Atomic and vibrational origins of mechanical toughness in bioactive cement during setting

Bioactive glass ionomer cements (GICs) have been in widespread use for ∼40 years in dentistry and medicine. However, these composites fall short of the toughness needed for permanent implants. Significant impediment to improvement has been the requisite use of conventional destructive mechanical testing, which is necessarily retrospective. Here we show quantitatively, through the novel use of calorimetry, terahertz (THz) spectroscopy and neutron scattering, how GIC's developing fracture toughness during setting is related to interfacial THz dynamics, changing atomic cohesion and fluctuating interfacial configurations. Contrary to convention, we find setting is non-monotonic, characterized by abrupt features not previously detected, including a glass-polymer coupling point, an early setting point, where decreasing toughness unexpectedly recovers, followed by stress-induced weakening of interfaces. Subsequently, toughness declines asymptotically to long-term fracture test values. We expect the insight afforded by these in situ non-destructive techniques will assist in raising understanding of the setting mechanisms and associated dynamics of cementitious materials.

Phospholipase Cγ2 is required for basal but not oestrogen deficiency-induced bone resorption

BACKGROUND

Osteoclasts play a critical role in bone resorption under basal conditions, but they also contribute to pathological bone loss during diseases including postmenopausal osteoporosis. Phospholipase Cγ2 (PLCγ2) is an important signalling molecule in diverse haematopoietic lineages. Here, we tested the role of PLCγ2 in basal and ovariectomy-induced bone resorption, as well as in in vitro osteoclast cultures using PLCγ2-deficient (PLCγ2(-/-) ) mice.

MATERIALS AND METHODS

The trabecular architecture of long bone metaphyses was tested by micro-CT and histomorphometric analyses. Postmenopausal osteoporosis was modelled by surgical ovariectomy. Osteoclast development and function, gene expression and PLCγ2 phosphorylation were tested on in vitro osteoclast and macrophage cultures.

RESULTS

  PLCγ2(-/-) mice had significantly higher trabecular bone mass under basal conditions than wild-type mice. PLCγ2 was required for in vitro development and resorptive function of osteoclasts, but not for upregulation of osteoclast-specific gene expression. PLCγ2 was phosphorylated in a Src-family-dependent manner upon macrophage adhesion but not upon stimulation by M-CSF or RANKL. Surprisingly, ovariectomy-induced bone resorption in PLCγ2(-/-) mice was similar to, or even more robust than, that in wild-type animals.

CONCLUSIONS

Our results indicate that PLCγ2 participates in bone resorption under basal conditions, likely because of its role in adhesion receptor signalling during osteoclast development. In contrast, PLCγ2 does not appear to play a major role in ovariectomy-induced bone loss. These results suggest that basal and oestrogen deficiency-induced bone resorption utilizes different signalling pathways and that PLCγ2 may not be a suitable therapeutic target in postmenopausal osteoporosis.

Serum albumin enhances bone healing in a nonunion femoral defect model in rats: a computer tomography micromorphometry study

PURPOSE

Blood-derived proliferative factors such as platelet rich plasma or activated plasma are promising adjuvants for bone grafts. Our earlier studies showed that serum albumin itself can markedly enhance the proliferation of stem cells on bone allograft and postulated that albumin coating alone may improve bone graft integration in vivo.

METHODS

Two femoral defect models were performed in adult male Wistar rats. In the critical size model a six millimetre gap was created in the midshaft of the femur and fixed with plate and screws, while a nonunion model was established by the interposition of a spacer in the osteotomy for four weeks which resulted in compromised healing and nonunion. Albumin coated and uncoated grafts were placed into the defects. Bone healing and morphometry were evaluated by μCT and histology four weeks after implantation of the grafts.

RESULTS

In the critical size model none of the bone grafts were able to bridge the defect, and graft resorption was the typical outcome. In the nonunion model regular uncoated grafts had a low union rate (two out of six), which increased markedly when albumin coating was applied (six out of eight). Trabecular thickness and pattern factor improved significantly in the albumin coated group versus uncoated or empty controls.

CONCLUSIONS

Our results showed that serum albumin coating of bone grafts can enhance the remodelling and efficacy of treatment in a nonunion model.

The phosphoinositide 3-kinase isoform PI3Kβ regulates osteoclast-mediated bone resorption in humans and mice

Objective

While phosphoinositide 3-kinases (PI3Ks) are involved in various intracellular signal transduction processes, the specific functions of the different PI3K isoforms are poorly understood. We have previously shown that the PI3Kβ isoform is required for arthritis development in the K/BxN serum–transfer model. Since osteoclasts play a critical role in pathologic bone loss during inflammatory arthritis and other diseases, we undertook this study to test the role of PI3Kβ in osteoclast development and function using a combined genetic and pharmacologic approach.

Methods

The role of PI3Kβ in primary human and murine osteoclast cultures was tested with the PI3Kβ-selective inhibitor TGX221 and by using PI3Kβ^−/− mice. The trabecular bone architecture of PI3Kβ^−/− mice was evaluated using micro–computed tomography and histomorphometric analyses.

Results

The expression of PI3Kβ was strongly and specifically up-regulated during in vitro osteoclast differentiation. In vitro development of large multinucleated osteoclasts from human or murine progenitors and their resorption capacity were strongly reduced by the PI3Kβ inhibitor TGX221 or by the genetic deficiency of PI3Kβ. This was likely due to defective cytoskeletal reorganization and vesicular trafficking, since PI3Kβ^−/− mouse multinucleated cells failed to form actin rings and retained intracellular acidic vesicles and cathepsin K. In contrast, osteoclast-specific gene expression and the survival and apoptosis of osteoclasts were not affected. PI3Kβ^−/− mice had significantly increased trabecular bone volume and showed abnormal osteoclast morphology with defective resorption pit formation.

Conclusion

PI3Kβ plays an important role in osteoclast development and function and is required for in vivo bone homeostasis.

Hematopoietic or Osteoclast-Specific Deletion of Syk Leads to Increased Bone Mass in Experimental Mice

Syk is a non-receptor tyrosine kinase critically involved in signaling by various immunoreceptors including B-cell-receptors and activating Fc-receptors. We have previously shown that Syk also mediates immunoreceptor-like signals required for the in vitro development and function of osteoclasts. However, the perinatal lethality of Syk ^-/- mice precluded the analysis of the role of Syk in in vivo bone metabolism. To overcome that problem, we generated mice with osteoclast-specific (Syk ^ΔOC ) or hematopoietic (Syk ^ΔHaemo ) Syk deficiency by conditional deletion of Syk using Cre recombinase expressed under the control of the Ctsk or Vav1 promoter, respectively. Micro-CT analysis revealed increased bone trabecular density in both Syk ^ΔOC and Syk ^ΔHaemo mice, although hematopoietic Syk deficiency caused a more severe phenotype than osteoclast-specific Syk deficiency. Osteoclast-specific Syk deficiency reduced, whereas hematopoietic Syk deficiency completely blocked in vitro development of osteoclasts. Both interventions inhibited the resorptive activity of osteoclasts and osteoclast-specific gene expression. Kinetic analysis of Syk protein levels, Cre expression and the genomic deletion of the Syk ^flox allele revealed complete and early deletion of Syk from Syk ^ΔHaemo osteoclasts whereas Syk was incompletely deleted at a later stage of osteoclast development from Syk ^ΔOC cultures. Those results provide an explanation for the in vivo and in vitro difference between the Syk ^ΔOC and Syk ^ΔHaemo mutant strains and suggest late activation of, and incomplete target gene deletion upon, osteoclast-specific Cre expression driven by the Ctsk promoter. Taken together, our results indicate that Syk plays an indispensable role in osteoclast-mediated in vivo bone resorption and suggest that Syk-specific inhibitors may provide therapeutic benefit in inflammatory and other diseases characterized by excessive osteoclast-mediated bone resorption.

A computerized method for mathematical description of three-dimensional root canal axis

Knowledge of the three-dimensional (3D) morphology of root canals is important for successful endodontic treatment. The objective of the present study was to determine the 3D root canal axis mathematically. Two views (mesiodistal and buccolingual) of digitized images were taken from extracted natural human teeth. Geometric reconstruction to standardize projection geometry was conducted on images. Because 90-degree turn-around image pairs are Monge images of a given root canal, these Monge images were positioned using photogrammetric methods. Each well-ordered axis pair of a given root canal was put into a common coordinate system resulting in 3D polynomial function of the actual root canal. On the basis of the results gained using 10 samples evaluated with the Friedman statistical test, this description seems to be reproducible. The 3D representation of the root canal may help the clinicians in choosing the optimal instruments and shaping techniques. The root canal axis that is described by the 3D function forms a basis for determination of curvature values and torsion values in each of the axis points. Evaluating these values may also yield a new type of classification.

Serum albumin-coated bone allograft (BoneAlbumin) results in faster bone formation and mechanically stronger bone in aging rats

Serum albumin-coated bone allografts (BoneAlbumin) have successfully supported bone regeneration in various experimental models by activating endogenous progenitors. However, the effect of tissue aging, linked to declining stem cell function, has yet to be explicitly examined within the context of BoneAlbumin's regenerative capacity. Stem cell function was tested with an in vitro attachment assay, which showed that albumin coating increases stem cell attachment on demineralized bone surfaces in an aging cell population. Bone regeneration was investigated in vivo by creating critical size bone defects on the parietal bones of aging female rats. Demineralized bone matrices with and without serum albumin coating were used to fill the defects. Bone regeneration was determined by measuring the density and the size of the remaining bone defect with computed tomography (CT). Microcomputed tomography (MicroCT) and mechanical testing were performed on the parietal bone explants. In vivo CT and ex vivo microCT measurements showed better regeneration with albumin-coated grafts. Additionally, the albumin-coated group showed a twofold increase in peak fracture force compared with uncoated allografts. In the present study, serum albumin-coated demineralized bone matrices successfully supported faster and functionally superior bone regeneration in aging rats. Because stem cell function, a key contributor of bone remodelling, decreases with age and serum albumin is an effective activator of endogenous progenitor cells, this method could be an effective and safe adjuvant in bone regeneration of aging adult and osteo-compromised populations.

Distortional effect of beam-hardening artefacts on microCT: a simulation study based on an in vitro caries model

OBJECTIVE

The aim of this study was to assess quantitatively the degrading effect of artefacts caused by beam hardening on the microscopic computerized tomography (microCT) measurements of an in vitro caries model.

STUDY DESIGN

A simulation-based method was described, with which the degrading effect of microCT artefacts on certain parameters of the observed structure could be determined. Simulations were carried out with polychromatic and monochromatic X-ray source, and a linearization method with a second-order polynomial fit algorithm was used in specific cases to correct the beam hardening artefact. The virtual test object was a half-crown of a tooth with an artificial caries lesion.

RESULTS

For simulation with monochromatic X-ray source, the relative error of lesion depth and thickness measurements of the remineralized layer was found to be 1%-2%. For polychromatic X-ray source, and omitting beam hardening correction, the relative error exceeded 6%. After appropriate beam-hardening correction, the relative error of the measurement could be reduced to 1%-2%.

CONCLUSION

With the adjustment simulated in this study, microCT having polychromatic X-ray source resulted in the same level of error as with monochromatic source if the linearization method to correct the beam hardening was used. The presented simulation-based method is a useful way to determine artefact-caused distortions for other studies testing objects with different material and geometry.

Comparison between Micro-Computed Tomography and Cone-Beam Computed Tomography in the Assessment of Bone Quality and a Long-Term Volumetric Study of the Augmented Sinus Grafted with an Albumin Impregnated Allograft

The purpose of our study was to compare micromorphometric data obtained by cone-beam computed-tomography (CBCT) and microcomputed-tomography (micro-CT) of the augmented sinus and to evaluate the long-term stability of the bone gain achieved using BoneAlbumin. Sinus lifts, and after 6-months, healing bone-biopsy and implant placement were carried out. Specimens were analyzed by micro-CT. A total of 16 samples were collected from nine patients (mean age 54.7 ± 6.5 years). Pre-, postoperative, and 3-year control CBCT-data were registered to determine from where the biopsy samples were harvested. Micromorphometric variables were calculated from the micro-CT- and CBCT-data, and their correlation was determined by Spearman's test. The volume of augmented bone was calculated at the time of implant placement and after 3 years. A positive correlation was found between bone-volume fraction, trabecular-separation, open-, and total-porosity, while a negative correlation was found between trabecular-thickness obtained from CBCT- and micro-CT-data (p < 0.05). Mean volumetric reduction of 39.28% (11.88-60.02%) was observed. Correlation of CBCT- and micro-CT-data suggested that micromorphometric analysis of CBCT reconstructions of the augmented sinuses provided reliable information on the microarchitecture of augmented bone. CBCT as a modality might be adequate in the analysis of bone quality in the augmented sinus. At the 3-year, control sinus grafts showed volumetric stability.

A comparison of the shaping characteristics of two nickel-titanium endodontic hand instruments

AIM

The purpose of this study was to compare the shaping characteristics of Ni-Ti K-files and Ni-Ti S-files manipulated by hand.

METHODOLOGY

A total of 60 extracted human roots were embedded in resin blocks. The embedded roots were divided into three groups: (i) roots with straight; (ii) apically curved; and (iii) continuously curved canals. Each of the three groups was randomly divided into two subgroups; one subgroup in each group was prepared with Ni-Ti K-files and the other with Ni-Ti S-files. The files were used with a step-back technique and enlarged so that the master apical file was size 30, and the canals were stepped back to size 40. The performance of the files was assessed by the superimposition of projected radiographs taken in bucco-lingual and mesio-distal directions before and after the preparation. The results were analysed statistically using analysis of covariance and Duncan's multiple range test.

RESULTS

Although canal preparation using Ni-Ti K-files was quicker, there were no statistically significant differences between file types. The Ni-Ti S-file removed significantly more material at the most coronal level (P < 0.05). There were minor differences between instruments at the apical level. Only in the proximal view of apically curved canals prepared with Ni-Ti S-files was significantly more dentine removed from the outer aspect of the curvature (P < 0.05). At the middle level (wide danger zone) the Ni-Ti S-files removed more dentine from the inner aspect of the curvature in those roots with apically curved canals.

CONCLUSIONS

Under the conditions of this study, preparation with Ni-Ti K-files produced more appropriate shapes in roots with apically curved canals than Ni-Ti S-files.

Remineralization of demineralized bone matrix in critical size cranial defects in rats: A 6-month follow-up study

The key drawback of using demineralized bone matrix (DBM) is its low initial mechanical stability due to the severe depletion of mineral content. In the present study, we investigated the long-term regeneration of DBM in a critical size bone defect model and investigated the remineralization after 6 months. Bone defects were created in the cranium of male Wistar rats which were filled with DBM or left empty as negative control. In vivo bone formation was monitored with computed tomography after 11, 19, and 26 weeks postoperatively. After 6 months, parietal bones were subjected to micro-CT. Mineral content was determined with spectrophotometric analysis. After 11 weeks the DBM-filled bone defects were completely closed, while empty defects were still open. Density of the DBM-treated group increased significantly while the controls remained unchanged. Quantitative analysis by micro-CT confirmed the in vivo results, bone volume/tissue volume was significantly lower in the controls than in the DBM group. The demineralization procedure depleted the key minerals of the bone to a very low level. Six months after implantation Ca, P, Na, Mg, Zn, and Cr contents were completely restored to the normal level, while K, Sr, and Mn were only partially restored. The remineralization process of DBM is largely complete by the 6th month after implantation in terms of bone density, structure, and key mineral levels. Although DBM does not provide sufficient sources for any of these minerals, it induces a faster and more complete regeneration process. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1336-1342, 2016.

Development and Characterisation of Gastroretentive Solid Dosage Form Based on Melt Foaming

Dosage forms with increased gastric residence time are promising tools to increase bioavailability of drugs with narrow absorption window. Low-density floating formulations could avoid gastric emptying; therefore, sustained drug release can be achieved. Our aim was to develop a new technology to produce low-density floating formulations by melt foaming. Excipients were selected carefully, with the criteria of low gastric irritation, melting range below 70°C and well-known use in oral drug formulations. PEG 4000, Labrasol and stearic acid type 50 were used to create metronidazole dispersion which was foamed by air on atmospheric pressure using in-house developed apparatus at 53°C. Stearic acid was necessary to improve the foamability of the molten dispersion. Additionally, it reduced matrix erosion, thus prolonging drug dissolution and preserving hardness of the moulded foam. Labrasol as a liquid solubiliser can be used to increase drug release rate and drug solubility. Based on the SEM images, metronidazole in the molten foam remained in crystalline form. MicroCT scans with the electron microscopic images revealed that the foam has a closed-cell structure, where spherical voids have smooth inner wall, they are randomly dispersed, while adjacent voids often interconnected with each other. Drug release from all compositions followed Korsmeyer-Peppas kinetic model. Erosion of the matrix was the main mechanism of the release of metronidazole. Texture analysis confirmed that stearic acid plays a key role in preserving the integrity of the matrix during dissolution in acidic buffer. The technology creates low density and solid matrix system with micronsized air-filled voids.

Microarchitectural study of the augmented bone following ridge preservation with a porcine xenograft and a collagen membrane: preliminary report of a prospective clinical, histological, and micro-computed tomography analysis

Socket preservation using a combination of porcine xenograft and collagen membrane maintains the vertical and horizontal dimensions of the ridge. The aim of this study was to evaluate the microarchitecture of the grafted area by histological analysis and micro-computed tomography. Patients in the test group (group 1; nine patients) underwent socket preservation, while the sockets in the control group (group 2; eight patients) were allowed to heal without preservation. After a 6-month healing period, bone core biopsy samples were obtained and implants were placed in the augmented sites in the test group (12 biopsy samples) and the non-augmented sockets of the control group (12 biopsy samples). Analysis of the biopsy samples obtained from group 1 revealed that particles of the graft were surrounded by newly formed bone in eight cases and by granulation tissue in four cases. Micromorphometric data showed statistically significant differences in several parameters between the microarchitecture of the native bone and the newly formed bone within the augmented sites, which suggests that the xenograft particles interfere with the bony healing of the alveoli.

Qualitative assessment of microstructure and Hertzian indentation failure in biocompatible glass ionomer cements

Discs of biocompatible glass ionomer cements were prepared for Hertzian indentation and subsequent fracture analyses. Specifically, 2 × 10 mm samples for reproducing bottom-initiated radial fracture, complemented by 0.2 × 1 mm samples for optimal resolution with X-ray micro tomography (μCT), maintaining dimensional ratio. The latter allowed for accurate determination of volumetric-porosity of the fully cured material, fracture-branching through three Cartesian axes and incomplete bottom-initiated cracking. Nanocomputed tomography analyses supported the reliability of the μCT results. Complementary 2-dimensional fractographic investigation was carried out by optical and scanning electron microscopies on the larger samples, identifying fracture characteristics. The combined 3-D qualitative assessment of microstructure and fractures, complemented by 2-D methods, provided an increased understanding of the mechanism of mechanical failure in these cements. Specifically, cracks grew to link pores while propagating along glass-matrix interfaces. The methodological development herein is exploitable on related biomaterials and represents a new tool for the rational characterisation, optimisation and design of novel materials for clinical service.

The influence of root canal shape on the sealing ability of two root canal sealers

AIM

To evaluate the influence of root canal form on the sealing ability of two root canal sealers.

METHODOLOGY

Twenty radiographically confirmed straight and 20 curved root canals were prepared with a stepback hand filing technique. Root canal aberrations created during preparation were determined by the use of double exposure radiographic technique. The prepared canals were filled with lateral condensation of gutta-percha and one or other of two root canal sealers (Pulp Canal Sealer and Sealapex). Leakage along the apical 10 mm of roots was measured with a fluid transport model at 1, 3, 6, 9 and 12-month intervals.

RESULTS

There were no statistically significant differences between straight and curved root canals (P > 0.05) for prevalence of root canal transportation. The prevalence of apical transportation was 80% in the straight and 85% in the curved root canals. A complete seal was more frequently observed in straight canals compared with curved canals. Utilizing the pi* index, analysis showed the filling with Sealapex allowed more leakage than Pulp Canal Sealer at 1 year.

CONCLUSION

Under the conditions of the study, root canal form influenced short-term sealing ability. In the long-term the seal was affected by the sealer rather than root canal form.

Development of a quantitative preclinical screening model for implant osseointegration in rat tail vertebra

Objectives

Functional tooth replacement and bone regeneration are parts of the daily practice in modern dentistry, but well-reproducible and relatively inexpensive experimental models are still missing. We aimed to develop a new small animal model to monitor osseointegration utilizing the combination of multiple evaluation protocols.

Material and methods

After cutting the tail between the C4 and C5 vertebrae in Wistar rats, costume made, parallel walled, non-threaded implants were placed into the center of the tail parallel with its longitudinal axis using a surgical guide. Osseointegration of the titanium implants was followed between 4 and 16 weeks after surgery applying axial extraction force, and resonance frequency analysis as functional tests, and histomorphometry and micro-CT as structural evaluations.

Results

In functional tests, we observed that both methods are suitable for the detection of the time-dependent increase in osseointegration, but the sensitivity of the pull-out technique (an approximately five times increase with rather low standard error) was much higher than that of the resonance frequency analysis. In structural evaluations, changes in the detected bone implant contact values measured by histomorphometry (yielding 1.5 times increase, with low variations of data) were more reliable than micro-CT based evaluations to screen the developments of contact between bone and implant.

Conclusion

Our results provide evidence that the caudal vertebrae osseointegration model is useful for the preclinical evaluation of implant integration into the bone.

Clinical relevance

The combination of the biomechanical and structural tests offers a well-reproducible small animal system that can be suitable for studying the integration of various implant materials and surface treatments.

Measurement of periapical pressure created by occlusal loading

AIM

To develop an in vitro model in which the pressure in the periapical tissues can be measured during loading.

METHODOLOGY

Extracted human maxillary central incisors were embedded in resin blocks that had physical characteristics similar to those of bone and periodontal ligament. Each tooth was loaded with 20, 40, 50, 60, 75, 85, 100, 200, 300 and 450 N vertical forces from the incisal edge of the crown on three consecutive occasions. A minute resistor embedded in the periapical space was used to detect apical pressure changes during occlusal loading. The ratio of apical pressure changes (DeltaP) to the loading force changes (DeltaF) was calculated.

RESULTS

The periapical pressure detected was in direct proportion to the loading force. The mean value of DeltaP/DeltaF was 5.994 kPa N-1 (SD = 2.04).

CONCLUSIONS

Direct proportionality was found between the coronal loading and the apical hydrostatic pressure. The DeltaP/DeltaF ratio determined in this study makes it easier to estimate the apical hydrostatic pressure values during occlusal loading of single-rooted teeth. In this study, the apical pressure generated under occlusal loading was the same magnitude as that estimated with the finite element method.

Are Artificial Intelligence-Assisted Three-Dimensional Histological Reconstructions Reliable for the Assessment of Trabecular Microarchitecture?

Objectives: This study aimed to create a three-dimensional histological reconstruction through the AI-assisted classification of tissues and the alignment of serial sections. The secondary aim was to evaluate if the novel technique for histological reconstruction accurately replicated the trabecular microarchitecture of bone. This was performed by conducting micromorphometric measurements on the reconstruction and comparing the results obtained with those of microCT reconstructions. Methods: A bone biopsy sample was harvested upon re-entry following sinus floor augmentation. Following microCT scanning and histological processing, a modified version of the U-Net architecture was trained to categorize tissues on the sections. Detector-free local feature matching with transformers was used to create the histological reconstruction. The micromorphometric parameters were calculated using Bruker's CTAn software (version 1.18.8.0, Bruker, Kontich, Belgium) for both histological and microCT datasets. Results: Correlation coefficients calculated between the micromorphometric parameters measured on the microCT and histological reconstruction suggest a strong linear relationship between the two with p-values of 0.777, 0.717, 0.705, 0.666, and 0.687 for BV/TV, BS/TV, Tb.Pf Tb.Th, and Tb.Sp, respectively. Bland-Altman and mountain plots suggest good agreement between BV/TV measurements on the two reconstruction methods. Conclusions: This novel method for three-dimensional histological reconstruction provides researchers with a tool that enables the assessment of accurate trabecular microarchitecture and histological information simultaneously.

Deep Learning-Based Periapical Lesion Detection on Panoramic Radiographs

Background/Objectives: Our study aimed to determine the accuracy of the artificial intelligence-based Diagnocat system (DC) in detecting periapical lesions (PL) on panoramic radiographs (PRs). Methods: 616 teeth were selected from 357 panoramic radiographs, including 308 teeth with clearly visible periapical radiolucency and 308 without any periapical lesion. Three groups were generated: teeth with radiographic signs of caries (Group 1), teeth with coronal restoration (Group 2), and teeth with root canal filling (Group 3). The PRs were uploaded to the Diagnocat system for evaluation. The performance of the convolutional neural network in detecting PLs was assessed by its sensitivity, specificity, and positive and negative predictive values, as well as the diagnostic accuracy value. We investigated the possible effect of the palatoglossal air space (PGAS) on the evaluation of the AI tool. Results: DC identified periapical lesions in 240 (77.9%) cases out of the 308 teeth with PL and detected no PL in 68 (22.1%) teeth with PL. The AI-based system detected no PL in any of the groups without PL. The overall sensitivity, specificity, and diagnostic accuracy of DC were 0.78, 1.00, and 0.89, respectively. Considering these parameters for each group, Group 2 showed the highest values at 0.84, 1.00, and 0.95, respectively. Fisher's Exact test showed that PGAS does not significantly affect (p = 1) the detection of PL in the upper teeth. The AI-based system showed lower probability values for detecting PL in the case of central incisors, wisdom teeth, and canines. The sensitivity and diagnostic accuracy of DC for detecting PL on canines showed lower values at 0.27 and 0.64, respectively. Conclusions: The CNN-based Diagnocat system can support the diagnosis of PL on PRs and serves as a decision-support tool during radiographic assessments.

Management of Odontogenic Sinusitis: Results with Single-Step FESS and Dentoalveolar Surgery

OBJECTIVE

Odontogenic sinusitis (OS) is a well-known and important border of specialties in otorhinolaryngology and dentoalveolar surgery. Odontogenic sinusitis can develop due to iatrogenic harm or odontogenic infection. The gold standard diagnostic method is clinical and radiological-CBCT (cone beam computed tomography)-examination. The treatment of this condition requires collaboration between ENT and dentoalveolar surgery specialists and can be non-surgical or surgical based on staging. This paper aims to share the results of our clinical study whereby complex therapy was administered by a dentoalveolar surgeon and an otorhinolaryngologist in cooperation.

PATIENTS AND METHODS

We conducted a retrospective study comprising 111 OS patients who underwent complex therapy between 2016 and 2023 at Semmelweis University, Budapest, Hungary. All patients were treated with concurrent FESS (functional endoscopic sinus surgery) and dentoalveolar surgery. Follow-up was based on symptoms, clinical examination and CBCT imaging.

RESULTS

Of the 111 patients, 107 were successfully treated with concurrent FESS and dentoalveolar surgery, and only 4 had further symptoms following the complex therapy and needed retreatment.

CONCLUSIONS

The complex, single-session therapy involving FESS and oral surgery is an effective treatment method, which is less invasive and associated with fewer complications compared to previous interventions, such as the Luc-Caldwell procedure.

MRI compatibility of orthodontic brackets and wires: systematic review article

BACKGROUND

Before the magnetic resonance imaging (MRI) examination fixed orthodontic devices, such as brackets and wires, cause challenges not only for the orthodontist but also for the radiologist. Essentially, the MRI-safe scan of the fixed orthodontic tools requires a proper guideline in clinical practice. Therefore, this systematic review aimed to examine all aspects of MRI-safe scan, including artifact, thermal, and debonding effects, to identify any existing gaps in knowledge in this regard and develop an evidence-based protocol.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was used in this study. The clinical question in "PIO" format was: "Does MRI examination influence the temperature of the orthodontic devices, the size of artifacts, and the debonding force in patients who have fixed orthodontic bracket and/or wire?" The search process was carried out in PubMed, PubMed Central, Scopus, and Google Scholar databases. The search resulted in 1310 articles. After selection according to the eligibility criteria, 18 studies were analyzed by two reviewers. The risk of bias was determined using the Quality In Prognosis Studies tool.

RESULTS

Out of the eligible 18 studies, 10 articles examined the heating effect, 6 were about the debonding effect, and 11 measured the size of artifact regarding brackets and wires. Considering the quality assessment, the overall levels of evidence were high and medium. The published studies showed that heating and debonding effects during MRI exposure were not hazardous for patients. As some wires revealed higher temperature changes, it is suggested to remove the wire or insert a spacer between the appliances and the oral mucosa. Based on the material, ceramic and plastic brackets caused no relevant artifact and were MRI-safe. Stainless steel brackets and wires resulted in susceptibility artifacts in the orofacial region and could cause distortion in the frontal lobe, orbits, and pituitary gland. The retainer wires showed no relevant artifact.

CONCLUSIONS

In conclusion, the thermal and debonding effects of the fixed orthodontic brackets and wires were irrelevant or resoluble; however, the size of the artifacts was clinically relevant and determined most significantly the feasibility of fixed brackets and wires in MRI examination.

[Clinical examination of the gingival effects of three glass ionomer restorative materials (GC Fuji IX GP, GC Fuji IX GP EXTRA és GC EQUIA)]

The restoration of cervical abrasions, erosions or cervical carious lesions is still challenging because of their unpredictable adhesion and possible negative effects on the marginal plaque accumulation. The impact of three different glass ionomer cements (GIC) on the marginal gingiva and root sensitivity was studied. Furthermore, it was investigated in details, whether or not a recently developed light curing varnish (GC Coat - EQUIA) had any additional effect on the gingival tissue. A total number of 30 non-smokers with healthy gingiva having at least one cervical supra/paragingival abrasion/erosion/abfraction defects were enrolled in the present study. The cervical defects were randomly restored by using one of the three GIC and the gingival parameters were recorded and evaluated at baseline, 6 weeks and 6 months. According to our results root sensitivity were substantially decreased in all the three groups. Plaque scores were also reduced in all groups with the greatest improvement at the sites where the new varnish were applied. Although this improvement was not reflected by the gingival parameters, such as bleeding on probing and crevicular fluid flow, since both were slightly increased in the varnish group. However, neither the intra-group, nor the intergroup differences reached statistical significance. Consequently, the three investigated GIC did not significantly affect the gingival health, therefore they might serve as alternative for the treatment of such cervical lesions. Nevertheless, the new light cure varnish-coated GIC did not seem to be either clinically or statistical significantly more favorable.

Evaluation of the effect of vitamin D3 on mandibular condyles in an ovariectomized mouse model: a micro-CT study

BACKGROUND

This study aimed to investigate the effect of ovariectomy and vitamin D3 on bone microstructure; this effect was examined in three regions of interest at one femoral and two mandibular sampling sites bone in an ovariectomized mouse model.

METHODS

Thirty-six week-old female mice were randomly divided into three groups: 10 subjects were given oral cholecalciferol (vitamin D3) daily for 6 weeks after undergoing bilateral ovariectomy (D3 group), while 10 ovariectomized subjects (OVX) and 10 subjects who underwent a sham operation (SHAM) received peanut oil daily during the investigation. After extermination, the left hemimandible and femur were removed and scanned by micro-CT. The bone micromorphology parameters were analyzed and the BMD was calculated.

RESULTS

The bone volume fraction (BV/TV) was significantly lower in the trabecular bone of the mandibular condyle in the OVX group than in the SHAM and D3 groups. Also there was a significant difference between the SHAM and D3 groups. The specific bone surface (BS/BV) was significantly higher in the OVX and D3 groups than in the SHAM group. Trabecular thickness (Tb.Th) was significantly higher in the SHAM group, and the trabecular bone pattern factor (Tb.Pf) was significantly higher in the OVX group than in the other two groups. Bone mineral density (BMD) of the femur and the mandible was significantly lower in the OVX group than in the SHAM and D3 groups.

CONCLUSIONS

Our results show that ovariectomy causes a significantly weaker bone microstructure in the mandibular condyle, where the protective effect of vitamin D3 resulted in a partial resorption.