Diagnostic accuracy of artificial intelligence-assisted caries detection: a clinical evaluation.

OBJECTIVE: This clinical study aimed to evaluate the practical value of integrating an AI diagnostic model into clinical practice for caries detection using intraoral images. METHODS: In this prospective study, 4,361 teeth from 191 consecutive patients visiting an endodontics clinic were examined using an intraoral camera. The AI model, combining MobileNet-v3 and U-net architectures, was used for caries detection. The diagnostic performance of the AI model was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, with the clinical diagnosis by endodontic specialists as the reference standard. RESULTS: The overall accuracy of the AI-assisted caries detection was 93.40%. The sensitivity and specificity were 81.31% (95% CI 78.22%-84.06%) and 95.65% (95% CI 94.94%-96.26%), respectively. The NPV and PPV were 96.49% (95% CI 95.84%-97.04%) and 77.68% (95% CI 74.49%-80.58%), respectively. The diagnostic accuracy varied depending on tooth position and caries type, with the highest accuracy in anterior teeth (96.04%) and the lowest sensitivity for interproximal caries in anterior teeth and buccal caries in premolars (approximately 10%). CONCLUSION: The AI-assisted caries detection tool demonstrated potential for clinical application, with high overall accuracy and specificity. However, the sensitivity varied considerably depending on tooth position and caries type, suggesting the need for further improvement. Integration of multimodal data and development of more advanced AI models may enhance the performance of AI-assisted caries detection in clinical practice.

Modified Le Fort I interpositional grafting of the severe atrophied maxilla-a retrospective study of 106 patients over 10 years.

OBJECTIVES: The objective of this study was to evaluate a modified Le Fort I interpositional grafting followed by dental implants for the rehabilitation of edentulous atrophied maxillae (Cawood classes IV and V). The surgical modification was a bilateral sinus floor augmentation prior to the osteotomy. This generated a closed recipient bed which allowed the use of particulated bone grafts (xenogenic bone mineral) and a reduced amount of autologous iliac bone grafts. MATERIALS AND METHODS: A total of 106 patients with maxillary interpositional bone grafts were included in this retrospective analysis between 2006 and 2020. The panoramic radiographs and lateral cephalograms were analyzed to assess the gain and stability of the maxillary bone and the peri-implant bone loss. In addition, the observational period of up to 14 years implant survival and success was evaluated. RESULTS: A stable vertical bone height with mean 0.63 ± 1.41 mm resorption over 5 years after implant loading was observed. A mean of 0.20 ± 0.37 mm marginal bone loss was noted after 5 years. The implant survival was 96.4% after 5 years and implant success can be rated 91.7% in a mean follow-up period of 93 months and 168 months maximal observation time. Perioperative complications included sinus membrane perforation (59.43%), wound healing disturbances (25.47%), and transient primary complications (13.78%). All receded apart from two subtotal graft losses (1.8%). CONCLUSIONS: The modified Le Fort I osteotomy with interpositional bone grafts is a predictable procedure in terms of bone and implant stability. Patients with atrophic maxillae who are fit for surgery should be informed about risks and benefits of this treatment alternative.

Dental implant location via surface scanner: a pilot study.

PURPOSE: Implant location is performed after placement to verify that the safety of neighboring anatomic structure and the realizability of prosthetic plan. Routine postoperative location is based on radiological scanning and raises the concerns on radiation exposure and inconveniency in practice. In the present study a location method based on surface scanning was introduced and the accuracy of this method was assessed in vitro. MATERIAL AND METHODS: A total of 40 implants were placed in 10 resin mandible models. The models were scanned with intraoral scanner (IS group) and extraoral scanner (ES group). The implant position was located with fusing the images of surface scanning and cone beam computerized tomography (CBCT) after implant placement. Deviations were measured between positions located by surface scanner and postoperative CBCT with the parameters: central deviation at apex (cda), central deviation at hex (cdh), horizontal deviation at apex (hda), horizontal deviation at hex (hdh), vertical deviation at apex (vda), vertical deviation at hex (vdh) and angular deviation (ad). RESULTS: In IS group, the mean value of cda, cdh, hda, hdh, vda, vdh and ad was 0.27 mm, 0.23 mm, 0.12 mm, 0.10 mm, 0.21 mm, 0.19 mm and 0.72°, respectively. In ES group, the mean value of cda, cdh, hda, hdh, vda, vdh and ad was 0.28 mm, 0.25 mm 0.14 mm, 0.11 mm, 0.22 mm, 0.20 mm and 0.68°, respectively. The implant deviations in IS and ES groups were of no significant difference for any of the measurements. CONCLUSIONS: Dental implant can be located via surface scanner with acceptable accuracy for postoperative verification. Further clinical investigation is needed to assess the feasibility of the method.

Sandwich osteotomy in atrophic mandibles: A retrospective study with a 2- to 144-month follow-up.

OBJECTIVES: The aim of the present retrospective study was to assess the long-term clinical outcome of sandwich osteotomy in pre-implant augmentation of atrophic mandible. MATERIALS AND METHODS: Sandwich osteotomies were performed in partially and fully edentulous mandibles of 63 consecutive patients in the present study. The vertical bone gain, graft stability, and marginal bone loss were measured radiographically. Implant survival and success rates were estimated in the follow-up ranged from 2 to 144 months (mean, 58 months). RESULTS: A total of 75 procedures were reviewed. After an average healing time of 148 days, 220 implants were placed in 74 procedures. Perioperative complications included intraoperative fracture (1/75), transient paresthesia (18/75), wound healing disturbance (18/75), and keratinized tissue deficiency (14/75). The average vertical bone gain was 5.4 mm at the time of implant placement. Significant marginal bone loss occurred during the first 6 months, after which the resorption remained stable. The implant survival rate was estimated as 96.7%, and the success rate was 95.3%. Implant survival and success showed no significant correlation with higher age, anticoagulation therapy, cardiovascular disease, or thyroid disorder. Smoking was correlated with significant lower success rate. CONCLUSION: Sandwich osteotomy is a suitable augmentation procedure for atrophic mandible, allowing for implant placement with promising outcome.

NIR Laser Irradiation Promotes Osteogenic Differentiation of PDLSCs Through the Activation of TRPV1 Channels and Subsequent Calcium Signaling.

Near-infrared (NIR) irradiation has shown potential to stimulate osteogenic differentiation, but the mechanisms are not fully understood. The study is to investigate the effects of NIR laser irradiation on osteoblastic differentiation. Human periodontal ligament stem cells (hPDLSCs) were cultured in osteogenic medium and exposed to 810 nm NIR laser at 0.5 J/cm2 every 48 h. The transient receptor potential vanilloid (TRPV1) channel inhibitor capsazepine (CPZ) was used to evaluate the role of calcium influx. Osteogenic differentiation was assessed by proliferation (CCK-8), alkaline phosphatase (ALP) activity, mineralization (Alizarin Red), and expression of bone markers by PCR and Western blot over 2 weeks. Intracellular calcium was measured by Fluo-4M dye and flow cytometry. Results showed that NIR irradiation enhanced hPDLSC proliferation, ALP activity, mineralization, and bone marker expression, indicating increased osteogenic differentiation. These effects were inhibited by CPZ. NIR induced a transient rise in intracellular calcium peaking at 3 min, which was blocked by CPZ. In conclusion, this study demonstrates that NIR laser irradiation promotes osteogenic differentiation of PDLSCs through the activation of TRPV1 channels and subsequent calcium signaling. Further research is warranted to optimize the treatment parameters and elucidate the detailed signaling pathways involved, paving the way for the clinical application of NIR therapy in the treatment of bone disorders and periodontal disease.

Bone regeneration with hydroxyapatite particles loaded in photo-cross-linkable hydrogel: An experimental study.

This study explores the use of in situ cross-linked hyaluronic acid methacryloyl (HAMA) and hydroxyapatite particles (HAP) for bone defect repair. Human periodontal ligament stem cells (PDLSCs) were isolated and co-cultured with the HAMA-HAP composite. Osteogenic differentiation was evaluated using Alizarin Red staining, alkaline phosphatase activity quantification, and polymerase chain reaction (PCR). A cranial defect was induced in Sprague-Dawley rats. This defect was then filled with the HAMA-HAP composite and cross-linked using UV light exposure. Bone formation was assessed through radiographic and histological analyses. The HAMA-HAP composite was found to promote cell viability similarly to pure HAP. It also enhanced gene expression of ALP, OPN, and Runx2, and increased ALP activity and mineralized nodule formation in vitro. Micro-CT scans showed defect restoration in the HAMA-HAP and HAP groups compared to the control group. The HAMA-HAP group exhibited higher Tb.N, Tb.Sp, Tb.Th, and BV/TV. Masson staining showed the HAMA-HAP composite restored the defect site, with new bone formation thicker than in the HAP group. The HAMA-HAP composite showed excellent biocompatibility and promoted osteogenic differentiation of PDLSCs. It effectively repaired cranial defects, indicating its potential for clinical use in bone defect repair.

Comparison of the accuracy of dental implant placement using static and dynamic computer-assisted systems: an in vitro study.

OBJECTIVES: The study aimed to compare the accuracy of implant placement between static and dynamic computer-assisted systems (CAS) in a partially edentulous mandible model. MATERIALS & METHODS: A total of 80 implants was placed in mandible models. The implants were placed using either static or dynamic computer-assisted system. Deviations of implant hex, apex and angulation were measured between preoperative planning and postoperative CBCT in planning software. RESULTS: The mean deviations of implant hex, apex and angulation in static CAS group were 1.15 ± 0.34 mm, 1.37 ± 0.38 mm and 2.60 ± 1.11 degree, while in dynamic CAS group were 0.40 ± 0.41 mm, 0.34 ± 0.33 mm and 0.97 ± 1.21 degree, respectively. Implant placement with dynamic CAS showed less deviations of shoulder, apex and angulation than with static CAS significantly. CONCLUSIONS: The implant accuracy using CAS system could be influenced by the guiding technique.

Accuracy of Implant Placement Guided with Surgical Template: An In Vitro and In Vivo Study.

This study evaluated the accuracy of implant placement with surgical-template guidance both in vitro and in vivo. Virtual surgical planning was performed based on the data from CBCT scans and an intraoral scanner. Surgical templates were designed according to the planned implants and manufactured with stereolithography. In vitro, 60 implants were placed in 15 resin models. In vivo, 74 implants were placed in 54 patients. The implants were scanned with CBCT postoperatively. Implant accuracy was evaluated by measuring the following parameters: central deviation at the apex and shoulder, horizontal deviation at the apex and shoulder, vertical deviation at the apex and shoulder, and angular deviation. There were statistically significant in vitro and in vivo deviations for all parameters, and the implant deviations in vivo were significantly greater than those in vitro. When using a mucosa-supported template, horizontal deviations at the apex were significantly greater than when a teeth-supported template was used. Within the limitation of the study design, inaccuracy existed in implant placement guided with a surgical template. More studies are needed to investigate the value of the procedure in future.

Prefabricated 3D-Printed Tissue-Engineered Bone for Mandibular Reconstruction: A Preclinical Translational Study in Primate.

The advent of three dimensionally (3D) printed customized bone grafts using different biomaterials has enabled repairs of complex bone defects in various in vivo models. However, studies related to their clinical translations are truly limited. Herein, 3D printed poly(lactic-co-glycolic acid)/ß-tricalcium phosphate (PLGA/TCP) and TCP scaffolds with or without recombinant bone morphogenetic protein -2 (rhBMP-2) coating were utilized to repair primate's large-volume mandibular defects and compared efficacy of prefabricated tissue-engineered bone (PTEB) over direct implantation (without prefabrication). 18F-FDG PET/CT was explored for real-time monitoring of bone regeneration and vascularization. After 3-month's prefabrication, the original 3D-architecture of the PLGA/TCP-BMP scaffold was found to be completely lost, while it was properly maintained in TCP-BMP scaffolds. Besides, there was a remarkable decrease in the PLGA/TCP-BMP scaffold density and increase in TCP-BMP scaffolds density during ectopic (within latissimus dorsi muscle) and orthotopic (within mandibular defect) implantation, indicating regular bone formation with TCP-BMP scaffolds. Notably, PTEB based on TCP-BMP scaffold was successfully fabricated with pronounced effects on bone regeneration and vascularization based on radiographic, 18F-FDG PET/CT, and histological evaluation, suggesting a promising approach toward clinical translation.

Hydroxyapatite-incorporation improves bone formation on endosseous PEEK implant in canine tibia.

BACKGROUND: Poly Ether Ether Ketone (PEEK) has been considered as a potential alternative material for endosseous dental implants, for its low elastic modulus, biocompatibility, and low cost in customized device manufacture. Hydroxyapatite-incorporation is supposed to improve the poor osseointegration of PEEK. METHODS: In the present study we analyzed the in vivo response of hydroxyapatite-incorporated PEEK (PEEK-HA) implants in canine tibia. PEEK-HA and PEEK implants were implanted and were examined 4 weeks and 12 weeks after implantation with radiology and histology. Commercial titanium dental implants served as controls. RESULTS: The ratio of bone volume to tissue volume of PEEK-HA implants was higher than that of PEEK implants 4 weeks after implantation in the µ-CT analysis. The bone implant contact of PEEK and PEEK-HA implants showed no statistical difference in the histological examination, but newly-formed bone around PEEK-HA implants showed more signs of mineralization than that around PEEK implants. CONCLUSION: The study suggested that bone formation was improved with hydroxyapatite-incorporation in PEEK. Hydroxyapatite-incorporated PEEK implants may represent a potential material for endosseous dental implant.