The Burden of Diagnostic Error in Dentistry: A Study on Periodontal Disease Misclassification.

BACKGROUND: Periodontal disease constitutes a widely prevalent category of non-communicable diseases and ranks among the top 10 causes of disability worldwide. Little however is known about diagnostic errors in dentistry. In this work, by retrospectively deploying an electronic health record (EHR)-based trigger tool, followed by gold standard manual review, we provide epidemiological estimates on the rate of diagnostic misclassification in dentistry through a periodontal use case. METHODS: An EHR-based trigger tool (a retrospective record review instrument that uses a list of triggers (or clues), i.e., data elements within the health record, to alert reviewers to the potential presence of a wrong diagnosis) was developed, tested and run against the EHR at the two participating sites to flag all cases having a potential misdiagnosis. All cases flagged as potentially misdiagnosed underwent extensive manual reviews by two calibrated domain experts. A subset of the non-flagged cases was also manually reviewed. RESULTS: A total of 2,262 patient charts met the study's inclusion criteria. Of these, the algorithm flagged 1,124 cases as potentially misclassified and 1,138 cases as potentially correctly diagnosed. When the algorithm identified a case as potentially misclassified, compared to the diagnosis assigned by the gold standard, the kappa statistic was 0.01. However, for cases the algorithm marked as potentially correctly diagnosed, the review against the gold standard showed a kappa statistic of 0.9, indicating near perfect agreement. The observed proportion of diagnostic misclassification was 32%. There was no significant difference by clinic or provider characteristics. CONCLUSION: Our work revealed that about a third of periodontal cases are misclassified. Diagnostic errors have been reported to happen more frequently than other types of errors, and to be more preventable. Benchmarking diagnostic quality is a first step. Subsequent research endeavor will delve into comprehending the factors that contribute to diagnostic errors in dentistry and instituting measures to prevent them. CLINICAL SIGNIFICANCE: This study sheds light on the significance of diagnostic excellence in the delivery of dental care, and highlights the potential role of technology in aiding diagnostic decision-making at the point of care.

Survival rate of teeth adjacent and nonadjacent to dental implants: A retrospective cohort study.

BACKGROUND: The aim of this retrospective study was to investigate the risk of tooth loss for teeth adjacent and nonadjacent to dental implants. METHODS: A total of 787 patients with an average follow-up of 57.1 months were examined to define the tooth loss, cumulative survival rate, and odds ratio (OR) for teeth adjacent versus nonadjacent to implants. A multivariate logistic regression was employed to assess the association between dental history and various recorded etiologies of tooth loss among teeth adjacent to implants. RESULTS: The incidence of tooth loss for teeth adjacent to implants was 8.1% at the tooth level and 15.1% at the patient level, while 0.7% and 9.5% at the tooth and patientlevel for teeth nonadjacent to implants. The 10-year cumulative survival rate for teeth adjacent to implants was 89.2%, and the primary etiology of tooth loss was root fracture (45.2%). The risk of tooth loss among teeth adjacent versus nonadjacent to implants was significantly higher (OR 13.15). Among teeth adjacent to implants, root canal-treated teeth had a significantly higher risk of tooth loss due to root fracture (OR 7.72), a history of existing restoration significantly increased the risk of tooth loss due to caries (OR 3.05), and a history of periodontitis significantly increased the risk of tooth loss due to periodontitis (OR 38.24). CONCLUSION: The present study demonstrated that after patients received dental implant treatment, teeth adjacent to implants showed a 13.2-fold higher risk of tooth loss compared to teeth nonadjacent to implants, with the primary etiology being root fracture.

Design, synthesis and evaluation of thieno[3,2-d]pyrimidine derivatives as novel potent CDK7 inhibitors.

The targeting of cyclin-dependent kinase 7 (CDK7) has become a highly desirable therapeutic approach in the field of oncology due to its dual role in regulating essential biological processes, encompassing cell cycle progression and transcriptional control. We have previously identified a highly selective thieno[3,2-d]pyrimidine-based CDK7 inhibitor with demonstrated efficacy and safety in animal model. In this study, we sought to optimize the thieno[3,2-d]pyrimidine core to discover a novel series of CDK7 inhibitors with improved potency and pharmacokinetic (PK) properties. Through extensive structure-activity relationship (SAR) studies, compound 20 has emerged as the lead candidate due to its potent inhibitory activity against CDK7 and remarkable efficacy on MDA-MB-453 cells, a representative triple negative breast cancer (TNBC) cell line. Furthermore, 20 has demonstrated favorable oral bioavailability and exhibited highly desirable pharmacokinetic (PK) properties, making it a promising lead candidate for further structural optimization.

Design and Synthesis of Novel Macrocyclic Derivatives as Potent and Selective Cyclin-Dependent Kinase 7 Inhibitors.

The duality of function (cell cycle regulation and gene transcription) of cyclin-dependent kinase 7 (CDK7) makes it an attractive oncology target and the discovery of CDK7 inhibitors has been a long-term pursuit by academia and pharmaceutical companies. However, achieving selective leading compounds is still difficult owing to the similarities among the ATP binding pocket. Herein, we detail the design and synthesis of a series of macrocyclic derivatives with pyrazolo[1,5-a]-1,3,5-triazine core structure as potent and selective CDK7 inhibitors. The diverse manners of macrocyclization led to distinguished selectivity profiles of the CDK family. Molecular dynamics (MD) simulation explained the binding difference between 15- and 16-membered macrocyclic compounds. Further optimization generated compound 37 exhibiting good CDK7 inhibitory activity and high selectivity over other CDKs. This work clearly demonstrated macrocyclization is a versatile method to finely tune the selectivity profile of small molecules and MD simulation can be a valuable tool in prioritizing designs of the macrocycle.

The Effect of Anti-Depressants on Dental Implant Failure: A Systematic Review and Meta-Analysis.

PURPOSE: The aim of this systematic review and meta-analysis is to analyze the risk of dental implant failure for patients who had a history of anti-depressant use. MATERIALS AND METHODS: An electronic search was performed up to June 2023 in three databases, including PubMed/MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials with data on comparison of implant failure rate for patients with and without the use of antidepressants were included. Meta-analyses for the risk ratio of implant failure rate at the patient level and implant level were performed. RESULTS: Eleven clinical studies were selected for inclusion in this review. The meta-analyses showed a risk ratio of 2.44 (95% confidence interval= 1.75 to 3.39, p< 0.0001) and 2.44 (95% CI= 1.73 to 3.46, p< 0.0001) for the implant failure at the patient level and implant level, respectively. The comparisons presented a low heterogeneity for the patient-level analysis and a moderate heterogeneity for the implant-level analysis among the pooled studies. Subgroup analyses also revealed that patients who received only selective serotonin reuptake inhibitors (SSRIs) or SSRIs with other type of anti-depressants had a higher risk of implant failure than those who were not on any anti-depressants. CONCLUSIONS: The current review demonstrates the use of anti-depressants, such as SSRIs, may increase the risk of dental implant failure at both patient level and implant level. Although limited evidence suggests that a certain type of SSRI (sertraline) may have more influence on implant failure than other SSRIs, future studies are needed to warrant this finding.

Epidemiology of functional dyspepsia and gastroparesis as diagnosed in Flemish-Belgian primary care: A registry-based study from the Intego database.

BACKGROUND: Dyspepsia is a prevalent condition in the general population. Besides organic causes, the differential diagnosis of dyspepsia includes functional dyspepsia (FD) and gastroparesis (GP) which share similar pathophysiological mechanisms and clinical presentation. So far, no study investigated the prevalence of FD and GP in a primary care in Belgium. METHODS: Data were obtained from Intego, a Flemish-Belgian general practice-based morbidity registration network. From 586,164 patients between 2000 and 2021, we selected patients with ICD-10 code for FD and GP. Patients with organic gastrointestinal diseases were excluded. We determined demographics and comorbidities of FD/GP. For prevalence and incidence calculation, we included those who consulted their general practitioners at least once in the given year. Pair-wise comparison was conducted to access the impact of comorbidities on risk of FD/GP. KEY RESULTS: Between 2011 and 2021, the prevalence of FD/GP ranged from 1.03% to 1.21%. The incidence of FD/GP ranged from 109 to 142 per 100,000 adults. In total 5242 cases of FD/GP were identified. These cases shared commonly coexisting diagnoses of gastroesophageal reflux disease (18.8%), irritable bowel syndrome (17.1%), and chronic constipation (18.7%). Patients with somatization/anxiety/depression had significantly higher risk of FD/GP, compared to the control (OR 1.38, 95% CI 1.19-1.61, p < 0.01). CONCLUSIONS AND INFERENCES: The prevalence (1.03%-1.21%) and incidence (109-142/100,000) of FD/GP in primary care over last decade appear to conflict with epidemiological research in the general population. The discrepancies suggest a potential lack of awareness of FD and GP among physicians and/or patients in Flemish-Belgium.

Development and validation of a rule-based algorithm to identify periodontal diagnosis using structured electronic health record data.

AIM: To develop and validate an automated electronic health record (EHR)-based algorithm to suggest a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal Diseases and Conditions. MATERIALS AND METHODS: Using material published from the 2017 World Workshop, a tool was iteratively developed to suggest a periodontal diagnosis based on clinical data within the EHR. Pertinent clinical data included clinical attachment level (CAL), gingival margin to cemento-enamel junction distance, probing depth, furcation involvement (if present) and mobility. Chart reviews were conducted to confirm the algorithm's ability to accurately extract clinical data from the EHR, and then to test its ability to suggest an accurate diagnosis. Subsequently, refinements were made to address limitations of the data and specific clinical situations. Each refinement was evaluated through chart reviews by expert periodontists at the study sites. RESULTS: Three-hundred and twenty-three charts were manually reviewed, and a periodontal diagnosis (healthy, gingivitis or periodontitis including stage and grade) was made by expert periodontists for each case. After developing the initial version of the algorithm using the unmodified 2017 World Workshop criteria, accuracy was 71.8% for stage alone and 64.7% for stage and grade. Subsequently, 16 modifications to the algorithm were proposed and 14 were accepted. This refined version of the algorithm had 79.6% accuracy for stage alone and 68.8% for stage and grade together. CONCLUSIONS: Our findings suggest that a rule-based algorithm for suggesting a periodontal diagnosis using EHR data can be implemented with moderate accuracy in support of chairside clinical diagnostic decision making, especially for inexperienced clinicians. Grey-zone cases still exist, where clinical judgement will be required. Future applications of similar algorithms with improved performance will depend upon the quality (completeness/accuracy) of EHR data.

Proximal Periodontal Support Adjacent to Untreated Peri-implantitis Lesions: A Cross-Sectional Analysis.

PURPOSE: To assess site-related features of peri-implantitis occurring adjacent to teeth and its association with the proximal periodontal bone level. MATERIALS AND METHODS: Periapical radiographs were collected from partially edentulous patients exhibiting peri-implantitis adjacent to teeth. The following variables were quantified: intrabony defect width (DW), implant marginal bone loss (MBLi), tooth marginal bone loss (MBLt), implant-tooth distance (ITd), intrabony defect angulation (DA), adjacent periodontal bone peak height (ABPh), and implant-tooth angulation (ITa). A correlation matrix using the Spearman correlation coefficient was created to explore the dependence of these variables. Univariate linear regression analysis was carried out by means of generalized estimating equations (GEE), using MBLt as dependent variable. RESULTS: Overall, 61 patients and 84 implants were included in this study, consisting of a total of 105 implant sites facing adjacent teeth. This resulted in 515 linear and 194 angular measurements. A total of 11 different statistically significant associations were demonstrated between the different variables analyzed. Moreover, the univariate regression analysis revealed significant positive associations between MBLt and MBLi (P = .013) and between MBLt and periodontitis (PD) (P = .014). These associations were confirmed in the multivariate model. CONCLUSIONS: Teeth adjacent to untreated peri-implantitis lesions are associated with proximal loss of periodontal support. This finding is more remarkable in scenarios that display short implant-tooth distance.

The Effect of Bone Morphogenetic Protein-2 (BMP-2) on Volumetric and Histometric Outcomes for Peri-Implant Defects in the Animal Model: A Systematic Review and Meta-Analysis.

Purpose: To study the effect of BMP-2 on the volumetric and histometric changes in peri-implant defect treatments in animal models. Materials and Methods: An electronic search of four databases and a manual search of peer-reviewed journals for relevant articles were performed. Animal studies with data that compared the volumetric and/or histometric outcomes of peri-implant defect treatment with and without the use of BMP-2 were included. Meta-analyses were performed to analyze the weighted mean difference (WMD) and confidence interval (CI) for the recorded variables. Results: After completing the search process, 21 randomized controlled trials were included. The results of the meta-analyses showed that the WMD of bone-to-implant contact (%BIC) with 4 to 8 weeks and 12 to 24 weeks of follow-up was 15.50% (95% CI = 3.28% to 27.72%, P = .01) and 16.17% (95% CI = 11.17% to 21.16%, P < .00001), respectively, favoring the BMP-2 group. The WMD for the percentage of defect fill with 4 to 8 weeks and 12 to 24 weeks of follow-up was 15.88% (95% CI = 3.90% to 27.86%, P = .009) and 10.48% (95% CI = 0.95% to 20.02%, P = .03), respectively, favoring the BMP-2 group. The WMD for the vertical bone gain with 8 to 16 weeks of follow-up was 1.63 mm (95% CI = 0.58 to 2.67 mm, P = .002), also favoring the BMP-2 group. Conclusion: This review demonstrated that the use of BMP-2 in treating peri-implant defects showed better clinical and histometric outcomes than defects not treated with BMP-2 in animal models.

Frequency of screw-retained angulated screw channel single crown following immediate implant placement and provisionalization in the esthetic zone: A cone beam computed tomography study.

OBJECTIVE: The purpose of this cone beam computed tomography (CBCT) study was to determine the frequency percentage of screw-retained crown using angulated screw channel (ASC) abutment for single immediate implant placement and provisionalization (IIPP) in the esthetic zone. METHODS: The CBCT images of 200 patients without disease and without metal restorations in maxillary anterior teeth were evaluated. The mid-sagittal-sectional CBCT images of maxillary anterior teeth (#6-#11) were created in an implant planning software, screen-captured, and transferred to a presentation program. Template of tapered implants with diameter of 3.5 mm (for central and lateral incisors) and 4.3 mm (for central incisors and canines) and lengths of 13, 15, and 18 mm were applied to the sagittal images to identify the IIPP cases. To qualify for IIPP, the implant must engage >35% bone with at least 1 mm of surrounding bone and no perforations. The IIPP cases were further divided into straight screw channel (IIPPSSC) abutment or 25-degree angulated screw channel abutment (IIPPASC), based upon its restorability. The frequency percentages of possible IIPP, IIPPSSC, and IIPPASC were reported and compared among all maxillary anterior teeth. RESULTS: A total of 1200 maxillary anterior teeth sagittal images from 200 patients (88 male and 112 female) with a mean age of 51.3 years (range 20-83 years) were evaluated in this study. The overall frequency percentages of IIPP, IIPPSSC, and IIPPASC possibility were 84% (74%-92%), 14% (10%-24%), and 75% (66%-87%), respectively. CONCLUSION: Within the limitations of this CBCT study, 90% of single IIPP in the esthetic zone can be restored with screw-retained crown when utilizing ASC. In addition, the possibility of using a screw-retained restoration following IIPP increases about five times with ASC abutment compared to the SSC abutment.

The association between Aggregatibacter actinomycetemcomitans JP2 clone and periodontitis: A systematic review and meta-analysis.

To appraise the literature on the prevalence of the JP2 clone of Aggregatibacter actinomycetemcomitans (A.a.) and on its association with presence and progression of periodontitis in different populations. A systematic search of the literature was conducted in Medline, Embase and Cochrane Library for studies reporting data on detection of the JP2 clone of A.a. A total of 56 papers were included in the review, from an initial search of 685 titles. Studies were carried out in populations with a mean age of 26.34 years (range 6.24-53.85 years). Just over 16% of the overall population assessed (n = 13 751) had the JP2 clone detected. Meta-analyses included 16 studies and 1775 patients, and revealed an association between detection of the JP2 clone and diagnosis of periodontitis (RR = 1.86, 95% 1.43-2.42) from saliva and plaque, with high heterogeneity (I2  = 85%, p < .00001). Meta-analyses included 5 studies and 616 patients, and revealed an association between baseline detection of the JP2 clone and onset of periodontitis over 2 to 5 years (RR = 4.12, 95% 2.42-7.00), with high heterogeneity (I2  = 81%, p < .0003). From the overall risk of bias score, 29 papers were judged as low risk of bias, whilst the remaining papers were judged to have an overall medium or high risk of bias. Detection of the JP2 clone of A.a. in subgingival plaque and saliva samples is associated with increased odds of diagnosis of periodontitis and may be able to predict onset of periodontitis. This systematic review provides clear evidence that in certain populations, the JP2 clone of A.a. is associated with early-onset periodontitis. Furthermore, detection of this bacterium seems to be predictive of disease onset.

The significance of vertical platform discrepancies and splinting on marginal bone levels for adjacent dental implants.

OBJECTIVE: The aim of this retrospective study was to investigate the influence of vertical platform discrepancies for splinted and non-splinted adjacent implants on radiographic marginal bone loss (RMBL). METHODS: Data from January 2000 to February 2021 were collected from the electronic charts of 156 patients with 337 implants at the UCSF School of Dentistry. Five different implant restoration categories were evaluated for radiographic evidence of proximal RMBL. Patients with (1) two adjacent single crowns, (2) two adjacent splinted crowns, (3) three-unit bridges supported by two implants, (4) three adjacent single crowns, and (5) three adjacent splinted crowns. Inclusion required baseline radiograph taken at the time of prosthesis delivery or final impression, and follow-up radiographs at least 12 months after restorations have been in function. Measurements assessed included vertical distance between adjacent implant platforms and proximal RMBL around implants. Odds ratios (ORs) and 95% confidence interval (95% CI) of implants with ≥1 mm RMBL between different type of restorations were calculated. RESULTS: In general, prostheses supported by splinted adjacent implants demonstrated a significant association with the presence of ≥1 mm RMBL (OR = 2.55, 95% CI = 1.17-5.17, p = 0.018) when compared to prostheses supported by non-splinted adjacent implants. In addition, prostheses with a vertical platform discrepancy ≥0.5 mm demonstrated a significant association with the presence of ≥1 mm RMBL (OR = 4.30, 95% CI = 1.85 to 10.01, p = 0.007) when compared to prostheses with a vertical platform discrepancy <0.5 mm. When adjacent implants had ≥0.5 mm vertical platform discrepancy, the majority (66.67%) of three splinted adjacent crowns had at least one implant with ≥1 mm RMBL. This was followed by two splinted adjacent crowns (58.97%), three-unit bridge (25.93%), two single adjacent crowns (24.24%), and three single adjacent crowns (18.18%). When adjacent implants had ≥1 mm vertical platform discrepancy, there was an increased percentage of implants with ≥1 mm RMBL. The restorative design associated with the highest percent of implants with bone loss was three splinted adjacent crowns (70%), two splinted adjacent crowns (61.11%), three single adjacent crowns (40%), and three-unit bridge and two single adjacent implants (21.05%). Three splinted adjacent crowns were significantly associated with ≥1 mm RMBL when compared to three-unit bridge (OR 6.56, 95% CI 1.59-27.07). Similarly, two splinted crowns were significantly associated with ≥1 mm RMBL when compared to two single crowns (OR = 2.50, 95% CI = 1.08-5.79). CONCLUSION: Two or three adjacent implants placed with a vertical platform discrepancy, when splinted together, are associated with higherincidence of ≥1 mm RMBL than non-splinted restorations.

The Pattern of Tooth Loss for Periodontally Favorable Teeth: A Retrospective Study.

To retrospectively analyze local and systemic factors that resulted in the short-term tooth loss of teeth that were previously assigned a favorable prognosis in patients who were seen and treated over an observational five-year period. This retrospective study included the records of patients who had a minimum of two dental exams at least twelve months apart over a 5-year period. This study investigated extracted teeth with an initially favorable periodontal prognosis that were then divided into one of four categories based on the reason for extraction: caries, periodontal disease, endodontic reasons, or fracture. Patient- and tooth-related factors associated with the extracted teeth were recorded: crown-to-root ratio, initial pocket depth, initial periodontal diagnosis, maintenance interval, presence of existing restoration, furcation involvement, and systemic conditions. Data analysis was performed using a linear mixed model. A total of 50 patients with 111 teeth met the inclusion criteria for this study. A higher odds ratio (OR) for tooth loss due to caries, endodontic reasons, and fracture were found in teeth with a history of root canal treatment with an OR of 3.61, 3.86, and 2.52, respectively. For tooth loss due to periodontal disease, higher ORs were found in patients who were on anti-depressants (OR = 4.28) and patients who had an initial diagnosis of Stage III/IV periodontitis (OR = 2.66). In addition, teeth with initial probing depths ≥5 mm (OR = 4.32) and with furcation involvement (OR = 1.93) showed a higher OR for tooth loss due to periodontal disease. Within the limitations of this study, previously root-canal-treated teeth present a higher OR for early loss due to caries, recurrent endodontic lesions, or fracture. In addition, patients with anti-depressant medication use, sporadic maintenance, initial probing depths ≥5 mm, and furcation involvement represent a significantly higher OR of tooth loss due to periodontal disease even for initially favorable teeth.

The relationship between forward head posture, postural control and gait: A systematic review.

BACKGROUND: Forward head posture (FHP) is a common postural deviation. An increasing number of studies have reported that people with FHP present with impaired postural control and gait; however, there is conflicting evidence. A systematic review focusing on these relationships has been unavailable to date. RESEARCH QUESTION: Is there a relationship between FHP, postural control and gait? METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (PROSPERO ID: CRD42021231908). Web of Science, PubMed, Scopus, and CINAHL Plus (via EBSCO) were systematically searched, and a manual search was performed using the reference lists of included studies. Eligible studies included observational studies addressing the relationship between FHP, postural control and/or gait. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. RESULTS: Nineteen studies were selected for this review. Consistent evidence supported that people with FHP had significant alterations in limits of stability (n = 3), performance-based balance (n = 3), and cervical proprioception (n = 4). Controversial evidence existed for a relationship of FHP with static balance (n = 4) and postural stability control (n = 4). Limited evidence existed to support an alteration in gait and vestibular function. Three studies on induced FHP consistently identified no reduced postural control. SIGNIFICANCE: Current evidence supports an association between FHP and a detrimental alteration in limits of stability, performance-based balance, and cervical proprioception. Instead of simply indicating impaired overall balance, the findings of this review indicate that a reduction in specific aspects of the postural control requires to be clarified in clinical evaluation for individuals with FHP, which would facilitate the planning and application of appropriate interventions to prevent dysfunctions and disability.

Translating periodontal data to knowledge in a learning health system.

BACKGROUND: A learning health system (LHS) is a health system in which patients and clinicians work together to choose care on the basis of best evidence and to drive discovery as a natural outgrowth of every clinical encounter to ensure the right care at the right time. An LHS for dentistry is now feasible, as an increased number of oral health care encounters are captured in electronic health records (EHRs). METHODS: The authors used EHRs data to track periodontal health outcomes at 3 large dental institutions. The 2 outcomes of interest were a new periodontitis case (for patients who had not received a diagnosis of periodontitis previously) and tooth loss due to progression of periodontal disease. RESULTS: The authors assessed a total of 494,272 examinations (new periodontitis outcome: n = 168,442; new tooth loss outcome: n = 325,830), representing a total of 194,984 patients. Dynamic dashboards displaying performance on both measures over time allow users to compare demographic and risk factors for patients. The incidence of new periodontitis and tooth loss was 4.3% and 1.2%, respectively. CONCLUSIONS: Periodontal disease, diagnosis, prevention, and treatment are particularly well suited for an LHS model. The results showed the feasibility of automated extraction and interpretation of critical data elements from the EHRs. The 2 outcome measures are being implemented as part of a dental LHS. The authors are using this knowledge to target the main drivers of poorer periodontal outcomes in a specific patient population, and they continue to use clinical health data for the purpose of learning and improvement. PRACTICAL IMPLICATIONS: Dental institutions of any size can conduct contemporaneous self-evaluation and immediately implement targeted strategies to improve oral health outcomes.

A generative adversarial inpainting network to enhance prediction of periodontal clinical attachment level.

OBJECTIVES: Bone level as measured by clinical attachment levels (CAL) are critical findings that determine the diagnosis of periodontal disease. Deep learning algorithms are being used to determine CAL which aid in the diagnosis of periodontal disease. However, the limited field-of-view of bitewing x-rays poses a challenge for convolutional neural networks (CNN) because out-of-view anatomy cannot be directly considered. This study presents an inpainting algorithm using generative adversarial networks (GANs) coupled with partial convolutions to predict out-of-view anatomy to enhance CAL prediction accuracy. METHODS: Retrospective purposive sampling of cases with healthy periodontium and diseased periodontium with bitewing and periapical radiographs and clinician recorded CAL were utilized. Data utilized was from July 1, 2016 through January 30, 2020. 80,326 images were used for training, 12,901 images were used for validation and 10,687 images were used to compare non-inpainted methods to inpainted methods for CAL predictions. Statistical analyses were mean bias error (MBE), mean absolute error (MAE) and Dunn's pairwise test comparing CAL at p=0.05. RESULTS: Comparator p-values demonstrated statistically significant improvement in CAL prediction accuracy between corresponding inpainted and non-inpainted methods with MAE of 1.04mm and 1.50mm respectively. The Dunn's pairwise test indicated statistically significant improvement in CAL prediction accuracy between inpainted methods compared to their non-inpainted counterparts, with the best performing methods achieving a Dunn's pairwise value of -63.89. CONCLUSIONS: This study demonstrates the superiority of using a generative adversarial inpainting network with partial convolutions to predict CAL from bitewing and periapical images. CLINICAL SIGNIFICANCE: Artificial intelligence was developed and utilized to predict clinical attachment level compared to clinical measurements. A generative adversarial inpainting network with partial convolutions was developed, tested and validated to predict clinical attachment level. The inpainting approach was found to be superior to non-inpainted methods and within the 1mm clinician-determined measurement standard.

Comparison of the efficacy of periodontal prognostic systems in predicting tooth loss.

AIM: The aim of this analysis was to assess how different tooth-prognosis systems could predict tooth loss in a cohort of periodontitis patients followed up prospectively during supportive periodontal care (SPC). MATERIALS AND METHODS: Clinical and radiographic data of 97 patients undergoing regular SPC for 5 years were used to assign tooth prognosis using four different systems (McGuire & Nunn, 1996; Kwok & Caton, 2007; Graetz et al., 2011; Nibali et al., 2017). Three independent examiners assigned tooth prognosis using all four systems, following a calibration exercise. The association between prognostic categories and tooth loss was tested for each prognostic system separately and across prognostic systems. RESULTS: All four systems showed good reproducibility and could identify teeth at higher risk of being lost during 5 years of SPC; the risk of tooth loss increased with the worsening of tooth-prognosis category (p < .0001). Although specificity and negative predictive values were good, low sensitivity and positive predictive values were detected for all systems. CONCLUSIONS: Previously published periodontal prognostic systems exhibited good reproducibility and predictive ability for tooth retention. However, low sensitivity was detected, with several teeth in the worst prognosis category being retained at 5 years. Some modifications in the number of categories and their definitions are suggested.

Association between BMI and periodontitis in women living with or at risk for HIV.

AIMS: Currently, there is no data available assessing the association between body mass index (BMI) and periodontitis among women living with HIV (WLWH). This study aims to investigate this association among WLWH and women at risk for HIV (WRH) in the United States. METHODS AND RESULTS: Data from 351 WLWH and 52 WRH participants from the Women's Interagency HIV Study having pocket depths and clinical periodontal attachment loss assessments in 2003-2004 were included. Multinomial logistic regression analyses in the full sample assessed the relationship between BMI (underweight/normal, overweight, or obese) and periodontitis by severity (mild, moderate, severe), adjusting for study sites, age, education, annual household income, smoking, alcohol consumption, and diabetes. Overall, 75.2% women (76.0% WLWH; 69.0% WRH) had periodontitis. Moreover, 75.0% obese and 75.3% overweight women were affected by periodontitis. In the full sample, adjusted odds ratio (aOR) of having mild, moderate, and severe periodontitis in obese women were: 1.14 (95% confidence interval [CI]: 0.51-2.52), 1.02 (95% CI: 0.46-2.29), and 0.24 (95% CI: 0.06-1.07), respectively, and in overweight women: 0.70 (95% CI: 0.31-1.58), 0.85 (95% CI: 0.38-1.90), and 0.31 (95% CI: 0.08-1.15), respectively. CONCLUSIONS: Even with high prevalence of periodontitis among women with or without HIV infection in this cohort, this study does not provide evidence of an association between BMI and periodontitis.

Risk of early implant failure in grafted and non-grafted sites: A systematic review and meta-analysis.

PURPOSE: To assess whether bone grafting is associated with early implant failure (defined as a lack of osseointegration detected prior to functional loading) and to evaluate the association between bone grafting procedures and other risk factors for early implant failure. MATERIALS AND METHODS: Two independent reviewers conducted an electronic search of MEDLINE (via PubMed). Meta-analysis was performed for the odds ratio of bone grafting procedures associated with early implant failure. The Newcastle-Ottawa Scale for cohort studies was used to assess the risk of bias. RESULTS: Of the 231 articles selected for full-text review, 10 were included in the qualitative analysis and for quantitative meta-analysis. An odds ratio of 1.50 (95% confidence interval 1.06-2.13) was recorded for bone grafting procedures associated with early implant failure. Data regarding the association of bone grafting and other risk factors in determining early implant failure were insufficient for quantitative analysis. CONCLUSIONS: Within the limitations of this study, a significant positive association was found between bone grafting procedures and early implant failure. The possible negative effect of bone grafting procedures on implant osseointegration should be considered when planning implant therapy.