Detection of periodontal bone loss patterns and furcation defects from panoramic radiographs using deep learning algorithm: a retrospective study.

BACKGROUND: This retrospective study aimed to develop a deep learning algorithm for the interpretation of panoramic radiographs and to examine the performance of this algorithm in the detection of periodontal bone losses and bone loss patterns. METHODS: A total of 1121 panoramic radiographs were used in this study. Bone losses in the maxilla and mandibula (total alveolar bone loss) (n = 2251), interdental bone losses (n = 25303), and furcation defects (n = 2815) were labeled using the segmentation method. In addition, interdental bone losses were divided into horizontal (n = 21839) and vertical (n = 3464) bone losses according to the defect patterns. A Convolutional Neural Network (CNN)-based artificial intelligence (AI) system was developed using U-Net architecture. The performance of the deep learning algorithm was statistically evaluated by the confusion matrix and ROC curve analysis. RESULTS: The system showed the highest diagnostic performance in the detection of total alveolar bone losses (AUC = 0.951) and the lowest in the detection of vertical bone losses (AUC = 0.733). The sensitivity, precision, F1 score, accuracy, and AUC values were found as 1, 0.995, 0.997, 0.994, 0.951 for total alveolar bone loss; found as 0.947, 0.939, 0.943, 0.892, 0.910 for horizontal bone losses; found as 0.558, 0.846, 0.673, 0.506, 0.733 for vertical bone losses and found as 0.892, 0.933, 0.912, 0.837, 0.868 for furcation defects (respectively). CONCLUSIONS: AI systems offer promising results in determining periodontal bone loss patterns and furcation defects from dental radiographs. This suggests that CNN algorithms can also be used to provide more detailed information such as automatic determination of periodontal disease severity and treatment planning in various dental radiographs.

Evaluation of antibacterial efficacy of Lawsonia inermis Linn (henna) on periodontal pathogens using agar well diffusion and broth microdilution methods: An in-vitro study.

Background: Although widely explored in medicine, limited evidence exists in the literature regarding the efficacy of Lawsonia inermis Linn (henna) in the dental field. Aim: This study aimed to investigate the antibacterial effect of henna on Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis in vitro. Methods: The agar well diffusion and broth microdilution methods were used to evaluate the antibacterial effect of henna extracts. Dimethyl sulfoxide was used to prepare the ethanol extract of henna, and distilled water was used to prepare the water extract. For both ethanol and water extracts, 4 different concentrations were prepared as 15, 30, 60, and 120 mg/mL. Results: It was determined that the water and ethanol extracts of the henna samples did not show an inhibition zone on P.gingivalis and A.actinomycetemcomitans. As a result of the evaluations made with the broth microdilution method, it was found that the ethanol extract had a higher inhibitory effect on both bacteria, and both extracts had more inhibitory effects against A.actinomycetemcomitans. Conclusion: To understand the effect of henna on periodontal pathogens, more comprehensive in vitro studies should be performed on henna samples at different concentrations and with different bases.

Detection of tooth numbering, frenulum attachment, gingival overgrowth, and gingival inflammation signs on dental photographs using convolutional neural network algorithms: a retrospective study.

OBJECTIVES: This study aimed to develop an artificial intelligence (AI) model that can determine automatic tooth numbering, frenulum attachments, gingival overgrowth areas, and gingival inflammation signs on intraoral photographs and to evaluate the performance of this model. METHOD AND MATERIALS: A total of 654 intraoral photographs were used in the study (n = 654). All photographs were reviewed by three periodontists, and all teeth, frenulum attachment, gingival overgrowth areas, and gingival inflammation signs on photographs were labeled using the segmentation method in a web-based labeling software. In addition, tooth numbering was carried out according to the FDI system. An AI model was developed with the help of YOLOv5x architecture with labels of 16,795 teeth, 2,493 frenulum attachments, 1,211 gingival overgrowth areas, and 2,956 gingival inflammation signs. The confusion matrix system and ROC (receiver operator characteristic) analysis were used to statistically evaluate the success of the developed model. RESULTS: The sensitivity, precision, F1 score, and AUC (area under the curve) for tooth numbering were 0.990, 0.784, 0.875, and 0.989; for frenulum attachment these were 0.894, 0.775, 0.830, and 0.827; for gingival overgrowth area these were 0.757, 0.675, 0.714, and 0.774; and for gingival inflammation sign 0.737, 0.823, 0.777, and 0.802, respectively. CONCLUSION: The results of the present study show that AI systems can be successfully used to interpret intraoral photographs. These systems have the potential to accelerate the digital transformation in the clinical and academic functioning of dentistry with the automatic determination of anatomical structures and dental conditions from intraoral photographs.

Assessing the Effectiveness of Artificial Intelligence Models for Detecting Alveolar Bone Loss in Periodontal Disease: A Panoramic Radiograph Study.

The assessment of alveolar bone loss, a crucial element of the periodontium, plays a vital role in the diagnosis of periodontitis and the prognosis of the disease. In dentistry, artificial intelligence (AI) applications have demonstrated practical and efficient diagnostic capabilities, leveraging machine learning and cognitive problem-solving functions that mimic human abilities. This study aims to evaluate the effectiveness of AI models in identifying alveolar bone loss as present or absent across different regions. To achieve this goal, alveolar bone loss models were generated using the PyTorch-based YOLO-v5 model implemented via CranioCatch software, detecting periodontal bone loss areas and labeling them using the segmentation method on 685 panoramic radiographs. Besides general evaluation, models were grouped according to subregions (incisors, canines, premolars, and molars) to provide a targeted evaluation. Our findings reveal that the lowest sensitivity and F1 score values were associated with total alveolar bone loss, while the highest values were observed in the maxillary incisor region. It shows that artificial intelligence has a high potential in analytical studies evaluating periodontal bone loss situations. Considering the limited amount of data, it is predicted that this success will increase with the provision of machine learning by using a more comprehensive data set in further studies.

Comparison of the effectiveness of Ankaferd Blood Stopper® and Emdogain in periodontal regeneration.

OBJECTIVES: The present study was performed to compare the effectiveness of Ankaferd Blood Stopper® (ABS) with enamel matrix derivatives (EMD) for treating fenestration defects in rats. MATERIALS AND METHODS: Forty-eight male Wistar rats were randomly divided into six groups (each n = 8). Fenestration defects were created in all rats, to which ABS, EMD, or saline (S) was then applied. The rats were grouped and sacrificed at one of two different time points, as follows: ABS-10-group, ABS-treatment/sacrifice on day 10; EMD-10-group, EMD-treatment/sacrifice on day 10; S-10-group, S-treatment/sacrifice on day 10; ABS-38-group, ABS-treatment/sacrifice on day 38; EMD-38-group, EMD-treatment/sacrifice on day 38; and S-38-group, S-treatment/sacrifice on day 38. Then, histomorphometric analysis including measurements of new bone area (NBA) and new bone ratio (NBR), and immunohistochemical analysis including the determination of osteopontin (OPN) and type-III-collagen (C-III) expression were performed. RESULTS: The NBA and NBR were significantly higher in the ABS-10-group and EMD-10-group compared to the S-10-group (p < .05), and in the EMD-38-group compared to the S-38-group (p < .05). The levels of C-III and OPN immunoreactivity were significantly higher in the ABS-10-group compared to the S-10-group (p < .017). CONCLUSIONS: The results of this study suggested that ABS can promote early periodontal regeneration, although its efficacy seems to decrease over time.

Is sexual dysfunction associated with periodontal status in perimenopausal women?: A pilot study.

OBJECTIVE: The current study aimed to investigate the possible relationship between periodontal status and sexual dysfunction in perimenopausal women. MATERIALS AND METHODS: This study was conducted on 106 participants. After the evaluation of the sexual functioning of participants with the Female Sexual Function Index (FSFI), their periodontal status and decayed-missing-filled teeth (DMFT) were assessed using appropriate indexes and obtained results were recorded for comparisons. Participants were divided into two groups by the periodontal status. Patients with periodontitis were grouped by the stage and the extent of the disease. Besides, participants were grouped according to the bleeding on probing (BOP) ratios for more detailed analyses. RESULTS: A negative significant correlation was observed between total FSFI scores and each of the clinical periodontal parameters. Total FSFI scores and the scores of arousal, lubrication, orgasm, satisfaction, and pain domains were significantly lower in periodontitis patients (p < .05). When the patients were grouped as having localized or generalized periodontitis or whether they had stage-I, -II, and -III periodontitis, no statistically significant differences were observed in the distribution of general sexual dysfunction parameters across the groups (p > .05). CONCLUSION: Periodontal status in perimenopausal women may be associated with sexual dysfunction.

Clinical and biochemical evaluation of oral irrigation in patients with peri-implant mucositis: a randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to compare the efficacy of an oral irrigator and an interdental brush in patients with peri-implant mucositis clinically and biochemically at different time points (at baseline and at the 2nd, 4th, and 12th weeks). MATERIALS AND METHODS: Forty-five patients with at least one implant with peri-implant mucositis were included in the present study (n = 45). The patients were divided into three groups: oral irrigator + toothbrush (OI group, n = 15), interdental brush + toothbrush (IB group, n = 15), and toothbrush only (control) (C group, n = 15). The modified plaque index (mPlI), modified sulcus bleeding index (mSBI), probing pocket depth (PPD), probing attachment level (PAL), and bleeding on probing (BOP) were recorded at baseline and at the 2nd, 4th, and 12th weeks. The levels of interleukin 1 beta (IL-1ß), transforming growth factor-beta (TGF-ß), tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) were also determined in the peri-implant crevicular fluid samples biochemically. RESULTS: The mSBI and t-PA at the 2nd week (p = 0.003; p = 0.003); the mPlI, mSBI, BOP, t-PA, and PAI-1 at the 4th week (p < 0.05; p < 0.001; p < 0.001; p = 0.015; p = 0.011); and the mPlI, mSBI, IL-1ß, t-PA, and PAI-1 at the 12th week (p < 0.05; p < 0.001; p = 0.013; p < 0.001; p = 0.002) were significantly lower in the OI group compared with those in the C group. Meanwhile, PAI-1 at the 2nd week, mSBI at the 4th week, and t-PA at the 12th week were significantly lower in the OI group compared with those in the IB group (p < 0.001; p = 0.011; p = 0.003). At the 2nd, 4th, and 12th weeks, all other parameters were not statistically different in the three groups. CONCLUSION: The clinical indexes (such as mSBI and BOP) that play an important role in the diagnosis of peri-implant mucositis showed the lowest means (although limited) in the OI group at all evaluation time points. Moreover, when the clinical and biochemistry results were interpreted altogether, it became apparent that the OI group exhibited similar or more effective results than the IB group in resolving peri-implant mucositis. In light of the foregoing, this study concluded that the use of an oral irrigator can be as effective as an interdental brush in interdental cleaning. CLINICAL RELEVANCE: In this study, it is suggested that the regular use of an oral irrigator along with a toothbrush could be an appropriate alternative to other oral hygiene products such as dental floss and interdental brush for the management of peri-implant mucositis by preventing the accumulation of dental plaque (NCT03844035).

Influences of periodontitis on hippocampal inflammation, oxidative stress, and apoptosis in rats.

BACKGROUND AND AIM: The hippocampus, which has a central role in cognitive and behavioral activities, is one of the most sensitive parts of the brain to systemic inflammatory diseases. This animal study aims to comprehensively investigate the possible inflammatory, oxidative, and apoptotic effects of periodontitis on the hippocampus. METHODS: Sixteen male Sprague-Dawley rats were randomly assigned to two groups: control and experimental periodontitis (Ep). In the Ep group, periodontitis was induced by placing 3.0 sutures sub-paramarginally around the necks of right and left mandibular first molars and maintaining the ligatures in place for 5 weeks. Following the euthanasia, mandibula and hippocampus samples were collected bilaterally. Alveolar bone loss was measured histomorphometrically and radiologically on the right and left mandibles. On the right hippocampal sections histological (Caspase-3, TNF-α, and 8-OHdG) and the left hippocampal sections, biochemical (IL-1ß, Aß1-42 , MDA, GSH, and TAS levels) evaluations were performed. RESULTS: Histopathological changes associated with periodontitis were limited (p > .05). A slight increase in caspase-3 positive neuron density in EP rats showed that apoptotic changes were also limited (p > .05). 8-OHdG activity, on the other hand, was significantly higher compared to controls (p < .05). In biochemical analysis, there was a significant increase in IL-1ß levels and oxidative membrane damage (MDA) (p < .05) whereas Aß1-42 and antioxidant marker (GSH and TAS) levels were slightly increased (p > .05). CONCLUSION: Periodontitis causes marked increases in IL-1ß levels and oxidative stress in the hippocampus, but limited degenerative and apoptotic changes.

Periodontitis exacerbates the renal degenerative effects of obesity in rats.

BACKGROUND/OBJECTIVES: Obesity and periodontitis are systemic subclinical inflammatory diseases with established negative renal effects. The aim of this animal study was to thoroughly investigate the possible effects of these two diseases on renal structure and function. METHODS: Thirty-two male Sprague Dawley rats were divided into four groups: control (C), obesity (Ob), experimental periodontitis (Ep), and Ob + Ep. The first 16 weeks of the experiment were aimed for the induction of obesity and the last 5 weeks for the induction of periodontitis. Throughout the experimental period, the C and Ep groups were fed standard rat chow, while the Ob groups (Ob and Ob + Ep) were fed high-fat rat chow. Right after the establishment of obesity, periodontal tissue destruction was achieved by placing 3.0 silk sutures in sub-paramarginal position around the cervices of mandibular right-left first molar teeth and preserving them for 5 weeks. On the last day of the 22nd week, following blood collection, all rats were euthanized, and kidneys and mandibles were collected. Alveolar bone loss was measured on microcomputed tomographic slices. Histopathological evaluations (light microscopy, semi-quantitative analysis of renal corpuscle area, and immunohistochemical analysis of caspase-3 activity) were done on right kidneys and biochemical evaluations (malonyl-aldehyde [MDA], glutathione [GSH], total oxidant status [TOS], total antioxidant status [TAS], oxidative stress [OSI], tumor necrosis factor-α [TNF-α], interleukin-1ß [IL-1ß], matrix metalloproteinase [MMP]-8, MMP-9, and cathepsin D [CtD] levels) were done on left kidneys. Renal functional status was evaluated with levels of serum creatinine, urea, and cystatin C. RESULTS: Periodontal bone loss was significantly higher in the Ep and Ob + Ep groups, compared with the C and Ob groups (p < .05). All parameters except TAS and GSH were highest in the Ob + Ep group, and the differences were statistically significant compared with the control group (p < .05). Although the mean TAS and GSH levels were lower in the Ob + Ep group than the other groups, the differences were not statistically significant (p > .05). While the atypical glomeruli score was significantly higher in the Ob + Ep group than in all other groups (p < .05), the acute tubular necrosis and histopathological scores were significantly different only compared with the control group (p < .05). CONCLUSION: This experimental study showed that the negative effects of the co-existence of periodontitis and obesity on inflammatory stress and apoptotic changes in the kidneys together with the functional parameters were significantly more severe, compared with the presence of one of these diseases alone. TNF-α could have a central role in the periodontitis and obesity-related structural and functional renal changes.

A Comparison of the Autogenous Bone Collection Capacity of Two Bur Drill Systems Used in Implant Surgery with Different Bur Diameters and Lengths at Different Drilling Speeds: An In Vitro Study.

PURPOSE: The aim of this study was to compare the bone collection capacity of bur drill systems used in implant surgery with different diameters, lengths, and drilling speeds. MATERIALS AND METHODS: This study was performed on bovine ribs. Two bur drill systems were studied: Implantium (Dentium) and Straumann (Institut Straumann). The groups were divided into subgroups according to the bur diameter. As a result, there were four Implantium subgroups (3.3, 3.8, 4.3, and 4.8 mm) and three Straumann subgroups (3.3, 4.1, and 4.8 mm). In addition, for each bur diameter, the bone collection capacities of the drill systems were evaluated at three different drilling speeds (150, 250, and 400 rpm) and two bur lengths (10 and 12 mm). The diameter, length, and speed changes were performed, and the results were compared between the two drill systems. RESULTS: The mean bone weight collected by using the Straumann burs was higher than that of the Implantium burs at each drilling speed and bur length. Using the Straumann system, the different drilling speeds/lengths of the burs had no impact on the bone collection capacity, irrespective of the bur diameter (P > .05). However, the drilling speeds/lengths of the Implantium system resulted in a statistically significant difference in the same diameters (P < .05). CONCLUSION: Both bur systems were suitable for autogenous graft collection for bone grafting in implant surgery, but the Straumann burs were more successful than the Implantium burs.

A deep learning approach for dental implant planning in cone-beam computed tomography images.

BACKGROUND: The aim of this study was to evaluate the success of the artificial intelligence (AI) system in implant planning using three-dimensional cone-beam computed tomography (CBCT) images. METHODS: Seventy-five CBCT images were included in this study. In these images, bone height and thickness in 508 regions where implants were required were measured by a human observer with manual assessment method using InvivoDental 6.0 (Anatomage Inc. San Jose, CA, USA). Also, canals/sinuses/fossae associated with alveolar bones and missing tooth regions were detected. Following, all evaluations were repeated using the deep convolutional neural network (Diagnocat, Inc., San Francisco, USA) The jaws were separated as mandible/maxilla and each jaw was grouped as anterior/premolar/molar teeth region. The data obtained from manual assessment and AI methods were compared using Bland-Altman analysis and Wilcoxon signed rank test. RESULTS: In the bone height measurements, there were no statistically significant differences between AI and manual measurements in the premolar region of mandible and the premolar and molar regions of the maxilla (p > 0.05). In the bone thickness measurements, there were statistically significant differences between AI and manual measurements in all regions of maxilla and mandible (p < 0.001). Also, the percentage of right detection was 72.2% for canals, 66.4% for sinuses/fossae and 95.3% for missing tooth regions. CONCLUSIONS: Development of AI systems and their using in future for implant planning will both facilitate the work of physicians and will be a support mechanism in implantology practice to physicians.

Melatonin improves periodontitis-induced kidney damage by decreasing inflammatory stress and apoptosis in rats.

BACKGROUND: Two main aims of this animal study were to inspect the possible effects of periodontitis on the structure and functions of the kidneys and the therapeutic effectiveness of melatonin. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into three groups: control, experimental periodontitis (Ep), and Ep-melatonin (Ep-Mel). Periodontitis was induced by placing 3.0-silk sutures sub-paramarginally around the cervix of right-left mandibular first molars and maintaining the sutures for 5 weeks. Then melatonin (10 mg/kg body weight/day, 14 days), and the vehicle was administered intraperitonally. Mandibular and kidney tissue samples were obtained following the euthanasia. Periodontal bone loss was measured via histological and microcomputed tomographic slices. On right kidney histopathological and immunohistochemical, and on the left kidney biochemical (malonyl-aldehyde [MDA], glutathione, oxidative stress [OSI], tumor necrosis factor [TNF]-α, interleukin [IL]-1ß, matrix metalloproteinase [MMP]-8, MMP-9, and cathepsin D levels) evaluations were performed. Renal functional status was analyzed by levels of serum creatinine, urea, cystatin-C, and urea creatinine. RESULTS: Melatonin significantly restricted ligature-induced periodontal bone loss (P <0 .01) and suppressed the levels of proinflammatory cytokines (TNF-α and IL-1ß), oxidative stress (MDA and OSI), and proteases (MMP-8, MMP-9, and CtD) that was significantly higher in the kidneys of the rats with periodontitis (P <0.05). In addition, periodontitis-related histological damages and apoptotic activity were also significantly lower in the Ep-Mel group (P <0.05). However, the markers of renal function of the Ep group were detected slightly impaired in comparison with the control group (P >0.05); and the therapeutic activity of melatonin was limited (P >0.05). CONCLUSION: Melatonin restricts the periodontitis-induced inflammatory stress, apoptosis, and structural but not functional impairments.

Comparison of gingival crevicular fluid and serum human beta-defensin-2 levels between periodontal health and disease.

BACKGROUND: The aim of this study was to evaluate the levels of serum and gingival crevicular fluid (GCF) human beta-defensin-2 (hBD-2), an antimicrobial peptide that takes roles in inflammatory diseases, in patients with chronic periodontitis (CP). SUBJECTS AND METHODS: A total of one hundred and one individuals, 59 controls and 42 patients with CP, participated in this study. Clinical index measurements were recorded during the periodontal examination, and radiographic evaluation was also performed. The serum and gingival crevicular fluid (GCF) samples were taken from all of the participants, and the hBD-2 levels were determined biochemically by enzyme-linked immunosorbent assay (ELISA). RESULTS: In our study, hBD-2 GCF levels in CP (stages II-IV periodontitis based on the new 2018 classification of periodontal diseases) group (2.77 ng/30 s) were higher than in the periodontally healthy (2.51 ng/30 s; p = .047) individuals. In contrast, serum hBD-2 levels in CP (2.92 ng/ml) were lower compared with those in healthy controls (7.75 ng/ml, p < .001). CONCLUSION: Interestingly, our results showed that while higher hBD-2 GCF levels are associated with CP, lower serum hBD-2 levels were detected in CP.

Melatonin ameliorates periodontitis-related inflammatory stress at cardiac left ventricular tissues in rats.

BACKGROUND: The aim of this experimental rat study was to investigate the potential inflammatory effects of periodontitis on cardiac left ventricular tissue and the therapeutic activity of melatonin on these effects. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into three groups: control, experimental periodontitis (Ep), and Ep-melatonin (Ep-Mel). Experimental periodontitis was induced by placing and maintaining 3.0 silk ligatures at a peri marginal position on the left and right mandibular first molars for 5 weeks. Afterward, following the removal of ligatures, melatonin (10 mg/body weight) to Ep-Mel group, and vehicle (saline) to Ep and control groups were administered intraperitoneally for 14 days. On the first day of the eighth week, mandibular and cardiac left ventricular tissue samples were obtained following the euthanasia of the rats in all groups. Alveolar bone loss measurements were made on histological and microcomputed tomographic slices. Cardiac tissue levels of malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), matrix metalloproteinase-9 (MMP-9), and cardiac Troponin-T (cTnT) were evaluated by appropriate biochemical methods. RESULTS: Measurements made on the histological and microcomputed tomographic slices showed that melatonin significantly limits the ligature-induced periodontal tissue destruction (P <0.01). In addition, melatonin was detected to cause a significant decrease of MDA, MMP-9, and cTnT levels which were found to be significantly higher on rats with Ep (P <0.05) while having no significant effect on antioxidant levels (GSH, SOD, and CAT) (P >0.05). CONCLUSION: Melatonin might be regarded as an important supportive therapeutic agent to reduce the early degenerative changes and possible hypertrophic remodeling at cardiac left ventricular tissues provoked by periodontitis-related bacteria and/or periodontal inflammation.

DEFB4A Promoter Polymorphism Is Associated with Chronic Periodontitis: A Case-Control Study.

Background: Human ß-defensin-2 is an antimicrobial peptide with antibiotic properties secreted by the oral cavity to protect the host against microbial attack. The inter-individual differences in defensin expression profiles due to genetic variation might be partly responsible for differences in disease susceptibility. Aims: The objective of this study was to examine whether variation in the human ß-defensin-2 gene (DEFB4A) is associated with chronic periodontitis (CP). Materials and Methods: This case-control study used Sanger sequencing to analyze two promoter polymorphisms of the DEFB4A gene with potential functional consequences using DNA samples collected from 200 unrelated individuals. Results: The DEFB4A rs1339258595 promoter polymorphism is associated with CP risk and clinical attachment level (CAL) but the rs3762040 polymorphism is not. Carriers of the T allele (rs1339258595) were approximately three times less likely to develop periodontitis compared with noncarriers (p = 0.0004, odds ratio = 0.35). Consistent with a protective role, the carriers of T allele had a lower CAL compared with the wild-type (G) allele. Moreover, the wild-type diplotype (GGGG) had a significantly higher risk of tooth loss compared with other diplotypes (p = 0.016). Conclusion: This study demonstrates that genetic variation in the promoter region of DEFB4A likely affects resistance to periodontal infection and might be a potential marker for CP risk and severity.