[A study on the application of intraoral camera in the identification of oral anatomical landmarks].

OBJECTIVE: To preliminarily explore the applicable scenarios of an intraoral camera to assist oral anatomical landmarks recognition, so as to improve the clinical diagnosis and treatment mode, cultivate the concept of caring for patients, strengthen doctor-patient communication, assist experts to teach, and improve the clinical diagnosis and efficacy rate. METHODS: A new type of an intraoral camera was applied in the recognition of oral anatomy landmarks and four application scenarios were developed, namely: (1) clinical diagnosis and treatment scenarios, in which doctors used intraoral camera to conduct a comprehensive examination of patients in the mouth and take videos and photos; (2) doctor-patient communication scenarios, when the doctor told the patient about the treatment plan, the video or photo taken by the intraoral camera was displayed to the patient; (3) expert teaching scenarios, when the expert used an intraoral camera to teach in the patient's mouth, and the young doctor learned oral anatomical signs on the projection screen, with the study of theoretical lessons; (4) difficult case recording scenarios, in the process of clinical diagnosis and treatment, when encountering difficult cases, you could use intraoral camera to record and take photos for young doctors to discuss, and experts to comment and guide. RESULTS: The application of intraoral camera could: (1) improve the clinical diagnosis and treatment mode and raise the clinical diagnosis and efficacy rate; (2) stimulate young doctors' interest in learning, use intraoral camera in assessments, and skillfully combine theoretical knowledge of anatomical landmarks with clinical practice, so as to improve the teaching effect; (3) cultivate, through self or mutual use, the concept of caring for patients and reinforce the importance of gentle operation; (4) strengthen doctor-patient communication. Doctors could communicate with patients more visually, so that the patients could better understand their own situation, and strengthen the patients' trust in the doctors. CONCLUSION: Intraoral camera can assist oral clinical diagnosis and treatment, such as the recognition of oral anatomical landmarks. It plays a certain role in promoting the improvement of clinical diagnosis and treatment mode, stimulating learning interest, cultivating the concept of caring for patients, and enhancing doctor-patient communication.

Diagnostic Accuracy of Cystic Lesions Using a Pre-Programmed Low-Dose and Standard-Dose Dental Cone-Beam Computed Tomography Protocol: An Ex Vivo Comparison Study.

BACKGROUND: This study aimed to analyze the diagnostic reliability of radiographic assessment of cystic lesions using a pre-set, manufacturer-specific, low-dose mode compared to a standard-dose dental cone-beam computed tomography (CBCT) imaging protocol. METHODS: Forty pig mandible models were prepared with cystic lesions and underwent both CBCT protocols on an Orthophos SL Unit (Dentsply-Sirona, Bensheim, Germany). Qualitative and quantitative analysis of CBCT data was performed by twelve investigators independently in SIDEXIS 4 (Dentsply-Sirona) using a trial-specific digital examination software tool. Thereby, the effect of the two dose types on overall detectability rate, the visibility on a scale of 1 (very low) to 10 (very high) and the difference between measured radiographic and actual lesion size was assessed. RESULTS: Low-dose CBCT imaging showed no significant differences considering detectability (78.8% vs. 81.6%) and visibility (9.16 vs. 9.19) of cystic lesions compared to the standard protocol. Both imaging protocols performed very similarly in lesion size assessment, with an apparent underestimation of the actual size. CONCLUSION: Low-dose protocols providing confidential diagnostic evaluation with an improved benefit-risk ratio according to the ALADA principle could become a promising alternative as a primary diagnostic tool as well as for radiological follow-up in the treatment of cystic lesions.

The development of a core syllabus for the teaching of oral anatomy, histology, and embryology to dental students via an international 'Delphi Panel'.

The formulation of core syllabuses for the biomedical sciences within medical and dental courses is partially driven by the need to cope with decreased time allocations for these subjects as a result of major curricular changes taking place worldwide. There is also a requirement to deal with the request for increased clinical relevance. In response to such demands, the International Federation of Associations of Anatomists (IFAA) is devising core syllabuses for the anatomical sciences relating to the education and training of both scientific and clinical professions. The process initially involves using Delphi Panels consisting of a team of anatomists, scientists, and clinicians who evaluate syllabus content in detail and accord each element/topic 'essential,' 'important,' 'acceptable,' or 'not required' status. Their conjectures, published on the IFAA website, provide merely a framework to enable other stakeholders to comment. The approach is international in scope, is conceptually 'democratic,' and is developmentally fluid in being readily available for amendment. The aim is to set internationally recognized standards and thus to provide guidelines concerning anatomical knowledge when engaged in course development. This article presents the deliberations of an IFAA Delphi Panel into a core syllabus for oral anatomy, histology, and embryology within the dental curriculum. Clin. Anat. 31:231-249, 2018. © 2017 Wiley Periodicals, Inc.

Anatomical characteristics of the lingual foramen in ancient skulls: a cone beam computed tomography study in an Anatolian population.

BACKGROUND: The purpose of this study is to evaluate the anatomical features of lingual foramina and their bony canals in Anatolian ancient mandibles (9-10th century) by using cone beam computed tomography (CBCT). MATERIALS AND METHODS: Fifty-eight ancient dry mandibles were scanned with CBCT. Lingual foramina were grouped into midline, paramedian, posterior foramina and combination of these groups. Midline group was also classified according to internal surface of the mandible (gonial tubercles [GTs]). The incidence, vertical distance and diameter of lingual foramina were measured according to age groups and gender. RESULTS: The incidence of the lingual foramen was 96.6%. Midline of the symphysis had the highest incidence (34.4%) of foramina (p < 0.05), followed by both midline and paramedian type (32.8%; p < 0.05). Classification in terms of GT represented class 3 as the most encountered group (28.6%). Number of foramina observed in the mandibles ranged from 0 to 6 with the incidence of 3.4% and 32.8%, respectively. The male and < 35 years groups presented larger measurement values in midline region (p < 0.05). CONCLUSIONS: Mandibular lingual foramina and bony canals are frequently present in ancient mandibles. When compared with modern subjects, similar findings are observed according to published literatures. CBCT is also proved to be an effective imaging modality in the detection of lingual foramina and canals in anthropological studies.

Diagnostic yield of dental radiography and digital tomosynthesis for the identification of anatomic structures in cats.

Introduction: Digital tomosynthesis (DT) has emerged as a potential imaging modality for evaluating anatomic structures in veterinary medicine. This study aims to validate the diagnostic yield of DT in identifying predefined anatomic structures in feline cadaver heads, comparing it with conventional intraoral dental radiography (DR). Methods: A total of 16 feline cadaver heads were utilized to evaluate 19 predefined clinically relevant anatomic structures using both DR and DT. A semi-quantitative scoring system was employed to characterize the ability of each imaging method to identify these structures. Results: DT demonstrated a significantly higher diagnostic yield compared to DR for all evaluated anatomic structures. Orthogonal DT imaging identified 13 additional anatomic landmarks compared to a standard 10-view feline set obtained via DR. Moreover, DT achieved statistically significant higher scores for each of these landmarks, indicating improved visualization over DR. Discussion: These findings validate the utility of DT technology in reliably identifying clinically relevant anatomic structures in the cat skull. This validation serves as a foundation for further exploration of DT imaging in detecting dentoalveolar and other maxillofacial bony lesions and pathologies in cats.

Localization of TRP Channels in Healthy Oral Mucosa from Human Donors.

The oral cavity is exposed to a remarkable range of noxious and innocuous conditions, including temperature fluctuations, mechanical forces, inflammation, and environmental and endogenous chemicals. How such changes in the oral environment are sensed is not completely understood. Transient receptor potential (TRP) ion channels are a diverse family of molecular receptors that are activated by chemicals, temperature changes, and tissue damage. In non-neuronal cells, TRP channels play roles in inflammation, tissue development, and maintenance. In somatosensory neurons, TRP channels mediate nociception, thermosensation, and chemosensation. To assess whether TRP channels might be involved in environmental sensing in the human oral cavity, we investigated their distribution in human tongue and hard palate biopsies. TRPV3 and TRPV4 were expressed in epithelial cells with inverse expression patterns where they likely contribute to epithelial development and integrity. TRPA1 immunoreactivity was present in fibroblasts, immune cells, and neuronal afferents, consistent with known roles of TRPA1 in sensory transduction and response to damage and inflammation. TRPM8 immunoreactivity was found in lamina propria and neuronal subpopulations including within the end bulbs of Krause, consistent with a role in thermal sensation. TRPV1 immunoreactivity was identified in intraepithelial nerve fibers and end bulbs of Krause, consistent with roles in nociception and thermosensation. TRPM8 and TRPV1 immunoreactivity in end bulbs of Krause suggest that these structures contain a variety of neuronal afferents, including those that mediate nociception, thermosensation, and mechanotransduction. Collectively, these studies support the role of TRP channels in oral environmental surveillance and response.

Clinical, Radiological, and Pathological Diagnosis of Fibro-Osseous Lesions of the Oral and Maxillofacial Region: A Retrospective Study.

BACKGROUND: Fibro-osseous lesions (FOL) of the jaw represent a rare, benign group of lesions that share similar clinical, radiological, and histopathological features and are characterized by progressive, variable replacement of healthy bone tissue by fibrous connective tissue. METHODS: This retrospective study aimed to evaluate the incidence of fibro-osseous lesions and to reassess the efficacy of case-specific treatment management from a clinical, radiological, and histopathological perspective based on 14 years of data. RESULTS: Forty-four patients with a radiological and/or histopathological diagnosis of benign FOLs were identified and re-evaluated. Cemento-osseous dysplasia was the most common group of FOLs present in our patient cohort (45%), followed by ossifying fibroma (39%) and fibrous dysplasia (16%). The diagnostic imaging technique of choice was CBCT (68%), followed by PAN (18%), with most patients (95 %) additionally undergoing biopsy. The mean age of the patients at the time of diagnosis was 40.54 ± 13.7 years, with most lesions being located in the mandible (86%), with females being predominantly affected (73%). CONCLUSION: An interdisciplinary approach that analyzes all case-specific factors, including demographic data, medical history, intraoperative findings, and, most importantly, histopathological and radiological features, is essential for an accurate diagnosis and key to avoiding inappropriate treatment.

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review.

Injury to the peripheral branches of the trigeminal nerve, particularly the lingual nerve (LN) and the inferior alveolar nerve (IAN), is a rare but serious complication that can occur during oral and maxillofacial surgery. Mandibular third molar surgery, one of the most common surgical procedures in dentistry, is most often associated with such a nerve injury. Proper preoperative radiologic assessment is hence key to avoiding neurosensory dysfunction. In addition to the well-established conventional X-ray-based imaging modalities, such as panoramic radiography and cone-beam computed tomography, radiation-free magnetic resonance imaging (MRI) with the recently introduced black-bone MRI sequences offers the possibility to simultaneously visualize osseous structures and neural tissue in the oral cavity with high spatial resolution and excellent soft-tissue contrast. Fortunately, most LN and IAN injuries recover spontaneously within six months. However, permanent damage may cause significant loss of quality of life for affected patients. Therefore, therapy should be initiated early in indicated cases, despite the inconsistency in the literature regarding the therapeutic time window. In this report, we present the visualization of two cases of nerve pathology using 3D double-echo steady-state MRI and evaluate evidence-based decision-making for iatrogenic nerve injury regarding a wait-and-see strategy, conservative drug treatment, or surgical re-intervention.

Larval chondrocranial and internal oral morphology of the neotropical treefrog Boana crepitans (Wied-Neuwied, 1824; Amphibia, Anura, Hylidae).

We describe the internal oral morphology and chondrocranial anatomy for Boana crepitans tadpoles, and compare them with available descriptions for other species in the subfamily Cophomantinae. Among species of the Boana faber group, the chondrocranial anatomy has been reported only for one species internal oral morphology and cranial anatomy are similar to other described species of Boana and Cophomantinae. B. crepitans lacks unique features in the oral cavity and chondrocranium that would distinguish it from other congeneric species. We identify six characters from the internal oral anatomy of tadpoles unique for Cophomantinae. In addition, Boana has infralabial papillae projections, buccal floor arena papillae, and lateral ridge papillae projections shorter than those described for Aplastodiscus and Bokermannohyla.

The Macroscopic and Radiographic Skull and Dental Pathology of the Tasmanian Devil (Sarcophilus harrisii).

While the gross skull and dental morphology, masticatory biomechanics, dental eruption patterns, and radiographic dental anatomy has been described in the Tasmanian devil (Sarcophilus harrisii), to date no studies have comprehensively examined the prevalence and appearance of pathologic processes affecting their skulls and dentition. As such, the aim of this study was to describe macroscopic and radiographic anatomy and identify the prevalence of anatomic variations and pathological processes in Tasmanian devil dentition and skulls. To do so, anatomical and pathological findings were documented in Tasmanian devil skulls using photography and dental radiography. Assessment of skull trauma, anatomical and developmental abnormalities, periodontitis, endodontic disease, and tooth resorption was performed. A total of 28 Tasmanian devil skulls containing 1,028 teeth were examined. Evidence of postmortem trauma was common. The most common positional abnormality was palatal or buccal rotation of the premolar teeth. While the alveolar bone margin was commonly positioned apically to the cementoenamel junction (98.2%), only 14.2% demonstrated evidence of periodontitis. Tooth fractures were common, affecting 27 skulls, however radiographic signs of endodontic disease were only noted in 4.5% of affected teeth, as was non-inflammatory root resorption (2.0%). A wider root canal width, which was used as a criterion for age determination, was associated with smaller skull dimensions, incompletely erupted teeth, and subjectively less fusion of the mandibular symphysis. Through an improved understanding of what constitutes normal anatomy and the appearance and frequency of pathologic processes that affect the skulls and teeth, this knowledge can help develop a foundation for understanding the oral health and management of live animals for this endangered species.

Comparison of Preoperative Cone-Beam Computed Tomography and 3D-Double Echo Steady-State MRI in Third Molar Surgery.

We investigated the reliability of assessing a positional relationship between the inferior alveolar nerve (IAN) and mandibular third molar (MTM) based on CBCT, 3D-DESS MRI, and CBCT/MRI image fusion. Furthermore, we evaluated qualitative parameters such as inflammatory processes and imaging fusion patterns. Therefore, two raters prospectively assessed in 19 patients with high-risk MTM surgery cases several parameters for technical image quality and diagnostic ability using modified Likert rating scales. Inter- and intra-reader agreement was evaluated by performing weighted kappa analysis. The inter- and intra-reader agreement for the positional relationship was moderate (κ = 0.566, κ = 0.577). Regarding the detectability of inflammatory processes, the agreement was substantial (κ = 0.66, κ = 0.668), with MRI providing a superior diagnostic benefit regarding early inflammation detection. Independent of the readers' experience, the agreement of judgment in 3D-DESS MRI was adequate. Black bone MRI sequences such as 3D-DESS MRI providing highly confidential preoperative assessment in MTM surgery have no significant limitations in diagnostic information. With improved cost and time efficiency, dental MRI has the potential to establish itself as a valid alternative in high-risk cases compared to CBCT in future clinical routine.

Cone Beam Computed Tomography (CBCT) Technology and Learning Outcomes in Dental Anatomy Education: E-Learning Approach.

E-learning is an educational method that improves knowledge innovation by sharing relevant images for advanced learning, especially in a pandemic state. Furthermore, cone-beam computed tomography (CBCT) is a method that gathers medical or dental diagnostic images. This study aimed to analyze the effectiveness of dental anatomy education through a CBCT technology tool, through teachers' and students' perspectives, adjusted according to the disruptions caused by the Covid-19 pandemic. A cohort study and longitudinal exploratory analysis were performed. Forty undergraduate first-year dental students, from the University of Coimbra in Portugal, were selected as per the inclusion and exclusion criteria. Two different teaching methods were applied during an identical time-period: face-to-face lectures complemented by physical models (T1 cohort) and webinar lectures complemented by CBCT images (T2 cohort). Learning outcomes were then studied according to theoretical and spatial orientation contexts. A self-reported survey that focused on students' satisfaction, stress, and support was studied. Both teaching methods were analyzed with paired sample student's t-test and Pearson Correlation Confidence intervals 95% with P < 0.05. Furthermore, exploratory factor analysis (EFA) was used for self-reported satisfaction survey validity and reliability analysis. The learning outcomes between T1 and T2 cohorts were statistically significant, (P < 0.001) corresponding to differences with a large effect degree (r > 0.60). Students' satisfaction, as measured on a six-point Likert scale, was positively influenced by the webinar lectures supplemented with CBCT images (T2 cohort) in a learning context (4.95 ± 0.5) and future applications (5.92 ± 0.27). In conclusion, the webinar approach with CBCT images was more effective and better learning method for teaching dental anatomy.

Relating oral physiology and anatomy of consumers varying in age, gender and ethnicity to food oral processing behavior.

The aim of this study was to link parameters describing oral physiology and anatomy of consumers varying in age, gender and ethnicity to food oral processing behavior. Three groups of healthy consumers were compared: Dutch, Caucasian adults (18-30 yrs, n =32), Chinese, Asian adults (18-30 yrs, n =32) and Dutch, Caucasian older adults (65-85 yrs, n =32). Mastication performance, salivary flow rate (stimulated and unstimulated) and dental status were quantified to characterize oral physiology. Volume of oral cavity, tongue dimensions, facial anthropometry, height and weight were quantified to characterize anatomy. Oral processing behavior of three solid foods (carrot, cheese and sausage) was quantified by video recordings and eating rate (g/s), average consumption time (s), chews per bite (-) and average bite size (g) were determined. Dutch, Caucasian older adults had smaller volume of oral cavity, lower number of teeth and larger head width compared to Dutch, Caucasian adults. Chinese, Asian adults showed significantly higher mastication performance and larger head width compared to Dutch, Caucasian consumers, while dental status did not significantly differ between groups. Males had significantly larger volumes of oral cavity and larger head height and width compared to females. Dutch, Caucasian adults had a shorter average consumption time (s), less chews per bite and consumed the three foods with higher eating rate (g/s) compared to Dutch, Caucasian older adults. Chinese, Asian adults had a significantly longer average consumption time (s), more chews per bite, smaller average bite size (g) and lower eating rate (g/s) compared to Dutch, Caucasian adults. Twenty-one significant relationships were found between oral physiological and anatomical parameters and oral processing behavior. Body weight resulted in the largest ß-values, indicating to be the anatomical parameter of largest influence on oral processing behavior. We conclude that only few oral physiological and anatomical parameters related with food oral processing behavior. We suggest that other factors, including cultural factors contribute to variation in food oral processing behavior between different consumer groups more than saliva flow, volume of oral cavity, mastication performance and dental status.

Diagnostic Yield of Dental Radiography and Cone-Beam Computed Tomography for the Identification of Anatomic Structures in Cats.

The objective of this study was to evaluate the diagnostic yield of dental radiography (DR) and 3 cone-beam computed tomography (CBCT) methods for the identification of predefined anatomic structures in cats. For 5 feline cadaver heads and 22 client-owned cats admitted for evaluation and treatment of dental disease, a total of 22 predefined anatomic structures were evaluated separately by use of the DR method and 3 CBCT software modules [multiplanar reconstructions (MPR), tridimensional (3-D) rendering, and reconstructed panoramic views (Pano)]. A semi quantitative scoring system was used, and mean scores were calculated for each anatomic structure and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the possible pairs of diagnostic methods. Differences of diagnostic yield among the DR and 3 CBCT methods were significant for 17 of 22 anatomic structures. For these structures, DR scores were significantly higher than scores for Pano views for 2 of 17 structures, but DR scores were significantly lower than scores for Pano views for 6 anatomic structures, tridimensional rendering for 10 anatomic structures, and MPR for 17 anatomic structures. In conclusion, it was found that CBCT methods were better suited than DR for the identification of anatomic structures in cats. Results of this study can serve as a basis for CBCT evaluation of dentoalveolar and other maxillofacial bony lesions in cats.

Assessment of Thiel-Embalmed Cadavers as a Teaching Tool for Oral Anatomy and Local Anesthesia.

The aim of this study was to determine whether Thiel-embalmed cadavers would provide a useful anatomy teaching tool for topics that cannot be approached using formalin-fixed cadavers such as oral cavity examination and maxillary anesthesia. The suitability of Thiel-embalmed bodies for performing oral examinations was assessed by asking first-year dental and dental hygiene students at a dental school in Ireland to identify oral structures on a classmate and on a Thiel-embalmed body. The study was conducted in 2016. The ease of location was compared in the two settings, and their quality was assessed on the cadavers. The suitability of Thiel-embalmed cadavers to teach maxillary anesthesia was assessed by students' performing mock injections at five adjacent sites daily for five consecutive days, followed by inspection of the gingival surface by experienced anatomists and dentists. Data were obtained from 57 students, but only the 54 forms that were fully completed were analyzed, for an overall response rate of 85.7%. The results showed that most oral structures were more difficult to locate on cadavers. The texture and appearance of features in the cadavers were rated at a midpoint between realistic and unrealistic. The relative inexperience of the participants, the accumulation of fixative in the oral cavity, and discoloration were mentioned as potential confounding factors. Visual analysis of images obtained following repeated injections revealed no deterioration of the tissue. Importantly, the puncture marks appeared to reduce over time, suggesting that the gingival tissue maintains some elasticity following Thiel fixation. These findings suggest that Thiel-embalmed cadavers may be a useful tool to provide students more time to localize and study aspects of the oral cavity. Likewise, the recoiling capacity of gingival tissue suggests that Thiel-embalmed cadavers may provide an ideal tool for teaching injection technique of local anesthetics.

Anatomy and Disorders of the Oral Cavity of Ornamental Fish.

Ornamental fish represent the largest and most diverse group of exotic animals kept as pets. The specific oral anatomy of each family or selected species has evolved to suit the natural environment, feeding behaviors, food or prey type, and location of the food/prey in the water column. The anatomy can change over the life of the animal, from fry to adult. The oral cavity of fish is susceptible to many problems including infectious and parasitic diseases, trauma, and neoplasia. Diagnosis may involve wet mount preparations of exfoliative cytology from the lesion, histopathology, and bacterial or fungal culture.

Anatomic and examination considerations of the oral cavity.

Patients often present to their physician with complaints of dental and/or oral pain. It is important for physicians to understand the complexities of oral anatomy and how to perform a basic clinical examination of this area to evaluate and potentially manage patients with these complaints. This article discusses anatomic structures of the oral cavity and systematic clinical examination of this area.