A novel collaborative learning model for mixed dentition and fillings segmentation in panoramic radiographs.

INTRODUCTION: It is critical for dentists to identify and differentiate primary and permanent teeth, fillings, dental restorations and areas with pathological findings when reviewing dental radiographs to ensure that an accurate diagnosis is made and the optimal treatment can be planned. Unfortunately, dental radiographs are sometimes read incorrectly due to human error or low-quality images. While secondary or group review can help catch errors, many dentists work in practice alone and/or do not have time to review all of their patients' radiographs with another dentist. Artificial intelligence may facilitate the accurate interpretation of radiographs. To help support the review of panoramic radiographs, we developed a novel collaborative learning model that simultaneously identifies and differentiates primary and permanent teeth and detects fillings. METHODS: We used publicly accessible dental panoramic radiographic images and images obtained from the University of Missouri-Kansas City, School of Dentistry to develop and optimize two high-performance classifiers: (1) a system for tooth segmentation that can differentiate primary and permanent teeth and (2) a system to detect dental fillings. RESULTS: By utilizing these high-performance classifiers, we created models that can identify primary and permanent teeth (mean average precision [mAP] 95.32 % and performance [F-1] 92.50 %), as well as their associated dental fillings (mAP 91.53 % and F-1 91.00 %). We also designed a novel method for collaborative learning that utilizes these two classifiers to enhance recognition performance (mAP 94.09 % and F-1 93.41 %). CONCLUSIONS: Our model improves upon the existing machine learning models to simultaneously identify and differentiate primary and permanent teeth, and to identify any associated fillings. CLINICAL SIGNIFICANCE: Human error can lead to incorrect readings of panoramic radiographs. By developing artificial intelligence and machine learning methods to analyze panoramic radiographs, dentists can use this information to support their radiograph interpretations, help communicate the information to patients, and assist dental students learning to read radiographs.

Chemometrics-Assisted Raman Spectroscopy Characterization of Tunable Polymer-Peptide Hybrids for Dental Tissue Repair.

The interfaces that biological tissues form with biomaterials are invariably defective and frequently the location where failure initiates. Characterizing the phenomena that lead to failure is confounded by several factors including heterogeneous material/tissue interfaces. To seamlessly analyze across these diverse structures presents a wealth of analytical challenges. This study aims to develop a molecular-level understanding of a peptide-functionalized adhesive/collagen hybrid biomaterial using Raman spectroscopy combined with chemometrics approach. An engineered hydroxyapatite-binding peptide (HABP) was copolymerized in dentin adhesive and dentin was demineralized to provide collagen matrices that were partially infiltrated with the peptide-functionalized adhesive. Partial infiltration led to pockets of exposed collagen-a condition that simulates defects in adhesive/dentin interfaces. The spectroscopic results indicate that co-polymerizable HABP tethered to the adhesive promoted remineralization of the defects. The spatial distribution of collagen, adhesive, and mineral as well as crystallinity of the mineral across this heterogeneous material/tissue interface was determined using micro-Raman spectroscopy combined with chemometrics approach. The success of this combined approach in the characterization of material/tissue interfaces stems from its ability to extract quality parameters that are related to the essential and relevant portions of the spectral data, after filtering out noise and non-relevant information. This ability is critical when it is not possible to separate components for analysis such as investigations focused on, in situ chemical characterization of interfaces. Extracting essential information from complex bio/material interfaces using data driven approaches will improve our understanding of heterogeneous material/tissue interfaces. This understanding will allow us to identify key parameters within the interfacial micro-environment that should be harnessed to develop durable biomaterials.

Using learning management software data to compare students' actual and self-reported viewing of video lectures.

PURPOSE: Student engagement is typically measured by class attendance and questionnaires. Learning management systems (LMS) provide additional sources of objective data that can evaluate student performance. This study compared dental students' self-report of course video viewing with LMS data. METHODS: Dental students in a 2018 flipped pediatric dentistry course were given a questionnaire after course completion that captured self-reported course video viewing. Student data and time spent on videos were extracted from the LMS and matched to the questionnaire. McNemar's test evaluated differences between self-reported and matching LMS data. RESULTS: Of the 109 enrolled students, 99 (91%) completed the questionnaire. Most students self-reported that they watched more than half of the videos (71%), re-watched at least once (89%), and watched at times other than 8 a.m.-5 p.m. (80%). Of the 104 students with data from the LMS, 40% of students watched more than half of the videos, 49% re-watched at least one video, and 60% watched between 8 a.m.-5 p.m. LMS data showed 14 (13%) students did not watch any videos. Significant differences were found between self-reported video viewing and matched LMS video data in (1) percentage of videos watched, (2) number of times videos were re-watched, and (3) most frequent time for watching the videos (p < 0.001 for all). CONCLUSION: Technology is a tool that helps instructors more accurately track students' study habits compared to observation or self-report. When evaluating time spent watching videos via an LMS, students tend to overestimate the amount of viewing time.

Dental anomalies in pediatric patients with familial adenomatous polyposis.

Familial adenomatous polyposis patients often present with non-malignant extra-intestinal manifestations which include dental anomalies that may be evident prior to the appearance of the colonic adenomas. The aims of this study were to describe the prevalence and type of dental anomalies and the relationships between gene mutations and dental anomalies in these patients. Twenty-two pediatric familial adenomatous polyposis patients and 46 controls, who were age and gender matched participated. Familial adenomatous polyposis patient's had a dental examination with panoramic radiograph and medical record review for age at diagnosis, the presence of the adenomatous polyposis coli gene mutation, and determination of other extra-intestinal manifestations on the body. The control group was identified from a retrospective chart review and selected if there was a current panoramic radiograph. The only significant difference between familial adenomatous polyposis patients and controls were the presence of jaw osteomas and sclerosis (p = .0001). Patients with a mutation in, or upstream of codon 1309 had a higher frequency of osteomas (77.8%) and jaw-bone sclerosis (44.4%), and 77% of these had at least one dental anomaly. This preliminary study showed an association between a genetic variant at, or upstream of codon 1309, and radiographic dental anomalies.

Dental Students' Study Habits in Flipped/Blended Classrooms and Their Association with Active Learning Practices.

In recognition of the importance for dental education programs to take a student-centered approach in which students are encouraged to take responsibility for their learning, a pediatric dentistry course redesign aimed at promoting greater active and self-directed learning was implemented at one U.S. dental school. The aim of this study was to examine the association between the students' self-reported study habits and active learning practices necessary for meaningful learning in the flipped/blended classroom. A convenience sample of two classes of second-year dental students in spring 2014 (SP14, n=106) and spring 2015 (SP15, n=106) was invited to participate in the study. Of the SP14 students, 84 participated, for a response rate of 79%; of the SP15 students, 94 participated, for a response rate of 87%. Students' self-reported responses to questions about study strategies with the prerecorded lecture materials and assigned reading materials were examined. Non-parametric analyses resulted in a cohort effect, so data are reported by class. In the SP15 class, 72% reported watching all/more than half of the prerecorded lectures versus 62% of the SP14 class, with a majority watching more than one lecture per week. In the SP15 cohort, 68% used active learning strategies when watching the lectures versus 58.3% of the SP14 cohort. The time of day preferred by the majority of both cohorts for interacting with course materials was 7-11 pm. Both SP14 and SP15 students reported being unlikely to read assigned materials prior to coming to class. Overall, the course redesign appeared to engage students in self-directed active learning. However, the degree to which active learning practices were taking place to achieve meaningful learning was questionable given students' self-reported study strategies. More work is needed to examine strategies for promoting study practices that will lead to meaningful learning.

Is histologic esophagitis associated with dental erosion: a cross-sectional observational study?

BACKGROUND: Gastroesophageal reflux disease (GERD) affects 15-25% of children and adolescents in the United States. The diagnosis of GERD in children is complex as reported symptoms or symptom profiles have been found to be unreliable. Frequently, the diagnosis must be confirmed by objective tests such as pH monitoring or histological evidence of esophagitis on an esophageal biopsy. Dental erosion has been shown to be associated with GERD as an atypical complication and has the potential to be a marker of GERD. The purposes of this study were to compare the frequency and patterns of dental erosion in children and adolescents with and without histologic esophagitis. METHODS: Twenty-five subjects were recruited from patients scheduled for an upper gastrointestinal endoscopy. Information regarding potential GERD symptoms, food habits, and dental hygiene habits were obtained. Intra-oral photographs were taken, and a dental exam for erosion was performed. The results of a standard biopsy taken from the lower third of the esophagus during an endoscopy were used to divide subjects into either the control group or the GERD group (i.e. those with histologic esophagitis). RESULTS: Twenty-two subjects yielded 586 evaluable teeth. No significant difference was found between frequency or erosion patterns of those with and without histologic esophagitis. Dental erosions were more frequent in primary teeth. CONCLUSIONS: Dental erosions do not appear to be associated with histologic esophagitis indicative of GERD.

Flipping the Classroom: Assessment of Strategies to Promote Student-Centered, Self-Directed Learning in a Dental School Course in Pediatric Dentistry.

The aim of this study was to explore student and course director experiences with the redesign of a traditional lecture-based course into a flipped classroom for teaching didactic content in pediatric dentistry to second-year dental students. The study assessed student satisfaction, extent of student engagement, overall course grades, and course director satisfaction. The students enrolled in a flipped classroom pediatric dentistry course (spring semester 2014; SP14) were asked to complete pre- and post-course questionnaires to assess their perceptions of active learning, knowledge acquisition, and course satisfaction. The process was repeated with the class enrolled in the same course the following year (SP15). Responses for SP14 and SP15 resulted in an overall response rate of 95% on the pre questionnaire and 84% on the post questionnaire. The results showed that the greatest perceived advantage of the flipped classroom design was the availability and access to online content and course materials. Students reported enhanced learning due to heightened engagement in discussion. The results also showed that students' overall course grades improved and that the course director was satisfied with the experience, particularly after year two. Many calls have been made for educational strategies that encourage critical thinking instead of passive learning environments. This study provides one example of a course redesign and demonstrates the need for both faculty and student development to ensure success when a flipped classroom methodology is introduced.

Posterior composite restoration update: focus on factors influencing form and function.

Restoring posterior teeth with resin-based composite materials continues to gain popularity among clinicians, and the demand for such aesthetic restorations is increasing. Indeed, the most common aesthetic alternative to dental amalgam is resin composite. Moderate to large posterior composite restorations, however, have higher failure rates, more recurrent caries, and increased frequency of replacement. Investigators across the globe are researching new materials and techniques that will improve the clinical performance, handling characteristics, and mechanical and physical properties of composite resin restorative materials. Despite such attention, large to moderate posterior composite restorations continue to have a clinical lifetime that is approximately one-half that of the dental amalgam. While there are numerous recommendations regarding preparation design, restoration placement, and polymerization technique, current research indicates that restoration longevity depends on several variables that may be difficult for the dentist to control. These variables include the patient's caries risk, tooth position, patient habits, number of restored surfaces, the quality of the tooth-restoration bond, and the ability of the restorative material to produce a sealed tooth-restoration interface. Although clinicians tend to focus on tooth form when evaluating the success and failure of posterior composite restorations, the emphasis must remain on advancing our understanding of the clinical variables that impact the formation of a durable seal at the restoration-tooth interface. This paper presents an update of existing technology and underscores the mechanisms that negatively impact the durability of posterior composite restorations in permanent teeth.

Durable bonds at the adhesive/dentin interface: an impossible mission or simply a moving target?

Composite restorations have higher failure rates, more recurrent caries and increased frequency of replacement as compared to dental amalgam. Penetration of bacterial enzymes, oral fluids, and bacteria into the crevices between the tooth and composite undermines the restoration and leads to recurrent decay and failure. The gingival margin of composite restora tions is particularly vulnerable to decay and at this margin, the adhesive and its seal to dentin provides the primary barrier between the prepared tooth and the environment. The intent of this article is to examine physico-chemical factors that affect the integrity and durability of the adhesive/dentin interfacial bond; and to explore how these factors act synergistically with mechanical forces to undermine the composite restoration. The article will examine the various avenues that have been pursued to address these problems and it will explore how alterations in material chemistry could address the detrimental impact of physico-chemical stresses on the bond formed at the adhesive/dentin interface.

Durable bonds at the adhesive/dentin interface: an impossible mission or simply a moving target? / Durabilidade da adesão na interface adesivo/dentina: uma missão impossível ou simplesmente um alvo em movimento?

Composite restorations have higher failure rates, more recurrent caries and increased frequency of replacement as compared to dental amalgam. Penetration of bacterial enzymes, oral fluids, and bacteria into the crevices between the tooth and composite undermines the restoration and leads to recurrent decay and failure. The gingival margin of composite restora tions is particularly vulnerable to decay and at this margin, the adhesive and its seal to dentin provides the primary barrier between the prepared tooth and the environment. The intent of this article is to examine physico-chemical factors that affect the integrity and durability of the adhesive/dentin interfacial bond; and to explore how these factors act synergistically with mechanical forces to undermine the composite restoration. The article will examine the various avenues that have been pursued to address these problems and it will explore how alterations in material chemistry could address the detrimental impact of physico-chemical stresses on the bond formed at the adhesive/dentin interface.

Restaurações em resina composta apresentam elevada taxa de falhas, recorrência de cárie e maior necessidade de troca quando comparadas às restaurações em amálgama. A penetração de enzimas bacterianas, fluidos orais e da própria bactéria nas fendas existentes entre o dente e o compósito, enfraquecem a restauração e levam à recorrência de cárie e falhas. A margem gengival das restaurações em resina composta é particularmente vulnerável à cárie e, nesta margem, o adesivo e o selamento dentinário funcionam como a primeira bareira entre o dente preparado e o ambiente oral. O objetivo deste artigo de revisão é examinar os fatores físico-químicos que afetam a integridade e a durabilidade da interface de adesão adesivo/dentina e explorar como esses fatores agem sinergicamente para minar a restauração de resina composta. A revisão irá examinar as diversas possibilidades para solucionar esses problemas, bem como explorar como alterações na química dos materiais poderiam solucionar o impacto negativo do estresse físico-químico na interface adesiva com a dentina.

Adhesive/Dentin interface: the weak link in the composite restoration.

Results from clinical studies suggest that more than half of the 166 million dental restorations that were placed in the United States in 2005 were replacements for failed restorations. This emphasis on replacement therapy is expected to grow as dentists use composite as opposed to dental amalgam to restore moderate to large posterior lesions. Composite restorations have higher failure rates, more recurrent caries, and increased frequency of replacement as compared to amalgam. Penetration of bacterial enzymes, oral fluids, and bacteria into the crevices between the tooth and composite undermines the restoration and leads to recurrent decay and premature failure. Under in vivo conditions the bond formed at the adhesive/dentin interface can be the first defense against these noxious, damaging substances. The intent of this article is to review structural aspects of the clinical substrate that impact bond formation at the adhesive/dentin interface; to examine physico-chemical factors that affect the integrity and durability of the adhesive/dentin interfacial bond; and to explore how these factors act synergistically with mechanical forces to undermine the composite restoration. The article will examine the various avenues that have been pursued to address these problems and it will explore how alterations in material chemistry could address the detrimental impact of physico-chemical stresses on the bond formed at the adhesive/dentin interface.

Physico-mechanical properties determination using microscale homotopic measurements: application to sound and caries-affected primary tooth dentin.

Microscale elastic moduli, composition and density have rarely been determined at the same location for biological materials. In this paper, we have performed homotopic measurements to determine the physico-mechanical properties of a second primary molar specimen exhibiting sound and caries-affected regions. A microscale acoustic impedance map of a section through this sample was acquired using scanning acoustic microscopy (SAM). Scanning electron microscopy was then used to obtain mineral mass fraction of the same section using backscattered images. Careful calibration of each method was performed to reduce system effects and obtain accurate data. Resorption, demineralization and hypermineralization mechanisms were considered in order to derive relationships between measured mineral mass fraction and material mass density. As a result, microscale mass density was determined at the same lateral resolution and location as the SAM data. The mass density and the acoustic impedance were combined to find the microscale elastic modulus and study the relationship between microscale composition and mechanical properties.

Comparison of interfacial characteristics of adhesive bonding to superficial versus deep dentine using SEM and staining techniques.

OBJECTIVES: A primary reason for premature failure of Class II composite restorations is recurrent decay at the gingival margin. The integrity of the gingival margin depends on the bond formed with dentine. Using scanning electron microscopy (SEM) and histomorphologic technique, the purpose of this study was to characterise the adhesive/dentine (a/d) bond in dentine sections from the dentinoenamel junction (DEJ) and the cementoenamel junction (CEJ) with commercial adhesives of varying hydrophobic/hydrophilic composition. MATERIALS AND METHODS: The occlusal 1/3 of the crown was removed from 20 human third molars, this exposed the surface used for the DEJ sections. The teeth were sectioned occluso-gingivally into equal halves: one-half representing the DEJ; the remaining half was sectioned 4mm deep to the exposed surface (CEJ). Each half was treated with the same adhesive. The teeth were randomly selected for treatment with Single Bond (SB, 3M) or Dentastic UNO (UNO, Pulpdent) using wet bonding technique as per manufacturers' instructions. Thin (3-5mum) sections of native a/d interfaces were cut and stained with Goldner's trichrome for light microscopic (LM) examination. Companion slabs were polished and acid-bleach treated, then analysed with SEM. RESULTS: DEJ sections: SB/dentine specimens had approximately 4mum exposed protein at the interface, UNO infiltrated the depth of the demineralised dentine and encapsulated exposed protein. CEJ sections: SB/dentine specimens had highly variable interface structure with localized exposed protein, UNO/dentine exhibited 3-5mum exposed protein at the interface. The quality of the interface was exaggerated and the above differences were not revealed based on SEM characterisation. CONCLUSIONS: As a result of adhesive phase separation, SB does not form structurally integrated a/d bonds at the DEJ or CEJ. The increased hydrophilic composition of UNO contributes to the formation of an integrated a/d bond at the DEJ, but structural differences and increased moisture leads to unprotected protein at the a/d interface in the CEJ sections. The inability of the SEM technique to reveal the complexity of the interface could be related to the modifications of the a/d interface caused by polishing and acid-bleach treatment.

Interfacial chemistry of moisture-aged class II composite restorations.

Under in vivo conditions, the adhesive/dentin bond at the gingival margin of class II composite restorations can be the first defense against substances that may penetrate and ultimately undermine the composite restoration. Deterioration of this bond during aqueous aging is an area of intense investigation, but to date, the majority of our techniques have provided only an indirect assessment of the degrading components. The purpose of this study was to analyze the in situ molecular structure of adhesive/dentin interfaces in class II composite restorations, following aging in aqueous solutions. Class II preparations were cut from 12 unerupted human third molars, with a water-cooled, high-speed, dental handpiece. The prepared teeth were randomly selected for restoration with single bond (SB) and Z100 (3M). Teeth were restored, as per the manufacturer's directions, under environmental conditions that simulated humidity and temperature characteristics of the oral cavity. Restored teeth were kept in sterile Delbecco's phosphate saline for 48 h or 90 days. The samples were sectioned occlusogingivally and micro-Raman spectra were acquired at approximately 1.5 microm spatial resolution across the composite/adhesive/dentin interfaces at the gingival margins. Samples were wet throughout spectral acquisition. The relative intensity of bands associated with the adhesive in the interfacial region decreased dramatically after aqueous storage. This decrease in concert with the similar depth of dentin demineralization provides direct spectroscopic evidence of leaching of adhesive monomer from the interface during the 90 days of storage. SB adhesive infiltrated 4-5 microm of 12-microm demineralized dentin at the gingival margin. After 90 days of aqueous storage, SB adhesive infiltration was reduced to approximately 2 microm, leaving approximately 10 microm of demineralized dentin collagen exposed at the gingival margin. The unprotected collagen at the gingival margin of the aged class II composite restorations was disorganized, suggesting hydrolysis of the collagen, with 90 days of aqueous storage.

The alternate forms reliability of the Oucher pain scale.

The purpose of this study was to determine the adequacy of the alternate forms reliability of three versions of the Oucher pain scale. Because the original large-sized posters were unwieldy for use by nurses with children in clinical settings, it became necessary to reduce it in size. To determine whether the resulting tools were psychometrically equivalent to the original versions of the Oucher, this study was undertaken. In a group of 3- to 12-year-old children who underwent surgical or dental procedures ( n = 137), scores were obtained after the procedure on small and large versions of the Oucher. The order of presentation of the two different Ouchers was randomized. Findings revealed that correlation coefficients between the scores provided for the small and large versions of the Oucher were strong, positive, and significant for the Caucasian, African-American, and Hispanic versions in 3- to 12-year-old children. These results provided evidence of the adequacy of the alternate forms reliability of these scales.