Guided biopsy of osseous pathologies in the jaw bone using a 3D-printed, tooth-supported drilling template

Suspicious radiological findings in the jaw bone require histopathological examination for the confirmation of a diagnosis. As pathologies in this region are difficult to reach or are in close proximity to relevant anatomical structures, e.g. tooth roots or nerves, they often represent a challenge. Such factors may adversely affect the predictability of the surgical outcome of a biopsy of the osseous tissues. This technical note introduces a novel method for performing a digitally planned, guided biopsy. For this purpose, a cone beam computed tomography scan and an intraoral scan are superimposed using specific planning software. The resulting three-dimensionally printed, tooth-supported drilling template is designed for a trephine biopsy. It allows a precise, minimally invasive approach, with an exact three-dimensional determination of the biopsy location prior to surgery. The risk of devitalization of the neighbouring teeth or possible damage to the nerve structures can be minimized. Furthermore, a small access flap can be sufficient. In summary, the method of bone biopsy presented here allows high precision and greater predictability for biopsy sampling and is minimally invasive for the patient

Technology enhanced learning:a role for video animation

The last 20 years has seen a shift in medical education from printed analogue formats of knowledge transfer to digital knowledge transfer via media platforms and virtual learning environments. Traditional university medical teaching was characterised by lectures and printed textbooks, which to a degree still have an important role to play in knowledge acquisition, but which in isolation do not engage the modern learner, who has become reliant on digital platforms and 'soundbite' learning. Recently, however, traditional methods of teaching and learning have been augmented by, and indeed sometimes replaced by, the alternative learning methods such as: problem-based learning; a greater integration of basic science and clinical considerations; smaller teaching groups; the 'flipped classroom' concept; and various technological tools which promote an interactive learning style. The aim of these new teaching methods is to overcome the well-documented limitations of traditional lectures and printed material in the transfer of knowledge from expert to student, by better engaging the minds of more visual learners and encouraging the use of diverse resources for lifelong learning. In this commentary paper, we share the concept of video animation as an additional educational tool, and one that can help to integrate molecular, cellular and clinical processes that underpin our understanding of biology and pathology in modern education. Importantly, while they can provide focused and attractive formats for 'soundbite' learning, their aim as a tool within the broader educational toolbox is to direct the interested reader towards more traditional formats of learning, which permit a deeper dive into a particular field or concept. In this manner, carefully constructed video animations can serve to provide a broad overview of a particular field or concept and to facilitate deeper learning when desired by the student

Accuracy of guided biopsy of the jawbone in a clinical setting: A retrospective analysis

The aim of this study was to investigate the accuracy of a previously described technique for guided biopsy of osseous pathologies of the jawbone in a clinical setting. The data sets of patients who had undergone guided biopsy procedures were retrospectively examined for accuracy. Digital planning of the biopsies and manufacturing of the tooth-supported drilling template were performed with superimposed cone beam computed tomography and intraoral scans using implant planning software. After a trephine biopsy was taken using the template, the postoperative low-dose cone beam computed tomography was analyzed for accuracy using the planning software with the corresponding (digitally-planned) biopsy cylinder. The mean angular deviation was 4.35 ± 2.5°. The mean depth deviation was -1.40 ± 1.41 mm. Guided biopsy seems to be an alternative to a conventional approach for minimally invasive and highly accurate jawbone biopsy

A 3-year Retrospective Analysis of Dento-Alveolar Injuries at the University Children's Hospital Zurich (2018-2020)

Children and adolescents are vulnerable to dental trauma due to their active lifestyles, lack of coordination, and inexperience in recognizing potentially dangerous situations. Early recognition and proper management of dental trauma is crucial in order to minimize the risk of complications and ensure optimal outcomes. The aim of this study was to perform a retrospective analysis of all dento-alveolar injuries in children and adolescents who were treated at the University Children's Hospital Zurich from 2018-2020 by the resident physicians of the Centre of Dental Medicine of the University of Zurich. All information concerning age and sex distribution, seasonal and weekly variations, as well as aetiology, types of trauma and co-affected structures in the head and neck area from 389 patients was analysed. For data extraction, a parameterised Excel list was created, enabling a continuous data collection. In the study, 65% of the patients were male and 35% female. The average patient age was 7 years and 4 months. The highest frequency of trauma occurred in mixed dentition (49%), followed by deciduous dentition (36%) and permanent dentition (15%). Most of the accidents occurred in the second quarter of the year, especially in the month of May slightly more injuries were reported. The most common injuries were increased tooth mobility (40%) and tooth fractures without pulp exposure (34%). Less frequent were tooth fractures with pulp exposure (12%), lateral dislocations (29%), avulsions (21%), intrusions (8%), extrusions (6%) and root fractures (4%). As in many studies the upper central incisors were most often affected. Main causes of dental trauma were falls, especially by bike (18%) or scooter (14%). Soft tissue injuries or fractures, in the area of the head and neck occurred in 59% and 10% of the cases simultaneously accompanied by dento-alveolar trauma

Magnetic resonance imaging for preoperative diagnosis in third molar surgery: a systematic review

In recent years, magnetic resonance imaging (MRI) has made great strides through various technical improvements and new sequences, which have made it one of the most promising and leading imaging techniques in the head and neck region. As modern imaging techniques in dentistry aim to reduce radiation exposure, this systematic review evaluated the possibilities, advantages, and disadvantages of advanced imaging diagnostics using dental MRI and its evidence for clinical indications and limitations relevant to mandibular third molar (MTM) surgery. Two reviewers performed multiple database searches (PubMed MEDLINE, EMBASE, Biosis, and Cochrane databases) following the PICOS search strategy using medical subject headings (MeSH) terms, keywords, and their combinations. Ten studies were included in this systematic review. By providing high spatial resolution and excellent soft tissue contrast, black bone MRI sequences such as 3D Double Echo Steady State (DESS) and 3D Short Tau Inversion Recovery (STIR) imaging protocols have the potential to become a valuable alternative to cone-beam computed tomography (CBCT) in future dental clinical routines. Overall, radiation-free MRI represents another step toward personalized dentistry and improved decision-making that avoids ineffectiveness and minimizes risks in oral surgery by taking into account additional patient-side factors such as comorbidity, anatomical norm variations, and imaging biomarkers

Imaging in Third Molar Surgery: A Clinical Update

Third molar surgery is one of the most common surgical procedures performed in oral and maxillofacial surgery. Considering the patient's young age and the often-elective nature of the procedure, a comprehensive preoperative evaluation of the surgical site, relying heavily on preoperative imaging, is key to providing accurate diagnostic work-up, evidence-based clinical decision making, and, when appropriate, indication-specific surgical planning. Given the rapid developments of dental imaging in the field, the aim of this article is to provide a comprehensive, up-to-date clinical overview of various imaging techniques related to perioperative imaging in third molar surgery, ranging from panoramic radiography to emerging technologies, such as photon-counting computed tomography and magnetic resonance imaging. Each modality's advantages, limitations, and recent improvements are evaluated, highlighting their role in treatment planning, complication prevention, and postoperative follow-ups. The integration of recent technological advances, including artificial intelligence and machine learning in biomedical imaging, coupled with a thorough preoperative clinical evaluation, marks another step towards personalized dentistry in high-risk third molar surgery. This approach enables minimally invasive surgical approaches while reducing inefficiencies and risks by incorporating additional imaging modality- and patient-specific parameters, potentially facilitating and improving patient management

Diffusion-Based Hierarchical Multi-Label Object Detection to Analyze Panoramic Dental X-rays

Due to the necessity for precise treatment planning, the use of panoramic X-rays to identify different dental diseases has tremendously increased. Although numerous ML models have been developed for the interpretation of panoramic X-rays, there has not been an end-to-end model developed that can identify problematic teeth with dental enumeration and associated diagnoses at the same time. To develop such a model, we structure the three distinct types of annotated data hierarchically following the FDI system, the first labeled with only quadrant, the second labeled with quadrant-enumeration, and the third fully labeled with quadrant-enumeration-diagnosis. To learn from all three hierarchies jointly, we introduce a novel diffusion-based hierarchical multi-label object detection framework by adapting a diffusion-based method that formulates object detection as a denoising diffusion process from noisy boxes to object boxes. Specifically, to take advantage of the hierarchically annotated data, our method utilizes a novel noisy box manipulation technique by adapting the denoising process in the diffusion network with the inference from the previously trained model in hierarchical order. We also utilize a multi-label object detection method to learn efficiently from partial annotations and to give all the needed information about each abnormal tooth for treatment planning. Experimental results show that our method significantly outperforms state-of-the-art object detection methods, including RetinaNet, Faster R-CNN, DETR, and DiffusionDet for the analysis of panoramic X-rays, demonstrating the great potential of our method for hierarchically and partially annotated datasets. The code and the data are available at: https://github.com/ibrahimethemhamamci/HierarchicalDet.Comment: MICCAI 202

Value of FDG-PET/MR in Oral Focus Assessment in Head and Neck Cancer Patients-A Feasibility Study

FDG-PET/MR is a hybrid imaging modality used for the staging and restaging of advanced head & neck cancer (HNC) patients. Their treatment typically involves radiation therapy, which requires previous dental focus assessment. The aim of this study was to analyze if staging FDG-PET/MR is a valuable tool for oral focus assessment. For this purpose, FDG-PET/MR findings, such as metabolic activity of periapical radiolucencies and marginal periodontitis, were retrospectively compared with conventional standardized dental focus assessment, including dental radiographs and clinical assessment of 124 teeth in seven patients. Increased FDG uptake of periapical lesions was found in one out of 23 lesions. Increased FDG uptake of the marginal periodontium was recorded in one out of 34 lesions. In summary, standardized dental focus assessment by panoramic radiography and periapical radiographs may be enriched by information from FDG-PET/MR, showing active inflammation in dental foci. However, many dental foci have no correlate in FDG-PET/MR. The treatment decision for oral foci may benefit from the visualized presence or absence of metabolic activity on FDG-PET/MR

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review

Injury to the peripheral branches of the trigeminal nerve, particularly the lingual nerve (LN) and the inferior alveolar nerve (IAN), is a rare but serious complication that can occur during oral and maxillofacial surgery. Mandibular third molar surgery, one of the most common surgical procedures in dentistry, is most often associated with such a nerve injury. Proper preoperative radiologic assessment is hence key to avoiding neurosensory dysfunction. In addition to the well-established conventional X-ray-based imaging modalities, such as panoramic radiography and cone-beam computed tomography, radiation-free magnetic resonance imaging (MRI) with the recently introduced black-bone MRI sequences offers the possibility to simultaneously visualize osseous structures and neural tissue in the oral cavity with high spatial resolution and excellent soft-tissue contrast. Fortunately, most LN and IAN injuries recover spontaneously within six months. However, permanent damage may cause significant loss of quality of life for affected patients. Therefore, therapy should be initiated early in indicated cases, despite the inconsistency in the literature regarding the therapeutic time window. In this report, we present the visualization of two cases of nerve pathology using 3D double-echo steady-state MRI and evaluate evidence-based decision-making for iatrogenic nerve injury regarding a wait-and-see strategy, conservative drug treatment, or surgical re-intervention