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The presence of facial jewelry and medical devices within a radiographic field of view may promote the formation of artifacts that challenge diagnostic interpretation. The objective of this article is to describe a previously unreported radiographic anomaly produced by an oral piercing site below the lower lip. This unusual artifact masqueraded as a severe resorptive defect, dental caries, or cervical abfraction and occurred following removal of an extremely large labret below the lower lip and subsequent acquisition of a radiographic image. The radiolucency was ultimately attributed to an extensive aperture below the lower lip created by a series of sequentially larger soft tissue expanders. Clinicians should seek correlation of atypical radiographic presentations with soft tissue defects secondary to injury or intentional oral piercing.
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Artefatos , Piercing Corporal , Lábio , Humanos , Lábio/lesões , Lábio/diagnóstico por imagem , Lábio/cirurgia , Piercing Corporal/efeitos adversos , Feminino , Radiografia Dentária , Mucosa Bucal/diagnóstico por imagem , AdultoRESUMO
Oral diseases pose a significant burden on global healthcare. While many oral conditions are preventable and manageable through regular dental office visits, a substantial portion of the population faces obstacles in accessing essential and affordable quality oral healthcare. In this mini review, we describe the issue of inequity and bias in oral healthcare and discuss various strategies to address these challenges, with an emphasis on the application of artificial intelligence (AI). Recent advances in AI technologies have led to significant performance improvements in oral healthcare. AI also holds tremendous potential for advancing equity in oral healthcare, yet its application must be approached with caution to prevent the exacerbation of inequities. The "black box" approaches of some advanced AI models raise uncertainty about their operations and decision-making processes. To this end, we discuss the use of interpretable and explainable AI techniques in enhancing transparency and trustworthiness. Those techniques, aimed at augmenting rather than replacing oral health practitioners' judgment and skills, have the potential to achieve personalized dental and oral care that is unbiased, equitable, and transparent. Overall, achieving equity in oral healthcare through the responsible use of AI requires collective efforts from all stakeholders involved in the design, implementation, regulation, and utilization of AI systems. We use the United States as an example due to its uniquely diverse population, making it an excellent model for our discussion. However, the general and responsible AI strategies suggested in this article can be applied to address equity in oral healthcare on a global level.
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INTRODUCTION: Orthodontic therapy in patients with osteopetrosis (OP) of the jaws has typically been contraindicated owing to the presence of poorly perfused and extremely compact bone, and the potential risk for infection and osteomyelitis. As such, completed orthodontic cases in association with OP have rarely been published. PATIENT CONCERNS: A patient aged 14 years 6 months, with no known diagnosis of OP, sought orthodontic assessment for anterior crowding. CLINICAL FINDINGS: The patient exhibited a straight facial profile and increased mandibular facial height, competent lips, shallow mentolabial sulcus with mild mentalis strain, flat/reverse smile arc and wide buccal corridors on smiling. PRIMARY DIAGNOSIS: The patient had a Class I incisor relationship on Class I skeletal bases with bilateral Class I molars and Class II canine relationships. This was complicated by a crossbite involving the lateral incisors and a Bolton discrepancy due to small maxillary lateral incisors. A radiologic assessment revealed polyostotic OP of the oromaxillofacial complex. INTERVENTIONS: Treatment consisted of maxillary and mandibular fixed orthodontic therapy, bite turbos and elastics to level and align the dentition. Extractions of permanent teeth were not needed. OUTCOMES: At the conclusion of treatment, there was a slight left Class II malocclusion, with incomplete intercuspation on the left side due to tooth size discrepancy, possibly attributed to inadequate elastics compliance and the presence of osteopetrotic bone. The treatment was completed in 3 years, 1 year longer than anticipated. CONCLUSION: This report represents the second published account of a patient with OP successfully managed with comprehensive orthodontic care and without osseous complications. Obtaining cephalometric measurements on OP-affected patients may be imprecise owing to the presence of extremely dense bone and difficulty to identify bony landmarks. To reduce osteopetrotic sequelae, attending clinicians should consider reduced exertional orthodontic forces and closely monitor patients for adverse alveolar events.
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BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is a potentially serious osteopathic disorder associated with coalescing ossifications of the anterior vertebrae and may be concomitant with a constellation of symptomatology and systemic comorbidities. There is limited dental literature describing this finding on panoramic radiographs and cone beam computed tomography (CBCT) scans. CASE PRESENTATIONS: Two case reports of DISH are provided. One patient manifested extensive ossifications along the cervical vertebrae and consequent episodes of dysphagia and hoarseness. The other affected patient's cervical ossification was found at an earlier stage of formation and without symptomatology. Panoramic radiography, cervical spine radiography, and CBCT examinations have been provided. CONCLUSION: Attending dental healthcare practitioners should carefully evaluate all areas of interest and surrounding fields of view when taking panoramic radiographs and CBCT scans for manifestations of DISH and other potential disorders of the cervical vertebrae. A suspected radiologic finding of DISH should prompt timely referral for comprehensive medical assessment to mitigate neurologic deficits and other comorbidities.
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OBJECTIVE: The aim of this report was to review oral follicular lymphoid hyperplasia, with emphasis on palatal lesions. METHOD AND MATERIALS: A comprehensive search was performed on PubMed for case reports and case series of palatal follicular lymphoid hyperplasia published in the English language literature. Relevant data from collated articles was sought, including patient demographics, clinical manifestations, imaging modalities and findings, comorbidities, etiopathogenesis, lesional management, and lesional outcome. A new palatal case has also been provided to illustrate several features of this lesion. RESULTS: In total, 32 cases were assembled to establish clinicopathologic correlations, representing the largest aggregation of published cases. Most of the affected patients were at least 60 years old and with a decisive female predilection. The majority of lesions were ≤ 3 cm, appearing as normal color, purple-red or red, and varied from soft to firm. Notably, 32% of palatal follicular lymphoid hyperplasias were associated with denture wear, and lesional recurrence was recorded in 16% of cases. To date, none of the reported cases of palatal follicular lymphoid hyperplasia has undergone malignant transformation. CONCLUSIONS: Palatal follicular lymphoid hyperplasias often arise as a reactive process. Critical histopathologic and histochemical assessments are necessary to establish benignity. Postoperatively, clinicians should follow patients for at least 5 years for recurrence and remain vigilant for neoplastic change as several published accounts of non-oral follicular lymphoid hyperplasias have undergone malignant transformation, usually to lymphoma.
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Hiperplasia , Humanos , Hiperplasia/patologia , Feminino , Pseudolinfoma/patologia , Pseudolinfoma/diagnóstico por imagem , Palato/patologia , Palato/diagnóstico por imagem , Diagnóstico Diferencial , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: In this study, we assessed 6 different artificial intelligence (AI) chatbots (Bing, GPT-3.5, GPT-4, Google Bard, Claude, Sage) responses to controversial and difficult questions in oral pathology, oral medicine, and oral radiology. STUDY DESIGN: The chatbots' answers were evaluated by board-certified specialists using a modified version of the global quality score on a 5-point Likert scale. The quality and validity of chatbot citations were evaluated. RESULTS: Claude had the highest mean score of 4.341 ± 0.582 for oral pathology and medicine. Bing had the lowest scores of 3.447 ± 0.566. In oral radiology, GPT-4 had the highest mean score of 3.621 ± 1.009 and Bing the lowest score of 2.379 ± 0.978. GPT-4 achieved the highest mean score of 4.066 ± 0.825 for performance across all disciplines. 82 out of 349 (23.50%) of generated citations from chatbots were fake. CONCLUSIONS: The most superior chatbot in providing high-quality information for controversial topics in various dental disciplines was GPT-4. Although the majority of chatbots performed well, it is suggested that developers of AI medical chatbots incorporate scientific citation authenticators to validate the outputted citations given the relatively high number of fabricated citations.
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Inteligência Artificial , Medicina Bucal , Humanos , Radiologia , Patologia BucalRESUMO
INTRODUCTION: The aim of this study was to investigate the feasibility of a real-time three-dimensional dynamic navigation system (3D-DNS) for post space preparation (PSP) in root canal-treated teeth and to compare the accuracy and efficiency of 3D-DNS to freehand (FH) for PSP. METHODS: Fifty-four maxillary molars were divided into two groups: 3D-DNS (n = 27) and FH group (n = 27). Cone beam computed tomography (CBCT) scans were taken preoperatively and postoperatively. The drilling path for the PSP was virtually planned in the preoperative CBCT scan in the X-guide software (X-Nav Technologies, Lansdale, PA). For the 3D-DNS group, the PSP drilling was conducted under dynamic navigation. The 3D deviations and angular deflections were calculated. The residual dentin thickness (RDT) was determined after PSP. The operation time and the total number of mishaps were recorded. Shapiro-Wilk, t-test or Mann-Whitney rank sum, weighted Cohen's kappa, and Fisher exact tests were used (P < .05). RESULTS: The PSP was completed in all samples (54/54). The 3D-DNS was more accurate than the FH, with significantly fewer 3D deviations and angular deflections (all, P < .05). The 3D-DNS required less operating time than the FH (P < .05). For the 3D-DNS, no teeth had RDT < 1 mm, whereas 6/27 in the FH showed RDT < 1 mm after the PSP. There was no difference in the total number of mishaps (P > .05). CONCLUSION: Within the limitations of this in vitro study, the 3D-DNS is feasible for PSP. The 3D-DNS improved the accuracy and efficiency of PSP. The dynamic navigation system can potentially become a safe and reliable technology for PSP.
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Tomografia Computadorizada de Feixe Cônico , Imageamento Tridimensional , Humanos , Imageamento Tridimensional/métodos , Técnicas In Vitro , Dente Molar/diagnóstico por imagem , Técnica para Retentor Intrarradicular , Preparo de Canal Radicular/métodos , Preparo de Canal Radicular/instrumentação , Estudos de Viabilidade , Tratamento do Canal Radicular/métodosRESUMO
BACKGROUND: Advances in digital radiography for both intraoral and panoramic imaging and cone-beam computed tomography have led the way to an increase in diagnostic capabilities for the dental care profession. In this article, the authors provide information on 4 emerging technologies with promise. TYPES OF STUDIES REVIEWED: The authors feature the following: artificial intelligence in the form of deep learning using convolutional neural networks, dental magnetic resonance imaging, stationary intraoral tomosynthesis, and second-generation cone-beam computed tomography sources based on carbon nanotube technology and multispectral imaging. The authors review and summarize articles featuring these technologies. RESULTS: The history and background of these emerging technologies are previewed along with their development and potential impact on the practice of dental diagnostic imaging. The authors conclude that these emerging technologies have the potential to have a substantial influence on the practice of dentistry as these systems mature. The degree of influence most likely will vary, with artificial intelligence being the most influential of the 4. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The readers are informed about these emerging technologies and the potential effects on their practice going forward, giving them information on which to base decisions on adopting 1 or more of these technologies. The 4 technologies reviewed in this article have the potential to improve imaging diagnostics in dentistry thereby leading to better patient care and heightened professional satisfaction.
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Inteligência Artificial , Odontologia , Diagnóstico por Imagem , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Odontologia/tendências , Odontologia/métodos , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/tendências , Previsões , Imageamento por Ressonância Magnética/métodos , Radiografia Dentária Digital/métodos , Tecnologia Odontológica/tendênciasRESUMO
Implant failures have been associated with a diversity of etiologic processes, predominately arising from bone loss (peri-implantitis) due to inadequate maintenance of oral hygiene or excess luting agents. The aim of this article is to report a novel case of the apparent failure of a dental implant to undergo osseointegration in the presence of submerged pencil graphite. Practitioners are advised to carefully evaluate the clinical and radiographic site of a proposed implant for occult foreign substances. Embedded pencil graphite in the jawbone may promote a foreign body reaction and should be considered in the list of possible contributing factors to dental implant complications.
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Implantes Dentários , Grafite , Humanos , Implantes Dentários/efeitos adversos , Grafite/efeitos adversos , Cimentos Dentários , Higiene Bucal , Complicações Pós-OperatóriasRESUMO
OBJECTIVE: This study aimed to review and synthesize studies using artificial intelligence (AI) for classifying, detecting, or segmenting oral mucosal lesions on photographs. MATERIALS AND METHOD: Inclusion criteria were (1) studies employing AI to (2) classify, detect, or segment oral mucosa lesions, (3) on oral photographs of human subjects. Included studies were assessed for risk of bias using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A PubMed, Scopus, Embase, Web of Science, IEEE, arXiv, medRxiv, and grey literature (Google Scholar) search was conducted until June 2023, without language limitation. RESULTS: After initial searching, 36 eligible studies (from 8734 identified records) were included. Based on QUADAS-2, only 7% of studies were at low risk of bias for all domains. Studies employed different AI models and reported a wide range of outcomes and metrics. The accuracy of AI for detecting oral mucosal lesions ranged from 74 to 100%, while that for clinicians un-aided by AI ranged from 61 to 98%. Pooled diagnostic odds ratio for studies which evaluated AI for diagnosing or discriminating potentially malignant lesions was 155 (95% confidence interval 23-1019), while that for cancerous lesions was 114 (59-221). CONCLUSIONS: AI may assist in oral mucosa lesion screening while the expected accuracy gains or further health benefits remain unclear so far. CLINICAL RELEVANCE: Artificial intelligence assists oral mucosa lesion screening and may foster more targeted testing and referral in the hands of non-specialist providers, for example. So far, it remains unclear if accuracy gains compared with specialized can be realized.
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Inteligência Artificial , Mucosa Bucal , Humanos , Encaminhamento e ConsultaRESUMO
The odontoma is regarded as a hamartomatous process of the jaws. Most are discovered as an incidental radiographic finding, averaging 15 mm in size. This report describes a case of a diminutive odontoma that was surgically removed before the onset of eruptive and pathologic consequences. A compilation of documented complications and syndromes associated with odontomas is also presented.