Assessment of 3D Facial Scan Integration in 3D Digital Workflow Using Radiographic Markers and Iterative Closest Point Algorithm

Introduction: Integration of 3 dimensional (3D) facial scanning into digital smile design workflows has been made available in multiple commercially available systems. Limited data exists on the accuracy of facial scans and accuracy of various methods of merging facial scans with cone beam computed tomography (CBCT) scans.Objective: The purpose of this prospective clinical study was to evaluate the accuracy of 2 methods used to integrate soft tissue facial scans with CBCT scans. It would allow proposal of a novel approach for integrating a 3D facial scan using facial radio-opaque markers in a 3D digital workflow.Material and methods: Fifteen CBCT and 3D face scans were obtained from patients who were undergoing treatment at MUSoD. A DICOM with RO markers and 3 STL data files from the facial scans were obtained for each patient. These files were superimposed using Exocad software. Accuracy of superimpositions was evaluated by measuring distances between RO markers on DICOM and STL data. The obtained dataset was analyzed using the paired t-test. Results: The results showed that the mean values for the 6 subsets, merging through the ICP algorithm, were 1.47-2mm. However, when merged by RO markers, the mean valuewas 0.14mm. Using a paired t-test, the novel RO points method was statistically more accurate than ICP algorithm method (

Changes of radiographic trabecular bone density and peri-implant marginal bone vertical dimensions around non-submerged dental implants with a laser-microtextured collar after 5 years of functional loading

Objectives: The progressive peri-implant bone remodeling caused by dynamic cycles of microdamage may change peri-implant bone characteristics and volume after the functional loading. This prospective study was designed to evaluate the radiographic trabecular bone density and peri-implant vertical dimensional changes around the non submerged dental implant with a laser-microtextured collar (NSLI)s after 5 years of functional loading. Methods: Digital periapical radiographs of 58 NSLIs supported fixed single crowns and fixed partial dentures in 26 patients (14 men, mean age of 52 ± 3.8 years) were used for comparative evaluation between the implant placement [Baseline (BSL)], the definitive Crowns Delivery (CD) and the 5 years post-functional loading examination (T5). Regions of interest (ROI) were taken into consideration for the measurement of mean gray levels, standard deviation, and variation coefficient. The texture parameters, such as contrast, correlation, angular second moment and entropy, were investigated by using the software ImageJ (v.1.50i), by means of the Gray-level Co-occurrence Matrix (GLCM) Texture Tool plugin. Vertical Periimplant Marginal Bone Level (VPMBL) was assessed at the mesial and the distal sides of each implant by subtracting the measure at BSL from the measure at T5 by means of dedicate software (VixWin Platinum Imaging Software). Mixed regression models were adopted to analyze data. The possible effects of some variables, such as the use of provisional denture, location, crown/implant ratio, type of prosthetic design (single or splinted), on radiographic dimensional vertical changes, gray levels and texture analysis variables were also evaluated. Results: From BSL to T5, mesial and distal VPMBL showed a statistically significant gain of 0.9 ±0.5, and 0.10 mm ±0.6, respectively (P<0.05). From CD to T5, mean gray levels increased from 94.4±26.8) to 111.8±27.1 (P<0.05), while the coefficient of variation decreased from 0.08±0,03 to 0.05±0.04) (P<0.05). Variables showed no statistically significant correlation with texture parameters (P > 0.05). Conclusion: NSLIs showed an increase in radiographic vertical peri-implant marginal bone levels and bone density up to 5 years of loading

Immediate implant with provisionalization and soft tissue grafting : a case report with 4-years follow-up

Purpose: This paper presents a case report of immediate implant placement (IIP) with provisionalization and soft-tissue grafting to restore function and esthetics, with follow-up of 14-months and 4-years. Materials and Methods: Minimally traumatic extraction was performed with IIP, soft-tissue grafting, and immediate provisional crown. Six months after optimal healing, the patient was submitted to an esthetic restorative work through veneers in lithium disilicate. Results: Fourteen months and 4-year follow-up visits revealed stability of the peri-implant soft-tissues with peri-implant health status. At both follow-up visits, pink and white esthetic score (PES/WES) were evaluated to objectively assess esthetic outcomes. Intraoral digital radiographs showed minimal crestal bone level changes throughout the follow-up period. It was demonstrated that IIP is a sensitive technique procedure and a 3D implant position is crucial for success. Conclusion: Immediate implant with grafting to fill the gap and soft tissue augmentation led to minimal changes of peri-implant tissues and PES/WES scores were high. Immediate provisionalization helped to maintain soft tissue architecture although proper case selection is key for long-term success.Objetivo: Este artigo apresenta um relato de caso de colocação imediata de implante (CII) com uma técnica de provisionalização para restaurar a função e a estética com seguimento, com acompanhamento de 14 meses e 4 anos. Materiais e métodos: Extração minimamente traumática foi realizada com CII, com enxerto de tecido mole e enxerto ósseo, além da coroa provisória imediata. Seis meses após a cicatrização ideal, o paciente foi submetido a um trabalho restaurador estético através de facetas em dissilicato de lítio. Resultados: Com catorze meses e com 48 meses, foram feitas visitas de acompanhamento que revelaram estabilidade dos tecidos moles peri-implantares com status de saúde. Nas duas visitas de acompanhamento, o escore estético rosa e branco (PES/WES) foi avaliado para avaliar objetivamente os resultados estéticos. As radiografias digitais intraorais mostraram alterações mínimas do nível ósseo da crista ao longo do período de acompanhamento. Foi demonstrado que o IIP é um procedimento técnico sensível e a posição do implante 3D é crucial para o sucesso. Conclusão: Assim, o CII é um procedimento sensível e a posição do implante 3D é crucial para o sucesso. Implante imediato com enxerto ósseo para preencher o “gap” e o aumento de tecidos moles levaram a menores alterações e à estabilidade da margem mucosa. A provisionalização imediata ajudou a manter a arquitetura dos tecidos moles e a seleção adequada de casos é a chave para o sucesso a longo prazo

Odontology & artificial intelligence

Neste trabalho avaliam-se os três fatores que fizeram da inteligência artificial uma tecnologia essencial hoje em dia, nomeadamente para a odontologia: o desempenho do computador, Big Data e avanços algorítmicos. Esta revisão da literatura avaliou todos os artigos publicados na PubMed até Abril de 2019 sobre inteligência artificial e odontologia. Ajudado com inteligência artificial, este artigo analisou 1511 artigos. Uma árvore de decisão (If/Then) foi executada para selecionar os artigos mais relevantes (217), e um algoritmo de cluster k-means para resumir e identificar oportunidades de inovação. O autor discute os artigos mais interessantes revistos e compara o que foi feito em inovação durante o International Dentistry Show, 2019 em Colónia. Concluiu, assim, de forma crítica que há uma lacuna entre tecnologia e aplicação clínica desta, sendo que a inteligência artificial fornecida pela indústria de hoje pode ser considerada um atraso para o clínico de amanhã, indicando-se um possível rumo para a aplicação clínica da inteligência artificial.There are three factors that have made artificial intelligence (AI) an essential technology today: the computer performance, Big Data and algorithmic advances. This study reviews the literature on AI and Odontology based on articles retrieved from PubMed. With the help of AI, this article analyses a large number of articles (a total of 1511). A decision tree (If/Then) was run to select the 217 most relevant articles-. Ak-means cluster algorithm was then used to summarize and identify innovation opportunities. The author discusses the most interesting articles on AI research and compares them to the innovation presented during the International Dentistry Show 2019 in Cologne. Three technologies available now are evaluated and three suggested options are been developed. The author concludes that AI provided by the industry today is a hold-up for the praticioner of tomorrow. The author gives his opinion on how to use AI for the profit of patients

Digital Dental Models: Is Photogrammetry an Alternative to Dental Extraoral and Intraoral Scanners?

Background: 3D models are nowadays part of daily clinical practice. Photogrammetry is a brand-new method for transforming small objects into 3D models while keeping their original shape and size. The aim of this study was to evaluate the accuracy, in terms of precision and trueness, of a digital dental model acquired with photogrammetry compared with those obtained using extraoral scanners and intraoral scanners, starting from the same plaster model. Methods: A plaster model was converted into a digital model using photogrammetry, an extraoral scanner and an intraoral scanner. Different references were measured twice at a distance of 30 min for each model, on the digital models using the software Blender and on the plaster model using a calibre. The Interclass Correlation Coefficient was calculated for each pair of measurements. A volumetric analysis was performed by superimposing the digital models. The coefficient of variation was calculated. A two-way ANOVA test was conducted. Results: For each reference, the coefficient of variation was less than 3%, and the two ANOVA tests resulted in a non-significant value in both cases (p > 0.05). The volumetric analysis demonstrated good agreement between the models derived from the different acquisition methods. Conclusions: Photogrammetry seems to be a good method for acquiring digital models starting from a plaster model, all the methods tested seem to be good for obtaining an accurate three-dimensional digital model. Other studies are needed to evaluate clinical efficacy

Identifying individuals at risk of fragility fractures in a dental setting

Introduction: The increasing life expectancy is only positive if the added years are healthy years. Fragility fractures are most common in older adults, and they can result in lowered quality of life and high costs for the society. About one-half of Swedish women and one-fourth of the men are expected to sustain at least one fragility fracture during their lifetime, so identifying the high-risk individuals would be favorable. Regular dental check-ups offer a possibility to identify individuals with a high risk of having a disease or condition outside the oral cavity. Features of the mandibular bone shown on dental radiographs have been found to reflect the bone density of the skeleton. Low Bone Mineral Density (BMD) is a risk factor for fragility fractures. Low physical performance is also a risk factor as a fall often precedes a fracture. FRAX is a tool commonly used in primary care to assess the ten-year risk of sustaining a fragility fracture. Aim: The aim of the thesis was to study different methods of identifying individuals with a high risk of fragility fracture, methods that could be used in a dental setting. Material and methods: In the first three studies, we used the unique REBUS cohort, a stratified random sample of the Stockholm population, where 32,183 men and women between the ages of 18-65 received a postal questionnaire in 1969-70. A smaller sample of the cohort had a dental assessment including intraoral radiographs. We acquired data concerning fractures during 1970-2016 from the National Patient Register. In study I, we assessed the trabecular pattern of mandibular bone in intraoral radiographs with two methods, one visual, and one semi-automated. We followed 837 individuals 18-65 years old for 47 years. In study II, we studied the association between questions of physical health and mobility for 16,766 participants 26-65 years, and hip fractures during 20-35 years of follow-up. In study III, we studied the association between questions about alcohol consumption for 27,766 participants, 18-65 years old, and hip fractures during 47 years of follow-up. We also studied diagnoses indicating high alcohol consumption before a fracture and the relationship to hip fractures. In study IV, a qualitative study, we interviewed patients at the Stockholm Public Dental Services about their thoughts about doing a FRAX assessment of ten-year fracture risk in a dental setting. Results: In study I, we found no fracture predictive value in the two methods of assessing the trabecular pattern of the mandibular bone. In study II, questions of physical health and mobility could predict a 2.69 (CI 1.85-3.90) – 3.30 (CI 1.51-7.23) increase in hip fractures. This was true for all men, 26-65 years old at the study start and followed for 20-35 years until they were 61-85 years old, but for women only for those who were 26-45 years old and followed for 35 years, until 61-80 years old. In study III, the questions about alcohol consumption had no fracture predictive value. A hospitalization event with a diagnosis indicating high levels of alcohol consumption resulted in a significantly elevated subhazard ratio (SHR) for hip fractures in men (3.29, CI 1.80-5.98) and women (2.73, CI 1.37-5.42), but only in the youngest age group who were age 18-25 at the start of the study and 65-72 years old at the end of the study. This was interpreted as an indication that high alcohol consumption has a predictive ability for hip fractures that occur at an early age, for both men and women. In study IV, the interviewed participants were mostly positive about doing a FRAX assessment of the ten-year fracture risk, but they expressed concerns that need to be considered before introducing FRAX in a dental setting. Conclusion: We found no evidence of fracture predictive ability using the semi-automated method. The visual method may not be suitable to use for all ages and both sexes. Questions about physical health and mobility, and high alcohol consumption need to be further developed and studied. Using FRAX may be a feasible way to identify high fracture risk, but further studies are needed

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

Issues in Contemporary Orthodontics

Issues in Contemporary Orthodontics is a contribution to the ongoing debate in orthodontics, a discipline of continuous evolution, drawing from new technology and collective experience, to better meet the needs of students, residents, and practitioners of orthodontics. The book provides a comprehensive view of the major issues in orthodontics that have featured in recent debates. Abroad variety of topics is covered, including the impact of malocclusion, risk management and treatment, and innovation in orthodontics