Dental Pathology Research Articles

Segmentation of periapical lesions with automatic deep learning on panoramic radiographs: an artificial intelligence study

Periapical periodontitis may manifest as a radiographic lesion radiographically. Periapical lesions are amongst the most common dental pathologies that present as periapical radiolucencies on panoramic radiographs. The objective of this research is to assess the diagnostic accuracy of an artificial intelligence (AI) model based on U²-Net architecture in the detection of periapical lesions on dental panoramic radiographs and to determine whether they can be useful in aiding clinicians with diagnosis of periapical lesions and improving their clinical workflow. 400 panoramic radiographs that included at least one periapical radiolucency were selected retrospectively. 780 periapical radiolucencies in these anonymized radiographs were manually labeled by two independent examiners. These radiographs were later used to train the AI model based on U²-Net architecture trained using a deep supervision algorithm. An AI model based on the U²-Net architecture was implemented. The model achieved a dice score of 0.8 on the validation set and precision, recall, and F1-score of 0.82, 0.77, and 0.8 respectively on the test set. This study has shown that an AI model based on U²-Net architecture can accurately diagnose periapical lesions on panoramic radiographs. The research provides evidence that AI-based models have promising applications as adjunct tools for dentists in diagnosing periapical radiolucencies and procedure planning. Further studies with larger data sets would be required to improve the diagnostic accuracy of AI-based detection models.

Diagnosis and endodontic treatment of odontogenic cutaneous sinus tracts: A report of two cases

Introduction: The odontogenic cutaneous sinus tract (OCST), caused by pulp necrosis, creates connections between pathological spaces and anatomical structures. Extraoral manifestations pose diagnostic challenges leading to inappropriate treatments such as multiple surgery and antibiotic therapies. Effective management requires the treatment of dental pathology through endodontic therapy or extraction. This paper presents two cases of OCST and emphasizes the importance of accurate diagnosis and successful non-surgical endodontic treatment. Observations: Case report 1: A 23-year-old male patient referred by his dermatologist with a cutaneous sinus tract on his chin that had appeared five years ago. During this period, he reported spontaneous pain and pus discharge from the chin area. The examination revealed a periapical lesion associated with tooth number 31. Cone beam computed tomography (CBCT) revealed the existence of a localized perforation on the buccal alveolar table and a second root canal of the tooth. After six months of follow-up, the cutaneous sinus tract was significantly improved by the appropriate endodontic treatment. Case report 2: A 36-year-old female patient was referred by her dentist to examine a chin lesion that had appeared a month ago. In clinical examination and radiographic assessment, periapical lesion associated with two mandibular central incisor teeth #41 and #31 was observed. After identifying the source of infection, endodontic treatment was carried out, and a good improvement in fistula was observed after one month. Conclusions: The correct diagnosis and treatment of OCST are important for healing. CBCT aids to identify odontogenic origin of the sinus tract through the detection of apical periodontitis and bone lesion. Root canal therapy is the treatment of choice for these cases and should always be attempted first. Monitoring the patients is necessary until complete healing of the disease.

Automating Dental Condition Detection on Panoramic Radiographs: Challenges, Pitfalls, and Opportunities.

Background/Objectives: The integration of AI into dentistry holds promise for improving diagnostic workflows, particularly in the detection of dental pathologies and pre-radiotherapy screening for head and neck cancer patients. This study aimed to develop and validate an AI model for detecting various dental conditions, with a focus on identifying teeth at risk prior to radiotherapy. Methods: A YOLOv8 model was trained on a dataset of 1628 annotated panoramic radiographs and externally validated on 180 radiographs from multiple centers. The model was designed to detect a variety of dental conditions, including periapical lesions, impacted teeth, root fragments, prosthetic restorations, and orthodontic devices. Results: The model showed strong performance in detecting implants, endodontic treatments, and surgical devices, with precision and recall values exceeding 0.8 for several conditions. However, performance declined during external validation, highlighting the need for improvements in generalizability. Conclusions: YOLOv8 demonstrated robust detection capabilities for several dental conditions, especially in training data. However, further refinement is needed to enhance generalizability in external datasets and improve performance for conditions like periapical lesions and bone loss.

An unexpected role of neurite outgrowth inhibitor A as regulator of tooth enamel formation

Neurite outgrowth inhibitor A (Nogo-A) is a major player in neural development and regeneration and the target of clinical trials aiming at promoting the regeneration of the central nervous system upon traumatic and ischemic injury. In this work, we investigated the functions of Nogo-A during tooth development to determine its role in dental physiology and pathology. Using immunohistochemistry and in situ hybridization techniques, we showed that Nogo-A is highly expressed in the developing mouse teeth and, most specifically, in the ameloblasts that are responsible for the formation of enamel. Using both Nogo-A knockout and K14-Cre;Nogo-A fl/fl transgenic mice, we showed that Nogo-A deletion in the dental epithelium leads to the formation of defective enamel. This phenotype is associated with overexpression of a set of specific genes involved in ameloblast differentiation and enamel matrix production, such as amelogenin, ameloblastin and enamelin. By characterising the interactome of Nogo-A in the dental epithelium of wild-type and mutant animals, we found that Nogo-A directly interacts with molecules important for regulating gene expression, and its deletion disturbs their cellular localisation. Furthermore, we demonstrated that inhibition of the intracellular, but not cell-surface, Nogo-A is responsible for gene expression modulation in ameloblasts. Taken together, these results reveal an unexpected function for Nogo-A in tooth enamel formation by regulating gene expression and cytodifferentiation events.

Extraction of teeth in dogs

The article is devoted to the problems with the dental apparatus, indications and techniques of tooth extraction in dogs. Tooth extraction is an operative intervention in which the gum and periodontal tissues are separated in order to extract a tooth or root from the alveolar well. Various dental pathologies in dogs are very common. Dentistry has recently become a popular specialty among veterinary specialists. Mostly owners go to the veterinary clinic with complaints about the presence of an unpleasant odor from the oral cavity of their pet. It is much rare for owners to notice soreness in the animal during feed consumption, hypersalivation, the presence of blood and pus impurities, and a violation of jaw closure. There are certain indications for tooth extraction, which are divided into urgent and planned. Indications for urgent extraction include tooth mobility with an acute pain reaction, inability to take food, periapical abscess, etc. The planned tooth extraction includes: temporary teeth, teeth that injure soft tissues, dental pathologies that are not amenable to therapy, the presence of granulomas, cysts, and tumors on the roots of the tooth.

Extent of Endoscopic Sinus Surgery for Odontogenic Sinusitis of Endodontic Origin with Ethmoid and Frontal Sinus Involvement.

Background/Objectives: Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification. Initial treatment consists of intranasal steroids and antimicrobial therapy. In case of persistence of the disease, endoscopic sinus surgery (ESS) is advised. It is still not clear what extension of ESS is required and whether frontal sinusotomy or ethmoidectomy is justified in ODS with frontal sinus involvement. Methods: Adult patients presented with uncomplicated recalcitrant bacterial ODS due to endodontic-related dental pathology were evaluated by an otolaryngologist and a dentist and scheduled for ESS. Sinus CT scan demonstrated opacification of maxillary sinus and partial or complete opacification of extramaxillary sinuses ipsilateral to the side of ODS. Patients were undergoing either maxillary antrostomy, antroethmoidectomy, or antroethmofrontostomy. Preoperative and postoperative evaluations were done with nasal endoscopy, dental examination, subjective and radiological symptoms. Results: The study group consisted of 30 patients. Statistically significant decreases in values after surgery were found for SNOT-22, OHIP-14, Lund-Mackay, Lund-Kennedy, and Zinreich scale. Tooth pain was present in 40% cases during the first visit and in 10% during the follow-up visit. Foul smell was initially reported by 73.3% and by one patient during follow-up visit (3.3%). Significantly longer total recovery time and more crusting was marked for antroethmofrontostomy when compared to maxillary antrostomy. Conclusions: ESS resolved ODS with ethmoid and frontal involvement in almost every case. Minimal surgery led to improved overall clinical success in the same way as antroethmofrontostomy without risking the frontal recess scarring and stenosis.

Comorbidity of inflammatory bowel diseases and periodontal pathology

Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, are a global disease of the 21st century. Periodontitis is the sixth most common disease in the world (second among dental pathologies after caries) and the leading cause of tooth loss in adults. At the beginning of the 21st century, the concept of “periodontal medicine” was formed, within the framework of which the bidirectional connection of periodontal pathology with systemic diseases of the body is considered. Extraintestinal manifestations of inflammatory bowel disease are associated with the generalized nature of the inflammatory response. In clinical guidelines, only aphthous stomatitis is described as a systemic manifestation of Crohn’s disease and ulcerative colitis from the oral cavity. Periodontitis is considered a less representative non-specific oral manifestation of inflammatory bowel disease. We searched the Pubmed and Scopus information databases for articles published before 02/15/2024 that examined the relationship between inflammatory bowel disease and periodontal pathology. The results of clinical studies, their synthesis in systematic reviews and meta-analyses, indicate a bidirectional relationship between Crohn’s disease and ulcerative colitis with periodontal pathology. The most likely mechanism is associated with a change in the microbiocenosis of the oral cavity and a further change in the intestinal microbiome due to oral intake of periodontal organisms, which leads to impaired intestinal permeability and the development of immune reactions that play a key role in the development of periodontal diseases and inflammatory bowel diseases.

Tomographic and ultrasound evaluation of the thyroid gland in pet guinea pigs.

There has been increasing interest in the literature on primary thyroid diseases in guinea pigs, which are believed to be underdiagnosed. This study describes the size and characteristics of the thyroid gland on ultrasound (US) and CT examinations in the guinea pig (Cavia porcellus) without evidence of thyroid pathology and examines the possible use of US as a routine examination for thyroid diseases. This prospective and anatomical study included 20 guinea pigs that underwent CT for dental pathologies and US for thyroid gland (TG) examination. Based on US and CT images, this study evaluated the thyroid lobe dimensions (length, height, and width) and shape. Echogenicity and homogeneity were assessed on US images, and attenuation values (HU) and homogeneity were evaluated on CT images. All animals underwent CT and US examinations under anesthesia. Thyroid lobes appeared more frequently as fusiform on CT (65%) and oval on US scans (67.5%). The attenuation values on CT scans were homogeneous. On the US scans, the TG was more frequently hypoechoic. No statistically significant differences were found between the size of the right and left thyroid lobes, both with CT and US. A statistically significant difference was found between the length values on CT and US. The US and CT thyroid gland dimensions, shape, and appearance were described. Both CT and US are useful techniques for evaluating the TG in guinea pigs.

Contrast-Enhanced Micro-CT Imaging of Murine Mandibles: A Multi-Method Approach for Simultaneous Hard and Soft Tissue Analysis.

To develop and evaluate a novel multi-method micro-computed tomography (μCT) imaging protocol for enhanced visualization of both hard and soft tissues in murine mandibles, addressing the limitations of traditional imaging techniques in dental research. We employed a contrast-enhanced (CE) μCT imaging technique using Lugol's iodine as a contrast agent to visualize the intricate structures of murine mandibles. The protocol involved the combination of conventional μCT imaging as well as CE-μCT, including decalcification with EDTA, allowing for simultaneous assessment of hard and soft tissues. The method is compared with standard imaging modalities, and the ability to visualize detailed anatomical features is discussed. The CE-μCT imaging technique provided superior visualization of murine mandibular structures, including dental pulp, periodontal ligaments and the surrounding soft tissues, along with conventional μCT imaging of alveolar bone and teeth. This method revealed detailed anatomical features with high specificity and contrast, surpassing traditional imaging approaches. Our findings demonstrate the potential of CE-μCT imaging with Lugol's iodine as a powerful tool for dental research. This technique offers a comprehensive view of the murine mandible, facilitating advanced studies in tissue engineering, dental pathology and the development of dental materials.

Mechanisms of functional asymmetry of the face formation in patients with dysfunctional condition of temporomandibular joint

Objective. To give a detailed description of clinical manifestations, diagnosis and treatment of functional asymmetry of the face in patients with dysfunctional condition of temporomandibular joint (TMJ). Materials and methods. A complete examination of 34 (25 %) patients with symptomatic facial asymmetry of the 3rd type according to H.S. Hwang classification was carried out. The group consisted of 5 males (14,71 %) and 29 females (85,29 %). Screening protocol included standard dental care, cone beam computer tomography of both jaws and TMJ, MRI of TMJ with functional load. Results. 24 patients (70.59 %) completed complex dental treatment; 10 (29.41 %) people stopped treatment for various reasons and were excluded from further study. Complete restoration of facial symmetry was achieved in 21 people (87.5 %), partial restoration in 3 (12.5 %) patients. The height of the lower facial part and the synchrony of occlusal contacts were restored in all patients. Noise in the joint area persisted in 3 (8.8 %) cases, which is associated with arthrosis in the articular heads. In patients with unreducible dislocations, the intensity of the clicks decreased, and there was no pain at the end of treatment. It should be noted that all patients of this group refused subsequent surgical treatment. Conclusion. Functional asymmetry of the face results from multifactorial impact on the human organism and is multimorbid by nature. This condition is accompanied by complicated dental pathology, such as increased hard tooth tissues attrition, functional overload with traumatic nodes formation, disturbance of muscles and TMJ functions. It requires following diagnostic and treatment algorithm under the supervision of internal medicine specialists to correct sleep, postural stability, impaired psychoneurological status.

Orofacial Migraine-A Narrative Review.

The diagnosis of migraine is based on clear criteria outlined in the International Classification of Headache Disorders version 3 (ICHD-3). Notably, the criteria in ICHD-3 omit the location of the migraine. There are increasing reports of migraine in the facial region. Facial presentations of migraine are not easy to diagnose as they appear in the lower two-thirds of the face, often in the maxillary sinus region, around the ear, the upper/lower jaws, and the teeth. Additionally, a similar but distinct entity, neurovascular orofacial pain, has been established. The symptomatology of facial presentations of these headaches often resembles sinusitis and dental pathology. We will review these presentations, their diagnosis, and possible pathophysiology.

Comparison of Faster R-CNN, YOLO, and SSD for Third Molar Angle Detection in Dental Panoramic X-rays.

The use of artificial intelligence algorithms (AI) has gained importance for dental applications in recent years. Analyzing AI information from different sensor data such as images or panoramic radiographs (panoramic X-rays) can help to improve medical decisions and achieve early diagnosis of different dental pathologies. In particular, the use of deep learning (DL) techniques based on convolutional neural networks (CNNs) has obtained promising results in dental applications based on images, in which approaches based on classification, detection, and segmentation are being studied with growing interest. However, there are still several challenges to be tackled, such as the data quality and quantity, the variability among categories, and the analysis of the possible bias and variance associated with each dataset distribution. This study aims to compare the performance of three deep learning object detection models-Faster R-CNN, YOLO V2, and SSD-using different ResNet architectures (ResNet-18, ResNet-50, and ResNet-101) as feature extractors for detecting and classifying third molar angles in panoramic X-rays according to Winter's classification criterion. Each object detection architecture was trained, calibrated, validated, and tested with three different feature extraction CNNs which are ResNet-18, ResNet-50, and ResNet-101, which were the networks that best fit our dataset distribution. Based on such detection networks, we detect four different categories of angles in third molars using panoramic X-rays by using Winter's classification criterion. This criterion characterizes the third molar's position relative to the second molar's longitudinal axis. The detected categories for the third molars are distoangular, vertical, mesioangular, and horizontal. For training, we used a total of 644 panoramic X-rays. The results obtained in the testing dataset reached up to 99% mean average accuracy performance, demonstrating the YOLOV2 obtained higher effectiveness in solving the third molar angle detection problem. These results demonstrate that the use of CNNs for object detection in panoramic radiographs represents a promising solution in dental applications.

The method of the etiological factor′s evaluation of the gingival recession, with count of their′s separately and common complicity in the pathogenesis

Introduction. Gingival recession is a highly relevant and common dental pathology. The prevalence of recession ranges from 45,5 to 99,3 % in people of different ages, with the risk of gingival recession increasing with age. The true etiology of gingival recession, its components and the degree of their influence, jointly or separately; the influence of the environment and lifestyle on the development of pathology are poorly understood. In the literature, for example, there is no classification of etiological factors according to the degree of their influence as triggers of gingival recession. It is of scientific interest to study the causes of gingival recession, their systematisation and assessment of the degree of influence of each factor separately and together.The aim of the study is to develop a classification system of etiological factors taking into account their significance and degree of influence on the formation of gingival recessions.Materials and methods. Analysis of scientific literature, methods of classification and structuring; methods of decomposition, integration and determination of cause-and-effect relationships.Results. A model of classification of factors of the etiology of gingival recessions was proposed, elements of the structure of etiological factors of gingival recessions were determined by the degree of their influence on pathogenesis.Conclusion. Conclusions. The study and understanding of the etiology of gingival recessions allows the clinician to select a personalised treatment taking into account individual characteristics that influence the recession occurrence and its condition: congenital and acquired factors; living conditions, habits, level of hygiene, as well as other components that aggravate or compensate for the degree and level of complexity of any recession - single, multiple or generalised. It is advisable to continue the study of literature data to expand the classification and detail the structure of etiological factors.

Comparison of Dental Findings with Computed Tomographic and Clinical Examination in Patients with End-Stage Heart Failure.

Background: This study aimed to evaluate the diagnostic value of pre-existing computed tomography (CT) examinations for the detection of dental pathologies compared with clinical dental examination in patients with end-stage heart failure. Methods: For this purpose, 59 patients with end-stage heart failure and pre-existing non-dental CT images of the craniofacial region were included. Virtual orthopantomograms (vOPG) were reconstructed. Dental pathologies were analyzed in vOPG and source-CT images. Imaging and clinical findings less than 6 months apart were compared (n = 24). Results: The subjective image quality of vOPG was more often rated as insufficient than CT (66%; 20%; p < 0.01). Depending on examination (CT, vOPG or clinic), between 33% and 92% of the patients could require dental intervention such as treatment of caries and periodontitis or tooth extraction. vOPG led to a higher (80%) prevalence of teeth requiring treatment than CT (39%; p < 0.01). The prevalence of teeth requiring treatment was similar in CT (29%) and clinic (29%; p = 1.00) but higher in vOPG (63%; p < 0.01). CT (stage 3 or 4: 42%) and vOPG (38%) underestimated the stage of periodontitis (clinic: 75%; p < 0.01). Conclusions: In conclusion, available CT images including the craniofacial region from patients with end-stage heart failure may contain valuable information regarding oral health status. The assessability of vOPGs might be insufficient and must be interpreted with caution.

Pre-implant surgery complexity for achieving implant-supported prosthetic rehabilitation in oligodontia patients: a retrospective study

IntroductionOligodontia is a rare dental developmental pathology that requires prolonged, complex and multidisciplinary treatment. Although bone augmentation is frequently required during a complete implant treatment of oligodontia. Therefore, we evaluated the ability to predict pre-implant surgery complexity based on age, number of missing teeth, and number of implants required to achieve implant-supported prosthetic rehabilitation.Material and methodsThis retrospectively registered study included all patients who underwent surgical treatment for oligodontia in our Oral and Maxillofacial Surgery Department between January 2012 and May 2023. Demographic data, number and location of missing teeth, pre- and per-implant surgical procedures, and the number of planned implants were recorded. A quantitative variable called “complexity score of pre-implant surgery” was created. This 10-point score was calculated by adding one point for each preimplant surgical procedure registered. A simple linear regression was calculated to explain the number of targeted implants based on number of missing teeth. A multiple linear regression model was used to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants.Results119 oligodontia patients were included in the study. The median number of tooth agenesis was 10. A total of 825 implants were placed, 14 (1.7%) of which failed. A significant regression equation was used (F(1,118) = 1098,338; p < 0.0001) to explain the number of targeted implants based on number of missing teeth, with a R2 of 0.903. A significant regression equation was found (F(3,116) = 107,229; p < 0.0001) to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants, with a R2 of 0.735.DiscussionThese results based on patient data indicate that age, number of missing teeth and number of targeted implants could reliably explain the complexity of pre-implant surgery.

Assessment of the Potential Role of Preoperative Dental Clearance in Total Joint Arthroplasty Optimization: A Pilot Study.

Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA) and is associated with significant morbidity, mortality, and cost. This pilot study primarily aimed to investigate if preoperative dental screenings would impact the rate of PJI following TJA when compared to historical controls. Secondarily, this study aimed to evaluate the prevalence of dental pathology in patients undergoing TJA. Charts from 103 consecutive patients undergoing primary or revision total hip arthroplasty (THA, rTHA) or total knee arthroplasty (TKA, rTKA) by a single surgeon at a single academic institution over a two-year period were reviewed and selected for inclusion. All patients were referred to a dentist for preoperative clearance using a standardized form. The rate of dental pathology before surgery, details of the dental intervention required, and any dental work performed within six months postoperatively were evaluated. The demographic and comorbidity composition of our patient population was also collected. Finally, rates of PJI following each type of TJA were obtained for demographic- and comorbidity-matched historical controls from similar study designs to examine the potential impact of preoperative dental intervention. Of the 103 patients, 31 (30.1%) were found to have preoperative dental pathology. Twenty-eight of these 31 patients (90.3%) required dental intervention prior to surgery. Based on demographic- and comorbidity-matched historical data, we expected two (95% CI (0, 6)) PJI cases for the THA group, 0 (95% CI (0, 2)) PJI cases for the TKA group, two (95% CI (0, 5)) PJI cases for the rTHA group, and two (95% CI (0, 5)) PJI cases for the rTKA group. However, in our study, there were no PJIs after any TJA up to the latest follow-up, which was unlikely for THA, rTHA, and rTKA groups given the calculated Poisson probabilities (9.39%, 15.11%, and 11.26%, respectively). Finding 0 cases was likely for the TKA group given the calculated Poisson probability of 72.61%. This pilot study demonstrated that preoperative dental screening, which aims to decrease the chance of PJI due to bacteremia, may have an impact on the rate of PJI following THA, rTKA, and rTHA but not TKA based on Poisson probabilities calculated from demographic- and comorbidity-matched historical controls that lacked preoperative dental screening. For THA, rTKA, and rTHA, the Poisson probabilities of observing 0 cases of PJI postoperatively, as was the case in our study, were unlikely, suggesting that some variable in our cohort was decreasing the PJI rate for these groups. However, in the case of TKA, the Poisson probability of observing 0 cases was likely and matched the results of our study, suggesting that no variable in our cohort was affecting the PJI rate for this group. We cannot draw direct conclusions from this retrospective observational study, but the preliminary findings prompt further investigation through an appropriately controlled, blinded, multi-centered, and powered prospective randomized controlled trial.

Multidisciplinary Applications of AI in Dentistry: Bibliometric Review

This review explores the impact of Artificial Intelligence (AI) in dentistry, reflecting on its potential to reshape traditional practices and meet the increasing demands for high-quality dental care. The aim of this research is to examine how AI has evolved in dentistry over the past two decades, driven by two pivotal questions: “What are the current emerging trends and developments in AI in dentistry?” and “What implications do these trends have for the future of AI in the dental field?”. Utilizing the Scopus database, a bibliometric analysis of the literature from 2000 to 2023 was conducted to address these inquiries. The findings reveal a significant increase in AI-related publications, especially between 2018 and 2023, underscoring a rapid expansion in AI applications that enhance diagnostic precision and treatment planning. Techniques such as Deep Learning (DL) and Neural Networks (NN) have transformed dental practices by enhancing diagnostic precision and reducing workload. AI technologies, particularly Convolutional Neural Networks (CNNs) and Artificial Neural Networks (ANNs), have improved the accuracy of radiographic analysis, from detecting dental pathologies to automating cephalometric evaluations, thereby optimizing treatment outcomes. This advocacy is underpinned by the need for AI applications in dentistry to be both efficacious and ethically sound, ensuring that they not only improve clinical outcomes but also adhere to the highest standards of patient care.

Analysis of eating and drinking habits of young people and the correlation of these activities with cervical dental pathology

Analysis of eating and drinking habits of young people and the correlation of these activities with cervical dental pathology

Endodontic radiography - what’s displaying the radiograph? The yield of commercial computer screens vs. DICOM calibrated medical screens in endodontic radiography

ObjectiveA comparison between commercial computer screens and DICOM-calibrated medical screens for characterizing anatomy and diagnosing dental pathologies was performed. The aim of this study was to evaluate and compare the ability of each of those screens to identify root apices and widening of the periodontal ligament (PDL) in the posterior maxillary area.Materials and MethodsDigital X-ray images of 53 maxillary molar teeth were examined by means of a commercial computer screen and again two months later with a DICOM screen to compare their ability to help identify and diagnose PDL widening and to locate the root apices of those teeth.ResultsThe DICOM screen had a significantly better ability to identify widened PDLs (from 31.4% to 34.8% of the cases compared to 19% to 26.1% for the commercial screens, P < .001), depending upon the observer. The DICOM screen was also significantly superior in depicting the root apices compared to the commercial screens (from 77.4% to 83.6% of the cases compared to 56% to 66.7% for the commercial screens, P < 0.001), depending upon the observer.ConclusionDICOM-calibrated medical screens were significantly superior to commercial computer screens for identifying widened PDLs and locating the root apex in the posterior maxillary area.

The traumatized immature permanent incisor with pulpal involvement: what conservative treatment options?

Traumatology is the second most common dental pathology, after caries and before periodontal pathologies. It is currently accepted that one child in two suffers an alveolar-dental trauma before leaving school, with a peak incidence between the ages of 8 and 12, all types of trauma combined. The maxillary central incisors are most affected (79.6%), with mainly "simple" or "complex" coronal fractures when the pulp is involved. The main objective in managing these complex fractures is to preserve pulpal vitality within an acceptable timeframe. The author presents three pulp vitality preservation therapies involving tissue preservation and regeneration techniques using bioactive materials applied directly to the pulp. Materials and clinical protocols are described. Knowledge of pulp biology and healing processes has led to the development of vitality-preserving therapeutic strategies that have become essential in the management of traumatized teeth in children and adolescents. The regenerative potential of immature tooth pulp is considerable, enabling dentine repair through the use of bioactive materials. These therapies require a rigorous surgical approach that determines prognosis, and precise monitoring to ensure that any complications are intercepted.