Artificial intelligence vs. semi-automated segmentation for assessment of dental periapical lesion volume index score: A cone-beam CT study.

INTRODUCTION: Cone beam computed tomography periapical volume index (CBCTPAVI) is a categorisation tool to assess periapical lesion size in three-dimensions and predict treatment outcomes. This index was determined using a time-consuming semi-automatic segmentation technique. This study compared artificial intelligence (AI) with semi-automated segmentation to determine AI's ability to accurately determine CBCTPAVI score. METHODS: CBCTPAVI scores for 500 tooth roots were determined using both the semi-automatic segmentation technique in three-dimensional imaging analysis software (Mimics Research™) and AI (Diagnocat™). A confusion matrix was created to compare the CBCTPAVI score by the AI with the semi-automatic segmentation technique. Evaluation metrics, precision, recall, F1-score (2×precision×recallprecision+recall), and overall accuracy were determined. RESULTS: In 84.4 % (n = 422) of cases the AI classified CBCTPAVI score the same as the semi-automated technique. AI was unable to classify any lesion as index 1 or 2, due to its limitation in small volume measurement. When lesions classified as index 1 and 2 by the semi-automatic segmentation technique were excluded, the AI demonstrated levels of precision, recall and F1-score, all above 0.85, for indices 0, 3-6; and accuracy over 90 %. CONCLUSIONS: Diagnocat™ with its ability to determine CBCTPAVI score in approximately 2 min following upload of the CBCT could be an excellent and efficient tool to facilitate better monitoring and assessment of periapical lesions in everyday clinical practice and/or radiographic reporting. However, to assess three-dimensional healing of smaller lesions (with scores 1 and 2), further advancements in AI technologies are needed.

Laser-fluorescence assessment of sodium hypochlorite quenching reversal agents on human dentine.

BACKGROUND: Laser-fluorescence diagnostic technology for real-time clinical assessment of residual bacteria could help assist in determining the endpoints for root canal debridement. Sodium hypochlorite (NaOCl) can however quench fluorescence and lead to false low reading. This study aims to evaluate various antioxidant for their ability to recover quenched fluorescence in dentine treated with NaOCl. METHODS: Human dentine fluorescence was measured using 655 nm laser at baseline and again after a 2 min application of 4% NaOCl. The putative recovery agents were then applied, and the fluorescence measured after 5, 10, 20, 30 and 60 min. Recovery from quenching was also assessed using laser confocal scanning microscopy (CLSM) with a bound tetracycline fluorophore using 488 nm excitation. RESULTS: A 5 min application of vitamin E oil or buffered 2% lignocaine solution (1:80,000 adrenaline) was effective in regaining quenched fluorescence within the following 5 mins. Distilled water, sodium thiosulfate, unbuffered 2% lignocaine with 1:80000 adrenaline and phosphate buffered saline were less effective, and of equal performance. Ascorbic acid and butylated hydroxyanisole were not effective and had deleterious effects on the levels of dentine fluorescence. CLSM provided confirmation of recovery from quenched fluorescence using vitamin E oil. CONCLUSION: Based on these findings, reversal agents should be employed when assessing the fluorescence of dentine that has been exposed to NaOCl or other quenching agents.

A systematic literature review of assessment feedback in preclinical dental education.

INTRODUCTION: Development of evaluative judgement abilities through assessment and feedback strategies is crucial in students' progress to become self-regulated lifelong learners. Dentists' ability to appraise the quality of treatment provided to their patients starts with development of competences in a simulated preclinical training environment. However, the effectiveness of these assessment and feedback strategies is not well understood. MATERIAL AND METHODS: This literature review aimed to identify the assessment and feedback interventions and their effect on dental students' appraisal and psychomotor skills during preclinical training. A search of the electronic databases PubMed, Ebscohost (Dentistry and Oral Health), Scopus, Web of Science and EMBASE was conducted of studies published until October 2019. RESULTS: Twelve studies met the inclusion criteria. Two studies were randomised controlled trials and ten non-randomised studies. All studies included students' self-assessment and grading criteria as part of their feedback interventions. Feedback utilisation training was reported in 66% of the included studies. Evidence suggests feedback strategies improve psychomotor skills and increase agreement between students' and teachers' awarded grades. However, these improvements vary with the complexity of the task. Only one study shows self-directed learning significantly contributing to students' psychomotor skill improvement. CONCLUSION: Although assessment and feedback are regarded as crucial for developing students' evaluative judgement capabilities to become self-regulated lifelong learners, there is limited empirical evidence of the assessment and feedback conditions that enhance students' judgement abilities, performance and self-regulation. Further research is needed to investigate and compare the effect of different assessment and feedback interventions on students' appraisal skills, their impact on learning and self-regulation.

Management of acute extensive portal vein thrombosis: the complexity and morbidity.

A 62-year-old patient was admitted with an acute unprovoked portal vein thrombosis with splenic and mesenteric extension. His progress was complicated by progressive small bowel ischaemia and increasing clot burden despite systemic anticoagulation. This case report describes the use of catheter-directed thrombolysis via a transjugular intrahepatic portosystemic shunt, with the disease and its treatment complicated by a ruptured iatrogenic pseudoaneurysm, abdominal compartment syndrome and small bowel infarction necessitating extensive small bowel resection.

Toxicological assessment of additively manufactured methacrylates for medical devices in dentistry.

The paucity of information on the biological risks of photopolymers in additive manufacturing is a major challenge for the uptake of the technology in the construction of medical devices in dentistry. In this paper, the biocompatibility of methacrylates for denture bases, splints, retainers and surgical guides were evaluated using the innovative zebrafish embryo model, which is providing a high potential for toxicity profiling of photopolymers and has high genetic similarity to humans. Toxicological data obtained confirmed gradations of toxicity influenced by ethanol treatment, exposure scenarios and extraction vehicles. In direct exposure tests, juvenile fish exposed to non-treated methacrylates in ultrapure water showed accelerated toxicity endpoints compared to fish in transparent E3 medium. Similarly, toxic extracts induced mostly acute responses (embryonic mortality) in contrast to cumulative chronic (sublethal and teratogenic effects) in direct exposure. Methacrylates composed of >60% Ethoxylated bisphenol A dimethacrylate produced a relatively lower conversion rate in FTIR spectroscopy, but were safe in zebrafish bioassays after ethanol treatment. The study affirms that biocompatibility was influenced primarily by physico-chemical characteristics of the materials, which subsequently influenced their residual monomer content before and after immersion in ethanol. Given the precautionary implications of the study, we propose a 3-tiered approach i.e. using approved materials, apposite manufacturing parameters and post-processing techniques that together guarantee optimal results for medical devices. STATEMENT OF SIGNIFICANCE: This study is timely and relevant since there is limited published literature that precisely describes the toxicological properties of additively manufactured methacrylates despite their increased popularity for medical devices. While it is generally accepted that the zebrafish excels as a model system for developmental toxicity, a further examination of its utility in this study using different protocols provides basis for its consideration and adoption at a crucial time when there is a lack of consensus regarding the most suited biological assessment methods for medical devices.

Performance assessment of novel side firing safe tips for endodontic applications.

During root canal or periodontal treatment, directing laser energy onto the walls of the root canal is essential for effective disinfection. This study assessed the performance of four different fiber modifications that have increased lateral emission, including three designs with safe tips to reduce irradiation directed toward the root apex. Free-running pulsed infrared lasers (Nd:YAG, Er:YAG, and Er,Cr:YSGG) and a diode laser (980 nm) were used in combination with plain ended (forward emitting) laser fibers; conical laser fibers, side firing honeycomb pattern fibers without a safe end; honeycomb fibers with silver coated ends, conical fibers with selectively abraded tips, and selectively abraded honeycomb fibers with silver coated tips (20 fibers for each laser type). Laser emissions forward and laterally were measured, and digital photographs and thermally sensitive paper used to record the emission profiles. Thermochromic dyes painted onto the root surface of an extracted tooth were used to explore the distribution of laser energy with different tips designs. All three safe tipped ends gave reduced emissions in the forward direction (range 17-59%), but had similar lateral emission characteristics. Fiber designs with reduced forward emission may be useful for various dental laser procedures.

Laser fluorescence assessment of the root canal using plain and conical optical fibers.

INTRODUCTION: Traditional culture-based techniques for assessing infection of the root canal system are difficult to use and prone to error. Real-time assessment of the microbial status of the root canal system using laser fluorescence would help address these limitations. METHODS: This study evaluated the performance of thin optical fibers of different diameters, with either plain or conically modified ends, connected to a KaVo KEY 3 laser with an inbuilt 655-nm laser fluorescence diagnostic system. Penetration was tested on sectioned extracted teeth. Fluorescence recordings were made ex vivo in the canals of extracted teeth with known periapical pathology. Several endodontic medicaments and irrigants were also tested for autofluorescence. RESULTS: The fibers could reach the apical third of the root canal, unless the canals had distal curvatures greater than 15 degrees . Penetration was greater for conical than for plain fibers. Fluorescence readings were significantly higher in infected canals (range, 19-99) than in noninfected canals and sound radicular dentin (range, 2-8). Of the medicaments examined, only tetracycline-based medicaments gave false-positive fluorescence signals. CONCLUSIONS: Fluorescence analysis of root canals with optical fiber probes has the potential for real-time assessment of the microbial status of the root canal system in clinical practice.

Performance assessment of novel side firing flexible optical fibers for dental applications.

BACKGROUND AND OBJECTIVE: Use of lasers in dentistry in root canals of teeth and in periodontal pockets for disinfection would be more effective if energy was delivered laterally. This study examined the energy emission profiles of fibers modified in various ways to enhance their lateral emissions for dental use. MATERIALS AND METHODS: Commercial optical fibers were altered by tube etching with hydrofluoric acid, modified tube etching (after removing the protective polyimide coating), alumina abrasive particle beams, and by etching and particle beams used in combination. Three free-running pulsed infrared lasers (Nd:YAG, Er:YAG, and Er,Cr:YSGG) were employed to test the modified fibers, with 25 fibers for each laser (modified or unmodified). Surface topography of fibers was examined using SEM. Laser emissions forward and laterally were measured, and thermally sensitive paper used to record the emission profiles. Visible tracing of emissions was undertaken using coaxial He-Ne or InGaAsP diode laser emissions. RESULTS: The etching/abrasion/etching combination gave a unique honeycomb surface configuration with grating-like properties, whilst etching alone gave a conical end. Conical and honeycomb tips showed greater lateral and lower forward emissions compared with plain fibers, with fourfold improvements in lateral emission. The most regular lateral emissions were from the honeycomb configuration. CONCLUSION: The honeycomb and the conical fiber modifications show dramatic improvements in lateral emissions. The unique emission profile obtained for the honeycomb fibers could play a significant role in increasing the efficiency of laser delivery for endodontic and periodontal applications in dentistry, as well as in other fields.