A Comparative Analysis of Deep Learning-Based Approaches for Classifying Dental Implants Decision Support System.

This study aims to provide an effective solution for the autonomous identification of dental implant brands through a deep learning-based computer diagnostic system. It also seeks to ascertain the system's potential in clinical practices and to offer a strategic framework for improving diagnosis and treatment processes in implantology. This study employed a total of 28 different deep learning models, including 18 convolutional neural network (CNN) models (VGG, ResNet, DenseNet, EfficientNet, RegNet, ConvNeXt) and 10 vision transformer models (Swin and Vision Transformer). The dataset comprises 1258 panoramic radiographs from patients who received implant treatments at Erciyes University Faculty of Dentistry between 2012 and 2023. It is utilized for the training and evaluation process of deep learning models and consists of prototypes from six different implant systems provided by six manufacturers. The deep learning-based dental implant system provided high classification accuracy for different dental implant brands using deep learning models. Furthermore, among all the architectures evaluated, the small model of the ConvNeXt architecture achieved an impressive accuracy rate of 94.2%, demonstrating a high level of classification success.This study emphasizes the effectiveness of deep learning-based systems in achieving high classification accuracy in dental implant types. These findings pave the way for integrating advanced deep learning tools into clinical practice, promising significant improvements in patient care and treatment outcomes.

A robust deep learning model for the classification of dental implant brands.

OBJECTIVE: In cases where the brands of implants are not known, treatment options can be significantly limited in potential complications arising from implant procedures. This research aims to explore the application of deep learning techniques for the classification of dental implant systems using panoramic radiographs. The primary objective is to assess the superiority of the proposed model in achieving accurate and efficient dental implant classification. MATERIAL AND METHODS: A comprehensive analysis was conducted using a diverse set of 25 convolutional neural network (CNN) models, including popular architectures such as VGG16, ResNet-50, EfficientNet, and ConvNeXt. The dataset of 1258 panoramic radiographs from patients who underwent implant treatment at faculty of dentistry was utilized for training and evaluation. Six different dental implant systems were employed as prototypes for the classification task. The precision, recall, F1 score, and support scores for each class have included in the classification accuracy report to ensure accurate and reliable results from the model. RESULTS: The experimental results demonstrate that the proposed model consistently outperformed the other evaluated CNN architectures in terms of accuracy, precision, recall, and F1-score. With an impressive accuracy of 95.74 % and high precision and recall rates, the ConvNeXt model showcased its superiority in accurately classifying dental implant systems. Notably, the model's performance was achieved with a relatively smaller number of parameters, indicating its efficiency and speed during inference. CONCLUSION: The findings highlight the effectiveness of deep learning techniques, particularly the proposed model, in accurately classifying dental implant systems from panoramic radiographs.

Dental versus zygomatic implants in the treatment of maxillectomy: a finite element analysis.

PURPOSE: This study analyzed the stress distributions on zygomatic and dental implants placed in the zygomatic bone, supporting bones, and superstructures under occlusal loads after maxillary reconstruction with obturator prostheses. MATERIALS AND METHODS: 12 scenarios of three-dimensional finite element models were constructed based on computed tomography scans of a patient who had hemimaxillectomy. Two obturator prostheses were analyzed for each model. A total force of 600 N was applied from the palatal to buccal bones at an angle of 45°. The maximum and minimum principal stress values for bone and also the von Misses stress values for dental implants and prostheses were calculated. RESULTS: When zygomatic implants were applied to the defect area, the maximum principal stresses were similar in intensity to the other models; however, the minimum principal stress values were higher than in scenarios without zygomatic implants. In models that used zygomatic implants in the defect area, von Misses stress levels were significantly higher in zygomatic implants than in dental implants. In scenarios where the prosthesis was supported by tissue in the non-defect area, the maximum and minimum principal stress values on cortical bone were higher than in scenarios where implants were applied to both defect and non-defect areas. CONCLUSIONS: In patients who lack an alveolar crest after maxillectomy, reduced stress on the zygomatic bone is expected if a custom bar-retained prosthesis is placed on the dental implant. The stress was higher on zygomatic implants without alveolar crest support than on dental implants.

Effect of Implant Diameter and Bruxism on Biomechanical Performance in Maxillary All-on-4 Treatment: A 3D Finite Element Analysis.

PURPOSE: To examine the stress distribution in the maxillary All-on-4 treatment concept supported by implants of different diameters under two different loading forces using finite element analysis. MATERIALS AND METHODS: Two distinct All-on-4 designs were prepared in a fully edentulous maxilla, supported by 3.3- and 4.1-mm-diameter implants. Posterior implants were tilted distally, approximately 30 degrees to the occlusal plane, and anterior implants were placed axially. Bone, implant, and prosthetic components were modeled separately and were tightly connected to each other. Under two distinct loading conditions representing the occlusal forces of healthy and bruxist individuals, the stresses on peri-implant bone, implant, and prosthetic components were evaluated using finite element analysis. RESULTS: There were higher stresses on cortical bone than on trabecular bone. The stresses on bone and implant components were concentrated around the posterior implants, whereas stresses on the prosthesis were concentrated anteriorly. With increasing implant diameter, the stresses on trabecular bone, abutments, and crowns increased, whereas the stresses on cortical bone, implants, and frameworks decreased. Compressive stresses in the cortical bone and von Mises stresses in the frameworks exceeded the overload limit in both models under bruxist loading. CONCLUSION: The stresses on the cortical bone, implants, and frameworks were slightly higher in the model with 3.3-mm-diameter implants, whereas the stresses on the trabecular bone, abutments, and crowns were slightly higher in the model with 4.1-mm-diameter implants.

Finite Element Analysis of the Stress Distribution Associated With Different Implant Designs for Different Bone Densities.

PURPOSE: The main objective of this study was to investigate the influence of implant design, bone type, and abutment angulation on stress distribution around dental implants. MATERIALS AND METHODS: Two implant designs with different thread designs, but with the same length and brand were used. The three-dimensional geometry of the bone was simulated with four different bone types, for two different abutment angulations. A 30° oblique load of 200 N was applied to the implant abutments. Maximum principal stress and minimum principal stresses were obtained for bone and Von misses stresses were obtained for dental implants. RESULTS: The distribution of the load was concentrated at the coronal portion of the bone and implants. The stress distributions to the D4 type bone were higher for implant models. Increased bone density and increased cortical bone thickness cause less stress on bone and implants. All implants showed a good distribution of forces for non-axial loads, with higher stresses concentrated at the crestal region of the bone-implant interface. In implant types using straight abutments there was a decrease in stress as the bone density decreased. The change in the abutment angle also caused an increase in stress. CONCLUSIONS: The use of different implant threads and angled abutments affects the stress on the surrounding bone and implant. In addition, it was observed that a decrease in density in trabecular bone and a decrease in cortical bone thickness increased stress.

Effect of Anterior Implant Position on Biomechanical Performance in the Maxillary All-on-Four Treatment: A 3-D Finite Element Analysis.

In the all-on-four concept, the positions of both posterior and anterior implants can affect stress distribution. The aim of this study was to examine the effect of the position of anterior implants on stress distribution in the implant, the bone around the implant, and prosthetic components in the resorbed maxilla using the all-on-four concept. All-on-four designs were prepared with 3 different anterior implant positions in a fully edentulous maxilla. Anterior implants were placed axially in the central incisor area in model 1, in the lateral incisors area in model 2, and in the canine area in model 3, forming 3 groups. The von Mises and principal stresses in the bone tissue and the von Mises stresses in the implant and prosthetic components were evaluated by 3-dimensional finite element analysis. There were more stresses on the cortical bone than trabecular bone. The stresses on the bone tissue and implant components were generally concentrated around the posterior implant, whereas the stresses on the prosthetic components were generally concentrated in the anterior region. Changing the anterior implant positions from the central tooth to the canine tooth reduced the stress on the bone around the implant. The highest von Mises stresses occurred in the prosthetic superstructure in all models, whereas the lowest stresses occurred in the trabecular bone. Changing the position of the anterior implants from the central tooth to the canine area in the maxillary all-on-four concept created a favorable stress distribution.

Effects of Different Therapeutic Modalities on the Clicking Sound and Quantitative Assessment of the Vertical and Lateral Mandibular Movements of Patients with Internal Derangements of the Temporomandibular Joint.

PURPOSE: To compare the efficacy of low-dose laser therapy to that of conservative treatment using two different occlusal splints (stabilization and anterior repositioning splints) in patients with internal derangements of the temporomandibular joint (TMJ). MATERIALS AND METHODS: The study population consisted of patients with disc displacement with reduction diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and Axis II. In addition, disc displacement with reduction was confirmed in all patients using TMJ ultrasonography. These tests were conducted for 6 months with an interim control in the third month. The "clicking" sound from the joint on opening and closing the mouth and the extent to which the mouth opened vertically and laterally were assessed. In all, 20 patients received low-dose laser therapy, 20 were treated with a stabilization splint, and 20 were treated with an anterior repositioning splint. In addition, 10 untreated patients were included as a patient control group, and a further 10 healthy subjects were included as a healthy control group. Changes in the condition were assessed based on the results of the RDC/TMD Axis II and with the use of an algometer. RESULTS: The anterior repositioning splint group showed improvement in the "clicking" sound during mouth opening. Lateral movement improved significantly in patients who received laser therapy. In the patient control group, the click disappeared during mouth opening, the algometrically determined pain improved, and the lateral movement increased. There were no statistically significant differences between groups in the improvement of vertical mouth movement or in the clicking sound during mouth closing. CONCLUSION: Each treatment modality applied in this study separately produced positive results for the clicking sound, restrictions in vertical and lateral movements, and reduction of the pressure pain threshold observed in cases of TMJ irregularity. The decision regarding which treatment modality should be employed can be made based on the patient's symptoms. However, this study also indicates that TMJ derangements can resolve spontaneously when left untreated.

Influence of Conventional Complete Dentures and Different Attachment Types in Implant-Supported Overdentures on Quality of Life and Nutritional Status in Edentulous Geriatric Patients.

PURPOSE: To determine whether the use of implant-supported overdentures (IODs) with different attachments influences the Mini Nutritional Assessment (MNA) and Geriatric Oral Health Assessment Index (GOHAI) scores in edentulous patients > 65 years of age. MATERIALS AND METHODS: The MNA and GOHAI were administered to 54 edentulous patients > 65 years of age (mean age = 68.35 ± 4.1 years) before treatment (A) and 6 months after treatment (B): 10 with maxillary + mandibular conventional complete dentures (CDs); 10 with a maxillary conventional CD + mandibular magnetic-retained IOD; 12 with a maxillary conventional CD + mandibular ball-retained IOD; 12 with a maxillary conventional CD + mandibular Locator-retained IOD; and 10 with a maxillary conventional CD + mandibular bar-retained IOD. Statistical differences between treatment types were evaluated using one-way analysis of variance and paired-sample t tests. The correlation between MNA and GOHAI scores was determined using Pearson correlation analysis (α = .05). RESULTS: The difference between mean GOHAI-A and GOHAI-B scores was statistically significant for each type of denture (P < .005). The difference between the mean MNA-A and MNA-B scores was statistically significant for all types of denture except for conventional CDs (P < .05). There was a statistically significant positive correlation between MNA and GOHAI scores (P < .01). CONCLUSION: Regardless of the type of denture used, treatment of edentulous geriatric patients is important for improving nutritional status and self-rated oral health.

The evaluation of agreement between high-frequency ultrasonography and research diagnostic criteria for the diagnosis of temporomandibular joint internal derangements.

AIM: The aim of this study is to compare the diagnosis of patients with temporomandibular joint (TMJ) internal derangements which had been diagnosed using Research Diagnostic Criteria/Temporomandibular Disorders (RDC/TMD) with the dynamic high resolution sonography findings. SETTINGS AND DESIGN: Axis I section of RDC/TMD form had been applied to participants. Participants were divided into three groups as healthy TMJ, disc displacement with reduction, and disc displacement without reduction. The diagnoses had been compared with the dynamic high-resolution sonography findings. MATERIALS AND METHODS: Twelve of the patients had been treated with laser therapy, whereas 13 patients were treated with stabilization splint. Seventeen patients were treated with anterior repositioning splint (n = 42). After the application of different treatment modalities, the position of the articular disc had been determined with Axis I of RDC/ TMD form and dynamic high-resolution sonography. The findings were compared and statistically analyzed. STATISTICAL ANALYSIS USED: Statistical analyses of data were analyzed with Turcosa Cloud (Turcosa Ltd Co, Turkey). RESULTS: For the right TMJ, pretreatment and posttreatment ultrasonography (USG) diagnoses and RDC/ TMD clinical diagnoses were found similar (κ = 0.125-0.008). No statistically significant relationship was found (P > 0.05). For the left TMJ, pretreatment USG diagnosis and RDC/TMD clinical diagnose were found similar (κ = 0.070). No statistically significant relationship was found (P > 0.05). For the left TMJ, posttreatment USG diagnosis and RDC/TMD clinical diagnose were compared. A statistically significant difference was found (κ = 0.256). A statistically significant relationship was found (P < 0.05). CONCLUSIONS: Axis 1 of RDC/TMD form which is used for the diagnosis of internal derangements and dynamic high resolution sonography was not found in the agreement.

Fracture resistance of teeth with oval canal morphology restored using oval and circular posts.

The study aimed to evaluate the effects of different post morphologies and placement lengths on the fracture resistance of teeth with oval canal morphology that had been restored with crowns. Extracted mandibular premolars with similar dimensions were decoronated. After the root canal treatment, the teeth were mounted on acrylic blocks. Samples were randomly divided into four groups (n = 10 each). In groups C-10 and C-5, 10-mm- and 5-mm-long circular post spaces were created. In groups O-10 and O-5, 10-mm- and 5-mm-long oval post spaces were ultrasonically created. After post cementation, all specimens were restored with composite cores and prepared at height of 6 mm. Thereafter, all teeth were restored with crowns. After thermocycling, all specimens underwent fracture resistance testing. Oval posts and placement at 10-mm depth showed higher fracture resistance than circular posts and placement at 5-mm depth (P < 0.001). Increased post length and use of oval posts enhanced the fracture strength of teeth with oval canal morphology. Based on the results of this study, although the fracture resistance of teeth restored with crowns was enhanced by deep fiber post placement, the use of oval fiber post is recommended in cases where deep placement is impossible. (J Oral Sci 58, 339-345, 2016).

Effect of Delayed Bonding and Antioxidant Application on the Bond Strength to Enamel after Internal Bleaching.

PURPOSE: This study evaluated the effect of delayed bonding and antioxidant application (AA, 10% sodium ascorbate) after internal bleaching (35% carbamide peroxide) on the shear bond strength of an adhesive cement to enamel. MATERIALS AND METHODS: Eighty-four human maxillary central incisors were endodontically treated. The control group remained unbleached with no AA. Experimental groups were all internally bleached. The buccal enamel was finished and polished with metallographic paper to a refinement of #600, in order to obtain a 5-mm(2) flat bonding area. An adhesive cement (Clearfil Esthetic) was placed into a plastic tube with internal diameter of 3 mm and a 3-mm height and cured on the enamel. Bonding occurred either immediately after bleaching (group Im), a 7-day delay (group 7), or a 14-day delay (group 14), and half the specimens were treated with antioxidant application (groups Im-AA, 7-AA, and 14-AA). Shear bond strength testing was performed on a universal testing machine, and data were analyzed with ANOVA and Fisher test (5%). RESULTS: Delaying of bonding is a useful factor for enhancing shear bond strength (p < 0.05), whereas AA only enhanced shear bond strength after 7 days delayed bleaching (p < 0.05). The highest bond strength was noted in groups 7-AA (20.51 ± 4.5 MPa), 14 (19.82 ± 4.6), 14-AA (20.27 ± 4.4), and control (20.51 ± 5.1), which were not significantly different from each other. CONCLUSIONS: After internal bleaching, adhesive cementation to enamel is recommended only when delayed 14 days, or delayed 7 days with sodium ascorbate application.

Evaluation of the resin cement thicknesses and push-out bond strengths of circular and oval fiber posts in oval-shapes canals.

PURPOSE: The aim of this study was to evaluate whether the push-out bond strength varies between oval and circular fiber posts, and to examine the effect on the resin cement thicknesses around the posts. MATERIALS AND METHODS: Eighteen mandibular premolar roots were separated into two groups for oval and circular fiber posts systems. Post spaces were prepared and fiber posts were luted to the post spaces. Roots were cut horizontally to produce 1-mm-thick specimens. Resin cement thicknesses were determined with a metallographic optical microscope and push-out tests were done. RESULTS: No significant differences were observed in terms of push-out bond strength between the oval and circular fiber posts (P>.05) The resin cement thicknesses of the oval posts were greater than those of the circular posts group in the coronal, middle and apical specimens (P<.05). CONCLUSION: In the light of these results, it can be stated that resin cement thickness does not affect the push-out bond strength.

Rebuilding Anterior Dental Esthetics: Interdisciplinary Treatment of an Iatrogenically Induced Marginal Tissue Recession.

INTRODUCTION: Root canal perforation during endodontic therapy is one of the most commonly encountered clinical situations that necessitates interdisciplinary therapy. CASE PRESENTATION: This case report presents the use of periodontal and prosthodontic teamwork to treat severely deteriorated anterior esthetics caused by an iatrogenically induced marginal tissue recession defect. CONCLUSION: In the case of deterioration of anterior dental esthetics, an interdisciplinary approach can successfully restore both esthetics and function, as observed in this case report.

Assessment of Candida species colonization and denture-related stomatitis in bar- and locator-retained overdentures.

The aim of this study was to assess the prevalence of denture-related stomatitis (DRS) in different attachment-retained overdenture wearers and its association with particular colonizing Candida species. Thirty-seven edentulous patients with implant-supported maxillary or mandibular overdentures were enrolled. A full clinical history was obtained, including details of patients' oral hygiene practices and the levels of erythema based on Newton's classification scale. Swabs were taken from the palate and investigated mycologically to identify the yeast colonies. Quantitative and qualitative microbiological assessments were performed, which included recording the total numbers of colonies (cfu), their color, and their morphological characteristics. Significant differences were found in cfu values between the attachment and inner surfaces of locator- and bar-retained overdentures (P < .05). Candida albicans was the most common species in both evaluations, being isolated from 81.3% of bar-retained overdentures and 38.1% of locator-retained overdentures. DRS developed in all patients using bar-retained overdentures but in only 71.4% of those using locator-retained overdentures. No statistically significant relationship was found between bar and locator attachments according to smoking habit, overnight removal, or plaque and gingival indices (P > .05).

Stress distribution of oval and circular fiber posts in amandibular premolar: a three-dimensional finite element analysis.

PURPOSE: The aim of the present study was to evaluate the effects of posts with different morphologies on stress distribution in an endodontically treated mandibular premolar by using finite element models (FEMs). MATERIALS AND METHODS: A mandibular premolar was modeled using the ANSYS software program. Two models were created to represent circular and oval fiber posts in this tooth model. An oblique force of 300 N was applied at an angle of 45° to the occlusal plane and oriented toward the buccal side. von Mises stress was measured in three regions each for oval and circular fiber posts. RESULTS: FEM analysis showed that the von Mises stress of the circular fiber post (426.81 MPa) was greater than that of the oval fiber post (346.34 MPa). The maximum distribution of von Mises stress was in the luting agent in both groups. Additionally, von Mises stresses accumulated in the coronal third of root dentin, close to the post space in both groups. CONCLUSION: Oval fiber posts are preferable to circular fiber posts in oval-shaped canals given the stress distribution at the post-dentin interface.

Do blood contamination and haemostatic agents affect microtensile bond strength of dual cured resin cement to dentin?

OBJECTIVE: The purpose of this study was to evaluate the effects of blood contamination and haemostatic agents such as Ankaferd Blood Stopper (ABS) and hydrogen peroxide (H2O2) on the microtensile bond strength between dual cured resin cement-dentin interface. MATERIAL AND METHODS: Twelve pressed lithium disilicate glass ceramics were luted to flat occlusal dentin surfaces with Panavia F under the following conditions: CONTROL GROUP: no contamination, Group Blood: blood contamination, Group ABS: ABS contamination Group H2O2: H2O2 contamination. The specimens were sectioned to the beams and microtensile testing was carried out. Failure modes were classified under stereomicroscope. Two specimens were randomly selected from each group, and SEM analyses were performed. RESULTS: There were significant differences in microtensile bond strengths (µTBS) between the control and blood-contaminated groups (p<0.05), whereas there were no significant differences found between the control and the other groups (p>0.05). CONCLUSIONS: Contamination by blood of dentin surface prior to bonding reduced the bond strength between resin cement and the dentin. Ankaferd Blood Stoper and H2O2 could be used safely as blood stopping agents during cementation of all-ceramics to dentin to prevent bond failure due to blood contamination.

Two case reports involving implants and fractured healing caps.

The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant and healing cap fracture are possible rare complications that can cause significant problems for both clinicians and patients. This article reports on 2 unique cases of implant and healing cap fracture, their possible causes, and how the cases were managed.

Infrared thermographic comparison of temperature increases on the root surface during dowel space preparations using circular versus oval fiber dowel systems.

PURPOSE: The purpose was to evaluate temperature increases during dowel space preparations with oval and circular fiber dowel systems. MATERIALS AND METHODS: This study included 42 single-rooted human mandibular premolars. Roots were scanned with cone-beam computerized tomography (CBCT) to determine the ovoid root canal morphology. Root canals were treated with Ni-Ti rotary instruments and obturated. A second CBCT was taken to determine the thinnest dentin thickness of each root. Roots were randomly divided into two groups (n = 21) according to the fiber dowel system used: group 1, circular fiber dowel system (D.T. Light-Post); group 2, oval fiber dowel system (Ellipson Post). Dowel spaces were prepared using a circular fiber dowel drill and a diamond-coated ultrasonic tip with an oval section under water cooling until 9 mm dowel spaces were obtained. Temperature changes were recorded from the thinnest root surfaces using a FLIR E60 thermal imaging camera. RESULTS: Temperature increases were significantly greater with the circular fiber dowel system than with the oval fiber dowel system (p < 0.05). CONCLUSIONS: Although both dowel systems generated high temperature increases on root surfaces, the relatively lower temperature increase associated with the use of oval fiber dowels in ovoid canals makes it preferable to the use of circular fiber dowels.

Evaluation of the retention force of double conical crowns used in combination with a galvanoforming and casting fabrication technique.

PURPOSE: The aim of this study was to measure the in vitro retention force of double conical crowns fabricated using primary galvanoforming and secondary casting techniques and those fabricated using primary casting and secondary galvanoforming techniques under simulated clinical conditions before and after a wear test. MATERIALS AND METHODS: Primary galvanoformed crowns (n = 10) with non-noble secondary crowns (n = 10; group A) and primary non-noble crowns (n = 10) with secondary galvanoformed crowns (n = 10; group B) were fabricated. Each primary and secondary crown was embedded in acrylic resin and weighed with a digital balance. Retention forces were then measured using a universal testing device. To simulate wear, specimens were inserted and separated horizonatally 3285 times in wear equipment with artificial saliva. Retention forces and weights of the double crowns were then remeasured. Data were analyzed using paired t-tests and Wilcoxon tests, and the groups were compared using Mann-Whitney U-tests. RESULTS: In group A, the wear test had a significant influence on the retentive force (p < 0.05), but wear produced no significant difference in weight (p > 0.05). In group B, the wear test had a significant influence on the retentive force (p < 0.05), and wear produced a significant difference in weight (p < 0.05). CONCLUSIONS: The results of this study indicated that the use of different combinations of galvanoforming and casting techniques in the fabrication of conical crowns significantly affected retention force.