The mandibular lingual foramen (MLF) is a clinically significant structure due to its proximity to neurovascular bundles. Variations in its morphology pose risks of hemorrhage and neurosensory injury during anterior mandibular surgery. The aim of this study was to evaluate the morphometric characteristics of the MLF using cone-beam computed tomography (CBCT) and analyze its relationship with age and gender to define safe surgical boundaries. A retrospective analysis was performed on 486 CBCT scans obtained from adult patients. Measurements included the number of lingual foramina, foramen diameter, canal length, distances from the alveolar crest and mandibular base, and total bone height. Gender-based comparisons were performed using Student's t-test, and correlations with age were assessed using Spearman's correlation analysis. Inter- and intra-observer reliability were evaluated using intraclass correlation coefficients (ICC). A single lingual foramen was observed in 62.8% of cases, while 31.9% presented with two foramina, 4.9% with three, and 0.4% with four foramina. Male patients exhibited significantly greater vertical and horizontal bone measurements, including distances from the alveolar crest and mandibular base, total bone height, and canal length (p < 0.05). No significant gender difference was observed in foramen diameter. Age showed no correlation with foramen diameter; however, a weak but significant negative correlation was detected between age and canal length (p = 0.045). Inter- and intra-observer reliability values were excellent (ICC > 0.98). The mandibular lingual foramen exhibits considerable anatomical variability influenced by gender and age. Male patients present with larger bone dimensions, while age-related bone resorption leads to a reduction in canal length without affecting foramen diameter. These findings emphasize the importance of individualized CBCT-based evaluation prior to surgical procedures in the anterior mandible to minimize the risk of complications.

Deep learning-based segmentation of enamel, cementum, alveolar bone, and gingiva in periodontal ultrasound images.

Accurate bucco-lingual bone width measurement is essential for implant planning. Manual cone-beam computed tomography (CBCT) assessment is time-intensive and operator-dependent. This study aimed to evaluate the accuracy of an artificial intelligence (AI)–based system for automated bone width measurement compared with manual methods. A retrospective diagnostic accuracy study was conducted using 300 CBCT scans of posterior mandibular edentulous sites. Manual bucco-lingual bone width was measured at 2-mm intervals from the alveolar crest to 2 mm superior to the mandibular canal. A deep learning framework with U-Net + + was trained to segment the alveolar ridge and mandibular canal, followed by automated bone width measurements. Model performance was assessed using Dice score, Intersection over Union (IoU), precision, and recall for segmentation accuracy, and regression metrics (mean squared error [MSE], mean absolute error [MAE], root mean squared error [RMSE], and coefficient of determination [R²]) for comparison with manual measurements. U-Net + + demonstrated high accuracy for alveolar ridge segmentation (Dice score, 0.9798; IoU, 0.9606; precision, 0.9820; recall, 0.9778) and moderate accuracy for mandibular canal segmentation (Dice score, 0.5640). Automated bucco-lingual width measurements showed reasonable correspondence with manual values (MSE, 1.9700 mm²; MAE, 1.1900 mm; RMSE, 1.4000 mm; R², 0.5300). Qualitative analysis confirmed high visual correspondence for ridge segmentation, though variability persisted in canal delineation. The AI-based U-Net + + system reliably segmented the alveolar ridge and provided bone width measurements with moderate agreement to manual methods. Mandibular canal segmentation remained a limitation. Broader validation across jaw regions and imaging systems is recommended to enhance clinical utility.

This prospective pilot study evaluated the clinical feasibility of autogenous tooth bone graft powder (ATBGP) for surgically assisted labial alveolar augmentation during orthodontic treatment, by assessing radiographic alveolar changes and patient-reported outcomes. Eleven adults with thin labial alveolar bone in the mandibular anterior region underwent surgically assisted alveolar augmentation with ATBGP, involving 52 teeth. Cone-beam computed tomography (CBCT) was performed at baseline and 0, 3, and 6 months postoperatively to assess alveolar bone parameters. Postoperative pain, function, and satisfaction were evaluated using a visual analog scale (VAS). Alveolar bone thickness and area increased at all postoperative time points, while alveolar crest height decreased (p<0.05). Labial bone defects decreased markedly, and sagittal root position improved. Mild root resorption was detected but remained within the physiological range. Most patients reported mild postoperative symptoms and high satisfaction. These findings suggest that ATBGP may represent a feasible, autogenous grafting material for surgically assisted alveolar augmentation in the mandibular anterior region, enabling biological reuse of extracted teeth and potentially reducing reliance on xenografts during orthodontic treatment. Larger randomized studies with longer follow-up are needed to confirm durability and safety.

Biologic width (BW) is the distance between the junctional epithelium and the supracrestal connective tissue above the alveolar crest, typically measuring approximately 2.04 mm. It is crucial for the health of periodontal, gingival, and alveolar bone tissues this creates a seal around the tooth’s neck to prevent periodontal disease and gingival inflammation. Violation of BW can create a myriad of complications, like gingival inflammation, attachment loss, and bone loss. The article further discusses restorative and implant margin placement strategies, as well as surgical interventions such as crown lengthening, which help preserve BW. New digital tools provide a more precise assessment of BW in dentistry.

This study evaluated the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and mandibular bone condition in adult individuals with periodontitis. Panoramic radiographs were obtained from 48 adult volunteers, who were categorized as having lower or higher vitamin D levels. Fractal dimensions (FD), Mental Index (MI), Panoramic Mandibular Index (PMI) and Mandibular Cortical Index (MCI) were evaluated using panoramic radiographs. Behavioural and sociodemographic data, as well as periodontal probing, were assessed. Statistical analyses were performed using the following tests: Student's t, the Mann-Whitney U and the chi-square or Fisher's exact, as appropriate. A p-value < 0.05 was considered statistically significant. Individuals with lower vitamin D levels showed a lower mean FD in the alveolar crest (0.63 ± 0.53), in contrast to subjects with higher vitamin D levels (0.68 ± 0.06, p = 0.01). The group with lower vitamin D levels had a reduced PMI (0.37 ± 0.05), compared to subjects with higher vitamin D levels (0.44 ± 0.06; p < 0.001). FD (apical region between premolars, mandibular condyle and mandibular angle), MI and MCI did not show significant differences between the groups (p ≥ 0.13). Lower serum vitamin D levels were associated with more porous trabeculae in the alveolar crest and reduced mandibular cortical thickness.

Automated detection of marginal bone loss levels in implant brands using deep learning on periapical radiographs.

The greater palatine foramen position during growth concerning deciduous dentition is extremely scarce. Knowledge of the anatomical variation of greater palatine foramen in infants and children is important to local anesthesia and to prevent injuries to the vascular-nervous bundle during surgeries. This study was conducted at Federal University of São Paulo (UNIFESP). Eighteen dry skulls of babies and children between 9 months to 7 years old were selected. The skulls were divided into two groups as follows: group 1: skulls with erupted first primary molars (N = 9) and group 2: skulls with erupted second primary molars (N = 9). To assess the shape and area of the greater palatine foramen, its antero-posterior and latero-lateral diameters (LL) were measured. After that, a formula was applied to determine its area. To assess the position of the foramen, a straight line was drawn and measured from it to the midpalatal suture and laterally to the margin of alveolar crest. In addition, a straight line was drawn between the midpalatal suture and the most convex region of the distal surface of the last molar. The distance between this reference line to the foramen was measured. Data were tabulated, analyzed using the Kolmogorov-Smirnov normality test and subsequently T-test was used to compare data between groups. The greater palatine foramen shifted significantly to lateral and posterior. The results show a change in the form and position of the foramen using the deciduous last molar as a reference, which is important for anesthetic techniques and surgical procedures performed in the region.

Alveolar bone augmentation (ABA) procedures are performed using a variety of substitute; however, studies comparing non-resorbable (NRM) and resorbable (RCM) membranes for horizontal ABA are limited. The objective of the present study is to conduct a radiologically comparison of the RCM and NRM on bone changes (BC), utilized in horizontal ABA treatment of edentulous sites. The present retrospective-designed study included patients who had received horizontal ABA treatment and, had pre- (T0) and post-treatment (T1) cone beam computed tomography (CBCT) scans were automatically superimposed by Dolphin Software. Two groups were defined in the study: horizontal ABA treatment with RCM and/or NRM. Radiographic measurements such as ridge width(RW), ridge height (RH), ridge angulation (RA), concavity location (CL), concavity depth (CD), cortical bone thickness (CT) on horizontal and vertical BC at 1, 3, 6, 9 and, 12mm from the alveolar crest. Logistic regression analysis was applied. Horizontal BC were not statistically significantly different between NRM and RCM at all levels. Membrane stabilization type, RA (T0) and CT-lingual/palatal variables had statistically significant effects on horizontal BC (1mm); the CA-T0 measurement among the variables of interest had a statistically significant effect on horizontal BC (3mm) and horizontal BC (6mm). CD-T0 and CT-coronal values showed a statistically significant association with bone gain; however, the magnitude of this effect per unit increase was limited. Non-resorbable membranes used for horizontal augmentation may be particularly important for stabilization at the alveolar crest. It has been shown that membrane stabilization type, radiographic angles and measurements may be also alter bone changes, highlighting the importance of preoperative radiographic evaluation. However, prospective studies with a more homogeneous distribution are needed.

The objective of this study is to evaluate the YOLOv11 and YOLOv12 deep learning models for the detection of overhanging restorations in panoramic radiographs and the calculation of the associated percentage of alveolar bone loss. Overhanging restorations were labeled using bounding boxes on 550 panoramic radiographs, while alveolar bone loss was labeled using position estimates of the enamel-cementum junction, alveolar crest, and root apex points. Two distinct models were developed, each based on the Ultralytics YOLOv11 and YOLOv12 architectures, and these models underwent a training, validation, and testing process on disparate datasets. The overhanging restoration detection model for YOLOv12 achieved a mean average precision at the 50-object level of 98.3%, a precision of 97.2%, and a recall of 96.5%. For YOLOv11, these values were 98.2%, 97.1%, and 96.3%, respectively. In the context of the bone loss position prediction model for YOLOv12, the values were determined to be 94.5%, 95.1%, and 96.1%, while for YOLOv11 these values were 94.1%, 94.5%, and 91.1%, respectively. The calculation of alveolar bone loss as a percentage is of paramount importance for the purpose of grading and staging according to the prevailing periodontal disease classification system. Nevertheless, the process is time-consuming, and it is susceptible to error, which can lead to incorrect or incomplete diagnoses. In this study, the percentage of alveolar bone loss was estimated by the proposed models with a technical inference speed of approximately 100ms under controlled experimental conditions. These results demonstrate that deep learning-based approaches may offer potential advantages in supporting clinical decision-making systems. However, further studies involving clinical time-motion analyses and diagnostic consistency comparisons are needed. It is therefore hypothesized that, with appropriate validation, the models developed in this study could eventually support clinical decision-making processes.

ObjectiveTo develop a predictive model for estimating cortical bone thickness at any maxillary location in patients with unilateral cleft lip and palate (UCLP).DesignRetrospective cross-sectional cohort study with machine learning.SettingUniversity hospital, Department of Oral and Maxillofacial Radiology.Patients, ParticipantsFifty patients with non-syndromic UCLP and 50 age- and gender-matched controls (total N = 100). Mean age: UCLP 14.8 ± 5.1 years; controls 16.5 ± 4.6 years. Age range: 8 to 27 years.InterventionsAll participants underwent CBCT (0.2 mm voxel, 14 × 16 cm FOV). Cortical bone thickness was measured at 4, 6, 8, 10, and 12 mm from the alveolar crest across six interradicular regions, yielding 4500 data points.Main Outcome Measure(s)Cortical bone thickness; model performance metrics (R2, RMSE); feature importance; accuracy by region and depth.ResultsRandom Forest regression explained 75% of variance (patient-level cross-validation: R2 = 0.75, RMSE = 0.102 mm). Anatomical region was the strongest predictor (0.38), followed by depth (0.27), age (0.18), cleft status (0.12), and side (0.05). Best accuracy in posterior regions (R2 = 0.84) and at 12 mm depth (R2 = 0.81); lowest in anterior regions (R2 = 0.72) and at 4 mm depth (R2 = 0.69). The model identified high-risk zones with 89% sensitivity (AUC = 0.94). External validation has not yet been performed; the author welcomes collaboration with other centers for independent testing.ConclusionsThis model provides accurate, patient-specific predictions of cortical bone thickness in UCLP patients, assisting in pretreatment risk assessment, surgical planning, and patient counseling.

Severe mandibular atrophy poses a significant challenge for dental implant placement due to insufficient bone volume. This study aimed to introduce and evaluate the efficacy of a buccal bone plate repositioning osteotomy technique for horizontal bone augmentation while preserving vertical bone height. In this prospective case series, 10 patients with severe mandibular atrophy (alveolar crest width 5 mm) underwent buccal bone plate repositioning osteotomy. Autogenous bone blocks were harvested from the surgical site, rotated 180 degrees and rigidly fixed to the lingual cortical plate with titanium screws. Guided bone regeneration was performed using xenograft, collagen membrane and platelet-rich fibrin. Horizontal bone width (at the crest and 1 mm below) and vertical height were measured by CBCT preoperatively, immediately postoperatively and at 6 months. Data were analysed with paired t tests. All patients experienced uneventful healing. At 6 months, significant horizontal bone gain was achieved (crest 4.67 ± 1.27 mm; 1 mm below crest 4.41 ± 1.33 mm; both P 0.001). Vertical bone height remained stable (13.26 ± 2.78 mm vs 13.31 ± 2.65 mm). All 12 implants placed after healing were successful, with stable bone levels at the 1-year follow-up. The buccal bone plate repositioning osteotomy technique provides predictable horizontal bone augmentation and maintains vertical height in cases of severe mandibular atrophy, eliminating the need for a secondary donor site. Rigid fixation to the lingual plate is crucial for success. Within the limitations of this case series, this approach appears to be a feasible solution for horizontal bone augmentation, with the advantage of avoiding a secondary donor site.

BackgroundThis study evaluated the influence of clinical periodontal, radiological, and demographic factors on gingival margin migration after fixed orthodontic treatment using linear mixed model analysis, with separate assessments of labial and lingual surfaces.MethodsThis retrospective single-cohort study analyzed pre and post treatment changes in 88 patients who underwent orthodontic treatment without a non treated control group. Patients were periodontally healthy based on the absence of bone loss on panoramic radiographs and three dimensional intraoral scans. The mean age was 19.25 ± 7.46 years, and measurements were performed on mandibular anterior teeth. Clinical crown length and keratinized tissue width were measured using three dimensional intraoral scans, and cephalometric variables were obtained from lateral radiographs. Gingival margin migration was defined as the change in clinical crown length from before to after treatment. Predictor variables included dental crowding, alveolar ridge width, incisor mandibular plane angle, gonion–menton–sella–nasion angle, symphysis morphology, age, sex, treatment duration, and keratinized tissue width. Linear mixed models were used to assess gingival margin migration across all surfaces and separately for labial and lingual surfaces, using baseline and treatment related changes as predictors.ResultsOf 530 screened patients, 88 were included (72% female). In baseline models, keratinized tissue width, dental crowding, and sex were significant predictors of gingival margin migration. Lingual migration was additionally associated with incisor mandibular plane angle, symphysis morphology, and age. On the labial surface, incisors showed more coronal gingival margin position than canines relative to baseline. In models based on treatment related changes, keratinized tissue width, dental crowding, and age were consistent predictors across all surfaces. Labial margins showed more coronal position than lingual margins, while lingual migration was negatively associated with changes in incisor mandibular plane angle. Changes in keratinized tissue width had the strongest effect.ConclusionsBaseline keratinized tissue width and its increase during treatment were the strongest predictors of gingival margin stability. Dental crowding, incisor inclination, and symphysis morphology showed surface and tooth specific effects, whereas alveolar crest width had no significant impact.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-026-08756-y.

Impact of upper central incisor contact with incisive canal on root resorption and retraction efficiency: A retrospective CBCT study.

Sufficient median ossification after surgically assisted maxillary expansion (SAME) facilitates rapid anterior tooth integration and accelerates orthodontic treatment, whereas insufficient ossification may necessitate additional surgery. This study aimed to evaluate the influence of different surgical techniques, distraction devices, and activation protocols on median palatal and alveolar crest ossification, tooth sensitivity, and incisor mobility after SAME. Seventy-one patients (38 males, 33 females; mean age 29.0±7.4 years, range 18-61) underwent SAME using either chisel or piezotome techniques and tooth-borne or bone-borne distractors. Activation protocols varied by initiation time, activation frequency and distraction duration. Median ossification was assessed using postoperative cone beam computed tomography (CBCT) and tooth sensitivity and mobility were evaluated six months postoperatively. No significant influence of surgical technique, distraction device or activation protocol was found on ossification, tooth sensitivity or mobility. However, smokers exhibited significantly reduced ossification compared to non-smokers (p=.015). Logistic regression revealed that greater distraction distance decreased the probability of complete ossification, while the use of bone-borne distractors increased it. In conclusion, optimal ossification after SAME is associated with bone-borne distractors, non-smoking status and shorter distraction distances.

ObjectivesTo examine and synthesize orthodontic outcomes, including treatment feasibility, spontaneous or orthodontically assisted eruption of maxillary canines, and periodontal or alveolar bone-related outcomes, following secondary alveolar bone grafting (SABG) in patients with cleft lip and palate (CLP).Materials and MethodsA comprehensive PubMed, Scopus, EBSCOhost (MEDLINE), and Cochrane Library search was conducted until February 9, 2025. Randomized controlled trials and observational clinical studies of non-syndromic unilateral or bilateral cleft lip and palate patients who had SABG were eligible. The GRADE framework rated evidence certainty, whereas the Cochrane RoB 2 tool assessed bias in randomized trials and the ROBINS-I instrument in non-randomized research. Narrative synthesis was used due to study design and orthodontic protocol heterogeneity.ResultsFrom 528 records, 6 studies (1 randomized controlled trial and 5 observational cohorts) with 167 patients met the inclusion criteria. The synthesized results showed that thorough orthodontic mechanics and spontaneous and directed canine eruption into the grafted region were possible after graft integration. Cone-beam computed CT showed excellent short- to mid-term periodontal architecture, including alveolar crest height and no prominent bone dehiscences.ConclusionSABG provides a clinically effective foundation for CLP patients' orthodontic rehabilitation. Directed orthodontic tooth movement and maxillary canine eruption are feasible; however, the low certainty of the evidence means that current data should inform clinical judgment and therapy planning rather than treatment efficacy.

Alveolar bone regions with low innate thickness are prone to dehiscence, potentially causing harmful gingival recession. In situ alveolar bone thickening via local bioagent administration has recently emerged as a promising research area. Parathyroid hormone-related protein (PTHrP), encoded by the Pthlh gene, plays a pivotal role in skeletal development and bone remodeling. In this study, we developed a recombinant adeno-associated virus (rAAV) vector overexpressing Pthlh (rAAV9-Pthlh). Using a split-mouth design, we administered rAAV9-Pthlh via a single submucosal injection into the right maxillary buccal gingiva of rats. Micro-computed tomography scans, both in vivo and ex vivo, revealed a significant increase in alveolar bone thickness on the PTHLH sides 6 wk post-transfection. This enhanced alveolar bone formation was accompanied by marked periosteal thickening, with elevated expression of PTHrP, parathyroid hormone 1 receptor (PTH1R), OCN, and COL1A1. RNA sequencing of the buccal bone tissue showed upregulation of osteogenesis-related pathways along with increased mitophagy activity. Immunofluorescence confirmed enhanced colocalization of mitochondrial and lysosomal markers in the PTHLH group, primarily in the periosteum. Overexpressing Pthlh in primary rat periosteal stem cells via lentiviral transduction promoted cell proliferation and migration and elevated expression of COL1A1, as well as mitophagy markers BNIP3 and LC3-II. These effects were mitigated by Mdivi-1, an inhibitor of mitochondrial fission, suggesting potential involvement of mitophagy-dependent mitochondrial homeostasis maintenance. Finally, we established a rat model of repeated maxillary expansion and validated the effects of prophylactic rAAV9-Pthlh injection to protect against alveolar crest loss in this scenario. In conclusion, local rAAV9-Pthlh injection enhances in situ alveolar bone formation, holding potential for preventing dehiscence in aging or following orthodontic interventions. Additionally, overexpression of PTHrP in the alveolar periosteum has reiterated its well-documented role in expanding the pool of chondroskeletal progenitors, a process vital for the development of long bones and the mandibular condyle.

Vascular injury to the posterior superior alveolar artery (PSAA) during lateral sinus floor augmentation is a recognized surgical complication, yet data on PSAA anatomy in severely atrophic edentulous maxillae remain scarce. This study aimed to evaluate the prevalence, location patterns, and morphometric characteristics of the PSAA in this specific population using cone-beam computed tomography (CBCT). Preoperative CBCT scans of 121 patients (242 sinuses) with severely atrophic posterior maxillae (residual ridge height ≤ 5mm) were retrospectively analyzed. PSAA location was classified as intraosseous (Type I), submembranous (Type II), extraosseous (Type III), or transosseous (Type IV). PSAA diameter and vertical distances to the sinus floor (PSAA-SF) and alveolar crest (PSAA-ALV) were measured. Generalized estimating equations accounted for within-patient correlation from bilateral evaluations. The PSAA was identified in 99.17% of sinuses, predominantly Type II (56.67%), followed by Type I (37.50%), Type IV (3.33%), and Type III (2.50%). Mean PSAA diameter was 1.02 ± 0.56mm, mean PSAA-SF distance 8.89 ± 4.61mm, and mean residual ridge height 3.55 ± 1.37mm. Type II location was significantly associated with Schneiderian membrane thickening (p = 0.018). In severely atrophic edentulous maxillae planned for lateral sinus floor augmentation, the PSAA predominantly follows a submembranous course alongside a clinically critical transosseous variant. Preoperative CBCT assessment of the PSAA is essential to inform individualized surgical planning and minimize hemorrhagic risks.

Biomechanical Effects of Implant-Root Fragment Contact in the Socket Shield Technique: A Finite Element Analysis

BackgroundImplant placement in the posterior maxilla is often complicated by anatomical limitations such as reduced alveolar bone volume, sinus pneumatization, sinus septa, and variations in ridge morphology. Accurate radiographic evaluation of these structures is therefore essential for predictable implant planning in the maxillary first molar region (MFMR). The aim of this study was to investigate the relationships between alveolar bone height (ABH), bucco-palatal crest thickness (CT), buccal concavity, sinus septa (SS), sinus pathology (SP), and demographic factors (age and gender), as well as jaw side and tooth presence in the MFMR, and to evaluate their relevance for implant planning.Materials and methodsA total of 798 cone-beam computed tomography (CBCT) images from 399 individuals were retrospectively analyzed. ABH and CT were measured from the alveolar crest to a point 2 mm coronal to the maxillary sinus membrane. The presence of concavity, SS, and SP was recorded using a binary (present/absent) classification.ResultsABH and CT were significantly greater in dentate sites compared to edentulous sites (p < 0.05). Age was significantly associated with CT, buccal concavity, SS, and SP (p < 0.05). Tooth presence was significantly associated with concavity and SP, gender with SP, and jaw side with SS (p < 0.05).ConclusionAnatomical variations in the MFMR are significantly influenced by demographic and site-related factors. Comprehensive CBCT-based evaluation of alveolar bone dimensions and sinus-related structures is essential for individualized and risk-aware implant planning in this region.