Assessing ChatGPT's Diagnostic Accuracy and Therapeutic Strategies in Oral Pathologies: A Cross-Sectional Study.

BACKGROUND: The rapid adoption of artificial intelligence (AI) models in the medical field is due to their ability to collaborate with clinicians in the diagnosis and management of a wide range of conditions. This research assesses the diagnostic accuracy and therapeutic strategies of Chat Generative Pre-trained Transformer (ChatGPT) in comparison to dental professionals across 12 clinical cases. METHODOLOGY: ChatGPT 3.5 was queried for diagnoses and management plans for 12 retrospective cases. Physicians were tasked with rating the complexity of clinical scenarios and their agreement with the ChatGPT responses using a five-point Likert scale. Comparisons were made between the complexity of the cases and the accuracy of the diagnoses and treatment plans. RESULTS: ChatGPT exhibited high accuracy in providing differential diagnoses and acceptable treatment plans. In a survey involving 30 attending physicians, scenarios were rated with an overall median difficulty level of 3, showing acceptable agreement with ChatGPT's differential diagnosis accuracy (overall median 4). Our study revealed lower diagnosis scores correlating with decreased treatment management scores, as demonstrated by univariate ordinal regression analysis. CONCLUSIONS: ChatGPT's rapid processing aids healthcare by offering an objective, evidence-based approach, reducing human error and workload. However, potential biases may affect outcomes and challenge less-experienced practitioners. AI in healthcare, including ChatGPT, is still evolving, and further research is needed to understand its full potential in analyzing clinical information, establishing diagnoses, and suggesting treatments.

How effective are concentrated growth factor and injectable platelets in reducing complications following impacted third molar surgery?

OBJECTIVES: This study examines the impact of injectable platelet-rich fibrin (iPRF) and concentrated growth factor (CGF) on postoperative pain, edema, trismus, and quality of life in impacted mandibular third molar surgery. The primary aim of this study was to minimize common sequelae following third molar surgery by using iPRF and CGF. Our secondary objective was to compare the postoperative effects of these products. METHOD AND MATERIALS: This study represents a single-center, randomized prospective clinical trial conducted at the Ordu University Faculty of Dentistry. It involved patients who underwent third molar surgery for various reasons between July and October 2022. The predictor variable was the implementation of CGF, and i-PRF which was categorized as CGF, i-PRF and control groups. The outcome variables include pain levels and analgesic consumption measured on a VAS scale, distances between predetermined anatomical points, maximum mouth opening capacity, and data from the postoperative symptom severity (PoSSe) scale. Some statistical tests were performed with a 95% confidence interval, which was considered significant. RESULTS: Total analgesic use was notably lower in the CGF group (p = .044). CGF and iPRF outperformed the control group in all edema measurements by the 7th day (T-Pog, L-A, T-C; p<.05). CGF significantly reduced trismus on the 2nd and 7th days. Quality of life was notably higher in the CGF group than in the control group (p = .026), although iPRF group differences were not significant. CONCLUSION: The results of this study indicate that CGF has a limited impact on postoperative pain, but significantly reduces edema, trismus, and enhances quality of life. The iPRF group experienced positive effects on pain, edema, and trismus, although the statistically significant differences observed with CGF highlight its potential for use instead of iPRF after third molar surgery. An increased sample size is essential for more comprehensive results.

Is Injectable Platelet-Rich Fibrin Really Effective in Reducing Expected Side Effects of Removing Impacted Third Molar Surgery?

BACKGROUND: Common side effects of third molar (M3) operations including pain, edema, and trismus have an adverse effect on patient quality of life. Injectable platelet-rich fibrin (i-PRF) may ameliorate some of the side effects of the operation. PURPOSE: The primary purpose of this study is to measure and compare differences in pain, swelling, trismus, and quality of life between i-PRF side and a control side of subjects undergoing M3 removal. STUDY DESIGN, SETTING AND SAMPLE: This study is a single-center, split-mouth, randomized prospective clinical trial conducted at Ordu University Faculty of Dentistry. Patients who presented between March and August 2022 for the extraction of impacted third molars due to various reasons were included in the study. The exclusion criteria were local conditions and systematic comorbidities. Additionally, patients with differences that could cause bias between the sides were excluded from the study. PREDICTOR VARIABLE: The predictor variable is treatment i-PRF or control. MAIN OUTCOME VARIABLE: The outcome variables of interest are the pain level and analgesic consumption values on the Visual Analog Scale, the distance between determined reference points, maximum mouth opening, and the Postoperative Symptom Severity scale data. A Postoperative Symptom Severity scale was created using questions commonly employed in the clinical evaluation of patients following the extraction of third molars. This scale was further divided into subscales corresponding to the 7 primary adverse effects identified in a prior study. COVARIATES: Covariate variables, sex, age, and operation times. ANALYSES: The normality of the distribution of the study data was assessed using the Kolmogorov-Smirnov test. Depending on whether the data exhibited a normal distribution or not, the data were analyzed using either the paired t-test or the Wilcoxon test. A P value < .05 was considered statistically significant. RESULTS: The study included 35 patients with a mean age of 19.97 ± 2.07 years. The i-PRF side significant success in postoperative edema measurements. There was a statistically significant difference observed between the control side and the i-PRF side on the second day (control: 9.74 ± 0.57 mm, i-PRF: 9.46 ± 0.51 mm) and seventh day (control: 9.33 ± 0.59 mm, i-PRF: 9.12 ± 0.50 mm) in lateral canthus-angulus measurements (P: .01 and P: .04, respectively). Additionally, on the second day, there was a statistically significant difference in tragus-commisura measurements (control: 11.53 ± 0.62 mm, i-PRF: 11.31 ± 0.58 mm) with a P value of .02. There was no significant difference observed between the sides in terms of postoperative pain (P > .05). However, analgesic consumption in the i-PRF side was significantly lower at the sixth hour (control: 1.8 ± 0.58 dose, i-PRF: 1.14 ± 0.35 dose), 24th hour (control: 1.77 ± 0.54 dose, i-PRF: 1.14 ± 0.35 dose), and second day (control: 1.8 ± 0.47 dose, i-PRF: 1.4 ± 0.73 dose) postoperatively (P: .000, P: .000, and P: .012). Mouth opening was significantly lower in the i-PRF side on the second day (control: 27.88 ± 6.48 mm, i-PRF: 25.51 ± 5.56 mm) (P: .025). However, i-PRF had no significant effect on postoperative quality of life (P > .05). CONCLUSIONS: According to the study results, i-PRF had a limited effect on the management of postoperative pain, but i-PRF was effective in reducing postoperative edema. Further studies with larger patient sides are now needed to yield more detailed findings on the subject.

Finite element analysis of different internal fixation methods for the treatment of atrophic mandible fractures.

The aim of this study is to evaluate different plate systems and contribute to revealing the most appropriate treatment option for severe atrophic edentulous mandible fractures. A total of 8 different types of rigid internal fixation methods, which were a 4-hole miniplate on the crest, a 4-hole miniplate on the basis, a 6-hole miniplate on the crest, a 6-hole miniplate on the basis, two 4-hole mini plates on both the crest and basis, two 6-hole mini plates on both crest and basis, a 6-hole reconstruction plate on the crest and a 6-hole reconstruction plate on the basis, were simulated. Stress analysis on plates and screws and the displacement between fragments were evaluated using finite element analysis. The lowest von Mises stress was observed on the basis plate in Group 6. The highest von Mises stresses were measured on the screws closes to the fracture line. Values exceeding the boundary conditions were observed only in Groups 3 and 4 under molar loading. The highest compressive stresses were measured in Group 1, and the lowest compressive stresses were measured in Group 6. Under molar loading, the highest displacement was observed in Group 3, and the lowest displacement was observed in Group 6. When all groups are evaluated in terms of stress distributions and stability, a 1.5 mm thick six-hole reconstruction plate can be a reliable method in the treatment of severe atrophic edentulous mandible fractures.

Retrospective Evaluation of Two-Implant-Supported Mandibular Overdentures with Radiographic and Clinical Aspects.

PURPOSE: The aim of this retrospective study was to evaluate the clinical performance of two implants supporting mandibular overdentures by means of clinical and radiologic parameters, and also to explore the relationship of marginal bone loss with implant-/patient-related factors and soft tissue parameters. MATERIALS AND METHODS: Data of patients who had undergone insertion of two implants into the interforaminal region between November 2012 and December 2016 using three different implant systems were retrieved from the archival records. Age, sex, implant length, implant diameter, observation period, mobility, and soft tissue parameters were recorded. Marginal bone levels and interimplant distances were measured with computer software on panoramic radiographs obtained at 3 months and at the recall session. RESULTS: A total of 43 patients with 86 implants were included in the study. Patients were evaluated with an average observation period of 41.79 months. Among the evaluated parameters, Gingival Index, Bleeding Index, and implant diameter were found to have significant effects on the marginal bone loss (P < .05). However, no significant effects of sex, age, implant length, observation period, and interimplant distance were observed on the marginal bone loss. No implants showed peri-implantitis or mobility, while eight implants showed peri-implant mucositis. CONCLUSION: Within the limitations of this study, it can be concluded that peri-implant soft tissue health and the diameter of the implant have an important effect on the marginal bone loss as well as the success of two-implant-supported mandibular overdentures.

Metastatic Prostate Adenocarcinoma of the Mandible Diagnosed With Oral Manifestations.

Metastasis from the prostate gland to the mandible is rarely encountered and commonly present with non-specific features like unexplained pain, swelling, and numb chin syndrome. Here we present a case with metastatic prostate adenocarcinoma detected secondary to oral manifestations. Patients present with unexplained facial pain and numbness should alert clinicians to the presence of malignant disease, and appropriate hematological, radiological and or histological investigations should be performed. Thereby, clinicians can prevent the overlook of the first signs of metastasis, accelerate the early diagnosis and positively orientate the prognosis of the disease, especially in a patient without known malignancy.

Buccal vascular malformation with multiple giant phleboliths: a rare case presentation and review of the literature.

PURPOSE: The purpose of this study was to describe a case and to review the diameters, symptoms, locations, and treatment methods for vascular malformations (VMs) with phleboliths. Our case report is probably the first to mention this observation because of sizes and large number of phleboliths in buccal region. CASE PRESENTATION: A 26-year-old male patient was referred to Ordu University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery for the evaluation and management of a painless tender swelling in the left buccal region. Clinically, a bluish mucosal lesion of the posterior region of the left buccal mucosa and lip is apparent. Panoramic radiography and CT were obtained for radiographical examinations. Multiple giant phleboliths with the largest dimension of 32 mm were seen in this region. Left maxillary first molar teeth extraction was indicated. An aspiration was performed and revealed that there is a risk of severe hemorrhage. The patient did not want to take MRI and stated that he only wanted to have dental treatment. Therefore, it was decided that the maxillary first molar should be retained in the region and endodontic treatment should be done, if necessary. CONCLUSIONS: The clinic of phlebolith patients is painless swelling and can reach up to 6 cm. The localization is not specific but is found in the masseter and parotid regions generally. Treatment may be invasive or non-invasive depending on, location, accessibility, depth of invasion, age, cosmetic issues, and risk of severe hemorrhage, as with the current case.

Resistance to vertical root fracture of apicoected teeth using different devices during two root canal irrigation procedures.

The aim of the present work was to measure the fracture resistance of endodontically treated teeth that were apicoected with different procedures. Seventy-two extracted human maxillary anterior teeth were included in this study. The specimens were randomly assigned to three main groups according to the apical surgery procedures and then two subgroups according to the irrigation protocols during root canal treatment and total of six groups were obtained (n = 12). Group 1: served as a control and apical surgery process was not performed in this group. Group 2: apical surgery process was performed with tungsten carbide fissure bur Group 3: apical surgery process was performed with Er:YAG laser. Subgroup a: In this group, the specimens were irrigated with %5 NaOCl. Subgroup b: 15% EDTA solution was filled into the root canal and then agitated using a 1.5 W/100 Hz diode laser. The specimens were filled and mounted in acrylic resin blocks and compression strength test was performed. Statistical analysis was performed using two-way ANOVA. The statistical analysis revealed that there were no statistical significant differences between apical surgery procedures (groups 1, 2, and 3) (p < 0.05). Apical resection procedures did not affect the fracture resistance Significant differences were determined between the subgroups (p < 0.05). Agitation of the EDTA with the diode laser reduced the fracture resistance of the specimens. The different canal irrigation techniques altered resistance to fracture; however, apical surgery procedures did not altered the resistance to fracture when compared with the control group.

Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series.

OBJECTIVE: Arthrocentesis and prolotherapy are nonsurgical treatments for temporomandibular joint (TMJ) diseases. This study aimed to evaluate the treatment of hypermobility, pain, and displacement of the TMJ by consecutively performing arthrocentesis and prolotherapy in the same session. MATERIALS AND METHODS: In this study, 10 adults with disc displacement and painful, hypermobile TMJ were selected. Arthrocentesis and prolotherapy were consecutively performed using a 30% dextrose solution that was simultaneously injected into five areas: posterior disc attachment, superior joint space, superior and inferior capsular attachments, and stylomandibular ligament. Paired t-test, McNemar test, and chi-square test were used to assess the maximum mouth opening, clicking sounds, pain, and subluxation of the TMJ. Patients with rheumatoid arthritis and parafunctional habits such as teeth clenching and grinding and biting of the cheeks or any other objects and those who had undergone surgery were excluded from this study. RESULTS: A total of 10 participants (36.20 ± 7.06 years old, 7 women and 3 men) received a single treatment session of combined arthrocentesis and prolotherapy at the same office visit. Subluxation frequency and pain significantly decreased after the first week of treatment (p < 0.05). Subluxation also decreased at the 3-month follow-up (p < 0.05). Clicking sound values did not significantly change at any of the follow-up time points. Maximum mouth opening values decreased at all follow-up time points compared to baseline (p < 0.05). CONCLUSION: A single session of combined arthrocentesis and prolotherapy to treat symptomatic TMJ safely and significantly improved the subluxation and pain after 1 week and subluxation after 3 months compared to baseline status. The maximum mouth opening significantly decreased at all follow-up time points. Future studies assessing multiple treatment sessions are warranted.

The Effect of Alendronate on Various Graft Materials Used in Maxillary Sinus Augmentation: A Rabbit Study.

BACKGROUND: Increasing sinus pneumatization and the accompanying alveolar bone resorption complicate dental implant placement. This problem can be overcome today by raising the maxillary sinus floor with graft materials. Bisphosphonates are commonly used to accelerate the recovery of the graft materials and to prevent resorption. OBJECTIVES: The purpose of this study is to investigate whether systemic administration of a bisphosphonate (alendronate) would improve new bone formation and reduce fibrous tissue formation over a 6-week follow-up in rabbits treated with two different grafting materials for maxillary sinus floor augmentation. MATERIALS AND METHODS: This experimental animal study was conducted at the Experimental Medical Application and Research Center at Erzurum/ Turkey. Twelve New Zealand rabbits, each weighing between 2.7 and 3.3 kg, were used. Twenty-four maxillary sinus floor elevation operations were performed, two on each animal (n = 24). Each elevation was repaired with either deproteinized bovine bone (xenograft) or autogenous bone graft obtained from the iliac crest. Both groups were divided into 2 subgroups: saline-treated and alendronate-treated. All groups underwent the same surgical procedures and evaluation, and were sacrificed at the 6th postoperative week. Sinuses augmented with deproteinized bovine bone (xenograft) and autogenous bone graft were examined histopathologically and histomorphometrically. RESULTS: At 6 weeks, the bone area was significantly larger in the Xenograft-Alendronate group (33.0% ± 5.0%) than in the Xenograft-Saline group (20.8% ± 4.9%) and the bone area was significantly larger in the Autogenous-Alendronate group (43.3% ± 3.8%) than in the Autogenous-Saline group (37.5% ± 6.6%) (P = 0.001). The histomorphometric and histopathological results consistently showed that alendronate stimulated bone formation and reduced fibrous tissue formation in maxillary sinus augmentation grafts, especially in the deproteinized bovine bone group (xenograft). CONCLUSIONS: Alendronate may be considered a therapeutic option for improving the bone formation process and reducing resorption in different bone grafting procedures. Further detailed studies should focus on dosage and time-dependent effects of alendronate on bone remodeling.