain were linked to higher patient anxiety and pain catastrophizing. Regression analyses confirmed associations between parental expectations and patient orofacial dysfunction, anxiety, pain catastrophizing, and oral health impact. The study indicates a proxy nocebo effect in orthodontics, where parental experiences and perceptions influence children's pain during treatment. Addressing parental perceptions may help reduce this effect and improve treatment experiences for children and adolescents.

BACKGROUND:Patient safety is a fundamental prerequisite for high-quality healthcare and central to clinical practice, including orthodontics. Despite the widespread emphasis on safety in healthcare delivery, knowledge specific to patient safety in orthodontics remains limited. AIMS:(1) To analyse the reasons why patients file claims for compensation related to orthodontic care, (2) to summarise the events that lead to patient harm, and (3) to describe the types of harms associated with the provision of orthodontic care. MATERIALS & METHODS:Data from the Danish Dental Compensation Association (DDCA), a national compensation scheme established by law, were retrospectively extracted from the electronic database and included all patient-reported claims between June 2017 and August 2024 related to orthodontic care. RESULTS:A total of 644 patient-reported orthodontic-related claims were reviewed. Of these claims, 196 (30.4%) were recognized as patient harm and led to compensation. Orthodontic treatment was the most frequently reported source of harm (51.5%, n = 101), followed by delayed diagnosis (24.5%, n = 48) and retention-related complications (9.2%, n = 18). Among the 196 approved claims, the most common harm was apical root resorption leading to tooth loss (14.8%, n = 29), followed by gingival or soft-tissue injury (13.3%, n = 26), worsening of occlusion after treatment (9.2%, n = 18), and other harm such as diagnostic delays causing tooth damage (8.2%, n = 16). CONCLUSION:Harm events can occur at any stage during the orthodontic treatment process, including the diagnostic and planning stage. Orthodontic harm mostly occurs in the active phase of treatment and is frequently a result of root resorption, soft tissue damage, and worsening of the occlusion. There is a discrepancy in patient-perceived harms and actual harm events that lead to compensation. This study highlights the importance of thorough risk assessment, optimal diagnostics and planning, clinical vigilance throughout treatment, and clear communication regarding potential side effects and patient concerns, particularly where perceptions of harm and compensability diverge.

BACKGROUND:Patient safety, defined as the absence of avoidable harm, in orthodontics is still in its early stages of development. Knowledge on the subject is limited. AIM:(1) To conduct an incident analysis, (2) to measure avoidability, (3) to investigate the relationship between contributory factors and perceived avoidability of harm from orthodontic care, and (4) to suggest methods to mitigate potential patient harm incidents. MATERIALS AND METHODS:Data were retrospectively collected from consecutively filed orthodontic-related claims from the Danish Dental Compensation Association (DDCA) and included all approved-for-compensation claims from September 2019 to August 2024. Reason for filing the claim, harm category, and harm-causing events were recorded. Incident analysis was conducted for each claim based on the Eindhoven criteria and AI-assisted qualitative analysis. A large language model was used to identify and interpret the interplay between the contributory factors. Perceived avoidability of harm was based on a 6-point rating system. RESULTS:A total of 125 claims of approved patient harm were included and reviewed. Based on the Eindhoven incident analysis, the most frequent root causes were human related factors (monitoring, verification and clinical knowledge among others) followed by organizational factors (management priorities, protocols and workplace culture), illustrating complex interrelationships. The majority of claims (70.1%, n = 82) were avoidable harm, being rated as either probably avoidable in more than 50% of cases, high certainty of avoidability, or completely avoidable. While low-avoidability harm events were characterized by few contributory factors, high-avoidability cases were characterized by the involvement of numerous human and organizational failures. CONCLUSION:The analysis of 125 compensated orthodontic harm cases showed that 70.1% of the cases were deemed avoidable and most harms were multifactorial in nature, with human and organizational contributors playing the primary role. This multifactorial pattern provides new insights and forms a foundation for future patient-safety initiatives in orthodontic practice and research.

ObjectiveThis prospective study investigates the efficacy of biologics in combination with methotrexate (MTX) or leflunomide (LEF) on juvenile idiopathic arthritis (JIA)-related temporomandibular joint (TMJ) arthritis measured by magnetic resonance imaging (MRI)-based inflammation score and deformity score.MethodsA prospective, single-center observational cohort study of 18 consecutive patients was performed between September 2018 and April 2023. Inclusion criteria were (1) diagnosis of JIA, (2) MRI-verified TMJ arthritis leading to treatment with tumor necrosis factor inhibitor (TNFi), (3) MRI at 6 months and 24 months after treatment initiation, and (4) clinical follow-up together with an MRI by a pediatric rheumatologist and an orthodontist.ResultsWe included 18 patients (89% female). At the time of the first MRI, median age was 13.2 years (IQR 9.9-17.4), median disease duration was 7.8 years (IQR 3.4-11.1), and 4 received MTX or LEF. During the observation period, significant improvements were observed in TMJ movement pain (P= 0.01), morning stiffness (P= 0.004), opening capacity (P= 0.03), and maximal incisal openingP= 0.006). The inflammation score decreased significantly from a median of 2 (IQR 1-3) at baseline to a median of 1 (IQR 0-2) at 24 months (P= 0.009). In 17 of 36 TMJs (47%), the deformity score improved or remained stable and no significant increase in the median score was observed.ConclusionThis is the first prospective, observational study with evidence to support that the orofacial signs, symptoms, and MRI-derived inflammation score in TMJ arthritis can be reduced by treatment with TNFi.

Background Understanding the psychological and professional consequences of patient harm events is crucial for improving clinical practice and support systems. This study aimed to 1) investigate the prevalence of orthodontic professionals’ involvement in patient harm incidents and secondly to 2) assess the emotional, psychological, and professional impact of these events while analysing differences amongst different educational backgrounds, genders and years of experience. Methods An online questionnaire-based survey was conducted amongst orthodontic professionals, including orthodontists, dentists, hygienists, and dental assistants during two orthodontic conferences in Denmark. This covered topics on the respondents’ experience with harm, types of harm, the emotional and physical impact of being involved in such event and their working environment. Results A total of 297 participants completed the survey, 45.9% (n=135) of which reported involvement in a patient harm event and 20.8% (n=61) experiencing such an event within the past year. Fear of causing harm was evident with 32.1% (n=94) reporting moderate concern and 32.4% (n=95) experiencing high to very high levels of stress. Psychological distress following involvement in harm was reported by 49.2% (n=87) of affected professionals, while 21.5% (n=38) experienced physical symptoms. Some (8.8%, n=16) considered leaving their job due to such incidents. No significant gender differences were found, but professional background and experience level influenced responses, with less experienced professionals exhibiting higher stress levels. Conclusion Patient harm incidents are common in orthodontics and have notable emotional and psychological consequences for care providers. The study underscores the need for further research improving the patient safety, and the emotional safety for the orthodontic care providers.

This investigation aimed to develop a radiographic 3D cephalometric index to grade severity of dentofacial deformity in patients with juvenile idiopathic arthritis (JIA), and to perform a validation against expert evaluations. Data were collected from a population-based Nordic JIA cohort of 240 patients that received a cone-beam computed tomography (CBCT) scan approximately 17 years after onset of JIA. The cohort was randomized into two groups: A baseline group for establishing the index (n = 210) and a test group (n = 30). The standardized index generation process led to the inclusion of six radiographic outcome measures, each representing different facets of dentofacial deformities. Specific severity scores were established for three domains; dentofacial asymmetry (0-8), vertical deviation (0-8), and sagittal deviation (0-8). An overall dentofacial deformity index score was computed by aggregating the scores from the six variables, with the total score ranging from 0 to 24. The validity of the index was assessed by comparing the index score with expert evaluations. Based on the generated index, 10 patients exhibited severe deformities. Reliable agreement between data-generated index scores and expert assessments was found. A 3D radiographic dentofacial deformity index was generated and tested. This index can support an objective assessment of the severity of dentofacial deformities related to JIA in a clinical setting and future research.

Objective:This pilot study aims to evaluate the clinical accuracy of Smart stereolithography (STL) files generated by the Dental Monitoring® (DM) system by comparing them with gold standard intraoral scans (IOSs). Methods:Seven aligner patients using the DM application were included. For each patient, Smart STL files generated from remote scans were superimposed onto IOSs using the best-fit algorithm in OnyxCeph software. Differences regarding inclination, angulation, rotation, buccal/lingual, mesial/distal, and intrusion/extrusion were quantified and statistically compared. Results:Statistically significant differences were observed in inclination, mesial/distal, and buccal/lingual movements, particularly in the posterior segments. However, all deviations remained within clinically acceptable thresholds for single aligner tooth movement. Conclusions:Despite minor deviations, Smart STL files generated by DM demonstrated sufficient accuracy for use in aligner planning and refinement. These findings highlight the potential of DM-generated Smart STL files for subsequent aligner treatment.

Juvenile idiopathic arthritis (JIA) commonly affects the temporomandibular joint (TMJ), leading to dentofacial deformities and orofacial symptoms. Timely diagnosis and treatment initiation are essential for optimizing patient outcomes. However, clinical examination—the primary screening method— has limited accuracy, increasing the risk of delayed TMJ involvement detection. This study develops, trains and tests an artificial intelligence (AI) model for predicting TMJ involvement in newly diagnosed JIA patients and compares its model performance with expert clinician assessments for validation. A longitudinal dataset of 6,153 standardized orofacial examinations from 1,054 patients with JIA was used to train an Extreme Gradient Boosting (XGBoost) model to predict TMJ involvement. An independent cohort of 55 newly diagnosed patients was used to evaluate the model. Twenty-six clinically relevant features were selected and preprocessed for model input. Model performance was evaluated based on classification accuracy and concordance with expert clinician assessments. Model interpretability was analysed using Shapley additive explanations (SHAP) to identify key predictive features. The XGBoost model achieved an overall accuracy of 85.5% in predicting TMJ involvement. Model predictions showed significant concordance with expert clinician assessments (p < 0.001), although the model identified a higher prevalence of TMJ involvement than experts. The most influential predictive features were reduced condylar translation, facial asymmetry, protrusion, patient-reported orofacial pain and reduced mouth-opening capacity. The developed AI model demonstrates strong predictive performance for TMJ involvement based on clinical examination. By facilitating earlier detection, the model has the potential to support clinical decision-making, enable timely intervention, and improve patient outcomes.

Objective This study aims to investigate (1) the factors that pediatric orthodontic patients consider important in defining a good orthodontist and treatment process, and (2) the core elements of a good orthodontic treatment as identified by young patients and their parents. Methodology Children and adolescent orthodontic patients were prospectively interviewed, along with a parent and their treating orthodontist, at Aarhus University's postgraduate clinic, Denmark, using a reconstructive grounded theory approach. The study consisted of (1) four open-ended questions for patients, grouped into thematic domains, and (2) a closed-ended questionnaire, based on the World Health Organization's pediatric healthcare quality framework, answered by patients and parents. Seven treatment-related items were rated on a Likert scale (1 = Not important at all to 5 = Very important). Results Thirty-six patients (mean age 13.7 years, standard deviation (SD) 1.9 years) and their parents participated. Most of the open-ended qualitative responses of a good orthodontic treatment referred to the following subdomains: Communication (52, 30%), Information at the right time (43, 25%), Pain during treatment (21, 12%), Competence (19, 11%), and Respect and mutual trust (18, 10%). In the closed-ended questionnaire, parents rate it with higher importance than the patients that the orthodontist is an expert (P = 0.01). Conclusions Young orthodontic patients consider the entire treatment process when evaluating a good treatment and a good orthodontist. The two main factors they value most are having a friendly orthodontist and being provided with valuable information on their orthodontic treatment at the right time. The findings of the current project can be used to improve the overall quality of care and increase patient satisfaction.

To support dentists with limited experience, this study trained and compared six convolutional neural networks to detect crossbites and classify non-crossbite, frontal, and lateral crossbites using 2D intraoral photographs. Based on 676 photographs from 311 orthodontic patients, six convolutional neural network models were trained and compared to classify (1) non-crossbite vs. crossbite and (2) non-crossbite vs. lateral crossbite vs. frontal crossbite. The trained models comprised DenseNet, EfficientNet, MobileNet, ResNet18, ResNet50, and Xception. Among the models, Xception showed the highest accuracy (98.57

BACKGROUND:An update on the knowledge regarding the orthopedic/orthodontic role in treating JIA-related dentofacial deformities is relevant.OBJECTIVES:This systematic review aimed to assess the level of evidence regarding the management of dentofacial deformity from juvenile idiopathic arthritis (JIA) with orthodontics and/or dentofacial orthopedics.SEARCH METHODS:The following databases were searched without time or language restrictions up to 31 January 2024 (Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature).SELECTION CRITERIA:Inclusion criteria were studies dealing with JIA subjects receiving treatment with orthodontic and/or dentofacial orthopedic functional appliances.DATA COLLECTION AND ANALYSIS:After the removal of duplicate studies, data extraction, and risk of bias assessment according to ROBINS-I guidelines were conducted. Data extraction was conducted by two independent authors.RESULTS:The electronic database search identified 397 eligible articles after the removal of duplicates. Following the application of the pre-defined inclusion and exclusion criteria, 11 articles were left for inclusion. Two trials were associated with a severe risk of bias, four trials were at moderate risk of bias, and the other five presented a low risk of bias. Various research groups employed and documented the effects of different types of appliances and methodologies. The study heterogeneity did not allow for meta-analyses. In addition, a lack of uniformity in treatment objectives was observed across the included studies. After treatment with dentofacial orthopedics skeletal improvement was demonstrated in 10 studies, and a decrease in orofacial signs and symptoms was reported in 7 studies.CONCLUSIONS:Across the available literature, there is minor evidence to suggest that dentofacial orthopedics may be beneficial in the management of dentofacial deformities from JIA. There is little evidence to suggest that it can reduce orofacial signs and symptoms in patients with JIA. Based on current evidence, it is not possible to outline clinical recommendations for specific aspects of orthopedic management in growing subjects with JIA-related dentofacial deformity.REGISTRATION:PROSPERO (CRD42023390746).

Background: Patients seeking orthodontic treatment may use large language models (LLMs) such as ChatGPT for self-education, thereby impacting their decision-making process. This study assesses the reliability and validity of Chat-GPT prompts aimed at informing patients about orthodontic side effects and examines patients' perceptions of this information. Materials and methods: To assess reliability, n = 28 individuals were asked to generate information from GPT-3.5 and Generative Pretrained Transformer 4 (GPT-4) about side effects related to orthodontic treatment using both self-formulated and standardized prompts. Three experts evaluated the content generated based on these prompts regarding its validity. We asked a cohort of 46 orthodontic patients about their perceptions after reading an AI-generated information text about orthodontic side effects and compared it with the standard text from the postgraduate orthodontic program at Aarhus University. Results: Although the GPT-generated answers mentioned several relevant side effects, the replies were diverse. The experts rated the AI-generated content generally as "neither deficient nor satisfactory," with GPT-4 achieving higher scores than GPT-3.5. The patients perceived the GPT-generated information as more useful and more comprehensive and experienced less nervousness when reading the GPT-generated information. Nearly 80% of patients preferred the AI-generated information over the standard text. Conclusions: Although patients generally prefer AI-generated information regarding the side effects of orthodontic treatment, the tested prompts fall short of providing thoroughly satisfactory and high-quality education to patients.

OBJECTIVE:To assess the agreement between child- and parent-reported orofacial symptoms in the Danish version of the patient questionnaire Assessment of Orofacial Symptoms in Juvenile Idiopathic Arthritis. METHOD:This cross-sectional study was conducted at Aarhus University in March 2023. Eligible candidates were consecutive subjects with juvenile idiopathic arthritis (JIA) and temporomandibular joint involvement accompanied by a parental proxy for examination in the Craniofacial Clinic. After obtaining written informed consent, the questionnaire was completed individually and separately by the child and the parent without any communication between them. The level of agreement was analysed using Cohen's (weighted) kappa for nominal and ordinal outcome variables (orofacial pain frequency, pain location, jaw function, orofacial symptoms, and changes since last visit) and the intraclass correlation coefficient for linear outcome variables (orofacial pain intensity and functional disability of the jaw). RESULTS:The 34 included dyads had an overall 'poor' to 'moderate' child-proxy reporting agreement on the questionnaire for the assessment of JIA-related orofacial symptoms. After dividing the children into two age groups, < 13 and ≥ 13 years old, we found substantial agreement on pain frequency and moderate to excellent agreement on pain intensity for the older group. The child-proxy agreement for children aged < 13 years was slight on pain frequency and poor to moderate on pain intensity. CONCLUSION:The child-proxy reporting agreement on JIA-related orofacial symptoms is inconsistent. We suggest collecting information from both children and parents, especially when assessing orofacial pain and symptoms in children < 13 years of age.

Safe delivery of care is a priority in dentistry, while basic epidemiological knowledge of patient safety incidents is still lacking. The objectives of this study were to (1) classify patient safety incidents related to primary dental care in Denmark in the period 2016–2020 and study the distribution of different types of dental treatment categories where harm occurred, (2) clarify treatment categories leading to "nerve injury" and "tooth loss" and (3) assess the financial cost of patient-harm claims. Data from the Danish Dental Compensation Act (DDCA) database was retrieved from all filed cases from 1st January 2016 until 31st December 2020 pertaining to: (1) The reason why the patient applied for treatment-related harm compensation, (2) the event that led to the alleged harm (treatment category), (3) the type of patient-harm, and (4) the financial cost of all harm compensations. A total of 9069 claims were retrieved, of which 5079 (56%) were found eligible for compensation. The three most frequent categories leading to compensation were "Root canal treatment and post preparation"(n = 2461, 48% of all approved claims), “lack of timely diagnosis and initiation of treatment” (n = 905, 18%) and “surgery” (n = 878, 17%). Damage to the root of the tooth accounted for more than half of all approved claims (54.36%), which was most frequently a result of either parietal perforation during endodontic treatment (18.54%) or instrument fracture (18.89%). Nerve injury accounted for 16.81% of the approved claims. Total cost of all compensation payments was €16,309,310, 41.1% of which was related to surgery (€6,707,430) and 20.4% (€3,322,927) to endodontic treatment. This comprehensive analysis documents that harm permeates all aspects of dentistry, especially in endodontics and surgery. Neglect or diagnostic delays contribute to 18% of claims, indicating that harm does not solely result from direct treatment. Treatment harm inflicts considerable societal costs.

Knowledge about patient safety in orthodontics is scarce. Lack of standardisation and a common terminology hinders research and limits our understanding of the discipline. This study aims to 1) summarise current knowledge about patient safety incidents (PSI) in orthodontic care by conducting a systematic literature search, 2) propose a new standardisation of PSI terminology and 3) propose a future research agenda on patient safety in the field of orthodontics. A systematic literature search was performed in the main online sources of PubMed, Web of Science, Scopus and OpenGrey from their inception to 1 July 2023. Inclusion criteria were based on the World Health Organization´s (WHO) research cycle on patient safety. Studies providing information about the cycle’s steps related to orthodontics were included. Study selection and data extraction were performed by two of the authors. A total of 3,923 articles were retrieved. After review of titles and abstracts, 41 articles were selected for full-text review and 25 articles were eligible for inclusion. Seven provided information on the WHO’s research cycle step 1 (“measuring harm”), twenty-one on “understanding causes” (step 2) and twelve on “identifying solutions” (step 3). No study provided information on Steps 4 and 5 (“evaluating impact” or “translating evidence into safer care”). Current evidence on patient safety in orthodontics is scarce due to a lack of standardised reporting and probably also under-reporting of PSIs. Current literature on orthodontic patient safety deals primarily with “measuring harms” and “understanding causes of patient safety”, whereas less attention has been devoted to initiatives “identifying solutions”, “evaluating impact” and “translating evidence into safer care”. The present project holds a proposal for a new categorisation, terminology and future research agenda that may serve as a framework to support future research and clinical initiatives to improve patient safety in orthodontic care. PROSPERO (CRD42022371982).

Aim To evaluate the impact of cone beam computed tomography (CBCT) on treatment planning for impacted maxillary canines; secondly, to identify CBCT factors influencing a change in the treatment plan; and thirdly, to assess 2D radiographic factors that can aid in selecting appropriate candidates for CBCT.Material and methods Patients with impacted maxillary canines and an overlap of a neighboring tooth in 2D radiographs and the suspicion of root resorption were referred for CBCT examination. An initial treatment plan was based on 2D radiographs, and the final treatment plan was established after the CBCT examination. Logistic regression analyses and t-tests were performed to evaluate differences in radiographic findings between the groups with and without a change in treatment plan.Results The study prospectively included 125 impacted canines, and 43 (34.4%) of them had a change in treatment plan after the CBCT examination. The most common change was a modification in the direction of cantilever traction (n = 28; 22.4%), while the least common was the change in decision to remove/keep the canine (n = 4; 3.2%). The size of the alpha and lateral angles had a significant impact on the decision to change the treatment plan. Other radiographic findings did not influence a change in treatment plan.Conclusions One-third of the canines had a change in treatment plan after supplemental CBCT examination. Canines with large alpha and lateral angles measured in the panoramic image were found to be significantly more likely to undergo changes in the initial direction of cantilever traction or changes to the canine extraction strategy following CBCT examination.

BACKGROUND:Magnetic resonance imaging (MRI) is a non-ionizing imaging technique. Using MRI in dentistry may potentially lower the general radiation dose of the examined population, provided MRI can replace various radiation-based images. Furthermore, novel MRI imaging modalities for three-dimensional and two-dimensional cephalometrics have recently been developed for orthodontic diagnosis. OBJECTIVES:This systematic review aimed to determine the diagnostic accuracy and reliability of MRI in orthodontic diagnosis and treatment planning. SEARCH METHODS:An electronic search was conducted on 20 November 2022 in the following databases: PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane. The search was updated on 30 August 2023. Furthermore, a grey literature search was performed in Google Scholar and Open-Grey. SELECTION CRITERIA:This review included descriptive, observational, cohort studies, cross-sectional, case-control studies, and randomized/non-randomized trials related to the research question. The study excluded studies related to patients with syndromes, chronic diseases, craniofacial anomalies, or bone diseases. DATA COLLECTION AND ANALYSIS:The included studies were quality assessed using the "Joanna Brigg's Critical Appraisal Tool for diagnostic test accuracy". The GRADE approach for non-randomized studies was used for strength-of-evidence analysis. RESULTS:Eight of the 10 included studies compared MRI with either cone beam computed tomography or lateral cephalogram and found a high intra- and inter-rater agreement for landmark identification. The risk of bias was high in four studies, moderate in three, and low in three studies. Homogeneity was lacking among the included studies in terms of MRI imaging parameters and sample characteristics. This should be taken into consideration by future studies where uniformity with respect to these parameters may be considered. CONCLUSIONS:Despite dissimilarity and heterogeneity in the sample population and other methodological aspects, all the included studies concluded that MRI enjoyed considerable intra- and inter-examiner reliability and was comparable to current diagnostic standards in orthodontics. Furthermore, the studies agreed on the innovative potential of MRI in radiation-free diagnosis and treatment planning in orthodontics in the future. REGISTRATION:CRD number: CRD420223XXXXX.

The aim of the study was to evaluate the effectiveness of a novel e-learning module in teaching the physical exam of the temporomandibular joint (TMJ) in Juvenile idiopathic arthritis (JIA.). An e-learning module was developed to convey the TMJ physical examination maneuvers that are considered to be best practice in JIA. Pediatric rheumatology fellows were randomized to two groups. One group received an article describing the physical examination skills while the second group received both the article and module. All participants completed a written pre-test, an in-person objective structured clinical examination (OSCE), a written post-test, and a follow-up survey. Twenty-two pediatric rheumatology fellows enrolled, with 11 per group. Written test: The two groups improved equally, although there was a trend toward improved defining of maximal incisal opening (MIO) in the module group. OSCE: The mean OSCE score was 11.1 (SD 3.3) in the article group and 13.5 (SD 1.9) in the module group (p = 0.06); significant differences were seen in measuring MIO (p = 0.01), calculating maximal unassisted mouth opening (MUMO; p = 0.01), and assessment of facial symmetry (p = 0.03), all favoring the module. Enjoyment scores in the module group were higher than in the article group (mean 7.7/10 vs. 5.9/10, p = 0.02). The two groups self-reported performing TMJ examinations at comparable rates three months following the intervention. The study demonstrated that a formalized educational program improved knowledge of the physical exam of the TMJ in JIA. Learners viewing the module were more adept at obtaining quantitative TMJ measurements.