{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T04:29:29Z","timestamp":1789878569181,"version":"4.0.1"},"reference-count":57,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,12,6]],"date-time":"2020-12-06T00:00:00Z","timestamp":1607212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2019s Horizon 2020 research and innovation programme","award":["857287"],"award-info":[{"award-number":["857287"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: The need to evaluate the condylar remodeling after orthognathic surgery, using three-dimensional (3D) images and volume rendering techniques in skeletal Class III patients has been emphasized. The study examined condylar positional, structural, and volumetric changes after bimaxillary or single-jaw maxillary orthognathic surgeries in skeletal Class III patients using the cone-beam computed tomography. Materials and Methods: Presurgical, postsurgical, and one-year post-surgical full field of view (FOV) cone-beam computed tomography (CBCT) images of 44 patients with skeletal Class III deformities were obtained. Group 1 underwent a bimaxillary surgery (28 patients: 24 females and 4 males), with mean age at the time of surgery being 23.8 \u00b1 6.0 years, and Group 2 underwent maxillary single-jaw surgery (16 patients: 8 females and 8 males), with mean age at the time of surgery being 23.7 \u00b1 5.1 years. After the orthognathic surgery, the CBCT images of 88 condyles were evaluated to assess their displacement and radiological signs of bone degeneration. Three-dimensional (3D) condylar models were constructed and superimposed pre- and postoperatively to compare changes in condylar volume. Results: Condylar position was found to be immediately altered after surgery in the maxillary single-jaw surgery group, but at the one-year follow-up, the condyles returned to their pre-surgical position. There was no significant difference in condylar position when comparing between pre-surgery and one-year follow-up in any of the study groups. Condylar rotations in the axial and coronal planes were significant in the bimaxillary surgery group. No radiological signs of condylar bone degeneration were detected one year after the surgery. Changes in condylar volume after surgery were found to be insignificant in both study groups. Conclusions: At one year after orthognathic surgery, there were no significant changes in positional, structural, or volumetric statuses of condyles.<\/jats:p>","DOI":"10.3390\/medicina56120672","type":"journal-article","created":{"date-parts":[[2020,12,6]],"date-time":"2020-12-06T22:27:12Z","timestamp":1607293632000},"page":"672","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Evaluation of Condylar Positional, Structural, and Volumetric Status in Class III Orthognathic Surgery Patients"],"prefix":"10.3390","volume":"56","author":[{"given":"Jevgenija","family":"Pod\u010dernina","sequence":"first","affiliation":[{"name":"Department of Orthodontics, R\u012bga Stradi\u0146\u0161 University, Dzirciema str. 20, LV-1007 R\u012bga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilga","family":"Urt\u0101ne","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, R\u012bga Stradi\u0146\u0161 University, Dzirciema str. 20, LV-1007 R\u012bga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pertti","family":"Pirttiniemi","sequence":"additional","affiliation":[{"name":"Department of Oral Development and Orthodontics, University of Oulu, 90014 Oulu, Finland"},{"name":"Medical Research Center (MRC), Oulu University Hospital, 90014 Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0122irts","family":"\u0160alms","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, R\u012bga Stardi\u0146\u0161 University, Dzirciema str. 20, LV-1007 R\u012bga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2443-9582","authenticated-orcid":false,"given":"Oskars","family":"Radzi\u0146\u0161","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, R\u012bga Stradi\u0146\u0161 University, Dzirciema str. 20, LV-1007 R\u012bga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Aleksej\u016bnien\u0117","sequence":"additional","affiliation":[{"name":"Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC V6T1Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,6]]},"reference":[{"key":"ref_1","first-page":"173","article-title":"Prevalence and treatment of dentofacial deformities on a multiethnic population: A retrospective study","volume":"18","author":"Sato","year":"2014","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"269","DOI":"10.2319\/043016-349.1","article-title":"Modern trends in Class III orthognathic treatment: A time series analysis","volume":"87","author":"Lee","year":"2017","journal-title":"Angle Orthod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.ajodo.2015.05.021","article-title":"Satisfaction with orthognathic surgery of skeletal Class III patients","volume":"148","author":"Asada","year":"2015","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ijsu.2016.12.033","article-title":"Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis","volume":"38","author":"He","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.ajodo.2004.06.003","article-title":"Stability and predictability of orthognathic surgery","volume":"126","author":"Bailey","year":"2004","journal-title":"Adv. Orthod. Dentofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1746-160X-3-21","article-title":"The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: An update and extension","volume":"3","author":"Proffit","year":"2007","journal-title":"Head Face Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/S0266-4356(02)00147-X","article-title":"Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy","volume":"40","author":"Reyneke","year":"2002","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.joms.2005.10.064","article-title":"Intraoperative Awakening of the Patient During Orthognathic Surgery: A Method to Prevent the Condylar Sag","volume":"65","author":"Politi","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jcms.2020.07.017","article-title":"The relationship between fixation method and early central condylar sagging after bilateral sagittal split ramus osteotomy in orthognathic surgery","volume":"48","author":"Karaali","year":"2020","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.joms.2003.04.010","article-title":"Stability of Skeletal Class III Malocclusion after Combined Maxillary and Mandibular Procedures: Rigid Internal Fixation Versus Wire Osteosynthesis of the Mandible","volume":"62","author":"Politi","year":"2004","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1016\/j.joms.2007.02.005","article-title":"A Method to Passively Align the Sagittal Ramus Osteotomy Segments","volume":"65","author":"Ellis","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1016\/j.joms.2009.12.015","article-title":"Postoperative condylar position by sagittal split ramus osteotomy with and without bone graft","volume":"68","author":"Kang","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1016\/j.joms.2008.01.046","article-title":"Stability After Bilateral Sagittal Split Osteotomy Setback Surgery With Rigid Internal Fixation: A Systematic Review","volume":"66","author":"Joss","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1080\/08869634.1988.11678253","article-title":"TMJ complications associated with superior repositioning of the maxilla","volume":"6","author":"Kahnberg","year":"1988","journal-title":"Cranio"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/0278-2391(90)90051-3","article-title":"Condylar position in superior maxillary repositioning and its effect on the temporomandibular joint","volume":"48","author":"Herbosa","year":"1990","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S1010-5182(97)80005-4","article-title":"Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: A magnetic resonance imaging and computed tomography prospective study","volume":"25","year":"1997","journal-title":"J. Cranio-Maxillofac.-Facial Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/ejo\/14.1.3","article-title":"Tomographic assessment of alterations of the temporomandibular joint after orthognathic surgery","volume":"14","author":"Mavreas","year":"1992","journal-title":"Eur. J. Orthod."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.joms.2005.10.057","article-title":"Radiographic Assessment of the Condylar Position After Le Fort I Osteotomy in Patients With Asymptomatic Temporomandibular Joints: A Prospective Study","volume":"65","author":"Cortez","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.ajodo.2005.03.029","article-title":"Three-dimensional cone-beam computed tomography for assessment of mandibular changes after orthognathic surgery","volume":"131","author":"Cevidanes","year":"2007","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0889-5406(96)70099-9","article-title":"Progressive mandibular retrusion-idiopathic condylar resorption. Part II","volume":"110","author":"Arnett","year":"1996","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0901-5027(98)80301-9","article-title":"Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite: A clinical and radiological study","volume":"27","author":"Hoppenreijs","year":"1998","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1177\/10454411950060030601","article-title":"Pathogenesis of degenerative joint disease in the human temporomandibular joint","volume":"6","author":"Haskin","year":"1995","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_23","first-page":"168","article-title":"Degenerative disease of the temporomandibular joint","volume":"9","author":"Kamelchuk","year":"1995","journal-title":"J. Orofac. Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10266-005-0056-7","article-title":"Pathogenesis of degenerative temporomandibular joint arthritides","volume":"93","author":"Milam","year":"2005","journal-title":"Odontol."},{"key":"ref_25","unstructured":"McNamara, J.A., Kapila, S.D., and VanRiper, K.Y. (2009). CBCT (3D imaging): Application for selected articular disorders and associated facial growth. Temporomandibular Disorders and Orofacial Pain: Separating Controversy from Consensus, Needham Press."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.tripleo.2009.02.023","article-title":"Research diagnostic criteria for temporomandibular disorders (RDC\/TMD): Development of image analysis criteria and examiner reliability for image analysis","volume":"107","author":"Ahmad","year":"2009","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.ijom.2018.06.008","article-title":"Condylar changes after orthognathic surgery for class III dentofacial deformity: A systematic review","volume":"48","author":"Vandeput","year":"2019","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1259\/dmfr\/17102411","article-title":"Superimposition of 3D cone-beam CT models of orthognathic surgery patients","volume":"34","author":"Cevidanes","year":"2005","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1053\/j.sodo.2010.08.011","article-title":"Advanced Applications of Cone Beam Computed Tomography in Orthodontics","volume":"17","author":"Mah","year":"2011","journal-title":"Semin. Orthod."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Schilling, J., Gomes, L.C.R., Benavides, E., Nguyen, T., Paniagua, B., Styner, M., Boen, V., Gon\u00e7alves, J.R., and Cevidanes, L.H.S. (2014). Regional 3D superimposition to assess temporomandibular joint condylar morphology. Dentomaxillofacial Radiol., 43.","DOI":"10.1259\/dmfr.20130273"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kapila, S.D., and Nervina, J.M. (2015). CBCT in orthodontics: Assessment of treatment outcomes and indications for its use. Dentomaxillofacial Radiol., 44.","DOI":"10.1259\/dmfr.20140282"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1016\/j.ejrad.2011.04.070","article-title":"Volumetric analysis of the mandibular condyle using cone beam computed tomography","volume":"81","author":"Bayram","year":"2012","journal-title":"Eur. J. Radiol."},{"key":"ref_33","first-page":"1","article-title":"Accuracy and Reliability of Cone-Beam Computed Tomography for Linear and Volumetric Mandibular Condyle Measurements. A Human Cadaver Study","volume":"7","author":"Guarinos","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1259\/dmfr\/25500850","article-title":"Analysis of the accuracy of linear measurements obtained by cone beam computed tomography (CBCT-NewTom)","volume":"33","author":"Lascala","year":"2004","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.ajodo.2005.08.034","article-title":"Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography","volume":"128","author":"Hilgers","year":"2005","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"17.e1","DOI":"10.1016\/j.ajodo.2008.08.021","article-title":"Accuracy and reliability of linear cephalometric measurements from cone-beam computed tomography scans of a dry human skull","volume":"136","author":"Berco","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1259\/dmfr\/27403192","article-title":"Radiographic examination of the temporomandibular joint using cone beam computed tomography","volume":"33","author":"Tsiklakis","year":"2004","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/0889-5406(87)90447-1","article-title":"Relationship of mandibular condylar position to dental occlusion factors in an asymptomatic population","volume":"91","author":"Pullinger","year":"1987","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3D Slicer as an image computing platform for the Quantitative Imaging Network","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn. Reson. Imaging"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Jolesz, F. (2014). 3D Slicer: A Platform for Subject-Specific Image Analysis, Visualization, and Clinical Support. Intraoperative Imaging and Image-Guided Therapy, Springer.","DOI":"10.1007\/978-1-4614-7657-3"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.oooo.2011.12.026","article-title":"A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: A review","volume":"114","author":"Ueki","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"316","DOI":"10.2319\/052113-387.1","article-title":"Effect of post-orthognathic surgery condylar axis changes on condylar morphology as determined by 3-dimensional surface reconstruction","volume":"84","author":"An","year":"2014","journal-title":"Angle Orthod."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.joms.2011.08.028","article-title":"Do patients treated with bimaxillary surgery have more stable condylar positions than those who have undergone single-jaw surgery?","volume":"70","author":"Kim","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.tripleo.2010.08.001","article-title":"Cone-beam computerized tomography evaluation of condylar changes and stability following two-jaw surgery: Le Fort I osteotomy and mandibular setback surgery with rigid fixation","volume":"111","author":"Kim","year":"2011","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1016\/j.jcms.2017.09.018","article-title":"Comparison of temporomandibular joint and ramus morphology between class II and class III cases before and after bi-maxillary osteotomy","volume":"45","author":"Iguchi","year":"2017","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.jcms.2014.05.001","article-title":"A CBCT study on positional change in mandibular condyle according to metallic anchorage methods in skeletal class III patients after orthognatic surgery","volume":"42","author":"Choi","year":"2014","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Choi, B.-J., Kim, B.-S., Lim, J.-M., Jung, J., Lee, J.-W., and Ohe, J.-Y. (2018). Positional change in mandibular condyle in facial asymmetric patients after orthognathic surgery: Cone-beam computed tomography study. Maxillofac. Plast. Reconstr. Surg., 40.","DOI":"10.1186\/s40902-018-0152-6"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-019-38786-2","article-title":"Changes of temporomandibular joint position after surgery first orthognathic treatment concept","volume":"9","author":"Holzinger","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.jcms.2015.05.007","article-title":"Changes in computed tomography values of mandibular condyle and temporomandibular joint disc position after sagittal split ramus osteotomy","volume":"43","author":"Ueki","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1016\/j.jcms.2015.08.004","article-title":"Three-dimensional analysis of postoperative returning movement of perioperative condylar displacement after bilateral sagittal split ramus osteotomy for mandibular setback with different fixation methods","volume":"43","author":"Han","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.jcms.2018.02.001","article-title":"Time-course change in temporomandibular joint space after advancement and setback mandibular osteotomy with Le Fort I osteotomy","volume":"46","author":"Ueki","year":"2018","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s10006-017-0612-7","article-title":"Condylar surface CT value in sagittal plane before and after sagittal split ramus osteotomy","volume":"21","author":"Ueki","year":"2017","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1093\/ejo\/cjn008","article-title":"Stability of hard tissue profile after mandibular setback in sagittal split osteotomies: A longitudinal and long-term follow-up study","volume":"30","author":"Joss","year":"2008","journal-title":"Eur. J. Orthod."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.ijom.2012.03.006","article-title":"The prevalence of TMJ osteoarthritis in asymptomatic patients with dentofacial deformities: A cone-beam CT study","volume":"41","author":"Krisjane","year":"2012","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1067\/moe.2001.112153","article-title":"Condylar bony change, disk displacement, and signs and symptoms of TMJ disorders in orthognathic surgery patients","volume":"91","author":"Yamada","year":"2001","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.jcms.2015.02.006","article-title":"3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies","volume":"43","author":"Xi","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13005-019-0202-z","article-title":"Comparison of condylar morphology changes and position stability following unilateral and bilateral sagittal split mandibular ramus osteotomy in patients with mandibular prognathism","volume":"15","author":"Lin","year":"2019","journal-title":"Head Face Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/56\/12\/672\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:41:36Z","timestamp":1760179296000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/56\/12\/672"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,6]]},"references-count":57,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["medicina56120672"],"URL":"https:\/\/doi.org\/10.3390\/medicina56120672","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,6]]}}}