A Comprehensive Review of Artificial Intelligence Based Algorithms Regarding Temporomandibular Joint Related Diseases

Biomarkers in orofacial pain conditions: A narrative review

Orofacial pain conditions, including temporomandibular disorder, migraine, dental pain, and trigeminal neuralgia, are complex, multifactorial disorders with significant impacts on patients' quality of life. As understanding of the pathophysiology of these conditions has deepened, the role of molecular and genetic biomarkers in diagnosing, monitoring, and potentially treating orofacial pain has garnered increasing interest. This scoping review provides a comprehensive overview of the current state of research on biomarkers associated with orofacial pain conditions. By analyzing existing literature, we identify key biomarkers linked to inflammation, neural activity, and tissue degradation that are common across multiple conditions, as well as those specific to particular disorders. Our findings underscore the potential of these biomarkers to guide the development of personalized therapeutic strategies. However, the review also highlights the challenges faced by current biomarker research, including heterogeneity in study designs, small sample sizes, and a lack of longitudinal data. Addressing these challenges is critical for translating biomarker research into clinical practice and improving outcomes for patients with orofacial pain.

Temporomandibular joint arthritis in rheumatic diseases patients: which are the effective rehabilitative approaches for pain relief? A systematic review

BACKGROUND

Temporomandibular disorders (TMD) are a set of musculoskeletal conditions involving the temporomandibular joint, masticatory muscles, and/or associated structures, characterized by symptoms as pain, joint stiffness with limited mouth opening, and joint sounds as crepitus. Rheumatic diseases (RD) are a heterogeneous group of conditions affecting the musculoskeletal system, including temporomandibular joint (TMJ). To date, there is a lack of systematic reviews that properly investigated the efficacy of conservative approaches in reducing pain in rheumatic patients affected by TMJ arthritis. Therefore, this systematic review aimed to evaluate the effectiveness of rehabilitative approaches in pain relief in rheumatic patients with TMJ arthritis.

METHODS

PubMed, Scopus, and Web of Science were searched from inception until February 25th, 2024, to identify studies including patients with diagnosis of rheumatic disease affecting the temporomandibular joint who underwent specific rehabilitative approaches to reduce pain intensity. The risk of bias of studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

RESULTS

Out of 479 search results, 115 duplicates were removed, and 364 studies were considered as eligible for inclusion and screened for title and abstract. Out of these, we included 19 papers for full-text screening. Then, 5 papers were included in the synthesis by this systematic review. Four studies assessed patients affected by rheumatoid arthritis, one systemic sclerodermia, and one included patients affected by ankylosing spondylitis, psoriatic arthritis, Sjogren's syndrome, fibromyalgia, common variable immunodeficiency, and chronic polyarthritis. In the included studies, the interventions consisted of intraarticular TMJ injection of corticosteroids performed with or without anesthetics, or irrigation in three studies, dextrose subcutaneous TMJ perineural injection, and lower-level laser therapy (LLLT).

CONCLUSIONS

This systematic review showed that rehabilitative approaches (e.g., intra-articular injections and LLLT) might be effective in terms of pain relief in TMD RD-related. However, the heterogeneity of the rehabilitative approaches performed, and the low quality of the included studies do not allow to draw certain conclusions regarding the efficacy of these approaches. Further high-quality studies are mandatory to improve the robustness of the efficacy of the different rehabilitative techniques for pain relief in TMD patients affected by rheumatic diseases.

Artificial Intelligence in Temporomandibular Joint Disorders: An Umbrella Review

OBJECTIVES

Given the complexity of temporomandibular joint disorders (TMDs) and their overlapping symptoms with other conditions, an accurate diagnosis necessitates a thorough examination, which can be time-consuming and resource-intensive. Consequently, innovative diagnostic tools are required to increase TMD diagnosis efficiency and precision. Therefore, the purpose of this umbrella review was to examine the existing evidence about the usefulness of artificial intelligence (AI) in TMD diagnosis.

MATERIAL AND METHODS

A comprehensive search of the literature was performed from inception to November 30, 2024, in PubMed-MEDLINE, Embase, and Scopus databases. This review evaluated systematic reviews (SRs) and meta-analyses (MAs) that reported TMD patients/datasets, any AI model as intervention, no treatment, placebo as comparator and accuracy, sensitivity, specificity, or predictive value of AI models as outcome. The extracted data were complemented with narrative synthesis.

RESULTS

Out of 1497 search results, this umbrella review included five studies. One of the five articles was an SR while the other four were SRMAs. Three studies focused on patients with temporomandibular joint (TMJ) problems as a group, whereas two were specific to temporomandibular joint osteoarthritis (TMJOA). The included studies reported the use of imaging datasets as samples, including cone-beam computed tomography (CBCT), magnetic resonance imaging (MRI), and panoramic radiography. The studies reported an accuracy level ranging from 0.59 to 1. Four studies reported sensitivity levels ranging from 0.76 to 0.80. Four studies reported specificity values ranging from 0.63 to 0.95 for TMJ conditions. However, only one study provided the area under the curve (AUC) in the diagnosis of TMDs.

CONCLUSIONS

AI has the ability to provide faster, more accurate, sensitive, and objective diagnosis of TMJ condition. However, the performance is determined on the AI models and datasets used. Therefore, before implementing AI models in clinical practice, it is essential for researchers to extensively refine and evaluate the AI application.

Automatic Vertical Root Fracture Detection on Intraoral Periapical Radiographs With Artificial Intelligence-Based Image Enhancement

BACKGROUND/AIM

To explore transfer learning (TL) techniques for enhancing vertical root fracture (VRF) diagnosis accuracy and to assess the impact of artificial intelligence (AI) on image enhancement for VRF detection on both extracted teeth images and intraoral images taken from patients.

MATERIALS AND METHODS

A dataset of 378 intraoral periapical radiographs comprising 195 teeth with fractures and 183 teeth without fractures serving as controls was included. DenseNet, ConvNext, Inception121, and MobileNetV2 were employed with model fusion. Prior to evaluation, Particle Swarm Optimization (PSO) and Deep Learning (DL) image enhancement were applied. Performance assessment included accuracy rate, precision, recall, F1-score, AUC, and kappa values. Intra- and inter-observer agreement, according to the Gold Standard (GS), were assessed using ICC and t-tests. Statistical significance was set at p < 0.05.

RESULTS

The DenseNet + Inception fusion model achieved the highest accuracy rate of 0.80, with commendable recall, F1-score, and AUC values, supported by precision (0.81) and kappa (0.60) values. Molar tooth examination yielded an accuracy rate, precision, recall, and F1-score of 0.80, with an AUC of 0.84 and kappa of 0.60. For premolar teeth, the fusion network showed an accuracy rate of 0.78, an AUC of 0.78, and notable metrics, including F1-score (0.80), recall (0.85), precision (0.71), and kappa (0.55). ICC results demonstrated acceptable agreement (≥ 0.57 for molars, ≥ 0.52 for premolars).

CONCLUSION

TL methods have demonstrated significant potential in enhancing diagnostic accuracy for VRFs in radiographic imaging. TL is emerging as a valuable tool in the development of robust, automated diagnostic systems for VRF identification, ultimately supporting clinicians in delivering more accurate diagnoses.

Automated tooth segmentation in magnetic resonance scans using deep learning - A pilot study

OBJECTIVES

The main objective was to develop and evaluate an artificial intelligence model for tooth segmentation in magnetic resonance (MR) scans.

METHODS

MR scans of 20 patients performed with a commercial 64-channel head coil with a T1-weighted 3D-SPACE (Sampling Perfection with Application Optimized Contrasts using different flip angle Evolution) sequence were included. Sixteen datasets were used for model training and 4 for accuracy evaluation. Two clinicians segmented and annotated the teeth in each dataset. A segmentation model was trained using the nnU-Net framework. The manual reference tooth segmentation and the inferred tooth segmentation were superimposed and compared by computing precision, sensitivity, and Dice-Sørensen coefficient. Surface meshes were extracted from the segmentations, and the distances between points on each mesh and their closest counterparts on the other mesh were computed, of which the mean (average symmetric surface distance) and 95th percentile (Hausdorff distance 95%, HD95) were reported.

RESULTS

The model achieved an overall precision of 0.867, a sensitivity of 0.926, a Dice-Sørensen coefficient of 0.895, and a 95% Hausdorff distance of 0.91 mm. The model predictions were less accurate for datasets containing dental restorations due to image artefacts.

CONCLUSIONS

The current study developed an automated method for tooth segmentation in MR scans with moderate to high effectiveness for scans with respectively without artefacts.

Temporomandibular joint assessment in MRI images using artificial intelligence tools: where are we now? A systematic review

OBJECTIVES

To summarize the current evidence on the performance of artificial intelligence (AI) algorithms for the temporomandibular joint (TMJ) disc assessment and TMJ internal derangement diagnosis in magnetic resonance imaging (MRI) images.

METHODS

Studies were gathered by searching 5 electronic databases and partial grey literature up to May 27, 2024. Studies in humans using AI algorithms to detect or diagnose internal derangements in MRI images were included. The methodological quality of the studies was evaluated using the Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2) and a proposed checklist for dental AI studies.

RESULTS

Thirteen studies were included in this systematic review. Most of the studies assessed disc position. One study assessed disc perforation. A high heterogeneity related to the patient selection domain was found between the studies. The studies used a variety of AI approaches and performance metrics with CNN-based models being the most used. A high performance of AI models compared to humans was reported with accuracy ranging from 70% to 99%.

CONCLUSIONS

The integration of AI, particularly deep learning, in TMJ MRI, shows promising results as a diagnostic-assistance tool to segment TMJ structures and classify disc position. Further studies exploring more diverse and multicentre data will improve the validity and generalizability of the models before being implemented in clinical practice.

Automatic classification of temporomandibular joint disorders by magnetic resonance imaging and convolutional neural networks

Background/purpose

In this study, we utilized magnetic resonance imaging data of the temporomandibular joint, collected from the Division of Oral and Maxillofacial Surgery at Taipei Veterans General Hospital. Our research focuses on the classification and severity analysis of temporomandibular joint disease using convolutional neural networks.

Materials and methods

In gray-scale image series, the most critical features often lie within the articular disc cartilage, situated at the junction of the temporal bone and the condyles. To identify this region efficiently, we harnessed the power of You Only Look Once deep learning technology. This technology allowed us to pinpoint and crop the articular disc cartilage area. Subsequently, we processed the image by converting it into the HSV format, eliminating surrounding noise, and storing essential image information in the V value. To simplify age and left-right ear information, we employed linear discriminant analysis and condensed this data into the S and H values.

Results

We developed the convolutional neural network with six categories to identify severe stages in patients with temporomandibular joint (TMJ) disease. Our model achieved an impressive prediction accuracy of 84.73%.

Conclusion

This technology has the potential to significantly reduce the time required for clinical imaging diagnosis, ultimately improving the quality of patient care. Furthermore, it can aid clinical specialists by automating the identification of TMJ disorders.

Artificial Intelligence in Dentistry: A Descriptive Review

Artificial intelligence (AI) is an area of computer science that focuses on designing machines or systems that can perform operations that would typically need human intelligence. AI is a rapidly developing technology that has grabbed the interest of researchers from all across the globe in the healthcare industry. Advancements in machine learning and data analysis have revolutionized oral health diagnosis, treatment, and management, making it a transformative force in healthcare, particularly in dentistry. Particularly in dentistry, AI is becoming increasingly prevalent as it contributes to the diagnosis of oro-facial diseases, offers treatment modalities, and manages practice in the dental operatory. All dental disciplines, including oral medicine, operative dentistry, pediatric dentistry, periodontology, orthodontics, oral and maxillofacial surgery, prosthodontics, and forensic odontology, have adopted AI. The majority of AI applications in dentistry are for diagnoses based on radiographic or optical images, while other tasks are less applicable due to constraints such as data availability, uniformity, and computational power. Evidence-based dentistry is considered the gold standard for decision making by dental professionals, while AI machine learning models learn from human expertise. Dentistry AI and technology systems can provide numerous benefits, such as improved diagnosis accuracy and increased administrative task efficiency. Dental practices are already implementing various AI applications, such as imaging and diagnosis, treatment planning, robotics and automation, augmented and virtual reality, data analysis and predictive analytics, and administrative support. The dentistry field has extensively used artificial intelligence to assist less-skilled practitioners in reaching a more precise diagnosis. These AI models effectively recognize and classify patients with various oro-facial problems into different risk categories, both individually and on a group basis. The objective of this descriptive review is to review the most recent developments of AI in the field of dentistry.

Automating Dental Condition Detection on Panoramic Radiographs: Challenges, Pitfalls, and Opportunities

Background/Objectives: The integration of AI into dentistry holds promise for improving diagnostic workflows, particularly in the detection of dental pathologies and pre-radiotherapy screening for head and neck cancer patients. This study aimed to develop and validate an AI model for detecting various dental conditions, with a focus on identifying teeth at risk prior to radiotherapy. Methods: A YOLOv8 model was trained on a dataset of 1628 annotated panoramic radiographs and externally validated on 180 radiographs from multiple centers. The model was designed to detect a variety of dental conditions, including periapical lesions, impacted teeth, root fragments, prosthetic restorations, and orthodontic devices. Results: The model showed strong performance in detecting implants, endodontic treatments, and surgical devices, with precision and recall values exceeding 0.8 for several conditions. However, performance declined during external validation, highlighting the need for improvements in generalizability. Conclusions: YOLOv8 demonstrated robust detection capabilities for several dental conditions, especially in training data. However, further refinement is needed to enhance generalizability in external datasets and improve performance for conditions like periapical lesions and bone loss.

An investigation of machine learning algorithms for prediction of temporomandibular disorders by using clinical parameters

This study aimed to predict temporomandibular disorder (TMD) using machine learning (ML) approaches based on measurement parameters that are practically acquired in clinical settings. 125 patients with TMD and 103 individuals without TMD were included in the study. Pain intensity (with visual analog scale), maximum mouth opening (MMO) and lateral excursion movements (with millimeter ruler), cervical range of motion (with goniometer), pressure pain threshold (PPT; with algometer), oral parafunctional behaviors (with Oral Behaviors Checklist), psychological status (with Hospital Anxiety and Depression Scale), and quality of life (with Oral Health Impact Profile) were evaluated. The measurements were analyzed via over 20 ML algorithms, taking into account an extensive parameter tuning and cross-validation process. Results of variable importance were also provided. Bagging algorithm using Multivariate Adaptive Regression Spline (MARS) algorithm (accuracy = 0.8966, area under receiver operating characteristic curve = 0.9387, F1-score = 0.9032) was the best performing model regarding the performance criteria. According to this model, the 5 most important variables for predicting TMD were pain intensity, MMO, lateral excursion and PPT values of masseter and temporalis anterior muscles, respectively. The Bagging algorithm using the MARS algorithm is a robust model that, in combination with clinical parameters, assists in the detection of patients with TMD in settings with limited capabilities. The clinical parameters and ML algorithm proposed in this study may assist clinicians inexperienced in TMD to make a preliminary detection of TMD in clinics where diagnostic imaging tools are limited.

An Examination of Temporomandibular Joint Disc Displacement through Magnetic Resonance Imaging by Integrating Artificial Intelligence: Preliminary Findings

Background and Objectives: This research was aimed at constructing a complete automated temporomandibular joint disc position identification system that could assist with magnetic resonance imaging disc displacement diagnosis on oblique sagittal and oblique coronal images. Materials and Methods: The study included fifty subjects with magnetic resonance imaging scans of the temporomandibular joint. Oblique sagittal and coronal sections of the magnetic resonance imaging scans were analyzed. Investigations were performed on the right and left coronal images with a closed mouth, as well as right and left sagittal images with closed and open mouths. Three hundred sagittal and coronal images were employed to train the artificial intelligence algorithm. Results: The accuracy ratio of the completely computerized articular disc identification method was 81%. Conclusions: An automated and accurate evaluation of temporomandibular joint disc position was developed by using both oblique sagittal and oblique coronal magnetic resonance imaging images.

Artificial intelligence in dentistry: A bibliometric analysis from 2000 to 2023

Background/purpose

Artificial intelligence (AI) is reshaping clinical practice in dentistry. This study aims to provide a comprehensive overview of global trends and research hotspots on the application of AI to dentistry.

Materials and methods

Studies on AI in dentistry published between 2000 and 2023 were retrieved from the Web of Science Core Collection. Bibliometric parameters were extracted and bibliometric analysis was conducted using VOSviewer, Pajek, and CiteSpace software.

Results

A total of 651 publications were identified, 88.7 % of which were published after 2019. Publications originating from the United States and China accounted for 34.5 % of the total. The Charité Medical University of Berlin was the institution with the highest number of publications, and Schwendicke and Krois were the most active authors in the field. The Journal of Dentistry had the highest citation count. The focus of AI in dentistry primarily centered on the analysis of imaging data and the dental diseases most frequently associated with AI were periodontitis, bone fractures, and dental caries. The dental AI applications most frequently discussed since 2019 included neural networks, medical devices, clinical decision support systems, head and neck cancer, support vector machine, geometric deep learning, and precision medicine.

Conclusion

Research on AI in dentistry is experiencing explosive growth. The prevailing research emphasis and anticipated future development involve the establishment of medical devices and clinical decision support systems based on innovative AI algorithms to advance precision dentistry. This study provides dentists with valuable insights into this field.

AI in Orthodontics: Revolutionizing Diagnostics and Treatment Planning-A Comprehensive Review

The advent of artificial intelligence (AI) in medicine has transformed various medical specialties, including orthodontics. AI has shown promising results in enhancing the accuracy of diagnoses, treatment planning, and predicting treatment outcomes. Its usage in orthodontic practices worldwide has increased with the availability of various AI applications and tools. This review explores the principles of AI, its applications in orthodontics, and its implementation in clinical practice. A comprehensive literature review was conducted, focusing on AI applications in dental diagnostics, cephalometric evaluation, skeletal age determination, temporomandibular joint (TMJ) evaluation, decision making, and patient telemonitoring. Due to study heterogeneity, no meta-analysis was possible. AI has demonstrated high efficacy in all these areas, but variations in performance and the need for manual supervision suggest caution in clinical settings. The complexity and unpredictability of AI algorithms call for cautious implementation and regular manual validation. Continuous AI learning, proper governance, and addressing privacy and ethical concerns are crucial for successful integration into orthodontic practice.