Comparison between periapical radiography and cone beam computed tomography for the diagnosis of anterior maxillary trauma in children and adolescents.

BACKGROUND/AIMS: Under-estimating the damage caused by trauma to the dental structures may delay treatment. Timely and accurate diagnosis remains challenging in clinical practice. Radiography is an important modality for the diagnosis of traumatic injuries. The aim of this study was to compare the efficacy of periapical radiography and cone beam computed tomography for the diagnosis of trauma to the anterior maxillary dentoalveolar region in children and adolescents. MATERIAL AND METHODS: Images of patients who underwent both periapical radiography and cone beam computed tomography simultaneously because of trauma to the anterior maxillary region between January 2016 and January 2020 were analyzed retrospectively. Pairwise comparison between the receiver operating characteristic curves was performed to statistically compare the two methods for the diagnosis of crown fractures, root fractures, alveolar bone fractures and luxations, tooth resorption, and periapical radiolucencies. RESULTS: A total of 190 patients met the inclusion criteria. There were 120 (63.2%) males and 70 (36.8%) females, with a mean age of 11.1 years (range: 6-17 years). A crown fracture was observed in 144 teeth, while a root fracture was observed in 71 teeth. Alveolar fracture and luxation were observed in 44 incisors. During follow-up, tooth resorption and periapical radiolucencies were observed in 25 and 33 teeth, respectively. Pairwise receiver operating characteristic curve analysis revealed that cone beam computed tomography was significantly superior to periapical radiography for the diagnosis of root fractures, alveolar fractures and luxations, and tooth resorption (p < .05). However, no significant differences were found for the diagnosis of crown fractures and periapical radiolucencies (p > .05). CONCLUSIONS: Cone beam computed tomography in the low-dose mode was better for diagnosing root and bone fractures and resorption, but no different to periapical radiographs for crown fractures and periapical radiolucencies in pediatric patients.

Detection of vertical root fractures by cone-beam computed tomography based on deep learning.

OBJECTIVES: This study aims to evaluate the performance of ResNet models in the detection of in vitro and in vivo vertical root fractures (VRF) in Cone-beam Computed Tomography (CBCT) images. METHODS: A CBCT image dataset consisting of 28 teeth (14 intact and 14 teeth with VRF, 1641 slices) from 14 patients, and another dataset containing 60 teeth (30 intact and 30 teeth with VRF, 3665 slices) from an in vitro model were used for the establishment of VRFconvolutional neural network (CNN) models. The most popular CNN architecture ResNet with different layers was fine-tuned for the detection of VRF. Sensitivity, specificity, accuracy, PPV (positive predictive value), NPV (negative predictive value), and AUC (the area under the receiver operating characteristic curve) of the VRF slices classified by the CNN in the test set were compared. Two oral and maxillofacial radiologists independently reviewed all the CBCT images of the test set, and intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement for the oral maxillofacial radiologists. RESULTS: The AUC of the models on the patient data were: 0.827(ResNet-18), 0.929(ResNet-50), and 0.882(ResNet-101). The AUC of the models on the mixed data get improved as:0.927(ResNet-18), 0.936(ResNet-50), and 0.893(ResNet-101). The maximum AUC were: 0.929 (0.908-0.950, 95% CI) and 0.936 (0.924-0.948, 95% CI) for the patient data and mixed data from ResNet-50, which is comparable to the AUC (0.937 and 0.950) for patient data and (0.915 and 0.935) for the mixed data obtained from the two oral and maxillofacial radiologists, respectively. CONCLUSIONS: Deep-learning models showed high accuracy in the detection of VRF using CBCT images. The data obtained from the in vitro VRF model increases the data scale, which is beneficial to the training of deep-learning models.

Sialoendoscopic and irrigation findings in chronic obstructive parotitis.

OBJECTIVES/HYPOTHESIS: To study the sialographic changes related to sialoendoscopic and irrigation fluid findings in chronic obstructive parotitis. STUDY DESIGN: The sialographic changes were classified according to previous studies and related to sialoendoscopic and irrigation fluid findings. METHODS: This study included 26 patients with a long history of parotid swelling. All patients were examined by radiography and sialography and were diagnosed as having chronic obstructive parotitis without sialolithiasis. Sialoendoscopy was used to observe the ductal system and perform an irrigation treatment. The irrigated liquid was centrifuged, and the fluid deposits were stained and observed using light microscopy. RESULTS: In all cases, sialoendoscopic examination showed the ductal system was filled with fiber-like substances and hyperemia of the ductal wall. Although a few of the thin and short fiber-like substances were found in the chronic obstructive parotitis patients with sialographic type I and type II changes, many thick and long wadding or lumpy fiber-like substances were revealed in chronic obstructive parotitis patients with sialographic type III and IV changes. Microstones were found in two chronic obstructive parotitis patients with sialographic type III changes, which were stained and identified using light microscopy. Irrigation fluid examination showed that the fiber-like substance was composed of desquamative duct epithelial cells, neutrophils, lymphocytes, and acidophils. Also, some epithelial cells were found in two microliths. CONCLUSIONS: Sialoendoscopy can provide direct and more detailed observation of the ductal system compared with sialography. Fiber-like substances in the lumen of the ductal system are considered one of the obstructive factors associated with chronic obstructive parotitis.

[Sialographic, sialoendoscopic and irrigation fluid study in chronic obstructive parotitis].

OBJECTIVE: To study the sialographic changes and to compare the changes with sialoendoscopic and irrigation fluid findings in chronic obstructive parotitis (COP). METHODS: This study involved 27 patients with a long history of parotid swelling. All patients were examined by X-ray, sialography, and were diagnosed as COP without sialolithiasis. Sialoendoscopy was used to observe the ductal system and irrigation treatment performed. The irrigated liquid was centrifuged and the deposits of fluid were stained and observed under microscopy. The sialographic changes were classified as previous studies and compared with sialoendoscopic and irrigation fluid findings. RESULTS: The sialographic changes of COP in 27 patients included 9 cases with type I, 5 cases with type II, 9 cases with type III and 3 cases with type IV changes, 1 case was normal. Marked obstructive factors such as stricture of ductal system were revealed in 21 cases on the sialogram. Sialoendoscopic examination showed that the ductal system was filled with fiber-like substances and hyperaemia of ductal wall in all cases. While few and thin fiber-like substances were found in the COP with sialographic type I and type II changes, many thick wadding or mass fiber-like substances were revealed in COP with sialographic type III and IV changes. Microstones were found in 2 COP with sialographic type III changes which were stained and identified by microscopy. Foreign body (drug bar) was found in one COP with sialographic type I changes with sialoendoscopy. Irrigation fluid examination showed fiber-like substance was composed of desquamative duct epithelial cells, neutrophil, lymphocytes, acidophile. Some epithelial cells were found in two microliths. CONCLUSIONS: The pathological basis of fiber-like substance on sialoendoscopy is desquamative duct epithelial cells. Fiber-like substance in the lumen of ductal system is considered as one of the obstructive factors in COP. Sialoendoscopic findings is related to sialographic changes.