Radiologic Assessment of the Periodontal Patient

Periodontal Health and Its Relationship with Psychological Stress: A Cross-Sectional Study

Background: Studies suggest that chronic psychological stress can lead to oral health deterioration, alter the immune response, and possibly contribute to increased inflammation, which can impact the physiological healing of periodontal tissues. This cross-sectional study seeks to assess and improve clinical understanding regarding the relationship between perceived stress, mindfulness, and periodontal health. Methods: A total of 203 people were analyzed from December 2022 to June 2023. The Periodontal Screening and Recording (PSR) score and Gingival Bleeding Index (GBI), and Plaque Control Record (PCR) of every patient were registered. Subsequently, participants completed the Sheldon Cohen Perceived Stress Scale (PSS) and the Mindfulness Awareness Attention Scale (MAAS) questionnaires. The collected data underwent statistical analysis, encompassing the evaluation of correlations and dependencies. Applying Welch's t-test to assess the relationship between MAAS and the variable indicating the presence or absence of periodontitis, a noteworthy p-value of 0.004265 was obtained. Results: This underscores a significant distinction in MAAS scores between patients affected by periodontitis and those unaffected by the condition. Additionally, Pearson correlations were computed for GBI and perceived stress, PCR and perceived stress, PCR and MAAS. The resulting p-values of 2.2-16, 3.925-8, and 2.468-8, respectively, indicate a statistically significant correlation in each instance. Conclusions: These findings contribute valuable insights into the interconnectedness of these variables, emphasizing the significance of their associations in the study context. Despite the limitations, the findings of this study suggest a significant relationship between psychological stress, mindfulness, and periodontal tissue health. Clinical trials are necessary to incorporate the assessment of a patient's psychological status as a new valuable tool in the management of periodontal health.

Utilizing ChatGPT-4 for Providing Information on Periodontal Disease to Patients: A DISCERN Quality Analysis

BACKGROUND

Due to their ability to mimic human responses, anthropomorphic entities such as ChatGPT have a higher likelihood of gaining people's trust. This study aimed to evaluate the quality of information generated by ChatGPT-4, as an artificial intelligence (AI) chatbot, on periodontal disease (PD) using the DISCERN instrument.

METHODS

Using Google Bard, the topics related to PD that had the highest search volume according to Google Trends were identified. An interactive dialogue was created by placing the topics in the standard question pattern. As a patient with PD, detailed information was requested from ChatGPT-4 regarding the relevant topics. The 'regenerate response' feature was not employed, and the initial response generated by ChatGPT-4 was carefully considered for each topic as new prompts in the form of questions were entered. The response to each question was independently assessed and rated by two experienced raters using the DISCERN instrument.

RESULTS

Based on the total DISCERN scores, the qualities of the responses generated by ChatGPT-4 were 'good', except for the two responses that rater-2 scored as 'fair'. It was also observed that the 'treatment choices' section of both raters had significantly fewer scores than the other sections. In both weighted kappa and Krippendorff alpha measures, the strength of agreement varied from 'substantial' to 'almost-perfect', and the correlation between values was statistically significant.

CONCLUSION

Despite some limitations in providing complete treatment choice information according to the DISCERN instrument, it is considered valuable for PD patients seeking information, as it consistently offered accurate guidance in the majority of responses.

Associated risks with periodontal x-rays or CBCT scans: Are there any?

Periodontal and implant radiography, mainly including intra-oral peri-apical and cone beam computed tomography images, are crucial in the diagnosis and treatment planning process. However, radiation safety concerns have been a chronic concern over the years, leading to uncomfortable situations. It is therefore crucial to understand the actual radiation exposure to determine if the patients' fear of necessary diagnostic exams is justified. In this perspective article, we aimed to provide concise information on dental imaging exposure, risks, and benefits, comparing them to that of absorbed radiation from daily life activities; and secondarily, to help periodontists choose the best option for each case and become more confident in addressing patients' concerns and providing a summary of safety guidelines as a reference for them.

Automatic Segmentation of Periodontal Tissue Ultrasound Images with Artificial Intelligence: A Novel Method for Improving Dataset Quality

This research aimed to evaluate Mask R-CNN and U-Net convolutional neural network models for pixel-level classification in order to perform the automatic segmentation of bi-dimensional images of US dental arches, identifying anatomical elements required for periodontal diagnosis. A secondary aim was to evaluate the efficiency of a correction method of the ground truth masks segmented by an operator, for improving the quality of the datasets used for training the neural network models, by 3D ultrasound reconstructions of the examined periodontal tissue.

METHODS

Ultrasound periodontal investigations were performed for 52 teeth of 11 patients using a 3D ultrasound scanner prototype. The original ultrasound images were segmented by a low experienced operator using region growing-based segmentation algorithms. Three-dimensional ultrasound reconstructions were used for the quality check and correction of the segmentation. Mask R-CNN and U-NET were trained and used for prediction of periodontal tissue's elements identification.

RESULTS

The average Intersection over Union ranged between 10% for the periodontal pocket and 75.6% for gingiva. Even though the original dataset contained 3417 images from 11 patients, and the corrected dataset only 2135 images from 5 patients, the prediction's accuracy is significantly better for the models trained with the corrected dataset.

CONCLUSIONS

The proposed quality check and correction method by evaluating in the 3D space the operator's ground truth segmentation had a positive impact on the quality of the datasets demonstrated through higher IoU after retraining the models using the corrected dataset.

The Radiographic Assessment of Furcation Area in Maxillary and Mandibular First Molars while Considering the New Classification of Periodontal Disease

This study aimed to evaluate the radiographic reliability in the diagnosis of furcation involvement in first molars. A total of 52 subjects were included in the current study. Personal history regarding smoking was recorded and a periodontal examination was performed. Pocket depth (PD), clinical attachment level (CAL), gingival recession, and furcation involvement in all first molars were assessed for each patient. Periodontal staging and grading were evaluated using the new classification of periodontal disease. Class II and Class III furcation classification were more frequently observed in radiographs than the Class I furcation; however, no significant differences were observed. Radiographic observation of the furcation was seen more when PD and CAL were >5 mm in all molars. The presence of gingival recession and its relation to the radiographic assessment did not reveal any statistically significant association (p > 0.05) except for tooth #16. The trend of visibility of furcation radiographically was more as the grade of staging was increased. Moreover, the presence of smoking habits and visibility of furcation radiographically did not have any statistical significance. Smoking may not be a factor in the furcation involvement. There is a direct relationship between the staging and grading of the periodontitis and furcation involvement.

Impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography with small and medium fields of view

OBJECTIVE

The purpose of this study was to evaluate the impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography (CBCT) with small and medium fields of view (FOVs).

STUDY DESIGN

Six CBCT protocols were investigated by exposing an adult anthropomorphic male phantom head without and with thyroid shielding, using 4 small (4 × 5 cm) and 2 medium (10 × 6 cm) FOVs. Twenty metal oxide semiconductor field-effect transistor dosimeters were placed in the phantom head to measure absorbed doses and calculate equivalent doses at 11 sites. Effective doses were calculated based on the tissue weighting factors in International Commission on Radiological Protection Publication 103. The data were analyzed using the independent samples t test.

RESULTS

Thyroid gland shielding led to significant equivalent dose reductions in many tissues for all protocols. Equivalent dose reductions to the thyroid were significant in all 6 protocols (P ≤ .037). Significant reduction depended on the FOV and ranged between 24.5% and 42.6% for the thyroid gland and 4.9% and 34.5% for other tissues and organs. Effective doses were significantly lower in all protocols (P ≤ .016).

CONCLUSIONS

Thyroid gland shielding protects the thyroid gland and other organs and should be utilized with all CBCT examinations where feasible.

Comparison of dental radiography and computed tomography: measurement of dentoalveolar structures in healthy, small-sized dogs and cats

BACKGROUND

Dental diseases are common in dogs and cats, and accurate measurements of dentoalveolar structure are important for planning of treatment. The information that the comparison computed tomography (CT) with dental radiography (DTR) is not yet reported in veterinary medicine.

OBJECTIVES

The purpose of this study was to compare the DTR with CT of dentoalveolar structures in healthy dogs and cats, and to evaluate the CT images of 2 different slice thicknesses (0.5 and 1.0 mm).

METHODS

We included 6 dogs (2 Maltese and 1 Spitz, Beagle, Pomeranian, mixed, 1 to 8 years, 4 castrated males, and 2 spayed female) and 6 cats (6 domestic short hair,8 months to 3 years, 4 castrated male and 2 spayed female) in this study. We measured the pulp cavity to tooth width ratio (P/T ratio) and periodontal space of maxillary and mandibular canine teeth, maxillary fourth premolar, mandibular first molar, maxillary third premolar and mandibular fourth premolar.

RESULTS

P/T ratio and periodontal space in the overall dentition of both dogs and cats were smaller in DTR compared to CT. In addition, CT images at 1.0 mm slice thickness was generally measured to be greater than the images at 0.5 mm slice thickness.

CONCLUSIONS

The results indicate that CT with thin slice thickness provides more accurate information on the dentoalveolar structures. Additional DTR, therefore, may not be required for evaluating dental structure in small-sized dogs and cats.

Contemporary imaging for the diagnosis and treatment of traumatic dental injuries: A review

Traumatic dental injuries (TDI) have an array of presentations. Diagnostic challenges are common and clinicians' ability to correctly identify specific injuries dictates the optimal course of treatment(s). The aim of this review was to outline and assess all dental imaging techniques and their applications to traumatic dental injuries. A particular interest is given to the advancement of 3D imaging techniques and their role in diagnosis and treatment planning. The benefits of achieving a more accurate diagnosis are paramount to perfecting clinical judgments and outcomes.

Dose optimization for assessment of periodontal structures in cone beam CT examinations

OBJECTIVES

To investigate the relationship between dose and image quality for a dedicated dental CBCT scanner using different scanning protocols and to set up an optimal imaging protocol for assessment of periodontal structures.

METHODS

Radiation dose and image quality measurements were made using 3D Accuitomo 170 (J. Morita, Kyoto, Japan) dental CBCT scanner. The SedentexCT IQ phantom was used to investigate the relationship between contrast-to-noise ratio (CNR) and dose-area product. Subjective image quality assessment was achieved using a small adult skull phantom for the same range of exposure settings. Five independent observers assessed the images for three anatomical landmarks using a three-point visual grade analysis.

RESULTS

When correlating the CNR of each scanning protocol to the exposure parameters used to obtain it, CNR decreased as these parameters decreased, especially current-exposure time product. When correlating to subjective image quality, the CNR level remained acceptable when 5 mA and 17.5 s or greater was selected and 80 kV could be used without compromising the CNR.

CONCLUSIONS

For a dedicated CBCT unit, changing the rotation angle from 360° to 180° degrades image quality. By altering tube potential and current for the 360° rotation protocol, assessment of periodontal structures can be performed with a smaller dose without substantially affecting visualization.

Conditions and calibration to obtain comparable grey values between different clinical cone beam computed tomography scanners

OBJECTIVES

The objective of the present study was to examine the grey value parameters and their magnitudes produced by CBCT and whether they are influenced by different scanners with various scanning conditions.

METHODS

An ATOM Max dental and diagnostic artificial head was scanned by two CBCT scanners (Planmeca and iCAT). Under full field of view with normal dose and ultralow-dose (ULD) conditions, the Planmeca scanner was examined for three scanning resolutions (200, 400, and 600 micron voxel sizes) and the iCAT scanner was tested for four scanning resolutions (200, 250, 300 and 400 micron voxel sizes). After 9 weeks, the artificial head was scanned again by the Planmeca scanner with the same scanning conditions. In addition, two hydroxyapatite phantoms (1220 and 1540 mg cm^-3) were adhered on the artificial head and scanned using normal and ULD scanning conditions of 400 micron voxel size with both scanners. The grey value histogram of each region, which is proportional to the bone mineral density (BMD) histogram, was utilized to determine grey value distribution parameters and compare scanners (ANOVA, p < 0.05).

RESULTS

The different scanning conditions and the bilateral locations of the artificial head did not have significant effects on measurements of the grey value parameters (p > 0.436) with excellent repeatability. However, the iCAT scanner produced significantly different grey values from the Planmeca scanner (p < 0.001).

CONCLUSIONS

CBCT can assess BMD, while calibration of absolute measures is necessary to obtain comparable values between different scanners that are currently used to assess oral bone quantity and quality.

Comparing Intraoral Radiography and Computed Tomography for Detecting Radiographic Signs of Periodontitis and Endodontic Disease in Dogs: An Agreement Study

OBJECTIVE

To determine whether computed tomography (CT) and intraoral radiography are interchangeable for detecting signs of periodontitis and endodontic disease in dogs.

MATERIALS AND METHODS

An agreement study was performed using 40 dogs that previously underwent intraoral radiography and CT during the same anesthetic episode. Images of each tooth were examined by two blinded observers for signs of periodontitis and/or endodontic disease. Agreement between imaging modalities and between observers was assessed using the Kappa statistic.

RESULTS

Agreement between modalities for detecting periodontitis in the maxillae ranged from poor to very good (κ 0.07-1.00) with 16/20 (80%) of the teeth having a score of moderate or better (κ ≥ 0.41). Agreement between modalities for detecting signs consistent with periodontitis in the mandibles ranged from poor to very good (κ 0.01-1.00) with 10/22 (45%) of the teeth having a score of good or better (κ ≥ 0.61); 50% of the disagreement was present in the incisors. Agreement between modalities for detecting signs consistent with endodontic disease in the whole mouth ranged from fair to very good (κ 0.21-1.00) with 30/42 (71%) of the teeth having a score of moderate or better (κ ≥ 0.41). Agreement between observers evaluating intraoral radiology ranged from poor to very good (κ 0.05-1) for detecting signs consistent with periodontitis and from fair to very good (κ 0.36-1) for detecting signs consistent with endodontic disease, in the whole mouth. Agreement between observers evaluating CT ranged from fair to very good (κ 0.35-1) for detecting signs consistent with periodontitis and from fair to very good (κ 0.36-1) for detecting signs consistent with endodontic disease, in the whole mouth.

CONCLUSION

Performing both CT and intraoral radiography may be unnecessary to detect signs consistent with periodontitis and endodontic disease in dogs based on the amount of agreement between modalities and observers when CT images are acquired and reconstructed in 0.5 or 1 mm slice thickness, except for diagnosing periodontitis in the mandibular incisors.