Detection and diagnosis of dental caries using a deep learning-based convolutional neural network algorithm.

Objectives: The distal root of the mandibular first molar occasionally has an extra root, which can directly affect the outcome of endodontic therapy. In this study, we examined the diagnostic perf...

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A deep-learning artificial intelligence system for assessment of root morphology of the mandibular first molar on panoramic radiography

The putative cardiovascular protective effects of hormone replacement therapy (HRT) are being increasingly questioned. Because the risk of both cardiovascular disease and osteoporosis increases markedly at the time of menopause, foods rich in phytoestrogens have been proposed for inhibiting bone loss and conferring cardiovascular protection by improving the lipid profile. This study examined the effects of flaxseed, a rich source of the phytoestrogens termed lignins, on lipid metabolism and bone turnover in postmenopausal women less than 65 years of age who were not receiving HRT. Using a parallel double-blind design, 58 such women were randomly assigned to 40 g daily of either ground whole flaxseed or a wheat-based control regimen for 3 months. All of the women received supplemental calcium (1000 mg) and vitamin D (400 IU) on a daily basis. A 1-week food frequency questionnaire was completed by interviewing at the outset and when the study ended. Twenty women receiving flaxseed and 16 control subjects completed the study. Body weight and body mass index tended to be higher after 3 months on the wheat-based regimen. Dietary intake was comparable in the two groups. Women given flaxseed had a significant 6% decrease in serum total and non-high density lipoprotein cholesterol levels. Serum low-density lipoprotein cholesterol decreased by 4.7% and triglycerides by 12.8%, but these changes were not statistically significant. High-density lipoprotein cholesterol levels were somewhat lowered by flaxseed consumption, and levels of apolipoprotein Al and B were significantly lowered. There were no significant changes in markers of bone turnover, and neither flaxseed nor the wheat-based regimen produced estrogenic effects. These findings indicate that postmenopausal women who consume flaxseed can anticipate reductions in total and non-high-density lipoprotein cholesterol as well as apolipoprotein B, all accepted risk factors for coronary heart disease. Sex hormone levels were not altered by this dietary measure, and it had no apparent effect on bone metabolism.

Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women

Background
Proximal dental lesions, limited to dentine, are traditionally treated by invasive (drill and fill) means. Non-invasive alternatives (e.g. fluoride varnish, flossing) might avoid substance loss but their effectiveness depends on patients' adherence. Recently, micro-invasive approaches for treating proximal caries lesions have been tried. These interventions install a barrier either on top (sealing) or within (infiltrating) the lesion. Different methods and materials are currently available for micro-invasive treatments, such as sealing via resin sealants, (polyurethane) patches/tapes, glass ionomer cements (GIC) or resin infiltration.

Objectives
To evaluate the effects of micro-invasive treatments for managing proximal caries lesions in primary and permanent dentition in children and adults.

Search methods
We searched the following databases to 31 December 2014: the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID, LILACs via BIREME Virtual Health Library, Web of Science Conference Proceedings, ZETOC Conference Proceedings, Proquest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and the World Health Organization (WHO) International Clinical Trials Registry Platform. We searched the metaRegister of Controlled Trials to 1 October 2014. There were no language or date restrictions in the searches of the electronic databases.

Selection criteria
We included randomised controlled trials of at least six months' duration that compared micro-invasive treatments for managing non-cavitated proximal dental decay in primary teeth, permanent teeth or both, versus non-invasive measures, invasive means, no intervention or placebo. We also included studies that compared different types of micro-invasive treatments.

Data collection and analysis
Two review authors independently screened search results, extracted data and assessed the risk of bias. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. We conducted meta-analyses with the random-effects model, using the Becker-Balagtas method to calculate the odds ratio (OR) for lesion progression. We assessed the quality of the evidence using GRADE methods.

Main results
We included eight trials, which randomised 365 participants. The trials all used a split-mouth design, some with more than one pair of lesions treated within the same participant. Studies took place in university or dental public health clinics in Brazil, Colombia, Denmark, Germany, Thailand, Greenland and Chile. Six studies evaluated the effects of micro-invasive treatments in the permanent dentition and two studies on the primary dentition, with caries risk ranging from low to high. Investigators measured caries risk in different studies either by caries experience alone or by using the Cariogram programme, which combines eight contributing factors, including caries experience, diet, saliva and other factors related to caries. The follow-up period in the trials ranged from one to three years. All studies used lesion progression as the primary outcome, evaluating it by different methods of reading radiographs. Four studies received industry support to carry out the research, with one of them being carried out by inventors of the intervention.

We judged seven studies to be at high overall risk of bias, primarily due to lack of blinding of participants and personnel. We evaluated intervention effects for all micro-invasive therapies and analysed subgroups according to the different treatment methods reported in the included studies.

Our meta-analysis, which pooled the most sensitive set of data (in terms of measurement method) from studies presenting data in a format suitable for meta-analysis, showed that micro-invasive treatment significantly reduced the odds of lesion progression compared with non-invasive treatment (e.g fluoride varnish) or oral hygiene advice (e.g to floss) (OR 0.24, 95% CI 0.14 to 0.41; 602 lesions; seven studies; I2 = 32%). There was no evidence of subgroup differences (P = 0.36).

The four studies that measured adverse events reported no adverse events after micro-invasive treatment. Most studies did not report on any further outcomes.

We assessed the quality of evidence for micro-invasive treatments as moderate. It remains unclear which micro-invasive treatment is more advantageous, or if certain clinical conditions or patient characteristics are better suited for micro-invasive treatments than others.

Authors' conclusions
The available evidence shows that micro-invasive treatment of proximal caries lesions arrests non-cavitated enamel and initial dentinal lesions (limited to outer third of dentine, based on radiograph) and is significantly more effective than non-invasive professional treatment (e.g. fluoride varnish) or advice (e.g. to floss). We can be moderately confident that further research is unlikely to substantially change the estimate of effect. Due to the small number of studies, it does remain unclear which micro-invasive technique offers the greatest benefit, or whether the effects of micro-invasive treatment confer greater or lesser benefit according to different clinical or patient considerations.

Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth.

Tooth impaction is a pathological situation where a tooth fails to attain its normal functional position. Impacted third molars are commonly encountered in routine dental practice. The impaction rate is higher for third molars when compared with other teeth. The mandibular third molar impaction is said to be due to the inadequate space between the distal of the second mandibular molar and the anterior border of the ascending ramus of the mandible. Impacted teeth may remain asymptomatic or may be associated with various pathologies such as caries, pericoronitis, cysts, tumors, and also root resorption of the adjacent tooth. Even though various classifications exist in the literature, none of those address the combined clinical and radiologic assessment of the impacted third molar. Literature search using the advanced features of various databases such as PubMed, Scopus, Embase, Google Scholar, Directory of Open Access Journals and Cochrane electronic databases was carried out. Keywords like impaction, mandibular third molar, impacted mandibular third molar, complications, anatomy, inferior alveolar nerve injury, lingual nerve injury were used to search the databases. A total of 826 articles were screened, and 50 articles were included in the review which was obtained from 1980 to February 2015. In the present paper, the authors have proposed a classification based on clinical and radiological assessment of the impacted mandibular third molar.

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Impacted mandibular third molars: Review of literature and a proposal of a combined clinical and radiological classification

Background Radiography plays an important role in the detection of interproximal caries. Objectives The aim of the present study was to determine diagnostic accuracy of chargecoupled devices (CCD), Photo Stimulable Phosphor (PSP) and film radiography in detecting non-cavitated caries. Patients and methods Seventy-two non-cavitated approximal surfaces of extracted human posterior teeth were radiographed under standardized conditions using three intraoral modalities: CCD Dixi3 (Planmeca, Finland), PSP Digora PCT (Soredex, Finland),and E-speed film (Kodak, USA). Radiographs were interpreted by four observers and caries lesions were classified as sound (R0), restricted to enamel (R1), reaching the dentinoenamel junction (DEJ) and the outer half of the dentin (R2) and the inner half of the dentin (R3). The teeth were subsequently sectioned for histological analysis which served as the gold standard for radiographic examination. Results Microscopic examinations showed that the distribution of caries were 63.9% sound, 18.1% enamel, 9.7% DEJ and outer half of the dentin and 8.3% into the inner half of the dentin. The sensitivity and specificity of film, CCD and PSP for the detection of enamel caries were 38% and 98%; 15% and 96 %; and 23% and 98%, respectively. The sensitivity and specificity of film, CCD and PSP for the detection of both dentin and enamel caries were 55% and 100%; 45% and 100% ; and 55% and 100%, respectively. Conclusions The results demonstrated that the diagnostic accuracy of digital images is similar to that of conventional film radiography in the detection of non-cavitated approximal caries.

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Diagnostic accuracy of digital and conventional radiography in the detection of non-cavitated approximal dental caries.

Introduction: The aim of this study was to evaluate the root canal morphology of mandibular first and second molars using cone-beam computed tomography (CBCT) in northern Iranian population and also to indicate the thinnest area around root canals. Methods and Materials: We evaluated CBCT images of 154 first molars and 147 second molars. By evaluating three axial, sagittal and coronal planes of each tooth we determined the number of root canals, prevalence of C-shaped Melton types, and prevalence of Vertucci configuration and inter orifice distance. Also the minimum wall thickness of root canals was determined by measuring buccal, lingual, distal and mesial wall thicknesses of each canal in levels with 2 mm intervals from apex to orifice. Results: Amongst 154 first mandibular molars, 149 (96.7%) had two roots, 3 (1.9%) had three roots and 2 (1.2%) had C-shaped root configuration. Of 147 second mandibular molars, 120 (81.6%) had two roots, 1 (0.6%) had three roots and 26 (17.6%) had C-shaped roots. There was no significant difference in the prevalence of Vertucci’s type between two genders. The most common configuration in mesial roots of first and second molars were type IV (57%-42.9%) and type II (31.5%-28%). Mesial and distal walls had the most frequency as the thinnest wall in all levels of root canals with mostly less than 1 mm thickness. In second molars the DB-DL inter orifice distance and in first molars the MB-ML distance were the minimum. MB-D in first molars had the maximum distance while ML-DL, MB-DB and ML-D had the same and maximum distance in second molars. Conclusion: Vertucci’s type IV and type I were the most prevalent configurations in mesial and distal roots of first and second mandibular molars and the thickness of thinnest area around the canals should be considered during endodontic treatments. Keywords: Cone-Beam Computed Tomography; C-Shaped Root Canals; Mandibular First Molar; Mandibular Second Molar; Root Canal Anatomy; Root Canal Morphology

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Root and Canal Morphology of Mandibular Molars in a Selected Iranian Population Using Cone-Beam Computed Tomography.

Introduction: The present study was conducted to assess the morphology of mandibular canines using cone-beam computed tomography (CBCT) in a north Iranian population. Methods and Materials: For the morphological assessment of mandibular canines, 150 CBCT images taken from patients for different reasons were used. The mandibular canines were examined in sagittal, coronal and axial dimensions. The canal pattern, number of roots/canals, the tooth length, the orientation of the roots and the position of the apical foramina were evaluated and the effect of gender on each variable was assessed. The obtained data were analyzed using the Chi-square and student’s t-tests. Results: According to the Vertucci’s criteria, the most common pattern was type I morphology (89.7%), followed by types III (5.7%), II (3.7%) and V (1%). No significant differences were observed between the male and female patients in terms of canal type ( P >0.05). Gender difference is a factor which affected the root length and the number of mandibular canine root and root canal. There were 296 single-root and four double-root canines. The double-root canines and mandibular canine with two canals were significantly more common among men than women ( P =0.00). The apical foramen was laterally positioned in 68.3% and centrally in 31.7% of the cases, and the root curvatures were mostly oriented toward the buccal region. No significant statistical difference was observed for mentioned parameters in right and left half of the jaw. Conclusion: Due the diverse morphology and the potential presence of a second mandibular canine among Iranians, dentists should perform endodontic treatments with greater care. CBCT is an accurate tool for the morphological assessment of root canals. Keywords: Canine; Cone-Beam Computed Tomography; Root Canals

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Root Canal Morphology of Mandibular Canine in an Iranian Population: A CBCT Assessment

Purpose: The aim of this study was to investigate the accuracy of cone-beam computed tomography (CBCT) in the diagnosis of vertical root fractures in a tooth with gutta-percha and prefabricated posts. Materials and Methods: This study selected 96 extracted molar and premolar teeth of the mandible. These teeth were divided into six groups as follows: Groups A, B, and C consisted of teeth with vertical root fractures, and groups D, E, and F had teeth without vertical root fractures; groups A and D had teeth with gutta-percha and prefabricated posts; groups B and E had teeth with gutta-percha but without prefabricated posts, and groups C and F had teeth without gutta-percha or prefabricated posts. Then, the CBCT scans were obtained and examined by three oral and maxillofacial radiologists in order to determine the presence of vertical root fractures. The data were analyzed using IBM SPSS 20.0 (IBM Corp., Armonk, NY, USA). Results: The kappa coefficient was 0.875±0.049. Groups A and D showed a sensitivity of 81% and a specificity of 100%; groups E and B, a sensitivity of 94% and a specificity of 100%; and groups C and F, a sensitivity of 88% and a specificity of 100%. Conclusion: The CBCT scans revealed a high accuracy in the diagnosis of vertical root fractures; the accuracy did not decrease in the presence of gutta-percha. The presence of prefabricated posts also had little effect on the accuracy of the system, which was, of course, not statistically significant. (Imaging Sci Dent 2014; 44 : 37-41)

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Assessment of vertical root fracture using cone-beam computed tomography.

Objective . The aim of this study was to evaluate the number and mor- phological characteristics of the roots and root canals in mandibular anterior teeth, using cone beam computed tomography. Methods and materials. In this cross-sectional study, 1053 anterior mandibular teeth from 200 CBCT scans were evaluated. The teeth were complete- ly developed and should have had no fillings in the root or crown. The teeth were investigated in terms of the number of roots and root canals, the location of the apical foramen, the distance of the apical foramen to the anatomical apex, root length, crown length, dilacera- tions and the type of canals according to Vertucci’s classification. Re- sults . 87.9% of teeth had one root canal and of all of the teeth, three canines (0.3%) were found that had two roots. In 80.3% (n: 848) of cases the foramen apical location was central, then the buccal (9.3%), lingual (3.9%), distal (3.8%), and mesial (2.7%). The type of root ca- nals, according to Vertucci’s classification, with respect to prevalence, included type I (88.2%), type III (8.1%), type II (3.3%), type V (0.3%), and type VI (0.1%), respectively. In terms of the characteristics inves- tigated, bilateral symmetry was observed. Dilaceration was not seen in any of the teeth. Conclusion . The root canal morphology of mandibu- lar anterior teeth has great diversity that may differ between different races, and should be considered by all dentists in order to achieve the best dental treatment.

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Ehsan Moudi

Papers

Diagnostic accuracy of digital and conventional radiography in the detection of non-cavitated approximal dental caries.

Root and Canal Morphology of Mandibular Molars in a Selected Iranian Population Using Cone-Beam Computed Tomography.

Root Canal Morphology of Mandibular Canine in an Iranian Population: A CBCT Assessment

Assessment of vertical root fracture using cone-beam computed tomography.

Morphologic assessment of mandibular anterior teeth root canal using CBCT