Exploring digital filters for internal root resorption : how can we improve the diagnosis of small lesions?

Objectives: This study aimed to evaluate the impact of enhancement filters in detecting small simulated internal root resorptions (IRR). Methods: Forty-two extracted human teeth were sectioned, connected, and stored in a dry human jaw and X-rayed with photostimulable phosphor plates (PSPs), composing the control group (CG). In the middle-third of the root canals, IRR lesions were simulated using Da Silveira protocol. Later, the specimens were X-rayed to create the test group (TG). All images acquired were exported with seven enhancement filters plus the original image. Three examiners used a five-point Likert scale to evaluate the images regarding the presence/absence of IRR. Diagnostic efficacy was assessed from sensitivity and specificity results. Comparison among filters was performed by using receiver operating characteristic (ROC) curve analysis. Results: Moderate values of Kappa interexaminer (0.403–0.620) and high values of Kappa intraexaminer (0.757–0.915) were observed. The best performance occurred in the CG (p < 0.05). Original images presented the greatest sensitivity and area under the ROC curve (0.595–0.750), while the Endo filter presented the greatest specificity (0.952). Inversion and Pseudo-3D images produced the greatest doubt in the diagnosis, significant for CG with the Pseudo-3D filter (p < 0.05). Conclusions: The Original and ‘Endo’ filters should be chosen as it offers greater diagnostic ability and allows more confidence during the evaluation

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

Bone mineral density of the mandible as predictor of osteoporosis among Malays

Relationship between craniofacial bone strength and other skeletal bone associated with osteoporosis were studied by measuring bone mineral density (BMD). The aim of this study is to compare and correlate the bone density of the mandible and other skeletal bone using Dual Energy X-ray Absorptiometry (DXA) and Cone Beam Computed Tomography (CBCT). The sensitivity of TLD 100H exposed to DXA also tested. For comparison of BMD value, the head phantom was scanned with different data acquisition protocol and patient positioning for mandibular DXA examination. For correlation of mandible with other skeletal bone, patient who had underwent CBCT examination underwent DXA examination of mandible, spine and hip. Linear measurement was then being made on the CBCT images of patients. The result from the measurement of CBCT image along with the result from DXA examination was taken for statistical analysis. The data was analysed using T-test, Pearson’s correlation, Spearman’s correlation, Kruskal Wallis and Mann Whitney. The result shows that there is no significant difference in BMD value using different data acquisition protocol and there was significant difference in BMD value using different positioning when scanning using DXA scanner. The study also found that there was no significant correlation between BMD of the mandible and other skeletal sites from DXA and significant difference was found between density of the mandible from CBCT and DXA. A strong negative correlation exists between computed tomography mandibular index inferior (CTI I) and computed tomography mandibular index superior (CTI S) with bone status (spine). As for TLD, sensitivity of TLD-100H compared TLD-100 was about 23 times higher when exposed to general radiography x-ray and 1.26 times when exposed to DXA energy. In conclusion, the evaluation of mandibular density to predict osteoporosis is possible using CTI I and CTI S indices

Management of bone defects with Bio-oss

Introduction: The defects in the alveolar bone might appear as a result of congenital malformations, traumatic injuries, periodontal disease, surgical traumas, chronic periapical changes and tumors from benign or malignant origin. The aim of this study was to provide solid and healthy area with application of Bio-Oss in the defect. Materials and methods: Based on the clinical diagnosisestablished by previously taken history, clinical examination and radiographic images oral-surgery interventions was made. To realize the aim of this work, augmentative material was implicated in the bone defects made in the patients after removal of follicular cyst, chronic periapical lesion, and parodontopathia. During the first and seventh day of the interventions, the patients have been followed through from aspect of possible development of local and general complications after the oral-surgery intervention. After period of one, three and six mount control x-ray was made. Results: Obtained results confirmed that: volume of the socket and defect of the bone was kept, fast revascularization was achieved, bone formation and slow resorption of the augmentative material was achieved, and period of normal healing without infection was also achieved. Conclusions: The augmentative materials used for treatment of bone defects besides their basic chemical and physical characteristics referring to their solubility in the body fluids, the transformation, modulation and resorption must be completely safe or secure, i.e. not to bring any risk of infection, immunological risk, physiological intolerance or inhibition of the process of restitutio ad integrum. In our study Bio-Oss was confirmed as augmentative material who had this characteristics. Keywords: bone defect, resorption of the bone, augmentative material, Bio-Os

Apikaalne periodontiit: levimus ja etiopatogeneetilised aspektid

Väitekirja elektrooniline versioon ei sisalda publikatsiooneApikaalne periodontiit (AP) on hamba juurekanalisüsteemis paikneva bakterpõletiku tagajärjel tekkinud kahjustus hambajuuretipu ümbruses. AP tekib enamasti kaugelearenenud hambakaariese tagajärjel ning sellega kaasnev hambajuuretipu ümbruse kudede häving on radioloogiliselt nähtav. AP on maailmas laialt levinud haigus, mille esinemist seostatakse vanuse, soo, teiste hambahaiguste, hambaravikvaliteedi ja indiviidi sotsiaalmajandusliku seisundiga. Käesoleva doktoritöö eesmärgiks oli välja selgitada AP levimus Eestis ning seda põhjustavad ja soodustavad faktorid. Selleks viidi läbi 3 suuremat uuringut. AP levimuse hindamiseks vaadeldi 6552 patsiendi radioloogilisi uuringuid, kus hinnati kõikide hammaste seisukorda. AP diagnoositi üle pooltel uuritavatest ja haigusel leiti tugev seos eelnevalt teostatud hambahaiguste ja -ravi kvaliteediga. Haigestumise risk oli oluliselt madalam kvaliteetse hambaravi korral. Mikrobioloogiliseks uuringuks koguti proove 12 hamba juurekanalist, eraldati DNA ja tuvastati bakteri liigid. Mikroobikooslused olid indiviiditi erinevad ja mitmekesised, kuid domineerisid anaeroobsed bakterid. Avastati mitmeid raskesti kultiveeritavaid ja seni juurekanalitest avastamata mikroobiliike. Eelnevast võib järeldada, et kuna AP’d põhjustavad väga paljud mikroobid, siis spetsiifiliste mikrobioloogiliste analüüside teostamine juurekanalisüsteemist ei ole mõistlik ja raviprotsess tuleb suunata kõikide mikroobide ja nende koosluste vastu. Oksüdatiivse stressi (OxS) markerite määramiseks kasutati 86 patsiendi sülge ja juurekanali sisaldust. OxS esines nii kõikide uuritud juureravi vajavate hammaste juurekanalis kui ka kogu organismis. Tervetel inimestel seevastu olid OxS tasemed madalad. Märkimisväärseks osutus OxS seos hambavalu ja hamba juuretipu ümbruse luu hävinguga. Seega on OxS tähtis mehhanism juurekanali põletike korral.Apical periodontitis (AP) is an inflammatory disease around the apex of a tooth root that is caused by infection in root canal system. AP can be considered a sequela of advanced dental caries, and it is radiologically visible as hard tissue destruction around the apex of the tooth root. AP is a widespread condition all around the world and its prevalence is associated with age, gender, level of previous dental diseases and treatment and socioeconomic status of the region. The general aim of the present thesis was to clarify the prevalence, determining factors and etiopathogentic aspects of AP among Estonian population. To clarify the prevalence of AP we analyzed radiographs of 6552 patient, we described and evaluated all teeth and their status. AP was diagnosed over half of the patients and we found a strong correlation between AP and previous dental diseases as well as the quality of previous dental treatment. The prevalence of AP was considerably lower in patients with high quality dental treatment. Microbial samples were collected from 12 root canals, DNA was isolated and the bacteria were characterized. The communities were individually different but anaerobic bacteria predominated as the rule. We discovered several hard to cultivate and even some not yet discovered spices from root canals. Therefore, the microbiological analysis of the root canal content in case of endodontic pathologies is meaningless, and the treatment measures must be directed against wide spectrum of aerobic and anaerobic bacteria. To measure oxidative stress (OxS), the saliva and root canal samples of 86 patients were analyzed. OxS levels were elevated in patients with endodontic pathologies compared to healthy subjects. OxS appeared to be an important pathogenetic mechanism in several endodontic pathologies being significantly associated with essential clinical markers like dental pain and bone destruction area around the apex of the tooth

Bone Quality of the Dento-Maxillofacial Complex and Osteoporosis. Opportunistic Radiographic Interpretation

Research suggests the use of different indexes on panoramic radiography as a way to assess BMD and to be able to detect changes in bone metabolism before fractures occur. Therefore, the objective of this chapter is to describe the use of these parameters as an auxiliary mechanism in the detection of low bone mineral density, as well as to characterize the radiographic findings of patients with osteoporosis

Cone Beam Computed Tomography and Impacted Maxillary Canines : Dose, Optimisation, and Justification

Retinerte hjørnetenner i overkjeven som er sperret av andre tenner for å vokse ut, er den vanligste grunnen til bruk av Cone Beam Computed Tomography (CBCT) hos barn og unge. Hvis diagnostisering av de retinerte hjørnetenner mangler eller kommer sent, kan rotresorpsjon forekomme på de permanente nabo tennene. Resorpsjonene kan senere føre til behov for kjeveortopedisk behandling, kirurgiske ekstraksjoner og i noen tilfeller implantat eller andre proteseløsninger. Retinerte hjørnetenner oppdages vanligvis hos barn ved klinisk undersøkelse i kombinasjon med intraorale og panorama røntgenbilder. Når mer informasjon er nødvendig for diagnostikk og planlegging, er CBCT-undersøkelse berettiget. På grunn av råd om strålevern er det enighet om at CBCT ikke bør brukes ved førstehånds undersøkelse, men det er fortsatt ingen konsensus om hvorvidt CBCT påvirker terapiplanlegging blant klinikere. Den ideelle radiografiske modaliteten og eksponering varierer, avhengig av den klinisk situasjonen. Når ioniserende stråling benyttes for å undersøke pasienter, må man være oppmerksom på balansen mellom fordelene for pasienten og klinikeren og risikoen ved stråling. Denne doktorgradsavhandlingen hadde som mål å vurdere belastningen ved strålingsdose for barn der retinerte hjørnetenner ble undersøkt. Avhandlingen ser også på metoder for å begrense doseeksponering ved å bruke protokoller for å optimaliserte en lav dose og begrense CBCT-undersøkelsene. Første artikkel i avhandlingen hadde som mål å se effektiv dose ved å sammenligne todimensjonale (2D) undersøkelser (panorama og periapikale røntgenbilder) og tredimensjonale (3D) CBCT. Dosen fra 2D-undersøkelse og CBC fra to enheter (Promax3D og NewTom 5G) ble sammenlignet etter måling av doser på et antropomorft barnefantom. Dosen fra CBCT-undersøkelsen var fra 15 til 140 ganger høyere enn for de konvensjonelle 2D-undersøkelsene, avhengig av CBCT-enhet og type 2D-undersøkelse. Andre artikkel evaluerte bildekvalitet og synlighet av anatomiske strukturer på lavdose CBCT-skanning og effekten av et støyreduksjonsfilter for vurdering av overkjevens front. Flere CBCT-protokoller (Promax3D), blant annet fire lavdoseprotokoller, ble testet på skallefantomer for å sammenligne bildekvalitet og synlighet av anatomiske strukturer som er relevante for vurdering av retinerte hjørnetenner. Tre av lavdoseprotokollene gav akseptabel diagnostisk bildekvalitet, selv om dosen ble redusert med 61 % – 77 %. I tredje artikkel ble det undersøkt hvordan CBCT påvirker behandlingsplanen til pasienter med retinerte hjørnetenner, samt mulige kliniske og 2D-bilde markører for planlagt CBCT-bruk. For å avgjøre om CBCT var berettiget for planlegging av behandling, evaluerte og planlagt en tverrfaglig gruppe 89 kasus med retinerte hjørnetenner. Mer enn halvparten av CBCT-undersøkelsene ble vurdert som uberettiget. Planlagt behandling ble endret i 9,8 % av tilfellene. Variable målt før CBCT som predikerte behovet for ytterligere CBCT, var horisontalt plasserte hjørnetenner, strategi for ekstraksjon på permanente tenner, og bukkalt posisjonerte hjørnetenner. Denne avhandlingen viser at, CBCT medfør høyere effektiv dose for pasienter sammenlignet med konvensjonell 2D røntgenbilder. Dosene pasienter får ved undersøkelse av retinerte hjørnetenner kan minimeres ved å 1) optimalisere protokoller for lavdose CBCT og 2) begrense bruk av CBCT til tilfeller der ytterligere 3D-informasjon er viktig for videre terapeutisk behandling.Impacted maxillary canines are the most common reason for Cone Beam Computed Tomography (CBCT) examinations of the anterior maxilla in children and adolescents today. If impacted canines are missed or diagnosed late, root resorptions may occur on permanent adjacent incisors. In turn, these resorptions may lead to the need for further orthodontic treatment, surgical extractions, and even implants or other prosthetic solutions. Impacted canines are usually discovered in children via clinical examinations in combination with intraoral periapical radiographs and panoramic images. When more diagnostic information is needed, the next step is a CBCT examination. While regulating authorities in radiation protection agree that CBCT should not be used first-hand, there is still no consensus over whether CBCT alters therapy planning amongst clinicians. The ideal radiographic modality and exposure parameters vary, depending on each individual clinical task. When using ionizing radiation to examine patients, attention must be paid to the balance between the benefit to the patient and clinician contra the radiation risk. This thesis aimed to assess the radiation dose burden to children examined for impacted canines and explore methods of limiting dose exposure by applying optimised low-dose protocols and by limiting CBCT examinations through a justification process performed at the therapeutic thinking level. The first paper aimed to measure the effective dose using two-dimensional (2D) examinations (panoramic and periapical radiographs) and three-dimensional (3D) CBCT devices. 2D examination doses and CBCT doses from two devices (Promax3D and NewTom 5G) were compared after measuring organ doses on an anthropomorphic child phantom. The dose from CBCT examinations ranged from 15 to 140 times higher than conventional 2D examinations, depending on the CBCT unit and the type of 2D examination. The second paper evaluated overall image quality and visibility of anatomic structures on low-dose CBCT scans and the effect of a noise reduction filter for assessment of the anterior maxilla. Multiple CBCT protocols (Promax3D), including four low-dose protocols, were tested on dry skull phantoms to compare overall image quality and visibility of anatomic structures pertinent to impacted canine assessment. Of the low-dose protocols, three provided acceptable diagnostic image quality while reducing the dose by 61% – 77%. The third paper investigated how CBCT affects the treatment plan of patients with impacted canines, as well as identified possible clinical and 2D imaging markers for the justified CBCT examination at the therapeutic thinking level. To decide whether CBCT was justified for therapy planning, an interdisciplinary therapy-planning group evaluated impacted canine cases and decided treatment alternatives, first without and later in addition to diagnostic information from CBCT examinations. More than half of the CBCT examinations were considered unjustified, and the therapy plan changed in 9.8% of the cases. Variables measured prior to CBCT that predict the need for further CBCT examinations were horizontally positioned canines (OR= 10.9, p = 0.013 when compared to vertically positioned canines), when extraction strategy was involved (OR = 6.7, p = 0.006), and buccally positioned canines when compared to palatal (OR = 5.3, p = 0.047), central (OR = 25.0, p = 0.001), and distal or uncertain positions (OR =7.7, p = 0.005). Even when optimised, CBCT examinations come at the cost of a higher radiation dose than conventional 2D images. Based on the papers comprising this thesis, patient dose burdens can be minimized when assessing impacted maxillary canines in radiosensitive paediatric patient populations by 1) optimising low-dose CBCT protocols and 2) limiting CBCT exposures to cases where additional 3D information is important for therapeutic thinking and planning.Doktorgradsavhandlin

ChatGPT for Shaping the Future of Dentistry: The Potential of Multi-Modal Large Language Model

The ChatGPT, a lite and conversational variant of Generative Pretrained Transformer 4 (GPT-4) developed by OpenAI, is one of the milestone Large Language Models (LLMs) with billions of parameters. LLMs have stirred up much interest among researchers and practitioners in their impressive skills in natural language processing tasks, which profoundly impact various fields. This paper mainly discusses the future applications of LLMs in dentistry. We introduce two primary LLM deployment methods in dentistry, including automated dental diagnosis and cross-modal dental diagnosis, and examine their potential applications. Especially, equipped with a cross-modal encoder, a single LLM can manage multi-source data and conduct advanced natural language reasoning to perform complex clinical operations. We also present cases to demonstrate the potential of a fully automatic Multi-Modal LLM AI system for dentistry clinical application. While LLMs offer significant potential benefits, the challenges, such as data privacy, data quality, and model bias, need further study. Overall, LLMs have the potential to revolutionize dental diagnosis and treatment, which indicates a promising avenue for clinical application and research in dentistry

Applications of artificial intelligence in dentistry: A comprehensive review

This work was funded by the Spanish Ministry of Sciences, Innovation and Universities under Projects RTI2018-101674-B-I00 and PGC2018-101904-A-100, University of Granada project A.TEP. 280.UGR18, I+D+I Junta de Andalucia 2020 project P20-00200, and Fapergs/Capes do Brasil grant 19/25510000928-3. Funding for open-access charge: Universidad de Granada/CBUAObjective: To perform a comprehensive review of the use of artificial intelligence (AI) and machine learning (ML) in dentistry, providing the community with a broad insight on the different advances that these technologies and tools have produced, paying special attention to the area of esthetic dentistry and color research. Materials and methods: The comprehensive review was conducted in MEDLINE/ PubMed, Web of Science, and Scopus databases, for papers published in English language in the last 20 years. Results: Out of 3871 eligible papers, 120 were included for final appraisal. Study methodologies included deep learning (DL; n = 76), fuzzy logic (FL; n = 12), and other ML techniques (n = 32), which were mainly applied to disease identification, image segmentation, image correction, and biomimetic color analysis and modeling. Conclusions: The insight provided by the present work has reported outstanding results in the design of high-performance decision support systems for the aforementioned areas. The future of digital dentistry goes through the design of integrated approaches providing personalized treatments to patients. In addition, esthetic dentistry can benefit from those advances by developing models allowing a complete characterization of tooth color, enhancing the accuracy of dental restorations. Clinical significance: The use of AI and ML has an increasing impact on the dental profession and is complementing the development of digital technologies and tools, with a wide application in treatment planning and esthetic dentistry procedures.Spanish Ministry of Sciences, Innovation and Universities RTI2018-101674-B-I00 PGC2018-101904-A-100University of Granada project A.TEP. 280.UGR18Junta de Andalucia P20-00200Fapergs/Capes do Brasil grant 19/25510000928-3Universidad de Granada/CBU

Artificial Intelligence in Oral Health

This Special Issue is intended to lay the foundation of AI applications focusing on oral health, including general dentistry, periodontology, implantology, oral surgery, oral radiology, orthodontics, and prosthodontics, among others