Preliminary study: Evaluating the reliability of cone-beam computed tomography images for upper airway volume in orthodontics Ivan A. Halim, Mohammad Zeinalddin, Himawan Halim, Krisna Fery Rahmantya, Ani Melani Maskoen, Ganesha Wandawa, Endah Mardiati Apos Trends in Orthodontics, 2025 Objectives: The primary aim of this study was to evaluate the reliability of cone-beam computed tomography (CBCT) in measuring upper airway volume in orthodontics. The secondary aim was to compare the upper airway volumes between laypeople and military personnel (physically fit individuals). Material and Methods: This study included 36 male participants aged 21–29 years who had no upper airway pathology or history of upper airway surgery. CBCT scans had been previously obtained as part of routine dental checkups using a standardized protocol by the same operator. The digital imaging and communications in the medicine files of the subjects were imported into the 3D analysis software SimPlant® 17 Pro (Materialize Dental, Leuven, Belgium) to facilitate the measurement of upper airway volume. The upper airway volume was divided into three sections and measured on days 0 and 14 by the same operator. The intrarater intra-class correlation coefficient (ICC) and Bland-Altman plot were used to assess reliability. The upper airway volumes of the laypeople and military personnel were compared using Tukey’s pairwise test. Results: The variables demonstrated excellent reliability across all sections of the upper airway; the Superior part of the upper airway has an ICC of 0.993, the middle part of the upper airway has an ICC of 0.995, and the inferior part of the upper airway has an ICC of 0.989. The ICC for the entire upper airway was 0.987. The intrarater plot for superior airway measurement showed that 8 out of 8 measurements (100%) fell within the limits of agreement. Similarly, the intrarater plot for the middle airway measurements indicated that 8 out of 8 measurements (100%) fell within the limits of agreement. For inferior airway measurement, the intrarater plot revealed that 7 out of 8 measurements (87.5%) fell within the limits of agreement. No significant differences were found between the upper airway volumes of the laypeople and military personnel. Conclusion: Preliminary evidence suggests that CBCT using a standardized protocol is reliable for measuring upper airway volume. Separating the upper airway into three different parts also demonstrated high reliability and reproducibility among the raters. The ability to accurately measure the upper airway enhances the evaluation of the effects of orthodontic treatment by comparing the pre-and post-upper airway volume.
Management of Unilateral Impacted Maxillary Permanent Canine: A Case Report Himawan Halim, Ivan A. Halim Open Dentistry Journal, 2024 Introduction The management of maxillary canine is very complex because it must be carefully planned and carried out as a team. The handling of impacted canine cases must be seen from a clinical and radiological point of view. Maxillary canine impaction can be caused by a lack of space or inadequate seed placement. The time to treat canine impaction is usually between the ages of 11 and 14. Objective The aim of this case report was to describe the management of an impacted maxillary left canine of a teenage girl. Successful treatment requires complete diagnostics, such as radiographs, good teamwork, and precise treatment planning of the dental team. Case Report An 11-year-old female patient with class I molar relationship, bimaxillary protrusive, and impacted left upper canine visited the clinic for orthodontic treatment. Extraction of four first premolars (bicuspids) was carried out, and exposure by the periodontist was completed on the maxillary left canine for the installation of a traction device (gold chain traction). Conclusion The appropriate timing, treatment plan, and proper surgical exposure preparation in handling this case produced optimal and ideal results.
The Differences Pattern of Tooth Agenesis in Non syndromic Cleft Lip and Palate among Male and Female Patients Journal of International Dental and Medical Research, 2024
Correlation of Upper Airway Volume Assessed by Cone-beam Computed Tomography with Salivary Cortisol and Salivary α-Amylase Ivan A. Halim, Mohammad Zeinalddin, Himawan Halim, Oryce Zahara, Shinta Wijayanti, Ani Melani Maskoen, Ganesha Wandawa, Endah Mardiati Open Dentistry Journal, 2024 Background The Indonesian National Armed Forces have the largest military personnel in Southeast Asia. Physical fitness is important for the overall health of these personnel. Cone-Beam Computed Tomography (CBCT) enables clinicians to accurately evaluate the upper airway volume. Objective This study aimed to investigate the correlation between the upper airway volume and salivary biomarkers, namely cortisol and salivary α-amylase (sAA), to introduce novel findings and aid the National Armed Forces in evaluating military personnel during recruitment and annual checkups. Methods This observational study included 30 Indonesian male marines aged 21–29 years. CBCT scans were previously performed using a standardized protocol. Head orientation was analyzed using Frankfort's horizontal, midsagittal, and transporionic planes. Participants were randomly assigned to three exercise intensity groups: Group 1 (intense exercise group) had to run for 12 min and do pull-ups, sit-ups, and push-ups (1 min each); group 2 (moderate exercise group) had to run for 12 min and do pull-ups and sit-ups (1 min each); and group 3 (mild exercise group) had to run for 12 min and do pull-ups (1 min). Saliva samples were collected pre- and post-exercise, with sAA levels analyzed via enzyme-linked immunosorbent assay and cortisol levels analyzed using reversed-phase chromatography. Results The correlation between upper airway volume and cortisol was very weak in groups 1 (r=0.066) and 3 (r=0.168) and moderate in group 2 (r=0.680). The correlation between upper airway volume and sAA was moderate in group 1 (r=0.452), weak in group 2 (r=0.232), and moderately negative in group 3 (r=-0.607). Conclusion There is no clear correlation between upper airway volume and salivary biomarkers, including cortisol or sAA. Upper airway volume is the only factor that determines physical fitness. Overall dynamics, including airway pressure, velocity, aerodynamic forces, and flow resistance, must also be evaluated in future studies.
Management of Impacted Mandibular Second Molar: A Case Report Himawan Halim, Ivan A. Halim Open Dentistry Journal, 2023 Introduction: In rare cases, impacted second molars may create additional problems for orthodontic treatment. Both parents and the orthodontist should be aware of this problem early to prevent further complications. Good teamwork between the orthodontist and oral maxillofacial surgeon is needed in handling these cases, especially if it involves removing the impacted second molar. The right time to treat an impacted second molar is between the age of 11 to 14 years old. An impacted second molar can lead to a lack of arch length in the patient. Objective: The case report described the management of a female patient with a treated left-and-right impacted second molar in the mandible. The chief complaint of the patient was a protrusive mouth and having two impacted second molars, as told by her general dentist. Case Report: A 15-years-old female patient with Class I molar relationship, bilateral second molar impaction, and bimaxillary protrusion visited the clinic for orthodontic treatment. Extraction of four first premolar and mandibular second molar was completed. Both mandibular third molars were moved anteriorly to help close the space. Conclusion: Good cooperation from various disciplines and treatment planning to resolve the case can produce excellent and ideal results.
Profile Changes in Class III Malocclusion using Protraction Facemask in Indonesian Young Patients (Cephalometric Study) Himawan Halim, Ivan A. Halim Open Dentistry Journal, 2023 Background: The prevalence of Class III malocclusion is highest in Southeast Asia. In countries such as Malaysia and Indonesia, the prevalence is as high as 15.80%. Treatment timing and options are very important in treating Class III malocclusion. A protraction facemask or also known as reverse headgear is one of the most used appliances as an interceptive tool for Class III malocclusion in young patients. Objectives: This study aims to evaluate the profile changes in treating Indonesian young patients using a protraction facemask. Methods: The sample consisted of 63 subjects, 25 males and 38 females. Lateral cephalograms were traced and analyzed using CephaloMetrics AtoZ™ ver. 12 (Yasunaga Computer Systems, Co. Inc., Hanando-Minami, Fukui, Japan). A total of 16 traditional cephalometric measurements (13 skeletal measurements and 3 dental measurements) were used to describe changes between pretreatment and posttreatment cephalograms. All recorded data were analyzed using IBM SPSS version 21 (IBM Corporation, Armonk, New York, USA). Results: SNA (p˂0.030), ANB (p=0.000), and Wits appraisal values (p=0.000) showed significant differences out of all measurements. FMA and occlusal plane also showed changes and indicated that a facemask is helpful with treatment. Conclusion: Timing, duration, and patient compliance are very important in the management of Class III skeletal malocclusion using a protraction facemask. The use of facemask therapy among Indonesian pediatric patients resulted in an anterior and downward movement of the maxilla, backward rotation of the mandible, and a better orthopedic response.
The application of pendulum as a space regainer in orthodontic treatment Himawan Halim Open Dentistry Journal, 2021 Background: The process of distalization in orthodontic treatment is often very difficult. The most common method is the use of cervical headgear. However, due to poor patient compliance, it leads to poor treatment outcomes. Treatment alternatives that require minimal compliance include Jones jig, magnets, and pendulum. Objective: This study aimed to perform distalization of a maxillary molars on a bilateral Class II molar relationship patient with a crowded maxillary arch. Case Report: A 10-year-old female with a Class II molar relationship, bilateral posterior crossbite, and nonerupted upper canines was treated with a rapid palatal expander (RPE), pendulum appliance, and fixed appliance. The crowding in the maxillary arch and spacing in the mandibular arch were eliminated, and transverse discrepancies were corrected. Conclusion: Pendulum appliance is very effective in creating spaces for the eruption of canines and ectopic premolars. Pendulum appliances have been introduced for a long time and have proven successful for molar distalization and space regainer and require minimal patient cooperation. Like other distalization appliances, distal tipping of the molars and mesial movement of the premolars could be observed.
Determination of pubertal growth plot using hand-wrist and cervical vertebrae maturation indices, dental calcification, peak height velocity, and menarche Endah Mardiati, Ira Komara, Himawan Halim, Ani Melani Maskoen Open Dentistry Journal, 2021 Introduction: Pubertal growth stages are important periods in orthodontic treatment with functional appliances and orthognathic surgery. Pubertal growth prediction, which determines the amount of growth that has taken place and estimates the remaining growth, can influence diagnosis, treatment goals, treatment plans, and orthodontic treatment outcomes, especially in cases requiring growth intensity or growth completion. Determination of pubertal growth stages is more accurate when performed using physiological maturation indicators than chronological age. There are several maturation indices that can be used to predict the pubertal growth stage, such as hand-wrist maturation, cervical vertebrae maturation index (CVMS), dental calcification, peak height velocity of body height (PHV), and menarche in females. The aim of this study was to identify the differences and correlation between hand-wrist, CVMS maturation stages, peak height velocity (PHV), canine and M2 calcification stages, and menarche age (of female subjects). The study also aimed to describe the pubertal growth curve plot of female and male subjects. Materials and Methods: This is a retrospective study with a cross-sectional approach, which included 279 females and 144 males aged 8-17 years. Subjects had digital lateral cephalograms, hand-wrist, and panoramic radiographs. The hand-wrist maturation stage was analyzed using the Fishman method, CVMS using Baccetti et al.’s method, and the stages of dental maturation were assessed using Demirjian and Goldstein method. PHV was measured from standing height using a wall-mounted plastic stadiometer, while menarche was analyzed through interviews. Statistical analysis by ANOVA, post hoc analysis, and Spearman’s rank correlation coefficient were determined with Excel Mega Stat. Results: There were significant differences between females and males in CVMS and hand-wrist (P< 0.05) except for radius union (Ru). No significant differences in canine and M2 calcification between females and males were observed. PHV females increased by 7.89 cm at 11-12 years, while males increased by 9.9 cm at 13-14 years. Menarche occurred at the age of 12.2 years on average, with the oldest being 14.7 years and the youngest being 9.6 years. The correlation between females’ and males’ hand-wrist and CVMS was very high. The lowest correlation in females was between menarche and CVMS and in males, it was between PHV and canine. Conclusion: Maturation stages of hand-wrist, CVMS, and PHV females were earlier than males. Pubertal growth curves plot of females tended to skew to the left, demonstrating that the time from the beginning to the peak of pubertal growth is shorter than that from the peak to the end of pubertal growth, while pubertal growth curves plot of males tended to skew to the right, demonstrating that the time from the beginning to the peak of pubertal growth is longer than that from the peak to the end of pubertal growth.
Sensitivity and specificity of mandibular third molar calcification at chronological age and hand wrist maturation stage to discriminate between female and male at pubertal growth period Endah Mardiati, Ira Komara, Himawan Halim, Dikdik Kurnia, Ani Melani Maskoen Open Dentistry Journal, 2021 Background: The mandibular third molar is the last tooth that is not completely developed by the time pubertal growth has been finished. Maturation of the mandibular third molar is one of the physiological maturation indicators that can be used to determine the stage of pubertal growth. Objective: The aim of the study was to determine the sensitivity and specificity of mandibular third molar calcification at chronological age and hand wrist maturation stage to discriminate between female and male at pubertal growth period. Methods: It is a retrospective study with a cross-sectional approach using panoramic and hand-wrist digital radiographs of 279 females and 144 males, age 8-17 years, with a total of 423 panoramic radiographs and 423 hand-wrist radiographs. Statistical analysis was performed using Excel Mega Stat. ANOVA to analyze the differences between mandibular third molar calcification at chronological age and hand-wrist maturation stage, and t-test was used to analyze the differences between females and males. Spearman rank correlation was used for the analysis of the correlation between mandibular third molar calcification with chronological age and hand-wrist maturation stage; sensitivity and specificity were used to discriminate the pubertal growth period between mandibular third molar calcification and hand-wrist maturation stage. Results: There were significant differences found in mandibular third molar crown maturation stage B and C, but no significant difference was observed between mandibular third molar stage A, D, E, F, G and H, between females and males. The highest percentage of mandibular third molar crown formation in females was observed at stage D (6.68%) at MP3u, and in males, it was observed at stage D (8.83%) at SMI-4. The highest percentage of root formation in females was stage E (8.24%) at the SMI-10 stage, and males stage F (4.86%) at MP3u. The correlation was observed between mandibular third molar calcification with hand-wrist, females 0.22 and males 0.43, and chronological age 0.60 for females and 0.69 for males. The highest sensitivity of mandibular third molar calcification of 97.0% was observed in female at SMI-4 of hand-wrist maturation with specificity of 100%, while in male, a sensitivity of 94.5% was observed at SMI-2 stage with a specificity of 99.99%. Conclusion: There were significant differences found in mandibular third molar calcification between females and males except for stage B and stage C; weak correlation was observed between mandibular third molar calcification and hand-wrist, and moderate correlation was observed with chronological age. The sensitivity and specificity in females and males indicate that mandibular third molar calcification is only useful for diagnosing the pre-pubertal growth phase.
