AI-initiated second opinions: a framework for advanced caries treatment planning.

Integrating artificial intelligence (AI) into medical and dental applications can be challenging due to clinicians' distrust of computer predictions and the potential risks associated with erroneous outputs. We introduce the idea of using AI to trigger second opinions in cases where there is a disagreement between the clinician and the algorithm. By keeping the AI prediction hidden throughout the diagnostic process, we minimize the risks associated with distrust and erroneous predictions, relying solely on human predictions. The experiment involved 3 experienced dentists, 25 dental students, and 290 patients treated for advanced caries across 6 centers. We developed an AI model to predict pulp status following advanced caries treatment. Clinicians were asked to perform the same prediction without the assistance of the AI model. The second opinion framework was tested in a 1000-trial simulation. The average F1-score of the clinicians increased significantly from 0.586 to 0.645.

Prediction of pulp exposure before caries excavation using artificial intelligence: Deep learning-based image data versus standard dental radiographs.

OBJECTIVES: The objective was to examine the effect of giving Artificial Intelligence (AI)-based radiographic information versus standard radiographic and clinical information to dental students on their pulp exposure prediction ability. METHODS: 292 preoperative bitewing radiographs from patients previously treated were used. A multi-path neural network was implemented. The first path was a convolutional neural network (CNN) based on ResNet-50 architecture. The second path was a neural network trained on the distance between the pulp and lesion extracted from X-ray segmentations. Both paths merged and were followed by fully connected layers that predicted the probability of pulp exposure. A trial concerning the prediction of pulp exposure based on radiographic input and information on age and pain was conducted, involving 25 dental students. The data displayed was divided into 4 groups (G): GX-ray, GX-ray+clinical data, GX-ray+AI, GX-ray+clinical data+AI. RESULTS: The results showed that AI surpassed the performance of students in all groups with an F1-score of 0.71 (P < 0.001). The students' F1-score in GX-ray+AI and GX-ray+clinical data+AI with model prediction (0.61 and 0.61 respectively) was slightly higher than the F1-score in GX-ray and GX-ray+clinical data (0.58 and 0.59 respectively) with a borderline statistical significance of P = 0.054. CONCLUSIONS: Although the AI model had much better performance than all groups, the participants when given AI prediction, benefited only 'slightly'. AI technology seems promising, but more explainable AI predictions along with a 'learning curve' are warranted.

Chapter 3: Pathological Features of Coronal Caries.

Pathology is the science of how a tissue changes during the process of the disease. The pathology is of important knowledge for understanding subsequent treatment concepts of a disease. In the cariology field, pathological features of caries are often presented using tooth sections, whereby the sequence and spread can be monitored. It is optimal to describe such changes using thin undecalcified tooth sections as an overview can be given of both enamel demineralization and pulp-dentine reactions. Also, an optimal understanding is achieved if the clinical status of carious lesion activity is known. Different studies using human teeth have shown the principle changes in progressive stages of carious lesions; the growth of the enamel lesion reflects the growth condition of the cariogenic biofilm. Surprisingly, the pulp (the odontoblast) is aware of the cariogenic stimuli even before mineral alteration has taken place within the dentine. The microorganisms mainly invade the dentine during enamel cavitation. In this chapter, the current improvement of knowledge on advanced carious lesions has been assessed in detail both histologically and radiographically. From a radiographic point of view, well-defined deep and extremely deep carious lesions and their difference are presented. Recent advances in artificial intelligence (AI) in medicine have raised the possibility of increasing the accuracy and speed of histopathological examination techniques. However, the literature involving AI-based histopathological features of hard and soft dentinal tissue pathologic changes is still scarce.

Reconstruction of Critical Sized Maxillofacial Defects Using Composite Allogeneic Tissue Engineering: Systematic Review of Current Literature.

The current review aimed to assess the reliability and efficacy of tissue-engineered composite grafts in the reconstruction of large maxillofacial defects resulting from trauma or a benign pathologic disease. A systematic review of the literature was conducted using PubMed/Medline, Embase, and Scopus up to March 2022. The eligibility criteria included patients who had been treated with composite allogeneic tissue engineering for immediate/delayed reconstruction of large maxillofacial defects with minimum/no bone harvesting site. In the initial search, 2614 papers were obtained, and finally, 13 papers were eligible to be included in the current study. Most included papers were case reports or case series. A total of 144 cases were enrolled in this systematic review. The mean age of the patients was 43.34 (age range: 9-89). Most studies reported a successful outcome. Bone tissue engineering for the reconstruction and regeneration of crucial-sized maxillofacial defects is an evolving science still in its infancy. In conclusion, this review paper and the current literature demonstrate the potential for using large-scale transplantable, vascularized, and customizable bone with the aim of reconstructing the large maxillofacial bony defects in short-term follow-ups.

The efficiency of artificial intelligence methods for finding radiographic features in different endodontic treatments - a systematic review.

OBJECTIVES: To assess the efficiency of AI methods in finding radiographic features in Endodontic treatment considerations. MATERIAL AND METHODS: This review was based on the PRISMA guidelines and QUADAS 2 tool. A systematic search was performed of the literature on cases with endodontic treatments, comparing AI algorithms (test) versus conventional image assessments (control) for finding radiographic features. The search was conducted in PubMed, Scopus, Google Scholar and the Cochrane library. Inclusion criteria were studies on the use of AI and machine learning in endodontic treatments using dental X-rays. RESULTS: The initial search retrieved 1131 papers, from which 24 were included. High heterogeneity of the materials left out a meta-analysis. The reported subcategories were periapical lesion, vertical root fractures, predicting root/canal morphology, locating minor apical foramen, tooth segmentation and endodontic retreatment prediction. Radiographic features assessed were mostly periapical lesions. The studies mostly considered the decision of 1-3 experts as the reference for training their models. Almost half of the included materials campared their trained neural network model with other methods. More than 58% of studies had some level of bias. CONCLUSIONS: AI-based models have shown effectiveness in finding radiographic features in different endodontic treatments. While the reported accuracy measurements seem promising, the papers mostly were biased methodologically.

Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis.

BACKGROUND: Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials. MATERIALS AND METHODS: After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis. RESULT: Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively. CONCLUSION: The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57). TRIAL REGISTRATION: This meta-analysis was registered at the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42020209644 ).

Complications Associated with Spreader Grafts and Spreader Flaps: A Systematic Review.

BACKGROUND AND PURPOSE: Spreader grafts and spreader flaps are one of the most common techniques utilized in rhinoplasty surgeries. The aim of this study was to determine the complications, satisfaction, and revision rates associated with spreader grafts and spreader flaps and to compare these two modalities. MATERIALS AND METHODS: PRISMA guidelines were followed for conducting this systematic review. The authors searched the literature systematically for pertinent materials in PubMed/Medline and Google Scholar. Inclusion criteria of this search included: randomized and non-randomized clinical trials, cohorts, and case series with more than 5 participants on rhinoplasty using spreader grafts or spreader flaps with detailed report either on complications, revision, and satisfaction rates. Furthermore, exclusion criteria included: any cadaveric or non-human study, case reports, technical notes, and review articles. RESULTS: The initial literature search yielded a total of 193 studies. Following screening each paper and implementing the inclusion and exclusion criteria, 40 articles were chosen. In the spreader graft group, from 21 studies reporting complications, 6 of them reported no complication. The most common complications were nasal obstruction, inverted V deformity and open roof deformity, deviation, and infection. In the spreader flap group, from 6 studies reporting any existing complications, 1 reported no complications. Five other studies reported some degree of complications. In terms of revision rate, 10 patients (0.62%) underwent revision surgery after spreader graft placement, while only 2 patients (0.35%) revised surgically in the spreader flap group. CONCLUSION: These two methods seem to have no significant difference in terms of complication rates, and both are recommended as a choice in middle vault reconstruction when each of their clinical use is indicated. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Vaccine-associated complications: a comparative multicenter evaluation among dental practitioners and dental students-which candidate vaccine is more safe in SARS COV II, Gam-COVID-Vac (Sputnik V), ChAdOx1 nCoV-19 (AstraZeneca), BBV152 (Covaxin), or BBIBP-CorV(Sinopharm)?

BACKGROUND: The rapidly developed vaccines against the severe acute respiratory syndrome coronavirus 2 carry a risk of provoking side effects. This study aimed to evaluate current vaccination non-serious/serious side effects. METHODS: A multicenter electronic questionnaire via an online platform was conducted over a 1-week period among vaccinated dental staff and dental students inquiring whether they experienced vaccine-related side-effects after vaccine administration. RESULTS: A total of 1205 respondents with a mean age of 39 (SD: 12) were retained for the analyses. The following vaccines were reported; Gam-COVID-Vac (Sputnik V), ChAdOx1 nCoV-19 (AstraZeneca), BBV152 (Covaxin), or BBIBP-CorV (Sinopharm). The majority of respondents received ChAdOx1 nCoV-19 (51.1%) and Gam-COVID-Vac (37.6%). The symptoms most frequently reported after vaccination were fatigue (79%), local pain in the injection site (77.4%), malaise (73%), and body pain (71.1%). Enrollees reported more onset of reactions on 0-12 h (44.1%) and 12-24 h (29.0%) after vaccine administration (p value <0.001). In 75.7%, the side effects last for up to 3 days. Merely 5.5% of cases reported the presence of side effects after the first week. Individuals with a history of SARSCoV-2 and other infections (MERS, influenza, and EBV) were more likely to report a number of unserious systemic side effects. CONCLUSION: The commonly reported adverse events were in line with similar studies. We have concerns with the frequency of serious adverse effects. This work necessitates the need for further clinical assessments with larger sample sizes.

Spreader Graft vs Spreader Flap in Rhinoplasty: A Systematic Review and Meta-Analysis of Aesthetic and Functional Outcomes.

BACKGROUND: Insufficient support of the nasal mid-vault during rhinoplasty can cause significant complications. Accordingly, surgeons have recently paid much more attention to the preservation of nasal patency. The spreader graft is the gold standard technique for the reconstruction of nasal mid-vault. OBJECTIVES: The objective of this study was to compare the spreader graft and spreader flap in terms of aesthetic and functional outcomes. METHODS: An inclusive search was performed with PubMed/Medline, Google Scholar, and Cochrane Library databases up to April 2021. Multiple aesthetic and functional factors, including dorsal aesthetic lines restoration, satisfaction rate, internal nasal valve angle improvement, nasal obstruction symptom evaluation scale, and active anterior rhinomanometry were evaluated. Also, a meta-analysis was performed on the included articles that provided adequate data for mentioned factors. RESULTS: After excluding papers that did not conform with the selection criteria, 10 articles with a total sample size of 567 cases with a mean age of 27.7 years (range, 18-65 years) were finally included. Analysis of the data revealed no statistically significant difference between the spreader graft and spreader flap techniques in terms of dorsal aesthetic lines restoration, internal nasal valve angle improvement, nasal obstruction symptom evaluation scale, and anterior rhinomanometry. CONCLUSIONS: However, in terms of satisfaction rate, the analyzes indicated that spreader graft has significantly superior aesthetic outcomes. Generally, in case of appropriately selected patients, there is no statistically significant difference between spreader graft and spreader flap techniques in terms of aesthetic and functional outcomes.

A literature review of applications of Kinesio Taping® in the craniomaxillofacial region.

This study was conducted to achieve an understanding of the potential applications of Kinesio Taping® (KT) in the craniomaxillofacial region. A comprehensive search of pertinent literature was performed through PubMed, Medline, Google Scholar, ProQuest, and ScienceDirect. The focused question that was addressed was, "What are the potential applications of KT in the craniomaxillofacial region?". The preliminary search identified 52 studies. Once duplicates were removed, the remaining 43 titles/abstracts were screened, where 9 studies were excluded and the remaining 34 were assessed. Three additional studies were obtained through reference review of the retrieved articles. KT is being used for the management of various conditions, including temporomandibular joint disorders, side effects associated with maxillofacial surgeries, various neurological conditions, etc. KT has not been proven as a reliable independent treatment option; however, it is considered to be useful as a complementary option to improve treatment outcomes for various conditions.

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation.

BACKGROUND: Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties. OBJECTIVES: The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates. METHODS: We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews. RESULTS: The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%. CONCLUSIONS: Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions.

Autologous Fat Injection for Augmentation Rhinoplasty: A Systematic Review.

BACKGROUND: Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections. OBJECTIVES: This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections. METHODS: The authors searched PubMed/Medline and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet. RESULTS: The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as an insufficient volume or decreased volume by resorption, tip excess and supratip fillness, and mild displacement, more than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%. CONCLUSIONS: Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Clinical expertise is essential to have a safe injection and to minimize the potential complications.

Psychologic Status and Influence of Surgery Techniques on Acute Nonneuropathic Pain After Dental Implant Surgery: Systematic Review and Meta-analyses.

PURPOSE: Dental implant placement is often followed by acute pain, which is one of the most important patient-centered matters of treatment. However, this pain is often not adequately appreciated by clinicians, and knowledge about risk factors associated with acute pain is scant. An understanding of these factors is important to help clinicians deliver efficient pain control advice based on individual demand. MATERIALS AND METHODS: A systematic review of the literature was carried out to identify published risk factors for acute pain after dental implant surgery. PubMed, Cochrane Central Register of Controlled Trials, Embase, and Google Scholar databases were searched to find pertinent studies up to August 2019. Cohorts and randomized controlled trials (RCTs; including split-mouth trials) were included. The criteria used were those described in the PRISMA statement for performing systematic reviews. RESULTS: Nine hundred twenty-five papers were identified through the initial searching. After three stages of screening, 38 articles were included in the qualitative analysis but only 8 in the quantitative analysis. Despite the heterogeneity of the included articles, these data showed that flapped (vs flapless) surgery, anxiety, longer surgical duration, anticipation of more pain before surgery, and higher pain levels at earlier time points play a key role in the intensity of acute pain after dental implant surgery. There is strong evidence to suggest that the place of insertion (maxilla/mandible) is not a risk factor for pain. CONCLUSION: The results for the effect of immediate loading (vs delayed loading), number of implants inserted, sex, age, and smoking on pain were inconclusive.

Zygomatic implants placed in atrophic maxilla: an overview of current systematic reviews and meta-analysis.

BACKGROUND: Zygomatic implants are a treatment option for severely atrophic maxilla. MAIN TEXT: This study aimed to summarize and evaluate systematic reviews assessing the clinical outcomes of zygomatic implants including survival/failure rate and complications. PubMed-MEDLINE, Google Scholar, LILACS, and the Cochrane Database were searched up to April 2020. Risk of bias assessment was conducted by the AMSTAR tool. Initial searches yielded 175 studies. These were assessed, and following title abstract and full-text evaluation, 7 studies (2 meta-analyses) were included in the final review. According to the AMSTAR tool, 1 was deemed high quality, 4 were classified as medium, and 2 as low quality. The mean AMSTAR score (±SD) was 5.28 of 9 (±2.36) ranging from 2/9 to 9/9. The reported survival rates ranged from 95.2 to 100% except for resected maxillas, which established higher failure rates up to 21.43%. Concerning the complications with the zygomatic implants, various surgical and prosthetic complications were reported with sinusitis being the most frequently observed complication. Zygomatic implants appears to offer a promising alternative to formal bone grafting techniques with lower costs, less complications, less morbidity, shorter treatment times, and comparably high survival rates. CONCLUSION: Complications were rare and usually easy to manage. However, the treatment should be directed by appropriately trained clinicians with noticeable surgical experience.

Dynamic-Assisted Navigational System in Zygomatic Implant Surgery: A Qualitative and Quantitative Systematic Review of Current Clinical and Cadaver Studies.

PURPOSE: The goal of this systematic review is to assess the accuracy and complications (including failure) of dynamic navigation in placing zygomatic implants. METHODS: PubMed, Cochrane Library (CENTRAL), trial register (clinicaltrial.gov), and Google Scholar were searched systematically up to May 2020. In addition, the reference lists of included systematic reviews were hand searched. The New Castle Ottawa and Joanna Briggs Institute Critical Appraisal Checklist for Case Reports were used for quality assessment. RESULTS: Ninety-four studies were assessed, and finally, 12 articles were included. According to Joanna Briggs Institute tool, the mean score of case reports (±standard deviation) was 6.4 (range, 5/9 to 8/9) and the mean score of observational studies (±standard deviation) was 5.66 (range, 5/9 to 7/9) as measured by New Castle Ottawa tool. Included materials pointed out that higher accuracy and drastic cut down on the risk of perioperative/postoperative complications were reported by using the dynamic navigation system compared with freehand implant placement. CONCLUSIONS: Application of dynamic navigation systems is a reliable technology for zygomatic implant placement, especially in difficult cases with a history of maxillary deficiency. Evidence of reliability and accuracy of dynamic navigation technique in multicenter large randomized and prospective controlled studies is still lacking.