Radiographical diagnostic competences of dental students using various feedback methods and integrating an artificial intelligence application-A randomized clinical trial.

INTRODUCTION: Radiographic diagnostic competences are a primary focus of dental education. This study assessed two feedback methods to enhance learning outcomes and explored the feasibility of artificial intelligence (AI) to support education. MATERIALS AND METHODS: Fourth-year dental students had access to 16 virtual radiological example cases for 8 weeks. They were randomly assigned to either elaborated feedback (eF) or knowledge of results feedback (KOR) based on expert consensus. Students´ diagnostic competences were tested on bitewing/periapical radiographs for detection of caries, apical periodontitis, accuracy for all radiological findings and image quality. We additionally assessed the accuracy of an AI system (dentalXrai Pro 3.0), where applicable. Data were analysed descriptively and using ROC analysis (accuracy, sensitivity, specificity, AUC). Groups were compared with Welch's t-test. RESULTS: Among 55 students, the eF group by large performed significantly better than the KOR group in detecting enamel caries (accuracy 0.840 ± 0.041, p = .196; sensitivity 0.638 ± 0.204, p = .037; specificity 0.859 ± 0.050, p = .410; ROC AUC 0.748 ± 0.094, p = .020), apical periodontitis (accuracy 0.813 ± 0.095, p = .011; sensitivity 0.476 ± 0.230, p = .003; specificity 0.914 ± 0.108, p = .292; ROC AUC 0.695 ± 0.123, p = .001) and in assessing the image quality of periapical images (p = .031). No significant differences were observed for the other outcomes. The AI showed almost perfect diagnostic performance (enamel caries: accuracy 0.964, sensitivity 0.857, specificity 0.074; dentin caries: accuracy 0.988, sensitivity 0.941, specificity 1.0; overall: accuracy 0.976, sensitivity 0.958, specificity 0.983). CONCLUSION: Elaborated feedback can improve student's radiographic diagnostic competences, particularly in detecting enamel caries and apical periodontitis. Using an AI may constitute an alternative to expert labelling of radiographs.

Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects.

AIM: Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY: Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS: In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.

Outcome after Partial Pulpotomy: Long-term Results of the Prospective Clinical MMP-9 Study.

PURPOSE: While the objective of partial pulpotomy is to preserve the vitality and function of the pulp tissue, the preopera-tive pulp status is the main prognostic factor for its success. To date, however, there is little data on long-term success rates. Therefore, the aim of this prospective pilot study was to assess the long-term outcome of partial pulpotomy in per-manent teeth after carious pulp exposure without signs or symptoms of irreversible pulpitis, verified clinically, radio-graphically, and via MMP-9 levels. MATERIALS AND METHODS: Patients in whom permanent teeth with extremely deep carious lesions were diagnosed as com-pletely asymptomatic (n = 8) or with signs of reversible pulpitis (n = 10) underwent non-selective caries removal followed by a blood test to assess the level of MMP-9. The teeth were thereafter partially pulpotomised, MTA-capped, and immedi-ately restored with composite resin. Follow-up examinations were performed by endodontically experienced examiners focusing on clinical and radiographic assessment. RESULTS: One patient could not be contacted and was lost to follow-up. Overall, the follow-up period ranged from 2-8 years (mean = 4.4 years). The majority of teeth remained functional and without pathology; one tooth was classified as having failed because of a vertical root fracture. There was no statistically significant difference in the groups' success rate (p = 0.3). The estimated overall survival rate was 94.1% (95% CI: 0.84-1.00) after 4 years according to the Kaplan-Meier method. CONCLUSION: Pulp vitality in permanent teeth can be preserved with high success rates by means of partial pulpotomy after carious pulp exposure in asymptomatic teeth or in teeth with reversible pulpitis.

A Prospective Clinical Pilot Study on the Level of Matrix Metalloproteinase-9 in Dental Pulpal Blood as a Marker for the State of Inflammation in the Pulp Tissue.

INTRODUCTION: Differentiation between reversible pulpitis (savable pulp) and irreversible inflammation of the pulp tissue (nonsavable pulp) based only on clinical and radiographic diagnoses has proven to be difficult. Pulp exposure allows for the collection of pulpal blood to quantitatively determine the level of inflammation markers or proteolytic enzymes, even with small samples. Pulpitis is associated with the invasion of neutrophil granulocytes and their release of matrix metalloproteinase-9 (MMP-9). METHODS: Forty-four patients (aged 18-74 years, mean = 35 years), each with 1 tooth with carious pulp exposure presenting with different stages of pulpitis, were included in this prospective, 2-center clinical study; 26 patients presented with irreversible pulpitis (groups 3 and 4), 10 with reversible pulpitis (group 2), and 8 with completely asymptomatic teeth with deep carious lesions (group 1). Six of the 26 patients with teeth diagnosed with irreversible pulpitis had not taken any nonsteroidal anti-inflammatory drugs and were evaluated as a separate group (group 4). Partial pulpotomy and blood sample collection from the pulp chamber were performed. The total levels of MMP-9 and tissue inhibitor of metalloproteinase-1 were assessed by fluorometric and colorimetric enzyme-linked immunosorbent assays, respectively. The Mann-Whitney U test and Spearman rank correlations were used to compare the MMP-9 levels with different stages of pulpal inflammation; significance was set at .05. RESULTS: The MMP-9 levels in the asymptomatic teeth (group 1) were significantly different from those in the teeth with reversible pulpitis (group 2, P = .006) or irreversible pulpitis (group 4, P < .001). A statistically significant difference was also observed between the MMP-9 levels in group 1 and group 3 (P < .001) in which the patients had taken nonsteroidal anti-inflammatory drugs. CONCLUSIONS: These findings indicate that the MMP-9 levels in pulpal blood samples could be a useful ancillary diagnostic tool for distinguishing different stages of pulp tissue inflammation.