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This study aimed to evaluate the bone volume change at donor sites in patients who received mandibular body bone block grafts using intensity-based automatic image registration. A retrospective study was conducted with 32 patients who received mandibular bone block grafts between 2017 and 2019 at the Pusan National University Dental Hospital. Cone-beam computed tomography (CBCT) images were obtained before surgery (T0), 1 day after surgery (T1), and 4 months after surgery (T2). Scattered artefacts were removed by manual segmentation. The T0 image was used as the reference image for registration of T1 and T2 images using intensity-based registration. A total of 32 donor sites were analyzed three-dimensionally. The volume and pixel value of the bones were measured and analyzed. The mean regenerated bone volume rate on follow-up images (T2) was 34.87% ± 17.11%. However, no statistically significant differences of regenerated bone volume were noted among the four areas of the donor site (upper anterior, upper posterior, lower anterior, and lower posterior). The mean pixel value rate of the follow-up images (T2) was 78.99% ± 16.9% compared with that of T1, which was statistically significant (p < 0.05). Intensity-based registration with histogram matching showed that newly generated bone is generally qualitatively and quantitatively poorer than the original bone, thus revealing the feasibility of pixel value to evaluate bone quality in CBCT images. Considering the bone mass recovered in this study, 4 months may not be sufficient for a second harvesting, and a longer period of follow-up is required.

The purpose of this study was to investigate the accuracy of the airway volume measurement by a Regression Neural Network-based deep-learning model. A set of manually outlined airway data was set to build the algorithm for fully automatic segmentation of a deep learning process. Manual landmarks of the airway were determined by one examiner using a mid-sagittal plane of cone-beam computed tomography (CBCT) images of 315 patients. Clinical dataset-based training with data augmentation was conducted. Based on the annotated landmarks, the airway passage was measured and segmented. The accuracy of our model was confirmed by measuring the following between the examiner and the program: (1) a difference in volume of nasopharynx, oropharynx, and hypopharynx, and (2) the Euclidean distance. For the agreement analysis, 61 samples were extracted and compared. The correlation test showed a range of good to excellent reliability. A difference between volumes were analyzed using regression analysis. The slope of the two measurements was close to 1 and showed a linear regression correlation (r2 = 0.975, slope = 1.02, p < 0.001). These results indicate that fully automatic segmentation of the airway is possible by training via deep learning of artificial intelligence. Additionally, a high correlation between manual data and deep learning data was estimated.

This study sought to test the feasibility of a newly developed plane called computed modified absolute mandibular midsagittal plane (cmAMP) based on the similarity index (SI) for evaluating the stereoscopical symmetry of the mandible by comparison with other proposed midsagittal planes. This study involved 29 adult patients (15 men, 14 women; average age, 23.1 ± 6.9 years) with skeletal Class III facial asymmetry who underwent bimaxillary orthognathic surgery. Using cone-beam computed tomography images taken before and 1 year after surgery, cmAMP with the highest SI value between the two anterior segments of the hemi-mandible was set by a computer algorithm. Results show that the SI using cmAMP had the highest value (0.83 ± 0.04) before surgery compared to the other midsagittal planes, and was not significantly different from the SI (0.80 ± 0.05) using a facial midsagittal plane (MSP) after surgery. The distance (1.15 ± 0.74 mm) and angle (2.02 ± 0.82°) between MSP and cmAMP after surgery were significantly smaller than those between MSP and other midsagittal planes. In conclusion, the cmAMP plane best matches the two anterior segments of hemi-mandible symmetrically and is the closest to MSP after orthognathic surgery in skeletal Class III patients with facial asymmetry.

The plane formed by the intersection of bilateral porions (PoR and PoL) and left orbitale (OrL) is conventionally defined as the Frankfort horizontal (FH) plane. We aim to test the influence of the FH plane definition on a 3D cephalometric assessment. We selected 38 adult patients (20 males, 18 females; average age: 22.87 ± 5.17 years) without any gross asymmetry from retrospective records and traced and analyzed their cone-beam computed tomographic images. The findings were categorized into the following four groups: FH1: conventional; FH2: PoR, PoL, right orbitale (OrR); FH3: OrR, OrL, PoL; FH4: OrR, OrL, PoR. The average menton (Me) deviation from the MSP was statistically significant for the FH1 group (0.56 ± 0.27 mm; p < 0.001), compared to the FH3 (1.37 ± 1.23 mm) and FH4 (1.33 ± 1.16 mm) groups. The spatial orientation level (SOL) of the FH plane showed a marked difference (p < 0.05) between the FH2 (0.602° ± 0.503°) and FH4 (0.944° ± 0.778°) groups. The SOL of the MSP was comparatively small (p < 0.001) for FH2 (0.015° ± 0.023°) in comparison to both FH 3 (0.644° ± 0.546°) and FH 4 (0.627° ± 0.516°). Therefore, the FH plane definition can significantly influence the interpretation of cephalometric findings. Future studies should focus on standardization to improve the reliability and reproducibility of 3D cephalometry.

A central odontogenic fibroma is a rare benign tumor composed of mature fibrous connective tissue with variable amounts of odontogenic epithelium. It appears at similar rates in the maxilla and mandible. In the maxilla, it usually occurs anterior to the molars. Radiographically, central odontogenic fibroma commonly presents as a multilocular or unilocular radiolucency with a distinct border. This paper reports a case of an aggressive central odontogenic fibroma involving the right posterior maxilla of a 53-year-old man. Radiographs showed an extensive soft tissue mass involving the entire right maxilla with frank bone resorption. The patient had a history of 2 operations in the region, both more than 2 decades ago. Although it was impossible to confirm the previous diagnoses, it was presumed that this case was a recurrent lesion. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated whether the relationship between the maxillary sinus and the root of the maxillary premolar is correlated with the root position and whether there is a difference in the long axis angle of premolars and the buccal bone thickness according to the sinus-root relationship and root position. Materials and Methods: Cone-beam computed tomographic images of 587 maxillary first premolars and 580 second premolars from 303 patients were retrospectively reviewed. The maxillary sinus floor-root relationship was classified into 4 types, and the root position in the alveolar bone was evaluated as buccal, middle, or palatal. The long axis angle of the maxillary premolars in the alveolar bone and the buccal bone thickness were measured. The correlation between these parameters was analyzed. Results: The maxillary sinus floor-root relationship showed a statistically significant correlation with the root position in the alveolar bone. Most maxillary first premolars were buccally located, and more than half of the second premolars had their roots in the middle. The long axis angle of the premolars was significantly larger in buccal-positioned teeth than in middle-positioned teeth, and the buccal bone was thinner. Conclusion: When the root of the maxillary premolar was separated from the sinus floor, the premolar was often located on the buccal side. Most of the maxillary first premolars had a thinner buccal bone and larger inclination than the second premolars. It is recommended to evaluate the root position, sagittal angle and buccal bone thickness using CBCT for implant treatment planning. [ABSTRACT FROM AUTHOR]

Ameloblastic carcinoma is a rare odontogenic malignant tumor with the histologic features of both ameloblastoma and carcinoma. It occurs more frequently in the mandible than in the maxilla and it may appear de novo or develop from a preexisting ameloblastoma or odontogenic cyst. Rapidly progressing, painful swelling is the most common symptom, and radiographically, it shows significant bone resorption and cortical perforation. This report described a case of ameloblastic carcinoma in a 45-year-old man who presented with swelling in the left mandible. The lesion showed combined features of benign findings, such as an expansile cortex with a distinct border, and malignant findings, such as a large exophytic mass with frank bone resorption. Excisional biopsy was performed and a final diagnosis of ameloblastic carcinoma was made. [ABSTRACT FROM AUTHOR]

Purpose: As cone-beam computed tomography (CBCT) has become the most widely used 3-dimensional (3D) imaging modality in the dental field, storage space and costs for large-capacity data have become an important issue. Therefore, if 3D data can be stored at a clinically acceptable compression rate, the burden in terms of storage space and cost can be reduced and data can be managed more efficiently. In this study, a deep learning network for super-resolution was tested to restore compressed virtual CBCT images. Materials and Methods: Virtual CBCT image data were created with a publicly available online dataset (CQ500) of multidetector computed tomography images using CBCT reconstruction software (TIGRE). A very deep superresolution (VDSR) network was trained to restore high-resolution virtual CBCT images from the low-resolution virtual CBCT images. Results: The images reconstructed by VDSR showed better image quality than bicubic interpolation in restored images at various scale ratios. The highest scale ratio with clinically acceptable reconstruction accuracy using VDSR was 2.1. Conclusion: VDSR showed promising restoration accuracy in this study. In the future, it will be necessary to experiment with new deep learning algorithms and large-scale data for clinical application of this technology. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated correlations between findings on panoramic radiographs and cone-beam computed tomography (CBCT) to assess the relationship between the maxillary sinus floor and the roots of maxillary posterior teeth. In addition, radiographic signs indicating actual root protrusion into the maxillary sinus were evaluated on panoramic radiographs. Materials and Methods: Paired panoramic radiographs and CBCT images from 305 subjects were analyzed. This analysis classified 2,440 maxillary premolars and molars according to their relationship with the maxillary sinus floor on panoramic radiographs and CBCT images. In addition, interruption of the sinus floor was examined on panoramic radiographs. Results: Root protrusion into the maxillary sinus occurred most frequently in the mesiobuccal roots of the second molars. The classification according to panoramic radiographs and CBCT images was the same in more than 90% of cases when there was no contact between the root apex and the sinus floor. When the panoramic radiograph showed root protrusion into the sinus, the CBCT images showed the same classification in 67.5% of second molars, 48.8% of first molars, and 53.3% of second premolars. There was a statistically significant relationship between interruption of the sinus floor on panoramic radiographs and root protrusion into the sinus on CBCT images. Conclusion: The presence of root protrusion into the sinus on panoramic radiographs demonstrated a moderate ability to predict root protrusion into the maxillary sinus. Interruption of the maxillary sinus floor could be considered an indicator of actual root protrusion into the maxillary sinus. [ABSTRACT FROM AUTHOR]

Objective: To compare mandibular morphology between an asymptomatic normal group and a temporomandibular osteoarthritis group. Method and Materials: The study sample consisted of 39 patients with temporomandibular joint osteoarthritis screened by computed tomography and 44 asymptomatic normal subjects. Panoramic radiographs were taken of all subjects. Linear and angular panoramic measurements were taken of the groups' mandibular characteristics, and a t test was used to compare them. Results: The condylar head and condylar and ramal height of the osteoarthritic joints were significantly shorter than in the control group. Moreover, the gonial angles were significantly larger, and the condylar head showed a more distal inclination in the arthritic group. The unilaterally osteoarthritic patients showed significant differences between the affected and contralateral sides of the condylar head and condylar height and the condylar head angle. Conclusions: The present study shows that the condylar head and condylar height were shorter, and the condylar head was more distally inclined in osteoarthritic joints. [ABSTRACT FROM AUTHOR]

A computer-aided defect inspection system is developed based on computed tomography (CT) and the x-ray imaging detector is based on the complementary metal-oxide-semiconductor photodiode array in conjunction with a scintillator. The developed system has provided rapid visual inspection as well as evaluation of defects by comparing the extracted computer-aided design (CAD) file with the original file.

Purpose: This study evaluated the prevalence and characteristics of maxillary antroliths using cone-beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes. Materials and Methods: CBCT scans of 13,946 patients over the age of 20 were reviewed for maxillary antroliths, and prevalence according to sex, age, and the side of the jaw was calculated. The relationships of single or multiple antroliths with sex, side, and the degree of sinus inflammation were evaluated. The shape and dimension of antroliths were also assessed. The data were analyzed using descriptive statistics, the chi-square or Fisher exact tests, and Kendall's tau-b. Results: A total of 138 (0.99%) of the 13,946 patients showed an antrolith in at least 1 sinus. Only 18 patients presented a bilateral manifestation, which brought the total number of sinuses containing an antrolith to 156 (0.56%). Multiple antroliths were observed in 36 sinuses, and the total number of antroliths was 207: 110 punctate, 65 linear, and 32 amorphous. The antrolith dimensions varied from 1 mm² to 91 mm² (average, 10.2±15.5 mm²). No statistically significant differences were found according to sex, side, and age group (P>0.05). However, there was a statistically significant difference between the multiplicity of antrolith and the degree of sinus inflammation (P<0.05). Conclusion: Cone-beam computed tomography is an effective modality for the detection of incidental antroliths. Maxillary antroliths were found to be very rare and were usually asymptomatic. Dentists should have a comprehensive understanding of their diagnosis and treatment in light of possible associated dental problems. [ABSTRACT FROM AUTHOR]

Purpose: Artificial intelligence (AI), represented by deep learning, can be used for real-life problems and is applied across all sectors of society including medical and dental field. The purpose of this study is to review articles about deep learning that were applied to the field of oral and maxillofacial radiology. Materials and Methods: A systematic review was performed using Pubmed, Scopus, and IEEE explore databases to identify articles using deep learning in English literature. The variables from 25 articles included network architecture, number of training data, evaluation result, pros and cons, study object and imaging modality. Results: Convolutional Neural network (CNN) was used as a main network component. The number of published paper and training datasets tended to increase, dealing with various field of dentistry. Conclusion: Dental public datasets need to be constructed and data standardization is necessary for clinical application of deep learning in dental field. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the location and the shape of the mandibular lingula in skeletal class I and III patients using panoramic radiography and cone-beam computed tomography. Materials and Methods: The sample group included 190 skeletal class I patients and 157 class III patients. The location of the lingula in relation to the deepest point of the coronoid notch was classified into 3 types using panoramic radiographs. The shapes of the lingulae were classified into nodular, triangular, truncated, or assimilated types using cone-beam computed tomographic images. The data were analyzed using the chi-square test. Results: The tips of the lingulae were at the same level as the coronoid notch in 75.3% of skeletal class I patients and above the coronoid notch in 66.6% of class III patients. The positions of the lingulae in relation to the deepest point of the coronoid notch showed statistically significant differences between class I and class III patients. The most common shape was nodular, and the least common was the assimilated shape. Although this trend was not statistically significant, the triangular shape was more frequently observed in class III patients than in class I patients. Conclusion: The locations and the shapes of the mandibular lingulae were variable. Most of the lingulae were at the same level as the coronoid notch in skeletal class I patients and above the coronoid notch in skeletal class III patients. The nodular and assimilated-shaped lingulae were the most and the least prevalent, respectively. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the radiographic features associated with impacted premaxillary supernumerary teeth, to determine the relationship between their characteristics and their effects on permanent incisors, and to investigate the types of orthodontic treatment that patients received after the extraction of impacted supernumerary teeth. Materials and Methods: The clinical records and radiographs of 193 patients whose impacted premaxillary supernumerary teeth were removed were retrospectively reviewed, and 241 impacted supernumerary teeth were examined. Cone-beam computed tomographic images and panoramic radiographs were examined to determine the number, location, sagittal position, orientation, and morphology of the supernumerary teeth. Their effects on permanent incisors and the orthodontic treatment received by patients after the extraction of the supernumeraries were also investigated. Results: Supernumerary teeth were most frequently observed in the central incisor region, in the palatal position, in the inverted orientation, and were most commonly conical in shape. The most common complication was median diastema, followed by displacement and delayed eruption of the adjacent incisors. Ten (71.4%) of the 14 odontomas showed delayed eruption of the adjacent incisors. Displacement of the incisors was more frequently observed in association with supernumerary teeth with tuberculate or supplemental shapes. Orthodontic traction was most frequently performed after the removal of odontomas. In 32 cases (13.3%), permanent incisors erupted after the orthodontic creation of sufficient space. Conclusion: Median diastema was most common complication. The delayed eruption of incisors was common in supernumerary teeth with a vertical orientation and an odontoma shape. [ABSTRACT FROM AUTHOR]

radiography and cone-beam computed tomography (CBCT) Materials and Methods: A total of 395 maxillary third molars in 234 patients were examined using panoramic radiographs and CBCT images. We examined the eruption level of the maxillary third molars, the available retromolar space, the angulation, the relationship to the second molars, the number of roots, and the relationship between the roots and the sinus. Results: Females had a higher frequency of maxillary third molars with occlusal planes apical to the cervical line of the second molar (Level C) than males. All third molars with insufficient retromolar space were Level C. The most common angulation was vertical, followed by buccoangular. Almost all of the Level C molars were in contact with the roots of the second molar. Erupted teeth most commonly had three roots, and completely impacted teeth most commonly had one root. The superimposition of one third of the root and the sinus floor was most commonly associated with the sinus floor being located on the buccal side of the root. Conclusion: Eruption levels were differently distributed according to gender. A statistically significant association was found between the eruption level and the available retromolar space. When panoramic radiographs showed a superimposition of the roots and the sinus floor, expansion of the sinus to the buccal side of the root was generally observed in CBCT images. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to investigate the course of the mandibular canal on panoramic radiography and the visibility of this canal on both panoramic radiography and cone-beam computed tomography (CBCT). Materials and Methods: The study consisted of panoramic radiographs and CBCT images from 262 patients. The course of the mandibular canal, as seen in panoramic radiographs, was classified into four types: linear, elliptical, spoon-shaped, and turning curves. The visibility of this canal from the first to the third molar region was evaluated by visually determining whether the mandibular canal was clearly visible, probably visible, or invisible. The visibihlity of the canal on panoramic radiographs was compared with that on CBCT images. Results: Elliptical curves were most frequently observed along the course of the mandibular canal. The percentage of clearly visible mandibular canals was the highest among the spoon-shaped curves and the lowest among the linear curves. On panoramic radiographs, invisible mandibular canals were found in 22.7% of the examined sites in the first molar region, 11.8% in the second molar region, and 1.3% in the third molar region. On CBCT cross-sectional images, the mandibular canal was invisible in 8.2% of the examined sites in the first molar region, 5.7% in the second molar region, and 0.2% in the third molar region. Conclusion: The visibility of this canal was lower in the first molar region than in the third molar region. The mandibular canal presented better visibility on CBCT images than on panoramic radiographs. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the developmental stages of third molars in relation to chronological age and compared third molar development according to location and gender. Materials and Methods: A retrospective analysis of panoramic radiographs of 2490 patients aged between 6 and 24 years was conducted, and the developmental stages of the third molars were evaluated using the modified Demirjian's classification. The mean age, standard deviation, minimal and maximal age, and percentile distributions were recorded for each stage of development. A Mann-Whitney U test was performed to test the developmental differences in the third molars between the maxillary and mandibular arches and between genders. A linear regression analysis was used for assessing the correlation between the third molar development and chronological age. Results: The developmental stages of the third molars were more advanced in the maxillary arch than the mandibular arch. Males reached the developmental stages earlier than females. The average age of the initial mineralization of the third molars was 8.57 years, and the average age at apex closure was 21.96 years. The mean age of crown completion was 14.52 and 15.04 years for the maxillary and the mandibular third molars, respectively. Conclusion: The developmental stages of the third molars clearly showed a strong correlation with age. The third molars developed earlier in the upper arch than the lower arch; further, they developed earlier in males than in females. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the prevalence of missing and impacted third molars in people aged 25 years and above. Materials and Methods: The study sample of 3,799 patients was chosen randomly from patients who visited Pusan National University Dental Hospital and had panoramic radiographs taken. The data collected included presence and impaction state, angulation, and depth of impaction of third molars, and radiographically detected lesions of third molars and adjacent second molars. Results: A greater percentage of men than women retained at least one third molar. The incidence of third molars decreased with increasing age. The incidence of partially impacted third molars greatly declined after the age of 30. Vertically impacted maxillary third molars and horizontally impacted mandibular third molars were most frequent in all age groups. Among the maxillary third molars, those impacted below the cervical line of the second molar were most frequent in all age groups, and among the mandibular third molars, deeply impacted third molars were most frequent in those aged over 40. Dental caries was the most common radiographic lesion of the third molars. Mesioangularly impacted third molars showed radiographic lesions in 13 (9.5%) adjacent maxillary second molars and 117 (27.4%) mandibular second molars. Conclusion: The number of remaining third molars decreased and the percentage of Class C depth increased with age. Caries was the most frequent lesion in third molars. Partially impacted mesioangular third molars showed a high incidence of caries or periodontal bone loss of the adjacent second molar. Regular oral examination will be essential to keep asymptomatic third molars in good health. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ. Materials and Methods: A total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests. Results: Fifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05). Conclusion: BMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the relationship between the roots of the maxillary molars and the maxillary sinus using cone beam computed tomography (CBCT), and measured the distances between the roots of the maxillary molars and the sinus floor as well as the thickness of the bone between the root and the alveolar cortical plate. Materials and Methods: The study sample consisted of 83 patients with normally erupted bilateral maxillary first and second molars. A total of 332 maxillary molars were examined using CBCT images. The vertical relationship of each root with the maxillary sinus was classified into four types on CBCT cross-sectional images. The distance between the sinus floor and root and the bone thickness between the root and alveolar cortical plate were measured. Results: In the buccal roots of the maxillary molars, a root protruding into the sinus occurred most frequently. A root projecting laterally along the sinus cavity was most common in the palatal roots of the maxillary first molars. The mesiobuccal roots of the maxillary second molar were closest to the sinus. The mesiobuccal roots of the first molars were closest to the cortical plate. Conclusion: The relationship between the roots of the maxillary molars and the sinus differed between the buccal and palatal roots. A root protruding into the sinus occurred more frequent in the buccal roots of the maxillary molars. The mesiobuccal root of the maxillary second molar was closest to the maxillary sinus floor and farthest from the alveolar cortical plate. [ABSTRACT FROM AUTHOR]

A diode-pumped solid state (DPSS) laser emitting at 473 nm was used to test its influence on the degree of polymerization of composite resins. Eight composite resins were chosen and light cured with three different light-curing systems [a quartz-tungsten-halogen (QTH) lamp-based unit, a light-emitting diode (LED) unit, and a DPSS laser]. Polymerization shrinkage and color change in specimens were measured. According to the statistical analysis, each light-curing system produced a significantly different value of maximum polymerization shrinkage. In most specimens, the DPSS laser induced the least polymerization shrinkage. After being immersed in distilled water for 10 days, specimens light-cured by the DPSS laser had undergone less color change than those cured by the other units. In conclusion, the DPSS laser induced better or similar polymerization in terms of polymerization shrinkage and color change in composite resins compared with those of the QTH lamp-based and LED units. [ABSTRACT FROM AUTHOR]