Search Results (321)

Objective: The accurate visualization of root canal systems on periapical radiographs is critical for successful endodontic treatment. This study aimed to evaluate and compare the effectiveness of several image enhancement algorithms—including a novel Total Variation–Contrast-Limited Adaptive Histogram Equalization (TV-CLAHE) technique—in improving the detectability of root canal configurations in mandibular incisors, using cone-beam computed tomography (CBCT) as the gold standard. A null hypothesis was tested, assuming that enhancement methods would not significantly improve root canal detection compared to original radiographs. Method: A retrospective analysis was conducted on 60 periapical radiographs of mandibular incisors, resulting in 420 images after applying seven enhancement techniques: Histogram Equalization (HE), Contrast-Limited Adaptive Histogram Equalization (CLAHE), CLAHE optimized with Pelican Optimization Algorithm (CLAHE-POA), Global CLAHE (G-CLAHE), k-Caputo Fractional Differential Operator (KCFDO), and the proposed TV-CLAHE. Four experienced observers (two radiologists and two dentists) independently assessed root canal visibility. Subjective evaluation was performed using an own scale inspired by a 5-point Likert scale, and the detection accuracy was compared to the CBCT findings. Quantitative metrics including Peak Signal-to-Noise Ratio (PSNR), Signal-to-Noise Ratio (SNR), image entropy, and Structural Similarity Index Measure (SSIM) were calculated to objectively assess image quality. Results: Root canal detection accuracy improved across all enhancement methods, with the proposed TV-CLAHE algorithm achieving the highest performance (93–98% accuracy), closely approaching CBCT-level visualization. G-CLAHE also showed substantial improvement (up to 92%). Statistical analysis confirmed significant inter-method differences (p < 0.001). TV-CLAHE outperformed all other techniques in subjective quality ratings and yielded superior SNR and entropy values. Conclusions: Advanced image enhancement methods, particularly TV-CLAHE, significantly improve root canal visibility in 2D radiographs and offer a practical, low-cost alternative to CBCT in routine dental diagnostics. These findings support the integration of optimized contrast enhancement techniques into endodontic imaging workflows to reduce the risk of missed canals and improve treatment outcomes. Full article

A novel macrodesign for a dental implant characterized by a non-monotonic variation in core diameter and thread shape has been described to produce lower stress levels during insertion as compared to conventional tapered implants. Two finite element models resembling the lower left molar region with preformed osteotomies were created based on a cone beam computed tomography (CBCT) scan. Insertion of both the novel and the conventional, tapered implant type were simulated using Standard for the Exchange of Product model data (STEP) files of both implant types. Von Mises equivalent stress, strain development, and amount of redistributed bone were recorded. The conventional implant demonstrated a continuous increase in strain values and reaction moment throughout the insertion process, with a brief decrease observed during the final stages. Stress levels in the cortical bone gradually increased, followed by a reduction when the implant was finally positioned subcrestally. The novel implant achieved the maximum magnitude of reaction moment and cortical bone strain values when the implant’s maximum core diameter passed the cortical bone layer at around 60% of the insertion process. Following a notable decrease, both the reaction moment and stress started to rise again as the implant penetrated further. The novel implant removed more bones in the trabecular region while the conventional implant predominantly interacted with cortical bone. Overall, the novel design seems to be less traumatic to alveolar bone during the insertion process and hence may lead to reduced levels of initial peri-implant bone loss. Full article

Background and Clinical Significance: The retreatment of failed dental implants remains a challenging clinical scenario, particularly when complicated by peri-implantitis and as sociated bone loss. Successful management requires a comprehensive and predictable approach that addresses both hard and soft tissue deficiencies. Case Presentation: This case report illustrates a fully digital, prosthetically driven workflow for the rehabilitation of a posterior mandibular site following implant failure. A 44-year-old female patient underwent removal of a failing implant and adjacent tooth due to advanced peri-implantitis and periodontitis. After healing, a digital workflow—including intraoral scanning, cone-beam computed tomography (CBCT), and virtual planning—was employed to design and fabricate a customized CAD/CAM titanium mesh for vertical guided bone regeneration. The grafting procedure utilized a composite mixture of autogenous bone and anorganic bovine bone (A-Oss). After nine months of healing, two implants with a hydrophilic surface (SOI) were placed using a fully guided surgical protocol (OneGuide system). Subsequent soft tissue grafting and final prosthetic rehabilitation with monolithic zirconia restorations resulted in stable functional and aesthetic outcomes. Conclusions: This case highlights how the integration of modern digital technologies with advanced regenerative procedures and innovative implant surfaces can enhance the predictability and long-term success of implant retreatment in compromised posterior sites. Full article

The design of custom abutments (CA) can affect the mechanical reliability of implant-supported restorations. The purpose of the study was to evaluate the influence of design parameters on the fatigue limit of CA and to compare optimized custom designs with the reference abutment (RA). A morse-tapered dental implant, an anatomical abutment, and a connector screw were digitalized using microcomputed tomography. A cone beam computed tomography scan was obtained from one of the authors to virtually place the implant-abutment assembly in the upper central incisor. Ten design parameters were selected according to the structural geometry of the RA and the implant planning. A reverse-engineered RA model was created in SOLIDWORKS and was modified considering a Taguchi orthogonal array to generate 36 CAs with ±20% dimensional variations. Finite element analysis was conducted in ABAQUS, and fatigue limits were estimated using Fe-safe. ANOVA (α = 0.1) identified the most influential parameters. Von Mises stress values ranged from 229 MPa to 302 MPa, and 94.4% of the CAs had a higher fatigue limit than the RA. Three parameters significantly affected the fatigue performance of the implant system. The design process of custom abutments includes critical design parameters that can be optimized for longer lifetimes of implant-abutment restorations. Full article

Objective: Mandibular expansion remains controversial due to concerns about long-term stability and effectiveness. While maxillary expansion protocols are well established, investigations into mandibular expansion remain limited. This study evaluates the efficacy of the Clara Expander appliance for mandibular expansion in early mixed dentition, assessing skeletal and dental changes using cone-beam computed tomography (CBCT). Materials and Methods: This prospective longitudinal study was conducted in Valencia, Spain, with a population of healthy children aged 6–10 years presenting negative osseodental mandibular discrepancies. CBCT scans were performed before and after treatment to evaluate mandibular dimensional changes, with statistical analyses conducted and a significance threshold of p < 0.05. A total of seven subjects were included in this case series, allowing for a descriptive analysis of treatment outcomes within this specific clinical context. Results: CBCT analysis confirmed significant mandibular expansion following the Clara Expander protocol. Post-treatment findings showed statistically significant increases in dental parameters, including Tooth 6 (furcation, MD = −2.25; p = 0.015), Tooth E (furcation, cementoenamel junction, vestibular, lingual, all p < 0.001), Tooth D (all variables significant), and Tooth C (furcation, MD = −4.18; p = 0.002; cementoenamel junction, MD = −3.56; p = 0.015). Conclusions: The Clara Expander appliance effectively promotes skeletal and dental mandibular expansion, with minimal adverse effects. Its user-friendly, non-invasive design enhances patient compliance and outcomes, contributing valuable data to the field of mandibular expansion and informing future research and clinical applications. Full article

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

Partially guided implant surgery has emerged as a technique that enhances the precision of implant placement while maintaining surgical flexibility. This in vitro experimental study evaluated the influence of the milling cutter drill on the angular and linear deviations of implant placement in synthetic polyurethane bone models using a partially guided surgical protocol. Additionally, the effects of bone density and implant macrogeometry were assessed. A total of 120 Straumann^® implants (BL, BLT, and BLX) were placed in polyurethane blocks simulating four bone densities (D1–D4). Implant positions were virtually planned with coDiagnostiX^® (version 10.9) software and executed with or without the use of the milling cutter drill. Deviations between planned and final implant positions were measured at the neck and apex using the software’s “Treatment Evaluation” tool. The use of the milling cutter drill significantly reduced angular deviation (p = 0.007), while linear deviations showed no statistically significant differences. Bone density and implant macrogeometry did not significantly affect angular deviation but influenced linear and 3D deviations. Given that angular deviation may compromise prosthetic fit and biomechanical function, the observed reduction is of potential clinical relevance. These findings indicate that the milling cutter drill enhances angular accuracy in partially guided implant surgery and may improve outcomes in anatomically challenging cases. However, the results should be interpreted within the limitations of this in vitro model, including the absence of soft tissue simulation, intraoral constraints, and inter-operator variability. Full article

Background and Objectives: Evaluating jaw augmentation procedures usually necessitates pre- and postoperative tomographic imaging. Ethical considerations emphasize minimizing radiation exposure. Given that panoramic radiographs (PR, 2D) offer a lower radiation dose compared to cone-beam CT (CBCT, 3D), this study explores the feasibility of estimating tooth root volume from PR, potentially allowing safer clinical assessments with reduced radiation exposure. Materials and Methods: To develop a mathematical approximation method, the 2D tooth root surface in PR was defined as an elliptical model and a cuboid (3D). The true root volume (mm³) was gathered from CBCTs. The missing link for tooth root volume assessment in 2D radiographs is the depth of the root (vestibulo-oral dimension). It was hypothesized that the tooth root surface and its volume are related. A correlation factor “r” corresponding to the tooth roots’ depths was then calculated. Descriptive and inferential statistics were computed (p < 0.05). Results: The mathematical model was performed on 27 molars with an average volume of 472.83 mm³ (±130.25–CBCT). The factor “r” (obtained by dividing the true root volume from CBCT by the total root surface from PR) was computed as 8.04 (±1.90). Using “r” for the volume calculation in the cuboid model, an average volume of 472.37 (±152.92) for the 27 molars was computed. These volumes did not differ significantly. Conclusions: This study demonstrates that a mathematical model using elliptical projections from panoramic radiographs reliably estimates molar root volume, yielding comparable results to CBCT while reducing radiation exposure. Full article

Background/Objectives: Among the paranasal sinuses, the maxillary antrum holds unique clinical relevance due to its proximity to the alveolar process of the maxilla, which houses the teeth. This study aimed to evaluate the position of the root apices of the maxillary canines and posterior teeth relative to the maxillary sinus floor in Romanian subjects. Methods: Data for the study were retrospectively obtained from cone-beam computed tomography (CBCT) scans. The evaluation considered the pattern of proximity to the sinus floor for each tooth type, comparisons of the sinus relationships of teeth within the same dental hemiarch, as well as those of homologous teeth, and variation in root-to-sinus distance in relation to sex and age. Nonparametric tests were used for statistical analysis, and multiple comparisons were performed using Bonferroni post hoc correction. Results: The study included 70 individuals aged 20 to 60 years. The distance to the sinus floor decreased progressively from the first premolar to the second molar, with median values of 3.68 mm (first premolar), 1.45 mm (second premolar), 0.50 mm (first molar), and 0.34 mm (second molar) (p < 0.01). Stronger correlations were observed between adjacent teeth than between non-adjacent ones. The distances to the sinus floor were greater on the right side compared to the left; however, these differences were not statistically significant (p > 0.05 for all teeth). Concordance between left and right dental hemiarches regarding the closest tooth to the sinus floor was found in 70% of cases (n = 49), most frequently involving the second molars (n = 38; 54.3%). On average, the distance from the sinus floor was smaller in males compared to females, with statistically significant differences observed only for the second molar. Increased age was associated with a greater distance to the sinus floor. Conclusions: Of all the teeth investigated, the second molar showed the highest combined prevalence of penetrating and tangential relationships with the maxillary sinus. At the dental hemiarch level, the second molar was most frequently the closest tooth to the sinus floor, and in the majority of cases, at least one posterior tooth was located within 0.3 mm. Accurate preoperative assessment of tooth position relative to the sinus floor is essential when performing non-surgical or surgical root canal therapy and extractions of maxillary molars and premolars. CBCT provides essential three-dimensional imaging that improves diagnostic precision and supports safer treatment planning for procedures involving the posterior maxilla. Full article

Background/Objectives: The infraorbital canal (IOC) is a critical anatomical structure that passes through the anterior surface of the maxilla and opens at the infraorbital foramen, containing the infraorbital nerve, artery, and vein. Accurate localization of this canal in maxillofacial, dental implant, and orbital surgeries is of great importance to preventing nerve damage, reducing complications, and enabling successful surgical planning. The aim of this study is to perform automatic segmentation of the infraorbital canal in cone-beam computed tomography (CBCT) images using an artificial intelligence (AI)-based model. Methods: A total of 220 CBCT images of the IOC from 110 patients were labeled using the 3D Slicer software (version 4.10.2; MIT, Cambridge, MA, USA). The dataset was split into training, validation, and test sets at a ratio of 8:1:1. The nnU-Net v2 architecture was applied to the training and test datasets to predict and generate appropriate algorithm weight factors. The confusion matrix was used to check the accuracy and performance of the model. As a result of the test, the Dice Coefficient (DC), Intersection over the Union (IoU), F1-score, and 95% Hausdorff distance (95% HD) metrics were calculated. Results: By testing the model, the DC, IoU, F1-score, and 95% HD metric values were found to be 0.7792, 0.6402, 0.787, and 0.7661, respectively. According to the data obtained, the receiver operating characteristic (ROC) curve was drawn, and the AUC value under the curve was determined to be 0.91. Conclusions: Accurate identification and preservation of the IOC during surgical procedures are of critical importance to maintaining a patient’s functional and sensory integrity. The findings of this study demonstrated that the IOC can be detected with high precision and accuracy using an AI-based automatic segmentation method in CBCT images. This approach has significant potential to reduce surgical risks and to enhance the safety of critical anatomical structures. Full article

Background: Eighty-five percent of peri-implant malignancies are oral squamous cell carcinomas (OSCCs), and most of them are misdiagnosed as peri-implantitis because of their clinical and radiological presentation; few studies have focused on addressing and solving the diagnostic issues related to peri-implant OSCCs. Objectives: The study aimed to describe the clinicopathological features of peri-implant OSCCs and to report the staging issues related to the diagnosis of these lesions. Methods: This retrospective cohort study included patients who received a diagnosis of and treatment for peri-implant OSCCs at the Unit of Dentistry of the “Aldo Moro” University of Bari (Italy) from 2018 to 2024. By using descriptive statistics, the authors highlighted the diagnostic issues related to the clinical presentation, radiological features, and histology of peri-implant OSCCs. Results: A total of 13 women and 8 men with a mean age of 70.6 ± 11.7 years met the inclusion criteria; the medical history of the participants showed potentially malignant disorders (OPMDs) in 52.4% of patients, whereas 14.3% had already developed an OSCC. The patients showed 24 peri-implant OSCCs; the clinical presentation was leuko-erythroplakia-like (41.7%) or erythroplakia-like (58.3%), thus simulating peri-implantitis; in addition, 52.0% of dental implants involved had a probing pocket depth ≥ 10 mm, further mimicking peri-implantitis. Panoramic radiograms and cone beam computed tomography were of little use in studying bundle bone–implant interfaces; in particular, the tomography showed circumferential bone resorption only in peri-implantitis-like OSCCs. In total, 91.6% of histological examinations of OSCCs showed peri-implantitis-like inflammation; early-stage lesions (pTNM I-II) accounted for 33.3%, whereas late-stage lesions (pTNM III-IV) accounted for 66.7%; lymph nodal metastases occurred in 25.0% and 62.5%, respectively. The mean follow-up was 3.4 ± 1.0 years; all patients with OPMDs had poorly differentiated tumors and thus showed a worse prognosis than those without OPMDs (mean disease-free survival of 15.5 ± 7.7 months and 44.7 ± 12.1 months, respectively). Conclusions: The results of the study showed that peri-implant OSCCs occurred most frequently in patients with OPMDs or previous OSCC; in addition, peri-implant OSCCs required demolition rather than conservative excision, and the prognosis of patients strictly depended on the grade of the cancer. In the authors’ experience, the clinical–radiological presentation simulating peri-implantitis was the feature that concurred most in complicating the diagnosis of those tumors. Full article

Background: Artificial Intelligence (AI) is revolutionizing healthcare by enhancing diagnostic precision and risk assessment. In dentistry, AI has been increasingly integrated into Cone Beam Computed Tomography (CBCT) to improve image interpretation and pre-surgical planning. The lingual foramen (LF), a vital anatomical structure that transmits neurovascular elements, requires accurate evaluation during implant procedures. Traditional CBCT studies describe LF variations but lack a standardized risk classification. This study introduces a novel AI-based model for stratifying the surgical risk associated with LF using machine learning. Objectives: This study aimed to (1) assess the prevalence and anatomical variations of the lingual foramen (LF) using CBCT, (2) develop an AI-driven risk classification model based on LF characteristics, and (3) compare the AI model’s performance with that of traditional statistical methods. Materials and Methods: A retrospective analysis of 166 CBCT scans was conducted. K-means clustering and decision tree algorithms classified foramina into Low, Moderate, and High-Risk groups based on count, size, and proximity to the alveolar crest. The model performance was evaluated using confusion matrix analysis, heatmap correlations, and the elbow method. Traditional analyses (chi-square and logistic regression) were also performed. Results: The AI model categorized foramina into low (60%), moderate (30%), and high (10%) risk groups. The decision tree achieved a classification accuracy of 92.6 %, with 89.4% agreement with expert manual classification, confirming the model’s reliability. Conclusions: This study presents a validated AI-driven model for the risk assessment of the lingual foramen. Integrating AI into CBCT workflows offers a structured, objective, and automated method for enhancing surgical safety and precision in dental implant planning. Full article

Background/Objectives: Osteoporosis is a widespread and chronic systemic bone disease that affects the jaws and teeth and, therefore, also dentistry. Osteoporosis can be diagnosed by different radiological methods. Dental cone beam computed tomography (CBCT) plays an important role in dentistry imaging. The aim of our retrospective pilot study was to find criteria in CBCT that point to the possible existence of osteoporosis. Methods: Pilot study. The hard palate thickness (HPT) of the patients was measured at a defined location in the CBCT. Additionally, the CBCT images were presented to a radiologist for visual assessment. Both results were compared with the DXA measurements—as the “gold standard”—and patient history. Results: We found a consistent correlation between the visual assessments using established radiological criteria, including the new criterion of hard palate thickness (HPT), and the diagnosis of normal or pathological bone density. Secondly, for the HPT measurement all “pathologic” CBCT had an HPT of ≤0.9 mm, and all normal patients had an HPT of ≥0.9 mm. Conclusions: Despite the small sample size, this CBCT pilot study showed a correlation between HPT and systemic bone disease. Therefore, as our main result, we found a new CBCT diagnostic criterion, which quickly and uncomplicatedly points to the possible existence of bone disease, especially osteoporosis. We propose HPT as a new criterion in the evaluation of CBCT images. A threshold of <0.9 mm may be indicative for osteoporosis or osteopenia, indicating a need for further evaluation. Full article

Background/Objectives: Periodontal and implant therapies frequently require soft tissue augmentation for optimal outcomes. As the hard palate serves as the primary donor site, this study evaluated palatal masticatory mucosa thickness variations in a Saudi population of the Eastern Province using cone-beam computed tomography (CBCT) at a teaching dental hospital, providing site-specific data for clinical applications. Methods: A retrospective cross-sectional analysis of 215 CBCT scans from systemically healthy, non-smoking adults (>18 years) was conducted at the University Dental Hospital. Measurements were taken at 12 standardized sites (3 mm, 6 mm, and 9 mm from the cementoenamel junction) across maxillary canines, premolars, and first molars. Statistical analysis included Friedman’s test and t-tests. Results: Significant site variations were observed, with the second premolar region showing greatest thickness (3.48 ± 0.80 mm at 9 mm) and the first molar region the lowest (1.88 ± 0.63 mm at 3 mm) (p < 0.001). Mucosal thickness generally increased coronally to apically (p < 0.001). Age >35 years correlated with significantly thicker mucosa (p < 0.05), while no statistically significant gender-based differences were observed for all sites (p > 0.05). Conclusions: CBCT provides reliable, non-invasive assessment of palatal mucosa thickness. These findings offer region-specific data for consideration in periodontal and implant procedures involving soft tissue grafting. Full article

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities. Full article