Assessing the reliability of CBCT-based AI-generated STL files in diagnosing osseous changes of the mandibular condyle: a comparative study with ground truth diagnosis.

OBJECTIVES: This study aims to evaluate the reliability of AI-generated STL files in diagnosing osseous changes of the mandibular condyle and compare them to a ground truth (GT) diagnosis made by six radiologists. METHODS: A total of 432 retrospective CBCT images from four universities were evaluated by six dentomaxillofacial radiologists who identified osseous changes such as flattening, erosion, osteophyte formation, bifid condyle formation, and osteosclerosis. All images were evaluated by each radiologist blindly and recorded on a spreadsheet. All evaluations were compared and for the disagreements, a consensus meeting was held online to create a uniform GT diagnosis spreadsheet. A web-based dental AI software was used to generate STL files of the CBCT images, which were then evaluated by two dentomaxillofacial radiologists. The new observer, GT, was compared to this new STL file evaluation, and the interclass correlation (ICC) value was calculated for each pathology. RESULTS: Out of the 864 condyles assessed, the ground truth diagnosis identified 372 cases of flattening, 185 cases of erosion, 70 cases of osteophyte formation, 117 cases of osteosclerosis, and 15 cases of bifid condyle formation. The ICC values for flattening, erosion, osteophyte formation, osteosclerosis, and bifid condyle formation were 1.000, 0.782, 1.000, 0.000, and 1.000, respectively, when comparing diagnoses made using STL files with the ground truth. CONCLUSIONS: AI-generated STL files are reliable in diagnosing bifid condyle formation, osteophyte formation, and flattening of the condyle. However, the diagnosis of osteosclerosis using AI-generated STL files is not reliable, and the accuracy of diagnosis is affected by the erosion grade.

The effect of game-based learning on basic life support skills training for undergraduate dental students.

OBJECTIVES: The aim of this study was to investigate the impact of serious game training on the performance of undergraduate dental students during basic life support (BLS) training. METHODS: Students at the Ankara University Faculty of Dentistry were divided into two groups at random: Serious Game (SG) (n = 46) and Traditional (Tr) (n = 45). Students completed the BLS pre-test following their lecture-based training. The SG set of students practiced until they achieved an 85 on the BLS Platform, after which they completed the BLS post-test. All students practiced cardiopulmonary resuscitation (CPR) on a manikin with the instructor's guidance, and then they independently applied CPR by using the model training component. The module evaluation scale was then used to determine each student's grade. Finally, the students provided input on surveys regarding technology perceptions of SG training, serious gaming, and hands-on training. RESULTS: In the SG group, the BLS post-test scores were significantly higher than the pre-test results (p = 0.00). In the SG and Tr groups, there was no statistically significant difference in the overall hands-on training scores (p = 0.11). Students in both groups evaluated the hands-on training on the manikin favorably and with high levels of participation. CONCLUSIONS: The SG-based training platform for BLS training has enhanced the BLS performance of undergraduate dental students in terms of knowledge and skill. It has been shown that digital learners have a beneficial impact on game-based learning outcomes; it is advised to use SGs and develop new games for various learning objectives.

Evaluation of a metal artifact reduction algorithm and an adaptive image noise optimization filter in the estimation of peri-implant fenestration defects using cone beam computed tomography: an in-vitro study.

OBJECTIVE: The aim of this study is to assess the effects of metal artifact reduction (MAR) and adaptive image noise enhancer (AINO) in CBCT imaging on the detection accuracy of artificially created fenestration defects in proximity to titanium and zirconium implants in sheep jaw. METHODS: Six zirconium and 10 titanium implants were planted on mandibular jaws of three sheep, and artificial defects were created. All images were obtained with a standard voxel size (0.150 mm3) and with 4 scan modes: (1) without MAR/without AINO; (2) with MAR/without AINO; (3) without MAR/with AINO; and (4) with MAR/with AINO during CBCT scanning. A total of 60 CBCT scans were produced. RESULTS: For all types of implants, intra- and inter-observer kappa values were the highest for MAR filter. The scan mode of with MAR filter was found to have the highest area under the curve (AUC), whereas the scan mode of without both MAR and AINO filters was found to have the lowest AUC values with statistical significance (p ≤ 0.05). Titanium implants were found to have higher AUC values than zirconium (p ≤ 0.05). CONCLUSION: Both MAR module and AINO filters enhance the accuracy of the detection of peri-implant fenestrations; however, the use of MAR filter solely can be recommended for detection of peri-implant fenestrations.

Evaluation of the detectability of early mandible fracture healing findings in terms of vitality aspect by using micro-CT technology in postmortem interval.

The purpose of the present study was to investigate the vitality aspect of mandibular fractures using micro-CT in the analysis of bone mineral density and other bone microstructure trabecular parameters in the postmortem interval. This study included 72 female Wistar rats. In the study groups, the rats' mandibles were first fractured and after three days of living, the rats were sacrificed. In the control groups, the rats were sacrificed first and then the mandibles were fractured. All rats were left for a natural putrefaction period according to their group's time as week-0, week-1, week-2, week-4, week-8, and week-12. All fractured hemi-mandibles were scanned by micro-CT and analyzed in terms of BMD and other bone trabecular microstructures. BMD and the other bone trabecular microstructures, such as bone volume, percent bone volume, trabecular separation, and trabecular pattern factor, showed statistically significant differences in both the study and control groups (p ≤ 0.05). There were statistically significant differences between the study and control groups in comparisons of BMD in groups 1, 2, 3, 4 and 5, bone volume and percent bone volume in groups 1 and 3, bone surface and bone surface density in group 6, trabecular separation in group 1, and trabecular number, trabecular pattern factor, and structural model index in group 6. Micro-CT scanning and analysis of BMD and other bone trabecular microstructure parameters for evaluation of vitality aspects of mandible fractures in the PMI has various valuable results that should provide guidance for possible studies in the future.

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.

Comparison of the different voxel sizes in the estimation of peri-implant fenestration defects using cone beam computed tomography: an ex vivo study.

BACKGROUND: To examine the influence of voxel sizes to detect of peri-implant fenestration defects on cone beam computed tomography (CBCT) images. MATERIALS AND METHODS: This study performed with three sheep heads both maxilla and mandible and two types of dental implant type 1 zirconium implant (Zr40) (n = 6) and type 2 titanium implant (Ti22) (n = 10). A total of 14 peri-implant fenestrations (8 buccal surfaces, 6 palatal/lingual surface) were created while 18 surfaces (8 buccal, 10 palatal/lingual) were free of fenestrations. Three observers have evaluated the images of fenestration at each site. Images obtained with 0.75 mm3, 0.100 mm3, 0.150 mm3, 0.200 mm3, and 0.400 mm3 voxel sizes. For intra- and inter-observer agreements for each voxel size, Kappa coefficients were calculated. RESULTS: Intra- and inter-observer kappa values were the highest for 0.150 mm3, and the lowest in 0.75 mm3 and 0.400 mm3 voxel sizes for all types of implants. The highest area under the curve (AUC) values were found higher for the scan mode of 0.150 mm3, whereas lower AUC values were found for the voxel size for 0.400 mm3. Titanium implants had higher AUC values than zirconium with the statistical significance for all voxel sizes (p ≤ 0.05). CONCLUSION: A voxel size of 0.150 mm3 can be used to detect peri-implant fenestration bone defects. CBCT is the most reliable diagnostic tool for peri-implant fenestration bone defects.

Evaluation of a metal artifact reduction algorithm and an optimization filter in the estimation of peri-implant dehiscence defects by using cone beam computed tomography: an in-vitro study.

OBJECTIVES: The aim of this study was to assess the effect of a metal artifact reduction (MAR) algorithm and the adaptive image noise optimizer (AINO) optimization filter in the detection of peri-implant dehiscences with cone beam computed tomography (CBCT). STUDY DESIGN: Nine implants (3 zirconium, 3 titanium, and 3 zirconium-titanium) were placed in 3 sheep heads. Dehiscences were created on the buccal and lingual/palatal surfaces. A total of 9 defects and 9 controls with no defects were evaluated by 3 observers. Each sheep head was scanned 5 times with 4 scan modes; (1) without MAR/without AINO; (2) with MAR/without AINO; (3) without MAR/with AINO; and (4) with MAR/with AINO. Receiver operating characteristic analysis and weighted kappa coefficients were used to calculate diagnostic efficacy and intra- and interobserver agreements for each implant type and scan mode. RESULTS: For all implant types, dehiscences were most accurately detected when both MAR and AINO were applied (P ≤ .045). Detection of dehiscences was more accurate with titanium implants (P ≤ .040). There were no significant differences in agreement among and between the observers. CONCLUSIONS: The use of both MAR and AINO enhanced the detection accuracy of artificially created dehiscences in proximity to implants. Their combined use is recommended for detecting peri-implant dehiscences.

Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study.

OBJECTIVE: This study was performed to evaluate the trabecular pattern of patients with cancer taking bisphosphonates on panoramic images using fractal dimension (FD) analysis by comparison with healthy subjects and to assess whether any difference exists between regions. METHODS: FD analysis was conducted using ImageJ 1.3 software (National Institutes of Health, Bethesda, MD, USA) with the box-counting method on panoramic radiographs of 33 patients taking bisphosphonates (13 males and 20 females) and 33 healthy sex- and age-matched individuals. RESULTS: FD values were higher (1.39 ± 0.14) in the study group than control group (1.38 ± 0.07) (p ≤ 0.05). No difference was detected in the FD values among the tested regions. The mean FD values in the control and study groups were as follows: region 1, 1.49 and 1.41 (p = 0.54); region 2, 1.36 and 1.37 (p = 0.84); region 3, 1.35 and 1.42 (p = 0.11); and region 4, 1.39 and 1.39 (p = 0.90), respectively. Female patients showed significantly lower values above the mandibular canal on the distal side of the second premolar and anterior to the mental foramen than did male patients (p ≤ 0.05). Age was unrelated to the FD in the study group (p ≥ 0.05). CONCLUSIONS: The FD values of the patients with cancer taking bisphosphonates were higher than those of the controls. FD analysis showed the potential for examining bone structure in panoramic radiographs. Studies with a larger sample size are necessary to confirm these results.

Evaluation of Anatomical and Volumetric Characteristics of the Nasopalatine Canal in Anterior Dentate and Edentulous Individuals: A CBCT Study.

OBJECTIVE: To examine the nasopalatine canal (NPC) anatomical and volumetric measurements in anterior edentulous (AE) and anterior dentate (AD) individuals and to compare these findings according to sex, age, shape, and severity of resorption in the premaxilla. METHODS: Two hundred cone beam computed tomography images were divided into 2 groups: AE and AD. The diameter, the length of the NPC and the width, the length of the buccal bone anterior to the NPC were measured and recorded. Linear and volumetric measurement results were evaluated in terms of age, sex, dental status, shape, and severity of resorption. RESULTS: No significant differences were observed between the AE and AD groups in terms of the NPC volume (P = 0.289). In the AE group, the spindle shape had the highest volume, and in the same group, with aging, the volume significantly increased (P = 0.00). The mean NPC volume was found to be statistically significantly larger in males than females (P = 0.02). A statistically significant relation was observed between NPC volume and resorption status. CONCLUSION: Severe bone resorption due to sustained edentation complicated implant surgery because of the increase in incisive and nasal foramen diameters and decrease in buccal residual bone dimensions. The NPC volume was found fewer in edentulous patients, and by the resorption, the volume was decreased.

Anatomic Study on Sphenoidal Emissary Foramen by Using Cone-Beam Computed Tomography.

OBJECTIVES: The goal of this retrospective study is to evaluate the radiologic anatomy of sphenoidal emissary foramen (SEF) by using cone-beam computed tomography (CBCT) scans. METHODS: Three hundred seventeen (189 female and 128 male) full-head CBCT images were evaluated in this study. Incidence, diameter, shape, confluence to foramen ovale, and distance to anatomic structures of SEF were noted. RESULTS: In the 317 analyzed images, the SEF was identified in 89 (28.1%) images. Of these, 67 (21.1%) were unilateral, 22 were (6.9%) bilateral. The maximum mean diameter of SEF was measured 2.66 mm on the right side and 2.82 mm on the left side (P = 0.16). The most observed SEF shape was oval with the incidence of 68.5% (P ≤ 0.05). Confluence was observed in 23.4% of SEF whereof 84.6% were in the left side (P ≤ 0.05). CONCLUSION: Observations in this study tender new anatomic parameters regarding SEF incidence, characteristics, and distances to proximate anatomic structures. Knowledge related to SEF variations will be helpful for neurosurgeons and radiologist.

Evaluation of the 3 mm Thickness Splint Therapy on Temporomandibular Joint Disorders (TMDs).

Objective. This study aimed at finding out whether the 3 mm thickness of stabilization splints has positive or negative effects on all temporomandibular disorder (TMD) symptoms. Materials and Methods. The statistical calculation included 25 (22 females; 3 males) TMD patients who received 3 mm thickness stabilization splint therapy. They were evaluated according to follow-up treatment period, TMD pain, muscle pain, mouth opening, diet score, and splint usage time per day. Results. There was important treatment success that 22 (88%) of patients were totally healed. There was not any remarkable effect or advancement of splints on total healings of TMDs in first 3 months' period (11/25 patients, 44%). The mouth opening mean reached 38, 67 mm at 6 months and 41 mm at 12 months with remarkable success. Except one (4%) patient, other 24 (96%) patients had a normal diet score of 3 at the end of splint therapy. There was no correlation between splint usage duration a day and total healing of TMDs. Conclusion. We conclude that 3 mm splint therapy should maintain at least 6 months to achieve remarkable results. Splint should be used at least 12 h a day consistent with our results. Finally, diet score should be incorporated with TMD pain and amount of mouth opening; hence, we advise to use in one term as "total healing."

Comparison of the effect of Naproxen, Etodolac and Diclofenac on postoperative sequelsfollowing third molar surgery: A randomised, double-blind, crossover study

OBJECTIVE: To compare the three non-steroidal anti-inflammatory agents (NSAIDs) Diclofenac potassium, Etodolac and Naproxen sodium in relation to pain, swelling and trismus following impacted third molar surgery. Study DESIGN: The study was a randomized and a double-blinded study which included 42 healthy young individuals with impacted third molars and bone retention. Patients were randomly assigned to 3 groups (n: 14) to which Diclofenac potassium, Naproxen sodium and Etodolac were administered orally an hour before the operation. Impacted third molars were surgically extracted with local anaesthesia. Visual analog scales (VAS) were used to assess the pain in the 6th, 12th hours and on the 1st, 2nd, 3rd, 5th, and 7th days postoperatively. Swelling was evaluated using ultrasound (US) and mouth opening (trismus) was measured with a composing stick pre and post operatively on the 2nd and 7th days respectively. RESULTS: Regarding pain alleviation, Diclofenac potassium was better than Naproxen sodium and Naproxen sodium was better than Etodolac but these differences were not statistically significant. US measurements showed that the swelling on postoperative 2nd day was significantly lowest with Diclofenac potassium as compared to others (p= 0.027) while Naproxen sodium and Etodolac acted similarly (p = 0.747). No difference was noted regarding trismus in any of the groups. CONCLUSION: NSAIDs (Diclofenac, Naproxen and Etodolac) are somehow similarly effective for controlling pain and trismus following extraction of mandibular third molars but Diclofenac potassium surpasses others in reduction of swelling

Use of canonical variate analysis biplot in examination of choline content data of some foods.

Adequate intake (AI) of choline as part of the daily diet can help prevent major diseases. Low choline intake is a major risk factor for liver and several neurological disorders. Extreme choline consumption may cause diseases such as hypotension, sweating, diarrhea, and fishy body odor. The AI of choline is 425 mg/day for adult women; higher for pregnant and lactating women. The AI for adult men is 550 mg/day. The total choline content of foods is calculated as the sum of free choline, glycerophosphocholine, phosphocholine, phosphatidylcholine and sphingomyelin. These are called the choline variables. Observed values of choline variables may be different in amounts of nutrients. So different food groups in terms of choline variables are useful to compare. The present paper shows the advantages of using canonical variate analysis biplot to optimally separate groups and explore the differentiality of choline variables amounts in foods.

Examination of relation between nutrient components and fruits: biplot approach.

Adequate intake of fruits and vegetables as part of the daily diet may help prevent major diseases. Low fruit intake is a major risk factor for cancer, coronary heart disease and stroke. The World Health Organization recommends eating at least five portions of a variety of fruit, which is nearly 400 g/day. Essential nutrients, water, carbohydrates, oils and vitamins are needed in appropriate quantities in order to have a well-functioning body. In this study we try to carry out a food composition study to identify and determine the chemical nature of the organic and inorganic macro-nutrient and micro-nutrient properties of the main fruit types that affect human nature, by a biplot graphical approach. The biplot can be considered as multivariate equivalents of scatter plots that have been used for graphically analyzing bivariate data. Biplot approaches show a simultaneous display of fruits and nutrient components in low dimensions. In the present study, the theory of biplot and different types of biplot will be given and than an application of the biplot approach will be applied to the real data.

Age-related changes in tooth enamel as measured by electron microscopy: implications for porcelain laminate veneers.

STATEMENT OF PROBLEM: Available information on the dimensions of the enamel and pulp tissues of tooth structure, as well as their correlation with chronologic age, is limited. However, this information is a significant determinate in planning the tooth reduction for a porcelain laminate veneer (PLV) restoration. PURPOSE: This study examined variations in tooth enamel thickness and its correlation with chronologic age as it relates to available tooth substrate for PLV restorations. MATERIAL AND METHODS: Forty human maxillary central incisors extracted from patients within the age range of 30 to 69 years were used to evaluate the thickness of tooth layers. Measurements were made for the following tooth areas using scanning electron microscopy (SEM): facial enamel thickness at 1, 3, and 5 mm above the cemento-enamel junction (CEJ), palatal enamel thickness at 5 mm above the CEJ, facial and palatal enamel thickness at the incisal edge, maximum facial-palatal (MFP) width at incisal edge, physiologic secondary dentin (PSD) height, facial-cervical enamel-pulp (FCEP) distance, and the incisal edge enamel-pulp (IEP) distance. The relationship between thickness and age was evaluated with a regression analysis (alpha=.05). RESULTS: Significant differences (P<.001) were observed in all of the relationships between tooth thicknesses and chronological age. Outcome variables of enamel thickness related to age showed a steady decrease, beginning at approximately age 50. Mean values of facial enamel thickness at 1, 3, and 5 mm above the CEJ were 0.31 +/- 0.01, 0.54 +/- 0.01, and 0.75 +/- 0.02 mm, respectively, for the age range of 30 to 69 years. The thickness of maximum incisal width (R(2) = 0.95), PSD height (R(2) = 0.76), and IEP distance (R(2) = 0.99) indicated that all are subject to an increase in relation to age. CONCLUSION: Facial enamel thickness above the CEJ decreases, while MFP increases in relation to age. The PSD height and IEP distance also increased with age.