EVALUATION OF MANDIBULAR TRABECULAR AND CORTICAL STRUCTURE BY FRACTAL ANALYSIS IN HYPERLIPIDEMIA AND HYPERTENSION PATIENTS.

INTRODUCTION: This study aimed to evaluate the mandibular trabecular and cortical changes in patients with hyperlipidemia (HL) and/or hypertension (HT) using fractal dimension (FD) analysis, mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI). MATERIALS AND METHODS: Panoramic radiographs of 100 patients were evaluated. FD measurement of three region of interest (ROI) including the angulus, corpus and interdental bone area were made. MCW, PMI and MCI were also measured and noted. RESULTS: Angulus, corpus and interdental FD values were significantly lower in three disease groups than the control group. Angulus, corpus, and interdental FD values were significantly lower in the HL+HT group than in the HL group and HT group. MCW value was significantly lower in the HL group, HT group, and HL+HT group than the control group. The cortical index C1 was more common in the control group while C2 was more common in the HT, HL and HL+HT group. CONCLUSION: The fact that FD was significantly lower in the HL+HT group compared to the HL and HT groups indicates the positive effect of their association on bone loss and quality. FD measurements on images obtained using a direct digital panoramic system can be used for treatment planning and follow-up of patients with HL and/or HT.

Evaluation of a Decision Support System Developed with Deep Learning Approach for Detecting Dental Caries with Cone-Beam Computed Tomography Imaging.

This study aims to investigate the effect of using an artificial intelligence (AI) system (Diagnocat, Inc., San Francisco, CA, USA) for caries detection by comparing cone-beam computed tomography (CBCT) evaluation results with and without the software. 500 CBCT volumes are scored by three dentomaxillofacial radiologists for the presence of caries separately on a five-point confidence scale without and with the aid of the AI system. After visual evaluation, the deep convolutional neural network (CNN) model generated a radiological report and observers scored again using AI interface. The ground truth was determined by a hybrid approach. Intra- and inter-observer agreements are evaluated with sensitivity, specificity, accuracy, and kappa statistics. A total of 6008 surfaces are determined as 'presence of caries' and 13,928 surfaces are determined as 'absence of caries' for ground truth. The area under the ROC curve of observer 1, 2, and 3 are found to be 0.855/0.920, 0.863/0.917, and 0.747/0.903, respectively (unaided/aided). Fleiss Kappa coefficients are changed from 0.325 to 0.468, and the best accuracy (0.939) is achieved with the aided results. The radiographic evaluations performed with aid of the AI system are found to be more compatible and accurate than unaided evaluations in the detection of dental caries with CBCT images.

Determining the reliability of diagnosis and treatment using artificial intelligence software with panoramic radiographs.

Purpose: The objective of this study was to evaluate the accuracy and effectiveness of an artificial intelligence (AI) program in identifying dental conditions using panoramic radiographs (PRs), as well as to assess the appropriateness of its treatment recommendations. Material and Methods: PRs from 100 patients (representing 4497 teeth) with known clinical examination findings were randomly selected from a university database. Three dentomaxillofacial radiologists and the Diagnocat AI software evaluated these PRs. The evaluations were focused on various dental conditions and treatments, including canal filling, caries, cast post and core, dental calculus, fillings, furcation lesions, implants, lack of interproximal tooth contact, open margins, overhangs, periapical lesions, periodontal bone loss, short fillings, voids in root fillings, overfillings, pontics, root fragments, impacted teeth, artificial crowns, missing teeth, and healthy teeth. Results: The AI demonstrated almost perfect agreement (exceeding 0.81) in most of the assessments when compared to the ground truth. The sensitivity was very high (above 0.8) for the evaluation of healthy teeth, artificial crowns, dental calculus, missing teeth, fillings, lack of interproximal contact, periodontal bone loss, and implants. However, the sensitivity was low for the assessment of caries, periapical lesions, pontic voids in the root canal, and overhangs. Conclusion: Despite the limitations of this study, the synthesized data suggest that AI-based decision support systems can serve as a valuable tool in detecting dental conditions, when used with PR for clinical dental applications.

Efficacy of low dose and ultra-low dose on the visibility of peri-implant fenestration and dehiscences: a computed tomography study.

PURPOSE: This study aimed to evaluate the visibility of peri-implant fenestration and dehiscences on computed tomography (CT) images taken with 2 different doses. MATERIAL AND METHODS: The defects were created on the apical of 6 implants randomly selected from 20 titanium implants placed in the ribs, and dehiscences were created on the cervical of 8 implants. No defects were created around 6 implants. Macroscopic analysis of the implanted ribs was accepted as the gold standard. From the samples, images were taken by using both ultra-low dose (80 kVp, 50 mA, 1.25 mm slice thickness) and low dose (100 kVp, 50 mA, 1.25 mm slice thickness) protocols in CT. The images obtained were evaluated using a 5-point scale. RESULTS: No significant difference was found between the area under the receiver operating characteristic of ultra-low dose protocol and low dose protocol in both defects based on the Wilcoxon test (p > 0.05). CONCLUSIONS: The ultra-low dose protocol could be applied by adhering to the "as low as reasonably achievable" principle in the diagnosis of peri-implant defects.

Determination of alveolar bone height according to the relationship between molar teeth and maxillary sinus.

PURPOSE: This study aims to analyze alveolar bone height (ABH) in the maxillary molar area according to the anatomical relationship between maxillary sinus and maxillary molar teeth via cone beam computed tomography images. METHODS: In 330 patients, 660 maxillary first molar (M1) and 648 maxillary second molar (M2) were evaluated. ABH measurements were made as to the shortest distance between the furcation midpoints of maxillary molars and the lowest point of the sinus floor. After the measurement, the positions of the maxillary molar teeth relative to the maxillary sinus were classified into four categories as type 1, 2, 3, and 4. RESULTS: ABH measurements in males were significantly higher than females (p < 0.05), but there were no differences between sides (p > 0.05). There were significant differences between types of both M1 and M2 for ABH, and the longest ABH was measured in type 1 (p < 0.05). Type 3 was the most common among 1308 maxillary molars teeth followed by type 1, type 2, and type 4. CONCLUSION: Determination of the relationship between maxillary molar teeth and the maxillary sinus and analysis of ABH according to this relationship may help plan endodontic treatment, apical surgery, and immediate implant therapy and prevent their complications.

MRI investigation of TMJ disc and articular eminence morphology in patients with disc displacement.

PURPOSE: The aim of this study was to evaluate the morphology of the temporomandibular joint (TMJ) articular eminence and disc and the relationship between morphology and inclination in patients with disc displacement. METHODS: TMJ magnetic resonance images (MRI) of 30 patients with disc displacement with reduction (DDWR) on one side and disc displacement without reduction (DDWOR) on the other side were analyzed. Articular eminence morphology was subdivided as box, sigmoid, flattened and deformed. Articular disc configuration was characterized as biconcave, biplanar, biconvex, hemiconvex and folded. The articular eminence inclination was measured as the angle between the Frankfurt plane and a line drawn from the glenoid fossa roof to the lowest point of the articular eminence. RESULTS: Regarding articular eminence shape, in both DDWR and DDWOR groups, the most frequent articular eminence shape was flattened shape. Regarding to the disc morphology, biplanar shape was the most frequently observed in both DDWR side and DDWOR side. The mean articular eminence inclination was 32.62 and 33.85 in the DDWR and DDWOR side, respectively. CONCLUSIONS: Disc and articular eminence morphology was found to have no relationship with TMJ internal derangement except the relationship between flattened type and internal derangement. The articular eminence inclination have no influence on disc reduction.

Volumetric and morphological analysis of condyle and glenoid fossa on computed tomography.

AIM: The aim of this study was to evaluate temporomandibular joint (TMJ) condyle and glenoid fossa morphology with measurements on Computed Tomography (CT) and volumetric analysis using InVesalius software program. MATERIALS AND METHODS: 250 condyles in 125 patients (mean age: 40.64) was evaluated on CT. Length, width, and height of the condyle, condylar volume, the thickness of glenoid fossa (TGF), condyle surface area, anterior space (AS), superior space (SS), and posterior space (PS) were measured in this study. Two left and right sides of the jaw have been measured. Linear measurements were performed with the image analysis program (Image J, 1.4 v version, National Institutes of Health, Bethesda, MD). Volume and surface area measurements were performed with InVesalius software (CTI, Campinas, SãoPaulo, Brazil). RESULTS: To compare the dimensions of the condyle between males and females, there was only a significant difference in left AS and SS and no significant difference was found between males and females in other measured factors. There was a significant difference between the age groups and left SS. A significant difference was also found between the age groups and condylar height, condyle surface area, and condylar volume on both right and left sides. CONCLUSION: Evaluation of condylar morphology is important to assess the TMJ anomalies and bony changes. This study showed no significant differences between gender and all measured factors except in the left AS and SS. However, age factor had a major effect on the morphology.

An evaluation of the relationship between maxillary sinus anterior wall depression and maxillary sinus opacity by computed tomography and panoramic radiography.

OBJECTIVE: Maxillary sinus anterior wall depression (AWD) has been associated with patterns such as the presence of panoramic innominate line and silent sinus syndrome. The aim of this study was to evaluate the relationship between AWD of maxillary sinus and both maxillary sinus opacity and the presence of innominate line using computed tomography (CT) and panoramic radiography (PR). MATERIALS AND METHODS: 250 CT and PR images (122 female, 128male) which had been taken for various reasons were randomly selected from the radiology archive of the our department. Innominate line visibility in PR is divided into three as invisible, obscure and clear. On CT images, the distance between guide line and the deepest point of the maxillary sinus anterior wall was calculated as AWD. The presence of maxillary sinus opacity and maxillary sinus AWD were evaluated on CT images. Demographic information such as age, gender and localization of the findings were noted in all measurements. RESULTS: In 143 (57.2%) patients, the innominate line (clear and obscure patterns) was seen on the PR images. AWD was observed in 104 (41.6%) CT images. The presence of maxillary sinus opacity was observed in 117 (46.8%) images. The mean right anterior wall depth was 5.69 and 4.88 in males and females, respectively, while the mean left anterior wall depth was 5.64 and 4.94 in males and females, respectively. Right wall depth was significantly higher in males (p < 0.05).There was no statistically significant difference in left wall depth (p > 0.05). CONCLUSIONS: Anterior wall depression was found to be associated with both maxillary sinus opacity and the visibility of the innominate line. Patients with AWD should be considered as susceptible to maxillary sinus diseases.

Fractal and radiomorphometric analysis of mandibular bone changes in patients undergoing intravenous corticosteroid therapy.

OBJECTIVE: To evaluate mandibular bone changes by comparing the fractal dimension (FD), mandibular cortical width (MCW), and panoramic mandibular index (PMI) on panoramic radiographs in patients using intravenous corticosteroids versus controls. STUDY DESIGN: In total, 60 patients were divided into 2 groups: 30 patients receiving intravenous corticosteroid treatment and 30 age- and sex-matched healthy people as the control group. Panoramic radiographs of all patients were evaluated. FD was measured in 4 regions: the subcortical area in the condyle, the area superior to the angle of the mandible, the alveolar bone distal to the mandibular left second premolar root, and the alveolar bone mesial to the mental foramen. MCW and PMI were calculated to assess cortical thickness. RESULTS: The FD values in the condyle, angle of the mandible, and mental foramen region were significantly lower in the corticosteroid group (P ≤ .011), but there was no significant difference in the second premolar area (P = .101). MCW values were significantly lower in the corticosteroid group (P < .001). There was no significant difference in PMI between the groups (P = .544). CONCLUSIONS: The FD and MCW values of the patients using corticosteroids can be helpful in quantitatively and objectively evaluating osseous changes in patients receiving intravenous corticosteroids.

Evaluation of the Relationship Between Olfactory Fossa Measurements and Nasal Septum Deviation for Endoscopic Sinus Surgery.

INTRODUCTION: Endoscopic sinus surgeries (ESS) are frequently used in the treatment of optic nerve decompression, other intracranial lesions and sinonasal pathologies. The olfactory fossa can be localized on different levels in relation to the anterior cranial fossa. The aim of the present study was to evaluate the depth and width of the olfactory fossa (OF) in relation to nasal septum deviation (NSD). METHODS: A total of 225 patient (141 female and 84 male, age range between 15 to 56 years) of cone beam computed tomography (CBCT) data was used in this study. NSD, OF width, OF depth were measured. OF depth which was grouped according to the Keros classification as Type I, II, and III was calculated. All measurements were performed bilaterally except for NSD. RESULTS: In the right and left OF depth were found Keros Type I 32 (14.2%) and 30 (13.3%), Keros Type II 171 (76%) and 167 (74.2%), and Keros Type III 22 (9.8%) and 28 (12.4%) respectively. There was no statistically significant found between OF depth and NSD (P > 0.05). The mean angle of the NSD in men and women were 4.36 ±â€Š4.69 in women 4.11 ±â€Š4.36, respectively. The mean width of the right OF was 2.50 ±â€Š0.64 mm and 2.58 ±â€Š0.72 mm for the left side and there was no statistically significant association between OF width - NSD and OF width - OF depth (P > 0.05). CONCLUSION: The anatomy of the OF should be well established before surgical intervention increase of the length of the lateral lamella is also increases the risk of developing complications such as cerebral damage, hemorrhage, and cerebrospinal fluid fistula during endoscopic sinus surgery. Although there is no significant difference between OF measurement and NSD, with three-dimensional imaging detailed research is required before endoscopic sinus surgical operations.

Evaluation of trabecular bone changes in patients with periodontitis using fractal analysis: A periapical radiography study.

BACKGROUND: The present study was aimed to evaluate the trabecular bone changes between healthy individuals and periodontitis patients with fractal dimension analysis on digital periapical radiographs. METHODS: Data from 35 healthy and 35 individuals with periodontitis were confirmed from the database of our faculty and included in the study. Two regions of interest (ROI) were selected belonging to mesial and distal region of mandibular first molar on periapical radiographs. The mean fractal dimension (FD) values of two regions were calculated with using box-counting method. Student t test was used for the comparison of the FDs. RESULTS: The mean FD of individuals with periodontitis was 0.97, whereas it was 1.04 for the healthy group. The mean FD values were significantly higher in the healthy group (P < 0.05). In the periodontitis group, as the FD of mesial interdental bone increased, the FD of distal interdental bone increased significantly (P < 0.05). CONCLUSION: Because of FD numerically showing changes in bone trabeculation, changes in the alveolar bone can be detected quantitatively.

Three-dimensional evaluation of maxillary sinus volume in different age and sex groups using CBCT.

AIM: Sinus maxillaris is an important anatomical formation in many branches of dentistry due to its proximity to the field of work. Various methods have been used in literature to measure the maxillary sinus volume (MSV) such as cadavers, stereology, two-dimensional conventional radiographs, computed tomography (CT), magnetic resonance imaging (MRI). The aim of this study is to evaluate the change of maxillary sinus volume according to age and gender with MIMICS 19.0 (Materialise HQ Technologielaan, Leuven, Belgium) which is one of three-dimensional modeling software. MATERIALS AND METHODS: This study was performed in 200 patients selected by a retrospective review of the archives of the Dicle University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology. Patients were divided into five age groups (18-24 years, 25-34 years, 35-44 years, 45-54 years, and ≥ 55 years) and by sex. Cone-beam computed tomography (CBCT) images of the patients were transferred to the MIMICS software and the MSV was measured. All statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 21) software. RESULTS: There was no statistically significant difference between the right and left maxillary sinus volume according to the findings obtained from our study, and maxillary sinus volume in males was found to be significantly higher than that of females. Another finding of our study is that the maxillary sinus volume decreases with age increase. Especially it was also found that the sinus volume in males in the 18-24 age group was statistically significantly higher than females. CONCLUSION: Consequently, maxillary sinus volume measurements can be made on CT, CBCT, MRI scans using reconstruction software.

Maxillary Cortical Bone Thickness in a South-Eastern Anatolian Population: A Cone-Beam Computed Tomography Study.

BACKGROUND The aim of this study was to measure the distance between the maxillary premolar and molar teeth apices to the buccal cortical bone and evaluate differences in gender and age group, using cone beam computed tomography (CBCT). MATERIAL AND METHODS This retrospective study comprised of 451 premolar and molar teeth of one hundred and thirteen patients who were admitted to Dicle University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology for different reasons. Data were analyzed using Student's t-tests and Tukey HSD tests. RESULTS There was significant difference in buccal bone thickness by gender (p<0.05). The thinnest point of the maxillary buccal bone was measured in women as 2.11 mm and in men as 2.02 mm in the first premolar teeth. The thickest point of maxillary buccal bone was measured in women as 9.87 mm and in men 10.71 mm palatinal root of the first molar. A comparison of buccal bone thickness between age showed a statistically significant difference at the distobuccal and palatinal roots of the first molar, at the mesiobuccal root of the second molar (p<0.05). CONCLUSIONS The measurements of maxillar buccal bone thickness using CBCT for various dental procedures especially in endodontic surgery, orthodontic mini implant treatment, dental implant procedures, and healing after tooth extraction that are important knowledge.