Analysis of the response to two pharmacological protocols in patients with oral lichen planus: A randomized clinical trial.

OBJECTIVE: To evaluate the effectiveness of two different therapies on oral lichen planus (OLP) treatment through the analysis of OLP symptoms and signs and to analyze the risk of side effects related to the adopted protocols. METHODS: Thirty-eight patients with OLP were selected according to van der Meij and van der Waal clinical and histopathological criteria. Through a randomized design, 19 patients received Tacrolimus 0.1% ointment (T group) and 19 an anti-inflammatory mouthwash (M group) composed of calcium hydroxide 10%, hyaluronic acid 0.3%, umbelliferone, and oligomeric proanthocyanidins. The patients were examined on a regular basis for OLP symptoms, signs, and disease severity score changes over a 3-month follow-up period. RESULTS: Both treatments were effective in the reduction of OLP signs and symptoms. However, at 3 months (T3), in comparison with the M group, T group patients showed significantly lower mean values of OLP signs (p = 0.035), symptoms (p = 0.045), and disease severity scores (p = 0.041). Moreover, the Spearman test showed that there was a significant correlation between OLP signs and symptoms at each follow-up session in all patients. CONCLUSIONS: Both treatments demonstrated a significant approach to control OLP. However, tacrolimus determined a more effective improvement in OLP signs and symptoms compared to anti-inflammatory mouthwash at 3-month follow-up.

Tooth automatic segmentation from CBCT images: a systematic review.

OBJECTIVES: To describe the current state of the art regarding technological advances in full-automatic tooth segmentation approaches from 3D cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: In March 2023, a search strategy without a timeline setting was carried out through a combination of MeSH terms and free text words pooled through Boolean operators ('AND', 'OR') on the following databases: PubMed, Scopus, Web of Science and IEEE Explore. Randomized and non-randomized controlled trials, cohort, case-control, cross-sectional and retrospective studies in the English language only were included. RESULTS: The search strategy identified 541 articles, of which 23 have been selected. The most employed segmentation methods were based on deep learning approaches. One article exposed an automatic approach for tooth segmentation based on a watershed algorithm and another article used an improved level set method. Four studies presented classical machine learning and thresholding approaches. The most employed metric for evaluating segmentation performance was the Dice similarity index which ranged from 90 ± 3% to 97.9 ± 1.5%. CONCLUSIONS: Thresholding appeared not reliable for tooth segmentation from CBCT images, whereas convolutional neural networks (CNNs) have been demonstrated as the most promising approach. CNNs could help overcome tooth segmentation's main limitations from CBCT images related to root anatomy, heavy scattering, immature teeth, metal artifacts and time consumption. New studies with uniform protocols and evaluation metrics with random sampling and blinding for data analysis are encouraged to objectively compare the different deep learning architectures' reliability. CLINICAL RELEVANCE: Automatic tooth segmentation's best performance has been obtained through CNNs for the different ambits of digital dentistry.

A Reciprocal Link between Oral, Gut Microbiota during Periodontitis: The Potential Role of Probiotics in Reducing Dysbiosis-Induced Inflammation.

Human body is colonized by a florid microbial community of bacteria, archaea, fungi, protists, helminths, and viruses, known as microbiota, which co-evolves with the host and influences its health through all stages of its life. It is well known that oral microorganisms form highly structurally and functionally organized multi-species biofilms and establish a network of complex mutual inter-species interactions having a primary function in synergy, signaling, or antagonism. This ecological model allows the microorganisms to increase their resistance to antimicrobial agents and settle a balanced microbes-host symbiotic relationship that ensures oral and global health status in humans. The host-associated microbiome is an important factor in human health and disease. Therefore, to develop novel diagnostic, therapeutic, and preventive strategies, microbiome's functions and the reciprocal interactions every microbiome entertains with other microbial communities in the human body are being investigated. This review provides an analysis of the literature about the close connection between the two largest microbial communities in humans: the oral and the gut microbiomes. Furthermore, it focuses on how the alteration of their microbial and functional characteristics can lead to and reciprocally influence the onset of both oral and intestinal microbiome-associated illness, along with the potential role of probiotics in ameliorating inflammation and microbial dysbiosis.

Accuracy (trueness and precision) of 3D printed orthodontic models finalized to clear aligners production, testing crowded and spaced dentition.

BACKGROUND: The study's objective was to assess the accuracy (trueness and precision) of orthodontic models obtained from crowded and spaced dentition finalized for the production of clear aligners. Four 3D printers featuring different technologies and market segments were used for this purpose. METHODS: Two digital master models were obtained from two patients featuring respectively crowded dentition (CM group) and diastema/edentulous spaces (DEM group). The 3D printers tested were: Form 3B (SLA technology, medium-professional segment), Vector 3SP (SLA technology, industrial segment), Asiga Pro 4K65 (DLP technology, high-professional segment), and Anycubic Photon M3 (LCD technology, entry-level segment). Each 3D printed model was scanned and superimposed onto the reference master model and digital deviation analysis was performed to assess the trueness and precision calculated as root mean square (RMS). All data were statistically examined to obtain intra-group and inter-groups comparisons(p 0.05). RESULTS: In both CM and DEM groups, SLA 3D printers (Vector 3SP and Form 3B) showed lower trueness error compared to DLP/LCD technologies (Asiga Pro 4K65, Anycubic Photon M3) (p < 0.001). In general, the entry-level printer (Anycubic Photon M3) showed the greatest trueness error (p < 0.001). Comparing CM and DEM models generated with the same 3D printer, statistically significant differences were found only for Asiga Pro 4k65 and Anycubic Photon M3 printers (p > 0.05). Concerning data of precision, the DLP technology (Asiga Pro 4k65) showed lower error compared to the other 3D printers tested. The trueness and precision errors were within the accepted clinical error for clear aligner manufacturing (< 0.25 mm), with the entry-level 3D printer nearly reaching this value. CONCLUSIONS: The accuracy of orthodontic models generated for clear aligners can be affected by different 3D printer technologies and anatomical characteristics of dental arches.

External root resorption and rapid maxillary expansion in the short-term: a CBCT comparative study between tooth-borne and bone-borne appliances, using 3D imaging digital technology.

BACKGROUND: The aim of the study was to analyze and compare external root resorption (ERR) in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME). METHODS: The sample included 40 subjects who received tooth-borne RME (TB group, average age: 13.1 ± 1.08 years) or bone-borne RME (BB group, average age: 14.5 ± 1.11 years) and Cone-beam computed tomography (CBCT) scans before treatment (T0) and after 3-month of retention (T1). A specific 3D Imaging technology was used to generate 3D models of posterior dentition (M1 = maxillary first molars, P2 = second premolars, P1 = first premolar) and calculate volumetric data (mean and percentage values) and shape changes, the latter obtained from deviation analysis between the radicular models at different time points. Evaluation of radicular length changes was performed for each tooth. Data were statistically analysed to perform intra-timing and inter-groups comparisons. RESULTS: A significant reduction of radicular volume and length was found in posterior dentition in both groups (p < 0.05), and the M1 (volume) and its palatal root (length) were mostly involved in this response. No differences were found between M1, P1 and P2 (p > 0.05) when volumetric changes were calculated as percentage of the total volume. Deviation analysis revealed that the radicular areas mostly affected by shape change were the apex and bucco-medial side. The amount of ERR was significantly greater in TB group compared to BB group. CONCLUSIONS: BB-RME treatment could reduce the amount of ERR at the post-expansion stage.

Palatal changes after treatment of functional posterior cross-bite using elastodontic appliances: a 3D imaging study using deviation analysis and surface-to-surface matching technique.

BACKGROUND: The present study aimed to evaluate the changes in palate dimension and morphology after treatment of functional posterior crossbite (FPXB) with elastodontic devices (EAs). METHODS: The treatment group (TG) consisted of 25 subjects (mean age 7.3 ± 0.9 years) who received treatment with EA for one year. The control group (CG) comprised 14 untreated subjects (mean age 6.8 ± 0.7 years). INCLUSION CRITERIA: intra-oral scan registered before (T0) and after treatment (T1), FPXB with a mandibular shift towards the crossbite site of ≥ 2 mm, class I molar relationship. EXCLUSION CRITERIA: missing teeth, anterior crossbite, temporomandibular disorders, previous orthodontic treatment, carious lesions, mobility of deciduous posterior teeth, craniofacial deformities. Digital models were analyzed to assess the inter-canine (ICW) and inter-molar widths (IMW) and the corresponding emi-lateral measurements (eICW and eIMW) using the median palatine plane as reference. According to a specific 3D imaging technology, the morphology and symmetry of the palate was investigated by analysing the 3D deviation between the two specular models of the palate. RESULTS: At T0, both groups showed a significantly narrower dimension of eICW and eIMW at the crossbite side compared to the non-crossbite side (p < 0.05). Also, the 3D deviation analysis demonstrates a limited matching percentage of the original/mirrored models in both TG (81.12%) and CG (79.36%), confirming the asymmetry of the palate. The area of mis-matching was located at the alveolar bone level. At T1, subjects in the TG showed a significant increment of ICW and IMW (p < 0.05), a reduction of the differences of eICW and eIMW between both sides (p < 0.05) and an increment of the percentage matching (TG = 92.32%) (p < 0.05), suggesting a significant recovery of the palatal asymmetry. No significant changes were found between T0 and T1 in the CG (p > 0.05). CONCLUSIONS: EAs could be successfully used to correct FPXB in mixed dentition and could restore the harmonious development of the palate in children.

Growth differentiation factor-15 and circulating biomarkers as predictors of periodontal treatment effects in patients with periodontitis: a randomized-controlled clinical trial.

BACKGROUND: During the last decades, in patients with periodontitis, periodontal treatment has been shown to reduce the potential release of local and systemic biomarkers linked to an early risk of systemic inflammatory disorders. This study evaluated the efficacy of non-surgical-periodontal treatment (NSPT) on growth differentiation factor 15 (GDF-15) and related circulating biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) in periodontal patients and explored whether subjects who had high GDF-15 levels at baseline showed increased clinical benefits following NSPT at 6-months follow-up. METHODS: For this two-arm, parallel randomized clinical trial, patients with periodontitis were randomly allocated to receive quadrant scaling and root-planing (Q-SRP, n = 23, median age 51 years old) or full-mouth disinfection (FMD, n = 23, median age 50 years old) treatment. Clinical and periodontal parameters were recorded in all enrolled patients. The primary outcome was to analyse serum concentrations changes of GDF-15 and of GPx-1, hs-CRP, and SP-D at baseline and at 30, 90, and 180-days follow-up after NSPT through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. RESULTS: In comparison with FMD, patients of the Q-SRP group showed a significant improvement in clinical periodontal parameters (p < 0.05) and a reduction in the mean levels of GDF-15 (p = 0.005), hs-CRP (p < 0.001), and SP-D (p = 0.042) and an increase of GPx-1 (p = 0.025) concentrations after 6 months of treatment. At 6 months of treatment, there was a significant association between several periodontal parameters and the mean concentrations of GDF-15, GPx-1, hs-CRP, and SP-D (p < 0.05 for all parameters). Finally, the ANOVA analysis revealed that, at 6 months after treatment, the Q-SRP treatment significantly impacted the reduction of GDF-15 (p = 0.015), SP-D (p = 0.026) and the upregulation of GPx-1 (p = 0.045). CONCLUSION: The results evidenced that, after 6 months of treatment, both NSPT protocols improved the periodontal parameters and analyzed biomarkers, but Q-SRP was more efficacious than the FMD approach. Moreover, patients who presented high baseline GDF-15 and SP-D levels benefited more from NSPT at 6-month follow-up. TRIAL REGISTRATION: NCT05720481.

Accuracy Of Imaging Software for 3d Rendering of Tooth Structures, Usable in Clinical Settings.

AIM: The aim of this study was to evaluate the segmentation accuracy of dentition testing four free-source semi-automatic software. MATERIALS AND METHODS: A total of 20 cone-beam computed tomography (CBCT) were selected to perform semi-automatic segmentation of maxillary and mandibular dentition. The software tested were Invesalius, ITK-Snap, 3D Slicer and Seg3D. Each tooth model was also manually segmented (Mimics software) and set as the gold standard (GS) reference of the investigation. A specific 3D imaging technology was used to perform the superimposition between the teeth models obtained with semi-automatic software and the GS model, and to perform the surface-to-surface matching analysis. The accuracy of semi-automatic segmentation was evaluated calculating the volumetric mean differences (mean bias and limits of agreement) and the percentage of matching of the tooth models compared to the manual segmentation (GS). Qualitative assessments were performed using color-coded maps. All data were statistically analysed to perform software comparisons. RESULT: Statistically significant differences were found in the volumetric and matching percentage data (p < 0,05). Invesalius was the most accurate software for 3D rendering of the dentition with a volumetric bias (Mimics) ranging from 4,59 mm3 to 85,79 mm3; instead, ITK-SNAP showed the higher volumetric bias, ranging from 30,22 mm3 to 319,83 mm3. The dis-matched area was mainly located at the radicular region of the teeth. Volumetric data showed excellent inter-software reliability with coefficient values ranging from 0,951 to 0,997. CONCLUSIO: Different semi-automatic software algorithms could generate different patterns of inaccuracy error in the segmentation of teeth.

Evaluation of the accuracy of orthodontic models prototyped with entry-level LCD-based 3D printers: a study using surface-based superimposition and deviation analysis.

OBJECTIVES: The objective of this study was to evaluate the accuracy of dental models prototyped via entry-level liquid crystal display (LCD) 3D printers. MATERIALS AND METHODS: Identical prototyped models were generated from a master digital file testing two entry-level LCD-based 3D printers and using one professional-grade 3D printer as gold standard (GS), with 50-µm and 100-µm layer thickness. Each 3D-printed model was scanned, and a specific 3D technology was used to perform surface-based superimposition and deviation analysis to evaluate trueness and precision. The distances between surface points of two superimposed models were converted to root mean square (RMS) and statistically analyzed. RESULTS: The RMS values detected were significantly higher in dental models prototyped with entry-level compared to the SLA printer (p < 0.001), in terms of trueness (50 µm: GS 0.075 mm, LCD1 0.192 mm, LCD2 0.179 mm; 100 µm: GS 0.066 mm, LCD1 0.209 mm, LCD2 0.199 mm) and precision (50 µm: GS 0.028 mm, LCD1 0.075 mm, LCD2 0.085 mm; 100 µm: GS 0.039 mm, LCD1 0.096 mm, LCD2 0.101 mm). No significant differences were found between the values of RMS of both entry-level 3D printers (p > 0.05). Layer thickness did not affect either the trueness or precision of the 3D-printed models (p > 0.05). CONCLUSION: Entry-level LCD-based 3D printers are not as accurate as professional-grade 3D printer, but still close to orthodontics clinical threshold values. CLINICAL RELEVANCE: Clinicians should evaluate the intended application of 3D-printed orthodontic models before using entry-level 3D printers.

Oral and throat microbiological changes after orthodontic debonding.

As already known, orthodontic treatment presents a factor of plaque retention, promoting an increase of bacterial growth in the oral cavity. Nevertheless, after orthodontic debonding an alteration of the previous microbiological status may occur. The present study was designed to assess variations among six bacterial species in the oral cavity and the status of oral health after orthodontic debonding. At the end of the fixed orthodontic treatment, 30 patients were divided into three groups based on the type of retention: I - 10 patients were treated with upper and lower fixed retention devices, II - 10 with upper and lower removable retention devices, and III - 10 with lower fixed and upper removable retention devices. To assess the alterations of oral microbiota after orthodontic debonding, two salivary swabs were collected for each individual: the first immediately after debonding (T0) and the other one 6 weeks later (T1). Six species, the ones most correlated with the development of caries and periodontal disease, were selected for microbiological analysis with Real-time PCR: Streptococcus mutans, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum. Furthermore, in order to correlate the microbiological outcomes with the clinical condition, oral health indexes at T0 and T1 were assessed for all patients. Six weeks after debonding, the salivary levels of the bacteria investigated tend to decrease and the values of the oral health indexes tend to improve with all types of treatment considered (p<.05). Salivary bacteria levels and oral health are similarly influenced by fixed and/or removable orthodontic retentions.

MicroRNA Modulation during Orthodontic Tooth Movement: A Promising Strategy for Novel Diagnostic and Personalized Therapeutic Interventions.

The Orthodontic Tooth Movement (OTM) is allowed through a mediated cell/tissue mechanism performed by applying a force or a pair of forces on the dental elements, and the tooth movement is a fundamental requirement during any orthodontic treatment. In this regard, it has been widely shown that each orthodontic treatment has a minimum duration required concerning numerous factors (age, patient compliance, type of technique used, etc.). In this regard, the aim of the following revision of the literature is to give readers a global vision of principal microRNAs (miRNAs) that are most frequently associated with OTM and their possible roles. Previously published studies of the last 15 years have been considered in the PubMed search using "OTM" and "miRNA" keywords for the present review article. In vitro and in vivo studies and clinical trials were mainly explored. Correlation between OTM and modulation of several miRNAs acting through post-transcriptional regulation on target genes was observed in the majority of previous studied. The expression analysis of miRNAs in biological samples, such as gingival crevicular fluid (GCF), can be considered a useful tool for novel diagnostic and/or prognostic approaches and for new personalized orthodontic treatments able to achieve a better clinical response rate. Although only a few studies have been published, the data obtained until now encourage further investigation of the role of miRNA modulation during orthodontic treatment. The aim of this study is to update the insights into the role and impact of principal micro-RNAs (miRNAs) that are most frequently associated during OTM.

Therapeutic and Metagenomic Potential of the Biomolecular Therapies against Periodontitis and the Oral Microbiome: Current Evidence and Future Perspectives.

The principles of periodontal therapy are based on the control of microbial pathogens and host factors that contribute to biofilm dysbiosis, with the aim of modulating the progression of periodontitis and periodontal tissue destruction. It is currently known how differently each individual responds to periodontal treatment, depending on both the bacterial subtypes that make up the dysbiotic biofilm and interindividual variations in the host inflammatory response. This has allowed the current variety of approaches for the management of periodontitis to be updated by defining the goals of target strategies, which consist of reducing the periodontopathogenic microbial flora and/or modulating the host-mediated response. Therefore, this review aims to update the current variety of approaches for the management of periodontitis based on recent target therapies. Recently, encouraging results have been obtained from several studies exploring the effects of some targeted therapies in the medium- and long-term. Among the most promising target therapies analyzed and explored in this review include: cell-based periodontal regeneration, mediators against bone resorption, emdogain (EMD), platelet-rich plasma, and growth factors. The reviewed evidence supports the hypothesis that the therapeutic combination of epigenetic modifications of periodontal tissues, interacting with the dysbiotic biofilm, is a key step in significantly reducing the development and progression of disease in periodontal patients and improving the therapeutic response of periodontal patients. However, although studies indicate promising results, these need to be further expanded and studied to truly realize the benefits that targeted therapies could bring in the treatment of periodontitis.

Analysis of galectin-3 levels as a source of coronary heart disease risk during periodontitis.

BACKGROUND AND OBJECTIVE: Different evidence has shown that Galectins have a key role as modulators of cell surface functions and signaling in a wide range of inflammatory diseases during their preclinical stages. The aim of this study was to analyze the association and impact of periodontitis and coronary heart disease (CHD) on salivary and serum Galectin-3 in patients with periodontitis and CHD. MATERIALS AND METHODS: For the present study, healthy controls (n = 38), periodontitis (n = 40), CHD (n = 39), and a combination of periodontitis +CHD (n = 38) patients were enrolled and analyzed. In each patient, demographic characteristics and a full-mouth clinical periodontal examination were achieved. Moreover, serum and salivary samples were collected to assess Galectin-3 and Endothelin-1 (ET-1) levels. The Jonckheere-Terpstra p-trend and Spearman's correlation tests as well as uni- and linear regression analyses were used to analyze the study data. RESULTS: Patients with periodontitis (serum, p = .003; saliva, p < .001) and periodontitis + CHD groups (serum p = .004; saliva, p < .001) had higher median serum and salivary concentrations of Galectin-3 in comparison with CHD and healthy controls. Serum (p = .006) and salivary (p = .009) Galectin-3 levels were significantly correlated with serum ET-1. The multivariate regression analysis highlighted that periodontitis (p = .047) was the significant predictor of serum Galectin-3 levels while ET-1 (p = .028) was the significant predictor of salivary Galectin-3 levels. CONCLUSION: The results showed that patients with periodontitis and periodontitis + CHD presented significant higher serum and salivary Galectin-3 levels in comparison with CHD patients and healthy subjects. Periodontitis and ET-1 were the significant predictors of serum and salivary Galectin-3 levels, respectively.

Fully automatic segmentation of the mandible based on convolutional neural networks (CNNs).

OBJECTIVES: To evaluate the accuracy of automatic deep learning-based method for fully automatic segmentation of the mandible from CBCTs. SETTING AND SAMPLE POPULATION: CBCT-derived mandible fully automatic segmentation. METHODS: Forty CBCT scans from healthy patients (20 females and 20 males, mean age 23.37 ± 3.34) were collected, and a manual mandible segmentation was carried out by using Mimics software. Twenty CBCT scans were randomly selected and used for training the artificial intelligence model file. The remaining 20 CBCT segmentation masks were used to test the accuracy of the CNN automatic method by comparing the segmentation volumes of the 3D models obtained with automatic and manual segmentations. The accuracy of the CNN-based method was also assessed by using the DICE Score coefficient (DSC) and by the surface-to-surface matching technique. The intraclass correlation coefficient (ICC) and Dahlberg's formula were used respectively to test the intra-observer reliability and method error. Independent Student's t test was used for between-groups volumetric comparison. RESULTS: Measurements were highly correlated with an ICC value of 0.937, while the method error was 0.24 mm3 . A difference of 0.71 (±0.49) cm3 was found between the methodologies, but it was not statistically significant (P > .05). The matching percentage detected was 90.35% (±1.88) (tolerance 0.5 mm) and 96.32% ± 1.97% (tolerance 1.0 mm). The differences, measured as DSC in percentage, between the assessments done with both methods were, respectively, 2.8% and 3.1%. CONCLUSION: The tested deep learning CNN-based technology is accurate and performs as well as an experienced image reader but at much higher speed, which is of significant clinical relevance.

Evaluation of pulp cavity/chamber changes after tooth-borne and bone-borne rapid maxillary expansions: a CBCT study using surface-based superimposition and deviation analysis.

OBJECTIVES: To compare volume and shape changes of pulp chamber of maxillary posterior teeth between tooth-borne and bone-borne maxillary expansions in adolescents. MATERIALS AND METHODS: This study included 36 adolescents with bilateral maxillary crossbite who received tooth-borne rapid maxillary expansion (TB group, average age 14.4 years) or bone-borne rapid maxillary expansion (BB group, average age 14.7 years). Cone beam computed tomography (CBCT) was taken before treatment (T1) and after a 6-month retention period (T2). Volumetric and shape changes of pulp chamber of maxillary first molars and premolars were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student's t tests were used to (1) compare T1 and T2 volumes of pulp chambers in TB and BB groups and (2) assess differences between the two groups in the post-treatment volumetric changes and in the percentage of matching of 3D pulp models. RESULTS: All investigated teeth showed a reduction of pulp volume, being this difference significant in both TB (p < 0.0001) and BB (p < 0.0001) groups. The volumetric reduction was greater in the TB group; also, subjects in the TB group showed a lower percentage of matching between T1 and T2 pulp models (p < 0.0001). The area most affected by shape change was that of pulp horns. CONCLUSIONS: TB expander could induce a higher volumetric reduction of pulp chamber of posterior teeth compared with BB expander, in the short term. CLINICAL RELEVANCE: The present findings add new information concerning the effects of RME protocols on pulp tissue.

Impact of Matrix Metalloproteinase-9 during Periodontitis and Cardiovascular Diseases.

Matrix metalloproteinase-9 (MMP-9) has been shown to play a key role in endothelial function and perhaps pivotal in the correlation between periodontal disease and cardiovascular disease (CVD). For the study, the impact of MMP-9 of periodontitis and CVD on serum and saliva concentrations was analyzed. For the study patients with periodontitis (n = 31), CVD (n = 31), periodontitis + CVD (n = 31), and healthy patients (n = 31) were enrolled. Clinical and demographic characteristics as well as serum and salivary MMP-9 were evaluated. MMP-9 concentrations in serum and saliva were statistically elevated in patients with CVD (p < 0.01) and in patients with periodontitis plus CVD (p < 0.001) compared to patients with periodontitis and healthy subjects. Multivariate regression analysis showed that c-reactive protein (hs-CRP) was the only significant predictor for MMP-9 serum (p < 0.001), whereas hs-CRP (p < 0.001) and total cholesterol (p = 0.029) were the statistically significant salivary MMP-9 predictors. This study evidenced that patients with CVD and periodontitis + CVD presented elevated MMP-9 concentrations in serum and saliva compared to patients with periodontitis and healthy subjects. Furthermore, hs-CRP was a negative predictor of serum and salivary MMP-9.

Fully automatic segmentation of sinonasal cavity and pharyngeal airway based on convolutional neural networks.

INTRODUCTION: This study aimed to test the accuracy of a new automatic deep learning-based approach on the basis of convolutional neural networks (CNN) for fully automatic segmentation of the sinonasal cavity and the pharyngeal airway from cone-beam computed tomography (CBCT) scans. METHODS: Forty CBCT scans from healthy patients (20 women and 20 men; mean age, 23.37 ± 3.34 years) were collected, and manual segmentation of the sinonasal cavity and pharyngeal subregions were carried out by using Mimics software (version 20.0; Materialise, Leuven, Belgium). Twenty CBCT scans from the total sample were randomly selected and used for training the artificial intelligence model file. The remaining 20 CBCT segmentation masks were used to test the accuracy of the CNN fully automatic method by comparing the segmentation volumes of the 3-dimensional models obtained with automatic and manual segmentations. The accuracy of the CNN-based method was also assessed by using the Dice score coefficient and by the surface-to-surface matching technique. The intraclass correlation coefficient and Dahlberg's formula were used to test the intraobserver reliability and method error, respectively. Independent Student t test was used for between-groups volumetric comparison. RESULTS: Measurements were highly correlated with an intraclass correlation coefficient value of 0.921, whereas the method error was 0.31 mm3. A mean difference of 1.93 ± 0.73 cm3 was found between the methodologies, but it was not statistically significant (P >0.05). The mean matching percentage detected was 85.35 ± 2.59 (tolerance 0.5 mm) and 93.44 ± 2.54 (tolerance 1.0 mm). The differences, measured as the Dice score coefficient in percentage, between the assessments done with both methods were 3.3% and 5.8%, respectively. CONCLUSIONS: The new deep learning-based method for automated segmentation of the sinonasal cavity and the pharyngeal airway in CBCT scans is accurate and performs equally well as an experienced image reader.

Digitally programmed (CAD) offset values for prototyped occlusal splints (CAM): assessment of appliance-fitting using surface-based superimposition and deviation analysis.

AIM: Limited data are available on the fitting properties of prototyped occlusal appliances. The aim of the present study was to assess the fitting of prototyped splints digitally designed with different offset values and generated with two different biocompatible resins. MATERIALS AND METHODS: Ten dental digital models were included, and occlusal splints were designed with different offset values (0.0, 0.05, 0.10, 0.15, 0.20, and 0.25 mm). Each splint was 3D printed using two different biocompatible resins, and the gap between the splint and the teeth was recorded by placing impression material. A specific 3D technology was used to assess the gap volume between the splint and the teeth and to calculate the Euclidean distance between the surface points of two digital models, with and without the gap volume. RESULTS: The splints with a 0.20-mm offset value showed smaller gap volume and deviation analysis values compared with those with offset values of 0.15 and 0.25 mm (P < 0.05). These results were consistent with both types of biocompatible resins used. For each offset value tested, the gap volume and deviation value analysis did not significantly differ between the splints printed with the two different resins. CONCLUSION: According to the present findings, the 0.20-mm offset value would be the best choice when digitally designing occlusal appliances.

Evaluation of condylar cortical bone thickness in patient groups with different vertical facial dimensions using cone-beam computed tomography.

The aim of this study is to evaluate through computed tomography differences in cortical plate thickness of condyle in patients with a different facial vertical skeletal pattern. The final sample of this retrospective study included CBCT exams of 60 adult subjects (mean age 33.2 ± 5.6), selected from the digital archive of a private practice. The subjects were assigned to 3 different groups according to the values of the Frankfurt-mandibular plane angle: hyper-, normo-, and hypodivergent groups. The volume rendering of the mandible was obtained and three condylar points were marked on it: median pole, lateral pole and the most cranial point. For each considered reference point, the minimum distance between external and internal cortical surface was measured, obtaining three different outcomes: condylar cortical bone thickness of median pole (CCBToMP), lateral pole (CCBToLP) and cranial pole (CCBToCP). The measurements were executed by means of Mimics software by the same expert operator in specific scan views. The cortical bone thickness of hyperdivergent patients was found to be statistically thicker than normodivergent patients and hypodivergent patients. Cortical bone thickness of normodivergent patients was found thicker than hypodivergent patients. All the differences were statistically significant (p < 0.05). The Pearson correlation coefficient showed a statistically significant correlation (p < 0.001) between the Frankfurt-mandibular plane angle and the evaluated cortical bone thickness outcomes. Facial biotype characteristics that define vertical facial skeletal pattern affect the cortical bone thickness of mandibular condyle.

Evaluation of mandibular symmetry and morphology in adult patients with unilateral posterior crossbite: a CBCT study using a surface-to-surface matching technique.

OBJECTIVES: To investigate mandibular morphology in adults affected by posterior unilateral crossbite (PUXB) and to evaluate the hemi mandibular volumes from the crossbite (CB) and non-CB sides of the same patients. METHODS: Thirty-eight cone beam computed tomography (CBCT) images were consecutively recruited and the Digital Imaging and Communications in Medicine (DICOM)-formatted scans were volume rendered into a surface three-dimensional (3D) mesh model and volumes to obtain the 3D model of the mandibular bone. To achieve the surface point-to-point analysis of the mandibular models, a reverse engineering software was used. The same procedure was performed for an age-matched control group (19 CBCT images). RESULTS: Total mandibular volume showed a difference of 2.46 cm3 between patients and controls, which was not statistically significant. A mean difference of 1.53 cm3 was found comparing the hemi mandibular volumes from the CB and non-CB sides of PUXB patients, this difference was statistically significant (P ≤ 0.01). Findings for the surface-to-surface deviation analysis, demonstrated a higher percentage of mismatch in patients PUXB, over 10% at 0.5 mm tolerance level. LIMITATIONS: Limitations are related to the intrinsic surfaces matching methodology, that make difficult to evaluate discrepancies among different mandibular anatomical units. CONCLUSION: Adult patients affected by PUXB show a greater mandibular structural asymmetry compared to controls because of a lower matching percentage obtained from the surface-to-surface matching technique. IMPLICATIONS: Treatment of adult patients affected by PUXB should take into consideration the possibility of a mild mandibular asymmetry mainly localized at the condyle and gonial angle levels.