Search Results (111)

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

Background: Positive identification is at the forefront of tasks for forensic practitioners when a set of remains is discovered. Standard means of identification include fingerprints, dental, and DNA analyses; however, additional methods are utilized by forensic practitioners to identify remains when these primary methods of identification are not applicable. Comparative radiography has become a frequently employed approach for positive identification, specifically focused on individualizing characteristics evident in human skeletal variation. Regions that display wide ranges of morphological variation within the human skeleton include the cranium as well as the thorax. With regard to the cranium specifically, paranasal sinuses have been recognized as unique features and are valuable for identification purposes. Objectives: This paper explores the basic information of the anatomy and development, range of variation, and the importance of paranasal sinuses in forensic contexts. Results: This article discusses how practitioners can best use the morphological information contained in the paranasal sinuses and how to compare the antemortem and postmortem datasets involving different imaging modalities for positive identification purposes, in order to provide practical concepts that may assist in cases where paranasal sinuses may be used for forensic human identification. Conclusions: Understanding the development of paranasal sinuses, the imaging techniques applied for their visualization, as well as the principles of identification, is key to conducting proper antemortem vs. postmortem comparisons and effectively utilizing paranasal sinuses in forensic identification contexts. Full article

This study investigated the radiation attenuation characteristics of commonly used dental implant materials across an energy spectrum relevant to dental radiology. Two titanium implants were examined, with densities of 4.428 g/cm³ and 4.51 g/cm³, respectively. The first consisted of 90.39% titanium, 5.40% aluminum, and 4.21% vanadium, while the second comprised 58% titanium, 33% oxygen, 7% iron, 1% carbon, and 1% nitrogen. The third material was a zirconia implant (5Y form) composed of 94.75% zirconium dioxide, 5.00% yttrium oxide, and 0.25% aluminum oxide, exhibiting a higher density of 6.05 g/cm³. Monte Carlo simulations (MCNP6) and XCOM data were utilized to estimate photon source parameters, geometric configuration, and interactions with biological materials to calculate the half-value layer, mean free path, and tenth-value layer at varying photon energies. The results indicated that titanium alloys are well suited for low-energy imaging modalities such as CBCT and panoramic radiography due to their reduced artifact production. While zirconia implants demonstrated superior attenuation at higher energies (e.g., CT), their higher density may induce beam-hardening artifacts in low-energy systems. Future research should validate these simulation results through in vitro and clinical imaging and further explore the correlation between material-specific attenuation and CBCT image artifacts. 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

Odontogenic abscesses are a frequent and challenging clinical issue in pet rabbits, often requiring a comprehensive diagnostic and therapeutic approach. This review collates current evidence on the etiology, diagnosis, and treatment of rabbit odontogenic abscesses, with a focus on imaging advances, microbial diversity, and local antimicrobial therapies. Predisposing factors include congenital conformation, inappropriate diet (insufficient abrasiveness, calcium or Vit D deficiencies, etc.), trauma, and neoplasia. Imaging techniques such as CT and cone-beam CT (CBCT) enable early detection and surgical planning, while traditional radiography remains useful in general practice. Treatment includes systemic antibiotics, surgical curettage, and the use of localized delivery systems such as antibiotic-impregnated polymethyl methacrylate (AIPMMA) beads. Adjunctive therapies like Manuka honey are also discussed. Two original heatmaps summarize bacterial prevalence and antimicrobial resistance from six peer-reviewed studies. These visualizations highlight the polymicrobial nature of these infections and the emergence of multidrug-resistant strains. Preventive strategies focus on optimal diet, regular dental checks, and owner education. The review also identifies key gaps in the literature, including the underreporting of anaerobes and lack of standardized treatment protocols. This article aims to support veterinary professionals in delivering evidence-based, individualized care to improve outcomes in rabbits with odontogenic abscesses. Full article

Proximal caries presents diagnostic and therapeutic challenges. Recent understanding of the etiology and pathology of dental caries has led to the adoption of non-invasive and/or minimally invasive approaches in the early stages of caries lesions. This clinical study aimed to compare the efficacy of resin infiltration and remineralization in the treatment of initial proximal caries lesions over a 1- and 2-year follow-up period. The study involved 47 patients aged between 18 and 38 years. Patients were clinically examined and underwent bitewing radiography to detect at least three initial proximal caries lesions. Each detected lesion (180 in total) was randomly assigned to one of three treatment groups: (1) resin infiltration with Icon Proximal Infiltrant (DMG); (2) remineralization with Clinpro White Varnish (3M); and (3) a control group receiving no treatment. One year after treatment, caries progression was found in 30 lesions (16.6%) with the following distribution across the three treatment groups: 2/60 (3%) in the infiltration group; 11/60 (18%) in the remineralization group; 17/60 (28.30%) in the no treatment control group with a significant statistical difference between the groups (p = 0.001). In terms of lesion depth, 12 (11%) out of 106 E2 lesions progressed and 18 out of 74 (24%) D1 lesions progressed, with a significant difference (p = 0.037). Two years after treatment, five new lesions were found to have progressed (one E2 and four D1), distributed as follows: 0% in the infiltration group, 3.6% in the remineralization group, and 5% in the control group. In conclusion, resin infiltration exhibited the lowest percentage of progressed lesions and could be considered a reliable, non-invasive treatment for initial proximal caries. Full article

Two-dimensional imaging is still commonly used in dentistry, but does not provide the three-dimensional information often required for the accurate assessment of dental structures. Photon-counting computed tomography (PCCT), a new three-dimensional modality mainly used in general medicine, has shown promising potential for dental applications. With growing digitalization and cross-disciplinary integration, using PCCT data from other medical fields is becoming increasingly relevant. Conventional CT scans, such as those of the cervical spine, have so far lacked the resolution to reliably evaluate dental structures or implants. This study evaluates the diagnostic utility of PCCT for visualizing peri-implant structures in routine clinical photon-counting CT acquisitions and assesses the influence of metal artifact reduction (MAR) algorithms on image quality. Ten dental implants were retrospectively included in this IRB-approved study. Standard PCCT scans were reconstructed at multiple keV levels with and without MAR. Quantitative image analysis was performed with respect to contrast and image noise. Qualitative evaluation of peri-implant tissues, implant shoulder, and apex was performed independently by two experienced dental professionals using a five-point Likert scale. Inter-reader agreement was measured using intraclass correlation coefficients (ICCs). PCCT enabled high-resolution imaging of all peri-implant regions with excellent inter-reader agreement (ICC > 0.75 for all structures). Non-MAR reconstructions consistently outperformed MAR reconstructions across all evaluated regions. MAR led to reduced clarity, particularly in immediate peri-implant areas, without significant benefit from energy level adjustments. All imaging protocols were deemed diagnostically acceptable. This is the first in vivo study demonstrating the feasibility of opportunistic dental diagnostics using PCCT in a clinical setting. While MAR reduces peripheral artifacts, it adversely affects image clarity near implants. PCCT offers excellent image quality for peri-implant assessments and enables incidental detection of dental pathologies without additional radiation exposure. PCCT opens new possibilities for opportunistic, three-dimensional dental diagnostics during non-dental CT scans, potentially enabling earlier detection of clinically significant pathologies. Full article

This study aimed to demonstrate the Convolutional Neural Network (CNN) algorithm’s efficiency in detecting alveolar bone loss using panoramic radiographs. The comparison was evaluated among 1874 pictures retrieved from an institution, from which the training set included 953 showing bone loss and 921 normal cases. A confusion matrix was performed for statistical analysis. The CNN method correctly identified 92 out of 100 bone loss cases and 89 out of 100 healthy cases. The model showed a sensitivity of 0.8327, a specificity of 0.8683, a precision of 0.8918, an accuracy of 0.8927, and an F1 score of 0.8615 in detecting bone loss. This study concluded that a faster CNN model may be used as an adjuvant technique to diagnose periodontal disease and alveolar bone loss using dental panoramic radiography images, thereby minimizing diagnostic effort, and saving assessment time. However, the execution of precisely detecting periodontal cases by fully automated AI models using panoramic radiographs appears imminent and needs clinical periodontal evaluation for definitive diagnosis. The suitability of this approach is supported by the sensitivity, specificity, accuracy, and F-measure, which showed satisfactory performance for classifying cases. Based on population and periodontal disease burden standpoint, the use of AI in diagnosing periodontal diseases may serve as an excellent surveillance method to classify alveolar bone loss. Monitoring a periodontal patient after treatment needs a wide area to cover by AI-based diagnostic modality. With AI as the future of dentistry, performance-based clinical usage of CNN models demands confirmed practical application by dentists. Full article

(1) Background: Advancements in dental imaging technologies have significantly transformed diagnostic and surgical practices. The integration of cone beam computed tomography (CBCT), artificial intelligence (AI), augmented reality (AR), and virtual reality (VR) is enhancing clinical precision, streamlining workflows, and redefining dental education. This review examines the evolution, applications, and future potential of these technologies in modern dental practice. (2) Methods: A narrative literature review was conducted, synthesizing findings from recent studies on digital radiography, CBCT, AI-assisted diagnostics, 3D imaging, and involving simulation tools (AR/VR). Peer-reviewed journal articles, systematic reviews, and clinical studies were analyzed to explore their impact on diagnosis, treatment planning, surgical execution, and training. (3) Results: Digital and 3D imaging modalities have improved diagnostic accuracy and reduced radiation exposure. AI applications enhance image interpretation, automate clinical tasks, and support treatment simulations. AR and VR technologies provide involved, competency-based surgical training and real-time intraoperative guidance. Integrating 3D printing and portable imaging expands accessibility and personalization in care delivery. (4) Conclusions: The integration of CBCT, AI, AR, and VR represents a paradigm shift in dentistry, elevating precision, efficiency, and patient outcomes. Continued research, standardization, and ethical practice will be essential for widespread adoption and maximizing clinical benefits. Full article

Background/Objectives: Panoramic radiography (PANO) is widely utilized for routine dental examinations, as a single PANO image captures most anatomical structures and clinical findings, enabling an initial assessment of overall dental health. Dentists rely on PANO images to enhance clinical diagnosis and inform treatment planning. With the advancement of artificial intelligence (AI), the integration of clinical data and AI-driven analysis presents significant potential for supporting medical applications. Methods: The proposed method focuses on the segmentation and localization of impacted third molars in PANO images, incorporating Sobel edge detection and enhancement methods to improve feature extraction. A convolutional neural network (CNN) was subsequently trained to develop an automated impacted tooth detection system. Results: Experimental results demonstrated that the trained CNN achieved an accuracy of 84.48% without image preprocessing and enhancement. Following the application of the proposed preprocessing and enhancement methods, the detection accuracy improved significantly to 98.66%. This substantial increase confirmed the effectiveness of the image preprocessing and enhancement strategies proposed in this study. Compared to existing methods, which achieve approximately 90% accuracy, the proposed approach represents a notable improvement. Furthermore, the entire process, from inputting a raw PANO image to completing the detection, takes only 4.4 s. Conclusions: This system serves as a clinical decision support system for dentists and medical professionals, allowing them to focus more effectively on patient care and treatment planning. Full article

Interdisciplinary decision-making significantly influences both the therapeutic potential and clinical outcomes, shaping clinical attitudes and management strategies. As the integration between endodontic and restorative-prosthetic considerations becomes increasingly prevalent, it is essential to understand how different dental specialists, particularly general dental practitioners, prosthodontists and endodontists, approach clinical decision-making and collaborate to optimize patient care. Objectives: This study aims to identify practice disparities in post-endodontic crown placement to inform national policy reforms, including standardised timing protocols and interdisciplinary referral criteria. Methods: A structured questionnaire was distributed to dentists practicing in Romania, yielding 238 collected responses. Results: Substantial variability was found in clinical approaches: diagnostic imaging preferences indicated frequent use of periapical radiography (83.49%) and CBCT (53.67%). Over 70% expressed high confidence in CBCT’s diagnostic precision, significantly higher than periapical radiography (Wilcoxon Signed-Rank test, p < 0.00001). A statistically significant majority (69.3%, binomial test, p < 0.001) preferred delaying definitive crown placement until radiographic healing of periapical lesions. Logistic regression analysis showed endodontists were significantly less likely to choose invasive treatments compared to other specialists (p = 0.027). Although clinicians widely recognize the significance of prosthetic planning, its early integration into the overall treatment strategy has been inconsistent. Conclusions: This study points out the necessity for standardised guidelines that clearly integrate prosthetic planning into endodontic decision-making, enhancing predictability and tooth preservation. Full article

In the dentistry field, dental caries is a common issue affecting all age groups. The presence of dental braces and dental restoration makes the detection of caries more challenging. Traditionally, dentists rely on visual examinations to diagnose caries under restoration and dental braces, which can be prone to errors and are time-consuming. This study proposes an innovative deep learning and image processing-based approach for automated caries detection under restoration and dental braces, aiming to reduce the clinical burden on dental practitioners. The contributions of this research are summarized as follows: (1) YOLOv8 was employed to detect individual teeth in bitewing radiographs, and a rotation-aware segmentation method was introduced to handle angular variations in BW. The method achieved a sensitivity of 99.40% and a recall of 98.5%. (2) Using the original unprocessed images, AlexNet achieved an accuracy of 95.83% for detecting caries under restoration and dental braces. By incorporating the image processing techniques developed in this study, the accuracy of Inception-v3 improved to a maximum of 99.17%, representing a 3.34% increase over the baseline. (3) In clinical evaluation scenarios, the proposed AlexNet-based model achieved a specificity of 99.94% for non-caries cases and a precision of 99.99% for detecting caries under restoration and dental braces. All datasets used in this study were obtained with IRB approval (certificate number: 02002030B0). A total of 505 bitewing radiographs were collected from Chang Gung Memorial Hospital in Taoyuan, Taiwan. Patients with a history of the human immunodeficiency virus (HIV) were excluded from the dataset. The proposed system effectively identifies caries under restoration and dental braces, strengthens the dentist–patient relationship, and reduces dentist time during clinical consultations. Full article

Background/Objectives: Digital transformation is reshaping dentistry by improving clinical efficiency, diagnostic accuracy, and patient care. However, the adoption of digital technologies in dental clinics varies widely, influenced by multiple factors, including technology readiness. This study aimed to assess the relationship between technology readiness and digital technology adoption among German dentists, focusing on the impact of clinic characteristics and professional development. Methods: A cross-sectional survey was conducted among 200 licensed German dentists. Technology readiness was measured using the validated Technology Readiness Index (TRI 2.0), encompassing four dimensions: optimism, innovativeness, discomfort, and insecurity. Data on the current use of digital technologies were collected, including digital radiography, CAD/CAM systems, AI-supported tools, and patient management solutions. Statistical analyses included correlation and quartile-based comparisons to identify patterns and significant associations. Results: Clinics with higher TRI scores demonstrated significantly greater adoption of digital technologies. Larger clinics (MVZs) showed higher levels of digital integration compared to solo practices. Younger dentists and those engaged in continuous professional development exhibited higher technology readiness and usage of advanced digital tools. No significant gender-based differences were identified in technology readiness or digital adoption. While basic technologies like digital radiography and CAD/CAM systems were widely used, AI-based diagnostics and 3D printing remained underutilized. Key barriers included financial constraints and limited training opportunities. Conclusions: Technology readiness plays a critical role in shaping digital adoption in dental clinics. The findings highlight the need for targeted support, especially for smaller clinics, through professional training and investment in digital infrastructure. This study contributes to a better understanding of digital transformation in dentistry and supports strategies aligned with global health goals to improve access to digital care. Full article

Background/Objectives: Rectangular collimation (RC) reduces patient radiation exposure but is uncommonly used due to cone-cut concerns. An audit at a dental practice was conducted to analyze impact of RC on the quality of intraoral radiographs. Methods: Four X-ray tubes with RC were used. 360 intraoral X-rays were collected, blinded and scored to pre-set qualitative criteria: maximum 14 points for bitewing radiographs (BWs), and 13 for periapical radiographs (PAs). Quality of the X-rays was assessed. Results: We found that 48.1% were acceptable, 32.5% were unacceptable and only 19.4% were good X-rays. The loss of image quality was unrelated to RC. Three cone-cuts occurred in PAs without RC. The mean scores for PAs performed without or with RC were as follows: 9.3 ± 1.9 points and 9.6 ± 1.9 points, respectively (p = 0.166). The mean scores for BWs performed without or with RC were as follows: 8.0 ± 1.9 points and 7.1 ± 1.9 points, respectively (p < 0.001). All scores declined over time. Conclusions: This audit highlighted the need for refresher training on film-holder use and the importance of regular maintenance of dental X-ray equipment. Decline in X-ray quality over time was related to wear and tear of X-ray equipment, incorrect image contrast, and technical errors unrelated to RC. No cone-cuts occurred when using RC. Full article

Background and Clinical Significance: Dental implants are widely used; however, tooth extraction often results in alveolar bone loss and gingival recession, necessitating bone and connective tissue reconstruction, especially in the esthetic anterior regions. To address these issues, implants are occasionally connected to adjacent teeth, but this remains controversial, as complications (e.g., intrusion of natural teeth) have been observed. This report demonstrates the long-term success of implants replaced after removing maxillary bilateral central incisors and connecting them to lateral incisors with reduced supportive bone due to periodontitis. Case Presentation: A 57-year-old woman with root fractures in maxillary bilateral central incisors, periodontitis, and malocclusion was treated with connecting implants and natural teeth. Bone levels surrounding maxillary bilateral lateral incisors were diminished due to root fractures in adjacent central incisors and periodontitis. After initial periodontal therapy, hopeless maxillary central incisors were extracted, replaced with implants using a digitally simulated surgical guide, and guided bone regeneration and connective tissue grafting were performed. Implants were connected to lateral incisors with provisional restorations, and orthodontic treatment was initiated following digital set-ups incorporating implants into the overall strategy. Final porcelain-fused-to-zirconia restorations were placed after orthodontic treatment. At the 5-year follow-up, gingival morphology, coloration, and position of lateral incisors remained stable. Conclusions: This case demonstrates that connecting implants to natural teeth in the anterior region can effectively maintain periodontal tissues around natural teeth and allow for minimally invasive, short-term, and esthetic treatment. However, careful long-term observation through maintenance is necessary due to limited evidence for this approach in the anterior region. Full article