Towards clinically applicable automated mandibular canal segmentation on CBCT.

OBJECTIVES: To develop a deep learning-based system for precise, robust, and fully automated segmentation of the mandibular canal on cone beam computed tomography (CBCT) images. METHODS: The system was developed on 536 CBCT scans (training set: 376, validation set: 80, testing set: 80) from one center and validated on an external dataset of 89 CBCT scans from 3 centers. Each scan was annotated using a multi-stage annotation method and refined by oral and maxillofacial radiologists. We proposed a three-step strategy for the mandibular canal segmentation: extraction of the region of interest based on 2D U-Net, global segmentation of the mandibular canal, and segmentation refinement based on 3D U-Net. RESULTS: The system consistently achieved accurate mandibular canal segmentation in the internal set (Dice similarity coefficient [DSC], 0.952; intersection over union [IoU], 0.912; average symmetric surface distance [ASSD], 0.046 mm; 95% Hausdorff distance [HD95], 0.325 mm) and the external set (DSC, 0.960; IoU, 0.924; ASSD, 0.040 mm; HD95, 0.288 mm). CONCLUSIONS: These results demonstrated the potential clinical application of this AI system in facilitating clinical workflows related to mandibular canal localization. CLINICAL SIGNIFICANCE: Accurate delineation of the mandibular canal on CBCT images is critical for implant placement, mandibular third molar extraction, and orthognathic surgery. This AI system enables accurate segmentation across different models, which could contribute to more efficient and precise dental automation systems.

Prediction of early recurrence of hepatocellular carcinoma after liver transplantation based on computed tomography radiomics nomogram.

BACKGROUND: Early recurrence results in poor prognosis of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). This study aimed to explore the value of computed tomography (CT)-based radiomics nomogram in predicting early recurrence of patients with HCC after LT. METHODS: A cohort of 151 patients with HCC who underwent LT between December 2013 and July 2019 were retrospectively enrolled. A total of 1218 features were extracted from enhanced CT images. The least absolute shrinkage and selection operator algorithm (LASSO) logistic regression was used for dimension reduction and radiomics signature building. The clinical model was constructed after the analysis of clinical factors, and the nomogram was constructed by introducing the radiomics signature into the clinical model. The predictive performance and clinical usefulness of the three models were evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA), respectively. Calibration curves were plotted to assess the calibration of the nomogram. RESULTS: There were significant differences in radiomics signature among early recurrence patients and non-early recurrence patients in the training cohort (P < 0.001) and validation cohort (P < 0.001). The nomogram showed the best predictive performance, with the largest area under the ROC curve in the training (0.882) and validation (0.917) cohorts. Hosmer-Lemeshow testing confirmed that the nomogram showed good calibration in the training (P = 0.138) and validation (P = 0.396) cohorts. DCA showed if the threshold probability is within 0.06-1, the nomogram had better clinical usefulness than the clinical model. CONCLUSIONS: Our CT-based radiomics nomogram can preoperatively predict the risk of early recurrence in patients with HCC after LT.

Deep learning-based evaluation of the relationship between mandibular third molar and mandibular canal on CBCT.

OBJECTIVES: The objective of our study was to develop and validate a deep learning approach based on convolutional neural networks (CNNs) for automatic detection of the mandibular third molar (M3) and the mandibular canal (MC) and evaluation of the relationship between them on CBCT. MATERIALS AND METHODS: A dataset of 254 CBCT scans with annotations by radiologists was used for the training, the validation, and the test. The proposed approach consisted of two modules: (1) detection and pixel-wise segmentation of M3 and MC based on U-Nets; (2) M3-MC relation classification based on ResNet-34. The performances were evaluated with the test set. The classification performance of our approach was compared with two residents in oral and maxillofacial radiology. RESULTS: For segmentation performance, the M3 had a mean Dice similarity coefficient (mDSC) of 0.9730 and a mean intersection over union (mIoU) of 0.9606; the MC had a mDSC of 0.9248 and a mIoU of 0.9003. The classification models achieved a mean sensitivity of 90.2%, a mean specificity of 95.0%, and a mean accuracy of 93.3%, which was on par with the residents. CONCLUSIONS: Our approach based on CNNs demonstrated an encouraging performance for the automatic detection and evaluation of the M3 and MC on CBCT. Clinical relevance An automated approach based on CNNs for detection and evaluation of M3 and MC on CBCT has been established, which can be utilized to improve diagnostic efficiency and facilitate the precision diagnosis and treatment of M3.

Lateral Lingual Foramina and Canals in the Mandible: CBCT Evaluation of 506 Patients in North China.

OBJECTIVE: To assess the prevalence, location, diameter, course and anastomosis of the lateral lingual foramina (LLF) and canals (LLCs) in a northern Chinese population using CBCT. METHODS: CBCT images of 506 patients (181 male and 325 female, mean age 21.03 ± 8.11 years) were collected. The prevalence, location, diameter, length, angle and anastomosis of the LLF and LLCs were assessed. The measurement variables were analysed by sex and age. Statistical analysis was performed using SPSS (v. 25, IBM, Armonk, NY, USA). RESULTS: A total of 461 LLF were detected in 307 (60.7%) subjects, 175 (57.0%) of whom had unilateral LLF and 132 (43.0%) of whom had bilateral LLF, with each lateral having one to four LLF. The majority of LLF (375/461, 81.3%) were located below the premolars, particularly the first premolar. The mean diameter of the LLF was 0.58 ± 0.20 mm. The mean vertical distance from the LLF to the inferior border and the alveolar crest was 6.68 ± 1.43 mm and 23.65 ± 2.89 mm, respectively. In total, 197 LLCs were visible in the cancellous bone and evaluated. The mean length of LLCs was 6.26 ± 1.29 mm, and the mean angle of LLCs was 140.64° ± 17.29°. The overwhelming majority (93.4%) of LLCs communicated with the mandibular incisive canal and the rest connected with the mandibular canal. CONCLUSION: The prevalence of LLCs was high in the northern Chinese population. The presence of LLCs is a significant predictor of communication with the mandibular incisive canal.

Root Canal Morphology of Mandibular Incisors with Double Root Canals in a Chinese Population.

OBJECTIVE: To investigate the bilateral symmetry of double root canals, variation in root canal bifurcation and position of canal orifices in mandibular incisors in a Chinese population. METHODS: A total of 149 subjects with mandibular incisors with two canals were selected from 866 patients based on CBCT images and divided into three groups: group 1 (< 21 years), group 2 (21-40 years) and group 3 (> 40 years). The prevalence of bilateral symmetry of double root canals (type III and type V), the distance between the cementoenamel junction (CEJ) and the bifurcation (D1) and the distance between the two canal orifices (D2) were calculated and analysed. RESULTS: The bilateral symmetry of type III for mandibular central incisors (MCIs) (44.4%) was significantly lower than that for mandibular lateral incisors (MLIs) (63.4%). D1 was greater in group 1 (4.63 ± 1.35mm) than in group 2 (3.99 ± 1.02 mm) and group 3 (3.90 ± 1.95 mm). D2 was shorter in in MCIs (0.65 ± 0.20 mm) than in MLIs (0.74 ± 0.22 mm). CONCLUSION: Special attention is required in the root canal treatment of mandibular incisors, especially in patients aged above 21 years.

Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: A randomised controlled study.

BACKGROUND: Anterior repositioning splint (ARS) can facilitate regenerative condylar remodelling. OBJECTIVE: To determine the effect of ARS on osseous condylar changes in adolescents/young adults with early-stage degenerative joint disease (DJD). METHODS: Sixty-nine patients with early-stage temporomandibular joint (TMJ) DJD based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and cone beam computed tomography (CBCT) imaging were recruited and randomly allocated to two treatment groups: (a) conservative therapy with ARS and (b) conservative therapy without ARS. Subjects with acute TMJ closed-lock had their displaced discs physically reduced by mandibular manipulation prior to ARS therapy. Clinical and CBCT data of 59 patients (86.4% females, mean age 17.95 ± 4.53 years, 67 joints) were attained pre- and at 6 or 12 months post-treatment. Osseous changes after treatment were categorised into (a) progressed, (b) unchanged, (c) repaired (remodelled without new bone formation) and (d) regenerated (remodelled with new bone formation). Statistical analysis including chi-square test, independent samples t test or Mann-Whitney U test was conducted. RESULTS: About 85.5% of patients (59/69) completed the study, with 28 subjects (32 joints) in the splint group and 31 (35 joints) in the control group. The occurrence of condylar repair and regeneration was significantly higher with ARS (78.1%/[25/32] of joints) when compared to control group (48.6%/[17/35]) (P < 0.05). Moreover, condylar regeneration was exclusively observed in 50%/(16/32) of joints with ARS. For the 14 joints in splint group that received physical TMJ closed-lock reduction, 85.7%/(12/14) exhibited condylar regeneration. The splint group (3.1%/[1/32]) also had significantly lower incidence of progressive TMJ degeneration than the control (37.1%/[13/35]) (P < 0.001). CONCLUSION: Condylar repair and regeneration in early-stage TMJ DJD are possible, and ideal spatial disc-condyle relationship appears important. The possibility of restoring TMJ form/structure by ARS therapy presents an attractive area of new basic science and clinical research (Bone defect repair in early osteoarthrosis of temporomandibular joint by joint distraction therapy: A randomized controlled trial/ChiCTR-TRC-14005172).

[CT imaging features of diffuse tenosynovial giant cell tumor of temporomandibular joint].

OBJECTIVE: This study aimed to investigate the characteristic features of CT images of diffuse tenosynovial giant cell tumor (D-TSGCT) from the temporomandibular joint (TMJ) to understand CT imaging diagnosis of the disease. METHODS: CT images and clinical information from 10 patients with D-TSGCT of TMJ were recruited for retrospective analysis from March 2013 to March 2017 in Peking University Hospital of Stomatology. All cases were treated by surgery and confirmed by pathology. RESULTS: CT scan demonstrated hyperdense soft-tissue masses and various kinds of calcification in all of the 10 subjects. Contrast-enhanced scan exhibited obvious enhancement in six patients. Bone destruction of the mandibular condyles and skull base was found in seven and six subjects, respectively. CONCLUSIONS: CT appearance of D-TSGCT of the TMJ is characterized by hyperdense soft tissue with calcification, further enhancement in contrast-enhanced scan, and bone destruction in the mandibular condyles and skull base in some cases.

Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement.

OBJECTIVE: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints) on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR), using magnetic resonance imaging (MRI). MATERIAL AND METHODS: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females) and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1), anterior repositioning splint position (Position 2), and stabilization splint position (Position 3). Disc/condyle coordinate measurements and disc condyle angles were determined and compared. RESULTS: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was -13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7%) than Position 3 (20/60, 33.3%). In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. CONCLUSIONS: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement

Abstract Objective: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints) on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR), using magnetic resonance imaging (MRI). Material and Methods: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females) and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1), anterior repositioning splint position (Position 2), and stabilization splint position (Position 3). Disc/condyle coordinate measurements and disc condyle angles were determined and compared. Results: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was −13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7%) than Position 3 (20/60, 33.3%). In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. Conclusions: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

Sleep disturbance and psychologic distress: prevalence and risk indicators for temporomandibular disorders in a Chinese population.

AIMS: To investigate the prevalence of sleep disturbance and psychologic distress in a population of Chinese patients with temporomandibular disorders (TMD) and whether sleep disturbance and psychologic distress are risk indicators for TMD. METHODS: Validated Chinese versions of the Self-Rating Scale of Sleep (SRSS) and Depression, Anxiety and Stress Scales-21 (DASS-21) were used to measure sleep disturbance and psychologic distress of 510 TMD patients with a mean (± SD) age of 31.06 ± 14.40 years. TMD signs/symptoms and sociodemographic data were also collected. The patients were divided into seven diagnostic groups based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). For statistical analysis, the patients were subsequently grouped into those with (n = 128) and without (n = 382) myofascial pain. The data were analyzed using chi-square tests, independent-samples t test, as well as stepwise logistic regression at a significance level of P < .05. RESULTS: The prevalence of moderate to severe sleep disturbance and psychologic distress was significantly higher in the myofascial pain group than in the non-myofascial pain group (P < .05). Stepwise logistic regression analysis demonstrated that sleep disturbance and anxiety were possible risk indicators for myofascial pain, with odds ratios of 2.41 and 4.10, respectively (P < .05). CONCLUSION: The Chinese population of TMD patients frequently reported a disturbed sleep condition and psychologic distress symptoms. Sleep disturbance and psychologic distress symptoms are possible risk indicators for myofascial pain in this population.

[Cone-beam computed tomography analysis of root canal configuration of 4 674 mandibular anterior teeth].

OBJECTIVE: To investigate the root canal configuration of mandibular anterior teeth with cone-beam computed tomography (CBCT). METHODS: The CBCT imaging data of 866 patients who visited Peking University School of Stomatology from October 2012 to July 2013 were inspected by an endodontist anda radiologists together. A total of 4 674 mandibular anterior teeth were involved. The number of root, root canals and root canal configuration were observed and analyzed statistically (Chi-squared test). RESULTS: All the mandibular central incisors and lateral incisors were single root, and 0.7% (11/1 542) of canines were double roots. 6.7% (105/1 566) of central incisors, 17.4% (273/1 566) of lateral incisors and 3.0% (46/1 542) of canines had double root canals. The frequency of symmetry of double root canal was 58.7% (37/63) in central incisors, 76.1% (108/142) in lateral incisors and 29.6% (8/27) in canines. The highest frequency of double root canals in different ages was 9.8% (28/287, 31-40 years) in central incisors, 21.5% (61/284, 31-40 years) in lateral incisors and 9.2% (19/207, ≥51 years) in canines. Vertucci type III canal configurations were the most prevalent in mandibular anterior teeth. CONCLUSION: The double root canals are most common in mandibular lateral incisors. The highest incidence of symmetry of double root canal is also observed in mandibular lateral incisors. Vertucci type III canal configurations are the most frequent type in mandibular anterior teeth.

Subarticular, cystlike lesion associated with avascular necrosis of the mandibular condyle: a case report.

Little is known about avascular necrosis of the mandibular condyle, which is necrosis of the epiphyseal or subarticular bone secondary to a diminished or disrupted blood supply in the absence of infection. We present a case of a large subarticular cystlike lesion that was found using cone-beam computed tomography (CBCT). There was an absence of osteoarthrosis, and the condylar articular surface was relatively intact. The patient's history, physical examination, and magnetic resonance images supported the diagnosis of avascular necrosis of the mandibular condyle. After 4 months of conservative therapy, new bone was observed in the cystlike marrow lesion, and a smooth articular surface was reestablished. Subarticular cystlike lesions without the collapse of the articular surface of mandibular condyles may be an early indicator of avascular necrosis.

Condylar subchondral formation of cortical bone in adolescents and young adults.

We investigated subchondral formation of cortical bone in the condyles of adolescents and young adults, and looked for age-related and sex-related differences in bony formation with the aid of cone-beam computed tomography data in 1438 subjects aged between 10 and 30 years. The scans were part of the hospital's clinical protocol for patients seeking orthodontic or orthognathic treatment. No patient had signs or symptoms of temporomandibular disorders. Central images of the coronal and sagittal planes of the condyle were acquired and scored. Subchondral formation of cortical bone was seen as a high-density compact linear image, and subjects were classified into complete, partial, and no formation. Subchondral formation of cortical bone was first seen at the ages of 13-14 in boys and 12-13 in girls. Complete cortical bony formation was seen after the age of 22 years for men and 21 for women. We conclude that cortical bone begins to form around the periphery of the condyles during adolescence (12-14 years). A continuous, homogeneous, and compact cortical bony layer is established in young adults by the age of 21-22, indicating full development of the mandibular condyle. The condylar bone developed gradually and was generally fully developed a year earlier in women than men.

Effect of laser acupuncture on disuse osteoarthritis: an ultrasound biomicroscopic study of patellar articular cartilage in rats.

To investigate the effect of laser acupuncture (LA) on disuse changes in articular cartilage using ultrasound biomicroscopy (UBM), Eighteen rats were randomly divided into the control group (C), the tail-suspended group (T), and the tail-suspended with LA treatment group (L). During 28-day suspension period, group L were treated with LA at acupoints on the left hindlimb while group T had a sham treatment. Ultrasound roughness index (URI), integrated reflection coefficient (IRC), integrated backscatter coefficient (IBC), cartilage thickness, and ultrasonographic score (US) of articular cartilage at patella were measured by using an ultrasound biomicroscopy system (UBS). Compared with the group C, URI significantly (P < 0.01) increased by 60.9% in group T, increased by 38.1% in group L. In addition, unloading induced a significant cartilage thinning (P < 0.05) in group T, whereas cartilage thickness in group L was 140.22 ± 19.61 µm reaching the level of the control group (147.00 ± 23.99 µm). There was no significant difference in IRC, IBC, and US among the three groups. LA therapy could help to retain the quality of articular cartilage which was subjected to unloading. LA would be a simple and safe nonpharmacological countermeasure for unloading-induced osteoarthritis. The UBM system has potential to be a sensitive, specific tool for quantitative assessment of articular cartilage.

Condylar remodeling accompanying splint therapy: a cone-beam computerized tomography study of patients with temporomandibular joint disk displacement.

OBJECTIVE: The aim of this study was to evaluate osseous changes accompanying anterior repositioning splint (ARS) therapy in patients with temporomandibular joint disk displacement. STUDY DESIGN: Cone-beam computerized tomography (CBCT) data of 36 patients with intermittent or permanent closed-lock were used; 23 patients with permanent closed-lock had their displaced disks physically reduced by mandibular manipulation before ARS therapy. CBCT was performed before and ≈ 6 months after ARS therapy. The presence and location of "double contour" images suggesting condylar bone remodeling were statistically analyzed. RESULTS: The "double contour" images after ARS therapy were observed in ≈ 80% of patients, more frequently in joints with signs of displaced disks. The "double contour" appeared more often on the posterior bevel as well as the medial and middle part of condyles (P < .01). CONCLUSIONS: ARS therapy can facilitate regenerative remodeling of condyles. CBCT is a useful tool for monitoring osseous changes in condyles.

Laser acupuncture and prevention of bone loss in tail-suspended rats.

BACKGROUND: Skeletal unloading during spaceflight results in bone loss. This study investigated whether laser acupuncture could be an effective countermeasure to prevent unloading-induced bone loss in rats. METHODS: There were 18 rats that were randomly assigned into three groups: a control group, a tail-suspended group (TS), and a tail-suspended with laser acupuncture treatment group (TSA). The rats in the TSA group were treated with laser acupuncture at the KI1 (Yong Quan) and ST36 (Zu San Li) acupoints of the left leg for 3 min per day. Bone mineral density (BMD), biomechanical properties, and histomorphometry of both tibiae were determined after the animals were euthanized at the end of week 4. RESULTS: Compared with the control group, BMD in the TS group significantly decreased by 12.3% in cortical bone and 15.1% in cancellous bone, whereas BMD in the TSA group decreased by only 3.1% in cortical bone and 9.0% in cancellous bone. The hardness of cortical bone dropped 44.1% in the TS group and 22.3% in the TSA group compared with the control group. The histomorphometry data were in accordance with BMD measurements. Although acupuncture treatment was applied only to the left side, we observed similar changes between the measurements of both the left and right tibiae. CONCLUSION: Laser acupuncture on KI1 and ST36 can inhibit bone loss in rats subjected to unloading. The fact that similar changes between the right and left sides when only the left limbs were treated suggests that the preventive effect of laser acupuncture occurs via a systemic regulation.

Ultrasound evaluation of site-specific effect of simulated microgravity on articular cartilage.

Space flight induces acute changes in normal physiology in response to the microgravity environment. Articular cartilage is subjected to high loads under a ground reaction force on Earth. The objectives of this study were to investigate the site dependence of morphological and ultrasonic parameters of articular cartilage and to examine the site-specific responses of articular cartilage to simulated microgravity using ultrasound biomicroscopy (UBM). Six rats underwent tail suspension (simulated microgravity) for four weeks and six other rats were kept under normal Earth gravity as controls. Cartilage thickness, ultrasound roughness index (URI), integrated reflection coefficient (IRC) and integrated backscatter coefficient (IBC) of cartilage tissues, as well as histological degeneration were measured at the femoral head (FH), medial femoral condyle (MFC), lateral femoral condyle (LFC), patello-femoral groove (PFG) and patella (PAT). The results showed site dependence not significant in all UBM parameters except cartilage thickness (p < 0.01) in the control specimens. Only minor changes in articular cartilage were induced by 4-week tail suspension, although there were significant decreases in cartilage thickness at the MFC and PAT (p < 0.05) and a significant increase in URI at the PAT (p < 0.01). This study suggested that the 4-week simulated microgravity had only mild effects on femoral articular cartilage in the rat model. This information is useful for human spaceflight and clinical medicine in improving understanding of the effect of microgravity on articular cartilage. However, the effects of longer duration microgravity experience on articular cartilage need further investigation.

[Clustering analysis applied to near-infrared spectroscopy analysis of Chinese traditional medicine].

The present article discusses the clustering analysis used in the near-infrared (NIR) spectroscopy analysis of Chinese traditional medicines, which provides a new method for the classification of Chinese traditional medicines. Samples selected purposely in the authors' research to measure their absorption spectra in seconds by a multi-channel NIR spectrometer developed in the authors' lab were safrole, eucalypt oil, laurel oil, turpentine, clove oil and three samples of costmary oil from different suppliers. The spectra in the range of 0.70-1.7 microm were measured with air as background and the results indicated that they are quite distinct. Qualitative mathematical model was set up and cluster analysis based on the spectra was carried out through different clustering methods for optimization, and came out the cluster correlation coefficient of 0.9742 in the authors' research. This indicated that cluster analysis of the group of samples is practicable. Also it is reasonable to get the result that the calculated classification of 8 samples was quite accorded with their characteristics, especially the three samples of costmary oil were in the closest classification of the clustering analysis.

[Application of extracorporeal shock-wave therapy (ESWT) in delayed unions and non-unions].

Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of delayed unions or non-unions. With the help of a review of the literature, the current author gave an overview of indications, choices of devices, success rates and complications for ESWT in the treatment of non-unions. The conceivable mechanism was also outlined.