Manifestaciones orales del COVID-19 en Paraguay: resultados de una encuesta en línea

Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

Could Teledentistry Be a Solution in the Diagnosis of Oral Lesions?

In recent years, teledentistry has gained visibility, especially because of the COVID-19 pandemic. Concerning oral medicine, there is great expectation, particularly about its potential to promote early diagnosis of oral lesions. In southern Brazil, two initiatives have shown a positive influence on each other and have led to greater awareness of oral cancer and more access to qualified advice on diagnosing and managing oral lesions. Although the contributions of this approach are promising, there are barriers to be overcome.

Dental Artificial Intelligence Systems: A Review of Various Data Types.

With the rapid development of dental artificial intelligence systems (DAIS), a new field known as "Data Dentistry", proposed by Schwendicke in 2021, has successfully bridged the gap between medicine and engineering. This literature review introduces advanced techniques in data collection, outlines the current state of DAIS in data processing, and anticipates the future of DAIS by emphasizing the importance of more extensive and enhanced datasets. The key findings include: Versatility of imaging data: Various types of imaging data, such as X-ray, cone beam computed tomography (CBCT), facial photos, and face and oral scans, can be transformed into datasets used by artificial intelligence systems. Uniform rules in electronic dental record (EDR) systems: EDR systems require standardized rules for general use in DAIS, ensuring compatibility and seamless integration. Potential of wearable device data: Data from wearable devices, including bioelectric signals (such as electromyography), stress sensors, AR glasses, etc., show great potential for enhancing DAIS capabilities. Current DAIS performance focus: Presently, DAIS demonstrate superior performance in object location and disease diagnosis compared to information integration and clinical decision-making. Need for data quality and quantity improvement: Further improvements are needed in both the quality and quantity of data for DAIS.

Quantifying error introduced by iterative closest point image registration.

OBJECTIVES: The aim of this paper was to quantify the analysis error introduced by iterative closest point (ICP) image registration. We also investigated whether a subsequent subtraction process can reduce process error. METHODS: We tested metrology and two 3D inspection software using calibration standards at 0.39 µm, and 2.64 µm and mathematically perfect defects (softgauges) at 2 and 20 µm, on free form surfaces of increasing complexity and area, both with and without registration. Errors were calculated in percentage relative to the size of the defect being measured. Data were analysed in GraphPad Prism 9, normal and two-way ANOVA with post-hoc Tukey's was applied. Significance was inferred at p < 0.05. RESULTS: Using ICP registration introduced errors from 0 % to 15.63 % of the defect size depending on the surface complexity and size of the defect. Significant differences were observed in analysis measurements between metrology and 3D inspection software and within different 3D inspection software, however, one did not show clear superiority over another. Even in the absence of registration, defects at 0.39 µm, and 2.64 µm produced substantial measurement error (13.39-77.50 % of defect size) when using 3D inspection software. Adding an additional data subtraction process reduced registration error to negligible levels (<1 % independent of surface complexity or area). CONCLUSIONS: Commercial 3D inspection software introduces error during direct measurements below 3 µm. When using an ICP registration, errors over 15 % of the defect size can be introduced regardless of the accuracy of adjacent registration surfaces. Analysis output between software are not consistently repeatable or comparable and do not utilise ISO standards. Subtracting the datasets and analysing the residual difference reduced error to negligible levels. CLINICAL SIGNIFICANCE: This paper quantifies the significant errors and inconsistencies introduced during the registration process even when 3D datasets are true and precise. This may impact on research diagnostics and clinical performance. An additional data processing step of scan subtraction can reduce this error but increases computational complexity.

The Patterns of Impacted Third Molars and Their Associated Pathologies: A Retrospective Observational Study of 704 Patients.

Background: The study aims to investigate parameters in patients attending Fujairah Dental Center, including assessing the prevalence of impacted teeth, determining the frequency of associated pathological conditions, and evaluating the patterns and angulations of impacted third molars. Methods: It is a retrospective descriptive study of the panoramic radiographs of patients who attended Fujairah Dental Center for dental care between January 2011 and December 2017. The minimum age for inclusion was 17 years. Clinical records were used to obtain the demographic details of patients, such as age, gender, nationality, medical history, and smoking history. Seven hundred and four panoramic radiographs and clinical records of patients were analyzed. The age range was between 17 and 112 years old, with a mean age of 34 years (S.D 13.5). Results: Of the 704 panoramic radiographs evaluated, 236 (33.6%) X-rays showed teeth impaction with a total of 562 impacted teeth in the upper and lower jaws. Five hundred and twenty-five (93.4%) were impacted third molars, and 37 (6.5%) teeth were other kinds of impacted teeth. Females showed a higher frequency of impacted teeth (62.6%) compared to males (37.4%). The highest prevalence of impacted teeth was found in the 17-25 year age group (61%), and the prevalence declined with advancing age. Impacted third molars were more likely to occur in the mandible (57.3%) than in the maxilla (42.7%). Most of the impacted third molars were in the mesioangular position, followed by the vertical position. The evaluation of the depth of impacted third molars demonstrated that level C impaction was the most frequently seen, followed by level B impaction. Impacted third-molar teeth often presented with two roots (60.7%), followed by a single root (31.3%). An evaluation of the relationship between lower third molars and the inferior dental canal (IDC) revealed that the most frequently observed relation was interrupted (61.5%), followed by a distant relation to the ID canal, and 13% were superimposed. The most common morphological pattern of roots of the impacted third molars was either straight-type or curved and dilacerated roots (5.7%). Additionally, the most noticed pathological conditions associated with impacted teeth were carious second molars adjacent to impacted third molars (42%), which was more likely to be seen in the 17-25-year age group, with females having a higher prevalence than males.

Quantitive Assessment of Gustatory Function and Its Association with Demographics, and Systemic Morbidity.

This study aimed to analyze the associations of gustatory dysfunction as measured by validated taste strips with demographics and co-morbidities. This cross-sectional study retrospectively analyzed records of patients who attended the Orofacial Chemosensory Center of Hadassah Medical Center between 2017 and 2020. Taste strips were used as a validated method to determine taste dysfunction. A total of 272 subjects were included, 137 (50.4%) women and 135 (49.6%) men, with a mean age of 53.5 ± 19.3 years and age range of 18-98 years. The total taste score among the study population was 8.53 ± 4.03 (scale range 0-16). Age had a significant negative correlation with the total taste score (p = 0.001), and men exhibited worse total (p < 0.001), salty (p = 0.003), and bitter (p < 0.001) scores. Major trauma was associated with worse total (p < 0.001) and specialized taste assessments (sweet (p = 0.001), sour (p = 0.002), salty (p = 0.016), and bitter (p < 0.001)). Chemotherapy was associated with reduced total (p < 0.001), salty (p = 0.003), and bitter (p = 0.001) taste scores. Zinc deficiency exhibited worse salty (p = 0.027) and total (p = 0.038) taste scores. Patients with burning mouth syndrome (BMS) showed higher salty scores (p = 0.017). Patients who experienced exposure to toxic chemicals exhibited worse salty scores (p = 0.024). We conclude that gustatory dysfunction is associated with older age, male sex, and co-morbidities of major trauma, current chemotherapy, zinc deficiency, BMS, and exposure to toxins. The study highlights the importance of systemic evaluation and quantitive gustatory dysfunction assessment as part of the diagnostic process of patients with subjective complaints of taste disorders.

Extensive carcinoma cuniculatum of the maxilla: A rare variant of oral carcinoma

Carcinoma cuniculatum (CC), is a rare well-differentiated, low-grade variant of squamous cell carcinoma. However, diagnosis of oral CC has remained very difficult, because many pathologists and clinicians remain un acquainted with oral CC, because there are very few reported cases of this disease in the oral cavity. To our knowledge, no more than 60 head and neck cases have been reported since Flieger and Owinski first described a case involving the mandible in 1977, because there are very few published cases of this disease in the oral cavity, the aim of this report is to provide a detailed clinical and histopathologic description of carcinoma cuniculatum of the maxila, provide a brief review of the literature, and highlight the difficulties in arriving at the correct diagnosis.

The development of an online serious game for oral diagnosis and treatment planning: evaluation of knowledge acquisition and retention.

BACKGROUND: While serious games seem to be supportive in healthcare education, none of them had been designed to develop competence in diagnosis and treatment planning of oral lesions. Therefore, this research aimed to develop an online simulation-based serious game for training diagnosis and treatment planning of oral lesions (SimOL) and to evaluate its educational impact in terms of knowledge improvement and retention. METHODS: As a mandatory task in an oral lesion course, all 28 students were required to participate in SimOL activities. Participants were instructed to complete a pre-knowledge assessment following a one-week washout period prior to the game activity. Subsequent to the game completion, they were tasked to complete a post-knowledge assessment I (Full score = 15) and satisfaction questionnaire. A post-knowledge assessment II was administered a week later to evaluate knowledge retention. RESULTS: The findings demonstrated a significant increase in the assessment scores after interacting with the game (P < 0.001), where the pre- and immediate post-knowledge assessment scores were 8.00 (SD = 2.11) and 11.71 (SD = 2.39), respectively. The game also exhibited a positive impact on knowledge retention, as there was no significant difference between the scores of post-knowledge assessment I and II (P > 0.05). Additionally, students perceived the game as positively in all aspects, although the entertainment aspect achieved a slightly lower score of 3.70 (SD = 0.21), in comparison to the usefulness and ease of use with a score of 4.02 (SD = 0.11) and 4.02 (SD = 0.16), respectively. CONCLUSION: SimOL demonstrated its potential as an effective learning tool for improving and retaining knowledge for diagnosis and treatment planning of oral lesions. The game was perceived positively by dental students in all aspects, however further improvements should prioritize the enhancement of entertaining components.

Sex as a Biological Variable in Oral Diseases: Evidence and Future Prospects.

The interest of the scientific community on sex and gender differences in health and disease has increased substantially over the past 25 to 30 y as a result of a long process of events and policies in the biomedical field. This is crucial as compelling evidence from human and animal model studies has demonstrated that sex and gender influence health, molecular and cellular processes, and response and predisposition to disease. The present scoping review aims to provide a synthesis of sex differences in oral diseases, ranging from periodontal disease to orofacial pain conditions, from risk of caries development to apical periodontitis. Overall, findings from this review further support a role for sexual dimorphism influencing disease predisposition and/or progression in oral diseases. Of note, this review also highlights the lack of consideration of additional factors such as gender and other psychosocial and external factors potentially influencing oral health and disease. New conceptual frameworks capable of capturing multiple fundamental domains and measurements should be developed in clinical and preclinical studies to inform sex-based individualized preventive and treatment strategies.

A Patient with Cerebral Palsy Presents for Evaluation of Third Molar Pain.

Cerebral palsy (CP) is a developmental disorder caused by brain trauma in utero or within the first few days of life, although symptoms may not develop until early infancy. Each of the 4 types of CP has its own signs and symptoms and can present unique challenges to accessing and providing dental care. Providers may be reluctant to treat these individuals due to uncontrolled body movements, primitive reflexes, varying mental capabilities, seizures, visual and hearing impairments, dysphagia, and dysarthria.

Importancia del diagnóstico precoz en el carcinoma mucoepidermoide. Relato de caso clínico / Importance of early diagnosis in mucoepidermoid carcinoma. Case report

El carcinoma mucoepidermoide es el tumor maligno más frecuente de las glándulas salivales menores localizándose por lo general en el paladar. El objetivo del presente reporte de caso es evidenciar en la literatura científica la importancia del diagnóstico precoz de carcinomas orales, así como, el rol fundamental que cumple el odontólogo general para identificar, guiar y derivar al paciente a un especialista. Se presenta el caso clínico de un paciente de sexo masculino que acudió a la Facultad de Odontología de la Universidad Nacional de Asunción, quien fue derivado por su odontóloga tras percibir un pequeño pero perceptible cambio en la coloración normal de la mucosa y molestias ocasionales en la zona del paladar duro. Al examen intraoral se observó en el paladar duro, a la altura de los premolares en la hemiarcada izquierda, una lesión nodular ovoidea, color violáceo, de 1cm de diámetro, depresible a la palpación. Se realizó una biopsia incisional para su estudio histopatológico, reportando un carcinoma mucoepidermoide. El diagnóstico precoz de este tipo de patologías es un desafío para el odontólogo general, quien debe orientar al paciente, ante cualquier cambio de la estructura normal de la cavidad bucal, para que acuda a un especialista.

Mucoepidermoid carcinoma is the most frequent malignant tumor of the minor salivary glands, usually located in the palate. The objective of this case report is to demonstrate in the Paraguayan scientific literature the importance of early diagnosis of oral carcinomas as well as the fundamental role of the general dentist in identifying, guiding and referring the patient to the corresponding specialist. The clinical case presented is about a male patient who attended the Faculty of Dentistry of the National University of Asuncion. His dentist referred him after noticing a small but perceptible change in the normal coloration of the mucosa and occasional discomfort in the area of the hard palate. In the intraoral examination, an ovoid nodular lesion, purplish in color, 1cm in diameter, depressible on palpation, observed on the hard palate at the level of the premolars in the left hemiarch. An incisional biopsy performed for histopathological study, reporting a mucoepidermoid carcinoma. Regarding the early diagnosis of this type of pathology, the challenge for the general dentist will continues to be his continuous training in order to be able to successfully guide the patient in seeking care from the right specialist in case of any change in the oral cavity.

Líquen Plano Oral e seu Potencial de Malignização / Lichen Planus and its potencial for malignancy

Objetivos: Instruir e orientar ao cirurgião dentista e demais profissionais de saúde a importância da detecção e rastreio precoce de lesões pré-malignas. Revisão de Literatura: O Líquen Plano Oral é uma condição dermatológica crônica, de origem auto-imune, relativamente comum na população, que atinge o epitélio de mucosa e pele, sendo considerada, pela Organização Mundial de Saúde (OMS), uma desordem potencialmente maligna quando associado a áreas de ulceração. A revisão de literatura foi realizada nas bases de dados PubMed e Lilacs. Buscamos investigar o potencial de malignização do Líquen Plano Oral associado a condições erosivas, analisando o processo de carcinogênese no processo inflamatório. Conclusão: Conclui-se que o objeto de estudo ainda é um assunto pouco explorado pela literatura, porém há indícios etiopatológicos que enfatizam o processo de malignização oriundo de uma lesão pré-maligna como o Líquen Plano Oral. Além disso, enfatizamos a importância do diagnóstico precoce das lesões estomatognáticas, para que assim possamos aumentar as chances de cura do paciente.(AU)

Objectives: To instruct and guide dentists and other health professionals on the importance of early detection and screening of pre-malignant lesions. Literature Review: Oral Lichen Planus is a chronic dermatological condition, of autoimmune origin, relatively common in the population, which affects the epithelium of the mucosa and skin, being considered, by the World Health Organization (WHO), a potentially fatal disorder. malignant when associated with areas of ulceration. A literature review was performed on the PubMed and Lilacs databases. We sought to investigate the potential for malignancy of Oral Lichen Planus associated with erosive conditions, analyzing the process of carcinogenesis in the inflammatory process. Conclusion: It is concluded that the object of study is still a subject little explored in the literature, but there are etiopathological accusations that emphasize the process of malignancy arising from a pre-malignant lesion such as Oral Lichen Planus. In addition, we emphasize the importance of early diagnosis of stomatognathic lesions, so that we can increase the patient's chances of cure.(AU)

Deep Learning for Diagnostic Charting on Pediatric Panoramic Radiographs.

Artificial intelligence (AI) based systems are used in dentistry to make the diagnostic process more accurate and efficient. The objective of this study was to evaluate the performance of a deep learning program for detection and classification of dental structures and treatments on panoramic radiographs of pediatric patients. In total, 4821 anonymized panoramic radiographs of children aged between 5 and 13 years old were analyzed by YOLO V4, a CNN (Convolutional Neural Networks) based object detection model. The ability to make a correct diagnosis was tested samples from pediatric patients examined within the scope of the study. All statistical analyses were performed using SPSS 26.0 (IBM, Chicago, IL, USA). The YOLOV4 model diagnosed the immature teeth, permanent tooth germs and brackets successfully with the high F1 scores like 0.95, 0.90 and 0.76 respectively. Although this model achieved promising results, there were certain limitations for some dental structures and treatments including the filling, root canal treatment, supernumerary tooth. Our architecture achieved reliable results with some specific limitations for detecting dental structures and treatments. Detection of certain dental structures and previous dental treatments on pediatric panoramic x-rays by using a deep learning-based approach may provide early diagnosis of some dental anomalies and help dental practitioners to find more accurate treatment options by saving time and effort.

Metabolic surgery and oral health: A register-based study.

OBJECTIVE: The impact of weight loss surgery on oral health is not clear. The aim of the present study was to investigate its impact on the risk for dental interventions. MATERIALS AND METHODS: All adults who underwent metabolic surgery in Sweden between January 1, 2009 and December 31, 2018 were identified in the Scandinavian Obesity Surgery Registry (SOReg; n = 53,643). A control cohort from the general population was created, matched 10:1 on sex, age and place of residence (n = 536,430). All individuals were followed in the Swedish Dental Register regarding event rates for four types of dental intervention: restorative, endodontic and periodontal interventions, and tooth extractions. RESULTS: The surgical cohort had increased interventional rates postoperatively regarding all studied outcomes except periodontal interventions. Dental interventions were more common in the surgical cohort both pre- and postoperatively. The difference between the groups increased markedly in the postoperative period. The between-group comparison postoperatively showed increased event rates for restorations (IRR 1.8; 95% CI 1.7-1.8), extractions (1.9; 95% CI 1.9-2.0) and endodontics (2.1; 95% CI 2.0-2.1). CONCLUSION: The surgical intervention might cause a substantial negative impact on oral health. These results imply an important role for counselling metabolic surgery patients regarding preventive oral health measures.

Why Are Family Doctors Still Not Addressing Oral Health?

Oral health dramatically affects overall health and vice versa. Oral health is a key health indicator for Healthy People 2030. Yet family physicians are not addressing this important health issue at the same level they address other essential health problems. Studies show that family medicine training and clinical activities are lacking in the area of oral health. The reasons are multi-factorial including insufficient reimbursement, lack of accreditation emphasis, and poor medical-dental communication. There is hope. Robust oral health curricula for family doctors exist and efforts are being made to create primary care oral health education champions. The tide is turning on accountable care organizations adding oral health services, access, and outcomes to their systems. Like behavioral health, oral health can be fully integrated into the care family physicians offer.

EstomatoNet: A 5-year experience of an oral medicine telediagnosis service.

OBJECTIVE: EstomatoNet is an online service driven by primary health care professionals to support diagnosis and decision-making for oral lesions. This study aimed to describe the experience of the service, depicting use cases and its impact on the referral to specialised services. MATERIALS AND METHODS: Patient/applicant demographics and information related to their oral lesions and/or complaints were retrieved from the service's cloud-based platform. The differential diagnosis provided by the applicants, their level of satisfaction and the teleconsultant's opinion in terms of diagnosis and management were also reported. The teleconsultant's suggestion was cross-referenced with the data from the regulation system to verify the avoidance of referral. RESULTS: Out of 2,002 teleconsultations, most patients were women (55.1%) and 50.1% were aged between 20 and 59 years. Applicants (96.5%) generally considered the service very satisfying/satisfying. Potentially malignant disorders were reported in 19.6% of cases and 7.7% were suspected to be malignant. The referral of 37.3% of patients was avoided after the suggestion of keeping the patient in the primary health care system (k = 0.234; p < 0.001; 62.2% agreement). CONCLUSION: The use of EstomatoNet for oral mucosal lesions improves support for primary health care professionals in the management of lesions and reduces referral to specialised services.

The oral manifestations of Huntington's disease: A systematic review of prevalence.

OBJECTIVES: The objective of this systematic literature review was to provide a complete panorama of the oral manifestations of Huntington's disease (HD). MATERIALS AND METHODS: Databases were searched, and original research studies or case report manuscripts up to May 2021 were included using keywords that describe HD combined with words related to oral health; MeSH terms were used exclusively. No time or language restrictions were applied. RESULTS: Twenty-two investigations (12 original articles and 10 case reports) regarding oral manifestations of HD were included. The subjects examined in the selected research articles were dental health, coordination of oral structures, speech, dysphagia, and swallowing alterations. The case reports described dental treatment procedures, oromandibular dyskinesia, dysphagia, and speech alterations. CONCLUSIONS: The oral manifestations of HD were found to be associated with the advance of the disease in that the more severe the HD, the worse the alterations affecting the oral cavity. Dysphagia, dysarthria, masticatory problems, oral health impairment, and choreiform movements involving the tongue and other orofacial muscles were the main manifestations of HD in the oral cavity. The PROSPERO systematic review registration number of this study is CRD42021238934.

Association between perceived self-confidence and abilities to distinguish oral mucosal lesions amongst dental students.

INTRODUCTION: Dentists usually refer to difficulties in performing the diagnosis of oral mucosal lesions. This may be attributed to limited access to theoretical lectures and practical training on this subject along the graduation course. The primary aim of this cross-sectional study was to verify if there is an association between the perception of time dedicated to lectures/training and oral diagnosis abilities in oral medicine. The secondary aim was to evaluate the association between self--confidence to perform oral mucosal lesions diagnosis and performance in a diagnostic abilities test. MATERIALS AND METHODS: The sample comprised 36 final-year dental students of a South-Brazilian dental school. The participants answered a questionnaire on their perception of time dedicated to lectures on oral medicine along the course (sufficient or insufficient) and their self-confidence to diagnose oral mucosal lesions or oral cancer (yes or not). The students were also submitted to a diagnostic abilities test based on 30 clinical photos of oral lesions, which should be classified as benign, potentially malignant or malignant. Moreover, the participants had to inform their clinical impression for each case. Finally, the participants informed their decision making for the case (refer the patient to a specialist or not). RESULTS: Students with higher self-confidence showed a higher percentage of correct answers on classification of the nature of lesions (81.1% vs. 68.5%, p = .03, teste t de Student) and on their clinical impression (66.3% vs. 41.7%, p < .01, Student's t-test). The perception of time dedicated to theoretical lectures on oral medicine as sufficient did not influence the students' diagnostic abilities (p > .05, Student's t-test) CONCLUSION: It may be concluded that self-confidence to diagnose oral lesions is associated with dental students' diagnostic abilities.

Evaluating a Periapical Lesion Detection CNN on a Clinically Representative CBCT Dataset-A Validation Study.

The aim of this validation study was to comprehensively evaluate the performance and generalization capability of a deep learning-based periapical lesion detection algorithm on a clinically representative cone-beam computed tomography (CBCT) dataset and test for non-inferiority. The evaluation involved 195 CBCT images of adult upper and lower jaws, where sensitivity and specificity metrics were calculated for all teeth, stratified by jaw, and stratified by tooth type. Furthermore, each lesion was assigned a periapical index score based on its size to enable a score-based evaluation. Non-inferiority tests were conducted with proportions of 90% for sensitivity and 82% for specificity. The algorithm achieved an overall sensitivity of 86.7% and a specificity of 84.3%. The non-inferiority test indicated the rejection of the null hypothesis for specificity but not for sensitivity. However, when excluding lesions with a periapical index score of one (i.e., very small lesions), the sensitivity improved to 90.4%. Despite the challenges posed by the dataset, the algorithm demonstrated promising results. Nevertheless, further improvements are needed to enhance the algorithm's robustness, particularly in detecting very small lesions and the handling of artifacts and outliers commonly encountered in real-world clinical scenarios.