The Impetus of Artificial Intelligence on Periodontal Diagnosis: A Brief Synopsis

The current advances in digitized data additions, machine learning and computing framework, lead to the swiftly emerging concept of "Artificial Intelligence" (AI), that are developing into areas that were formerly contemplated for human expertise. AI is a relatively rapid paced mechanics wherein the computer technology is tuned to perform human tasks. An auxiliary domain of AI is machine learning (ML), and Deep learning, a subclass of ML technique comprehends multi-layer mathematical operations. AI-based applications have tremendous potential to improve and systematize patient care thereby alleviating dentists from laborious regular tasks, and facilitate personalized, predictive and preventive dentistry. In the dental clinic, AI can execute a variety of easy tasks with greater accuracy, minimal manpower, and with fewer mistakes over human equivalents. These tasks range from appointment scheduling and coordination to helping with clinical evaluation and therapy. Besides, this could assist in the early diagnosis of dental and maxillofacial abnormalities like periodontal ailments, root caries, bony lesions, and facial malformations in addition to automatically identifying and classifying dental restorations on digital radiographs. This brusque narrative review describes the AI-based systems, their respective applications in periodontal diagnosis, the multifarious studies, possible limitations and the predictable future of AI-based dental diagnostics and treatment planning.

Efficacy of a smartphone application as an aid to enhance the instruction of radiographic differential diagnosis of maxillofacial bony lesions

OBJECTIVES

The purpose of this study was to assess the efficacy of a smartphone application for instruction of radiographic differential diagnosis of maxillofacial bony lesions as an aid to enhance to traditional learning (lecture-based learning) for dental students.

METHODS

This quasi-experimental study evaluated 50 fifth-year dental students who were randomly divided into two groups. The two groups were matched in terms of grade point average to ensure their equal baseline knowledge level. The experimental group (n = 25) received instructions regarding differential diagnosis of maxillofacial bony lesions via a self-designed smartphone application, while the control group (n = 25) received lecture-based instruction of the same topic. The students participated in a written exam (10 questions) immediately and 2 months after the interventions. Each question had 3 differential diagnosis choices. The best answer choice was allocated a score of 0.5, while other answer choices were allocated a score of 0.25. Data were analyzed using repeated measures ANOVA, and Mann-Whitney U and Wilcoxon tests.

RESULTS

The mean score of the experimental group was significantly higher than that of the control group immediately after the intervention (p < 0.001) and also at 2 months (p < 0.001). The mixed effect linear model revealed that after controlling for the effect of age and sex, the mean score of the experimental group was still significantly higher than that of the control group immediately and at 2 months after the intervention (p < 0.001).

CONCLUSIONS

Smartphone-based mobile learning can effectively enhance the knowledge and practical skills of dental students in differential diagnosis of maxillofacial bony lesions as an aid to enhance to traditional learning.

Sinonasal Manifestations of Severe Cherubism: A Case with 11-year Follow-up

Cherubism, a type of fibroosteodysplasia, is a rare hereditary disease that causes variable degrees of facial deformity in children. Hypertrophy of the mandible is the most common symptom, but in severe cases, the disease affects the eyes, teeth, and sinonasal cavity. There have been few reports regarding sinonasal complications and no standard treatment has been established. This paper reports long-term treatment of severe cherubism that invaded the sinonasal cavity treated with consecutive endoscopic sinonasal surgeries.

Nasolabial Appearance in 5-Year-Old Patients with Repaired Complete Unilateral Cleft Lip and Palate: A Comparison of Two Different Techniques of Lip Repair

Different surgical techniques are available to adequately correct the primary cleft lip deformity; however, when compared, none of these techniques have proven superior with regard to achieving optimal aesthetic results. Thus, the aim of this retrospective study was to assess the nasolabial appearance in patients with unilateral cleft lip and palate (UCLP) at age five with reference to two techniques for primary cleft lip repair used in our service: Pfeifer’s wave-line procedure and Randall’s technique. A modified Asher–McDade Aesthetic Index was applied to appraise the nasolabial area by means of 2D photographs of non-syndromic five-year-old patients with a UCLP. In this context, three parameters were assessed: 1. nasal frontal view; 2. shape of the vermilion border and philtrum length; and 3. the nasolabial profile. Five professionals experienced in cleft care were asked to rate the photographs on two occasions. Overall, 53 patients were included in the final analysis, 28 of whom underwent lip repair according to Pfeifer; 25 were treated employing Randall’s technique. Statistically significant differences between the two techniques regarding philtrum length and vermilion border were found (p = 0.046). With reference to the other parameters assessed, no significant differences were determined. The results suggest that Randall’s cleft lip repair may allow for more accurate alignment of the vermilion border and more adequate correction of the cleft lip length discrepancy in comparison to Pfeifer’s wave-line technique.

Use of Diode Laser for Lip Repositioning, Evolution of the Conventional Technique. A Case Report

Introduction

LipStaT® lip repositioning surgery using a diode laser for the management of gummy smiles offers promising and consistent long-term results.

Objective

To describe the technique through a clinical case, including its indications, preoperative evaluation, surgical approach, and recommendations after the intervention.

Case Report

A 29-year-old woman with excessive gingival display (EGD) of 4 mm when smiling; the LipStaT® technique was performed with a 940 nm diode laser to remove a strip of mucosa by ablating the epithelial tissue, and thus, achieve aesthetic, harmonic and functional results. The inflammation and postoperative pain were treated with the diode laser assisted lymphatic drainage technique. After follow-up, a satisfactory tissue response was observed, and no pain or inflammation was reported.

Conclusion

The use of a 940 nm diode laser proved to be an effective treatment option for patients with a gummy smile, allowing control of intraoperative bleeding and improvement of the healing process obtaining predictable long-term results.

Patient- and clinician-reported outcomes of lower jaw contouring using patient-specific 3D-printed titanium implants

The main aim of this study was to assess patient-reported outcomes of jawline contouring with patient-specific three-dimensional (3D) -printed titanium alloy implants using validated Face-Q questionnaires. Four FACE-Q questionnaires (Appearance Appraisal Scale, Quality of Life Scales for Psychological and Social Function, and Adverse Effects Scale) were sent to 21 patients consecutively operated on by the same surgeon between 2014 and 2019. Thirteen patients responded. Mean Rasch Transformed Scores for Satisfaction, Psychological Function and Social Function (0-100) were 70.6, 73.2, and 71.1, respectively. These values are difficult to interpret, however, as comparative literature and prospective follow-up scores are lacking. The second objective was to correlate clinician-reported morphology improvement by panel scoring (Likert scale) with patient-reported appearance appraisal. As for satisfaction, we can conclude that an objective acceptable result does not corroborate patients' perceptions (Spearman Rho test r_s = -0.021). Psychological factors and results from previous surgeries probably modulate patients' views. The mean score for the Adverse Effect Scale (15-45) was low (18.6), indicating that the intraoral drop-in fit of customized titanium implants does not cause major side effects.

PIN1 Attenuation Improves Midface Hypoplasia in a Mouse Model of Apert Syndrome

Premature fusion of the cranial suture and midface hypoplasia are common features of syndromic craniosynostosis caused by mutations in the FGFR2 gene. The only treatment for this condition involves a series of risky surgical procedures designed to correct defects in the craniofacial bones, which must be performed until brain growth has been completed. Several pharmacologic interventions directed at FGFR2 downstream signaling have been tested as potential treatments for premature coronal suture fusion in a mouse model of Apert syndrome. However, there are no published studies that have targeted for the pharmacologic treatment of midface hypoplasia. We used Fgfr2^S252W/+ knock-in mice as a model of Apert syndrome and morphometric analyses to identify causal hypoplastic sites in the midface region. Three-dimensional geometric and linear analyses of Fgfr2^S252W/+ mice at postnatal day 0 demonstrated distinct morphologic variance. The premature fusion of anterior facial bones, such as the maxilla, nasal, and frontal bones, rather than the cranium or cranial base, is the main contributing factor toward the anterior-posterior skull length shortening. The cranial base of the mouse model had a noticeable downward slant around the intersphenoid synchondrosis, which is related to distortion of the airway. Within a skull, the facial shape variance was highly correlated with the cranial base angle change along Fgfr2 S252W mutation-induced craniofacial anomalies. The inhibition of an FGFR2 downstream signaling enzyme, PIN1, via genetic knockdown or use of a PIN1 inhibitor, juglone, attenuated the aforementioned deformities in a mouse model of Apert syndrome. Overall, these results indicate that FGFR2 signaling is a key contributor toward abnormal anterior-posterior dimensional growth in the midface region. Our study suggests a novel therapeutic option for the prevention of craniofacial malformations induced by mutations in the FGFR2 gene.

3D-cinematic rendering for dental and maxillofacial imaging

OBJECTIVES

Aim of this technical note is to show the applicability of cinematic rendering (CR) for a photorealistic 3-dimensional (3D) visualization of maxillofacial structures. The focus is on maxillofacial hard tissue pathologies.

METHODS

High density maxillofacial pathologies were selected in which CR is applicable. Data from both, CT and cone beam CT (CBCT) were postprocessed using a prototype CR software.

RESULTS

CR 3D postprocessing of CT and CBCT imaging data is applicable on high density structures and pathologies such as bones, teeth, and tissue calcifications. Image reconstruction allows for a detailed visualization of surface structures, their plasticity, and 3D configuration.

CONCLUSIONS

CR allows for the generation of photorealistic 3D reconstructions of high density structures and pathologies. Potential applications for maxillofacial bone and tooth imaging are given and examples for CT and CBCT images are displayed.

Quality of life, work ability, and facial deformities

Background

The face plays a central role in interpersonal relationships. Individuals with congenital or acquired facial deformities might experience difficulties with interpersonal relationships. Treatment should seek to improve their quality of life and work ability.

Objective

To analyze the health-related quality of life and work ability of individuals with facial deformities.

Method

Study with mixed, quantitative and qualitative methods. We conducted semi-structured interviews on health-related quality of life and its implications for work with 16 individuals with facial deformities, eight cases of congenital and eight of acquired deformities, cared at specialized services in Salvador, Bahia, Brazil. The Work Ability Index (WAI) and 36-Item Short-Form Health Survey were administered.

Results

Thematic analysis led us to detect two categories of themes associated with facial deformities: interpersonal relationships and work ability; and quality of life and access to treatment. The participants with acquired facial deformities exhibited lower educational level and income, and lower quality of life and WAI scores compared to the ones with congenital deformities. All the participants with congenital deformities had received some form of rehabilitation and their social relationships were less impaired.

Conclusions

Individuals with acquired facial deformities exhibited poorer work ability and quality of life compared to the ones with congenital deformities. Early rehabilitation of congenital deformities seems to considerably improve work ability and health-related quality of life.

Incidental findings in pre-orthodontic treatment radiographs

OBJECTIVES

To determine the frequency, radiodensity characteristics, topographic location and number per patient of incidental findings observed in radiographs taken before orthodontic treatment and to evaluate the relationship of the findings with age and sex.

METHODS

This was a cross-sectional study that investigated 1,887 panoramic and lateral cephalogram radiographs from 783 patients (23.31 ± 13.11 years of age; 453 women and 330 men) who were randomly selected from the orthodontics department of a private university. The images were systematically evaluated by an oral pathologist. A chi-square test was applied to evaluate the association between sex and the presence of pathology, radiodensity characteristics and topographic location. The Mann-Whitney U and Kruskal-Wallis tests were used to establish the association between age or number of findings per patient with other variables in the study.

RESULTS

The prevalence of incidental findings was 88.12%. The most frequent finding was maxillary sinus pneumatisation (25.80%). No significant association was detected between frequency or number of findings per patient and either sex or diagnostic hypothesis. A significant association was found between age and the presence of pathology and number of incidental findings per patient (P < 0.001), as well as between the type of radiographic image and incidental finding (P < 0.001).

CONCLUSION

The prevalence of incidental findings in the sample studied was high, and the structures most commonly involved were the maxillary sinuses. The results suggest that both the presence and the number of findings per patient increase with age but there is no association with sex.

Hallmark of success: top 50 classics in oral and maxillofacial cone-beam computed tomography

Purpose

The aim of this study was to identify the top 50 cited articles on the use of cone-beam computed tomography (CBCT) for oral and maxillofacial applications and to summarise the characteristics of the most impactful research articles in this domain.

Material and methods

A database was generated by combining the search results from Thomson Reuters Web of Science and Elsevier's Scopus to ensure that all top-cited publications were captured. We used three search fields to generate the database: 1) CBCT, 2) oral and maxillofacial pathologies, and 3) oral and maxillofacial anatomical structures. Publications were then ranked by citation counts and reviewed by two independent reviewers.

Results

A total of 50 top publications were included in the study. Their citation count ranged from 43 to 170 with a median of 55.5. Five publications were cited more than 100 times. All except for one paper were published after 2000. The most well published journal was the American Journal of Orthodontics and Dentofacial Orthopedics (n = 12), and the United States of America (n = 15) was the most productive country in the field. The majority of the studies (n = 27) discussed the imaging of primary tooth pathologies, but there are also a significant number of articles that discuss imaging of bone grafts or dental implants (n = 7), upper airways (n = 5), the skull (n = 4), and other maxillofacial structures (n = 7).

Conlcusions

Our study identifies 50 research articles with the highest number of citations in oral and maxillofacial CBCT, discusses the characteristics and commonalities between these articles, and predicts future trends in the field.

Microbiological analysis of conjunctival secretion in anophthalmic cavity, contralateral eye and ocular prosthesis of patients with maxillofacial abnormalities

The purpose of this study was to identify and analyse the micro-organisms present in the conjunctival secretion in anophthalmic cavities of wearers of ocular prostheses, as well as on the prostheses used by them, correlating them with the microbiota of the contralateral eye. Nine patients with maxillofacial abnormalities, wearers of an acrylic resin ocular prosthesis participated in the study. Collections of conjunctival secretions and biofilm were performed on the prosthesis, anophthalmic cavity and contralateral eye for the mycological and bacterial analyses. The data were submitted to statistical analysis, performing a Kendall correlation test to identify the correlation between the collection site and the identified micro-organism (P < 0·05). It was verified that the most prevalent micro-organisms were the Staphylococcus aureus and Staphylococcus epidermidis, independent of the collection site, and that negative cultures for fungi were encountered in 85·2% of collections, independent of the region. It was not possible to establish a correlation among the types of micro-organisms and the collection sites.

SIGNIFICANCE AND IMPACT OF THE STUDY

Some evidence suggests that the surface roughness of ocular prostheses can influence interactions with micro-organisms, with greater prejudicial consequences, such as the establishment of biofilms, which could lead to infections. Thus, it becomes extremely important to identify the micro-organisms present on the acrylic surfaces of ocular prostheses, as well as the microbiota of the anophthalmic cavity and contralateral eye of wearers of the same, so that subsequent control measures promote the homeostatic maintenance of the ocular region.

Oral and Craniofacial Anomalies of Bardet-Biedl Syndrome: Dental Management in the Context of a Rare Disease

Standardized guidelines for the oral health management of patients with rare diseases exhibiting morphologic anomalies are currently lacking. This review considers Bardet-Biedl syndrome (BBS), a monogenic autosomal recessive nonmotile ciliopathy, as an archetypal condition. Dental anomalies are present in a majority of individuals affected by BBS due to abnormal embryonic orofacial and tooth development. Genetically encoded intrinsic oral structural anomalies and heterogeneous BBS clinical phenotypes and consequent oral comorbidities confound oral health management. Since the comorbid spectrum of BBS phenotypes spans diabetes, renal disease, obesity, sleep apnea, cardiovascular disease, and cognitive disorders, a broad spectrum of collateral oral disease may be encountered. The genetic impact of BBS on the anatomic development of oral components and oral pathology encountered in the context of various BBS phenotypes and their associated comorbidities are reviewed herein. Challenges encountered in managing patients with BBS are highlighted, emphasizing the spectrum of oral pathology associated with heterogeneous clinical phenotypic expression. Guidelines for provision of care across the spectrum of BBS clinical phenotypes are considered. Establishment of integrated medical-dental delivery models of oral care in the context of rare diseases is emphasized, including involvement of caregivers in the context of managing these patients with special needs.

Management of a large diffuse maxillofacial arteriovenous malformation previously treated with ligation of ipsilateral arterial supply

A 32 year-old male presented with a pulsatile facial mass with palpable thrill and audible bruit. Imaging revealed a very large diffuse left-sided facial arteriovenous malformation with extensive bilateral supply, as well as a previously ligated left external carotid artery. Endovascular treatment was required to control associated hemorrhagic events as well as for palliation and was delivered via the contralateral and ipsilateral collateral supply because of ligation of the direct route to the nidus. In addition, the patient received intravenous bevacizumab and intraarterial bleomycin therapy. Under such circumstances, endovascular embolization remains often the only option when emergent therapy for massive haemorrhage is required. Collaboration and treatment planning with head and neck surgery is imperative and should be performed from the onset, avoiding disastrous ligation of arterial feeders.

Speech language pathology findings in a Treacher Collins syndrome patient

BACKGROUND

Treacher Collins syndrome (TCS) is a rare disorder with different levels of severity due to congenital head and face abnormalities which affect language, orofacial musculature, voice and breadth, suction, chewing and swallowing functions.

AIMS

This paper objectifies to report a Treacher Collins syndrome patient, describing phonoaudiological changes that can be found in individuals suffering from this syndrome.

METHODS & PROCEDURES

The study was carried out with a male child at a teaching Speech Language Pathology clinic in Southern Brazil. The patient underwent audiological assessment, as well as orofacial motricity, swallowing, voice and speech assessments.

OUTCOMES & RESULTS

By means of the assessments, it was possible to perceive that the patient presents moderate hearing loss, inadequacy of phonoarticulatory organs, base of the tongue going backwards and epiglottis collapse over the larynx. In spite of evidencing significant difficulty in producing speech sounds, due to musculoskeletal changes, he effectively interacts in communicative situations, besides understanding sentences and narrated stories.

CONCLUSIONS & IMPLICATIONS

The screened case report evidences that an interdisciplinary follow-up is indispensable for this patient suffering from Treacher Collins syndrome, which implies not only speech language therapeutic follow-up, but also in ear, nose and throat and orthodontics areas.

Tongue pressure production during swallowing in patients with mandibular prognathism

Abnormalities of swallowing in patients with mandibular prognathism have not been evaluated quantitatively. The aim of this study was to compare tongue pressure production for bolus transfer between volunteers with normal occlusion and patients with mandibular prognathism. The control group had 10 female volunteers with normal occlusion, and the patient group had 10 women with mandibular prognathism. Tongue pressure was measured by a palatal sensor sheet at five sites on swallowing 4 mL of a tasteless and odourless jelly.

RESULTS

The tongue pressure waveform differed between the control and patient groups. The incidence of a double-peak tongue pressure waveform was more frequent in the patient group. In both groups, the exertion of tongue pressure began at the anterior point of the sensor sheet, followed by the peripheral parts. Although the order of expression of tongue pressure was the same for the two groups, maximum tongue pressure at all parts of the sensor sheet was lower in the patient group than in the control group. Furthermore, swallowing time was longer in the patient group than in the control group at the peripheral parts of the palate. These results clearly show the difference in tongue pressure production during swallowing between patients with mandibular prognathism and volunteers with normal occlusion. The current findings suggest that maxillofacial morphology may affect tongue movement during swallowing.

Clinical and radiographic maxillofacial features of pycnodysostosis

The aim of this study was to review of the literature to determine the radiographic and clinical maxillofacial features of pycnodysostosis emphasizing the main aspects of interest to the dentist in order to make them fit for the proper treatment of this population. It is important to make the diagnosis as early as possible in order to plan the treatment more suitable to provide a better life's quality to the patients. The most frequent clinical maxillofacial features were: grooved palate, midfacial hypoplasia, mandibular hypoplasia and enamel hypoplasia. The most common radiographic maxillofacial features were: obtuse mandibular angle, frontal/parietal/occiptal bossing, open fontanels and sutures, multiple impacted teeth. The earlier diagnostic of pycnodysostosis has a fundamental role in general health of the patients. We consider that is very important that the dentist know recognize the radiographic and clinical maxillofacial features of pycnodysostosis, which allows correct treatment planning avoiding risks and ensuring better life's quality to the patients.