Edentulous Region Research Articles

Ultrasonography-Guided Dental Implant Surgery: A Feasibility Study.

To evaluate the feasibility of ultrasound-image-based computer-assisted implant planning and placement. Intraoral scans, cone-beam computerized tomography (CBCT), and ultrasound (US) scans with a custom positioning device were acquired in nine patients. Prosthetic-driven surgical guides were planned and fabricated based on ultrasound images and intraoral scans. Implants were then placed. Postoperative implant position was obtained intra-surgically by intraoral scan. Aside from the ultrasound-based plan, conventional implant planning was performed by the same operator on a pre-surgical CBCT for comparison. Linear deviations between ultrasound and CBCT-planned implant positions were measured and compared with the intra-surgical implant position, and the position deviations between two consecutive plannings were performed on the same CBCT by the same operator. The linear deviation between the 3D scan surface of the edentulous region and the ultrasonographic soft tissue profile segmentation was also assessed with reverse-engineering software. Means, standard deviations, and root mean square differences (RMSD) were calculated for every variable. All the ultrasound-planned implants were successfully placed, and no complications were recorded. The mean deviations in angles, shoulders, and apexes were 5.27 ± 1.75° (RMSD: 5.53°), 0.92 ± 0.26 mm (RMSD: 0.95 mm), and 1.41 ± 0.61 mm (RMSD: 1.53 mm), respectively, between the US and CBCT-planned implants; 2.63 ± 0.43° (RMSD: 2.66°), 1.16 ± 0.30 mm (RMSD: 1.19 mm), and 1.26 ± 0.27 mm (RMSD: 1.28 mm) between the planned implant and intra-surgically recorded positions; and 2.90 ± 1.36° (RMSD: 3.18°), 0.65 ± 0.27 mm (RMSD: 0.70 mm), and 0.99 ± 0.37 mm (RMSD: 1.05 mm) between two consecutive CBCTs planning performed by the same operator. The mean deviation between the 3D surfaces of model scans and ultrasound-derived soft tissue profile in the edentulous area was 0.19 ± 0.08 mm. Ultrasound-guided implant surgery represents a feasible non-ionizing alternative to conventional static guided implant surgical protocols for implant placement in sites with favorable characteristics.

Retrospective study on the clinical and radiographic outcomes of 2.8 mm diameter implants supporting fixed prostheses up to 11 years.

This study aimed to report the clinical and radiographic results of 2.8 mm two-piece narrow diameter implant (NDI) supporting fixed restorations. Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow-up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated. An implant failed during the follow-up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33-9.00) and 7.42 ± 1.03 (range: 3.67-9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25-4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri-implantitis. Within the limitation of the study, the results indicate that the use of two-piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal-lingual width is viable.

Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study.

This cross-sectional retrospective study was conducted to assess the differences in the microarchitecture of the trabecular bone of the posterior mandibular region at dentulous and edentulous sites with the help of fractal dimension (FD) and lacunarity using cone-beam computed tomography (CBCT). Ninety CBCT scans were analyzed for the purpose of the present study. Inclusion criteria included subjects with unilaterally missing mandibular molars or premolars and an with intact contralateral opposing tooth. The coronal view of the dentulous and edentulous sites was used, and the region of interest (ROI) was selected 2.6 mm below the apex of the tooth present. These images were then transferred to ImageJ Software, and fractal analysis was done using the box-counting method of the FracLac plug-in. A paired samples t-test was performed to compare the means of FD and lacunarity, and a Kendall correlation was performed to check correlations. A p-value less than 0.05 was considered to indicate statistical significance. Statistical analysis revealed that the mean FD of the edentulous side was significantly greater than that of the dentulous side (p-value = 0.011). Additionally, the mean lacunarity of the edentulous side was marginally significantly greater than that of the dentulous side (p-value = 0.089). A significant negative correlation was detected between the FD and lacunarity of the edentulous region (p-value = 0.017), and a marginally significant negative correlation was detected between edentulous lacunarity and dentulous lacunarity (p-value = 0.081). The differences in occlusal forces exerted in dentulous and edentulous regions can lead to a change in the trabecular pattern of the bone in these regions. This change in the microarchitecture of bones can be detected by FD and lacunarity, which can further help us assess changes pre- and post-implant. The advanced technology, the assessment of microarchitecture of the bone has been made easy, using FD and lacunarity, as done in the present study. This analysis can further aid us in both pre- and post-implant analysis to prevent failure of the implant. How to cite this article: Bhoraskar M, Denny C, Srikant N, et al. Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study. J Contemp Dent Pract 2024;25(6):581-587.

The comparison of Mandibular Cortical Index based on dental status in women using panoramic radiographs

Objectives: The aim of this study is to analyze the difference of the Mandibular Cortical Index (MCI) between dentate and edentulous regions in women using panoramic radiographs. Materials and Methods: This is a comparative analytical observational research with a cross-sectional approach. The samples used were 250 female panoramic radiographs, which were divided into 125 dental region samples and 125 edentulous samples which were available at the Dental Radiology Installation, Dental and Oral Teaching Hospital (RSGM-P) Faculty of Dentistry, Trisakti University. MCI assessment uses i-Dixel software version 2.2.0.3. Morita Japan. The comparative test was carried out using the Mann-Whitney test to determine whether there was a significant difference or not. Results: There is a significant difference in MCI based on dental status with p-value = 0.000 (p <0.05). The percentage of category C1 was found higher (26%) in the dentate group than edentulous group (9,2%), whereas the percentage of category C3 was found higher in the edentulous group (16,3%) than dentate group (3,2%). Conclusion: There is a significant difference in MCI based on dental status with p-value = 0.000 (p <0.05). The percentage of category C1 was found higher (26%) in the dentate group than edentulous group (9,2%), whereas the percentage of category C3 was found higher in the edentulous group (16,3 %) than dentate group (3,2%).

New scenarios for training in oral radiology: clinical performance and predoctoral students' perception of 3D-printed mannequins.

This study aimed to evaluate the impact of 3D-printed mannequins on the training of predoctoral students. Two 3D-printed training models were developed: a traditional model that simulates a sound adult patient and a customized model with pathological and physiological changes (impacted third molar and edentulous region). Students accomplished their pre-clinical training divided into a control group (CG, n = 23), which had access to the traditional model, and a test group (TG, n = 20), which had access to both models. Afterward, they performed a full mouth series on patients and filled out a perception questionnaire. Radiographs were evaluated for technical parameters. Descriptive statistics and the Mann-Whitney test were used to compare the groups. Students provided positive feedback regarding the use of 3D printing. The TG reported a more realistic training experience than the CG (P = .037). Both groups demonstrated good clinical performance (CG = 7.41; TG = 7.52), and no significant differences were observed between them. 3D printing is an option for producing simulators for pre-clinical training in Oral Radiology, reducing student stress and increasing confidence during clinical care.

Avoiding Sinus Floor Elevation by Placing a Palatally Angled Implant: A Morphological Study Using Cross-Sectional Analysis Determined by CBCT.

Tooth loss in the posterior maxilla often necessitates dental implant placement, but the maxillary sinus anatomy poses challenges, especially during sinus floor elevation. Mesially angled implants are an alternative for total edentulism, but for single tooth deficiencies, palatally angled implants may offer a solution. This study evaluates the prevalence of avoiding sinus floor elevation by placing palatally angled implants in cases with a single missing tooth. A retrospective study at Ahmet Keleşoğlu Faculty of Dentistry involved 100 participants with a single missing tooth and prior CBCT scans. Virtual implants were placed using OnDemand3D (version 1.0.7462) software. On CBCT sections, implants were angled palatally to avoid sinus or nasal cavity perforation. Statistical analysis was conducted using R and MedCalc (version 4.3.2) software. Of the participants (60% female, average age 50.45), 76 edentulous regions required sinus elevation. The implant placeability rates varied across zones (second molar: 39.3%, first molar: 63.1%, second premolar: 78.5%). Implant placement at a palatal angle was significantly higher in the second premolar and first molar regions. Statistically significant differences were observed in the implant placeability between regions. This study supports the feasibility of avoiding sinus floor elevation through palatally angled implants in specific cases, reducing the associated complications.

Localization of Mandibular Canal in Dentulous and Edentulous Regions

Objectives: Retrospective determination of the changes in the mandibular canal (MC) course in men and women in the second premolar, first molar and second molar regions of the dentulous and edentulous mandible.
 Methods: In CBCT images of 274 patients aged 18-88 years who were systemically healthy, the distances of the outer cortex of the MC to the mandible superior, lingual, inferior and buccal cortical bone border were measured in the right and left mandible 2nd premolar, 1st molar and 2nd molar regions. In these regions, the differences in MC course between left and right hemimandible, dentulous and edentulous, and males and females were examined by independent t-test and paired t-test (p< .05).
 Results: As a result of the statistical analysis, statistical significance was observed in the linear measurements of the MC to the superior cortical bone border in dentulous and edentulous patients in the relevant regions. In female and male patients, the distance of the MC to the inferior cortical edge of the mandible in the dentulous and edentulous dentition was statistically less in females. The superior distance of the mandible was found to be less in the edentulous regions than in the dentulous regions.
 Conclusions: The course of the MC in the posterior mandible is generally close to the inferior and lingual wall, but it changes direction towards the superior and buccal regions as it approaches the mental foramen. Furthermore, in women, the MC is located closer to the inferior border of the mandible compared to men.

Assessment of the of fixed dental prosthesis impressions received at commercial dental laboratories in Aljabal-Alakhdar region, Libya0

Background: Crown and bridge prosthodontics needs an accurate and precise impression (positive replica) of the abutment teeth and the edentulous region to be rehabilitated for the dental technician to be able to construct the high quality and well adapted fixed dental restoration without mistakes. The aim of the current survey was to assess any visible mistakes commonly observed in fixed dental prosthesis impressions received at five commercial dental laboratories, frequency errors determination, and to determine any possible association between the preparation finish line errors and other assessed factors. Materials and methods: 150 fixed prosthodontic impressions were collected from five commercial dental laboratories located at Aljabal-Alakhdar region, Libya. All the fixed prosthodontic impressions which had been received by the visited commercial dental laboratories were assessed for many factors in relation to the accuracy such as the dental arch involved, prepared abutment teeth, dental impression materials used, and final techniques and viscosity of the impression, the type of impression tray, full-arch or segmental impression tray, the impression tray size, type of fixed dental restoration requested, mistakes in impression material or tray used, gingival tissue dilation errors, closed-mouth impression technique errors, and finish line errors. No attempts were made to determine the reason of the detected errors in each fixed prosthodontic impression assessed. Association between dental practitioner years of experience and gender and impression errors was evaluated. The association between categorical variables and the outcomes were examined by the use of Chi square and Fisher exact tests. Results: Condensation silicone was the most impression material used. Of the impressions evaluated 121(80.6%), 97% have at least one detectable error, 103(68.6%) had finish line errors, 53.9% had tooth preparation area errors. Visible contamination of impression with blood was seen in about 79(52.2%) of the assessed impressions. There was significant association between the type of dental impression material and errors in the preparation cervical finish line and tooth preparation area. Conclusion: In the present study, it has been found that a high frequency of recognizable errors was detected in crown and bridge impressions received by the five commercial dental laboratories. This can result in poorly fitted fixed restorations cemented for the fixed prosthodontic patients.

Minimally invasive techniques for sinus floor elevation using dental implants among Indians.

It is of interest to compare conventional lateral window technique, trans-alveolar technique with minimally invasive technique like modified trephine technique and antral membrane balloon elevation technique for sinus floor elevation in placement of dental implants. The current study included 140 participants (191 dental implants) who had maxillary posterior edentulous regions and had low sinuses and insufficient alveolar ridges but had chosen an implant-retained prosthesis. The minimally invasive techniques of sinus augmentation can be suitable alternative to conventional traumatic techniques due to low incidence of pain, gingival swelling. Moreover, the success rate of implants and increase in total bone height was almost same in minimally invasive techniques of sinus augmentation as compared to conventional traumatic techniques.

Evaluation of Alveolar Bones in the Context of Orthodontic Single-Tooth Space Closure: A Retrospective Cone Beam Computed Tomography-Based Analysis

In the literature, there are no studies evaluating alveolar bone width in areas with a single missing tooth in terms of orthodontic tooth movement. This study was meant to determine whether residual alveolar bone width in edentulous crests is a risk factor for orthodontic tooth movement. The aim of this study was to evaluate the change in the residual alveolar bone width in the edentulous region compared to the alveolar bone width on the symmetrical toothed side using CBCT in individuals with a single missing tooth in whom orthodontic tooth movement was planned. This retrospective radiographic study was performed using CBCT images that were taken before orthodontic treatment for the evaluation of the edentulous area between January 2010 and January 2022. Individuals without any systemic disease aged 18 years or older whose edentulous area was restricted to one tooth were included in this study. Bone measurements were made on cross-sectional CBCT images. Of the 265 individuals participating in this study, 129 were male and 136 were female, with a mean age of 32.67 ± 6.50 years. The distribution of 265 edentulous regions (caused by 265 tooth extractions) was as follows: 23 were in the incisor region, 54 were in the premolar region, and 188 were in the molar region. The molar region had the highest bone width among the edentulous regions (p < 0.01). Bone widths were smaller in the edentulous crests for all regions (p < 0.01). In this study, it was determined that the bone width in the areas with a single missing tooth was insufficient, and this is a risk factor for orthodontic treatment.

Clinical dental management of the head and neck irradiated patient

To discuss important topics regarding the dental procedures performed in patients before, during and after the radiotherapy treatment. The biological effects of ionizing radiation on bone tissue focusing on clinical care will be described. The invasive and not invasive procedures after radiotherapy treatment in the head and neck region will be addressed using scientific evidences to determine the appropriate moment for tooth extractions, periodontal management, and preventive procedures for osteoradionecrosis. Methods: Thirty-three studies including original studies and reviews were selected in MEDLINE database (PubMed). No year of publication restriction was applied. Language was restricted to the English, and the following Medical Subject Heading terms were used: radiotherapy, osteoradionecrosis, dental management. Studies of osteoradionecrosis involving clinical management of irradiated patients, with an emphasis on updated guidelines and protocols were selected. Results: Care in dental procedures were related about restorative treatment, endodontic treatment, rehabilitation for edentulous regions using prostheses and implants and periodontal procedures before, during and after RTX treatment. Conclusions: The dental procedures should and can be performed before, during but also after radiotherapy. However, the clinical procedures should be less invasive as possible. A maintenance plan that reduces the necessity for major and more invasive treatments after radiotherapy is recommended.

A Prospective Study of the Assessment of the Efficacy of a Biodegradable Poly(l-lactic acid/ε-caprolactone) Membrane for Guided Bone Regeneration.

Biodegradable guided bone regeneration (GBR) membranes consist primarily of collagen and aliphatic polyesters. This study assessed the comparative efficacy of a poly(l-lactic-caprolactone) [P(LA/CL)] membrane versus that of a collagen membrane in GBR. Patients requiring GBR simultaneously or before dental implant placement in edentulous regions were randomly assigned to one of two membranes. Within each membrane, they were subdivided into 3 groups: dental implants were placed simultaneously with GBR in groups A and B, and 180 days post-GBR in group C. The augmented bone width was measured at 1, 3, and 6 mm from the implant's neck (groups A and B) or the reference line (group C), utilizing cone-beam computed tomography images, immediately and 150 days post-surgery. A histological study was performed to evaluate bone formation in group C. No adverse events were observed. In the collagen group, the absorbed ratios of the augmented bone were 40.9 ± 36.7%, 29.4 ± 30.1%, and 11.1 ± 22.0% at 1, 3, and 6 mm, respectively; the ratio at 6 mm was significantly lower than that at 1 mm (p = 0.0442). In the P(LA/CL) group, those were 26.2 ± 27.3%, 17.1 ± 19.7%, and 13.3 ± 16.4% at 1, 3, and 6 mm, respectively, with no significant difference at each point. No significant inter-membrane differences were observed. The bone augmentation potential of the P(LA/CL) membrane matched that of the collagen membrane. P(LA/CL) could be used as a safe and effective membrane in GBR.

The comparison of Mental Index based on dental status in women using panoramic radiographs

Background: Bones will experience a decrease in density due to an imbalance in the process of resorption and remodeling. Women are known to be at greater risk of bone density loss than men, due to aging and hormonal effects. Decreased bone density can also affect alveolar bone and attachment to teeth, leading to tooth loss and edentulous. Panoramic radiographs are one of the regular examinations at dental clinics. They observe changes in the thickness of the cortical bone of the mandible and detect abnormalities in bone density by measuring them using the Mental Index (MI).
 Objectives: This research is aimed to determine the differences in Mental Index (MI) between dentate and edentulous regions in women through panoramic radiographs. 
 Materials and Methods: This research is using comparative analytic observational study with a cross-sectional approach, with 160 women panoramic radiograph samples available at the Dentistry Radiology Installation, RSGM-P, Trisakti University FKG, divided between 80 samples of the dentate region and 80 samples of the edentulous region. Calculations using MI with i-Dixel software version 2.2.0.3. (Morita, Japan) results in millimeters. 
 Results: There is a significant difference of MI between dentate and edentulous region (p = 0.000). The mean of dentate MI (right region 3.7443 ± 0.47927 mm and left region 3.7373 ± 0.41075 mm) was greater than edentulous MI (right region 2.4725 ± 0.48391 mm and left region 2.4421 ± 0.43962 mm). 
 Conclusion: The loss of teeth in women may lead to any change in the Mental Index (MI) 
 Keywords: Bone Density; Dental Status; Mental Index; Panoramic Radiograph

Influence of CBCT-derived panoramic curve variability in the measurements for dental implant planning.

To investigate whether the curve markings performed prior to panoramic and cross-sectional reconstructions can influence the planning of oral implants. Twenty oral radiologists landmarked the reference panoramic curves in 25 CBCT scans of the mandible. Bone height was measured on the resulting cross-sectional slices in the edentulous region of the lower first molar. The following data were recorded: (1) number of landmarks used to build each reference curve; (2) shape of the reference curve (inverted "U", inverted "V" or "horseshoe"); and (3) measurement in the first molar region. The data were assessed for variability based on the number of landmarks, the shape of the reference curve, and the measurements obtained. The number of landmarks used to guide the panoramic reconstruction varied among radiologists (p < 0.05), but most of them draw curves in inverted "U" shape (68-100%). The reproducibility of the measurements taken in the edentulous mandibular first molar region was excellent (84.7%). The number of landmarks and the shape of the curve did not have a significant influence on the reproducibility of the measurements (p > 0.05). Variations of the operator-dependent steps during the panoramic reconstructions occur but do not play a significant part changing the measurements taken for oral implant planning.

Guided bone regeneration in reconstruction of the jaw and role tissue engineering in dental membrane, a review of literature

Tooth loss can significantly impact the quality of human life, affecting overall well-being, appearance, and nutrition. In advanced dentistry, implant therapy has become a popular option for restoring edentulous regions. Guided Bone Regeneration (GBR) is a bone grafting technique that utilizes a protective barrier membrane to prevent soft tissue penetration. This study aims to review various GBR methods, focusing on topics such as bone resorption in the edentulous jaw, different types of GBR techniques, indications for GBR, and limitations associated with this approach.

SinusC-Net for automatic classification of surgical plans for maxillary sinus augmentation using a 3D distance-guided network

The objective of this study was to automatically classify surgical plans for maxillary sinus floor augmentation in implant placement at the maxillary posterior edentulous region using a 3D distance-guided network on CBCT images. We applied a modified ABC classification method consisting of five surgical approaches for the deep learning model. The proposed deep learning model (SinusC-Net) consisted of two stages of detection and classification according to the modified classification method. In detection, five landmarks on CBCT images were automatically detected using a volumetric regression network; in classification, the CBCT images were automatically classified as to the five surgical approaches using a 3D distance-guided network. The mean MRE for landmark detection was 0.87 mm, and SDR for 2 mm or lower, 95.47%. The mean accuracy, sensitivity, specificity, and AUC for classification by the SinusC-Net were 0.97, 0.92, 0.98, and 0.95, respectively. The deep learning model using 3D distance-guidance demonstrated accurate detection of 3D anatomical landmarks, and automatic and accurate classification of surgical approaches for sinus floor augmentation in implant placement at the maxillary posterior edentulous region.

Risk assessment of mandibular incisive canal perforation during dental implant surgery in the anterior edentulous mandible: a virtual implant placement study using cone beam computed tomography

The aim of this study was to evaluate the risk of mandibular incisive canal (MIC) perforation caused by implants placed on cone beam computed tomography (CBCT) images in the edentulous mandibular anterior region. A total of 1200 dental implants were virtually inserted on 150 eligible CBCT scans. The relationship of different implant sizes with the incidence of MIC perforation and the relationship between crest height and perforation were evaluated. A total of 1200 virtual implant applications were performed on 150 patients. In 87% of cases, MIC was identified. Perforation in 12 and 14 mm implants was significantly higher than in 8- and 10-mm implants (P < .05). Perforation was found to be statistically significantly higher in crest heights that were ≤20 mm than in crest heights >20 mm (P < .05). Our results showed high perforation rates in the 12- and 14-mm implants and crests heights that were ≤20 mm during implant surgery in the mandibular anterior edentulous region. Perforation of the MIC should be considered a complication of implant surgery in the mandibular anterior region; therefore, CBCT images should be evaluated before implant placement.

Comparison between Platelet-rich Fibrin and Saline Filling after Sinus Elevation without Adjunctive Bone Graft in Dental Implants Insertion Using CBCT.

The goal of this research was to compare radiographically the outcomes of hydraulic transcrestal sinus lifting with platelet-rich fibrin (PRF) or normal saline filling on implant survival rates, negative outcomes, and variations in the height of residual alveolar ridge (HARB). There were 80 study participants included and 90 dental implants were placed. The study participants were divided into two categories: Category A and Category B. Each category consists of 40 study participants. Category A: Normal saline was placed in the maxillary sinus. Category B: PRF was placed in the maxillary sinus. Implant survival, complications, and HARB alterations were the outcome metrics. Radiographic images through Cone-beam computed tomography (CBCT) were retrieved and compared prior to surgery (T0), immediately following surgery (T1), three months later (T2), 6 months later (T3), and 12 months later (T4). There are 90 implants having an average length of 10.5 ± 0.7 mm were inserted into the posterior portion of the maxilla of 80 patients with an average HARB of 6.9 ± 1.2 mm. At T1, elevation in HARB peaked, and the sinus membrane continued to droop but steadied while observed at T3. The steady increment of areas of radiopacities was noticed below the elevated membrane of the maxillary antrum. A radiographic intrasinus bone increase of 2.9 ± 1.4 mm was caused by the PRF filling, compared to 1.8 ± 1.1 mm by the saline filling at T4 (p < 0.05). Over the course of the one-year follow-up period, all of the implants were operating normally with no major issues. Platelet-rich fibrin when used as a filling medium alone without bone graft can cause significant ascend in height of the residual alveolar bone (HRAB). The degradation of the alveolar bone under the maxillary sinus following tooth loss frequently restricts the placement of the implant in the edentulous region of posterior maxilla. Numerous sinus-lifting surgery procedures and tools have been developed to address these problems. It has been a topic of debate regarding the benefits of bone grafts placed at the apical region of the implant. The sharp protrusions of the granules of bone graft may also provide a danger of membrane puncture. Recently, it was shown that regular bone gain might occur inside the maxillary antrum without the use of any bone transplant material. Additionally, if there were substances that filled the gap between the floor of the sinus and the raised sinus membrane, then the membrane of the maxillary sinus could be raised greater and for a longer period of time during the phase of formation of new bone formation.

Automated Detection of Periodontal Bone Loss Using Deep Learning and Panoramic Radiographs: A Convolutional Neural Network Approach

(1) Background: The accurate diagnosis of periodontal disease typically involves complex clinical and radiologic examination. However, recent studies have demonstrated the potential of deep learning in improving diagnostic accuracy and reliability through the development of computer-aided detection and diagnosis algorithms for dental problems using various radiographic sources. This study focuses on the use of panoramic radiographs, which are preferred due to their ability to assess the entire dentition with a single radiation dose. The objective is to evaluate whether panoramic radiographs are a reliable source for the detection of periodontal bone loss using deep learning, and to assess its potential for practical use on a large dataset. (2) Methods: A total of 4083 anonymized digital panoramic radiographs were collected using a Proline XC machine (Planmeca Co., Helsinki, Finland) in accordance with the research ethics protocol. These images were used to train the Faster R-CNN object detection method for detecting periodontally compromised teeth on panoramic radiographs. (3) Results: This study demonstrated a high level of consistency and reproducibility among examiners, with overall inter- and intra-examiner correlation coefficient (ICC) values of 0.94. The Area Under the Curve (AUC) for detecting periodontally compromised and healthy teeth was 0.88 each, and the overall AUC for the entire jaw, including edentulous regions, was 0.91. (4) Conclusions: The regional grouping of teeth exhibited reliable detection performance for periodontal bone loss using a large dataset, indicating the possibility of automating the diagnosis of periodontitis using panoramic radiographs.

The impact of software updates on accuracy of intraoral scanners

BackgroundDigital workflow is showing an increasing tendency in everyday dentistry. Accuracy is essential during digital dental workflows for all indication areas. The present study aimed to evaluate the effect of software updates on the accuracy of intraoral scanner (IOS) devices.Methods3Shape Trios 3 Pod with software versions 18.1.2. (TRI3_1) and 20.1.2. (TRI3_2); 3Shape Trios 4 Move, version 19.2.2. (TRI4_1); and 3Shape Trios 4 Pod, version 20.1.1. (TRI4_2) were used to take direct optical impressions from a polymethyl methacrylate (PMMA) full arch reference model with prepared teeth (FDI 11,14,17 for crowns and FDI 26 for onlay) and an edentulous region (between FDI 14 and 17). The scanners were used eight times; STL files were imported into Geomagic Control X for accuracy assessment by comparing them to a reference data set created by an industrial high-precision scanner (AICON SmartScan-3D C5). The average deviation of the surface points was calculated in three locations: across a full arch (Parameter 1), the region of a four-unit bridge (Parameter 2), and a single prepared abutment (Parameter 3).ResultsIn parameter 1 and 2, the newest model with the latest software (TRI4_2) reached the highest accuracy (31.06 ± 5.24 µm and 21.69 ± 7.50 µm). In parameter 3, an older generation scanner running legacy software produced the highest accuracy: TRI4_1, 11.75 ± 0.35 µm.ConclusionAppropriate software updates can significantly increase the trueness and precision of intraoral scanner devices. With updated software, the older generation can match the accuracy level of latest equipment.