Search Results (30)

Lateral cephalometric analysis is commonly used in orthodontics for skeletal classification to ensure an accurate and reliable diagnosis for treatment planning. However, most current research depends on analyzing different type of radiographs, which requires more computational time than 3D analysis. Consequently, this study addresses fully automatic orthodontics tracing based on the usage of artificial intelligence (AI) applied to 2D and 3D images, by designing a cephalometric system that analyzes the significant landmarks and regions of interest (ROI) needed in orthodontics tracing, especially for the mandible and maxilla teeth. In this research, a computerized system is developed to automate the tasks of orthodontics evaluation during 2D and Cone-Beam Computed Tomography (CBCT or 3D) systems measurements. This work was tested on a dataset that contains images of males and females obtained from dental hospitals with patient-informed consent. The dataset consists of 2D lateral cephalometric, panorama and CBCT radiographs. Many scenarios were applied to test the proposed system in landmark prediction and detection. Moreover, this study integrates the Grad-CAM (Gradient-Weighted Class Activation Mapping) technique to generate heat maps, providing transparent visualization of the regions the model focuses on during its decision-making process. By enhancing the interpretability of deep learning predictions, Grad-CAM strengthens clinical confidence in the system’s outputs, ensuring that ROI detection aligns with orthodontic diagnostic standards. This explainability is crucial in medical AI applications, where understanding model behavior is as important as achieving high accuracy. The experimental results achieved an accuracy exceeding 98.9%. This research evaluates and differentiates between the two-dimensional and the three-dimensional tracing analyses applied to measurements based on the practices of the European Board of Orthodontics. The results demonstrate the proposed methodology’s robustness when applied to cephalometric images. Furthermore, the evaluation of 3D analysis usage provides a clear understanding of the significance of integrated deep-learning techniques in orthodontics. Full article

Purpose: The objective of this study was to determine the prevalence of exostosis in the Mississippi population. Methods: The patient archives of the UMMC School of Dentistry between January 2018 and May 2021 were examined. Patients with exostosis were included in the study based on the findings from intraoral photographs, full-moth series (FMS), panoramic radiographs, and cone-beam computerized tomography (CBCT) images of the patients. Patients were excluded from the study if they did not have maxillary or mandibular exostosis. In addition, each patient’s age, gender, and ethnic origins, such as Caucasian, African-American, or Asian, were recorded. All data regarding exostosis were evaluated and categorized according to age, gender, and ethnicity. Multiple logistic regression analysis was performed for more detailed statistical analysis. Results: A total of 1242 patients were examined for the presence of maxillary and mandibular tori. In total, 303 patients were diagnosed with maxillary and/or mandibular tori among the Mississippi population, with a prevalence rate of 24.4%. Exostosis was seen more in females (57.4%) compared to males (42.6%). The highest prevalence of exostosis was seen in Caucasians (71.3%), followed by African-Americans (23.8%) and Asians (5%). Conclusions: High prevalence of exostosis was seen in the Mississippi population. Our findings will help clinicians to be more aware of these bony protuberances and, thus, better at diagnosing them. This may specifically help oral surgeons, periodontists, and prosthodontists in pre-prosthodontic surgery and denture fabrication. Full article

Measurements of tooth size for estimating inter-arch tooth size discrepancies and inter-tooth distances, essential for orthodontic diagnosis and treatment, are primarily done using traditional methods involving plaster models and calipers. These methods are time-consuming and labor-intensive, requiring multiple steps. With advances in cone-beam computerized tomography (CBCT) and intraoral scanning technology, these processes can now be automated through computer analyses. This study proposes a multi-step computational method for measuring mesiodistal tooth widths and inter-tooth distances, applicable to both CBCT and scan images of plaster models. The first step involves 3D segmentation of the upper and lower teeth using CBCT, combining results from sagittal and panoramic views. For intraoral scans, teeth are segmented from the gums. The second step identifies the teeth based on an adaptively estimated jaw midline using maximum intensity projection. The third step uses a decentralized convolutional neural network to calculate key points representing the parameters. The proposed method was validated against manual measurements by orthodontists using plaster models, achieving an intraclass correlation coefficient of 0.967 and a mean absolute error of less than 1 mm for all tooth types. An analysis of variance test confirmed the statistical consistency between the method’s measurements and those of human experts. Full article

(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted. Full article

The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements (p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements (p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans. Full article

Background: We aimed to develop a new tumor response assessment method for lung SBRT. Methods: In total, 132 lung cancer patients with 134 tumors who received SBRT treatment with daily CBCT were included in this study. The information about tumor size (area), contrast (contrast-to-noise ratio (CNR)), and density/attenuation (μ) was derived from the CBCT images for the first and the last fractions. The ratios of tumor area, CNR, and μ (R_A, R_CNR, R_μ) between the last and first fractions were calculated for comparison. The product of the three rations was defined as a new parameter (R) for assessment. Tumor response was independently assessed by a radiologist based on a comprehensive analysis of the CBCT images. Results: R ranged from 0.27 to 1.67 with a mean value of 0.95. Based on the radiologic assessment results, a receiver operation characteristic (ROC) curve with the area under the curve (AUC) of 95% was obtained and the optimal cutoff value (R_C) was determined as 1.1. The results based on R_C achieved a 94% accuracy, 94% specificity, and 90% sensitivity. Conclusion: The results show that R was correlated with early tumor response to lung SBRT and that using R for evaluating tumor response to SBRT would be viable and efficient. Full article

This study compared tooth color and enamel and dentinal thickness between orthodontically treated and untreated individuals. (1) Methods: A matched case–control study was conducted. The sample included 26 patients who had received orthodontic treatment and 31 matched controls. The color assessment was performed subjectively using the VITA 3D-Master (VM) shade guide and objectively using the VITA Easyshade (VE) spectrophotometer. Differences in L*, a*, and b* (lightness, red/green, and blue/yellow) were calculated. The color change was evaluated using ΔE*ab and the whiteness index (WID). Tooth structure thickness (labiolingual, labial enamel, and labial dentin) was evaluated using cone-beam computerized tomography. The correlations between overall tooth color and tooth structure thickness were evaluated. (2) Results: A total of 228 teeth were evaluated. Color assessment using VM showed significant differences between orthodontically treated and untreated teeth (p < 0.001), while VE revealed no significant differences. Both groups showed no difference in tooth enamel and dentinal thickness. Significant differences in tooth color (p < 0.05) were observed between genders. Both VM and VE showed weak to moderate correlations with tooth color and enamel and dentinal thickness (p < 0.05). (3) Conclusions: Orthodontic treatment may demonstrate visually perceptible but acceptable and clinically undetectable tooth color alteration. Full article

Immediate dental implant placement with or without immediate loading is reported in daily dentistry and implantology, but these procedures are not common in the case of periradicular and periapical lesions around the tooth needed to be replaced. In the following retrospective evaluation, 10 cases with a 1-year follow-up were selected to propose the technique of an immediate provisional non-loading prosthesis being delivered on the same day of the post-extraction implant placement in multiradicular teeth affected by chronic periradicular and periapical lesions. Post-extractive sockets underwent immediate dental implant placement by filling the empty space with sterile, re-absorbable gelatin sponges. The widths of the alveolar ridge were measured on three-dimensional radiographs before and after the operation, 4 and 12 months later. Non-parametric statistics were performed to compare the outcomes over time with a level of significance of 0.05. Comparing the preoperative cross-sectional images of cone beam computerized tomography (CBCT) scans to the postoperative ones, it was noted that changes in the crestal ridge width, ΔCW, (compared to baseline) were negligible and not clinically appreciable. However, while ΔCW at 4 months appeared to be negative (−0.17 ± 045 mm), crestal width at 12 months was at the same level as the baseline (ΔCW = 0.02 ± 0.48 mm), with a significant difference between 4 and 12 months (p-value = 0.0494). Immediate implant placement with an immediate non-loading provisional customized healing abutment of polyether-ether-ketone placed into the post-extractive sockets with asymptomatic and large chronic periapical and periradicular lesions could represent a further treatment strategy for patients’ rehabilitation and soft tissue preservation to replace a hopeless tooth. Full article

Microimplant-assisted rapid palatal expansion (MARPE) has been demonstrated successfully in maxillary expansion in late adolescence and adulthood. The maxillary advancement accompanied by expansion is frequently anticipated, which is beneficial for the treatment of class III malocclusion. Airway volume increase can also be noted in some cases from the measurement of cone beam computerized tomography (CBCT) after expansion. The objective of this case report is to demonstrate the feasibility of applying MARPE on late adolescence patients with maxillary transverse deficiency and to present the changes in transverse and anteroposterior dimensions as well as the volume increase in velopharyngeal airway after MARPE. A 15-year-old female presented class III skeletal pattern. She had maxillary transverse deficiency with moderate crowding and posterior/anterior crossbites. Maxillary Skeletal Expander (MSE; Biomaterials Korea Inc.) type-2 was used as a MARPE device in this case. After four weeks of maxillary expansion, a significant amount of expansion was achieved and the anterior crossbite was spontaneously corrected. Fixed appliance treatment was commenced four weeks after MARPE with 0.022-slot preadjusted brackets (MBT prescription). Temporary anchorage devices (TADs) were placed over the mandibular buccal shelves for posterior teeth distalization and crowding relief. After 25 months of treatment, the facial profile was improved with maxillary advancement (SNA: 83° to 83.5°) and mandibular backward rotation (SNB: 83° to 82°; SN-MP: 34.5° to 35°). In this case, MARPE not only engenders significant transverse correction but also aids in anteroposterior change. The treatment effects of maxillary advancement and mandibular backward rotation can lead to a more esthetic profile in skeletal class III cases. Full article

Sialography is used for diagnosis of obstructive salivary gland diseases and prior to sialendoscopy. Three-dimensional cone beam computerized tomography (CBCT) sialography allows imaging and measurement of salivary duct structures. Salivary gland endoscopy has a long learning curve. The aim of this retrospective study is to create an anatomical quantitative guide of different distances and angles significant for endoscopy. Twenty-six CBCT sialographies of healthy parotid ducts were included. Outcome parameters included diameters, distances, angles and number of minor tributaries. Results show the average distance from the papilla to the curvature of the gland was 41.5 mm (Q1 36.97 mm–Q3 45.32 mm), with an angle of 126.9° (Q1 107.58°–Q3 135.6°) of the curvature and a distance of 35.25 mm (±7.81 mm) between the curvature and the hilus. The mean width of the duct was 0.8 mm (Q1 0.7 mm–Q3 1.15 mm) at its narrowest and 2 mm (Q1 1.4 mm–Q3 2.2 mm) at its widest. This is the first anatomical quantitative study of the parotid duct in relation to sialendoscopy. Full article

Background: The collum angle (CA) is an extremely significant for patients who are undergoing orthodontic, dental implant restoration, prosthodontic and periodontic treatments. Aim and Objectives: To determine and compare the mean CA for maxillary central incisor in different types of malocclusion utilizing 3D Cone Beam Computerized Tomography (CBCT) images. The additional objectives were to determine and compare the mean CA for maxillary central incisor based upon the demographic characteristics among Saudi, Jordan and Egypt subpopulation and to test for significant differences in the CA of maxillary central incisor with different molar malocclusions. Methodology: A total of 400 CBCT images were included from the radiology archive at the College of Dentistry, Jouf University (Sakaka, Saudi Arabia). The CBCT images were divided into four groups based upon molar classifications. The selected records were used for the measurement of CA of maxillary central incisor using the measurement tool built into 3D:OnDemand software. Statistical analysis was done using independent t test and ANOVA to examine the differences between gender and races. Results: The mean CA for Class II div 2 exhibited significantly higher crown-root variation as compared other groups (p < 0.0001). Males sample showed greater value of CA for each group as compared to the females and this difference was statistically significant for all the groups other than for Class I (p < 0.05). The post hoc pairwise comparisons between the races showed statistically insignificant findings (p > 0.05). Significant difference was found on pairwise comparisons among different malocclusion groups other than for group Class I/Class II div 1 (p < 0.05). Conclusion: The CA of Class II div 2 group was the greatest as compared to other malocclusion groups. Males sample showed greater value of CA for each group as compared to the females and this difference was statistically significant for all the groups other than for Class I. Statistically insignificant difference was noted for the mean CA among different races whereas significant difference was found on pairwise comparisons among different malocclusion groups other than for group Class I/Class II div 1. Full article

The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant placement using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted sites. We followed a parallel study design with patients divided into two groups: grafted group (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed up for 1-year post-loading. MBL after one year, in the control group, was −0.31 ± 0.11 mm (mesial) and −0.28 ± 0.09 mm (distal); and in the test group was −0.35 ± 0.11 mm (mesial) and −0.33 ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups after one year. ISR was similar between groups and the marginal bone changes were comparable one year after functional loading, without statistical significance, suggesting that bioactive glass permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants. Full article

The purpose of this study was to develop a technique to record the natural head position (NHP) of a subject using the scout images of cone beam computerized tomography (CBCT) scans. The first step was to align a hanging mirror with the vertical (XY) plane of the CBCT field-of-view (FOV) volume. Then, two scout CBCT images, at frontal and at sagittal planes, were taken when the subject exhibited a NHP. A normal CBCT scan on the subject was then taken separately. These scout images were used to correct the orientation of the normal CBCT scan. A phantom head was used for validation and performance analysis of the proposed method. It was found that the orientation detection error was within 0.88°. This enables easy and economic NHP recording for CBCT without additional hardware. Full article

Introduction: This study aimed to show the clinical outcomes of implants inserted by guided surgery supporting mandibular overdentures in edentulous patients. Patients and methods: Mandibular edentulous patients were diagnosed with an oral examination, cone-beam computerized tomography, and diagnostic casts for intermaxillary relations and treated with overdentures over two implants by guided surgery. After flapless surgery, implants were early loaded with an overdenture at 6 weeks. Results and discussion: Fourteen patients (nine females and five males) were treated with 28 implants. Four patients (28.6%) had a previous history of periodontitis. Five patients (35.7%) were smokers. Nine patients (64.3%) suffered from systemic diseases (i.e., diabetes, cardiovascular diseases). The clinical follow-up of the study was 44.7 ± 31.4 months. Clinical outcomes showed a global success of 100% of implants. Fourteen overdentures were placed in the patients over the implants. Mean marginal bone loss was 1.25 mm ± 0.95 mm. Four patients (28.6%) showed some kind of mechanical prosthodontic complications. Six implants (21.4%) were associated with peri-implantitis. Conclusions: This study indicates that treatment of mandibular edentulous patients with overdentures by guided surgery and early loading of implants placed appears to be a successful implant protocol. Full article

“Big-nose variant” is an anatomical phenomenon defined as the pneumatization of inferior third of the nasal cavity within the alveolar ridge while simultaneously displacing the maxillary sinus laterally. The purpose of the present study was to assess the prevalence of the big-nose variant phenomenon and suggest a morphology classification system. Diagnostic anatomical evaluation was performed in a tertiary medical center on 321 randomly selected maxillary cone beam computerized tomography scans of patients who presented at an oral and maxillofacial department. Two anatomical categories were defined for anatomical identification: classes for horizontal mesiodistal distribution, and divisions for vertical distribution. Class 2, defined as location of the nasal/sinus border between the distal edge of the canine up to the distal edge of second premolar, was found to be the most prevalent (64.6%). Class 3, defined as location of the nasal/sinus border distal to mesial edge of the first molar, was found in 17.9% of cases. Regarding the divisions category, in 96% and 58.2% of teeth examined, nasal cavity alone was found to be superior to the canine and first premolar, respectively, defined as Division A. In 46.9% and 85.6% of teeth examined, maxillary sinus alone was located above the second premolar and first molar, respectively, defined as Division C. Identifying Class 3 on the paraxial reconstruction is the first step in identifying big-nose variant, with further assurance gained from each determining division. The use of the classes and divisions may enable better maxillary treatment planning, alert surgeons for the unexpected, and avoid complications. Full article