Search Results (32)

Background/Objectives: Accurate scientific methods are essential for monitoring the osseointegration of dental implants postoperatively. This study aims to evaluate peri-implant bone changes using the fractal analysis (FA) method during follow-up. Methods: Periapical radiographs were obtained from 77 patients with dental implants, and 33 permanent teeth serving as a control group, retrieved from the radiology archive. Radiographs were taken using the parallel technique at 3, 6, and 12 months post-surgery. All images were digitized and saved in TIFF. Each image was aligned using the TurboReg plugin in ImageJ software. Regions of interest (ROIs) were selected from the mesial and distal aspects of the implants, then prepared for fractal analysis. FA was performed to assess changes in bone structure over time. Results: In the study group, radiographs of 24 patients for 0, 3 and 6 month, radiographs of 34 patients for 0, 6 and 12 month, radiographs of 8 patients for 0 and 12 month, radiographs of 5 patients for 0 and 3 month, radiographs of 5 patients for 0 and 6 month, and 1 patient of 0, 3, 6 and 12 month of radiographs were used in the study. There were no statistically significant differences in FA values over time when analyzed by gender and age in both the study and control groups. However, a statistically significant difference was observed in FA value changes over time and jaws. Conclusions: The study indicates a positive correlation between bone remodeling over time and FA results, likely due to the restoration of masticatory forces in the implant area. Image analysis on two-dimensional dental radiographs can be a useful tool for detecting changes in bone density. Fractal analysis is a cost-effective and practical diagnostic method for monitoring bone changes over time. 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

Background/Objectives: Accurate localization of fractured endodontic instruments (FEIs) in periapical radiographs (PAs) remains a significant challenge. This study aimed to evaluate the performance of YOLOv8 and Mask R-CNN in detecting FEIs and root canal treatments (RCTs) and compare their diagnostic capabilities with those of experienced endodontists. Methods: A data set of 1050 annotated PAs was used. Mask R-CNN and YOLOv8 models were trained and evaluated for FEI and RCT detection. Metrics including accuracy, intersection over union (IoU), mean average precision at 0.5 IoU (mAP50), and inference time were analyzed. Observer agreement was assessed using inter-class correlation (ICC), and comparisons were made between AI predictions and human annotations. Results: YOLOv8 achieved an accuracy of 97.40%, a mAP50 of 98.9%, and an inference time of 14.6 ms, outperforming Mask R-CNN in speed and mAP50. Mask R-CNN demonstrated an accuracy of 98.21%, a mAP50 of 95%, and an inference time of 88.7 ms, excelling in detailed segmentation tasks. Comparative analysis revealed no statistically significant differences in diagnostic performance between the models and experienced endodontists. Conclusions: Both YOLOv8 and Mask R-CNN demonstrated high diagnostic accuracy and reliability, comparable to experienced endodontists. YOLOv8’s rapid detection capabilities make it particularly suitable for real-time clinical applications, while Mask R-CNN excels in precise segmentation. This study establishes a strong foundation for integrating AI into dental diagnostics, offering innovative solutions to improve clinical outcomes. Future research should address data diversity and explore multimodal imaging for enhanced diagnostic capabilities. Full article

Background/Objectives: Our study aimed to determine the accuracy of the artificial intelligence-based Diagnocat system (DC) in detecting periapical lesions (PL) on panoramic radiographs (PRs). Methods: 616 teeth were selected from 357 panoramic radiographs, including 308 teeth with clearly visible periapical radiolucency and 308 without any periapical lesion. Three groups were generated: teeth with radiographic signs of caries (Group 1), teeth with coronal restoration (Group 2), and teeth with root canal filling (Group 3). The PRs were uploaded to the Diagnocat system for evaluation. The performance of the convolutional neural network in detecting PLs was assessed by its sensitivity, specificity, and positive and negative predictive values, as well as the diagnostic accuracy value. We investigated the possible effect of the palatoglossal air space (PGAS) on the evaluation of the AI tool. Results: DC identified periapical lesions in 240 (77.9%) cases out of the 308 teeth with PL and detected no PL in 68 (22.1%) teeth with PL. The AI-based system detected no PL in any of the groups without PL. The overall sensitivity, specificity, and diagnostic accuracy of DC were 0.78, 1.00, and 0.89, respectively. Considering these parameters for each group, Group 2 showed the highest values at 0.84, 1.00, and 0.95, respectively. Fisher’s Exact test showed that PGAS does not significantly affect (p = 1) the detection of PL in the upper teeth. The AI-based system showed lower probability values for detecting PL in the case of central incisors, wisdom teeth, and canines. The sensitivity and diagnostic accuracy of DC for detecting PL on canines showed lower values at 0.27 and 0.64, respectively. Conclusions: The CNN-based Diagnocat system can support the diagnosis of PL on PRs and serves as a decision-support tool during radiographic assessments. Full article

Background/Objectives: This study aims to evaluate the accuracy of digital dental radiography in determining working length in root canal treatment via various image modules. Methods: A total of 40 intact single-rooted, single-canal human premolar teeth were examined. Following meticulous cleaning, the teeth were placed in a maxillary premolar socket within a dry human skull. X-ray images were systematically captured via a Carestream RVG digital sensor under standardized conditions. The digital images are processed under five distinct image modules: 1. original module, 2. autoenhancement module, 3. autoenhancement+negative module, 4. negative module, 5. colored module. Three calibrated observers determined the working length of each digital radiograph after the specified image modules were applied. The agreement between the actual working length and the lengths determined by the observers was evaluated via Pearson correlation analysis. A significance level of 0.05 was set for the statistical tests. Results: A high level of intra- and interobserver agreement, with a strong correlation between the actual measurements and all image module groups, was obtained (p < 0.001). The original image module group demonstrated the highest compatibility (ICC = 0.940, r = 0.912), whereas the colored image module group exhibited the lowest compatibility (ICC = 0.924, r = 0.879) with the actual measurement. Conclusions: This study demonstrates the accuracy of digital radiography in determining working length through the application of various image modules, with the original image module exhibiting the closest alignment to actual working lengths. These findings support the continued use and further development of computer-based image processing tools to optimize clinical outcomes in root canal therapy. Full article

Background: Cemento-osseous dysplasias (CODs) are rare lesions of the jawbone. Their occurrence, localization, type, size, and shape can vary between cases. This fibro-osseous lesion is typically found in the jaw near tooth-bearing areas and is often asymptomatic, discovered incidentally, and may be associated with the periapical region of the teeth. In rare cases, COD can lead to secondary bone osteomyelitis. Currently, there is limited information in the literature on the occurrence and characteristics of COD. This paper’s main aim was to focus on the authors’ COD experience in the lower Silesian area. Methods: A retrospective evaluation of radiographies (RTG-Panx, cone-beam computed tomography (CBCT)) was conducted on patients treated, diagnosed, or consulted by the authors. A statistical correlation analysis was made to establish any relationship within the gathered data. Results: COD is predominantly an incidental finding in the mandibular bone near tooth apices. It is most commonly diagnosed in females. Both CBCT and panoramic radiographies are generally sufficient for diagnosing the lesion. COD rarely requires treatment. Conclusions: COD lesions are mostly discovered incidentally during routine radiographies or cone-beam computed tomography (CBCT) scans. In most cases, clinical and radiological monitoring is sufficient, along with evaluating the teeth’s response to cold stimuli and assessing the surrounding bone structures. Biopsies or tooth extractions are seldom necessary. When oral hygiene is well-maintained and no periapical inflammation is present, COD lesions typically remain asymptomatic. Full article

Periapical radiography is a regular radiographic procedure performed by dentists. However, at times, it may not be possible to position the image receptor into a patient’s mouth in an optimized or practical way. For these cases, some dentists advocated the use of extraoral periapical radiography (EOPA). This literature review aimed to review the dental literature on the use of EOPA. In October 2023, PubMed, Web of Science, and Scopus were searched to identify papers that reported on the use of EOPA, supplemented by manual reference tracing and Google Scholar searches. After screening, 18 papers published between 2003 and 2022 were identified, including 14 original articles and 4 reviews. From very limited and conflicting evidence, it was found that root length/working length measurements between EOPA and IOPA did not significantly differ or EOPA showed inferiority. No data were available to compare EOPA with other extraoral modalities such as panoramic radiography. The technique used in EOPA to visualize posterior teeth in the maxilla and mandible varied across studies, such as the vertical angulation of the primary beam, whether mouth should be opened or closed, and whether a holder should be used or not. At the current time, EOPA probably should not be advocated for regular use. Full article

(1) Background: In this study, the efficacy of cone-beam computed tomography (CBCT) in detecting dental posts was compared to periapical radiography. (2) Methods: A retrospective evaluation of 53 patients’ periapical radiographs and CBCT images was performed. The presence and type of the intra-canal dental post were initially determined on the periapical images (PA) radiographs’ examination and were then compared to the observer’s ability to detect the dental post on a CBCT image. The effect of the post’s type (metal cast or prefabricated) on its detection on CBCT images was determined. (3) Results: 10.5% of teeth that were identified as having a post on a PA radiograph were not identified as having a post on the CBCT examination (p < 0.05). Approximately 17.6% of teeth that were identified as not having a post on a PA radiograph were identified as having a post on the CBCT examination (p < 0.05). Moreover, 16.3% and 50% of teeth with a prefabricated or cast posts on PA radiographs were falsely identified on the CBCT examination, respectively (p < 0.05). (4) Conclusions: A CBCT image is an insufficient tool for the identification of metal prefabricated and cast posts. A PA image is the recommended radiographic tool for achieving information about the post-endodontic restoration status of teeth candidates for endodontic retreatment in patients with a former CBCT scan. Full article

Background/Objectives: Periapical lesions (PLs) are frequently detected in dental radiology. Accurate diagnosis of these lesions is essential for proper treatment planning. Imaging techniques such as orthopantomogram (OPG) and cone-beam CT (CBCT) imaging are used to identify PLs. The aim of this study was to assess the diagnostic accuracy of artificial intelligence (AI) software Diagnocat for PL detection in OPG and CBCT images. Methods: The study included 49 patients, totaling 1223 teeth. Both OPG and CBCT images were analyzed by AI software and by three experienced clinicians. All the images were obtained in one patient cohort, and findings were compared to the consensus of human readers using CBCT. The AI’s diagnostic accuracy was compared to a reference method, calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and F1 score. Results: The AI’s sensitivity for OPG images was 33.33% with an F1 score of 32.73%. For CBCT images, the AI’s sensitivity was 77.78% with an F1 score of 84.00%. The AI’s specificity was over 98% for both OPG and CBCT images. Conclusions: The AI demonstrated high sensitivity and high specificity in detecting PLs in CBCT images but lower sensitivity in OPG images. Full article

Introduction: Periapical lesions of teeth are typically evaluated using periapical X-rays (PA) or cone-beam computer tomography (CBCT); however, ultrasound imaging (US) can also be used to detect bone defects. A comparative analysis is necessary to establish the diagnostic accuracy of US for the detection of periapical lesions in comparison with PA and CBCT. Objectives: This study aimed to evaluate and compare the measurement precision of US against PA and CBCT in detecting periapical lesions. Methods: This study included 43 maxillary and mandibular teeth with periapical lesions. All teeth were examined clinically, radiographically, and ultrasonographically. Observers evaluated and measured the periapical lesions on CBCT, PA, and US images. Results: The comparison of lesion size showed that it differs significantly between the different methods of examination. A statistically significant difference was found between CBCT and US (mean difference = 0.99 mm, 95% CI [0.43–1.55]), as well as between CBCT and PA (mean difference = 0.61 mm, 95% CI [0.17–1.05]). No difference was found between the US and PA methods (p = 0.193). Conclusion: US cannot replace PA radiography in detecting pathologies but it can accurately measure and characterize periapical lesions with minimal radiation exposure. CBCT is the most precise and radiation-intensive method so it should only be used for complex cases. Full article

Objective: The objective of this study was to evaluate the effects of keratinized mucosa width (KMW) and mucosal thickness (MT) around dental implants on marginal bone loss (MBL). The evaluation was performed one year after loading by comparing clinical, radiographic, and biochemical parameters. Methods: The study included 87 implants in 87 patients undergoing regular follow-ups without hard or soft tissue augmentation one year after loading. Clinical measurements included plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), KMW, and MT. MBL was assessed with periapical radiography. The peri-implant crevicular fluid (PICF) was analyzed for tumor necrosis factor-alpha (TNF-α), receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG), and microRNA-27a. Results: The MBL of implants with thin MT (<2 mm) was higher than that of implants with thick MT (≥2 mm) (p < 0.05). A significant negative correlation (r: −0.217) was established between MT and MBL. No significant association was found between KMW and MBL (p > 0.05). No significant associations was found between KMW and MT with TNF-α, RANKL, OPG and RANKL/OPG (p > 0.05), with the exception of increased microRNA-27a levels in implants with KMW ≥ 2 mm (p < 0.05). Conclusions: Implants with a thick MT had a lower MBL. There may be an association between adequate KMW and high miRNA-27a levels. The relationship between MBL and miRNA-27a remains unclear. Full article

Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of “Definitely present”. The data suggested that CBCT outperformed PR when using a less stringent criterion (“Definitely present” or “Probably present”), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong’s test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients. Full article

(1) Background: We aimed to identify factors associated with the presence of apical lesions (AL) in panoramic radiographs and to evaluate the predictive value of the identified factors. (2) Methodology: Panoramic radiographs from 1071 patients (age: 11–93 a, mean: 50.6 a ± 19.7 a) with 27,532 teeth were included. Each radiograph was independently assessed by five experienced dentists for AL. A range of shallow machine learning algorithms (logistic regression, k-nearest neighbor, decision tree, random forest, support vector machine, adaptive and gradient boosting) were employed to identify factors at both the patient and tooth level associated with AL and to predict AL. (3) Results: AL were detected in 522 patients (48.7%) and 1133 teeth (4.1%), whereas males showed a significantly higher prevalence than females (52.5%/44.8%; p < 0.05). Logistic regression found that an existing root canal treatment was the most important risk factor (adjusted Odds Ratio 16.89; 95% CI: 13.98–20.41), followed by the tooth type ‘molar’ (2.54; 2.1–3.08) and the restoration with a crown (2.1; 1.67–2.63). Associations between factors and AL were stronger and accuracy higher when using fewer complex models like decision tree (F1 score: 0.9 (0.89–0.9)). (4) Conclusions: The presence of AL was higher in root-canal treated teeth, those with crowns and molars. More complex machine learning models did not outperform less-complex ones. Full article

The elimination of necrotic and inflamed pulp tissue, dentin debris, and microorganisms is essential for the success of endodontic treatment. However, the root canal’s complexity has led to incomplete cleaning and disinfection. This study aims to compare the efficacy of the penetrability of three different irrigation activating techniques to the apical third of the root canal. Sixty sound single-rooted human mandibular premolars are prepared with rotary instrumentation under continuous sodium hypochlorite irrigation. Three irrigation activation techniques are utilized: group 1 (n = 20), conventional needle irrigation (CN); group 2 (n = 20), side-vented endodontic needle irrigation (EN); and group 3 (n = 20), manual activation irrigation with gutta-percha cone (MA). The penetrability is assessed with the aid of a radiopaque irrigation solution using digital radiography in conjunction with cone-beam computed tomographic (CBCT) measurements. Data are analyzed using a statistical package for social sciences (SPSS), using multiple comparisons to compare the baseline and test values. One-way analysis of variance with post hoc analysis (Tukey honestly significant difference) is performed to detect the statistically significant differences between groups. Manual activation (MA) shows effective delivery of the irrigant into full WL, followed by endodontic needle (EN) and conventional (CN) methods of activation (p < 0.001). The results of the present study show that maximum penetrability of the irrigant is observed with manual activation (MA) using a gutta cone in comparison with the conventional needle (CN). Full article

Oral health screening is important for maintaining and improving quality of life. The present study aimed to determine whether patients with a certain level of alveolar bone resorption could be screened by salivary bacterial test along with their background information. Saliva samples were collected from 977 Japanese patients, and the counts of each red-complex, that is, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, were measured using quantitative polymerase chain reaction analysis. Mean bone crest levels (BCLs) were measured using a full-mouth periapical radiograph. Multiple logistic regression analysis was used to determine associations between BCLs (1.5–4.0 mm in 0.5 mm increments) and explanatory variables, such as the number of each red-complex bacteria and the patients’ age, sex, number of teeth, stimulated saliva volume, and smoking habits. When the cutoff BCL value was set at 3.0 mm, the area under the curve, sensitivity, and specificity values were optimal at 0.86, 0.82, and 0.76, respectively. In addition, all tested explanatory variables, except sex and T. denticola count, were significantly associated with BCLs according to a likelihood ratio test (p < 0.05). Additionally, the odds ratio (OR) was substantially increased when a patient was >40 years old and the bacterial count of P. gingivalis was >10⁷ cells/µL (OR: >6). Thus, P. gingivalis count and patients’ background information were significantly associated with the presence of a certain amount of bone resorption, suggesting that it may be possible to screen bone resorption without the need for radiography or oral examination. Full article