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Suryani IR, Shujaat S, Ivković U, Coucke W, Coropciuc R, Jacobs R. Risk of healing impairment following tooth extraction in patients administered with antiresorptive and non-antiresorptive polypharmacy. J Stomatol Oral Maxillofac Surg 2024; 125:101645. [PMID: 37748709 DOI: 10.1016/j.jormas.2023.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/23/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Lack of evidence existed related to the essential role by which anticancer medications alone or in combination with other polypharmacy would be accountable for wound healing impairment post-dental extraction. The following study was conducted to assess the influence of antiresorptive (AR) and non-antiresorptive (non-AR) drugs and other patient-related risk factors on wound healing status following tooth extraction. MATERIAL AND METHODS A total of 353 patients (age range: 40-90 years, average age: 67.4 years, clinical and radiological follow-up) were recruited. All the patients were divided into three groups, which included, patients used polypharmacy with non-AR drugs, polypharmacy with a combination of AR + non-AR drugs, and the control group. Based on time of healing, the outcome was defined as, normal healing, delayed healing, and Medication-related osteonecrosis of the jaw (MRONJ). The polypharmacy score was categorized depending on the sum of the number of administered medications. RESULTS The odds of delayed healing were significantly higher in 80+ years old patients (OR=6.98, 95 %CI:2.45-19.88, p = < 0.001) administered with AR+ non-AR drugs (OR=14.68, 95 %CI:4.67-46.14, p = < 0.001), having a major polypharmacy score (OR= 15.37, 95 %CI:4.83-48.91, p = < 0.001). On the contrary, patient administered with non-AR drugs (OR=11.52, 95 %CI: 4.45-29.83, p = < 0.001) with hyper polypharmacy (OR=58.86, 95 %CI:25.03-138.40, p = < 0.001) were significantly more likely to develop MRONJ. Smoking and extraction sites showed no significant impact on wound healing impairment. DISCUSSION Wound healing status in patients administered with both non-AR and AR+ non-AR polypharmacy was significantly impaired following tooth extraction. Other risk factors, such as increased age and high polypharmacy scoring, also significantly contributed towards the occurrence of delayed healing and MRONJ.
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Affiliation(s)
- Isti Rahayu Suryani
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sohaib Shujaat
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Una Ivković
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Wim Coucke
- Freelance Statistician, Brugstraat, Heverlee, Belgium
| | - Ruxandra Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Elgarba BM, Fontenele RC, Tarce M, Jacobs R. Artificial intelligence serving pre-surgical digital implant planning: A scoping review. J Dent 2024; 143:104862. [PMID: 38336018 DOI: 10.1016/j.jdent.2024.104862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To conduct a scoping review focusing on artificial intelligence (AI) applications in presurgical dental implant planning. Additionally, to assess the automation degree of clinically available pre-surgical implant planning software. DATA AND SOURCES A systematic electronic literature search was performed in five databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus), along with exploring gray literature web-based resources until November 2023. English-language studies on AI-driven tools for digital implant planning were included based on an independent evaluation by two reviewers. An assessment of automation steps in dental implant planning software available on the market up to November 2023 was also performed. STUDY SELECTION AND RESULTS From an initial 1,732 studies, 47 met eligibility criteria. Within this subset, 39 studies focused on AI networks for anatomical landmark-based segmentation, creating virtual patients. Eight studies were dedicated to AI networks for virtual implant placement. Additionally, a total of 12 commonly available implant planning software applications were identified and assessed for their level of automation in pre-surgical digital implant workflows. Notably, only six of these featured at least one fully automated step in the planning software, with none possessing a fully automated implant planning protocol. CONCLUSIONS AI plays a crucial role in achieving accurate, time-efficient, and consistent segmentation of anatomical landmarks, serving the process of virtual patient creation. Additionally, currently available systems for virtual implant placement demonstrate different degrees of automation. It is important to highlight that, as of now, full automation of this process has not been documented nor scientifically validated. CLINICAL SIGNIFICANCE Scientific and clinical validation of AI applications for presurgical dental implant planning is currently scarce. The present review allows the clinician to identify AI-based automation in presurgical dental implant planning and assess the potential underlying scientific validation.
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Affiliation(s)
- Bahaaeldeen M Elgarba
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals, Campus Sint-Rafael, 3000 Leuven, Belgium & Department of Prosthodontics, Faculty of Dentistry, Tanta University, 31511 Tanta, Egypt.
| | - Rocharles Cavalcante Fontenele
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals, Campus Sint-Rafael, 3000 Leuven, Belgium
| | - Mihai Tarce
- Division of Periodontology & Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China & Periodontology and Oral Microbiology, Department of Oral Health Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals, Campus Sint-Rafael, 3000 Leuven, Belgium & Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Lemberger M, Benchimol D, Pegelow M, Jacobs R, Karsten A. Validation and comparison of 2D grading scales and 3D volumetric measurements for outcome assessment of bone-grafted alveolar clefts in children. Eur J Orthod 2024; 46:cjae002. [PMID: 38346109 PMCID: PMC10872128 DOI: 10.1093/ejo/cjae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Several methods have been proposed to assess outcome of bone-grafted alveolar clefts on cone beam computed tomography (CBCT), but so far these methods have not been compared and clinically validated. OBJECTIVES To validate and compare methods for outcome assessment of bone-grafted clefts with CBCT and provide recommendations for follow-up. METHODS In this observational follow-up study, two grading scales (Suomalainen; Liu) and the volumetric bone fill (BF) were used to assess the outcome of 23 autogenous bone-grafted unilateral alveolar clefts. The mean age at bone grafting was 9 years. The volumetric BF was assessed in five vertical sections. The bone-grafted cleft outcome was based on a binary coding (success or regraft) on a clinical multidisciplinary expert consensus meeting. Grading scales and volumetric assessment were compared in relation to the bone-grafted cleft outcome (success or regraft). Reliability for the different outcome variables was analyzed with intra-class correlation and by calculating kappa values. LIMITATIONS The study had a limited sample size. Clinical CBCT acquisitions had a varying tube current and exposure time. RESULTS Volumetric 3D measurements allowed for outcome assessment of bone-grafted alveolar clefts with high reliability and validity. The two grading scales showed highly reliable outcomes, yet the validity was high for the Suomalainen grading scale but low for the Liu grading scale. CONCLUSIONS Volumetric 3D measurement as well as the Suomalainen grading can be recommended for outcome assessment of the bone-grafted cleft. Yet, one must always make a patient-specific assessment if there is a need to regraft.
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Affiliation(s)
- Mathias Lemberger
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
- Eastman Institute, Department of Orthodontics, Public Dental Services Stockholm, Box 6031, SE-102 31, Stockholm, Sweden
| | - Daniel Benchimol
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
| | - Marie Pegelow
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
| | - Reinhilde Jacobs
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël |Kapucijnenvoer 33, BE-3000 Leuven, Belgium
| | - Agneta Karsten
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
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Wang X, Shujaat S, Shaheen E, Jacobs R. Quality and haptic feedback of three-dimensionally printed models for simulating dental implant surgery. J Prosthet Dent 2024; 131:660-667. [PMID: 35513918 DOI: 10.1016/j.prosdent.2022.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM A model offering anatomic replication and haptic feedback similar to that of real bone is essential for hands-on surgical dental implant training. Patient-specific skeletal models can be produced with 3-dimensional (3D) printing, but whether these models can offer optimal haptic feedback for simulating implant surgery is unknown. PURPOSE The purpose of this trial was to compare the haptic feedback of different 3D printed models for simulating dental implant surgery. MATERIAL AND METHODS A cone beam computed tomography image of a 60-year-old man with a partially edentulous mandible was manipulated to segment the mandible and isolated from the rest of the scan. Three-dimensional models were printed with 6 different printers and materials: material jetting-based printer (MJ, acrylic-based resin); digital light processing-based printer (DLP, acrylic-based resin); fused filament fabrication-based printer (FFF1, polycarbonate filament; FFF2, polylactic acid filament); stereolithography-based printer (SLA, acrylic-based resin); and selective laser sintering-based printer (SLS, polyamide filament). Five experienced maxillofacial surgeons performed a simulated implant surgery on the models. A 5-point Likert scale questionnaire was established to assess the haptic feedback. The Friedman test and cumulative logit models were applied to evaluate differences among the models (α=.05). RESULTS The median score for drilling perception and implant insertion was highest for the MJ-based model and lowest for the SLS-based model. In relation to the drill chips, a median score of ≥3 was observed for all models. The score for corticotrabecular transition was highest for the MJ-based model and lowest for the FFF2-based model. Overall, the MJ-based model offered the highest score compared with the other models. CONCLUSIONS The 3D printed model with MJ technology and acrylic-based resin provided the best haptic feedback for performing implant surgery. However, none of the models were able to completely replicate the haptic perception of real bone.
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Affiliation(s)
- Xiaotong Wang
- Doctoral Candidate, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Clinical Surgeon, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sohaib Shujaat
- Postdoctoral Researcher, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Eman Shaheen
- Clinical Engineer, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Professor, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Professor, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
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Dubron K, Yang LH, Jacobs R, Politis C, Willaert R, Shaheen E. Symmetry recovery in zygomaticomaxillary complex fractures compared to normal unfractured population: A new reliable 3D evaluation. J Stomatol Oral Maxillofac Surg 2024:101857. [PMID: 38556166 DOI: 10.1016/j.jormas.2024.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes. MATERIAL AND METHODS Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed. RESULTS The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±0.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥0.99). CONCLUSIONS This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.
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Affiliation(s)
- K Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - L H Yang
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - R Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - E Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
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Chopra S, Vranckx M, Ockerman A, Östgren P, Krüger-Weiner C, Benchimol D, Shujaat S, Jacobs R. Author Correction: A retrospective longitudinal assessment of artificial intelligence-assisted radiographic prediction of lower third molar eruption. Sci Rep 2024; 14:6558. [PMID: 38503879 PMCID: PMC10951315 DOI: 10.1038/s41598-024-57144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Affiliation(s)
- Shivi Chopra
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden.
| | - Myrthel Vranckx
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anna Ockerman
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Östgren
- Department of Oral and Maxillofacial Radiology, Eastmaninstitutet, Folktandvården Stockholm Län AB, Stockholm, Sweden
| | - Carina Krüger-Weiner
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden
- Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Stockholm, Sweden
| | - Daniel Benchimol
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Reinhilde Jacobs
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Lahoud P, Jacobs R, Elahi SA, Ducret M, Lauwers W, van Lenthe GH, Richert R, EzEldeen M. Developing Advanced Patient-Specific In Silico Models: A New Era in Biomechanical Analysis of Tooth Autotransplantation. J Endod 2024:S0099-2399(24)00157-2. [PMID: 38452866 DOI: 10.1016/j.joen.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/20/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION As personalized medicine advances, there is an escalating need for sophisticated tools to understand complex biomechanical phenomena in clinical research. Recognizing a significant gap, this study pioneers the development of patient-specific in silico models for tooth autotransplantation (TAT), setting a new standard for predictive accuracy and reliability in evaluating TAT outcomes. METHODS Development of the models relied on 6 consecutive cases of young patients (mean age 11.66 years ± 0.79), all undergoing TAT procedures. The development process involved creating detailed in silico replicas of patient oral structures, focusing on transplanting upper premolars to central incisors. These models underpinned finite element analysis simulations, testing various masticatory and traumatic scenarios. RESULTS The models highlighted critical biomechanical insights. The finite element models indicated homogeneous stress distribution in control teeth, contrasted by shape-dependent stress patterns in transplanted teeth. The surface deviation in the postoperative year for the transplanted elements showed a mean deviation of 0.33 mm (±0.28), significantly higher than their contralateral counterparts at 0.05 mm (±0.04). CONCLUSIONS By developing advanced patient-specific in silico models, we are ushering in a transformative era in TAT research and practice. These models are not just analytical tools; they are predictive instruments capturing patient uniqueness, including anatomical, masticatory, and tissue variables, essential for understanding biomechanical responses in TAT. This foundational work paves the way for future studies, where applying these models to larger cohorts will further validate their predictive capabilities and influence on TAT success parameters.
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Affiliation(s)
- Pierre Lahoud
- Department of Oral and Maxillofacial Surgery & Imaging and Pathology, OMFS-IMPATH Research Group, University Hospitals Leuven, KU Leuven, Belgium; Division of Periodontology & Oral Microbiology, Department of Oral Health Sciences-University Hospitals Leuven, KU Leuven, Belgium.
| | - Reinhilde Jacobs
- Department of Oral and Maxillofacial Surgery & Imaging and Pathology, OMFS-IMPATH Research Group, University Hospitals Leuven, KU Leuven, Belgium; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Seyed Ali Elahi
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium; Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Maxime Ducret
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, UMS 3444 BioSciences Gerland- Lyon Sud, Lyon, France; Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Wout Lauwers
- Department of Oral and Maxillofacial Surgery & Imaging and Pathology, OMFS-IMPATH Research Group, University Hospitals Leuven, KU Leuven, Belgium
| | | | - Raphaël Richert
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France; Univ Lyon, INSA Lyon, CNRS, LaMCoS, UMR5259, Villeurbanne, France
| | - Mostafa EzEldeen
- Department of Oral and Maxillofacial Surgery & Imaging and Pathology, OMFS-IMPATH Research Group, University Hospitals Leuven, KU Leuven, Belgium; Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Li J, Shujaat S, Ver Berne J, Shaheen E, Coucke W, Politis C, Jacobs R. Postoperative complications following orthognathic surgery in patients with rheumatic diseases: A 2-year follow-up study. Oral Dis 2024; 30:586-592. [PMID: 36301158 DOI: 10.1111/odi.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/06/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the complications following orthognathic surgery in patients with rheumatic diseases and to evaluate rheumatic disease as a possible risk factor. METHODS A retrospective cohort study was conducted during a 6-year period. The sample consisted of rheumatic and healthy patients who underwent orthognathic surgery. The outcome variables included infection, relapse, respiratory complications, hemorrhage, neurosensory disturbances, temporomandibular joint complications, and removal of osteosynthesis material. Bivariate analysis and logistic regression were applied to identify rheumatic disease as an independent risk factor for complications after orthognathic surgery. RESULTS Twenty patients were identified as having rheumatic diseases (male: 2; female: 18; mean age: 37.8 ± 13.6 years), and 278 patients were systemically healthy (male: 105; female: 173; mean age: 25.8 ± 11.8 years). The most frequent complications in rheumatic and healthy patients were delayed recovery from neurosensory disturbance (55% and 33%), removal of osteosynthesis material (45% and 26%), and infection (35% and 7%). Following adjustment for possible confounders, rheumatic disease showed a significant association with infection (OR = 4.191, p = 0.016). CONCLUSION Patients with rheumatic diseases are at a higher risk of postoperative infection following orthognathic surgery compared to healthy patients.
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Affiliation(s)
- Jiqing Li
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jonas Ver Berne
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Freelance Statistician, Heverlee, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Salar Amoli M, Yang H, Anand R, EzEldeen M, Aktan MK, Braem A, Jacobs R, Bloemen V. Development and characterization of colloidal pNIPAM-methylcellulose microgels with potential application for drug delivery in dentoalveolar tissue engineering strategies. Int J Biol Macromol 2024; 262:129684. [PMID: 38307741 DOI: 10.1016/j.ijbiomac.2024.129684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/28/2023] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
Incorporation of growth factors, signaling molecules and drugs can be vital for the success of tissue engineering in complex structures such as the dentoalveolar region. This has led to the development of a variety of drug release systems. This study aimed to develop pNIPAM-methylcellulose microgels with different synthesis parameters based on a 23 full factorial design of experiments for this application. Microgel properties, including volume phase transition temperature (VPTT), hydrodynamic size, drug loading and release, and cytocompatibility were systematically evaluated. The results demonstrated successful copolymerization and development of the microgels, a hydrodynamic size ranging from ∼200 to ∼500 nm, and VPTT in the range of 34-39 °C. Furthermore, loading of genipin, capable of inducing odontoblastic differentiation, and its sustained release over a week was shown in all formulations. Together, this can serve as a solid basis for the development of tunable drug-delivering pNIPAM-methylcellulose microgels for specific tissue engineering applications.
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Affiliation(s)
- Mehdi Salar Amoli
- Surface and Interface Engineered Materials (SIEM), Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium; Biomaterials and Tissue Engineering Research Group, Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 - box 2450, B-3001 Leuven, Belgium
| | - Huimin Yang
- Surface and Interface Engineered Materials (SIEM), Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
| | - Resmi Anand
- Surface and Interface Engineered Materials (SIEM), Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; Prometheus, Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium
| | - Mostafa EzEldeen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium; Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Merve Kübra Aktan
- Biomaterials and Tissue Engineering Research Group, Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 - box 2450, B-3001 Leuven, Belgium
| | - Annabel Braem
- Biomaterials and Tissue Engineering Research Group, Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 - box 2450, B-3001 Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Veerle Bloemen
- Surface and Interface Engineered Materials (SIEM), Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; Biomaterials and Tissue Engineering Research Group, Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 - box 2450, B-3001 Leuven, Belgium; Prometheus, Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium.
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Salar Amoli M, Anand R, EzEldeen M, Geris L, Jacobs R, Bloemen V. Development of 3D Printed pNIPAM-Chitosan Scaffolds for Dentoalveolar Tissue Engineering. Gels 2024; 10:140. [PMID: 38391470 PMCID: PMC10887597 DOI: 10.3390/gels10020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
While available treatments have addressed a variety of complications in the dentoalveolar region, associated challenges have resulted in exploration of tissue engineering techniques. Often, scaffold biomaterials with specific properties are required for such strategies to be successful, development of which is an active area of research. This study focuses on the development of a copolymer of poly (N-isopropylacrylamide) (pNIPAM) and chitosan, used for 3D printing of scaffolds for dentoalveolar regeneration. The synthesized material was characterized by Fourier transform infrared spectroscopy, and the possibility of printing was evaluated through various printability tests. The rate of degradation and swelling was analyzed through gravimetry, and surface morphology was characterized by scanning electron microscopy. Viability of dental pulp stem cells seeded on the scaffolds was evaluated by live/dead analysis and DNA quantification. The results demonstrated successful copolymerization, and three formulations among various synthesized formulations were successfully 3D printed. Up to 35% degradability was confirmed within 7 days, and a maximum swelling of approximately 1200% was achieved. Furthermore, initial assessment of cell viability demonstrated biocompatibility of the developed scaffolds. While further studies are required to achieve the tissue engineering goals, the present results tend to indicate that the proposed hydrogel might be a valid candidate for scaffold fabrication serving dentoalveolar tissue engineering through 3D printing.
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Affiliation(s)
- Mehdi Salar Amoli
- Surface and Interface Engineered Materials (SIEM), Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Resmi Anand
- Surface and Interface Engineered Materials (SIEM), Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Mostafa EzEldeen
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
- Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Liesbet Geris
- Prometheus, Division of Skeletal Tissue Engineering Leuven, KU Leuven, 3000 Leuven, Belgium
- Biomechanics Research Unit, GIGA-R In Silico Medicine, University of Liège, Quartier Hôpital, Avenue de l'Hôpital 11, 4000 Liège, Belgium
- Biomechanics Section, KU Leuven, Celestijnenlaan 300C (2419), 3000 Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Veerle Bloemen
- Surface and Interface Engineered Materials (SIEM), Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering Leuven, KU Leuven, 3000 Leuven, Belgium
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Doucet K, Shaheen E, Danneels M, Dormaar T, Verdonck A, Willems G, Politis C, Jacobs R, Cadenas de Llano-Pérula M. Three-dimensional evaluation of secondary alveolar bone grafting in patients with unilateral cleft lip and palate: A 2-3 year post-operative follow-up. Orthod Craniofac Res 2024. [PMID: 38299981 DOI: 10.1111/ocr.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES The present study aims to quantitatively assess secondary alveolar bone graft (SABG) resorption in unilateral cleft lip, alveolus and palate (UCLAP) patients in a 2-3 year longitudinal follow-up setting by using a validated 3D protocol. Furthermore, the potential relation of SABG resorption with maxillary canine position and a number of patient-related factors was investigated. METHODS UCLAP patients who underwent SABG and had good quality CBCT images at the following timepoints were included in the study: pre-operative (T0), immediate (T1), 6 months (T2) and either 1-2 years (T3) or 2-3 years (T4) post-operative. The final bone grafted region was defined on the T1 scans and refined in the registered T0 scans. The bone graft after resorption was determined by applying threshold-based segmentation on the registered T2, T3 or T4 scans within the segmented bone graft volume. The position of the canines was determined at every timepoint at the cleft and non-cleft side. RESULTS Forty-five UCLAP patients (mean age 9.0 ± 1.3 years) were included. In the first 6 months after SABG, 43.6% bone resorption was recorded. 2-3 years post-operative, 56% bone resorption was found if the maxillary canine was not yet erupted and 42.7% if it erupted through the graft. The vertical position of the canines was significantly higher on the cleft side at T3. CONCLUSIONS The present study reports significant SABG resorption over time. However, no correlation was found between SABG resorption and canine position, nor between other patient-related factors.
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Affiliation(s)
- Kaat Doucet
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Margaux Danneels
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Titiaan Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anna Verdonck
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
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12
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Nogueira-Reis F, Morgan N, Suryani IR, Tabchoury CPM, Jacobs R. Full virtual patient generated by artificial intelligence-driven integrated segmentation of craniomaxillofacial structures from CBCT images. J Dent 2024; 141:104829. [PMID: 38163456 DOI: 10.1016/j.jdent.2023.104829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/13/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES To assess the performance, time-efficiency, and consistency of a convolutional neural network (CNN) based automated approach for integrated segmentation of craniomaxillofacial structures compared with semi-automated method for creating a virtual patient using cone beam computed tomography (CBCT) scans. METHODS Thirty CBCT scans were selected. Six craniomaxillofacial structures, encompassing the maxillofacial complex bones, maxillary sinus, dentition, mandible, mandibular canal, and pharyngeal airway space, were segmented on these scans using semi-automated and composite of previously validated CNN-based automated segmentation techniques for individual structures. A qualitative assessment of the automated segmentation revealed the need for minor refinements, which were manually corrected. These refined segmentations served as a reference for comparing semi-automated and automated integrated segmentations. RESULTS The majority of minor adjustments with the automated approach involved under-segmentation of sinus mucosal thickening and regions with reduced bone thickness within the maxillofacial complex. The automated and the semi-automated approaches required an average time of 1.1 min and 48.4 min, respectively. The automated method demonstrated a greater degree of similarity (99.6 %) to the reference than the semi-automated approach (88.3 %). The standard deviation values for all metrics with the automated approach were low, indicating a high consistency. CONCLUSIONS The CNN-driven integrated segmentation approach proved to be accurate, time-efficient, and consistent for creating a CBCT-derived virtual patient through simultaneous segmentation of craniomaxillofacial structures. CLINICAL RELEVANCE The creation of a virtual orofacial patient using an automated approach could potentially transform personalized digital workflows. This advancement could be particularly beneficial for treatment planning in a variety of dental and maxillofacial specialties.
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Affiliation(s)
- Fernanda Nogueira-Reis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven Kapucijnenvoer 7, Leuven 3000, Belgium; Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, Piracicaba, São Paulo 13414‑903, Brazil
| | - Nermin Morgan
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven Kapucijnenvoer 7, Leuven 3000, Belgium; Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia 35516, Egypt
| | - Isti Rahayu Suryani
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven Kapucijnenvoer 7, Leuven 3000, Belgium; Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cinthia Pereira Machado Tabchoury
- Department of Biosciences, Division of Biochemistry, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, Piracicaba, São Paulo 13414‑903, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven Kapucijnenvoer 7, Leuven 3000, Belgium; Department of Dental Medicine, Karolinska Institutet, Box 4064, Huddinge, Stockholm 141 04, Sweden.
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Coropciuc R, Moreno-Rabié C, De Vos W, Van de Casteele E, Marks L, Lenaerts V, Coppejans E, Lenssen O, Coopman R, Walschap J, Nadjmi N, Jacobs R, Politis C, Van den Wyngaert T. Navigating the complexities and controversies of medication-related osteonecrosis of the jaw (MRONJ): a critical update and consensus statement. Acta Chir Belg 2024; 124:1-11. [PMID: 38059301 DOI: 10.1080/00015458.2023.2291295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To provide a critical update identifying the knowledge gaps and controversies in medication-related osteonecrosis of the jaw (MRONJ) within the Belgian healthcare context and outline opportunities for improvement and research in these areas. METHODS A literature review was performed to identify guidelines from international clinical societies in oncology or oral and maxillofacial surgery on diagnosing, preventing, and treating MRONJ. The recommendations were critically assessed in light of recent developments in the field and confronted with the clinical experience of experts. RESULTS Despite progress in the diagnostic criteria of MRONJ, the continued need for an 8-week timeout period should be reconsidered. Furthermore, 3D imaging techniques should be introduced to improve diagnosis and staging. The staging system remains ambiguous regarding Stage 0 MRONJ, and ongoing confusion exists regarding the term non-exposed MRONJ. The prevention of MRONJ should be tailored, considering the individual patient's risk of MRONJ, frailty, and life expectancy. More research seems needed into the efficacy and safety of drug holidays, considering the risks of rebound remodeling on fractures. With renewed interest in surgical and adjunct management techniques, adequately designed clinical studies are needed to help translate trial outcomes into universally applicable treatment guidelines taking into account individual patient characteristics. CONCLUSIONS Important knowledge gaps remain and hamper the development of clinical guidelines. Several controversies were identified where consensus is lacking, and further harmonization between stakeholders is necessary. Finally, the need for randomized controlled comparative clinical trials in MRONJ resonates harder than ever to identify the best treatment for individual patients.
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Affiliation(s)
- Ruxandra Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Catalina Moreno-Rabié
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Wouter De Vos
- Department of Oral and Maxillofacial Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Elke Van de Casteele
- Department of Oral and Maxillofacial Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Marks
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Special Care Dentistry, Antwerp University Hospital, Antwerp, Belgium
| | - Vincent Lenaerts
- Department of Oral and Maxillofacial Surgery, VITAZ, Sint-Niklaas, Belgium
| | - Evy Coppejans
- Department of Oral and Maxillofacial Surgery, VITAZ, Sint-Niklaas, Belgium
| | - Olivier Lenssen
- Department of Oral and Maxillofacial Surgery, ZNA Middelheim, Antwerpen, Belgium
| | - Renaat Coopman
- Department of Oral and Maxillofacial and Plastic Surgery, University Hospital of Ghent, Ghent, Belgium
| | | | - Nasser Nadjmi
- Department of Oral and Maxillofacial Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Reinhilde Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tim Van den Wyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
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14
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Chopra S, Vranckx M, Ockerman A, Östgren P, Krüger-Weiner C, Benchimol D, Shujaat S, Jacobs R. A retrospective longitudinal assessment of artificial intelligence-assisted radiographic prediction of lower third molar eruption. Sci Rep 2024; 14:994. [PMID: 38200067 PMCID: PMC10781671 DOI: 10.1038/s41598-024-51393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024] Open
Abstract
Prediction of lower third molar eruption is crucial for its timely extraction. Therefore, the primary aim of this study was to investigate the prediction of lower third molar eruption and its uprighting with the assistance of an artificial intelligence (AI) tool. The secondary aim was identifying the incidence of fully erupted lower third molars with hygienic cleansability. In total, 771 patients having two panoramic radiographs were recruited, where the first radiograph was acquired at 8-15 years of age (T1) and the second acquisition was between 16 and 23 years (T2). The predictive model for third molar eruption could not be obtained as few teeth reached full eruption. However, uprighting model at T2 showed that in cases with sufficient retromolar space, an initial angulation of < 32° predicted uprighting. Full eruption was observed for 13.9% of the teeth, and only 1.7% showed hygienic cleansability. The predictions model of third molar uprighting could act as a valuable aid for guiding a clinician with the decision-making process of extracting third molars which fail to erupt in an upright fashion. In addition, a low incidence of fully erupted molars with hygienic cleansability suggest that a clinician might opt for prophylactic extraction.
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Affiliation(s)
- Shivi Chopra
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden.
| | - Myrthel Vranckx
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anna Ockerman
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Östgren
- Department of Oral and Maxillofacial Radiology, Eastmaninstitutet, Folktandvården Stockholm Län AB, Stockholm, Sweden
| | - Carina Krüger-Weiner
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden
- Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Stockholm, Sweden
| | - Daniel Benchimol
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Reinhilde Jacobs
- Section of Oral Diagnostics and Surgery, Division of Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 53, Stockholm, Sweden
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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15
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Xu L, Jacobs R, Cao Y, Sun X, Qin X. Tissue-engineered bone construct promotes early osseointegration of implants with low primary stability in oversized osteotomy. BMC Oral Health 2024; 24:69. [PMID: 38200461 PMCID: PMC10782778 DOI: 10.1186/s12903-023-03834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES To evaluate the histological parameters and bone mechanical properties around implants with low primary stability (PS) in grafted bone substitutes within an oversized osteotomy. MATERIALS AND METHODS An oversized osteotomy penetrating the double cortical bone layers was made on both femora of 24 New Zealand white rabbits. Bilaterally in the femur of all animals, 48 implants were installed, subdivided into four groups, corresponding to four prepared tissue-engineering bone complexes (TEBCs), which were placed between the implant surface and native bone wall: A: tricalcium phosphate β (TCP-β); B: autologous adipose derived-stem cells with TCP-β (ASCs/TCP-β); C: ASCs transfected with the enhanced-GFP gene with TCP-β (EGFP-ASCs/TCP-β); D: ASCs transfected with the BMP-2 gene with TCP-β (BMP2-ASCs/TCP-β). Trichrome fluorescent labeling was conducted. Animals were sacrificed after eight weeks. The trichromatic fluorescent labeling (%TFL), area of new bone (%NB), residual material (%RM), bone-implant contact (%BIC), and the removal torque force (RTF, N/cm) were assessed. RESULTS ASCs were successfully isolated from adipose tissue, and the primary ASCs were induced into osteogenic, chondrogenic, and adipogenic differentiation. The BMP-2 overexpression of ASCs sustained for ten days and greatly enhanced the expression of osteopontin (OPN). At eight weeks post-implantation, increased %NB and RTF were found in all groups. The most significant value of %TFL, %BIC and lowest %RM was detected in group D. CONCLUSION The low PS implants osseointegrate with considerable new bone in grafted TEBCs within an oversized osteotomy. Applying BMP-2 overexpressing ASCs-based TEBC promoted earlier osseointegration and more solid bone mechanical properties on low PS implants. Bone graft offers a wedging effect for the implant with low PS at placement and promotes osteogenesis on their surface in the healing period.
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Affiliation(s)
- Lianyi Xu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, Hubei, China
- Department of Imaging and Pathology, OMFS-IMPATH, KU Leuven, Kapucijnenvoer 7, Leuven, 3000, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH, KU Leuven, Kapucijnenvoer 7, Leuven, 3000, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, SE-171 77, Sweden
| | - Yingguang Cao
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, Hubei, China
| | - Xiaojuan Sun
- Department of Oral and Maxillofacial Surgery, General Hospital, Ningxia Medical University, 804 Shengli Street, Yinchuan, 750004, China.
| | - Xu Qin
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, Hubei, China.
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Swaity A, Elgarba BM, Morgan N, Ali S, Shujaat S, Borsci E, Chilvarquer I, Jacobs R. Deep learning driven segmentation of maxillary impacted canine on cone beam computed tomography images. Sci Rep 2024; 14:369. [PMID: 38172136 PMCID: PMC10764895 DOI: 10.1038/s41598-023-49613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
The process of creating virtual models of dentomaxillofacial structures through three-dimensional segmentation is a crucial component of most digital dental workflows. This process is typically performed using manual or semi-automated approaches, which can be time-consuming and subject to observer bias. The aim of this study was to train and assess the performance of a convolutional neural network (CNN)-based online cloud platform for automated segmentation of maxillary impacted canine on CBCT image. A total of 100 CBCT images with maxillary canine impactions were randomly allocated into two groups: a training set (n = 50) and a testing set (n = 50). The training set was used to train the CNN model and the testing set was employed to evaluate the model performance. Both tasks were performed on an online cloud-based platform, 'Virtual patient creator' (Relu, Leuven, Belgium). The performance was assessed using voxel- and surface-based comparison between automated and semi-automated ground truth segmentations. In addition, the time required for segmentation was also calculated. The automated tool showed high performance for segmenting impacted canines with a dice similarity coefficient of 0.99 ± 0.02. Moreover, it was 24 times faster than semi-automated approach. The proposed CNN model achieved fast, consistent, and precise segmentation of maxillary impacted canines.
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Affiliation(s)
- Abdullah Swaity
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Prosthodontic Department, King Hussein Medical Center, Jordanian Royal Medical Services, Amman, Jordan
| | - Bahaaeldeen M Elgarba
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Prosthodontics, Tanta University, Tanta, Egypt
| | - Nermin Morgan
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Saleem Ali
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Restorative Dentistry Department, King Hussein Medical Center, Jordanian Royal Medical Services, Amman, Jordan
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Elena Borsci
- Oral Diagnostic Clinic, Karolinska Institute, Stockholm, Sweden
| | - Israel Chilvarquer
- Department of Oral Radiology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
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Van der Cruyssen F, Palla B, Jacobs R, Politis C, Zuniga J, Renton T. Consensus guidelines on training, diagnosis, treatment and follow-up care of trigeminal nerve injuries. Int J Oral Maxillofac Surg 2024; 53:68-77. [PMID: 37365073 DOI: 10.1016/j.ijom.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
The aim was to present expert-based guidelines on the management of trigeminal nerve injuries. A two-round multidisciplinary Delphi study was conducted amongst international trigeminal nerve injury experts with a set of statements and three summary flowcharts using a nine-point Likert scale (1 = strongly disagree; 9 = strongly agree). An item was deemed appropriate if the median panel score was within the range of 7-9, undecided if the score was 4-6, and inappropriate if the score was 1-3. Consensus was achieved if at least 75% of panelists scored within one range. Eighteen specialists from dental, medical, and surgical specialties participated in both rounds. Consensus was reached on most statements related to training/services (78%) and diagnosis (80%). Statements related to treatment were mainly undecided due to a lack of sufficient evidence for some of the proposed treatments. Nevertheless, the summary treatment flowchart reached consensus with a median score of eight. Recommendations on follow-up and opportunities for future research were discussed. None of the statements were deemed inappropriate. A set of recommendations and accepted flowcharts are presented; these will aid professionals involved in managing patients with trigeminal nerve injuries.
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Affiliation(s)
- F Van der Cruyssen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium.
| | - B Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - R Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium; Dentomaxillofacial Imaging Center, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - J Zuniga
- Departments of Surgery and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - T Renton
- Department of Oral Surgery, King's College London Dental Institute, King's College London, London, United Kingdom
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Bangia M, Ahmadzai I, Casselman J, Politis C, Jacobs R, Van der Cruyssen F. Accuracy of MR neurography as a diagnostic tool in detecting injuries to the lingual and inferior alveolar nerve in patients with iatrogenic post-traumatic trigeminal neuropathy. Eur Radiol 2023:10.1007/s00330-023-10363-2. [PMID: 38047973 DOI: 10.1007/s00330-023-10363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES MR neurography has the ability to detect and depict peripheral nerve injuries. This study evaluated the potential of MR neurography in the diagnosis of post-traumatic trigeminal neuropathy. METHODS Forty-one participants prospectively underwent MR neurography of the lingual and inferior alveolar nerves using a 3D TSE STIR black-blood sequence. Two blinded and independent observers recorded the following information for each nerve of interest: presence of injury, nerve thickness, nerve signal intensity, MR neurography Sunderland class, and signal gap. Afterwards, the apparent nerve-muscle contrast-to-noise ratio and apparent signal-to-noise ratio were calculated. Clinical data (neurosensory testing score and clinical Sunderland class) was extracted retrospectively from the medical records of patients diagnosed with post-traumatic trigeminal neuropathy. RESULTS Compared to neurosensory testing, MR neurography had a sensitivity of 38.2% and specificity of 93.5% detecting nerve injuries. When differentiated according to clinical Sunderland class, sensitivity was 19.1% in the presence of a low class injury (I to III) and improved to 83.3% in the presence of a high class (IV to V). Specificity remained unchanged. The area under the curve using the apparent nerve-muscle contrast-to-noise ratio, apparent signal-to-noise ratio, and nerve thickness to predict the presence of an injury was 0.78 (p < .05). Signal intensities and nerve diameter increased in injured nerves (p < .05). Clinical and MR neurography Sunderland scores positively correlated (correlation coefficient = 0.53; p = .005). CONCLUSIONS This study shows that MR neurography can accurately differentiate between injured and healthy nerves, especially in the presence of a more severe nerve injury. CLINICAL RELEVANCE STATEMENT MR neurography is not only able to detect trigeminal nerve injuries, but it can also provide information about the anatomical specifications of the injury, which is not possible with clinical neurosensory testing. This makes MR neurography an added value in the management of post-traumatic trigeminal neuropathy. KEY POINTS • The current diagnosis of post-traumatic trigeminal neuropathy is mainly based on clinical examination. • MR neurography is able to visualize and stratify peripheral trigeminal nerve injuries. • MR neurography contributes to the diagnostic process as well as to further decision-making.
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Affiliation(s)
- Mado Bangia
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Iraj Ahmadzai
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Brugge, Belgium
- Department of Radiology, AZ St-Augustinus, Antwerp, Belgium
- University Ghent, Ghent, Belgium
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Reinhilde Jacobs
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
- Dentomaxillofacial Imaging Center, University Hospitals Leuven, Louvain, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium.
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium.
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Molina MAV, Silva GO, Candemil AP, Camargo RVD, Pauwels R, Jacobs R, Sousa-Neto MD, Mazzi-Chaves JF. Evaluation of 2- and 3-dimensional anatomic parameters of C-shaped root canals with cone beam computed tomography, microcomputed tomography, and nanocomputed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:759-768. [PMID: 37580223 DOI: 10.1016/j.oooo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate 2-dimensional (2D) and 3D morphometric parameters of C-shaped root canals on cone beam computed tomography (CBCT) and microcomputed tomography (microCT) images using nanocomputed tomography (nanoCT) as the reference standard. STUDY DESIGN Sixty mandibular molars with C-shaped canals were individually scanned using nanoCT and microCT. Cone beam computed tomography acquisitions were then performed with 4 CBCT systems, using high and standard resolutions. The 2D parameters of roundness and major and minor diameters were obtained in the cross sections of the root canals at 1, 2, and 3 mm from the root apex. The 3D parameters of surface area, volume, and structure model index were measured considering the entire extension of the root canals. Absolute error (AE) in measurement was calculated against the nanoCT values. Data were statistically analyzed with the Shapiro-Wilk test and analysis of variance (α = 0.05). RESULTS No significant differences in AE were discovered for the 2D parameters among microCT and the CBCT scans. The AE values for the 3D parameters of volume and surface area were significantly smaller in microCT compared to all CBCT units (P < .05). Significantly lower AE values for surface area were observed in high resolution compared to standard resolution for all CBCT units (P < .05). Structure model index did not differ significantly among microCT and all CBCT protocols. CONCLUSIONS Cone beam computed tomography images showed accuracy for evaluating 2D parameters and over- and underestimation for 3D parameters.
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Affiliation(s)
- Miguel Angel Ventura Molina
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Giovane Oliveira Silva
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Amanda Pelegrin Candemil
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Rafael Verardino de Camargo
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Ruben Pauwels
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, University Hospitals Leuven, Leuven, Belgium; Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil.
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Picoli FF, Fontenele RC, Van der Cruyssen F, Ahmadzai I, Trigeminal Nerve Injuries Research Group, Politis C, Silva MAG, Jacobs R. Risk assessment of inferior alveolar nerve injury after wisdom tooth removal using 3D AI-driven models: A within-patient study. J Dent 2023; 139:104765. [PMID: 38353315 DOI: 10.1016/j.jdent.2023.104765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To compare a three-dimensional (3D) artificial intelligence (AI)- driven model with panoramic radiography (PANO) and cone-beam computed tomography (CBCT) in assessing the risk of inferior alveolar nerve (IAN) injury after mandibular wisdom tooth (M3M) removal through a within-patient controlled trial. METHODS From a database of 6,010 patients undergoing M3M surgery, 25 patients met the inclusion criteria of bilateral M3M removal with postoperative unilateral IAN injury. In this within-patient controlled trial, preoperative PANO and CBCT images were available, while 3D-AI models of the mandibular canal and teeth were generated from the CBCT images using the Virtual Patient Creator AI platform (Relu BV, Leuven, Belgium). Five examiners, who were blinded to surgical outcomes, assessed the imaging modalities and assigned scores indicating the risk level of IAN injury (high, medium, or low risk). Sensitivity, specificity, and area under receiver operating curve (AUC) for IAN risk assessment were calculated for each imaging modality. RESULTS For IAN injury risk assessment after M3M removal, sensitivity was 0.87 for 3D-AI, 0.89 for CBCT versus 0.73 for PANO. Furthermore, the AUC and specificity values were 0.63 and 0.39 for 3D-AI, 0.58 and 0.28 for CBCT, and 0.57 and 0.41 for PANO, respectively. There was no statistically significant difference (p>0.05) among the imaging modalities for any diagnostic parameters. CONCLUSION This within-patient controlled trial study revealed that risk assessment for IAN injury after M3M removal was rather similar for 3D-AI, PANO, and CBCT, with a sensitivity for injury prediction reaching up to 0.87 for 3D-AI and 0.89 for CBCT. CLINICAL SIGNIFICANCE This within-patient trial is pioneering in exploring the application of 3D AI-driven models for assessing IAN injury risk after M3M removal. The present results indicate that AI-powered 3D models based on CBCT might facilitate IAN risk assessment of M3M removal.
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Affiliation(s)
- Fernando Fortes Picoli
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Rocharles Cavalcante Fontenele
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Frederic Van der Cruyssen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Iraj Ahmadzai
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | | | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
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21
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Shujaat S, Politis C, Van Den Bogaert T, Vueghs P, Smeets M, Verhelst PJ, Grymonprez E, Jacobs R. Morphological characteristics of coronoid process and revisiting definition of coronoid hyperplasia. Sci Rep 2023; 13:21049. [PMID: 38030618 PMCID: PMC10687078 DOI: 10.1038/s41598-023-46289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
The aim of this study was to assess the morphological characteristics of the coronoid process (CP) and define coronoid hyperplasia (CH) using cadaveric mandibles of a Caucasian population. A sample of 151 adult dry cadaveric mandibles (302 CPs) was acquired. Three distances were measured, which included the width, height, and length of CP. The surface area measurements involved area A: above the width distance line; area B: between incisura mandibulae-Alveolar ridge line and width distance line; area C: between distance lines of width and height. Finally, angulations of the CP and gonial angles were identified. Both length and surface area A + B acted as hyperplastic indicators. Based on the selection criteria, a sample of 197 CPs was included. The hooked shape (59%) was most commonly observed. No significant difference existed between left and right sides (p > 0.05). The mean values of length and surface area A + B were 2.2 ± 0.3 cm and 3.3 ± 0.8 cm2, and any values above 2.7 cm (n = 5 CPs- 2.5%) and 5.0 cm2 (n = 9 CPs- 4.6%) were described as hyperplastic, respectively. The presented data could act as quantitative reference for differentiating between normal and hyperplastic conditions.
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Affiliation(s)
- Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Van Den Bogaert
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Vueghs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maximiliaan Smeets
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pieter-Jan Verhelst
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Edouard Grymonprez
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- Section of Oral Diagnostics and Surgery, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden.
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Verbist M, Dubron K, Bila M, Jacobs R, Shaheen E, Willaert R. Accuracy of surgical navigation for patient-specific reconstructions of orbital fractures: a systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg 2023:101683. [PMID: 37951500 DOI: 10.1016/j.jormas.2023.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques. MATERIALS AND METHODS A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles. RESULTS After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm3 ± 0.47 cm3) when surgical navigation was used compared with conventional surgery (2.17 cm3 ± 1.35 cm3). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used. CONCLUSION Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs.
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Affiliation(s)
- M Verbist
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium.
| | - K Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - M Bila
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - R Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - R Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
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Tarce M, Becker K, Lahoud P, Shujaat S, Jacobs R, Quirynen M. Non-invasive oral implant position assessment: An ex vivo study using a 3D industrial scan as the reference model to mimic the clinical situation. Clin Oral Implants Res 2023. [PMID: 37927146 DOI: 10.1111/clr.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/17/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
AIM To introduce an objective method to evaluate the accuracy of implant position assessment in partially edentulous patients by comparing different techniques (conventional impression, intraoral scan, CBCT) to a reference 3D model obtained with an industrial scanner, the latter mimicking the clinical situation. MATERIALS AND METHODS Twenty-nine implants were placed in four human cadaver heads using a fully guided flapless protocol. Implant position was assessed using (a) a conventional impression, (b) an intraoral scan, and (c) CBCT and compared to an industrial scan. Three-dimensional models of intraoral scan body and implant were registered to the arch models and the deviation at implant shoulder, apex, and the angle of deviation were compared to each other as well as to the reference model. RESULTS The three assessment techniques showed statistically significant deviations (p < .01) from the industrial scan, for all measurements, with no difference between the techniques. The maximum deviation at the implant shoulder was 0.16 mm. At the implant apex this increased to 0.38 mm. The intraoral scan deviated significantly more than the CBCT (0.12 mm, p < .01) and the conventional impression (0.10 mm, p = .02). The maximum implant angle deviation was 1.0°. The intraoral scan deviated more than the conventional impression (0.3°, p = .02). CONCLUSION All assessment techniques deviated from the reference industrial scan, but the differences were relatively small. Intraoral scans were slightly less accurate than both conventional impressions and CBCT. Depending on the application, however, this inaccuracy may not be clinically relevant.
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Affiliation(s)
- Mihai Tarce
- Division of Periodontology & Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
- Periodontology and Oral Microbiology, Department of Oral Health Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Kathrin Becker
- Charité- Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Orthodontics and Dentofacial Orthopedics, Berlin, Germany
| | - Pierre Lahoud
- Periodontology and Oral Microbiology, Department of Oral Health Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Quirynen
- Periodontology and Oral Microbiology, Department of Oral Health Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Moreno Rabie C, Cavalcante Fontenele R, Oliveira Santos N, Nogueira Reis F, Van den Wyngaert T, Jacobs R. Three-dimensional clinical assessment for MRONJ risk in oncologic patients following tooth extractions. Dentomaxillofac Radiol 2023; 52:20230238. [PMID: 37874081 DOI: 10.1259/dmfr.20230238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES To identify clinical and local radiographic predictors for medication-related osteonecrosis of the jaws (MRONJ) by the assessment of pre-operative CBCT images of oncologic patients treated with anti-resorptive drugs (ARDs) undergoing tooth extractions. METHODS This retrospective, longitudinal, case-control study included clinical and imaging data of 97 patients, divided into study and control group. Patients in the study group (n = 47; 87 tooth extractions) had received at least one dose of ARD, undergone tooth extraction(s), and had a pre-operative CBCT. An age-, gender-, and tooth extraction-matched control group (n = 50; 106 tooth extractions) was selected. Three calibrated, blinded, and independent examiners evaluated each tooth extraction site. Statistical analysis used χ2/Fisher's exact/Mann-Whitney U test to contrast control and study group, ARD type used, and sites with or without MRONJ development. p-value ≤ 0.05 was considered significant. RESULTS From the study group, 15 patients (32%) and 33 sites (38%) developed MRONJ after tooth extraction. When controls were compared to study sites, the latter showed significantly more thickening of the lamina dura, widened periodontal ligament space, osteosclerosis, osteolysis, and sequestrum formation. In the study group, MRONJ risk significantly increased in patients who had multiple tooth extractions, were smokers, and had shorter drug holidays. Periosteal reaction and sequestrum formation may indicate latent MRONJ lesions. Additionally, patients given bisphosphonates showed considerably more osteosclerosis than those given denosumab. CONCLUSIONS Periosteal reaction and sequestrum formation are suspected to be pre-clinical MRONJ lesions. Furthermore, ARD induced bony changes and radiographic variations between ARD types were seen.
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Affiliation(s)
- Catalina Moreno Rabie
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Rocharles Cavalcante Fontenele
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Nicolly Oliveira Santos
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Fernanda Nogueira Reis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Candemil AP, Mazzi-Chaves JF, Oliveira ML, Ambrosano GB, Vasconcelos KF, Pauwels R, Jacobs R, Sousa-Neto MD. Assessment of the root filling volume in C-shaped root canal on cone-beam CT and micro-CT in relation to nano-CT. Clin Oral Investig 2023; 27:6413-6420. [PMID: 37704914 DOI: 10.1007/s00784-023-05244-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
AIM To assess the observed volume of filled C-shaped root canals from different CBCT and micro-CT having nano-CT as a reference. MATERIALS AND METHODS Twelve extracted mandibular molars with C-shaped root canals were endodontically treated using Reciproc Blue R25 (VDW GMBH, Munich, Germany) in a reciprocating system and filled with gutta-percha (Dentsply Maillefer) and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). CBCT scans were performed using 3 units-3D Accuitomo 170 (J. Morita, Kyoto, Japan), ProMax 3D Max (Planmeca, Helsinki, Finland), and NewTom VGi EVO (Cefla QR, Verona, Italy)-at two resolution modes: standard and high. Micro-CT and nano-CT scans were also obtained. The volume of all filled C-shaped root canals was obtained using CTAn software (Bruker, Kontich, Belgium), and the blooming artifact, in relation to nano-CT volume, was calculated. The data were evaluated by the Bland-Altman plots and ANOVA two-way for repeated measures (α = 0.05). RESULTS All CBCT units and micro-CT showed significantly larger observed volume of root canal filling when compared to nano-CT. The blooming artifact of root canal filling in standard resolution was significantly larger than that in high resolution (p < 0.05) in all CBCT units. CONCLUSIONS Endodontic filling material with AH Plus sealer causes blooming artifacts in CBCT units and micro-CT. CLINICAL RELEVANCE Considering the anatomical complexity of C-shaped root canals and the challenges associated with endodontic treatment, CBCT is frequently recommended for follow-up evaluations. However, the presence of endodontic filling material can result in blooming artifacts that may potentially impact the accurate diagnosis of endodontic complications.
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Affiliation(s)
- Amanda Pelegrin Candemil
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil.
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Matheus Lima Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Guilherme Bovi Ambrosano
- Department of Statistical Genetics, Luiz de Queiroz College of Agriculture, University of São Paulo, São Paulo, Brazil
| | | | - Ruben Pauwels
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil
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Moreno Rabie C, García-Larraín S, Contreras Diez de Medina D, Cabello-Salazar I, Fontenele RC, Van den Wyngaert T, Jacobs R. How does the clinical and tomographic appearance of MRONJ influences its treatment prognosis? Dentomaxillofac Radiol 2023; 52:20230304. [PMID: 37870051 DOI: 10.1259/dmfr.20230304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVES To identify clinical and tomographic prognostic factors for conservative and surgical treatment of medication-related osteonecrosis of the jaws (MRONJ). METHODS A retrospective search identified patients treated with antiresorptive drugs (ARDs), diagnosed with Stage 1, 2 or 3 MRONJ, and having CBCT scans previous to conservative or surgical treatment. Following data collection, imaging assessment of the following parameters on each MRONJ site was performed: involvement of teeth and/or implants, presence of osteosclerosis, osteolysis, sequestrum formation, periosteal reaction, and pathological fractures. For statistical analysis, patients and lesions were divided into conservative and surgical treatment. Comparisons were made between successful and unsuccessful outcomes. Significance was set at p ≤ 0.05. RESULTS 115 ARD-treated patients who developed 143 osteonecrosis lesions were selected. 40 patients and 58 lesions received conservative treatment, of which 14 patients (35%) and 25 lesions (43%) healed. Additionally, 75 patients and 85 lesions underwent surgery, with 48 patients (64%) and 55 lesions (65%) that healed. Clinical and tomographic risk factors for conservative treatment were MRONJ staging, tooth involvement, extensive osteosclerosis, and deep sequestrum formation (p < 0.05). Complementarily, poor prognostic indicators for surgical therapy were a short bisphosphonate (BP) holiday, MRONJ staging, absence of sequestrum formation, and presence of periosteal reaction (p < 0.05). CONCLUSIONS Lesions at Stage 3 MRONJ, with tooth involvement, or sequestrum formation showed poor outcomes when conservative treatment is chosen. Alternatively, surgical treatment is most effective when BPs are discontinued, in Stage 1 lesions, in the presence of sequestrum formation, and absence of periosteal reaction.
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Affiliation(s)
- Catalina Moreno Rabie
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Santiago García-Larraín
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Radiology, Facultad de Odontología, Universidad de los Andes, Santiago, Chile
| | - David Contreras Diez de Medina
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Radiology, Facultad de Odontología, Universidad de los Andes, Santiago, Chile
| | - Isadora Cabello-Salazar
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Radiology, Facultad de Odontología, Universidad de los Andes, Santiago, Chile
| | - Rocharles Cavalcante Fontenele
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Merken K, Monnens J, Marshall N, Johan N, Brasil DM, Santaella GM, Politis C, Jacobs R, Bosmans H. Development and validation of a 3D anthropomorphic phantom for dental CBCT imaging research. Med Phys 2023; 50:6714-6736. [PMID: 37602774 DOI: 10.1002/mp.16661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Optimization of dental cone beam computed tomography (CBCT) imaging is still in a preliminary stage and should be addressed using task-based methods. Dedicated models containing relevant clinical tasks for image quality studies have yet to be developed. PURPOSE To present a methodology to develop and validate a virtual adult anthropomorphic voxel phantom for use in task-based image quality optimization studies in dental CBCT imaging research, focusing on root fracture (RF) detection tasks in the presence of metal artefacts. METHODS The phantom was developed from a CBCT scan with an isotropic voxel size of 0.2 mm, from which the main dental structures, mandible and maxilla were segmented. The missing large anatomical structures, including the spine, skull and remaining soft tissues, were segmented from a lower resolution full skull scan. Anatomical abnormalities were absent in the areas of interest. Fine detailed dental structures, that could not be segmented due to the limited resolution and noise in the clinical data, were modelled using a-priori anatomical knowledge. Model resolution of the teeth was therefore increased to 0.05 mm. Models of RFs as well as dental restorations to create the artefacts, were developed, and could be inserted in the phantom in any desired configuration. Simulated CBCT images of the models were generated using a newly developed multi-resolution simulation framework that incorporated the geometry, beam quality, noise and spatial resolution characteristics of a real dental CBCT scanner. Ray-tracing and Monte Carlo techniques were used to create the projection images, which were reconstructed using the classical FDK algorithm. Validation of the models was assessed by measurements of different tooth lengths, the pulp volume and the mandible, and comparison with reference values. Additionally, the simulated images were used in a reader study in which two oral radiologists had to score the realism level of the model's normal anatomy, as well as the modelled RFs and restorations. RESULTS A model of an adult head, as well as models of RFs and different types of dental restorations were created. Anatomical measurements were consistent with ranges reported in literature. For the tooth length measurements, the deviations from the mean reference values were less than 20%. In 77% of all the measurements, the deviations were within 10.1%. The pulp volumes, and mandible measurements were within one standard deviation of the reference values. Regarding the normal anatomy, both readers considered the realism level of the dental structures to be good. Background structures received a lower realism score due to the lack of detailed enough trabecular bone structure, which was expected but not the focus of this study. All modelled RFs were scored at least adequate by at least one of the readers, both in appearance and position. The realism level of the modelled restorations was considered to be good. CONCLUSIONS A methodology was proposed to develop and validate an anthropomorphic voxel phantom for image quality optimization studies in dental CBCT imaging, with a main focus on RF detection tasks. The methodology can be extended further to create more models representative of the clinical population.
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Affiliation(s)
- Karen Merken
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
| | - Janne Monnens
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
| | - Nicholas Marshall
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
| | - Nuyts Johan
- Department of Imaging and Pathology, Division of Nuclear Medicine & Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Danieli Moura Brasil
- Department of Diagnosis and Oral Health, School of Dentistry, University of Louisville, Louisville, Kentucky, USA
| | - Gustavo Machado Santaella
- Department of Diagnosis and Oral Health, School of Dentistry, University of Louisville, Louisville, Kentucky, USA
| | - Constantinus Politis
- Department of Imaging and Pathology, Division of Oral and Maxillofacial Surgery, KU Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, Division of Oral and Maxillofacial Surgery, KU Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Hilde Bosmans
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
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Jindanil T, Marinho-Vieira LE, de-Azevedo-Vaz SL, Jacobs R. A unique artificial intelligence-based tool for automated CBCT segmentation of mandibular incisive canal. Dentomaxillofac Radiol 2023; 52:20230321. [PMID: 37870152 DOI: 10.1259/dmfr.20230321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVES To develop and validate a novel artificial intelligence (AI) tool for automated segmentation of mandibular incisive canal on cone beam computed tomography (CBCT) scans. METHODS After ethical approval, a data set of 200 CBCT scans were selected and categorized into training (160), validation (20), and test (20) sets. CBCT scans were imported into Virtual Patient Creator and ground truth for training and validation were manually segmented by three oral radiologists in multiplanar reconstructions. Intra- and interobserver analysis for human segmentation variability was performed on 20% of the data set. Segmentations were imported into Mimics for standardization. Resulting files were imported to 3-Matic for analysis using surface- and voxel-based methods. Evaluation metrics involved time efficiency, analysis metrics including Dice Similarity Coefficient (DSC), Intersection over Union (IoU), Root mean square error (RMSE), precision, recall, accuracy, and consistency. These values were calculated considering AI-based segmentation and refined-AI segmentation compared to manual segmentation. RESULTS Average time for AI-based segmentation, refined-AI segmentation and manual segmentation was 00:10, 08:09, and 47:18 (284-fold time reduction). AI-based segmentation showed mean values of DSC 0.873, IoU 0.775, RMSE 0.256 mm, precision 0.837 and recall 0.890 while refined-AI segmentation provided DSC 0.876, IoU 0.781, RMSE 0.267 mm, precision 0. 852 and recall 0.902 with the accuracy of 0.998 for both methods. The consistency was one for AI-based segmentation and 0.910 for manual segmentation. CONCLUSIONS An innovative AI-tool for automated segmentation of mandibular incisive canal on CBCT scans was proofed to be accurate, time efficient, and highly consistent, serving pre-surgical planning.
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Affiliation(s)
- Thanatchaporn Jindanil
- Department of Imaging and Pathology, Faculty of Medicine, OMFS-IMPATH Research Group, KU Leuven, Leuven, Belgium
| | - Luiz Eduardo Marinho-Vieira
- Department of Imaging and Pathology, Faculty of Medicine, OMFS-IMPATH Research Group, KU Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Reinhilde Jacobs
- Department of Imaging and Pathology, Faculty of Medicine, OMFS-IMPATH Research Group, KU Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Pálvölgyi L, Kesztyűs A, Shujaat S, Jacobs R, Nagy K. Creation of Dimicleft radiological cleft phantom skulls using reversed virtual planning technique. Dentomaxillofac Radiol 2023; 52:20230121. [PMID: 37395648 PMCID: PMC10552124 DOI: 10.1259/dmfr.20230121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES The aim of this technical report was to develop customized pediatric phantoms for cone-beam computed tomography (CBCT)-related research in cleft patients. METHODS Six human pediatric skulls (age: 5-10 years) were recruited. A cone-beam computed tomography (CBCT) scan was taken for each skull, followed by virtual modeling through the process of segmentation. An artificial cleft was designed and printed to be applied onto the skull for the creation of an artificial cleft. The skulls were covered with non-radiopaque tape and immersed in melted Mix-D soft tissue equivalent material. The resulting phantoms covered with Mix-D were assessed radiologically by two expert radiologists. These phantoms were referred to as Dimicleft pediatric skull phantoms. RESULTS Dimicleft phantoms were able to appropriately mimic in vivo circumstances. No gaps existed between Mix-D and bony tissue. Virtual planning allowed the optimal designing of an artificial cleft onto the phantom. The artificially created cleft was suitable to determine the size, location, and extent of the cleft. CONCLUSIONS Dimicleft phantoms could act as a viable alternative to other commercially available options for assessing image quality and optimizing CBCT protocols in cleft patients for diagnostics and three-dimensional treatment planning.
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Affiliation(s)
- Laura Pálvölgyi
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Artúr Kesztyűs
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | | | | | - Krisztián Nagy
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
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Elgarba BM, Van Aelst S, Swaity A, Morgan N, Shujaat S, Jacobs R. Deep learning-based segmentation of dental implants on cone-beam computed tomography images: A validation study. J Dent 2023; 137:104639. [PMID: 37517787 DOI: 10.1016/j.jdent.2023.104639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES To train and validate a cloud-based convolutional neural network (CNN) model for automated segmentation (AS) of dental implant and attached prosthetic crown on cone-beam computed tomography (CBCT) images. METHODS A total dataset of 280 maxillomandibular jawbone CBCT scans was acquired from patients who underwent implant placement with or without coronal restoration. The dataset was randomly divided into three subsets: training set (n = 225), validation set (n = 25) and testing set (n = 30). A CNN model was developed and trained using expert-based semi-automated segmentation (SS) of the implant and attached prosthetic crown as the ground truth. The performance of AS was assessed by comparing with SS and manually corrected automated segmentation referred to as refined-automated segmentation (R-AS). Evaluation metrics included timing, voxel-wise comparison based on confusion matrix and 3D surface differences. RESULTS The average time required for AS was 60 times faster (<30 s) than the SS approach. The CNN model was highly effective in segmenting dental implants both with and without coronal restoration, achieving a high dice similarity coefficient score of 0.92±0.02 and 0.91±0.03, respectively. Moreover, the root mean square deviation values were also found to be low (implant only: 0.08±0.09 mm, implant+restoration: 0.11±0.07 mm) when compared with R-AS, implying high AI segmentation accuracy. CONCLUSIONS The proposed cloud-based deep learning tool demonstrated high performance and time-efficient segmentation of implants on CBCT images. CLINICAL SIGNIFICANCE AI-based segmentation of implants and prosthetic crowns can minimize the negative impact of artifacts and enhance the generalizability of creating dental virtual models. Furthermore, incorporating the suggested tool into existing CNN models specialized for segmenting anatomical structures can improve pre-surgical planning for implants and post-operative assessment of peri‑implant bone levels.
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Affiliation(s)
- Bahaaeldeen M Elgarba
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Department of Prosthodontics, Faculty of Dentistry, Tanta University, 31511 Tanta, Egypt
| | - Stijn Van Aelst
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium
| | - Abdullah Swaity
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Prosthodontic Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Nermin Morgan
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
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Ver Berne J, Politis C, Shaheen E, Jacobs R. Cumulative exposure and lifetime cancer risk from diagnostic radiation in patients undergoing orthognathic surgery: a cross-sectional analysis. Int J Oral Maxillofac Surg 2023; 52:1064-1070. [PMID: 36804279 DOI: 10.1016/j.ijom.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
Radiation doses in dentomaxillofacial imaging are typically very low. However, diagnostic and follow-up protocols in orthognathic surgery result in a patient-specific risk in effective dose. Estimating the cancer risks from these exposures remains abstract for many maxillofacial surgeons. In this study, 40 orthognathic patients were randomly sampled and their cumulative effective dose (ED) calculated. The lifetime attributable risk of cancer (LAR) was calculated based on the standard radiological protocol for orthognathic surgery follow-up using methods described in the BEIR VII report and RadRAT. The mean cumulative ED of the 40 sampled patients at the end of their 2-year follow-up period was 1.91 ± 0.58 mSv. The LAR at the end of follow-up was 17.65 (90% confidence interval 6.46-32.90) per 100,000 person-years for male orthognathic patients and 13.93 (90% confidence interval 6.27-25.24) per 100,000 person-years for female orthognathic patients. This represents 0.70% and 0.68%, respectively, of the baseline cancer risk for oral, thyroid, and brain cancer combined. Although theoretical, these results provide a framework for interpreting radiation doses and cancer risks in patients undergoing orthognathic surgery. Considering the increased radiation sensitivity in children and adolescents, indication-oriented and patient-specific imaging protocols should be advised.
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Affiliation(s)
- J Ver Berne
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium.
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - E Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - R Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium; Department of Dentistry, Karolinska Institutet, Stockholm, Sweden
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El Bachaoui S, Verhelst PJ, de Faria Vasconcelos K, Shaheen E, Coucke W, Swennen G, Jacobs R, Politis C. The impact of CBCT-head tilting on 3D condylar segmentation reproducibility. Dentomaxillofac Radiol 2023; 52:20230072. [PMID: 37606052 PMCID: PMC10461261 DOI: 10.1259/dmfr.20230072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To investigate whether variations in head positioning may influence the reproducibility of cone-beam CT (CBCT) three-dimensional (3D) segmented models of the mandibular condyle. METHODS Five fresh frozen cadaver heads were scanned in four different positions: reference position (RP) and a set of three tilted alternative head positions (AP) in anteroposterior direction (AP1: 2 cm anterior translation, AP2: 5° pitch rotation, AP3: 10° pitch rotation). Surface models of mandibular condyles were constructed and compared with the condylar reference position using voxel-based registration. Descriptive statistics and a linear mixed-effects model were performed to compare condylar volumetric differences and root mean square (RMS) distance between surfaces of AP vs RP. RESULTS The mean differences in condylar volumes of AP vs RP were 14.1 mm³ (95% CI [-79.3, 107.4]) for AP1, 1.0 mm³ (95% CI [-87.2, 89.2]) for AP2 and 0.1 mm³ (95% CI [-88.3, 88.4]) for AP3. Mean and absolute volumetric differences did not exceed earlier reported intraoperator differences of 30 mm³. The RMS distance values obtained per group were 0.12 mm (95% CI [0.05,0.20]) for AP1, 0.17 mm (95% CI [0.10, 0.22]) for AP2 and 0.17 mm for AP3 (95% CI [0.10,0.22]). The confidence intervals (CI) for RMS distance remained far below the threshold for clinical acceptability (0.5 mm). CONCLUSIONS Within the limits of the present study, it is suggested that tilted head positions may affect the reproducibility of 3D condylar segmentation, thereby influencing outcome in repeated CBCT scanning. Nevertheless, observed differences are unlikely to have a meaningful impact on clinical patient diagnosis and management.
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Affiliation(s)
| | | | | | | | - Wim Coucke
- Certified Freelance Statistician, Heverlee, Belgium
| | - Gwen Swennen
- Division of Maxillofacial Surgery, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
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Shujaat S, Kesztyüs A, Song D, Regnstrand T, Benchimol D, Nagy K, Jacobs R. Moving toward patient specificity for devising cone-beam computed tomography field-of-views: A normative maxillary skeletal dimensional analysis. Int J Paediatr Dent 2023; 33:477-486. [PMID: 37203232 DOI: 10.1111/ipd.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND A lack of evidence exists comprehensively assessing skeletal dimensions in a Caucasian population group at different ages. AIM To provide age- and gender-specific normative skeletal dimensional measurements of the maxillary region using cone-beam computed tomography (CBCT) imaging. DESIGN Cone-beam computed tomography images of Caucasian patients were acquired and divided into different age groups ranging from 8 to 20 years. Linear measurements were taken to evaluate seven distance-based variables, which included anterior nasal spine-posterior nasal spine (ANS-PNS) distance, bilateral maxillary first molar's central fossae (CF) distance, palatal vault depth (PVD), bilateral palatal cementoenamel junction (PCEJ) distance, bilateral vestibular CEJ (VCEJ) distance, bilateral jugulare distance (Jug) and arch length (AL). RESULTS A total of 529 patients (243 male, 286 female) were selected. ANS-PNS and PVD showed the highest change in dimensions from 8 to 20 years of age. On the contrary, AL had the least variability in all age groups. Male patients had larger dimensions and showed a significant change in all dimensional measurements (p < .001) than female patients. CONCLUSION The maxillary linear dimensions varied across different age groups. The presented maxillary normative data could serve as a reference guide for devising patient-specific CBCT field of views.
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Affiliation(s)
- Sohaib Shujaat
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Artúr Kesztyüs
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Dandan Song
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Regnstrand
- Section of Oral Diagnostics and Surgery, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden
| | - Daniel Benchimol
- Section of Oral Diagnostics and Surgery, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden
| | - Krisztian Nagy
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Section of Oral Diagnostics and Surgery, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden
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Li J, Shujaat S, Shaheen E, Politis C, Jacobs R. Autoimmune diseases and orthognathic surgery: A case series of 12 patients. J Plast Reconstr Aesthet Surg 2023; 84:413-421. [PMID: 37406372 DOI: 10.1016/j.bjps.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023]
Abstract
Autoimmune diseases result from the immune system attacking native cells and tissues due to the recognition of "self" antigens as foreign antigens. This group of disorders is associated with an increased risk of complications after surgical interventions, as the immune system may cause tissue destruction. The study aimed to investigate the risk of surgical complications in patients with autoimmune diseases, who are at a higher risk of complications due to their condition. Among 886 patients who underwent orthognathic surgery, twelve types of autoimmune diseases with 22 patients were identified. For this case-series study, 12 patients were selected with a follow-up period of at least two years. The surgical procedures were executed by a single surgical team, which involved single or multi-piece Le Fort I osteotomy, Hunsuck/Epker modification of bilateral sagittal split osteotomy (BSSO), and/or genioplasty. The recorded outcome variables were postoperative adverse events, including respiratory or blood-related complications, wound infection, neurosensory disturbances, temporomandibular joint (TMJ) complications, and relapse. Only two patients recovered after surgery without any postoperative complications, whereas others had delayed recovery from neurosensory disturbance (5/12), infection (5/12), TMJ complications (2/12), and other complications. The findings of this study suggest that patients with autoimmune diseases undergoing orthognathic surgery are at higher risk of complications, highlighting the importance of careful consideration of patient selection and risk stratification before surgical intervention. The study also emphasizes the importance of close postoperative follow-up to detect and manage complications promptly.
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Affiliation(s)
- Jiqing Li
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Eman Shaheen
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Suryani IR, Ahmadzai I, That MT, Shujaat S, Jacobs R. Are medication-induced salivary changes the culprit of osteonecrosis of the jaw? A systematic review. Front Med (Lausanne) 2023; 10:1164051. [PMID: 37720502 PMCID: PMC10501800 DOI: 10.3389/fmed.2023.1164051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose This systematic review was performed to assess the potential influence of medication-induced salivary changes on the development of medication-related osteonecrosis of the jaw (MRONJ). Methods An electronic search was conducted using PubMed, Web of Science, Cochrane, and Embase databases for articles published up to June 2023. A risk of bias assessment was performed according to the modified Newcastle-Ottawa Scale (NOS). Due to the heterogeneity of the selected studies in relation to the type of medications and outcomes evaluated, a meta-analysis could not be performed. Results The initial search revealed 765 studies. Only 10 articles were found to be eligible based on the inclusion criteria that reported on the impact of salivary changes on MRONJ following the administration of different medications. A total of 272 cases of MRONJ (35% women, 32% men, and 32% with no gender reported) with a mean age of 66 years at the time of diagnosis were included. Patients administered with bisphosphonates, steroids, chemotherapy, thalidomide, interferon, and hormone therapy had a significantly higher association between decreased salivary flow and MRONJ occurrence. In addition, bisphosphonates, denosumab, and other bone-modifying agents showed a significantly higher risk of developing MRONJ owing to the changes in salivary microbiome profiles, cytokine profiles, interleukins, hypotaurine, and binding proteins. Conclusion The reduction in salivary flow and changes in the concentration of salivary proteins were associated with the development of MRONJ. However, due to the availability of limited evidence, the findings of the review should be interpreted with caution. Prospero review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022327645.
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Affiliation(s)
- Isti Rahayu Suryani
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Iraj Ahmadzai
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Minh Ton That
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Christiaens V, Pauwels R, Mowafey B, Jacobs R. Accuracy of Intra-Oral Radiography and Cone Beam Computed Tomography in the Diagnosis of Buccal Bone Loss. J Imaging 2023; 9:164. [PMID: 37623696 PMCID: PMC10455186 DOI: 10.3390/jimaging9080164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The use of cone beam computed tomography (CBCT) in dentistry started in the maxillofacial field, where it was used for complex and comprehensive treatment planning. Due to the use of reduced radiation dose compared to a computed tomography (CT) scan, CBCT has become a frequently used diagnostic tool in dental practice. However, published data on the accuracy of CBCT in the diagnosis of buccal bone level is lacking. The aim of this study was to compare the accuracy of intra-oral radiography (IOR) and CBCT in the diagnosis of the extent of buccal bone loss. METHODS A dry skull was used to create a buccal bone defect at the most coronal level of a first premolar; the defect was enlarged apically in steps of 1 mm. After each step, IOR and CBCT were taken. Based on the CBCT data, two observers jointly selected three axial slices at different levels of the buccal bone, as well as one transverse slice. Six dentists participated in the radiographic observations. First, all observers received the 10 intra-oral radiographs, and each observer was asked to rank the intra-oral radiographs on the extent of the buccal bone defect. Afterwards, the procedure was repeated with the CBCT scans based on a combination of axial and transverse information. For the second part of the study, each observer was asked to evaluate the axial and transverse CBCT slices on the presence or absence of a buccal bone defect. RESULTS The percentage of buccal bone defect progression rankings that were within 1 of the true rank was 32% for IOR and 42% for CBCT. On average, kappa values increased by 0.384 for CBCT compared to intra-oral radiography. The overall sensitivity and specificity of CBCT in the diagnosis of the presence or absence of a buccal bone defect was 0.89 and 0.85, respectively. The average area under the curve (AUC) of the receiver operating curve (ROC) was 0.892 for all observers. CONCLUSION When CBCT images are available for justified indications, other than bone level assessment, such 3D images are more accurate and thus preferred to 2D images to assess periodontal buccal bone. For other clinical applications, intra-oral radiography remains the standard method for radiographic evaluation.
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Affiliation(s)
- Véronique Christiaens
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Ruben Pauwels
- Department of Dentistry and Oral Health, Aarhus University, 8000 Aarhus, Denmark;
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Radiology, Chulalongkorn University, 10330 Bangkok, Thailand
| | - Bassant Mowafey
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Oral medicine, Periodontology, Diagnosis and Oral radiology, Faculty of Dentistry, Mansoura University, 35516 Mansoura, Egypt
| | - Reinhilde Jacobs
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Dental Medicine, Karolinska Institutet, 14152 Huddinge, Sweden
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Dubron K, Verbist M, Jacobs R, Olszewski R, Shaheen E, Willaert R. Augmented and Virtual Reality for Preoperative Trauma Planning, Focusing on Orbital Reconstructions: A Systematic Review. J Clin Med 2023; 12:5203. [PMID: 37629251 PMCID: PMC10455745 DOI: 10.3390/jcm12165203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in preoperative planning for orbital fractures. METHODS A systematic search was conducted in PubMed, Embase, Web of Science and Cochrane on 6 April 2023. The included studies compared extended reality with conventional planning techniques, focusing on computer-aided surgical simulation based on Computed Tomography data, patient-specific implants (PSIs), fracture reconstruction of the orbital complex, and the use of extended reality. Outcomes analyzed were technical accuracy, planning time, operative time, complications, total cost, and educational benefits. RESULTS A total of 6381 articles were identified. Four articles discussed the educational use of VR, while one clinical prospective study examined AR for assisting orbital fracture management. CONCLUSION AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time. Consequently, intraoperative imaging enhancement helps to guide the orientation of the orbital reconstruction plate and better visualize the precise positioning and fixation of the PSI of the fractured orbital walls. However, the technical accuracy of 2-3 mm should be considered. VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.
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Affiliation(s)
- Kathia Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint Luc, UCLouvain, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Maarten Verbist
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Raphael Olszewski
- Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint Luc, UCLouvain, Av. Hippocrate 10, 1200 Brussels, Belgium
- Oral and Maxillofacial Surgery Research Lab (OMFS Lab), NMSK, Institut de Recherche Expérimentale et Clinique (IREC), SSS, UCLouvain, 1200 Brussels, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Robin Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
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Adriaenssens J, Vaesen Bentein H, Jacobs R, Politis C, Van der Cruyssen F. Prospective orofacial quantitative sensory testing data of the human face and mouth. Data Brief 2023; 49:109316. [PMID: 37360670 PMCID: PMC10285537 DOI: 10.1016/j.dib.2023.109316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Quantitative sensory testing (QST) is a valuable tool in the assessment of orofacial somatosensory function and dysfunction. QST is a method where thermal and mechanical stimuli are applied to the area of interest in a noninvasive way. The QST technique can detect patterns of loss of sensation that may happen in case of hypoesthesia, hypoalgesia, anesthesia, or gain of sensation in the context of allodynia, hyperalgesia or spontaneous pain. Normal values have already been recorded for some parts of the face and mouth, but not for the complete innervation area of the trigeminal nerve. This dataset involves orofacial QST gathered from ten healthy volunteers, a standardized QST battery was applied to 24 regions (14 extraoral and 10 intraoral) innervated by the trigeminal nerve. Descriptive statistics were applied to compare the different regions. This dataset can be used to inform future studies involving orofacial sensory function, pain studies and pharmacological trials.
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Affiliation(s)
- Julie Adriaenssens
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Hannah Vaesen Bentein
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
- Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals, Leuven, Belgium
- Department of Dental Medicine, Karolinksa Institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
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Govaerts D, Da Costa O, Garip M, Combes F, Jacobs R, Politis C. Can surgically assisted rapid palatal expansion (SARPE) be recommended over orthodontic rapid palatal expansion (ORPE) for girls above the age of 14? : A cone-beam CT study on midpalatal suture maturation. J Orofac Orthop 2023:10.1007/s00056-023-00487-x. [PMID: 37407791 DOI: 10.1007/s00056-023-00487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND For patients with a maxillary transversal deficiency (MTD), various treatment options are available, partly based on the practitioner's experience. This study aimed to determine a cut-off age for decision making between surgically assisted rapid palatal expansion (SARPE) over orthodontic rapid palatal expansion (ORPE) based on skeletal maturation in a female population. METHODS A total of 100 cone beam computed tomography (CBCT) images of young females were analyzed on maturation of the pterygomaxillary (PMS), zygomaticomaxillary (ZMS), transpalatal (TPS), and midpalatal (MPS) sutures. Based on the maturation of these four junctions, four independent observers had to determine whether they would prefer ORPE or SARPE to widen the maxilla. RESULTS For the PMS, the results show a closure of 83-100% from 13 to 17 years. As for the TPS, a closure of 78-85% was observed from 15 years of age. For the 15- to 17-year-old females, a closed ZMS was present in 32-47%. Regarding MPS, closed sutures presented in 61% (stages D and E) of the 15-year-old females. The cut-off age at which SARPE was recommended was 15.1 years for the orthodontist observers and 14.8 years for the maxillofacial surgeon observers. CONCLUSIONS Significant maturation of MPS was reached at the age of 15 in a female population. The PMS, TPS, MPS, and ZMS closed sequentially. A comprehensive diagnostic approach is necessary for choosing the appropriate treatment. When in doubt, age could assist decision making in a female population, with a cut-off age of 15 years in favor of SARPE based on this study.
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Affiliation(s)
- Dries Govaerts
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Oliver Da Costa
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Melisa Garip
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - François Combes
- Department of Oral and Maxillofacial Surgery, AZ Delta Hospital, Roeselare, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Oliveira-Santos N, Jacobs R, Picoli FF, Lahoud P, Niclaes L, Groppo FC. Automated segmentation of the mandibular canal and its anterior loop by deep learning. Sci Rep 2023; 13:10819. [PMID: 37402784 DOI: 10.1038/s41598-023-37798-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023] Open
Abstract
Accurate mandibular canal (MC) detection is crucial to avoid nerve injury during surgical procedures. Moreover, the anatomic complexity of the interforaminal region requires a precise delineation of anatomical variations such as the anterior loop (AL). Therefore, CBCT-based presurgical planning is recommended, even though anatomical variations and lack of MC cortication make canal delineation challenging. To overcome these limitations, artificial intelligence (AI) may aid presurgical MC delineation. In the present study, we aim to train and validate an AI-driven tool capable of performing accurate segmentation of the MC even in the presence of anatomical variation such as AL. Results achieved high accuracy metrics, with 0.997 of global accuracy for both MC with and without AL. The anterior and middle sections of the MC, where most surgical interventions are performed, presented the most accurate segmentation compared to the posterior section. The AI-driven tool provided accurate segmentation of the mandibular canal, even in the presence of anatomical variation such as an anterior loop. Thus, the presently validated dedicated AI tool may aid clinicians in automating the segmentation of neurovascular canals and their anatomical variations. It may significantly contribute to presurgical planning for dental implant placement, especially in the interforaminal region.
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Affiliation(s)
- Nicolly Oliveira-Santos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, UZ Campus St Rafael, Leuven, Belgium
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, UZ Campus St Rafael, Leuven, Belgium.
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Fernando Fortes Picoli
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, UZ Campus St Rafael, Leuven, Belgium
- Department of Stomatology and Oral Radiology, Dental School, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Pierre Lahoud
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, UZ Campus St Rafael, Leuven, Belgium
| | - Liselot Niclaes
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, UZ Campus St Rafael, Leuven, Belgium
| | - Francisco Carlos Groppo
- Department of Biosciences, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Lahoud P, Badrou A, Ducret M, Farges JC, Jacobs R, Bel-Brunon A, EzEldeen M, Blal N, Richert R. Real-time simulation of the transplanted tooth using model order reduction. Front Bioeng Biotechnol 2023; 11:1201177. [PMID: 37456726 PMCID: PMC10339382 DOI: 10.3389/fbioe.2023.1201177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
The biomechanics of transplanted teeth remain poorly understood due to a lack of models. In this context, finite element (FE) analysis has been used to evaluate the influence of occlusal morphology and root form on the biomechanical behavior of the transplanted tooth, but the construction of a FE model is extremely time-consuming. Model order reduction (MOR) techniques have been used in the medical field to reduce computing time, and the present study aimed to develop a reduced model of a transplanted tooth using the higher-order proper generalized decomposition method. The FE model of a previous study was used to learn von Mises root stress, and axial and lateral forces were used to simulate different occlusions between 75 and 175N. The error of the reduced model varied between 0.1% and 5.9% according to the subdomain, and was the highest for the highest lateral forces. The time for the FE simulation varied between 2.3 and 7.2 h. In comparison, the reduced model was built in 17s and interpolation of new results took approximately 2.10-2s. The use of MOR reduced the time for delivering the root stresses by a mean 5.9 h. The biomechanical behavior of a transplanted tooth simulated by FE models was accurately captured with a significant decrease of computing time. Future studies could include using jaw tracking devices for clinical use and the development of more realistic real-time simulations of tooth autotransplantation surgery.
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Affiliation(s)
- Pierre Lahoud
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Division of Periodontology and Oral Microbiology, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Arif Badrou
- Laboratoire de Mécanique Des Contacts Et Structures, CNRS/INSA, Villeurbanne, France
| | - Maxime Ducret
- Laboratoire de Biologie Tissulaire Et Ingénierie Thérapeutique, UMR5305 CNRS/UCBL, Lyon, France
- Hospices Civils de Lyon, Lyon, France
- Faculty of Odontology, Lyon 1 University, Lyon, France
| | - Jean-Christophe Farges
- Laboratoire de Biologie Tissulaire Et Ingénierie Thérapeutique, UMR5305 CNRS/UCBL, Lyon, France
- Hospices Civils de Lyon, Lyon, France
- Faculty of Odontology, Lyon 1 University, Lyon, France
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Aline Bel-Brunon
- Laboratoire de Mécanique Des Contacts Et Structures, CNRS/INSA, Villeurbanne, France
| | - Mostafa EzEldeen
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Leuven, Belgium
| | - Nawfal Blal
- Laboratoire de Mécanique Des Contacts Et Structures, CNRS/INSA, Villeurbanne, France
| | - Raphaël Richert
- Laboratoire de Mécanique Des Contacts Et Structures, CNRS/INSA, Villeurbanne, France
- Hospices Civils de Lyon, Lyon, France
- Faculty of Odontology, Lyon 1 University, Lyon, France
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Michielsens H, Decreus J, Begnoni G, Verdonck A, Jacobs R, Willems G, Cadenas de Llano-Pérula M. Performance of the Malmgren Index for Assessing Root Resorption on 2D vs. 3D Radiographs: A Pilot Study. Healthcare (Basel) 2023; 11:1860. [PMID: 37444694 DOI: 10.3390/healthcare11131860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVES To compare the performance of the Malmgren index on 2D and 3D radiographs. METHODS Patients with a panoramic radiograph and a cone beam computed tomography (CBCT) taken at an interval of <3 months and presenting root resorption (RR) on at least one incisor and/or canine were retrospectively included. RR was scored twice by two observers using the Malmgren index in both the 2D and 3D sets, and intra-class correlation coefficient (ICC) was calculated. RESULTS 155 teeth were analyzed. The ICC was the lowest in 2D, followed by overall, transversal and sagittal 3D. Malmgren scores were systematically higher in 2D, which overestimated RR, especially in the transversal plane on all incisors and canines and in the sagittal plane on the maxillary incisors. 2D respectively leads to 28.0-34.8% of false positives and negatives when discriminating between RR or not. The early stages of RR are often misdiagnosed in 2D, while later stages are more accurate. CONCLUSIONS The original Malmgren index is not suited for 3D images, especially axial, where using dichotomized values (resorption yes/no) leads to overestimation of RR. A low-dose CBCT of the upper incisors could detect RR with high diagnostic accuracy in the early stages of orthodontic treatment, especially in patients with dental trauma or familial RR history.
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Affiliation(s)
- Hanne Michielsens
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Julie Decreus
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Giacomo Begnoni
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Anna Verdonck
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
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Rodrigues CT, Jacobs R, Ezeldeen M, Vasconcelos KDF, Lambrechts P, Tanomaru Filho M, Pinto JC, Duarte MAH. How does nano-focus computed tomography impact the quantification of debris within the root canal system? Braz Oral Res 2023; 37:e059. [PMID: 37341232 DOI: 10.1590/1807-3107bor-2023.vol37.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 01/05/2023] [Indexed: 06/22/2023] Open
Abstract
The aim of this study was to compare the quantification of hard-tissue debris by using micro-computed tomography (micro-CT) and nano-focus computed tomography (nano-CT) after root canal instrumentation. Ten mandibular molars containing an isthmus in the mesial root were scanned in a SkyScan 1172 micro-CT device with a voxel size of 12.8 µm and in a NanoTom nano-CT device with 5.5 µm. The mesial root canals were irrigated with 5 mL of saline solution at the orifice level, instrumented with Reciproc R25 files and a second scanning was performed by micro-CT and nano-CT devices for post-instrumentation images. DataViewer software was used for registering the pre- and post-operative micro-CT and nano-CT images. The root canal and the debris were segmented for quantitative analysis of the volume of the canal and volume of debris using CTAn software. Statistical analysis was performed using the T test for comparison between volume of the canal after instrumentation and volume of debris in both image modalities. The level of significance was set at p < 0.05. Nano-CT images showed higher values of debris when compared with micro-CT (p < 0.05) after root canal instrumentation. No difference was observed between the volume of the root canal after instrumentation in the two imaging methods used (p > 0.05). Nano-CT technology can be recommended as a more precise method for quantitative analysis of hard-tissue debris. Moreover, in Endodontic research it is a promising method, as it is capable of providing higher spatial and contrast resolution, faster scanning and higher image quality.
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Affiliation(s)
- Clarissa Teles Rodrigues
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Restorative Dentistry, Endodontics and Dental Materials, Bauru, SP, Brazil
| | - Reinhilde Jacobs
- University Hospitals Leuven, Faculty of Medicine, Department of Imaging and Pathology, Leuven, Belgium
| | - Mostafa Ezeldeen
- University Hospitals Leuven, Faculty of Medicine, Department of Imaging and Pathology, Leuven, Belgium
| | | | - Paul Lambrechts
- University Hospitals Leuven, KU Leuven and Dentistry, Department of Oral Health Sciences, Endodontology, Leuven, Belgium
| | - Mario Tanomaru Filho
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | - Jader Camilo Pinto
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | - Marco Antonio Hungaro Duarte
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Restorative Dentistry, Endodontics and Dental Materials, Bauru, SP, Brazil
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Wang X, Shujaat S, Shaheen E, Ferraris E, Jacobs R. Trueness of cone-beam computed tomography-derived skull models fabricated by different technology-based three-dimensional printers. BMC Oral Health 2023; 23:397. [PMID: 37328901 PMCID: PMC10273646 DOI: 10.1186/s12903-023-03104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing is a novel innovation in the field of craniomaxillofacial surgery, however, a lack of evidence exists related to the comparison of the trueness of skull models fabricated using different technology-based printers belonging to different cost segments. METHODS A study was performed to investigate the trueness of cone-beam computed tomography-derived skull models fabricated using different technology based on low-, medium-, and high-cost 3D printers. Following the segmentation of a patient's skull, the model was printed by: (i) a low-cost fused filament fabrication printer; (ii) a medium-cost stereolithography printer; and (iii) a high-cost material jetting printer. The fabricated models were later scanned by industrial computed tomography and superimposed onto the original reference virtual model by applying surface-based registration. A part comparison color-coded analysis was conducted for assessing the difference between the reference and scanned models. A one-way analysis of variance (ANOVA) with Bonferroni correction was applied for statistical analysis. RESULTS The model printed with the low-cost fused filament fabrication printer showed the highest mean absolute error ([Formula: see text]), whereas both medium-cost stereolithography-based and the high-cost material jetting models had an overall similar dimensional error of [Formula: see text] and [Formula: see text], respectively. Overall, the models printed with medium- and high-cost printers showed a significantly ([Formula: see text]) lower error compared to the low-cost printer. CONCLUSIONS Both stereolithography and material jetting based printers, belonging to the medium- and high-cost market segment, were able to replicate the skeletal anatomy with optimal trueness, which might be suitable for patient-specific treatment planning tasks in craniomaxillofacial surgery. In contrast, the low-cost fused filament fabrication printer could serve as a cost-effective alternative for anatomical education, and/or patient communication.
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Affiliation(s)
- Xiaotong Wang
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, 3000 Belgium
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23, Nangang, 150001 Harbin China
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, 3000 Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Kingdom of Saudi Arabia, Riyadh, 14611 Saudi Arabia
| | - Eman Shaheen
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, 3000 Belgium
| | - Eleonora Ferraris
- Department of Mechanical Engineering, KU Leuven Campus De Nayer, Jan Pieter de Nayerlaan 5, 2860 Sint-Katelijne-Waver, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, 3000 Belgium
- Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allé 8, 141 52, Huddinge, Sweden
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EzEldeen M, Pedano De Piero MNS, Xu L, Driesen RB, Wyatt J, Van Gorp G, Meschi N, Van Meerbeek B, Lambrichts I, Jacobs R. Multimodal Imaging of Dental Pulp Healing Patterns following Tooth Autotransplantation And Regenerative Endodontic Treatment. J Endod 2023:S0099-2399(23)00324-2. [PMID: 37315781 DOI: 10.1016/j.joen.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Understanding the healing process of dental pulp after tooth autotransplantation (TAT) and regenerative endodontic treatment (RET) of immature teeth is important both clinically and scientifically. This study aimed to characterize the pattern of dental pulp healing in human teeth that underwent TAT and RET using state-of-the-art imaging techniques. MATERIALS AND METHODS This study examined four human teeth, two premolars that underwent TAT and two central incisors that received RET. The premolars were extracted after one year (case 1) and two years (case 2) due to ankylosis, while the central incisors were extracted after three years (cases 3 and 4) for orthodontic reasons. Nanofocus x-ray computed tomography was used to image the samples before being processed for histological and immunohistochemical analysis. Laser scanning confocal second harmonic generation imaging (SHG) was used to examine the patterns of collagen deposition. A maturity-matched premolar was included as a negative control for the histological and SHG analysis. RESULTS Analysis of the four cases revealed different patterns of dental pulp healing. Similarities were observed in the progressive obliteration of the root canal space. However, a striking loss of typical pulpal architecture was observed in the TAT cases, while a pulp-like tissue was observed in one of the RET cases. Odontoblast-like cells were observed in cases 1 and 3. CONCLUSION This study provided insights into the patterns of dental pulp healing after TAT and RET. The SHG imaging sheds light on the patterns of collagen deposition during reparative dentin formation.
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Affiliation(s)
- Mostafa EzEldeen
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; KU Leuven (University of Leuven), Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium.
| | - Mariano N Simon Pedano De Piero
- KU Leuven (University of Leuven), Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Lianyi Xu
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Ronald B Driesen
- Biomedical Research Institute, Hasselt University, Campus Diepenbeek, Agoralaan Building C, B-3590 Diepenbeek, Belgium
| | - Jan Wyatt
- KU Leuven (University of Leuven), Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Gertrude Van Gorp
- KU Leuven (University of Leuven), Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Nastaran Meschi
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, C. Heymanslaan 10/P8, 9000 Ghent, Belgium
| | - Bart Van Meerbeek
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven, University Hospitals Leuven, Dentistry, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Ivo Lambrichts
- Biomedical Research Institute, Hasselt University, Campus Diepenbeek, Agoralaan Building C, B-3590 Diepenbeek, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Berne JV, Saadi SB, Politis C, Jacobs R. A deep learning approach for radiological detection and classification of radicular cysts and periapical granulomas. J Dent 2023:104581. [PMID: 37295547 DOI: 10.1016/j.jdent.2023.104581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES Dentists and oral surgeons often face difficulties distinguishing between radicular cysts and periapical granulomas on panoramic imaging. Radicular cysts require surgical removal while root canal treatment is the first-line treatment for periapical granulomas. Therefore, an automated tool to aid clinical decision making is needed. METHODS A deep learning framework was developed using panoramic images of 80 radicular cysts and 72 periapical granulomas located in the mandible. Additionally, 197 normal images and 58 images with other radiolucent lesions were selected to improve model robustness. The images were cropped into global (affected half of the mandible) and local images (only the lesion) and then the dataset was split into 90% training and 10% testing sets. Data augmentation was performed on the training dataset. A two-route convolutional neural network using the global and local images was constructed for lesion classification. These outputs were concatenated into the object detection network for lesion localization. RESULTS The classification network achieved a sensitivity of 1.00 (95% C.I. 0.63 - 1.00), specificity of 0.95 (0.86 - 0.99), and AUC (area under the receiver-operating characteristic curve) of 0.97 for radicular cysts and a sensitivity of 0.77 (0.46 - 0.95), specificity of 1.00 (0.93 - 1.00), and AUC of 0.88 for periapical granulomas. Average precision for the localization network was 0.83 for radicular cysts and 0.74 for periapical granulomas. CONCLUSIONS The proposed model demonstrated reliable diagnostic performance for the detection and differentiation of radicular cysts and periapical granulomas. Using deep learning, diagnostic efficacy can be enhanced leading to a more efficient referral strategy and subsequent treatment efficacy. CLINICAL SIGNIFICANCE A two-route deep learning approach using global and local images can reliably differentiate between radicular cysts and periapical granulomas on panoramic imaging. Concatenating its output to a localizing network creates a clinically usable workflow for classifying and localizing these lesions, enhancing treatment and referral practices.
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Affiliation(s)
- Jonas Ver Berne
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Belgium.
| | - Soroush Baseri Saadi
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Belgium; Department of Dentistry, Karolinska Institutet, Stockholm, Sweden
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Quirynen M, Van der Veken D, Lahoud P, Neven J, Politis C, Jacobs R. Diffuse Sclerosing Osteomyelitis: A Potential Risk Indicator for Peri-implantitis? A Case Series. Int J Oral Maxillofac Implants 2023; 38:503-515. [PMID: 37279221 DOI: 10.11607/jomi.9773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
PURPOSE To propose diffuse osteomyelitis as risk indicator for peri-implantitis following the loss of several dental implants in patients that present with highly sclerotic bone areas. MATERIALS AND METHODS A total of six "nightmare cases"-three of which were treated at the Department of Periodontology of the University Hospitals of the Catholic University Leuven and three of which were referred there for a second opinion-were retrospectively analyzed using radiographs obtained via contact with referring clinicians in order to fully reconstruct the treatment pathway and dental history for each of these patients. RESULTS All patients suffered from early implant failures and/or severe peri-implantitis with bone loss and crater formation up to the apical level, as well as the loss of all or nearly all implants. Re-examination of their preand postoperative CBCTs, in combination with several bone biopsies, confirmed the diagnosis of a diffuse sclerosing osteomyelitis in the treated area. Osteomyelitis could be linked to a longstanding history of chronic and/or therapyresistant periodontal/endodontic pathology. CONCLUSION The current retrospective case series seems to suggest that diffuse osteomyelitis should be considered as a risk indicator for severe peri-implantitis. Int J Oral Maxillofac Implants 2023;38:503-515. doi: 10.11607/jomi.9773.
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Torres A, Dierickx M, Coucke W, Pedano MS, Lambrechts P, Jacobs R. Ex-vivo and in-vivo validation of a novel measuring protocol for guided endodontics. J Dent 2023:104566. [PMID: 37263407 DOI: 10.1016/j.jdent.2023.104566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To (1) validate the use of a post-operative intraoral scan (IOS) versus Cone Beam Computed Tomography (CBCT), gold standard, on its ability to measure the accuracy of guided endodontics, and (2) present clinical data on the accuracy of guided endodontics. METHODS Four models, including 10 extracted teeth each, were created. Forty guided access cavities were planned on dentin to simulate pulp canal obliteration (PCO). Two operators performed guided access cavities. A post-operative CBCT and IOS were acquired. The deviation coronally, apically, and angular deviation was measured with CBCT and IOS. Clinical accuracy was measured using an IOS acquired immediately after drilling the access cavity with the aid of a guide. Data analysis was performed using multiway Anova and corrected for simultaneous hypothesis testing according to Tukey. P ≤ 0.05 was considered statistically significant. Descriptive statistics on the clinical accuracy of guided endodontics were performed. RESULTS Thirty-eight cavities were assessed with a mean length of 13.8 mm. No statistical difference between operators and methods was found for all parameters (P > 0.05). Thirty-three patients were treated with guided endodontics and measured using an IOS. Results show an average coronal, apical, and angular deviation of 0.2 mm, 0.45 mm, and 1.91° respectively. The average length of the access cavities was 12.5 mm. CONCLUSIONS An IOS can be used to measure the accuracy of guided endodontics. Clinical data showed high accuracy of guided endodontics with a mean apical deviation smaller than 0.5 mm and a mean angular deviation of less than 2°. CLINICAL SIGNIFICANCE The use of an IOS does not involve additional radiation exposure. A safety margin of at least 1 mm around the planned trajectory should be respected when planning the case to minimize the possibility of root perforation.
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Affiliation(s)
- A Torres
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - M Dierickx
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - W Coucke
- Certified Freelance Statistician, Heverlee, Belgium.
| | - M S Pedano
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - P Lambrechts
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - R Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Van Gorp G, Maes A, Lambrechts M, Jacobs R, Declerck D. Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study. BMC Oral Health 2023; 23:270. [PMID: 37165416 PMCID: PMC10170728 DOI: 10.1186/s12903-023-03013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Proper skills in radiographic diagnosis are essential for optimal management of dental trauma. AIM To assess diagnostic accuracy obtained by paediatric dentists using Cone Beam Computed Tomography (CBCT) without specific training and to compare this with their performance using intraoral radiographs. METHODS Intraoral and CBCT images of 89 teeth, spread over twenty dental trauma cases were presented in random order to nine paediatric dentists. Diagnostic findings were compared with those of a benchmark reference. Sensitivity and specificity were calculated and compared using paired t-tests. RESULTS Overall, observers' diagnostic performance was rather poor with significantly higher sensitivity when using 2D images (P = 0.017). Performance differed considerably according to the type of pathology. Using either imaging modality, sensitivity for diagnosing apical pathology and root fractures was high while the opposite was seen for inflammatory root resorption, root cracks and subluxations. Statistically significant differences between imaging modalities were seen for root fractures (P = 0.013) and apical pathology (P = 0.001), in favor of 3D, and for crown fractures (P = 0.009) in favor of 2D. CONCLUSION Overall poor performance of paediatric dentists indicates that additional training in radiographic diagnosis is required. In order to justify the use of CBCT to increase diagnostic performance, proper training of the paediatric dentist is mandatory.
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Affiliation(s)
- Gertrude Van Gorp
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium.
| | - Arno Maes
- KU Leuven Department of Oral Health Sciences, Master in Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Marjan Lambrechts
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dominique Declerck
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium
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Morgan N, Meeus J, Shujaat S, Cortellini S, Bornstein MM, Jacobs R. CBCT for Diagnostics, Treatment Planning and Monitoring of Sinus Floor Elevation Procedures. Diagnostics (Basel) 2023; 13:diagnostics13101684. [PMID: 37238169 DOI: 10.3390/diagnostics13101684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Sinus floor elevation (SFE) is a standard surgical technique used to compensate for alveolar bone resorption in the posterior maxilla. Such a surgical procedure requires radiographic imaging pre- and postoperatively for diagnosis, treatment planning, and outcome assessment. Cone beam computed tomography (CBCT) has become a well-established imaging modality in the dentomaxillofacial region. The following narrative review is aimed to provide clinicians with an overview of the role of three-dimensional (3D) CBCT imaging for diagnostics, treatment planning, and postoperative monitoring of SFE procedures. CBCT imaging prior to SFE provides surgeons with a more detailed view of the surgical site, allows for the detection of potential pathologies three-dimensionally, and helps to virtually plan the procedure more precisely while reducing patient morbidity. In addition, it serves as a useful follow-up tool for assessing sinus and bone graft changes. Meanwhile, using CBCT imaging has to be standardized and justified based on the recognized diagnostic imaging guidelines, taking into account both the technical and clinical considerations. Future studies are recommended to incorporate artificial intelligence-based solutions for automating and standardizing the diagnostic and decision-making process in the context of SFE procedures to further improve the standards of patient care.
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Affiliation(s)
- Nermin Morgan
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium
- Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt
| | - Jan Meeus
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafael, 3000 Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafael, 3000 Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
| | - Simone Cortellini
- Department of Oral Health Sciences, Section of Periodontology, KU Leuven, 3000 Leuven, Belgium
- Department of Dentistry, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafael, 3000 Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, 141 04 Huddinge, Sweden
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