Artificial intelligence (A.I.) in dental curricula: Ethics and responsible integration.

The use of artificial intelligence (AI) is deeply embedded in all aspects of our daily lives, promoting efficiency and safety in routine tasks at home and work. Likewise, dentistry is rapidly exploring new uses of AI for image analysis, electronic health records, and clinical decision-making. The accelerating advancement of AI and its application in dentistry demands dental education conscientiously integrate AI into curricula and equip graduates to use it ethically and responsibly in practice. The approach must be threefold: instill knowledge of the basic algorithms and appropriate application of AI, discuss its limitations/biases, and examine current and potential ethical challenges in practice. Furthermore, dental education must protect the public from intentional and unintentional harm introduced by AI. Therefore, the purpose of this perspective paper is to discuss various considerations for integrating AI into the dental curriculum, prioritizing patient safety by ensuring knowledgeable, safe, and ethical application by future providers.

Orthognathic surgery effects on temporomandibular joint compressive stresses.

INTRODUCTION: This study tested orthognathic surgery effects on temporomandibular joint (TMJ) compressive stresses. METHODS: Pre- (T1) and post-surgery (T2) cone-beam computed tomography images were collected from consenting subjects aged ≥15 years. Anatomical data were used to measure surgical changes in anteroposterior mandibular position and occlusal plane angle (FH-OP), estimate condylar loading areas (mm2 ) and calculate T1 and T2 TMJ and jaw muscle forces (N) during canine biting via numerical modelling. Analysis of covariance tested for sex and biting angle differences in T2 - T1 TMJ compressive stresses (TMJ force/loading area, MPa). Principal component analyses identified jaw muscle forces that accounted for changes in T2 - T1 TMJ loads. Regression analyses tested the correlations between surgical changes in mandibular position, FH-OP, TMJ loads and muscle forces. RESULTS: Of 148 cases screened, 28 females and 16 males provided complete records. Condylar loading areas were significantly smaller (P = .024) for females vs males (124 ± 5 vs 144 ± 7 mm2 ). T2 - T1 differences in TMJ compressive stresses varied by surgical change, biting angle and sex. Overall, the largest increases in TMJ compressive stresses post-surgery were for females with mandibular setbacks where FH-OP angle decreased. T2 - T1 changes in jaw muscle forces had moderate (ipsilateral, λ = 4.59; η2 = 0.071) to large (contralateral, λ = 1.49; η2 = 0.31) effects on TMJ loads. CONCLUSIONS: T2 - T1 differences in TMJ compressive stresses during canine biting were affected by surgical changes in mandibular position and occlusal plane angle, biting angle and sex. Surgical changes altered jaw muscle forces for the same biting conditions and, thus, affected TMJ loads and compressive stresses.

Three-Dimensional Assessment of Cervical Vertebrae Anomalies in Patients With Cleft Lip and Palate.

OBJECTIVE: To evaluate the occurrence of cervical vertebrae anomalies (CVA) in patients with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) using cone beam computed tomography (CBCT) examinations. DESIGN: Retrospective assessment of CBCT images. Descriptive statistics were calculated. Fisher exact test or χ2 test was performed to evaluate the differences among each CVA between sex and type of cleft. SETTING: School of Dentistry. PARTICIPANTS: One hundred fifty-one patients with cleft lip and palate (103 UCLP/48 BCLP). INTERVENTIONS: No relevant intervention. MAIN OUTCOME MEASURES: Cone beam computed tomography images were assessed for the presence or absence of 12 most commonly observed CVA: spina bifida, dehiscence, cleft of the posterior arch, cleft of the anterior arch, fusion between cervical vertebrae, block fusion, occipitalization, narrowing of the intervertebral space, posterior ponticle, os odontoideum, ossiculum terminale, and subdental cartilaginous remnants. RESULTS: The presence of subdental cartilaginous remnants was the most frequently observed alteration-found in 81.45% of the sample-and it was the only CVA with statistically significant frequencies in the individuals with BCLP. Considering only the other CVA, 22.51% presented 1 and 5.29% presented 2 or more CVA. CONCLUSIONS: Patients with cleft lip and palate may present an overall high incidence of CVAs. However, when comparing the distribution of the CVAs among sex and types of cleft, the only significant difference noted was a higher incidence of subdental cartilaginous remnants among patients with BCLP.

Variations in pulp volume between normotensive and hypertensive individuals on CBCT imaging.

OBJECTIVES: To compare the pulp volume of individuals with altered and normal systemic blood pressure (BP) in order to verify if high BP promotes dimensional modifications in the pulp space. MATERIALS AND METHODS: Cone beam computed tomography scans of 91 patients (49 females and 42 males, mean age 31.7 ± 6.38 years) who had a healthy maxillary canine were selected. Values of arterial BP measured at two dental visits were used to classify the sample as normal BP (< 130 × 80 mmHg) and altered BP (≥ 130 × 80 mmHg); 49 patients had normal BP and 42 had altered BP. One oral radiologist evaluated each patient's pulp and tooth volumes, using semi-automatic segmentation, and the tooth length. Data were submitted to Student's t test and logistic regression, with a significance level of 5% (p < 0.05). RESULTS: Pulp volume (p = 0.0027), pulp volume/tooth volume (p = 0.0013), and pulp volume/tooth length (p = 0.0007) ratios were greater in the altered BP group. Conversely, there was no difference in tooth volume between the groups (p = 0.0697). A logistic regression model (p = 0.0002) using pulp volume and age enabled the development of a formula for predicting altered BP, with 68% accuracy. CONCLUSIONS: Individuals with altered systemic BP have greater pulp volumes than those with normal BP. The formula developed in this study may indicate the presence of altered BP. CLINICAL RELEVANCE: As arterial hypertension is a silent disease that produces no warning signs or symptoms, identification of modifications in the pulp volume in cone beam computed tomography scans may be an adjuvant sign of the diagnosis of this disease.

Assessment of the Influence of Different Intracanal Materials on the Detection of Root Fracture in Birooted Teeth by Cone-beam Computed Tomography.

INTRODUCTION: The aim of this study was to assess 2 cone-beam computed tomographic systems on the detection of artificially induced vertical root fractures (VRFs) and artifact intensity using birooted teeth restored with different intracanal materials. METHODS: The sample consisted of 20 extracted birooted premolars. Root fracture was induced in half of the sample. Seven intracanal material combinations were used in each tooth, 1 at a time: unrestored, gutta-percha, a buccal root with gutta-percha and a lingual root with a fiberglass post, a buccal root with gutta-percha and a lingual root with a metal core fiberglass post, fiberglass posts, metal core fiberglass posts, and NiCr posts. Cone-beam computed tomographic scans were acquired using CS 9000 3D (Carestream Dental Rochester, NY) and OP300 (Instrumentarium Dental Inc, Tuusula, Finland) units. Exposure parameters were fixed at 90 kV and 8 mA. The voxel size and field of view were set at 0.085 mm and 5 × 5 cm for OP300 and 0.076 mm and 5 × 3.75 cm for CS 9000, respectively. Two observers assessed all images using a 5-point confidence scale for VRF detection and a 4-point score for artifact interference. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were compared using 2-way analysis of variance and the Tukey test (α = 0.05). Artifact interference was evaluated by descriptive statistics and the chi-square test. RESULTS: There were significant differences between scanners (P > .05) and among the different intracanal material groups (OP300) (P < .05) for specificity. When a metal post was present in both roots, severe artifact interference was observed in all images. CONCLUSIONS: CS 9000 3D presented better performance than OP300 on VRF detection of endodontically treated teeth. Unrestored teeth and teeth filled with fiberglass posts were considered the groups with the lowest artifact interference and the highest VRF detection results.

Accuracy of Presurgical Limited Field of View Cone-beam Computed Tomography in Predicting Intraoperative Buccal Cortical Bone.

INTRODUCTION: Limited field of view cone-beam computed tomography (LFOV CBCT) is the primary imaging modality recommended for treatment planning before endodontic microsurgery (EMS). Persistent apical periodontitis, often treated with EMS, results in changes in the buccal cortical plate that may detrimentally impact prognosis. The accuracy of a preoperative LFOV CBCT to predict intraoperative findings is unclear. METHODS: Electronic health records (EHRs) of EMS performed at 2 endodontic offices between 2016 and 2018 were reviewed retrospectively. EHR data extracted were documented for surgical findings of intact buccal cortical plate, fenestration, dehiscence, and height of remaining buccal collar of bone. Two calibrated, independent reviewers evaluated presurgical LFOV CBCTs in the multiplanar paraxial and parasagittal planes at 2 different reconstructed viewing plane thicknesses. Reviewer findings were compared with EHR documentation. Data were analyzed by using χ2, logistic regression, and multivariable analysis. Significance was set at P < .05. RESULTS: Within the 125 EMS cases included in the study, the EHR prevalence of intact buccal cortical plate was 49%, dehiscence 7%, and fenestration 44%. The imaging predictive value, whether it was negative (NPV) or positive (PPV), was higher when predicting presence of buccal bone (PPV of intact buccal cortical plate = 86.5%; NPV of dehiscence = 96%; NPV of fenestration = 89%). Sensitivity and specificity ranged from 80%-90%. Accuracy in prediction was high for all variables, exceeding 80%. Accuracy was not significantly influenced by reconstructed viewing slice thickness, viewing plane, or reviewer. CONCLUSION: Preoperative LFOV CBCT was highly discriminatory and accurately predicted intraoperative buccal cortical bone status, especially intact buccal cortical plate and fenestration.

Assessment of Cone-beam Computed Tomographic Artifacts from Different Intracanal Materials on Birooted Teeth.

INTRODUCTION: This study quantitatively evaluated the type and amount of image artifacts generated by different intracanal materials in birooted teeth scanned at different exposure parameters. METHODS: The sample consisted of 15 birooted premolars. Seven different intracanal material combinations were used in each tooth one at a time: (1) roots without intracanal materials, (2) roots with gutta-percha, (3) a buccal root with gutta-percha and a lingual root with a fiberglass post, (4) a buccal root with gutta-percha and a lingual root with a metal core fiberglass post, (5) buccal and lingual roots with fiberglass posts, (6) buccal and lingual roots with metal core fiberglass posts, and (7) buccal and lingual roots with NiCr metal posts. Cone-beam computed tomographic scans were acquired using a CS 9000 unit (Carestream Dental, Atlanta, GA). An image of each tooth was captured under 5 exposure parameters: 2.5, 4, 6.3, 8, and 12 mA. The voxel size, field of view, and tube voltage were fixed at 0.076 mm, 5 × 3.75 cm, and 75 kV. We assessed each artifact quantitatively using ImageJ's threshold tool (National Institutes of Health, Bethesda, MD) to determine the hypodense and hyperdense artifact areas within 8-bit images extracted from the scans. All analyses were conducted with a 95% confidence level (α <0.05). RESULTS: The inferential analysis showed that roots filled with metal posts presented the highest amount of hypodense and hyperdense artifacts, whereas fiberglass post in both roots presented fewer artifacts. All materials presented more hypodense than hyperdense artifact formation. Overall, the low-exposure settings presented fewer artifacts and higher values of preserved dental images. CONCLUSIONS: Low-exposure protocols and fiberglass posts presented fewer image artifacts in CBCT scans.

Buccal bifurcation cyst as an incidental finding in cone beam computed tomography scans / Cisto da bifurcação vestibular como um achado incidental em exames de tomografia computadorizada de feixe cônico

ABSTRACT Buccal bifurcation cyst is an unusual inflammatory odontogenic cyst of unknown etiology which occurs at the buccal region of the permanent mandibular first molars in children and adolescents aged 6-15 years old. The aim of this manuscript is to present two clinical cases of buccal bifurcation cyst incidentally detected in adolescents referred for tomographic exams (CBCT) as part of the treatment planning for the management of impacted mandibular molars. The first case is very interesting due to the proximity of the lesion to the inferior alveolar canal. In the second case the inferior alveolar canal was not in close proximity to the lesion, but in contact with the mesiobuccal root of the second molar. The diagnosis of Buccal bifurcation cyst is of utmost importance in order to avoid complications during surgical procedures. In addition, the present case reports have highlighted the importance for dental practitioners to be aware of the possibility of a buccal bifurcation cyst being present as an incidental finding in CBCT images, especially in young patients.

RESUMO O cisto da bifurcação vestibular é uma lesão odontogênica inflamatória, incomum e de etiologia desconhecida que ocorre na região vestibular de primeiros molares permanentes inferiores em crianças e adolescentes na faixa etária de 6-15 anos. O objetivo deste trabalho é apresentar dois casos clínicos de cisto da bifurcação vestibular detectados incidentalmente em imagens de tomografia computadorizada de feixe cônico de adolescentes, indicadas como parte do tratamento e avaliação de terceiros molares inferiores impactados. O primeiro caso relatado é bastante interessante devido à presença de cisto de bifurcação bucal ter proximidade com o canal mandibular. No segundo caso o canal alveolar inferior não estava próximo da lesão, mas em contato com a raiz mésio-vestibular do segundo molar. O diagnóstico da bifurcação vestibular é de grande relevância para evitar possíveis complicações durante a realização de cirurgias. Os casos relatados destacam a importância para os cirurgiões-dentistas estarem cientes da possibilidade de um Cisto da bifurcação vestibular estar presente como um achado incidental em imagens de tomografia computadorizada de feixe cônico, especialmente em pacientes jovens.

Mucoepidermoid carcinoma mimicking a mucocele (ranula) in the floor of the mouth.

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. The submandibular gland is rarely involved, about less than 10% of all other major salivary glands. We report a case of a 49-year-old female who presented with a mass on the left side of the floor of the mouth. She was complaining of neck pain for the last 2-3 days and had noticed the mass growing in size and becoming tender to palpation. There was no exacerbation of pain during eating, drinking, or opening of mouth. A multidetector CT scan was made. The radiographic examination revealed a mostly well-defined hypodense area suggestive of mucocele (ranula), which was thought to be corroborated by the clinical findings. The treatment of choice was the complete excision of the mucocele and the left submandibular salivary gland. The histopathological examination surprisingly revealed a low-grade MEC. No further treatment was recommended; however, a follow up was scheduled in 4 months. This atypical location of MEC in the floor of the mouth simulated the clinical and radiographic features of a mucocele. This case highlights the value and importance of using all the available diagnostic tools and modalities for optimal patient management, as the histopathological analysis played an important role to confirm the diagnosis.

Impact of cone-beam computed tomography scan mode on the diagnostic yield of chemically simulated external root resorption.

INTRODUCTION: The aim of this in-vitro study was to evaluate the influence of cone-beam computed tomography scans on the diagnosis of chemically simulated external root resorption. METHODS: One hundred extracted anterior teeth were selected. Subsurface demineralization was induced on a limited area of the apical third of the root of 49 teeth. Each tooth was placed in an empty socket of a partially edentulous dry mandible. Cone-beam computed tomography images were obtained according to 3 protocols: (1) half scan, 0.40-mm voxel size; (2) full scan, 0.40-mm voxel size; and (3) full scan, 0.125-mm voxel size. Three observers evaluated the images. Sensitivity, specificity, accuracy, and area under the curve were compared with the Cochran Q and Mann-Whitney U tests. RESULTS: Protocol 3 had the highest sensitivity (81.63%), accuracy (80.67%), and area under the curve (0.807). There were statistically significant differences between protocol 3 and the other 2 protocols (P <0.001). The specificity of protocol 1 (84.97%) was greater than that of protocols 2 (69.93%) and 3 (79.74%); however, a statistically significant difference was found only between protocols 1 and 2 (P = 0.005). CONCLUSIONS: A more dedicated, high-resolution scan should be acquired when one intends to investigate the early stage of external root resorption during orthodontic treatment. However, this does not imply that all orthodontic patients should be subjected to high-dose cone-beam computed tomography scans.

Expression of Membrane-Bound Mucins and p63 in Distinguishing Mucoepidermoid Carcinoma from Papillary Cystadenoma.

The aim of this study was to compare the immunoexpression of epithelial mucins (MUCs) in salivary duct cysts, papillary cystadenomas, and mucoepidermoid carcinomas and to evaluate if any of these markers could be useful for differentiating between mucoepidermoid carcinoma and papillary cystadenoma. We also sought to validate the p63 expression pattern found to differentiate between mucoepidermoid carcinoma and papillary cystadenoma. Immunoexpression of MUC1, MUC2, MUC4, MUC7, and p63 was studied and quantified in 22 mucoepidermoid carcinomas, 12 papillary cystadenomas, and 3 salivary duct cysts. The immunohistochemical evaluation was collectively performed by 3 oral pathologists. Scores and trends in proportions were assessed using the nonparametric Wilcoxon-Mann-Whitney rank sum test. Mucoepidermoid carcinomas, papillary cystadenomas, and salivary duct cysts demonstrated variable MUC expression patterns. All tumors were positive for p63 immunoexpression with p63 labeling in salivary duct cysts and papillary cystadenomas (15/15) limited to the basal layers of the cystic spaces, whereas in mucoepidermoid carcinomas (22/22) the p63 labeling extended throughout the suprabasal layers (p < 0.001). This study adds more confirmatory data to validate that the reactivity pattern of p63 protein can be used in distinguishing between papillary cystadenoma and low-grade mucoepidermoid carcinoma. Although positive reactivity in a tumor with MUC1 and MUC4 was inconclusive, negative reactivity suggests the diagnosis of a benign PC or SDC.