Prediction of extraction difficulty for impacted maxillary third molars with deep learning approach.

OBJECTIVE: The aim of this study is to determine if a deep learning (DL) model can predict the surgical difficulty for impacted maxillary third molar tooth using panoramic images before surgery. MATERIALS AND METHODS: The dataset consists of 708 panoramic radiographs of the patients who applied to the Oral and Maxillofacial Surgery Clinic for various reasons. Each maxillary third molar difficulty was scored based on dept (V), angulation (H), relation with maxillary sinus (S), and relation with ramus (R) on panoramic images. The YoloV5x architecture was used to perform automatic segmentation and classification. To prevent re-testing of images, participate in the training, the data set was subdivided as: 80 % training, 10 % validation, and 10 % test group. RESULTS: Impacted Upper Third Molar Segmentation model showed best success on sensitivity, precision and F1 score with 0,9705, 0,9428 and 0,9565, respectively. S-model had a lesser sensitivity, precision and F1 score than the other models with 0,8974, 0,6194, 0,7329, respectively. CONCLUSION: The results showed that the proposed DL model could be effective for predicting the surgical difficulty of an impacted maxillary third molar tooth using panoramic radiographs and this approach might help as a decision support mechanism for the clinicians in peri­surgical period.

Temporomandibular joint disorders and associated factors in a Turkish pediatric population.

OBJECTIVE: To explore the presence and severity of temporomandibular disorders (TMD) signs and symptoms in a Turkish pediatric population, as well as their relationship to parafunctional behaviors, bruxism, malocclusion, anxiety, and sociodemographic traits. METHODS: A cross-sectional study was conducted with patients between the ages of 5-15. Demographic variables, TMD signs and symptoms, parafunctional habits, bruxism, and malocclusion were evaluated by clinical examination. Fonseca Anamnestic Index (FAI) was used to determine the presence and severity of TMD. State-Trait Anxiety Scale for Children (STAI-C) was used to evaluate the anxiety. Student t, Mann-Whitney U, chi-square tests, and logistic regression were used for statistical analysis. RESULTS: One hundred sixty-two participants (85 girls, 77 boys) with a mean age of 10.03 ± 1.88 years were included. The frequency of the participants who reported signs/symptoms of TMD was 19.7% according to FAI scores. Logistic regression analysis with the associated factors showed a significant relationship between the presence of the signs/symptoms of TMD and parafunctional habits (OR 4.24, 95% CI 1.64-10.93), and the presence of signs/symptoms of anxiety (OR 1.09, 95% CI 1.02-1.16). CONCLUSIONS: Children and adolescents who exhibit parafunctional behaviors and anxiety had a higher likelihood of having TMD signs/symptoms of varying degrees of severity.

Evaluation of antibacterial efficacy of Lawsonia inermis Linn (henna) on periodontal pathogens using agar well diffusion and broth microdilution methods: An in-vitro study.

Background: Although widely explored in medicine, limited evidence exists in the literature regarding the efficacy of Lawsonia inermis Linn (henna) in the dental field. Aim: This study aimed to investigate the antibacterial effect of henna on Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis in vitro. Methods: The agar well diffusion and broth microdilution methods were used to evaluate the antibacterial effect of henna extracts. Dimethyl sulfoxide was used to prepare the ethanol extract of henna, and distilled water was used to prepare the water extract. For both ethanol and water extracts, 4 different concentrations were prepared as 15, 30, 60, and 120 mg/mL. Results: It was determined that the water and ethanol extracts of the henna samples did not show an inhibition zone on P.gingivalis and A.actinomycetemcomitans. As a result of the evaluations made with the broth microdilution method, it was found that the ethanol extract had a higher inhibitory effect on both bacteria, and both extracts had more inhibitory effects against A.actinomycetemcomitans. Conclusion: To understand the effect of henna on periodontal pathogens, more comprehensive in vitro studies should be performed on henna samples at different concentrations and with different bases.

Investigation of the clinical efficacy of CGF and ozone in the management of alveolar osteitis: a randomized controlled trial.

OBJECTIVES: To investigate the efficacy of concentrated growth factors (CGF) and ozone in the treatment of alveolar osteitis (AO). MATERIALS AND METHODS: Patients admitted for the treatment of AO and eligible for the study were included and divided into control, ozone, and CGF + ozone groups. For the treatment of AO alveogyl, ozone, and CGF + ozone were applied to control, ozone, and CGF + ozone groups, respectively, and repeated on 3rd day. Demographic data and oral hygiene were recorded at the initial visit. Pain with visual analog scale (VAS) and analgesic consumption were evaluated at the 6th and 24th h, and on 2nd-7th days. Granulation tissue health and inflammation severity were evaluated on the 1st, 3rd, and 7th days. Quality of life was evaluated with the postoperative symptom severity scale (Posse) on the 7th day. RESULTS: A total of 60 patients (43 females/17 males; mean age 42.7 ± 13.76 years), 20 patients per group were included. Among the groups, pain scores on the 7th day (p = 0.042), granulation tissue health on the 3rd (p = 0.003) and 7th (p = 0.015) days showed a significant difference while analgesic consumption, Posse scores, and inflammation severity showed no significant differences (p > 0.05). Between genders analgesic consumption at 6 h (p = 0.027), 24 h (p = 0.033), and on the 2nd day (p = 0.034) and inflammation severity on the 7th day (p = 0.012) showed significant differences while Posse scores and granulation tissue health showed no significant differences (p > 0.05). CONCLUSIONS: This study demonstrates that regenerative treatment which modulates angiogenesis, and tissue regeneration by stimulating stem cells, growth factors, and cytokines with CGF + ozone are more effective than conventional treatment regarding AO. CLINICAL RELEVANCE: Usage of CGF and ozone together provides faster and more satisfactory management of AO.

Does Modifying the Consent Process Based on the Dominant Intelligence Type Reduce Anxiety During 3rd Molar Operations?

PURPOSE: Third molar surgery is one of the most commonly performed operations, usually associated with high anxiety. The purpose of this study was to determine if patients' anxiety would reduce if consent was modified to match their dominant intelligence type (DIT). METHODS AND MATERIALS: A single center, prospective randomized clinical study was conducted in the Maxillofacial Surgery Clinic of Ordu University on patients admitted for lower third molar removal between October 2020 and June 2021. The participants were randomly assigned to a study group where consent was based on DIT or a control group where consent was obtained in the standard fashion. DIT was determined using the multiple intelligence test and was further categorized as visual/spatial, verbal/linguistic, and bodily/kinesthetic. The consent method was the primary and the type of DIT was the secondary predictor variable. The primary and secondary outcome variables were the salivary cortisol level and Modified Dental Anxiety Scale (MDAS) scores measured before and after the consent, and after the operation. Mann-Whitney U, Friedman, Kruskal Wallis, Pearson correlation, and χ2 tests were conducted for statistical analysis. RESULTS: Eighty patients (55 females and 25 males; mean age 23.5 ± 6.2) were included. No significant difference was observed between the study and control groups for the change in cortisol levels and MDAS scores before-after consent (-11.15 ± 62.64; -6.84 ± 32.9) (P = .389), (-0.6 ± 3.46; -0.7 ± 2.49) (P = .832) and before consent-after operation (-39.80 ± 108.2; -39.72 ± 77.04) (P = .987), (-4.31 ± 5.97; -3 ± 4.34) (P = .867). The change in MDAS scores and cortisol levels was not correlated after consent (P = .587, r = 0.62) and operation (P = .406, r = 0.94). CONCLUSION: Providing consent based on DIT is not statistically different than providing consent in the standard fashion. The role of consent strategy in managing anxiety and lack of correlation between salivary cortisol and MDAS requires further investigation.

Comparative evaluation of the trabecular structure of the mandibular condyle, the levels of salivary cortisol, MMP-3, TNF-α, IL-1ß in individuals with and without temporomandibular joint disorder.

OBJECTIVE: Temporomandibular disorder (TMD) is still a challenge in terms of diagnosis and management. The aim of this study is to explore if the evaluation of salivary biomarkers and fractal dimension (FD) of mandibular condyle could be useful for interpreting early degenerative changes and the effectiveness of salivary cortisol in determining the stress levels of TMD patients. MATERIALS AND METHODS: 34 patients with TMD, and 34 healthy controls were included in this study. Saliva samples were obtained from all participants between 09:00-12:00 am. Salivary cortisol, IL-1ß, TNF-α, and MMP-3 levels were evaluated with ELISA method. FD of the mandibular condyle was determined by means of box-counting method. Depression and anxiety were determined with PHQ-9 and GAD-7 questionnaires. RESULTS: The salivary cortisol and depression/anxiety were higher in study group; however, not significant (p>0.05). FD of the study group was found significantly lower than the control group (p<0.01). Salivary TNF-α, IL-1ß and MMP-3 levels were showed no significant difference between the two groups (p>0.05). There were no significant correlations between the evaluated parameters. CONCLUSION: Salivary cortisol seems to be a non-invasive way of measuring physiological stress of TMD patients. Fractal analysis may be a useful tool in detecting early structural changes in mandibular condyle. Salivary TNF-α. IL-1ß and MMP-3 have not a diagnostic value in terms of interpreting early degenerative changes.

Temporomandibular disorder severity and its association with psychosocial and sociodemographic factors in Turkish adults.

BACKGROUND: There is a lack of awareness regarding temporomandibular disorder (TMD) and its association with psychological and sociodemographic factors in the Turkish population. This study aimed to evaluate the relationship between signs/symptoms of anxiety-depression, sociodemographic factors, parafunctional habits, bruxism, and the presence and severity of the symptoms of TMD in Turkish adults. METHODS: The participants completed an online questionnaire consisting of sociodemographic questions, the Fonseca Anamnestic Index, and the Patient Health Questionnaire-4. RESULTS: The mean age of the 2580 participants was 35.29 ± 12.70 years, and 63.3% were women. The frequency of the participants who showed symptoms of TMD was 69.8%. The severity of TMD symptoms was significantly greater in participants who had signs/symptoms of anxiety and depression (p < 0.05). Sociodemographic and psychological data showed an association between the presence and severity of the symptoms of TMD and sex (OR 1.52, 95% confidence interval (CI) 1.26-1.85), parafunctional habits (OR 2.64, 95% CI 2.36-2.99), bruxism (OR 3.14, 95% CI 1.78-4.90), signs/symptoms of anxiety (OR 2.30, 95% CI 1.76-3.00), and signs/symptoms of depression (OR 1.90, 95% CI 1.48-2.42). CONCLUSIONS: The results of the present study suggest that females and those who report bruxism, parafunctional habits, and signs/symptoms of anxiety-depression are more likely to show symptoms of TMD with different severity.

Investigation of the biomechanical stability of Cfr-PEEK in the treatment of mandibular angulus fractures by finite element analysis.

The purpose of this study is to explore the effectiveness of Cfr-PEEK, in the fixation of unfavorable fractures of mandibular angulus by comparing it with the titanium and resorbable biomaterials. 8 different fixation models were created. In the first 4 groups, a single mini plate was applied to the upper edge of the fracture line by the Champy method. In the other 4 groups, an additional plate was placed on the lower edge of the fracture line. In these models, titanium, resorbable and Cfr-PEEK plate/screw systems were investigated by the finite element analysis method. The highest Von Mises stress was observed on the upper plate in the group 5 while the lowest was seen in the lower plate in the group 7. The highest stress values on the screws were observed on the screws placed closer to the fracture line. Considering the stresses on the bone around the screws, the highest Pmax and Pmin values were seen in group 5, and the lowest values were seen in the group 7. The highest displacement was observed in the group 3, while the lowest was observed in the group 5. According to the results it can be said that Cfr-PEEK plate/screw systems may provide advantages by decreasing the stresses on the fixation systems over the titanium plates and providing more stable fixation over the resorbable systems. Cfr-PEEK plates of 2 mm thickness seems to be a potential alternative to 1 mm thick titanium plates.

Is Teledentistry a Feasible Alternative for People Who Need Special Care?

OBJECTIVE: The aim of this study is to explore the feasibility and acceptability of teledentistry as a vehicle that provides enhanced delivery of oral care for the people who need special care (PNSC). METHODS: Between January 2018 and September 2020, PNSC who were admitted in the study were either waiting for a follow-up (F) appointment or on a waiting list. An examination via video call was carried out for initial examination (IE) and F purposes. The virtual examination was scored by the clinician who performed the examinations. The experience of the participants was evaluated with a satisfaction questionnaire. RESULTS: Forty PNSC (26 females, 14 males) between ages 7 and 48 years (21.17 ± 10.62) participated in the study. According to the clinician ratings, the accuracy of the examination was rated as the lowest. The F group had higher scores when compared to the IE group regarding clinician rating. No significant differences were found in terms of the scoring of the clinician and patient/parent satisfaction regarding cooperation status and type of examination (P ≥ 0.05). CONCLUSIONS: Through adequate adaptation of the technology into clinical practice and overcoming the barriers for wider implementation, the teledentistry approach could be a reliable and feasible alternative in triaging, treatment planning, and F purposes for PNSC.

The influence of education and gender on the esthetic perception of facial profile.

PURPOSE: The aim of the present study was to evaluate the facial esthetic perception of dental students, non-dental students, and laypersons with respect to digitally altered profile photographs in the vertical and sagittal dimensions. MATERIALS AND METHODS: Colored profile photographs of a male subject and a female subject were digitally altered in the sagittal and vertical dimensions. Preclinical and clinical dental students, clinical medical students, senior art and engineering students, and laypersons with various occupations were invited to rate the profile photographs and their treatment need by means of a questionnaire created on Google Forms. RESULTS: The study involved 574 participants (378 females, 196 males). Male and female straight normal profiles were found to be the most attractive facial profiles by all groups, followed by convex profiles. Concave profiles were rated as the least attractive and in need of more treatment. No significant difference was observed between the ratings of the preclinical and clinical dental students. The ratings of dental students showed significant differences in terms of esthetic perception compared with the engineering students and laypersons. Regarding the gender of the participants, there were significant differences between males and females. CONCLUSION: The perception of facial esthetics was influenced by education, and students whose study curriculum was esthetic in nature or clinically based were more critical in their judgment. The gender of the participants significantly influenced their esthetic judgment.

Evaluation of the xerostomia, taste and smell impairments after Covid-19 / Evaluación de la xerostomía, alteraciones del gusto y del olfato tras el Covid-19

Background: The purpose of this study was to explore the effects of coronavirus disease 19 (Covid-19) on the oralcavity by evaluating the oral findings in the patients who recovered after treatment.Material and Methods: This study involved confirmed Covid-19 patients whose treatment completed at least twoweeks ago. A questionnaire consist of eight parts was applied to explore the oral findings after Covid-19. Alsostimulated salivary flow rate was evaluated with a salivary flow test.Results: 177 patients reached and 107 of them participate in the study. Regarding gender significant differenceswere found in terms of the presence of taste impairment after treatment (p=0.007), the degree of taste (p=0.021)and smell (p=0.010) impairment. 18 % (5/27) of the patients evaluated were showed hyposalivation. No significantdifferences were observed regarding salivary flow between males (mean±SD: 1.14±0.65) and females (mean±SD:1.12±0.43), (p=0.928); among the patients having treatment at home (mean±SD: 1.03±0.48) or hospital (mean±SD:1.33±0.65), (p=0.187). In some of the patients’ taste [15], smell [23] impairment, and xerostomia [43] still observedat least two weeks after the treatment is completed.Conclusions: The most frequent finding in patients after the treatment was xerostomia. Taste and smell impair-ments were more frequently observed in females.(AU)

Retrospective Evaluation of Two-Implant-Supported Mandibular Overdentures with Radiographic and Clinical Aspects.

PURPOSE: The aim of this retrospective study was to evaluate the clinical performance of two implants supporting mandibular overdentures by means of clinical and radiologic parameters, and also to explore the relationship of marginal bone loss with implant-/patient-related factors and soft tissue parameters. MATERIALS AND METHODS: Data of patients who had undergone insertion of two implants into the interforaminal region between November 2012 and December 2016 using three different implant systems were retrieved from the archival records. Age, sex, implant length, implant diameter, observation period, mobility, and soft tissue parameters were recorded. Marginal bone levels and interimplant distances were measured with computer software on panoramic radiographs obtained at 3 months and at the recall session. RESULTS: A total of 43 patients with 86 implants were included in the study. Patients were evaluated with an average observation period of 41.79 months. Among the evaluated parameters, Gingival Index, Bleeding Index, and implant diameter were found to have significant effects on the marginal bone loss (P < .05). However, no significant effects of sex, age, implant length, observation period, and interimplant distance were observed on the marginal bone loss. No implants showed peri-implantitis or mobility, while eight implants showed peri-implant mucositis. CONCLUSION: Within the limitations of this study, it can be concluded that peri-implant soft tissue health and the diameter of the implant have an important effect on the marginal bone loss as well as the success of two-implant-supported mandibular overdentures.

Is Tele-Dentistry an Effective Approach for Patient Follow-up in Maxillofacial Surgery.

PURPOSE: To explore the feasibility and diagnostic accuracy of the tele-dentistry for the follow-up of different diagnostic groups of Turkish patients in maxillofacial surgery. MATERIALS AND METHODS: In this study, follow-up patients were allocated to four groups as dental implant, minor surgical procedure, infection-medication-related osteonecrosis of the jaws (MRONJ) and temporomandibular joint disorder (TMD). In all groups, remote examination via video call and subsequently face-to-face clinic examination were performed. The quality and accuracy of the video call were scored by the same investigator. Also, patient satisfaction regarding the video call was evaluated with a questionnaire. RESULTS: Twenty-one patients (12 females, 9 males) between 18 and 71 years (38.90 ± 17.88) participated in the study. A strong preference of 71% and 95% toward video call by patients was seen in the questionnaires performed after video call and face-to-face examination, respectively. Regarding the rating of the clinician, no significant differences were found between groups in terms of the quality and accuracy of video call (p ≥ 0.05). CONCLUSION: Remote follow up of diagnostic groups which can benefit from tele-dentistry pose a promising remedy that is reliable as in-person visits and also can reduce the clinical visits in routine clinical practice.

Is saliva a reliable biofluid for the detection of COVID-19?

This review aimed to assess the current evidence on the diagnostic potential of saliva regarding the detection of coronavirus disease 2019 (COVID-19). The literature published until May 24, 2020 was searched in the Web of Science, PubMed and Google Scholar databases with the keywords "COVID-19", "SARS-CoV-2", "2019-nCoV", "oral fluid", "saliva", and "diagnosis", individually and in combination, and 11 studies that explored the efficacy of saliva in the diagnosis of COVID-19 in different patient groups were found. Together, these studies suggest that saliva is a safe and reliable tool for the diagnosis of COVID-19. Further, saliva offers enhanced safety as well as logistical and economic benefits as compared to the current methods used to diagnose COVID-19. However, there is still limited evidence in the literature to make a definitive, clinically appropriate decision. The ideal specimen for the detection of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still an issue under investigation. Thus, new studies with large sample sets for the validation of easy, safe and reliable methods applicable for large-scale testing are immediately required.

Mirror-image phenomenon in Turkish monozygotic twins: A report of 3 cases.

Due to the special circumstances and the pre-natal environment in twin gestations, disruptions in the development of the embryo are more frequently observed in twin births as compared to singleton births. Twin research provides an excellent model to explore the etiology of disruptions in craniofacial biology. Mirror imaging (MI) is a special manifestation of twinning, and the elucidation of the etiology of this phenomenon is important to understand the biological mechanisms which underlie congenital defects, like orofacial clefts, and to provide insight into left-right asymmetry. The aim of this paper was, therefore, to present 3 pairs of Turkish monozygotic (MZ) twins with MI dental features, and to contribute to the knowledge of the MI phenomenon in the literature. We examined 2 male and 1 female MZ twin pairs clinically and radiographically in terms of their MI features. Mirrorimage features in dental and other ectodermal structures were detected in all the twins. Understanding the biological mechanisms of MI provides broad insight into preventive measures and treatment protocols. Furthermore, the presence of MI features may lead to the detection of other MI pathologies in twins.

Complex-Compound Odontoma: A Rare Clinical Presentation / Odontoma compuesto complejo: Una presentación clínica rara

ABSTRACT Odontomas can be detected as complex or compound variants and they rarely show the histologic characteristics of both types together. The tumor commonly associated with malocclusion, eruption disturbances and pathological anomalies, but they seldom cause bony expansion. Early detection and management of odontoma with multidisciplinary approach pose an important role to prevent disturbances associated with this common odontogenic tumor. Here we report a rare case of an odontoma which show the features of both complex and compound types and also cause bony expansion, eruption failure in an 8-year-old boy.

RESUMEN Los odontomas pueden detectarse como variantes complejas o compuestas y rara vez muestran la característica histológica de ambos tipos juntos. El tumor comúnmente se asocia con maloclusión, alteraciones de la erupción y anomalías patológicas, pero rara vez causan expansión ósea. La detección temprana y el manejo del odontoma con abordaje multidisciplinario representan un papel importante para prevenir las alteraciones asociadas con este tumor odontogénico común. Aquí presentamos un caso raro de un odontoma que muestra las características de los tipos complejos y compuestos y también causa expansión ósea, falla de erupción en un niño de 8 años.

Does Watching Videos Increase the Perioperative Anxiety in Patients Undergoing Third Molar Surgery? A Randomized Trial.

PURPOSE: The extraction of third molar teeth has usually been associated with a high level of anxiety, mainly from a lack of knowledge. We compared the effect of different informed consent formats on the perioperative anxiety level of patients scheduled for third molar surgery and explored the effects of watching a video about the surgical procedure from the Internet before the procedure on the patients' anxiety level. PATIENTS AND METHODS: A total of 113 patients who had been admitted for the removal of impacted third molars were randomly divided into control (verbal information) and study (video plus verbal information) groups. The anxiety level was assessed using the Amsterdam Preoperative Anxiety and Information Scale, Modified Dental Anxiety Scale, and Spielberger's State-Trait Anxiety Inventory. Pain was evaluated using the visual analog scale (VAS). RESULTS: The results showed that the study group had higher anxiety scores than the control group immediately after the consent process (P < .05). In all groups, the anxiety levels showed a decreasing trend after surgery. The VAS scores did not show significant differences when stratified by gender or educational level. No correlation was observed between age and the other variables. CONCLUSIONS: According to our results, the patients who watched the procedural video in an uncontrolled situation from websites before the operation were prone to high anxiety. The verbal and written consent format resulted in satisfactory anxiety management. Further studies are needed to clarify whether the use of video consent with different formats, such as animation, would be more effective in managing anxiety when applied carefully and under the control of a clinician.

Metastatic Prostate Adenocarcinoma of the Mandible Diagnosed With Oral Manifestations.

Metastasis from the prostate gland to the mandible is rarely encountered and commonly present with non-specific features like unexplained pain, swelling, and numb chin syndrome. Here we present a case with metastatic prostate adenocarcinoma detected secondary to oral manifestations. Patients present with unexplained facial pain and numbness should alert clinicians to the presence of malignant disease, and appropriate hematological, radiological and or histological investigations should be performed. Thereby, clinicians can prevent the overlook of the first signs of metastasis, accelerate the early diagnosis and positively orientate the prognosis of the disease, especially in a patient without known malignancy.

Persistent palatal hypertrophy associated with rapid maxillary expansion procedure: Report of a rare case.

Maxillary transversal deficiency (MTD) is a common skeletal problem. If not treated on time, MTD evolve to a more complex malocclusion. This problem can affect facial growth and development. Rapid maxillary expansion (RME) procedure frequently used for the management. This technique is usually successful in young individuals but as the age advances and the articulations of the maxilla with surrounding facial bones get more rigid, it becomes ineffective. Undesirable side effects or results have been reported after use of RME in skeletally mature patients such as buccal tipping of posterior teeth, extrusion, periodontal tissue recession, fenestration of buccal cortex, necrosis of palatal tissue, failure in opening of midpalatal suture, pain, and relapse of expansion. Side effects of RME are often temporary and permanent damages are rarely seen. The aim of this report is to present the management of a permanent side effect of the RME procedure in a 13-year-old child.

Isolated Actinomycosis of the Hard Palate Incurred Subsequent to Local Anesthesia.

Tissue necrosis associated with local anesthesia and actinomycosis is rare. Here, the authors present management of excessive palatal necrosis associated with local anesthesia and actinomycotic infection. In oral surgery a simple procedure can lead to severe complications. Thus, preformation of any surgical procedure with a rigorous manner preferably by a qualified clinician may prevent the occurrence of this type of complications.