Jawbone measurements of edentulous sites related to implant planning using magnetic resonance imaging compared to cone beam computed tomography: An ex vivo study.

AIM: To compare measurements on images obtained by magnetic resonance imaging (MRI) and cone beam CT (CBCT) for height, width, and area in alveolar bone sites in human jaw specimens. MATERIAL AND METHODS: Forty edentulous alveolar posterior sites in human cadaver specimens were imaged using CBCT scanners, and with zero-echo-time MRI (ZTE-MRI). Semi-automatic volume registration was performed to generate representative coronal sections of the sites related to implant planning. ZTE-MRI sections were also presented after grayscale inversion (INV MRI). Three observers measured bone height, bone width 5 mm from the alveolar crest, and bone area stretching from the width measurement to the top of the alveolar crest in the images. Interobserver agreement was assessed by intra-class correlation coefficients (ICC). The measurements were analyzed using two-way repeated measures ANOVA factoring observer and image type. RESULTS: ICC was >0.95 for bone height, width, and bone area. No significant differences among observers (p = 0.14) or image type (p = 0.60) were found for bone height. For bone width, observer (p = 0.14) was not a significant factor, while ZTE-MRI produced width estimates that were significantly different and systematically smaller than CBCT-based estimates (p ≤ 0.001). Observer (p = 0.06) was not a significant factor regarding the bone area measurements, contrary to the imaging type where ZTE-MRI led to significantly smaller area estimates than CBCT (p ≤ 0.001). CONCLUSION: Bone height measurements were essentially equivalent using CBCT and MRI. This was found regardless of grayscale choice for the MRI. However, ZTE-MRI resulted in smaller estimates of bone width and area.

Clinical accuracy of partially guided implant placement in edentulous patients: A computed tomography-based retrospective study.

OBJECTIVES: This retrospective study was intended to evaluate the clinical accuracy of partially guided template in guiding implant placement in edentulous patients. METHODS: A total of 120 implants were placed in 24 patients with at least one completely edentulous arch with a partially guided system. Based on CBCT data, a repeatable method was used to measure linear and angular deviations of implants at 3D level in Mimics medical software. The influence of supporting tissue and implant region on the accuracy was assessed, followed by the evaluation of direction of linear deviations in biologically vital areas. RESULTS: Linear deviations of all implants were 1.91 ± 0.68 mm, 1.47 ± 0.68 mm, and 1.02 ± 0.69 mm at apical, apical lateral, and apical vertical levels. When at the cervical, cervical lateral, and cervical vertical levels, the linear deviations were 1.53 ± 0.65 mm, 0.98 ± 0.53 mm, and 1.01 ± 0.69 mm, respectively. Angular deviation of all implants was 7.14 ± 3.41°. Implants guided by mucosa + tooth-supported templates showed higher linear deviations at apical vertical level (1.21 ± 0.72 mm vs. 0.86 ± 0.63 mm, p < .05) and cervical vertical level (1.18 ± 0.72 mm vs. 0.87 ± 0.63 mm, p < .05) than mucosa-supported templates, and implants in maxilla were found higher angular deviation than mandible (7.89 ± 3.61° vs. 6.29 ± 2.97°, p < .05). CONCLUSIONS: The partially guided template served as clinically viable surgical assistance in implant placement in edentulous patients. When using mucosa + tooth-supported template or placing implants in maxilla, more caution was required, especially in biologically vital areas.

A nomogram prediction of implant apical non-coverage on bone-added transcrestal sinus floor elevation: A retrospective cohort study.

OBJECTIVES: To identify the risk indicators and develop and validate a nomogram prediction model of implant apical non-coverage by comprehensively analyzing clinical and radiographic factors in bone-added transcrestal sinus floor elevation (TSFE). MATERIAL AND METHODS: A total of 260 implants in 195 patients receiving bone-added TSFE were included in the study. The population was divided into a development (180 implants) and a validation (80 implants) cohort. According to 6 months post-surgery radiographic images, implants were categorized as "apical non-coverage" or "apical covered." The association of risk factors including clinical and radiographic parameters with implant apical non-coverage was assessed using regression analyses. A nomogram prediction model was developed, and its validation and discriminatory ability were analyzed. RESULTS: The nomogram predicting bone-added TSFE's simultaneously placed implant's apex non-coverage after 6 months. This study revealed that sinus angle, endo-sinus bone gain, implant protrusion length, graft contact walls, and distal angle were predictors of implant apical non-coverage. The generated nomogram showed a strong predictive capability (area under the curve [AUC] = 0.845), confirmed by internal validation using 10-fold cross-validation (Median AUC of 0.870) and temporal validation (AUC = 0.854). The calibration curve and decision curve analysis demonstrated good performance and high net benefit of the nomogram, respectively. CONCLUSIONS: The clinical implementation of the present nomogram is suitable for predicting the apex non-coverage of implants placed simultaneously with bone-added TSFE after 6 months.

Accuracy of template-based guided dental implant placement-An in vitro comparison of different manufacturing methods.

OBJECTIVES: This study investigates effects of surgical guide manufacturing process on 3D transfer accuracy of planned dental implant position, using three production methods: additive 3D-printed (3DF), subtractive milled (MF), and analog laboratory fabricated templates (LF). MATERIAL AND METHODS: Implant position for a single-tooth gap (#26) planned digitally. 3DF and MF templates were designed digitally, while LF templates were analogously created. For each manufacturing type, 10 surgical guides were fabricated. Each guide was used for template-guided implant placement in model replicas. For evaluation of implant placement, cone beam computed tomography scans of all implanted models were superimposed, and implant positions were determined. Deviations at implant shoulder/apex were measured, and median and inter-quartile range (IQR) were determined for mesio-distal, oro-facial, coronal apico, 3D spaces, and angles. RESULTS: At implant shoulder, vertical components dominated position deviations (up to 1.04 mm, IQR 0.28 mm for 3DF). Horizontal deviations were much lower (mesio-distally up to 0.38 mm, IQR 0.36 mm (LF)). Implant apex shows similar vertical deviations, while horizontal deviations clearly increased compared to shoulder, especially in mesio-distal direction. Median angular deviations were between 2.1° (IQR 2.0 mm, max. 4.2°) for 3DF and 3.3° (IQR 1.9 mm, max. 5.3°) for MF. No statistical differences were found between manufacturing types (Kruskal-Wallis test, p = .05). CONCLUSIONS: The study showed the method of implant guide fabrication did not affect the accuracy of implant placement within the limits of an in vitro environment. All methods resulted in implant placement which did not exceed the accepted safety deviation envelope (1.5-2.0 mm).

Accuracy of manual and artificial intelligence-based superimposition of cone-beam computed tomography with digital scan data, utilizing an implant planning software: A randomized clinical study.

OBJECTIVES: To investigate the accuracy of conventional and automatic artificial intelligence (AI)-based registration of cone-beam computed tomography (CBCT) with intraoral scans and to evaluate the impact of user's experience, restoration artifact, number of missing teeth, and free-ended edentulous area. MATERIALS AND METHODS: Three initial registrations were performed for each of the 150 randomly selected patients, in an implant planning software: one from an experienced user, one from an inexperienced operator, and one from a randomly selected post-graduate student of implant dentistry. Six more registrations were performed for each dataset by the experienced clinician: implementing a manual or an automatic refinement, selecting 3 small or 3 large in-diameter surface areas and using multiple small or multiple large in-diameter surface areas. Finally, an automatic AI-driven registration was performed, using the AI tools that were integrated into the utilized implant planning software. The accuracy between each type of registration was measured using linear measurements between anatomical landmarks in metrology software. RESULTS: Fully automatic-based AI registration was not significantly different from the conventional methods tested for patients without restorations. In the presence of multiple restoration artifacts, user's experience was important for an accurate registration. Registrations' accuracy was affected by the number of free-ended edentulous areas, but not by the absolute number of missing teeth (p < .0083). CONCLUSIONS: In the absence of imaging artifacts, automated AI-based registration of CBCT data and model scan data can be as accurate as conventional superimposition methods. The number and size of selected superimposition areas should be individually chosen depending on each clinical situation.

Image fusion-based low-dose CBCT enhancement method for visualizing miniscrew insertion in the infrazygomatic crest.

Digital dental technology covers oral cone-beam computed tomography (CBCT) image processing and low-dose CBCT dental applications. A low-dose CBCT image enhancement method based on image fusion is proposed to address the need for subzygomatic small screw insertion. Specifically, firstly, a sharpening correction module is proposed, where the CBCT image is sharpened to compensate for the loss of details in the underexposed/over-exposed region. Secondly, a visibility restoration module based on type II fuzzy sets is designed, and a contrast enhancement module using curve transformation is designed. In addition to this, we propose a perceptual fusion module that fuses visibility and contrast of oral CBCT images. As a result, the problems of overexposure/underexposure, low visibility, and low contrast that occur in oral CBCT images can be effectively addressed with consistent interpretability. The proposed algorithm was analyzed in comparison experiments with a variety of algorithms, as well as ablation experiments. After analysis, compared with advanced enhancement algorithms, this algorithm achieved excellent results in low-dose CBCT enhancement and effective observation of subzygomatic small screw implantation. Compared with the best performing method, the evaluation metric is 0.07-2 higher on both datasets. The project can be found at: https://github.com/sunpeipei2024/low-dose-CBCT .

Mandibular advancement device in obstructive sleep apnea treatment: what happens to the condyle position and patient response?

BACKGROUND: This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS: 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS: The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION: MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

A retrospective study of alveolar bone remodelling after anterior retraction in orthodontic tooth extraction cases with clear aligners and fixed appliances.

OBJECTIVES: To evaluate alveolar bone dimensions and its relationship with tooth movement (retraction, intrusion and torque) during orthodontic treatment with fixed appliance and clear aligners. METHODS: Thirty-two patients were included in this retrospective clinical study. Cone beam computed tomography (CBCT) was collected before and after treatment to measure the volume of dehiscence and fenestrations in the maxillary anterior region, anterior alveolar bone thickness and height and degree of tooth movement. Rank-sum tests were used to compare the differences in alveolar bone defect volumes between clear aligners and fixed appliance, multiple linear regression analysis was used for study evaluation, and kappa statistics were used to assess internal consistency and test-retest reliability. RESULTS: Post-operatively, most alveolar bone defects occurred on the labial side. The incidence of bone fenestration was 23.96% in the clear aligner group and 26.18% in the fixed appliance group, which was higher than the incidence of bone dehiscence (5.21%). The labial bone height decreased by 0.272 mm, and the palatal bone height increased by 0.617 mm for every 1 mm downward intrusion of the anterior tooth apex in the fixed appliance group. In the clear aligner group, there was no significant change in the labial bone height, and the palatal bone height decreased by 0.447 mm for every 1 mm of anterior tooth retraction coronally. CONCLUSIONS: In the fixed appliance group, anterior tooth intrusion and retraction may have led to alveolar bone resorption by its compression at the cervical level. This study provides a three-dimensional tooth movement evaluation method by using CBCT.

Asymmetry in Class II subdivision malocclusion: Assessment based on 3D surface models.

INTRODUCTION: There is currently no consensus in the literature whether the aetiology of a Class II subdivision is dental, skeletal or both. The aim of this study was to identify and quantify skeletal and dental asymmetries in Class II subdivision malocclusions. METHODS: CBCTs from 33 Class II subdivision malocclusion patients were used to construct 3D volumetric label maps. Eighteen landmarks were identified. The original scan and associated 3D volumetric label map were mirrored. Registration of the original and mirrored images relative to the anterior cranial base, maxilla and mandible were performed. Surface models were generated, and 3D differences were quantified. Statistical analysis was performed. RESULTS: Anterior cranial base registration showed significant differences for fossa vertical difference, fossa roll, mandibular yaw, mandibular lateral displacement and lower midline displacement. Regional registrations showed significant differences for antero-posterior (A-P) mandibular length, maxillary roll, A-P maxillary first molar position, maxillary first molar yaw and maxillary first molar roll. Class II subdivision patients also show an asymmetric mandibular length as well as an asymmetric gonial angle. Moderate correlations were found between the A-P molar relationship and fossa A-P difference, mandibular first molar A-P difference, maxillary first molar A-P difference and maxillary first molar yaw. CONCLUSIONS: This study suggests that Class II subdivisions can result from both significant skeletal and dental factors. Skeletal factors include a shorter mandible as well as posterior and higher displacement of the fossa on the Class II side, resulting in mandibular yaw. Dental factors include maxillary and mandibular first molar antero-posterior asymmetry.

The success rate of mini-screws for incisors intrusion and patient age, gender, and insertion angle in the maxilla using CBCT and implant-guided surgery. A split-mouth, randomized control trail.

BACKGROUND AND OBJECTIVES: The intrusion of anterior teeth is a routine procedure in orthodontics, which has been performed efficiently with the help of mini-screws in the anterior region, especially the upper maxilla. This study aimed to investigate the effect of insertion angle and sociodemographic features on the success rate of mini-screws at the anterior maxillary region. MATERIALS AND METHODS: Twenty-nine patients (18 Females and 11 Males) aged 18-40 years old were involved in the current study. A split-mouth design was carried out in which recruited patients needed bilateral anterior screws at the labial bone in the region of the incisor for the intrusion of upper anterior incisor teeth as part of their orthodontic treatment with a fixed appliance (upper right side received 90-degree insertion angle mini-screw and 45° for left side) using a surgical guide fabricated from patients CBCT and intraoral scans. The mini-screws were inserted at the attached gingiva bilaterally to achieve intrusion of upper anterior teeth with a power chain ligated from the main archwire to the anterior min-implants. The patient was recalled monthly for orthodontic appliance activation and screw assessment for 6 months. The intrusion force was 15 g on each side. RESULTS: The results of the study showed that screw stability was higher in the male group than the female group at the 6th monthly follow-up visit with a statistically significant difference between both genders (P = .044). Concerning insertion angle, results showed a statistically significant difference between 45° and 90° as an insertion angle with a P-value <.01 in most of the follow-up months. CONCLUSION: This study found that male patients with mini-screws inserted at 90° showed greater screw stability over time.

Efficacy of maxillary molar intrusion and quantification of related external apical root resorption - A comparison of two approaches.

OBJECTIVE: This retrospective single-centre study aimed to compare the efficacy of maxillary second molar intrusion with two different approaches, miniscrew-assisted molar intrusion and traditional segmental archwire intrusion, and to compare orthodontically induced external apical root resorption (OIERR) during intrusion between two groups via cone beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 40 adult patients (33.6 ± 10.3 years old) with supraerupted maxillary second molars due to the loss of antagonistic teeth were recruited, with 20 patients in each group. A segmental archwire with adjacent teeth as an anchorage was used in the control group, and 60-100 g of intrusive force was applied by using miniscrews in the experimental group to intrude the overerupted molars. Full-volume CBCT was performed before and after intrusion, and the amount of intrusion and extent of OIERR of the overerupted molars were compared between the two groups. RESULTS: Supraerupted maxillary second molars could be successfully intruded in an average of 5 months. There was more intrusive movement of the buccal and palatal cusps in the mininscrew group than that in the segmental archwire group (P < .05). The intrusive amount of palatal cusp was 3.67 ± 1.13 mm in the miniscrew group and 2.38 ± 0.74 mm in the segmental archwire group. More palatal OIERR was observed in the miniscrew group (30.3 ± 11.6 mm3) than in the segmental archwire group (21.0 ± 8.66 mm3) (P = .0063). There was no significant difference in OIERR between the two groups for mesial and distal buccal roots (P > .05). CONCLUSION: Miniscrews help effectively with supraerupted maxillary second molar intrusion, especially for palatal cusps. There was more OIERR in the palatal root when using miniscrews compared to the segmental archwire approach.

Alveolar bone morphology in patients with palatally-displaced maxillary lateral incisors before and after orthodontic treatment: A cone-beam computed tomography study.

INTRODUCTION: Palatal displacement of maxillary anterior teeth is common in clinical practice. Previous studies have reported that the labial bone around palatally-displaced incisors is thinner than that around normally-placed teeth. Therefore, it is necessary to elucidate alveolar bone changes after alignment to guide orthodontic treatment. In this study, we investigated the alveolar bone changes around palatally-displaced maxillary lateral incisors before and after treatment, and the effects of extraction and age using cone-beam computed tomography. METHODS: In this retrospective study, 55 patients with unilateral palatally-displaced maxillary lateral incisors were included. Three-dimensional alveolar bone changes were measured at three levels (25%, 50% and 75% of the root length) using cone-beam computed tomography. Group comparisons were made between displaced and control teeth, extraction and non-extraction groups, and adult and minor groups. RESULTS: After orthodontic treatment, labiopalatal and palatal alveolar bone widths decreased at all measured levels. Labial alveolar bone width increased significantly at P25, but decreased at P75. Concavity decreased, while tooth-axis angle, tooth length, B-CEJ and P-CEJ increased. Changes in LB and LP at P75, B-CEJ and P-CEJ were statistically significant. After treatment, the tooth-axis angle on the PD side increased by 9.46°. The change in tooth-axis angle on the PD side was significantly smaller, and LB and LP decreased more at P75, in the extraction group. CONCLUSIONS: Compared to the control teeth, alveolar bone thickness and height for the displaced teeth decreased more significantly after treatment. Tooth extraction and age also influenced alveolar bone changes.

Multivariate analysis of alveolar bone dehiscence and fenestration in anterior teeth after orthodontic treatment: A retrospective study.

OBJECTIVE: To compare the prevalence of fenestration and dehiscence between pre- and post-orthodontic treatment and to explore the factors related to fenestration and dehiscence in the anterior teeth after treatment. METHODS: This study included 1000 cone-beam computed tomography (CBCT) scans of 500 patients before (T1) and after (T2) orthodontic treatment. These images were imported into Dolphin 11.9 software to detect alveolar fenestration and dehiscence in the anterior teeth area. The chi-square test and Fisher's exact test were performed to compare the prevalence of alveolar bone defects between time points T1 and T2. A total of 499 patients were selected for logistic regression analysis to examine the correlation among age, sex, crowding, sagittal facial type, extraction, miniscrew use and fenestration or dehiscence post-treatment. RESULTS: Except for the maxillary lingual fenestration and labial fenestration of mandibular canines, a significant change in the prevalence of fenestration and dehiscence was noted between time points T1 and T2 (P < .025). Multinomial logistic regression showed that age, miniscrew use and extraction highly influenced the prevalence of anterior lingual dehiscence (P < .05). Dehiscence of the mandibular labial side (skeletal Class III vs. I, OR = 2.368, P = .000) and fenestration of the mandibular lingual side (skeletal Class II vs. I, OR = 2.344, P = .044) were strongly correlated with the sagittal facial type. Dehiscence of the maxillary labial side (moderate vs. mild, OR = 1.468, P = .017) was significantly associated with crowding. CONCLUSIONS: Older age, maxillary moderate crowding, skeletal Class III, extraction and miniscrew potentially significantly affect the prevalence of anterior teeth dehiscence. Adult females, skeletal Class III patients on the mandibular labial side and skeletal Class II patients on the mandibular lingual side should be monitored for anterior teeth fenestration.

Comparison of CBCT radiation doses with conventional radiographs in TMJ imaging using Monte Carlo simulations.

Three-dimensional imaging methods are widely used for evaluation of bony changes of temporomandibular joint (TMJ). Besides, lateral and posterio-anterior TMJ projections in both closed- and open-jaw positions for each temporomandibular joint are used as two-dimensional diagnostic tools. The purpose of the present study was to compare effective and mean organ absorbed doses of plain radiography techniques with those of different modalities of cone beam computed tomography (CBCT) scanning of an adult's temporomandibular joint. PCXMC 2.0 software was used to calculate mean organ and effective doses. A NewTom CBCT device (Newtom 5G XL; QR systems; Verona, Italy) was simulated at 360° rotation using a 6 × 6 cm2 FOV in standard and high-resolution modes. Lateral and posterio-anterior TMJ plain projections were simulated according to recommendations of the manufacturer of the Planmeca ProMax® 2D S3 device. Doses for both projections were simulated with Monte Carlo methods and the International Commission on radiological protection adult reference computational phantoms. The highest mean organ absorbed doses occurred in bone surfaces, salivary glands, and skull for posterio-anterior TMJ and lateral TMJ, and for CBCT scanning in all examinations. The effective doses of posterio-anterior and lateral TMJ plain radiographs were found to be higher than those of the Standard Mode-Eco Scan CBCT. Therefore, the lowest effective dose was calculated in Standard Mode-Eco Scan CBCT. It is concluded that NewTom 5G XL Standard Mode-Eco Scan CBCT can be used instead of plain radiographs (lateral and posterio-anterior TMJ) in temporomandibular joint imaging as it allows visualizing the three-dimensional structure of the temporomandibular joint as an advantage.

Long-term prognosis for teeth with external cervical resorption based on periapical images and cone beam CT: A clinical study.

AIM: To evaluate whether supplemental information from CBCT changed long-term prognosis for teeth with external cervical resorption (ECR) compared to periapical (PA) images. Furthermore, to assess predictive findings in PA images and evaluate which findings in CBCT affected the long-term prognosis of teeth with ECR. METHODOLOGY: One hundred and ninty-four patients, mean age 41.2, range 13-81, having 244 teeth with ECR were included. An initial long-term prognosis determined either good or poor was established based on intraoral images. Afterwards, the patients underwent CBCT, and final long-term prognosis was decided. From the PA images and CBCT, ECR using Heithersay's classification system, pulp involvement and extension of ECR was assessed. In CBCT, the number of surface lesion(s) was additionally assessed. Descriptive statistics evaluated changes in long-term prognosis after CBCT. Logistic regression analyses tested if findings in PA images and CBCT affected the long-term prognosis. RESULTS: Based on CBCT, out of 244 teeth the long-term prognosis was assessed to be poor for 173 (70.9%) teeth and good for 71 (29.1%) teeth. The long-term prognosis changed in 76 (31.1%) teeth after CBCT; 5 (2.0%) changed from poor to good, and 71 (29%) changed from good to poor long-term prognosis. In 81 (33.2%) teeth the H-class increased, and in 10 (4.1%) teeth the H-class decreased after assessing CBCT. In 70 (28.7%) teeth, there was a change from no pulp involvement to involvement of the pulp after CBCT; eight (3.3%) teeth changed in the opposite direction. H-class 2 and 4 in PA images significantly increased the probability for a change in long-term prognosis compared to an H-class 3 (p < .05). H-class 4, pulp involvement, ECR in the oral 1/3 of the root, and more than two surface lesions seen in CBCT significantly influenced a poor long-term prognosis (p < .05). CONCLUSIONS: Supplemental information from CBCT changed long-term prognosis in almost one third of teeth with ECR. In most cases, the long-term prognosis changed from good to poor. H-class 3 in PA images had a significant influence on change in long-term prognosis. Several findings in CBCT influenced a poor long-term prognosis.

Two- and three-dimensional healing assessment after endodontic microsurgery in through-and-through periapical lesions: 5-year follow-up from a randomized controlled trial.

AIM: To evaluate clinical and radiographic outcome of endodontic microsurgery in through-and-through periapical lesions at 1-year and 5-year follow-up with adjunct use of platelet-rich plasma (PRP). METHODOLOGY: Thirty-two patients with large through-and-through periapical lesions were randomized in platelet-rich plasma (PRP) group and control group. Two-dimensional (2D) healing was evaluated with Molven's criteria and three-dimensional (3D) healing with modified PENN 3D criteria. Healing at resection plane (R), apical area (A), buccal cortex (BC), palatal cortex (PC) and overall bone healing (B) was assessed using CBCT scans. The volume of lesion was measured using ITK-Snap software. The analysis included comparison of 1- to 5-year intragroup (Friedman test/McNemar test) and intergroup scoring (Chi-square/ Mann-Whitney test). Logistic regression analysis was performed to determine the effect of various factors on healing at 5 years. RESULTS: Out of 32 patients/59 teeth evaluated after 1-year of endodontic microsurgery, 24 patients/44 teeth reported at 5 - year follow-up. Healing assessment with modified PENN 3D criteria revealed improvement in overall success rate of 66.7% at 1 year to 83.3% at 5 years, with no deterioration in any healing category. PRP group exhibited significantly better 3D healing than control group; both at 1 year (84.6% vs. 45.5%) and 5 years (100% vs. 63.6%). A significantly higher number of completely healed teeth were observed in PRP group than the control group at 5 years with respect to R, BC and B parameters. A volume reduction of 88% (91.4% PRP, 84% control) was depicted at 1 year and 94% (97.1% PRP, 91.1% control) at 5 years. None of the recorded factors including age, gender, size of lesion, preoperative swelling and sinus, histology of lesion, use of PRP, tooth location, preoperative buccal bone had significant effect on 3D healing at 5 years. CONCLUSIONS: This 5-year study suggested improvement in 3D radiographic healing of large through-and-through periapical lesions from 1 to 5 years with no deterioration in any healing parameter in both control and PRP groups. The additional use of PRP led to significantly better healing in such lesions. RACB index using CBCT allows better estimation of healing at resected, apical and cortical plane over modified PENN 3D or Molven's criteria.

Exploring the potential of ChatGPT as an adjunct for generating diagnosis based on chief complaint and cone beam CT radiologic findings.

AIM: This study aimed to assess the performance of OpenAI's ChatGPT in generating diagnosis based on chief complaint and cone beam computed tomography (CBCT) radiologic findings. MATERIALS AND METHODS: 102 CBCT reports (48 with dental diseases (DD) and 54 with neoplastic/cystic diseases (N/CD)) were collected. ChatGPT was provided with chief complaint and CBCT radiologic findings. Diagnostic outputs from ChatGPT were scored based on five-point Likert scale. For diagnosis accuracy, the scoring was based on the accuracy of chief complaint related diagnosis and chief complaint unrelated diagnoses (1-5 points); for diagnosis completeness, the scoring was based on how many accurate diagnoses included in ChatGPT's output for one case (1-5 points); for text quality, the scoring was based on how many text errors included in ChatGPT's output for one case (1-5 points). For 54 N/CD cases, the consistence of the diagnosis generated by ChatGPT with pathological diagnosis was also calculated. The constitution of text errors in ChatGPT's outputs was evaluated. RESULTS: After subjective ratings by expert reviewers on a five-point Likert scale, the final score of diagnosis accuracy, diagnosis completeness and text quality of ChatGPT was 3.7, 4.5 and 4.6 for the 102 cases. For diagnostic accuracy, it performed significantly better on N/CD (3.8/5) compared to DD (3.6/5). For 54 N/CD cases, 21(38.9%) cases have first diagnosis completely consistent with pathological diagnosis. No text errors were observed in 88.7% of all the 390 text items. CONCLUSION: ChatGPT showed potential in generating radiographic diagnosis based on chief complaint and radiologic findings. However, the performance of ChatGPT varied with task complexity, necessitating professional oversight due to a certain error rate.

Association between the irrigation-agitation techniques and Periapical Healing of large periapical lesions: a Randomized Controlled Trial.

OBJECTIVES: The aim of this study was to evaluate the effects of manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), and laser-activated irrigation (shock wave-enhanced emission photoacoustic streaming (SWEEPS)) on the periapical healing of large periapical lesions following nonsurgical root canal treatment. MATERIALS AND METHODS: A total of fifty-six systemically healthy patients with a mandibular single-rooted tooth with periapical lesions of endodontic origin and a periapical index score of 3 or higher were included in the study. Before the treatment procedures, lesion volumes were determined volumetrically using cone-beam computed tomography (CBCT). Patients were randomized into treatment (MDA, PUI, SWEEPS) and control groups (n = 14). Root canal treatment and irrigation procedures were performed by a calibrated postgraduate operator and completed at one visit. For routine follow-up, clinical and radiographic evaluations were performed by a blinded evaluator using periapical (PA) radiographs according to Molven's criteria at 3, 6, and 9 months. At 12 months, lesion volumes were quantified volumetrically using CBCT (ITK-SNAP). The data were statistically analyzed with the Wilcoxon test. The significance level was set at p < 0.05. RESULTS: In all groups, the mean lesion volume after treatment was significantly smaller than the mean volume before treatment (p = 0.001). Among the 56 teeth, 11 teeth were 'totally healed', and 39 teeth were 'reduced' on PA radiographs. No 'enlargement' was detected in any group. On CBCT, the lesion volume decreased in the following order: LAI-SWEEPS (86.9%) > PUI (85.4%) > MDA (80.4%) > control (74.5%), with no statistically significant difference (p > 0.05). CONCLUSIONS: Despite the limitations of the present study, although a greater percentage of healing was observed in the LAI-SWEEPS and PUI groups, irrigation procedures had no statistically significant effect on the healing of periapical lesions with a single root canal at the 12-month follow-up. On the other hand, the outcome may change in multirooted teeth with curved and complex root canal systems. CLINICAL RELEVANCE: In the short term and in single-canal teeth, advanced irrigation agitation methods such as laser and ultrasonic did not make a difference in healing other than manual irrigation agitation.

Site and severity of facial asymmetry after bimaxillary surgery for class III deformity: a case-control study.

OBJECTIVES: The study aimed (1) to evaluate the site and severity of facial asymmetry in Class III patients before and after bimaxillary surgery, and (2) to identify the influence of initial severity and positional jaw asymmetry on residual facial asymmetry. MATERIALS AND METHODS: Preoperative and postoperative cone-beam computed tomography of 65 patients with Class III facial asymmetry who underwent bimaxillary surgery were evaluated. Five midline and 14 paramedian facial soft tissue landmarks were identified to assess facial asymmetry. The outcomes were compared to a control group consisting of 30 age- and gender-matched Class I subjects. The postoperative positional jaw asymmetry (i.e., shift, roll, yaw) of each osteotomy segment (maxilla, mandible, chin, ramus) was also measured. RESULTS: Before surgery, the asymmetry was more severe at the chin, middle and lower contour. Bimaxillary surgery effectively corrected facial asymmetry, particularly in achieving normalization of chin deviation. However, significant asymmetry persisted postoperatively in the middle and lower contour (p < 0.001 and p < 0.01, respectively), which was affected by the positional ramus asymmetry in the roll and shift. CONCLUSIONS: Deviation of the chin, middle and lower contour contributed significantly to overall facial asymmetry in Class III asymmetry. Despite normalization of the chin deviation after bimaxillary surgery, asymmetry persisted at the middle and lower contour, primarily as the result of insufficient correction of the positional ramus asymmetry. CLINICAL RELEVANCE: Understanding the residual asymmetry after bimaxillary surgery is important for minimizing deviation and optimizing the surgical planning for its correction.

Nomogram to predict radicular grooves in maxillary lateral incisors in preoperative orthodontic population.

OBJECTIVES: This study aimed to develop and validate a predictive nomogram for diagnosing radicular grooves (RG) in maxillary lateral incisors (MLIs), integrating demographic information, anatomical measurements, and Cone Beam Computed Tomography (CBCT) data to diagnose the RG in MLIs based on the clinical observation before resorting to the CBCT scan. MATERIALS AND METHODS: A retrospective cohort of orthodontic patients from the School and Hospital of Stomatology, Wuhan University, was analyzed, including demographic characteristics, photographic anatomical assessments, and CBCT diagnoses. The cohort was divided into development and validation groups. Univariate and multivariate logistic regression analyses identified significant predictors of RG, which informed the development of a nomogram. This nomogram's performance was validated using receiver operating characteristic analysis. RESULTS: The study included 381 patients (64.3% female) and evaluated 760 MLIs, with RG present in 26.25% of MLIs. The nomogram incorporated four significant anatomical predictors of RG presence, demonstrating substantial predictive efficacy with an area under the curve of 0.75 in the development cohort and 0.71 in the validation cohort. CONCLUSIONS: A nomogram for the diagnosis of RG in MLIs was successfully developed. This tool offers a practical checklist of anatomical predictors to improve the diagnostic process in clinical practice. CLINICAL RELEVANCE: The developed nomogram provides a novel, evidence-based tool to enhance the detection and treatment planning of MLIs with RG in diagnostic and therapeutic strategies.