Ultrasound Imaging in Dentistry: A Literature Overview

Effectiveness of ultrasound-guided peripheral mandibular nerve block: A systematic review

BACKGROUND

The inferior alveolar nerve block (IANB) is commonly used in dentistry for pain management before and after dental procedures. Traditional nerve block techniques can sometimes be associated with complications such as anesthetic failure and nerve damage. Ultrasound-guided (USG) nerve blocks have emerged as a promising alternative. This systematic review aimed to evaluate the effectiveness of USG mandibular nerve blocks in pain control in adults.

METHODS

A systematic search of English literature was conducted using the PubMed, Web of Science, Scopus, Google Scholar, and Cochrane Library databases. Articles published between 2020 and September 2024 were selected based on a set of preestablished inclusion criteria. These articles were analyzed according to the PRISMA-2020 guidelines to seek evidence of effective pain management following USG IANB.

RESULTS

Seven articles including 193 patients and 176 ultrasound scans met the eligibility criteria. The included studies reported the effectiveness of USG mandibular nerve blocks by using various pain measurement scales. In addition, other indirect measures of pain control, such as maximum mouth opening, were used.

CONCLUSION

This systematic review showed that USG IANB can effectively manage pain in adult patients undergoing specific dental surgical procedures including third molar extraction. Furthermore, it can provide relief for those suffering from chronic orofacial pain associated with conditions, such as temporomandibular disorders.

Do dental students need sonography training? A prospective observational study

INTRODUCTION

Sonography is a key diagnostic tool in oral and maxillofacial surgery and complements other imaging methods such as computer tomography or X-rays. While X-ray courses are integral to dentistry students' training, ultrasound diagnostics have not been integrated into undergraduate and postgraduate training. This study investigates whether there is a demand for undergraduate sonography training among dental students.

METHODS

An online questionnaire was developed by a team of experts (dentistry, maxillofacial surgery, otorhinolaryngology, radiology, and didactics) based on the "Checklist for Reporting Results of Internet E-Surveys (Cherries)". Multiple items addressed several topics using dichotomous ("yes"/ "no"), free text, and 7-level Likert answering formats (1 = not at all; 7 = fully and entirely). These included "personal data", "previous experience", "demand for ultrasound diagnostics in an undergraduate degree program", "desired topics of ultrasound training", "teaching methods", and "study materials". Dentistry students completed the questionnaire in the winter semester of 2023/24. The questionnaire's validity was assessed using factor analysis, reliability testing (Cronbach's Alpha, KR-20), and item discrimination.

RESULTS

129 dental students participated (74% female). Many respondents (approx. 90%) were in higher semesters (6-10 semesters) and stated that they had not yet had any contact with ultrasound diagnostics (75%) and had not performed an ultrasound examination as yet (97%). The overall demand for ultrasound training was high (5.8 ± 1.3), particularly for the mandibular joint (6.3 ± 1.1), parotid gland (6.2 ± 1.0), submandibular gland, sublingual gland (6.1 ± 1.1), and floor of the mouth and tongue (5.9 ± 1.4) topics. Concerning the teaching methods and teaching materials, "practical training on a proband" (82%), and the use of "teaching scripts" (85%), "video instructions" (74%), "digital pathological experts" (66%), "e-learning" (62%), and "blended learning" (52%) were most desired. The questionnaire demonstrated high reliability (Cronbach's Alpha 0.93-0.95), strong factor structure (84% and 64% variance explained), and effective item discrimination.

CONCLUSION

The data suggest a demand for undergraduate ultrasound training in dentistry. A practice-oriented, digitally supported training should be developed and implemented.

CLINICAL TRIAL NUMBER

Not applicable.

Machine learning for automated identification of anatomical landmarks in ultrasound periodontal imaging

OBJECTIVES

To identify landmarks in ultrasound periodontal images and automate the image-based measurements of gingival recession (iGR), gingival height (iGH), and alveolar bone level (iABL) using machine learning.

METHODS

We imaged 184 teeth from 29 human subjects. The dataset included 1580 frames for training and validating the U-Net convolutional neural network machine learning model, and 250 frames from new teeth that were not used in training for testing the generalization performance. The predicted landmarks, including the tooth, gingiva, bone, gingival margin (GM), cementoenamel junction (CEJ), and alveolar bone crest (ABC), were compared to manual annotations. We further demonstrated automated measurements of the clinical metrics iGR, iGH, and iABL.

RESULTS

Over 98% of predicted GM, CEJ, and ABC distances are within 200 µm of the manual annotation. Bland-Altman analysis revealed biases (bias of machine learning vs ground truth) of -0.1 µm, -37.6 µm, and -40.9 µm, with 95% limits of agreement of [-281.3, 281.0] µm, [-203.1, 127.9] µm, and [-297.6, 215.8] µm for iGR, iGH, and iABL, respectively, when compared to manual annotations. On the test dataset, the biases were 167.5 µm, 40.1 µm, and 78.7 µm with 95% CIs of [-1175 to 1510] µm, [-910.3 to 990.4] µm, and [-1954 to 1796] µm for iGR, iGH, and iABL, respectively.

CONCLUSIONS

The proposed machine learning model demonstrates robust prediction performance, with the potential to enhance the efficiency of clinical periodontal diagnosis by automating landmark identification and clinical metrics measurements.

Accuracy of intraoral ultrasound to evaluate alveolar bone level: an ex vivo study in human cadavers

OBJECTIVES

This study aimed to evaluate the reliability and accuracy of an intraoral ultrasound (US) device to evaluate alveolar bone by comparing it between different raters and to microCT (µCT) measurements.

METHODS

38 teeth distributed across three human cadavers were prepared by placing two notches on the facial enamel surface. The maxillary and mandibular teeth were imaged with a custom-designed intraoral 20 MHz ultrasound and µCT with 0.03 mm voxel size. µCT was considered the reference standard for this study. For each sample, the distance from the inferior border of the most apical notch to the tip of the alveolar bone crest on the facial aspect of the teeth was measured from the US and µCT images. Intraclass correlation coefficient (ICC) and standard deviation were calculated.

RESULTS

The intra-examiner and inter-examiner reliability for both the µCT and US alveolar bone measurements were found to be excellent (intra-examiner ICC was 0.998 for µCT and 0.997 for US, inter-examiner ICC was 0.996 for µCT and between 0.947 and 0.950 for US). The accuracy of the US was found to be good compared to µCT (ICC between 0.885 and 0.894).

CONCLUSION

The study demonstrated that intraoral ultrasound is highly reliable and accurate compared to the µCT reference standard for evaluating facial alveolar bone height.

Intraoral ultrasonography image registration for evaluation of partial edentulous ridge: A methodology and validation study

OBJECTIVES

Ultrasound (US) reveals details for diagnosing soft- and hard-tissue dimensions around teeth, implants, and the edentulous ridge, not seen in 2D radiographs. Co-registering free-hand US scans with other 3D modalities presents reliability challenges. This study first aims to develop and validate a registration method to longitudinally reproduce US images of the jawbone on a simulator. In addition, it also evaluates the degree of the anatomical match in humans between US images acquired by the proposed registration method and the commonly used freehand acquisitions in comparison to cone beam computed tomography (CBCT) and intra-oral optical scan (IOS), used as references.

METHODS

A previously introduced ultrasound phantom was employed as a CBCT-US hybrid, suitable for training and technique development of US guides in edentulous ridges. After establishing feasibility in the phantom, the methodology was validated in a cohort of 24 human subjects (26 cases). Soft tissues were delineated on US and IOS, and hard tissues on US and CBCT. US accuracy and repeatability from both guided and freehand scans (non-guided) was assessed as the average distance between US and the references.

RESULTS

Guided US images resembled the references more closely than freehand (non-guided) scans. Notably, delineation of soft and hard tissues was significantly more accurate when employing guides. In the phantom, guided scans exhibited an absolute mean deviation of 81.8 µm for gingiva and 90.4 µm for bone, whereas non-guided scans showed deviations of 150.4 µm and 177.2 µm, respectively. Similarly, in vivo, guided US outperformed non-guided US, with gingiva deviations of 125 µm and 196 µm, and bone deviations of 354 µm and 554 µm, respectively.

CONCLUSIONS

By using a registration method, guided US scans improved repeatability and accuracy of mapping hard and soft tissue of the edentulous ridge when compared to non-guided scans.

CLINICAL RELEVANCE

This guided US imaging method could lay the foundation for longitudinal evaluation of tissue behavior and dimensional changes with improved accuracy.

Research in methodologies for modelling the oral cavity

The paper aims to explore the current state of understanding surrounding in silico oral modelling. This involves exploring methodologies, technologies and approaches pertaining to the modelling of the whole oral cavity; both internally and externally visible structures that may be relevant or appropriate to oral actions. Such a model could be referred to as a 'complete model' which includes consideration of a full set of facial features (i.e. not only mouth) as well as synergistic stimuli such as audio and facial thermal data. 3D modelling technologies capable of accurately and efficiently capturing a complete representation of the mouth for an individual have broad applications in the study of oral actions, due to their cost-effectiveness and time efficiency. This review delves into the field of clinical phonetics to classify oral actions pertaining to both speech and non-speech movements, identifying how the various vocal organs play a role in the articulatory and masticatory process. Vitaly, it provides a summation of 12 articulatory recording methods, forming a tool to be used by researchers in identifying which method of recording is appropriate for their work. After addressing the cost and resource-intensive limitations of existing methods, a new system of modelling is proposed that leverages external to internal correlation modelling techniques to create a more efficient models of the oral cavity. The vision is that the outcomes will be applicable to a broad spectrum of oral functions related to physiology, health and wellbeing, including speech, oral processing of foods as well as dental health. The applications may span from speech correction, designing foods for the aging population, whilst in the dental field we would be able to gain information about patient's oral actions that would become part of creating a personalised dental treatment plan.

A Life-Size Three-Dimensional Phantom for Periodontal Imaging Development and Treatment-Planning

RATIONALE AND OBJECTIVES

This study aims to (1) describe a periodontal and implant ultrasound imaging phantom designed for training of common periodontal and peri-implant soft- and hard-tissue deficiencies, and (2) detail the specific anatomical phantom features and showcase imaging data obtained from intraoral scans, cone beam computed tomography (CBCT) as well as ultrasound.

MATERIALS AND METHODS

A prototype, full-sized, three-dimensional (3D), periodontal ultrasound phantom was created. To mimic periodontal and peri-implant soft-tissue, a phantom material similar to soft-tissue was attached. Several features were added to imitate clinical scenarios and enable use as a teaching tool. To understand hard-tissue anatomy, the phantom was imaged using a commercially available CBCT scanner. In addition, an optical scan was taken to generate a 3D surface model. Images obtained were analyzed using a public domain software (3D Slicer). Ultrasound brightness mode images (B-mode) were taken of the regions of interest.

RESULTS

CBCT and intraoral reference scans are overlaid with the ultrasound images obtained. Four different views are provided: facial, occlusal, lingual, and transverse. Our group was able to scan and delineate in ultrasound images vertical and horizontal bone loss, peri-implant bone loss, buccal dehiscence, apical fenestrations, and edentulous crest soft- and hard-tissue.

CONCLUSION

To our knowledge, this is the first study to present a prototype (full-sized, 3D, for periodontal ultrasound) phantom for intraoral periodontal and peri-implant ultrasound scanning training. Creating training scenarios that mimic clinical reality might allow trainees to obtain skills and build toward acceptable and individualized technical performance.

Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications

BACKGROUND

Ultrasound is a non-invasive, cross-sectional imaging technique emerging in dentistry. It is an adjunct tool for diagnosing pathologies in the oral cavity that overcomes some limitations of current methodologies, including direct clinical examination, 2D radiographs, and cone beam computerized tomography. Increasing demand for soft tissue imaging has led to continuous improvements on transducer miniaturization and spatial resolution. The aims of this study are (1) to create a comprehensive overview of the current literature of ultrasonic imaging relating to dentistry, and (2) to provide a view onto investigations with immediate, intermediate, and long-term impact in periodontology and implantology.

METHODS

A rapid literature review was performed using two broad searches conducted in the PubMed database, yielding 576 and 757 citations, respectively. A rating was established within a citation software (EndNote) using a 5-star classification. The broad search with 757 citations allowed for high sensitivity whereas the subsequent rating added specificity.

RESULTS

A critical review of the clinical applications of ultrasound in dentistry was provided with a focus on applications in periodontology and implantology. The role of ultrasound as a developing dental diagnostic tool was reviewed. Specific uses such as soft and hard tissue imaging, longitudinal monitoring, as well as anatomic and physiological evaluation were discussed.

CONCLUSIONS

Future efforts should be directed towards the transition of ultrasonography from a research tool to a clinical tool. Moreover, a dedicated effort is needed to introduce ultrasonic imaging to dental education and the dental community to ultimately improve the quality of patient care.

Comparative Evaluation of the Accuracy of Gingival Thickness Measurement by Clinical Evaluation and Intraoral Ultrasonography

This study aimed to investigate the accuracy of gingival thickness measurement by two methods of clinical evaluation and intraoral ultrasonography. The gingival thickness was measured in the midbuccal area of the right maxillary lateral incisor and first molar teeth in 30 individuals. For clinical measurement, a #15 K-file with rubber stops was vertically inserted 2 mm apical to the gingival margin and the length of the file in the tissue was measured using a digital caliper. Ultrasonographic measurement was performed using an intraoral probe on the gingival surface in the midbuccal area, at the entry point of the file. Statistical analysis was performed by paired t-test, correlation coefficient, and receiver operating characteristic (ROC) curve (α = 0.05). In the anterior region, the mean gingival thicknesses using ultrasonography (1.517 ± 0.293 mm) and clinical evaluation (1.610 ± 0.272 mm) were not significantly different (p = 0.434). In the posterior region, the mean gingival thicknesses were significantly different between ultrasonography (1.372 ± 0.442 mm) and clinical evaluation (1.626 ± 0.310 mm) (p = 0.006). The area under ROC curve values for ultrasonographic measurements in the anterior and posterior regions were 0.681 and 0.597, respectively. The use of ultrasonography with an intraoral probe has acceptable accuracy for the determination of gingival thickness, especially for the anterior regions.

Carbonic Anhydrase II Activators in Osteopetrosis Treatment: A Review

Osteopetrosis is a rare hereditary illness generated by failure in osteoclasts resulting in elevated bone densities. Patients with osteopetrosis possess several complications, like dental caries, earlier teeth loss, delayed eruption, malformed crowns and roots, and lamina dura thickening. Since deficiency of carbonic anhydrase II is a major cause behind osteopetrosis, carbonic anhydrase II activators have a large number of applications in osteopetrosis treatment. There is a lack of a comprehensive review on osteopetrosis, pathogenesis of dental abnormalities, and the role of carbonic anhydrase II activators in osteopetrosis treatment. To address this research gap, the authros perfomed a comprehensive review on osteopetrosis and its types, pathogenesis of dental abnormalities, and the role of carbonic anhydrase II activators in osteopetrosis treatment. A brief introduction to the pathogenesis of dental abnormalities and regeneration is provided in this survey. A discussion of types of osteopetrosis depending on genetic inheritance, such as autosomal dominant, autosomal recessive, and X-linked inheritance osteopetrosis, is presented in this survey. The paper also focuses on the importance of carbonic anhydrase II activators as a potential drug therapy for dental osteopetrosis. In addition, a brief note on the role of azole and fluconazole in treating osteopetrosis is given. Finally, future directions involving gene therapy for dental osteopetrosis are described.

Three Visual-Diagnostic Methods for the Detection of Enamel Cracks: An In Vitro Study

Tooth fractures are a common cause of tooth loss, frequently starting as enamel cracks. However, methods for the detection of enamel cracks are poorly investigated. The aim of the study was the validation of three clinical methods for the detection of enamel cracks: dental operating microscope (DOM), near-infrared transillumination (NIR), and fiber-optic transillumination (FOTI), with hard-tissue slices serving as controls. A total of 89 extracted teeth, set up as diagnostic models, were investigated, and the maximum crack depth was scored by two examiners. The actual crack depth was determined microscopically (25×) using horizontal sections. The accuracy of each method was analyzed using receiver operating characteristic (ROC) curves. Across all tooth surfaces, the area under the curve (AUC) amounted to 0.57 (DOM), 0.70 (FOTI), and 0.67 (NIR). For crack detection on vestibular/oral surfaces, the AUC was 0.61 (DOM), 0.78 (FOTI), and 0.74 (NIR); for proximal surfaces, it was 0.59 (DOM), 0.65 (FOTI), and 0.67 (NIR). However, the actual crack depth was underestimated with each method (p < 0.001). Under in vitro conditions, FOTI and NIR are suitable for detection of enamel cracks, especially on vestibular and oral tooth surfaces. However, an exact estimation of crack depth is not possible. Therefore, FOTI and NIR seem to be helpful for the clinical detection of enamel cracks.

Effect of amniotic membrane and platelet-rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study

The use of membrane barriers and bone grafting materials in endodontic surgery promotes healing by regeneration rather than repair by scar tissue. Due to its valuable regenerative and therapeutic properties, the human amniotic membrane can support ideal periapical rehabilitation and promote better healing after surgery. The current trial aimed to evaluate the amniotic membrane's healing potential and compare it with platelet-rich fibrin using color doppler sonography. The current study is a randomized, double-blinded, parallel-group, single-center study. Thirty-four systematically healthy individuals requiring endodontic surgery who fulfilled all inclusion and exclusion criteria were selected and randomly placed in two groups. Surgical curettage of the bony lesion was performed and filled with hydroxyapatite graft. Amniotic membrane (Group 1) and platelet-rich fibrin (Group 2) were placed over the bony crypt, and the flap was sutured back. The lesion's surface area and vascularity were the parameters assessed with ultrasound and color doppler. and observations: The groups found a significant difference in mean vascularity at 1 month and mean vascularity change from baseline to 1 month (p < 0.05). Mean surface area had no statistically significant difference between the groups. However, in terms of the percentage change in surface area, a significant difference was found from baseline to 6 months (p < 0.05). Amniotic membrane was a significantly better promoter of angiogenesis than platelet-rich fibrin in the current trial. The osteogenic potential of both materials was similar. However, the clinical application, availability, and cost-effectiveness of amniotic membrane support it as a promising therapeutic alternative in clinical translation. Further large-scale trials and histologic studies are warranted.

Location angle of second mesio-buccal canal in maxillary molars of an Indian population: an in vivo retrospective CBCT evaluation and proposal of a new classification

Background

The current investigation was designed for predicting the location angle of second mesio-buccal root canal in permanent maxillary (first and second) molars with the aid of proposed measuring points and line using cone beam computed tomography in an Indian population.

Methods

Three-hundred and twenty-four scans of permanent maxillary (first (n = 162) and second (n = 162)) molars with mesio-buccal 2 root canals and unassociated to the current evaluation were acquired. The maxillary molars were viewed with CSI imaging software. The images were captured and were further assessed using 3D Slicer. The assessment included of measuring the distance between the main mesio-buccal and mesio-buccal 2 canal and the angle at which the MB2 it is located utilizing proposed lines joining the disto-buccal and palatal canals. The data was tabulated for the incidence of various angles where the MB2 is located and MB-MB2 distance was determined. The angles denoted were either positive; I (0.1° to 1.9°), II (2° to 4°), III (>4°) or negative I (-0.1° to -1.9°), II (-2° to -4°), III (>-4°). On the data tabulated a new Banga Vhorkate and Pawar's (BVP's) angular classification for maxillary molars was proposed.

Results

The existence of positive angle III was found in 41.35% of maxillary first molars (36 right and 31 left of 162), whereas positive angle II appeared in 41.98% of maxillary second molars (32 right and 36 left of 162). The MB1-MB2 in maxillary 1^st molar is seen to be 3.12-3.31 mm and this distance in maxillary 2^nd molar is 2.8-3.1 mm. The disto-buccal to palatal canal orifice mean distance was 5.06-5.22 mm in maxillary first molars and 4.9-5.8 mm in maxillary second molars.

Conclusion

Accurate diagnosis of the location of second mesio-buccal canal increases the success rate of endodontic treatment and a better prognosis. The new proposed classification may be considerably helpful in the urge to locate the mesio-buccal 2 canal.

Evaluation of the Response to Pulpal Sensibility Tests (Cold, EPT) in Anemic and Healthy Women

Introduction

The prevalence of anemia has been reported high in the female population in Iran. Anemia can be asymptomatic or can present in a variety of symptoms, especially when serum Hb values decrease. The present study would assess dental pulp response to cold and EPT sensibility tests in anemic and healthy women.

Materials and Methods

One hundred twenty maxillary central incisors belonging to participants aged 18–58 years were included in this survey. 60 patients had anemia (Hb ≤ 12.5) with/without medication (30 in each group) and 60 women as controls had no anemia (Hb > 12.5) with/without medication (30 in each group). Electric and cold pulpal sensibility tests were performed for all teeth. Statistical analysis was performed with t-student, Chi-square test, and two-way ANOVA. The significance level was set as p < 0.05.

Results

According to the results of this study, the mean value of hemoglobin in anemic and healthy women was 11.5 and 14.08 g/dl, respectively. The mean value of response to EPT in anemic women with and without medication was 3.21 and 3.14, respectively. The mean value of response to EPT in healthy women with and without medication was 3.81 and 3.58 g/dl, respectively. The mean value of time delay response to cold test was 3.03 and 2.82 s in anemic patients with/without medication. Also, the mean value of time delay response to cold test was 2.80 and 2.93 s in healthy women with/without medication. The pulpal responses to EPT tests had significant differences between anemic and healthy women (p=0.043). There were no significant differences between anemic and healthy women considering time delay response to the cold test (p=0.077).

Conclusion

Based on the results of the present study, tooth response to the EPT  sensibility test may alter in anemic patients despite medication. The evidence from this preliminary study suggests that peripheral neuropathy in anemic patients could affect pulpal sensibility tests.

Detection Rate and Variability in Measurement of Mandibular Incisive Canal on Cone-Beam Computed Tomography: A Study of 220 Dentate Hemi-Mandibles from Italy

The mandibular incisive canal (MIC) is a small bony channel located in the interforaminal region; it represents the anterior continuation of the mandibular canal. Cone-beam computed tomography (CBCT) is the most commonly utilized radiological technique for assessing the MIC. The main purpose of this study was to evaluate the detectability and variability in measurements of the MIC on CBCT. A total of 220 dentate hemi-mandibles were retrospectively selected for this study. For each hemi-mandible, the detectability, diameter, and distance of the MIC from anatomical landmarks (cortical plates and tooth apices) were evaluated in consensus by two observers. The analysis was performed at four different levels (first premolar, canine, lateral incisor, and central incisor) and was repeated after one month. The variability of MIC measurements was expressed as the coefficient of repeatability (CR), obtained from the Bland-Altman analysis. The MIC detection rate reduced from the first premolar to the central incisor (from 82.3% to 0.5%). The CR of MIC measurements (diameter and distances from anatomical landmarks) was ≤0.74 mm. Although the MIC is difficult to detect in a non-negligible percentage of cases, the limited variability in measurements confirms that CBCT is an effective technique for the assessment of the MIC.

Dual Mode pHRI-teleHRI Control System with a Hybrid Admittance-Force Controller for Ultrasound Imaging

The COVID-19 pandemic has brought unprecedented extreme pressure on the medical system due to the physical distance policy, especially for procedures such as ultrasound (US) imaging, which are usually carried out in person. Tele-operation systems are a promising way to avoid physical human-robot interaction (pHRI). However, the system usually requires another robot on the remote doctor side to provide haptic feedback, which makes it expensive and complex. To reduce the cost and system complexity, in this paper, we present a low-cost, easy-to-use, dual-mode pHRI-teleHRI control system with a custom-designed hybrid admittance-force controller for US imaging. The proposed system requires only a tracking camera rather than a sophisticated robot on the remote side. An audio feedback is designed for replacing haptic feedback on the remote side, and its sufficiency is experimentally verified. The experimental results indicate that the designed hybrid controller can significantly improve the task performance in both modes. Furthermore, the proposed system enables the user to conduct US imaging while complying with the physical distance policy, and allows them to seamlessly switch modes from one to another in an online manner. The novel system can be easily adapted to other medical applications beyond the pandemic, such as tele-healthcare, palpation, and auscultation.

Dental Undergraduates and Interns’ Awareness, Attitudes, and Perception of Radiological Protection

Medical ionizing radiation is widely used in hospitals, in particular dental clinics, and in medical research to facilitate the diagnosis and treatment of patients. The awareness, attitude, and perception of ionizing radiation exposure among dental undergraduate students and interns in radiological investigations and dental care clinics were investigated. A cross-sectional study was conducted; 17 questions were designed online using the software “QuestionPro,” which was licensed to the University of Imam Abdulrahman Bin Faisal. Participants included senior medical dental students from Imam Abdulrahman Bin Faisal University in their third to fifth years, as well as interns from King Fahad University Hospital and private dental care clinics. A total of 855 participants viewed, 360 started the questionnaire, and 258 (72%) completed it online. Overall, knowledge was lacking; 32% of respondents incorrectly believed that magnetic resonance imaging and ultrasound used ionizing radiation, while 38% were unsure. Dental X-rays were deemed harmful by 40% (n = 104) of respondents. According to 33% (n = 85) of participants, there is no radiation scatter during an X-ray or CT scan, while 30% (n = 76) are unsure. Respondents (44%; n = 104) were unaware of the radiation dose from a chest radiograph and (45%; n = 116) overestimated the radiation dose. The effects of ionizing radiation on healthy tissue are known to more than half of the participants (54%). According to 39% of respondents, digital radiography exposes them to less radiation than traditional radiography. In terms of radiation protection and hazard, 46% said personal monitoring badges should be always worn and 58% (n = 150) said lead aprons should be used on a regular basis. 63% of the subjects had received radiation protection education, such as formal lectures, tutorials, or workshops, while 37% (n = 95) had not. 53% of the respondents were not aware of the international recommendations from the International Commission on Radiological Protection. When asked if they would follow radiation protection protocols if they opened a private dental clinical practice in the future, 50% (n = 129) said they would.

Herbal Medications in Endodontics and Its Application-A Review of Literature

Herbal products are gaining popularity in dental and medical practice nowadays due to their biocompatibility, higher antimicrobial activity, antioxidant and anti-inflammatory properties. Herbal medicine has experienced rapid growth in recent years due to its beneficial properties, ease of availability, and lack of side effects. As pathogenic bacteria become more resistant to antibiotics and chemotherapeutic agents, researchers are becoming more interested in alternative products and treatment choices for oral diseases. As a result, natural phytochemicals separated from plants and utilized in traditional medicine are suitable substitutes for synthetic chemicals. The aim of this review article is to list and understand several herbal alternatives that are currently accessible for use as efficient endodontic medicaments. The herbal products used in endodontics have several advantages, including safety, ease of use, increased storability, low cost, and a lack of microbial tolerance. However, preclinical and clinical testing and interactions with other materials and adverse effects are required for these herbal products.

Reliability of OMERACT Scoring System in Ultra-High Frequency Ultrasonography of Minor Salivary Glands: Inter-Rater Agreement Study

Minor salivary gland ultra-high frequency ultrasonography (UHFUS) has recently been introduced for the evaluation of patients with suspected primary Sjögren’s Syndrome (pSS). At present, ultrasonographic assessment of major salivary glands is performed using the Outcome Measures in Rheumatology (OMERACT) scoring system. Previous reports have explored the possibility of applying the OMERACT scoring system to minor salivary glands UHFUS, with promising results. The aim of this study was to test the inter-reader concordance in the assignment of the OMERACT score to minor salivary gland UHFUS. The study was conducted on 170 minor salivary glands UHFUS scans of patients with suspected pSS. Three independent readers performed UHFUS image evaluation. Intraclass correlation coefficient (ICC) was employed to assess inter-reader reliability. Bland and Altman analysis was employed to test the agreement with a gold standard examiner. ICC values > 0.9 were found for scores 0 and 1, while score 2 and score 3 presented ICCs of 0.873 and 0.785, respectively. The measurements performed by the three examiners were in agreement with the gold standard examiner. According to these results, UHFUS interpretation showed good inter-observer reliability, suggesting that OMERACT score can be effectively used for the evaluation of glandular alterations, even for minor salivary glands.

Consanguineous Marriages and Dental Anomalies: A Cross-Sectional Analytical Study

Objective

To determine the correlation between consanguineous marriages and dental anomalies. Study Design. A cross-sectional analytical study.

Materials and Methods

This cross-sectional analytical multicentered study was carried out at Foundation University College of Dentistry after approval of the Ethical Research Committee (ERC) from September 2021 to November 2021 in Pakistan. All pediatric patients (4–10 years old) with dental malformations undergoing dental procedures or examinations and born with spontaneous vaginal delivery and uncomplicated cesarean section participated in the study. First, second, and third-degree relatives' marriages of parents were used to define consanguinity. The Basic Pay Scale was the reference of estimation of socioeconomic status. Participants with a history of orofacial trauma, pertinent parental history (infertility, hormonal treatment, or infectious diseases during pregnancy, conception with assisted reproductive techniques, prolonged complicated labor, premature deliveries, and twin births), and prolonged hospital admission immediately after birth were excluded from the study.

Results

The mean maternal and paternal age was recorded to be 23.86 ± 5.4 and 27.07 ± 9.6, respectively, whereas the mean age of participants was 6.60 ± 1.67. There were 297 children with congenital abnormalities, with 203 (68.4%) males and 94 (31.6%) females. The prevalence of consanguineous marriage was found to be in 210 (70.7%) participants. Congenital dental anomalies correlation was found to be significant with consanguineous marriages (p value <0.001). Consanguineous marriages were more frequent in the lower socioeconomic group when compared with the middle and upper socioeconomic groups, respectively (74.7% vs. 8.1% vs. 17.2%, p value 0.007).

Conclusion

Congenital dental anomalies were significantly prevalent in consanguineous marriages with greater incidence in lower socioeconomic groups. Consanguineous marriages have the propensity to transmute population conformation, but due to religious and social beliefs, literature is hesitant to ascribe congenital dental anomalies persuasive relevance with consanguinity.

Live Intraoral Dirofilaria repens of Lower Lip Mimicking Mucocele-First Reported Case from Croatia

Dirofilariasis is an endemic infestation in tropical and subtropical countries caused by about 40 different species. It rarely occurs in the oral cavity and is mostly presented as mucosal and submucosal nodules. Differential diagnoses include lipoma, mucocele, and pleomorphic adenoma. We report a rare case of oral dirofilariasis mimicking mucocele in a 41-year-old male patient from Croatia without an epidemiological history of travelling outside the country. He came in because of non-painful lower lip swelling that had lasted for two months. The parasite was surgically removed from the lesion. This is the first reported case of oral dirofilariasis in Croatia. It is important to point out this rare diagnosis in order to make dentists aware of the possibility of the presence of such an infestation in common lesions of the oral mucosa.

Bone Augmentation for Implant Placement: Recent Advances

There are various advancements in biomaterials and methods for bone augmentation. This article aims to review the recent advances in bone augmentation for dental implants. Relevant articles on bone augmentation for dental implants were searched in PubMed/Medline, Scopus, Google Scholar, and Science Direct published in English literature published between January 1996 and March 2021. Relevant studies on bone grafts for dental implants were included and critically analyzed in this review. Various biomaterials can be used to augment bone for implant placement. Each graft procedure has advantages and disadvantages in each clinical application and needs to choose the graft material with a high success rate and less morbidity.

Shear Bond Strength and Microleakage of Pit and Fissure Sealants Placed after Saliva-Contaminated Etched Enamel

Saliva contamination of etched enamel before sealant application is the most common reason for failure of fissure sealants, thus affecting the effect of caries prevention. This study aimed to evaluate the shear bond strength (SBS) and microleakage of resin-based fissure sealant on saliva-contaminated etched enamel after rinsing, re-etching, and applying universal adhesive. Fifty human third molars were sectioned into 2 parts and embedded in acrylic resin to obtained 100 samples. The samples were randomly assigned to 5 groups: 1, etching; 2, etching + contamination; 3, etching + contamination + rinsing; 4, etching + contamination+ re-etching; 5, etching + contamination + universal adhesive. Each group was divided into 2 subgroups: 24 h storage and 5000× thermocycling. After measuring SBS, failure mode was analyzed. In an additional 15 teeth, microleakage was tested using dye penetration method. Three more teeth were used for scanning electron microscope (SEM) observation of the enamel surface morphology in each group. The adhesive group had significantly higher mean SBS after 24 h storage, while the re-etching group were better after 5000× thermocycling. The etching, etching+ contamination+ re-etching, and etching+ contamination+ universal adhesive groups showed the least microleakage. The SEM reveals considerable variations in the enamel surface appearance within groups. Re-etching or applying universal adhesive in saliva-contaminated etched enamel before sealant can achieve satisfactory results. Considering the less operative steps and the shorter chair time, applying universal adhesive is more recommended for a pediatric patient if saliva-contamination happened before sealant application.

Applications and Clinical Behavior of BioHPP in Prosthetic Dentistry: A Short Review

(1) Background: BioHPP® (Bredent, UK) is a partially crystalline poly ether ether ketone (PEEK) that is strengthened using ceramic. PEEK and its various formulations represent a very interesting alternative, and has been in-depth with its literature in recent years; (2) Methods: A PubMed and Scopus search for the term “BioHPP” yielded 73 results and 42 articles which were included in this short review. Considering the scarce literature on the subject, each article was considered in this review; (3) Results: the articles analyzed are very recent, all published in the last 5 years. Their clinical evaluation of BioHPP® highlights many positive aspects, and few articles have highlighted critical issues in its multiple clinical applications; (4) Conclusions: this material is not only extremely interesting for the future, but possesses characteristics suitable for clinical application today, for endocrowns, small adhesive bridges, temporary prostheses and for immediate loads on implant restorations. The excellent aesthetics and the possibility of simple reprocessing of the restorations made with this material invite its clinical application.

Clinical, Radiological, and Pathological Diagnosis of Fibro-Osseous Lesions of the Oral and Maxillofacial Region: A Retrospective Study

Background: Fibro-osseous lesions (FOL) of the jaw represent a rare, benign group of lesions that share similar clinical, radiological, and histopathological features and are characterized by progressive, variable replacement of healthy bone tissue by fibrous connective tissue. Methods: This retrospective study aimed to evaluate the incidence of fibro-osseous lesions and to reassess the efficacy of case-specific treatment management from a clinical, radiological, and histopathological perspective based on 14 years of data. Results: Forty-four patients with a radiological and/or histopathological diagnosis of benign FOLs were identified and re-evaluated. Cemento-osseous dysplasia was the most common group of FOLs present in our patient cohort (45%), followed by ossifying fibroma (39%) and fibrous dysplasia (16%). The diagnostic imaging technique of choice was CBCT (68%), followed by PAN (18%), with most patients (95 %) additionally undergoing biopsy. The mean age of the patients at the time of diagnosis was 40.54 ± 13.7 years, with most lesions being located in the mandible (86%), with females being predominantly affected (73%). Conclusion: An interdisciplinary approach that analyzes all case-specific factors, including demographic data, medical history, intraoperative findings, and, most importantly, histopathological and radiological features, is essential for an accurate diagnosis and key to avoiding inappropriate treatment.

Influence of Enamel Exposure to Acidic Drink on Shear Bond Strength of Different Fissure Sealants

In the present study, we evaluated the influence of bovine enamel exposure to acidic drinks (Coca-Cola, Coca-Cola Company, Milano, Italy, pH = 2.37) on shear bond strength of three sealants (Fissurit; Grandio Seal and Admira Fusion-Voco Gmbh, Cuxhaven, Germany). For each sealant, two adhesive techniques were tested to investigate the impact of the adhesive application on shear bond strength of sealants after immersion in acidic drink and in the control: Group 1-Control: enamel surface was not in contact with acid drinks, acid etching application and self-adhesive technique for fissure sealant; Group 2-enamel surface was not in contact with acid drinks, acid etching, and adhesive applications, an etch-and-rinse technique for fissure sealant; Group 3-enamel surface was immersed in acid drink, acid etching application and self-adhesive technique for fissure sealant; Group 4-enamel surface was immersed in acid drink, acid etching, and adhesive applications, an etch-and-rinse technique for fissure sealant. For each specimen, the sealant composite resin was applied to the enamel surface and tested with a universal testing machine. Shear bond strength was measured in MPa and with an optical microscope to determine failure modes, quantified with adhesive remnant index (ARI). Enamel acidification variably influenced bond strength values of the different sealants. When no enamel pretreatment was applied, no significant differences were found among the sealants (p > 0.05). However, the mere application of acid etching without adhesive procedures resulted in lower bond strength (p < 0.001). The acid pretreatment affected significantly the bond strength of all sealants tested (p < 0.001), but no significant differences were recorded between the subgroups.

Modern Approaches and Innovations on Methods and Imaging Protocols of the Maxillofacial District

In recent years, improvements in imaging techniques have profoundly changed the diagnosis of pathologies of the maxillofacial district [...].