Tele-dentistry in COVID-19 era: A conduit for dental care in uncertain times.

Tele-dentistry encompasses all sorts of digital technologies that involve the exchange of patient's clinical data from a distant site for the provision of dental health care. Tele-dentistry has emerged from the concept of telemedicine, which has been in practice since the 19th century. In recent times, an upsurge in the digital technologies was noted, which has made the possibility of remote access to dental care. The outbreak of COVID- 19 pandemic has restricted the normal routine ways of clinical practice. In these challenging times, tele-dentistry serves as effective platform for providing dental health care. Tele-dentistry has vast applications across various disciplines of dentistry, including preventive dentistry, paediatric dentistry, oral medicine, and oral pathology etc. In these pandemic times, tele-dentistry can be efficiently used for identification of dental emergencies, allowing effective triage and subsequent management. There are different communication platforms available for tele-dentistry. The most common technologies used are web-based video conferencing and smart phone-based applications. As the clinicians are not aware of these digital technologies utilised in tele-dentistry, there are certain challenges associated with its use. In conclusion, tele-dentistry serves as an effective tool in providing health care in challenging times, but it has been underutilised by the dental fraternity. The legislative authorities should establish proper standard protocols to ensure the safety and confidentiality of patient information while using these digital platforms.

Does the sagittal root position of maxillary anterior teeth affect the decision making on immediate implants in the anterior maxilla? A CBCT-based study.

BACKGROUND: Immediate implant placement in the maxillary esthetic zone is a challenging and demanding task. To achieve favorable results, proper case selection and treatment planning are necessary. Variables like the sagittal root position (SRP) and the labial bone thickness (LBT) of maxillary anterior teeth are of paramount importance for predictable outcomes. OBJECTIVES: The aim of the present study was to evaluate the SRP and LBT of maxillary anterior teeth in the context of immediate implant placement by using cone-beam computed tomography (CBCT) in a sample of the Pakistani population. MATERIAL AND METHODS: A cross-sectional study was conducted using the CBCT scans of patients. The SRP of each tooth (maxillary canine to canine) was evaluated in the sagittal section of a CBCT scan according to the classification by Kan et al. The LBT of each tooth was measured perpendicularly to the long axis of tooth at 3 sites: at the alveolar crest (P1); 2 mm from the alveolar crest (P2); and 4 mm from the alveolar crest (P3). Descriptive statistics were reported for SRP and LBT. The χ2 test was employed to assess any association between the variables. RESULTS: Class I SRP was the most prevalent (n = 196, 81.7%), while Class III was the least frequent (n = 1, 0.4%). The association between the tooth type and SRP was statistically non-significant (p = 0.510). CONCLUSIONS: In the evaluated sample of the Pakistani population, the most frequent type of the SRP of maxillary anterior teeth was Class I, which is most favorable for immediate implant placement. Furthermore, the labial bone in the maxillary esthetic zone was found to be mostly thin - LBT was within the range of 0.5-0.9 mm - which makes immediate implant placement in the anterior maxilla a challenge. The results of the present study could serve as a guide for clinicians in terms of appropriate patient selection for immediate implant placement in the maxillary esthetic zone.

Oral mycotic infection caused by a rare Verticillium species - a case report.

BACKGROUND: Deep-seated fungal infections of the oral cavity present a diagnostic challenge as the clinical presentation is usually aggressive leading to misdiagnosis of malignancy. Nevertheless, the species of fungi responsible for such diseases in immunocompromised individuals are varied thus, further complicating the diagnosis. CASE PRESENTATION: Presented below is a case regarding the diagnosis and management of deep mycotic infection of the oral cavity caused by a fungus that very rarely causes disease in humans, the Verticillium species. CONCLUSIONS: The case highlights the fact that rare pathogens should also be considered in the differential diagnosis, especially in patients with debilitating conditions like uncontrolled diabetes. Likewise, histopathological evaluation and microbiological investigations are of paramount importance and remain the gold standard to reach a definitive diagnosis.

Mesenchymal stem cells and its translation into clinical orthodontics: current trends and future perspectives.

Oral mesenchymal stem cell populations in humans have been discovered in close vicinity to oral mucosal tissues and both primary (deciduous) and secondary (permanent) teeth. All these different kinds of stem cells have the ability to divide and replenish themselves, however they vary in their gene expression profiles and their capacity to give rise to distinct cell lineages. They all have multipotentiality i.e. chondrogenic, osteogenic, adipogenic, and neurogenic. Due to their relative accessibility, these cell types may form a source of stem cells with substantial potential for application in tissue regeneration. In this review, discoveries outlining stem cell potential are discussed on various aspects as, are their various applications in orthodontics i.e. orthodontic tooth movement, fixing external root resorption, correcting craniofacial anomalies, accelerating craniofacial distraction osteogenesis, recreating the TMJ, and ensuring a stable maxillary expansion.

Evaluation of the Nasopalatine Canal (NPC) in a subset of Pakistani population, using Cone Beam Computed Tomography (CBCT).

OBJECTIVE: To evaluate variations in the shape, diameter, length and width of the nasopalatine canal along with the width of the buccal cortical bone anterior to it, using cone beam computed tomography imaging. METHODS: The retrospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September to October 2020, and comprised pre-existing cone beam computed tomography scans taken between 2015 and 2020 of patients of either gender aged 18-60 years who had maxillary central incisors present. The shapes and dimensions of the nasopalatine canal were observed along with the buccal bone anterior to the nasopalatine canal. Data was compared with respect to age and gender. Data was analysed using SPSS 23. RESULTS: Of the 90 scans evaluated, 46(51.1%) belonged to females with a mean age of 37.85±18.19 years, and 44(48.9%) belonged to males with a mean age of 38.07±13.58 years. The mean length and width of the nasopalatine canal was 11.28±1.90mm and 2.62±0.91mm, respectively. The nasopalatine canal was significantly longer (p<0.01) and wider (p=0.02) in males than females. The mean diameter of foramen of Stenson was 2.99±1.17mm and incisive foramen was 6.09±1.80mm. The mean width of the buccal cortical bone at the most coronal, middle and most incisal levels was 7.20±1.70mm, 6.12±1.31mm and 6.12±1.31mm, respectively. Buccal bone width was wider in males than females, but the difference was significant only at the midpoint (p<0.05). CONCLUSIONS: There was a significant difference in the dimensions of the width and length of the NPC with respect to gender. No significant differences were observed with respect to age.

Application of deep learning in teeth identification tasks on panoramic radiographs.

OBJECTIVES: To investigate the current developments of Artificial Intelligence (AI) in teeth identification on Panoramic Radiographs (PR). Our aim was to evaluate and compare the performances of Deep Learning (DL) models that have been employed in the execution of this task. METHODS: The systematic review was registered on PROSPERO. All recent studies that utilized DL models for identifying teeth on PRs were included in this review. An extensive search of the medical electronic databases including PubMed NLM, EBSCO Dentistry & Oral Sciences Source, and Wiley Cochrane Library was conducted. This was followed by a hand search of the IEEE Xplore database. The diagnostic performance of DL models in teeth identification tasks on PR was the primary outcome assessed in this review. The risk of bias assessment of the included studies was evaluated via the modified QUADAS-2 tool. Owing to the heterogeneity of the reported performance metrics, a meta-analysis was not possible.. RESULTS: The search yielded a total of 282 articles, out of which 13 relevant ones were included in this review. These studies utilized a diverse range of DL models for teeth identification tasks on PRs and reported their performances using a variety of metrics. CONCLUSION: The results of teeth identification tasks carried out by DL models are encouraging; however, there is a need for the shortcomings that have been identified in our preliminary review, to be addressed by future researchers.

Critical Analysis of Artificial Intelligence in Endodontics: A Scoping Review.

INTRODUCTION: Artificial intelligence (AI) comprises computational models that mimic the human brain to perform various diagnostic tasks in clinical practice. The aim of this scoping review was to systematically analyze the AI algorithms and models used in endodontics and identify the source quality and type of evidence. METHODS: A literature search was conducted in October 2020 to identify the relevant literature in English language in the 4 major health sciences databases, ie, MEDLINE, Dentistry & Oral Science, CINAHL Plus, and Cochrane Library. Our review questions were the following: what are the different AI algorithms and models used in endodontics?, what are the datasets being used?, what type of performance metrics were reported?, and what diagnostic performance measures were used?. The quality of the included studies was evaluated by a modified Quality Assessment of Studies of Diagnostic Accuracy risk (QUADAS) tool. RESULTS: Out of 300 studies, 12 articles met our inclusion criteria and were subjected to final analysis. Among the included studies, 6 studies focused on periapical pathology, and 3 studies investigated vertical root fractures. Most studies (n = 10) used neural networks, among which convolutional neural networks were commonly used. The datasets that were mostly studied were radiographs. Out of 12 studies, only 3 studies achieved a high score according to the modified QUADAS tool. CONCLUSIONS: AI models had acceptable performance, ie, accuracy >90% in executing various diagnostic tasks. The scientific reporting of AI-related research is irregular. The endodontic community needs to implement recommended guidelines to improve the weaknesses in the current planning and reporting of AI-related research to improve its scientific vigor.

Effect of Direct versus Indirect Bonding Technique on the Failure Rate of Mandibular Fixed Retainer-A Systematic Review and Meta-Analysis.

INTRODUCTION: Fixed retainer failure is a common cause of relapse and may require additional orthodontic treatment. The two main methods for bonding the mandibular fixed retainer include direct and indirect techniques. This topic has not been explored previously in a systematic review. Therefore, the objective of this systematic review was to evaluate the effect of direct versus indirect bonding technique on the failure rate of mandibular fixed retainer. METHODS: Online databases (PubMed, Dental and Oral Science, CINAHL, and Cochrane Central Register of Controlled Trials, Scopus) were systematically searched electronically for articles up until April 2021. Google Scholar and clinicaltrials.gov databases were utilized for hand searching. Randomized, non-randomized clinical trials and cohort studies on human subjects were considered regardless of language or year of publication. Orthodontic patients in their retention phase (mandibular 3×3 fixed retainer), in which the retainer was bonded using direct bonding technique as control and indirect as intervention were included. The outcome assessed was retainer failure rate. Two authors independently examined and extracted the data from the studies that satisfied the inclusion criteria. Risk of bias in clinical trials was assessed using the Cochrane Collaboration's tool, whereas risk of bias in cohort studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis was conducted using the RevMan software V.5.3.5.22. The outcome was estimated using weighted average difference and 95% confidence intervals (CIs). The studies' heterogeneity was assessed using Cochrane's heterogeneity test (I2 Test). RESULTS: Four articles fulfilling the inclusion criteria were included in qualitative and quantitative synthesis. Retainer failure rates were analysed in a total number of 266 patients bonded with mandibular 3×3 retainers after orthodontic therapy. Direct bonding technique of fixed retainer on 131 patients was compared with indirect technique on 135 patients. There was no statistically significant difference in the rate of retainer failure between the two methods (95% CI, 0.67, 1.40). CONCLUSIONS: Within the limitations of insufficient evidence this systematic review and meta-analysis concluded that there is no difference in the failure rate of mandibular fixed retainers between direct and indirect bonding techniques. Due to the scarcity of available data, further studies are needed to establish definitively one's clinical benefit over the other.

Comparison of antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of chronic apical periodontitis: a randomised controlled trial study protocol.

INTRODUCTION: Various intracanal medicaments have been used in cases of chronic apical periodontitis for appropriate disinfection of the root canal system to eliminate microbes especially from the inaccessible areas. Calcium hydroxide is the most common intracanal medicament available in various forms, but its effectiveness with or without iodoform using microbial culture is unknown. Therefore, our aim is to compare the antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of teeth presenting with chronic apical periodontitis by assessing the bacterial load reduction. METHOD AND ANALYSIS: 60 single rooted teeth of patients with diagnosis of chronic apical periodontitis will be selected and the canals debrided chemomechanically. The patients will be randomised into two groups: Calcipex and Metapex. The first sample (S1) for bacterial culture will be taken before placement of intracanal medicament and the second sample (S2) will be taken after 7 days, before final obturation from the canal and sent to lab for culture. Colony-forming unit will be evaluated. Paired t-test will be used to assess difference between antimicrobial efficacies within the group of medicaments. Independent sample t-test will be used to assess antimicrobial efficacies between groups. Level of significance will be kept at 0.05. ETHICS AND DISSEMINATION: Approval from Aga Khan University Hospital Ethical review committee is taken. Findings will be reported according to the Standard Protocol Items for Randomised Trials guidelines. Research findings will be disseminated through annual reports, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT04336709.

Aesthetic rehabilitation with immediate implant placement in anterior maxilla after traumatic avulsive injury: A case report.

Traumatic oral injuries present their own unique restorative challenges to the clinician due to their variable clinical presentation. In such cases, achieving optimum aesthetics and function in the maxillary aesthetic zone is challenging. This case report describes the rehabilitation of a patient with immediate implant placement after suffering trauma to the oral cavity resulting in a complete loss (avulsion) of a permanent central incisor tooth. In order to preserve the existing soft and hard tissue and to achieve predictable and aesthetically pleasing results, we decided to place an immediate implant as opposed to replantation of the avulsed tooth. Flapless implant surgery was planned and a dental implant (Bio horizons Implant Systems, Inc.) was placed following non-submerged protocol. At six year follow-up, the clinical and radiographic examination revealed a well osseo-integrated implant with an intact buccal cortical plate. No clinical and radiographic signs of peri-implant disease were noted on follow-up. This case report supports the fact that immediate implant placement for missing teeth in the aesthetic zone results in favourable outcomes both in terms of function and aesthetics.