Evaluation of impacted canines' localization and adjacent lateral incisors' root resorption with orthopantomography and cone-beam computed tomography

Performance of Chat Generative Pretrained Transformer-4.0 in determining labiolingual localization of maxillary impacted canine and presence of resorption in incisors through panoramic radiographs: A retrospective study

INTRODUCTION

This study evaluates the diagnostic accuracy of Chat Generative Pretrained Transformer (ChatGPT)-4.0 in determining the labiolingual position of impacted maxillary canines and identifying resorptive changes in adjacent incisors using panoramic radiographs (PRs).

METHODS

A retrospective analysis was conducted on 105 patients with unilaterally impacted maxillary canine, including 25 patients with root resorption in adjacent incisors. To ensure accurate classification, PRs and cone-beam computed tomography images were independently evaluated by 3 orthodontists, serving as the reference standard for assessing ChatGPT-4.0's performance. Patients were categorized into 3 groups based on canine position: palatal (n = 49), midalveolar (n = 26), and labial (n = 30). For resorption evaluation, a balanced subset of 50 PRs was selected to maintain equal group sizes. Group 1 (with resorption, n = 25) included all available patients with resorption, whereas group 2 (without resorption, n = 25) was randomly selected from 80 patients without resorption. ChatGPT-4.0 analyzed the PRs to determine the labiolingual position of impacted canines and detect resorption in adjacent incisors. The results were recorded by the first researcher. ChatGPT-4.0's performance was evaluated using accuracy, precision, recall, and F1 score for both canine localization and resorption detection.

RESULTS

The model achieved an overall accuracy of 37.1% in canine localization, with the highest sensitivity (61.2%) and precision (48.4%) observed in palatal patients. However, its performance was considerably lower for midalveolar and labial positions. In detecting resorption, the model achieved an accuracy of 46.0%, performing better in identifying the absence of resorption compared with its presence.

CONCLUSIONS

ChatGPT-4.0 demonstrated insufficient accuracy in determining the labiolingual position of impacted maxillary canines and detecting resorptive changes based on PRs, indicating its unsuitability for clinical applications.

Simulation of an Orthodontic System Using the Lingual Technique Based on the Finite Element Method

Backgrounds/Objectives: The finite element method (FEM) is an advanced numerical technique that can be applied in orthodontics to study tooth movements, stresses, and deformations that occur during orthodontic treatment. It is also useful for simulating and visualizing the biomechanical behavior of teeth, tissues, and orthodontic appliances in various clinical scenarios. The objective of this research was to analyze the mechanical behavior of teeth, tissues, and orthodontic appliances in various clinical scenarios. Materials and Methods: For this study, we utilized a model derived from a set of CBCT scans of a 26-year-old female patient who underwent fixed orthodontic treatment using the lingual technique. Through a series of programs based on reverse engineering, we constructed a three-dimensional reconstruction of the teeth and their internal structures. Using the finite element method (FEM), we obtained six simulations of an orthodontic system utilizing the fixed lingual technique, in which we employed brackets made of chrome-nickel or gold, and archwires made of nitinol, gold, or stainless steel. Results: The study reveals that although the deformation of the archwires during orthodontic treatment is the same, the forces generated by the three types of archwires on brackets differ. The variation in forces applied to the brackets in the fixed lingual orthodontic technique is essential for customizing orthodontic treatment, as these forces must be precisely controlled to ensure effective tooth movement and prevent overloading of the dental structures. Conclusions: The FEM analysis allows for the identification of ideal combinations between the materials used for orthodontic archwires and the materials used for brackets. This ensures that the optimal intensity of forces applied during the fixed lingual orthodontic technique results in desired tooth movements without causing damage to the enamel, dentin, or pulp of the teeth.

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

Applications of cone-beam CT (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing. The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis-including soft tissue diagnosis and airway morphology-needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognized guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.

Advancements in oral and maxillofacial surgery medical images segmentation techniques: An overview

OBJECTIVES

This article reviews recent advances in computer-aided segmentation methods for oral and maxillofacial surgery and describes the advantages and limitations of these methods. The objective is to provide an invaluable resource for precise therapy and surgical planning in oral and maxillofacial surgery. Study selection, data and sources: This review includes full-text articles and conference proceedings reporting the application of segmentation methods in the field of oral and maxillofacial surgery. The research focuses on three aspects: tooth detection segmentation, mandibular canal segmentation and alveolar bone segmentation. The most commonly used imaging technique is CBCT, followed by conventional CT and Orthopantomography. A systematic electronic database search was performed up to July 2023 (Medline via PubMed, IEEE Xplore, ArXiv, Google Scholar were searched).

RESULTS

These segmentation methods can be mainly divided into two categories: traditional image processing and machine learning (including deep learning). Performance testing on a dataset of images labeled by medical professionals shows that it performs similarly to dentists' annotations, confirming its effectiveness. However, no studies have evaluated its practical application value.

CONCLUSION

Segmentation methods (particularly deep learning methods) have demonstrated unprecedented performance, while inherent challenges remain, including the scarcity and inconsistency of datasets, visible artifacts in images, unbalanced data distribution, and the "black box" nature.

CLINICAL SIGNIFICANCE

Accurate image segmentation is critical for precise treatment and surgical planning in oral and maxillofacial surgery. This review aims to facilitate more accurate and effective surgical treatment planning among dental researchers.

The diagnostic accuracy of cone-beam computed tomography and two-dimensional imaging methods in the 3D localization and assessment of maxillary impacted canines compared to the gold standard in-vivo readings: A cross-sectional study

BACKGROUND

Although the widespread cone-beam computed tomography (CBCT) is a diagnosing tool for impacted canines, the surgical exposure-based diagnostic accuracy of this 3D imaging modality has not been established yet. Therefore this study aimed to (1) compare the accuracy of CBCT- and 2D-based interpretations of impacted canine and its relationships with the neighbouring structures with the gold standard (GS) readings, (2) and calculate the diagnostic accuracy, sensitivity, and specificity values of the variables assessed using CBCT and 2D methods.

MATERIAL AND METHODS

Patients with unilateral impacted maxillary canines (IMCs) planned for surgical extraction between 2016-2018 were checked in-depth to include in this cross-sectional study. For each patient, 2D and 3D radiographic records were obtained and assessed by eight postgraduate orthodontic students. These assessments were compared with the GS readings based on surgical exposure and direct vision of the IMCs. To compare 2D- and CBCT-based assessments with the GS values, Cochran's Q tests, Friedman's tests, McNemar's, McNemar-Bowker's, and Wilcoxon tests were applied.

RESULTS

A total of 17 patients (6 males, 11 females; mean age: 20.52±3.98 years) were randomly selected and included in this study. Significant differences were found between the CBCT-based assessments and the GS only concerning shape and bony coverage of the IMC (P=0.001 and P<0.001, respectively). On the contrary, there were significant differences between the 2D-based assessments and the GS regarding all the assessed variables except for the ankylosis and the proximity to the adjacent teeth (P=0.424, and P=0.080, respectively). CBCT-based assessments had remarkably higher values of diagnostic accuracy, sensitivity, and specificity compared to 2D-based ones.

CONCLUSIONS

The diagnostic accuracy of CBCT outperformed 2D radiography in localizing the IMC (labiopalatal, mesiodistal, and vertical location), detecting root apex development of the IMCs, and the resorption of the adjacent incisors. Although both 2D and 3D techniques showed the same ability in the diagnosis of IMCs ankylosis, the diagnostic accuracy of CBCT was superior. However, both techniques inaccurately determined the shape of the impacted canine and the bony coverage.

Root Resorption of the Permanent Central Incisor through Ectopic Eruption of the Maxillary Canine

Although ectopic eruption of the maxillary canine has a low prevalence, a late diagnosis can have serious consequences. A careful clinical examination, assisted with radiographic examination, ensures early diagnosis, facilitates planning, and minimizes possible adverse consequences. This study reports a case of ectopic eruption of the permanent maxillary canine, with complete root resorption of the central permanent incisor, the consequences of which caused functional, aesthetic, and psychological harms to the patient. The procedures used included canine ectopic remodeling of the ectopic canine in the central incisor and orthodontic correction, which treated the anomaly and rebuilt the patient's self-esteem.

Frequency of Dental X-ray Diagnostics in Children and Adolescents: What Is the Radiation Exposure?

Children are exposed to ionizing radiation through radiographs during their development for various reasons. At present, there are no officially valid reference values for dental X-rays in children and adolescents for dental X-ray diagnostics. This study retrospectively examined 9680 extraoral dental radiographs in pediatric patients between 2002 and 2020. The aim was to analyze the radiation doses in pediatric patients, which indications were used, and whether there were specific age and gender differences. The evaluation showed that radiation doses were considered low, with dose area products of 2.2 cGy × cm2 for a lateral cephalogram, 14 cGy × cm2 for an orthopantomogram (OPG), and 45 cGy × cm2 for cone beam computer tomography (CBCT). This corresponds to an effective dose of 1.5 μSv for a lateral cephalogram, 7 μSv for an OPG, and 33.8 μSv for CBCT. Of the 9680 images, 78% were orthopantomograms, and only 0.4% were CBCT images. OPG has become more important over the years, as reflected in the indication. Approximately one-third of all extraoral exposures are orthodontic indications. Overall, the indications were similar for both genders. According to the dental indications, boys were X-rayed slightly more frequently than girls (54.5-45.5%). A future publication of dose guide values and corresponding guidelines is of high priority.

The labiopalatal impacted canine: Accurate diagnosis based on the position and size of adjacent teeth: A cone-beam computed tomography study

INTRODUCTION

Labiopalatal impacted canines (L-PICs) occur when the canines lie between central and lateral incisors, with their tip palatal to the central incisor and part of their crown labial to the lateral incisor. Because of their unusual position, they are often misdiagnosed, and their orthodontic resolution fails. This study aims to provide clinicians with pathognomonic features for early and accurate positional diagnosis of L-PICs.

METHODS

The L-PIC sample included 21 subjects with full diagnostic records. The control group of normally erupted canines was taken from a previous study. Clinical photographs, 2-dimensional radiographs, and cone-beam computed tomography were used to evaluate the positions of the adjacent incisors and first premolars, the canine incisor index, and the mesiodistal width of the lateral vs central incisors.

RESULTS

Central incisors adjacent to L-PICs showed significant mesial root angulation, labial root inclination, and mesiolabial crown rotation, whereas lateral incisors presented significant distal root angulation, palatal root inclination, and mesiolabial crown rotation, in comparison to controls. The roots of the central and lateral incisors were divergent, in contrast to the controls, in which they were slightly convergent. The first premolar positions were not affected. The mean canine incisor index was significantly bigger in L-PICs vs the controls, suggesting a palatal canine. The lateral incisor widths were similar between the groups.

CONCLUSIONS

This study provides the orthodontist with evidence-based clinical and radiographic red flags for diagnosing L-PIC, which may allow timely initiation of orthodontic treatment and correct planning of mechanotherapy.

Root Resorption of Adjacent Teeth Associated with Maxillary Canine Impaction in the Saudi Arabian Population: A Cross-Sectional Cone-Beam Computed Tomography Study

This study aimed to identify the location of root resorption in relation to an impacted maxillary canine and grade its severity using cone-beam computed tomography (CBCT) in the Saudi Arabian population. Materials and Methods: CBCT scans of 169 patients with maxillary canine impaction were evaluated. The location and the severity of root resorption of the affected tooth in relation to the impacted maxillary canine were recorded for each patient. Results: a total 204 impacted maxillary canines caused root resorption in 218 adjacent teeth. Maximum root resorption was present in 63.3% of the apical one-third of the root and 37.6% of the palatal surfaces. There was mild root resorption in 55%, moderate in 10% and severe in 35%. There was no statistically significant difference between the gender, age, type of impaction, side of impaction, and the number, location, or degree of root resorption. Multiple logistic regression models showed significant association (p = 0.024) between gender, type of impaction, and root resorption. A significant correlation was found between the level and the surface of the root resorption (p = 0.018). Conclusion: In the Saudi population, apical one-third root levels and palatal surfaces were primarily involved in root resorption caused by impacted canines. The females with bilateral canine impaction were more likely affected by root resorption.