Emergence of artificial intelligence for automating cone-beam computed tomography-derived maxillary sinus imaging tasks. A systematic review.

Cone-beam computed tomography (CBCT) imaging of the maxillary sinus is indispensable for implantologists, offering three-dimensional anatomical visualization, morphological variation detection, and abnormality identification, all critical for diagnostics and treatment planning in digital implant workflows. The following systematic review presented the current evidence pertaining to the use of artificial intelligence (AI) for CBCT-derived maxillary sinus imaging tasks. An electronic search was conducted on PubMed, Web of Science, and Cochrane up until January 2024. Based on the eligibility criteria, 14 articles were included that reported on the use of AI for the automation of CBCT-derived maxillary sinus assessment tasks. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool was used to evaluate the risk of bias and applicability concerns. The AI models used were designed to automate tasks such as segmentation, classification, and prediction. Most studies related to automated maxillary sinus segmentation demonstrated high performance. In terms of classification tasks, the highest accuracy was observed for diagnosing sinusitis (99.7%), whereas the lowest accuracy was detected for classifying abnormalities such as fungal balls and chronic rhinosinusitis (83.0%). Regarding implant treatment planning, the classification of automated surgical plans for maxillary sinus floor augmentation based on residual bone height showed high accuracy (97%). Additionally, AI demonstrated high performance in predicting gender and sinus volume. In conclusion, although AI shows promising potential in automating maxillary sinus imaging tasks which could be useful for diagnostic and planning tasks in implantology, there is a need for more diverse datasets to improve the generalizability and clinical relevance of AI models. Future studies are suggested to focus on expanding the datasets, making the AI model's source available, and adhering to standardized AI reporting guidelines.

Progress of artificial intelligence-driven solutions for automated segmentation of dental pulp cavity on cone-beam computed tomography images. A systematic review.

INTRODUCTION: Automated segmentation of three-dimensional pulp space on cone-beam computed tomography (CBCT) images presents a significant opportunity for enhancing diagnosis, treatment planning, and clinical education in endodontics. The aim of this systematic review was to investigate the performance of AI-driven automated pulp space segmentation on CBCT images. METHODS: A comprehensive electronic search was performed using PubMed, Web of Science, and Cochrane databases, up until February 2024. Two independent reviewers participated in the selection of studies, data extraction, and evaluation of the included studies. Any disagreements were resolved by a third reviewer. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the risk of bias. RESULTS: Thirteen studies that met the eligibility criteria were included. Most studies demonstrated high accuracy in their respective segmentation methods, although there was some variation across different structures (pulp chamber, root canal) and tooth types (single-rooted, multi-rooted). Automated segmentation showed slightly superior performance for segmenting the pulp chamber compared to the root canal and single-rooted teeth compared to multi-rooted ones. Furthermore, second mesiobuccal (MB2) canal segmentation also demonstrated high performance. In terms of time efficiency, the minimum time required for segmentation was 13 seconds. CONCLUSION: AI-driven models demonstrated outstanding performance in pulp space segmentation. Nevertheless, these findings warrant careful interpretation, and their generalizability is limited due to the potential risk and low evidence level arising from inadequately detailed methodologies and inconsistent assessment techniques. In addition, there is room for further improvement, specifically for root canal segmentation and testing of AI performance in artifact-induced images.

A Bibliometric Analysis of Most Cited Papers on Vesiculobullous Oral Lesions.

Aim: A well-known method for quantitatively evaluating scholarly work is bibliometric analysis. Best-cited papers raise awareness of the influential publications and patterns in the literature on a specific subject. The aim was to conduct bibliometric analysis to determine most cited articles on vesiculobullous oral lesions. This is the first study on citation analysis with respect to vesiculobullous oral lesions. Materials and Methods: A retrospective data search was explored on December 2022 using the Scopus database. The articles were evaluated, and fundamental data for bibliometric analysis was reviewed. Standard details about the author, linked organizations, publishing year, and place of origin were noted. Statistical analysis was performed using Chi-square analysis. VOSviewer software was used to determine the bibliometric network analysis for co-occurrence among coauthors and commonly used keywords. Results: A total of 344 articles published from 1971 to 2022 were included in the study. A total of 6680 citations and 19.41 citations per article were observed. The journal Archives of Dermatology received the most citation. There was a significant association between the number of citations and the journal type (open access vs. non-open access) (P < 0.05). Four to five highly related clusters with the help of VOSviewer software were found during co-occurrence network analysis. Conclusions: The top 10 articles on vesiculobullous oral lesions that received the most citations were listed in detail in the present study. This will be a valuable resource for academics, clinicians, and researchers in the fields of dermatology, general pathology, oral pathology, and oral medicine.

The effect of oral chronic graft-versus-host disease on bodyweight: A cohort study.

AIM: This retrospective cohort study aimed to evaluate the association between body weight and oral cGVHD (chronic graft versus host disease). METHODS: Patients with oral cGVHD were compared with an age and gender-matched non-GVHD cohort in terms of demographic information, body mass index (BMI), date of transplant, length of hospitalization, and oral complications. Weight was stratified in pre-and post-transplant weight, mean weight after acquiring cGVHD for the first year, and post-oral cGVHD BMI. Each patient was matched and compared with two controls at a 1:2 ratio. Firth's penalized likelihood logistic regression was used to investigate the association between oral complications and weight loss greater than 5% in the oral cGVHD group. RESULTS: This study included 137 patients (n = 42 oral cGVHD, n = 12 non oral-cGVHD and n = 83 non-GVHD). The oral cGVHD cohort had a 1.44 times higher risk (RR) of being underweight (BMI<18.5 kg/m2) compared to the non-GVHD cohort. Oral mucositis was an independent predictor of weight loss above 5% in the oral cGVHD cohort (p < 0.001). CONCLUSION: The weight loss was more prevalent among oral cGVHD, and oral mucositis was linked to significant weight loss. Weight loss may indicate the need to initiate early and aggressive symptomatic oral cGVHD treatment.

A Rare Case of Hair Dye Induced Oral Lichenoid Reaction.

Oral lichenoid lesions or reactions (OLLs/OLRs), which are clinical and histological contemporaries of the traditional oral lichen planus (OLP), had already garnered a great deal of attention in the literature. In contrast to idiopathic OLP, OLLs frequently have a definite, recognizable initiating component. Although a cursory clinical and histological evaluation of lesions frequently demonstrates numerous similarities with OLP, relatively new data has demonstrated that distinct features exist and serve as the foundation for the majority of categories. Although many systemic pharmaceuticals can lead to end oral lichenoid reactions, medications for diabetes, hypertension, nonsteroidal anti-inflammatory, antimalarial, and antifungal treatments are frequently blamed. Oral drugs, metallic dental restorations, acrylates, composite resins, glass ionomer cement, cinnamates, flavorings, and other chemical substances have all been associated when in direct contact. The objective of the case report is to elaborate the correlation between the oral lichenoid reaction and the use of hair dye. The incident under consideration is significant because the majority of past reports of allergic reactions to hair dye involved the face and scalp rather than the oral cavity. This report recommends that oral physicians inquire about the patient's use of cosmetics during history-taking whenever dealing with abrupt inflammatory responses in the orofacial area in order to diagnose and treat lesions more efficiently.

The Effect of Antiresorptive Drug Holidays on Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis.

The objective of this study is to evaluate the effectiveness of discontinuing high-dose antiresorptive (AR) therapy in reducing the risk of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with AR medications and undergoing dentoalveolar surgery or tooth extractions. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A literature search was conducted using the databases MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception till the 1st of April, 2022. Both observational and interventional studies that evaluated the effect of AR drug holiday in the development of MRONJ in patients receiving AR medications and who require dentoalveolar surgical procedures were included. Trials published as abstracts, case reports, case series, non-systematic reviews, and others were excluded. All findings were reported as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the methodological quality assessment, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to evaluate the quality of the evidence. Eight articles (6808 subjects) were included for analysis. Of the participants, 4847 cases (drug holiday group) were compared to 1961 controls (non-drug holiday group). Based on the random effects model, the pooled summary OR was 0.73 (95% CI: 0.51-1.06) for the drug holiday group compared to the non-drug holiday group. In other words, the drug holiday group was not significantly different from the non-drug holiday group in the development of MRONJ following a tooth extraction procedure (p = 0.10). The statistical heterogeneity was low across all studies (I2 = 13%, p = 0.33). Within the limits of the available evidence, our findings revealed that drug holidays with AR will not minimize the risk of MRONJ and thus cannot be advised. It may be possible to arrive at more definitive conclusions from large prospective studies and randomized trials of good quality.

The Posterior Extension of the Palatal Rugae as an Anatomical Constraint for Soft Tissue Grafts in a Saudi Arabian Population.

Background The purpose of this study was to investigate the distal extension of the palatal rugae area as an anatomical constraint on the harvesting of palatal soft tissue grafts in a Saudi Arabian population. Additionally, factors that could affect or predict the extension were considered. Methods Three hundred seventy-four (374) dental casts from Saudi nationals currently residing in Riyadh (170 males and 204 females) were included. Two independent observers used a standardized probe to measure the posterior extent of the rugae on each stone cast bilaterally on a horizontal base. A sharp graphite pencil was used to mark the measurements from the origin of the rugae to their terminal ends on the cast, and a magnification lens was used to identify them. Using this technique, the most posterior extension of the rugae was marked and then analyzed. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar, and logistic regression was used to see the association of this extension with other factors. Results The asymptotic chi-squared (p = 0.0002) McNemar tests revealed that the posterior distal extension of the rugae was not the same on both sides. A normal approximation test for the left side with 95% confidence intervals (CIs) with the "rugael extension proximal to the mesial end of the upper second premolar" category considered "success" found that the proportion of upper second premolars with rugael extensions proximal to the mesial end was not significantly different to the proportion of rugael extensions beyond the mesial end of the upper second premolars (95% CI: 48.69%-58.79%, p = 0.147). Conversely, the proportion of the upper second premolars with rugael extensions proximal to the mesial end was significantly lower than that beyond the mesial end on the right (95% CI: 35.92%-45.89%, p = 0.00004). Gender, age, and palatal shape did not significantly affect the posterior extension of palatal rugae. Conclusions The palatal rugae on the left side of a sample of the Saudi Arabian population do not considerably extend beyond the upper second premolar mesial aspect, which may provide reliable soft tissue grafts for esthetic mucogingival surgery.

A Morphometric Analysis of Palatal Rugae Patterns in a Saudi Arabian Population.

Background Palatal rugae patterns are useful in the field of forensic dentistry. Ethnicity has a significant effect on the development and final morphological pattern of palatal rugae. This study focused on a morphological analysis of the palatal rugae in a Saudi population to determine if any differences based on age and gender could support identifying an individual. Materials and methods This cross-sectional study conducted at the College of Dentistry, King Saud bin Abdul Aziz University for Health Sciences, was undertaken to evaluate 496 dental casts from the participant database of Saudi nationals from Riyadh. The rugae were delineated using a sharp graphite pencil under adequate light and magnification. The rugae patterns were classified based on the length, shape, and direction of the rugae by two observers as per Thomas and Kotze's criteria. Results The asymptotic chi-square McNemar test indicated bilateral symmetry for all the characteristics of the palatal rugae, except for the backward and forward directions of the rugae. Two-way analysis of variance (ANOVA) revealed a statistically significant interaction between the effects of age group and gender on the primary rugae count (F(3, 488) = 7.466, p <0.05)). In addition, age had a statistically significant effect on the fragmentary rugae (p <0.05), and gender had a statistically significant effect on the circular and backward patterns of the rugae (p<0.05). The females had a higher incidence of backward-directed rugae and the males had more circular rugae. No other significant difference was evident, based on gender. The logistic regression analyses showed a significant association between the circular (OR=1.298; 95% CI= 1.061-1.588) and backward (OR= 0.898; 95% CI= 0.828-0.975) palatal rugae and gender. Also, there was a significant association of the fragmentary palatal rugae (PR) (OR=1.274; 95% CI= 1.084-1.498) with the age group younger than 16 years. Conclusion In a Saudi Arabian ethnic group, the varying type of length of the palatal rugae patterns can be used to identify the age group while the direction and shape can be used to determine gender, although with limited accuracy. Post-mortem identification may benefit from using them along with other reliable forensic tools. There is a need to conduct continued research on diverse populations and ethnic groups in order to evaluate the PR potential in forensic dentistry.

Oral and oropharyngeal cancer: Knowledge, attitude and practices among medical and dental practitioners.

BACKGROUND: Oral and oropharyngeal cancer are significant health problems. They are both life-threatening conditions usually diagnosed at an advanced stage causing survival rates to decline. AIM: To assess and compare practices, knowledge and attitude regarding oral and oropharyngeal cancer between dental and medical practitioners. METHODS: A cross-sectional study was conducted to assess knowledge, attitude and practices of oral and oropharyngeal cancer among dental and medical practitioners at King Abdulaziz Medical City, Riyadh, Saudi Arabia. 360 participants were included in the study using a convenient sampling technique. Participants were approached in their clinics and printed self-administered questionnaire were handed over to them after signing a written consent form. Frequency distribution and Chi-Square test were used for the statistical analysis and the level of significance was set at P value of .05 or less. RESULTS: A total of 174 participants responded. Assessment of oral and oropharyngeal cancer knowledge between dental practitioners and medical practitioners showed comparable results. Regarding practices, a significant difference was seen between medical practitioners and dental practitioners in determining the duration of intra-oral ulcer to consider urgent referral (P = .006) and in number of referrals made in relation to suspicious oral lesions (P = .002). Moreover, a significant difference (P = .006) was seen between medical practitioners and dental practitioners in determining the duration of intra-oral ulcer to consider urgent referral. CONCLUSION: Medical and dental practitioners showed areas of differences in practice, attitude and knowledge of oral and oropharyngeal cancer that when addressed would lead to improved survival rates.

Dental practitioners' and students' knowledge of medication related osteonecrosis of the jaw (MRONJ).

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a complication affecting patients who are being treated with antiresorptive or antiangiogenic medication. These patients require meticulous treatment planning and management strategies. This research aimed to assess the knowledge of dental practitioners and students in their professional years regarding MRONJ. METHODS: A cross-sectional study was conducted among 345 dental practitioners and students in their professional years of both genders, in governmental and private dental schools. The data was collected using an electronic and paper-based self-administered structured questionnaire with six sections. The data was entered and analyzed using SPSS Version 23, and a P-value <0.05 was considered significant. A Chi-square test was used to compare the categorical variables. RESULTS: Though more than half of the sample 68% received information about antiresorptive and antiangiogenic drugs during their studies, the level of knowledge was low. The primary diseases targeted by antiresorptive and antiangiogenic medications were not known by the majority of the sample. Almost half of the sample could not identify any antiresorptive or antiangiogenic medication and only 28.1% knew the correct definition of MRONJ. CONCLUSION: The level of knowledge regarding MRONJ is a concern, necessitating more educational courses and workshops.

Everolimus-associated stomatitis in a patient who had renal transplant.

Everolimus is used as an immunosuppressant in renal allograft transplant rejection and in metastatic breast cancer treatment. One side effect of everolimus is stomatitis, referred to as mammalian target of rapamycin inhibitor-associated stomatitis. This side effect can affect treatment course and contribute to discontinuation of therapy or dose reduction, previously reported in the treatment of metastatic breast cancer. Here, we present a case of everolimus-associated stomatitis with a novel management method with intralesional triamcinolone that allows for continuous course of everolimus.

Utilization of Compounded Medications in an Oral Medicine Practice.

For many oral medicine conditions, the use of compounded topical therapies that are locally absorbed and act directly at the affected site can provide greater efficacy compared with systemically delivered medications while minimizing systemic side effects. The objective of this study was to characterize the utilization and costs associated with the use of compounded medications in an academic, hospital-based oral medicine practice. This was a retrospective analysis of outpatients treated at the Center for Oral Disease at Brigham and Women's Hospital (Boston, Massachusetts) during the five-year period from November 2006 through November 2011. Patient prescription and payment information were obtained from the pharmacy's patient database. Variables included prescription compound, number of prescriptions refilled, prescription cost, and payment contributions from insurance and patients. An electronic medical record review was conducted to obtain patient demographics and diagnoses. There were 510 unique perscriptions corresponding to 423 patients filled during the study period. Four distinct medications comprised the majority (479/510; 94%) of prescriptions filled. The vast majority (94%) of prescriptions filled were at least partially paid for by insurance, with median patient co-pays ranging from $21 (clonazepam solution) to $34 (ketoprofen cream). Compound medications provide an affordable, flexible therapeutic option for patients being treated for a variety of oral medicine conditions.

Oral Medicine referrals at a hospital-based practice in the United States.

OBJECTIVE: The objective of this study was to characterize the outpatient oral medicine (OM) clinic at Brigham and Women's Hospital (BWH), with particular emphasis on patient demographic characteristics and referral patterns. MATERIALS AND METHODS: A retrospective case record review of all initial consultations with OM experts at BWH from 2008 to 2010 was conducted. Data included demographic information, type of medical insurance, reason for referral, referring doctor's specialty, and distance between the patient's home and the referring doctor as well as BWH, number of prior doctors seen for the presenting problem (per patient report), tests ordered at the consultation visit, and clinical diagnoses. RESULTS: There were 1043 new outpatient consultation visits. Patients lived a median distance of 9.5 miles from the referring doctor and 18.9 miles from BWH and saw a median of one doctor (range 0-9) before consultation. Two thirds of patients were referred by physicians. The most common diagnoses included immune-mediated mucosal conditions (27.2%), orofacial pain disorders (25.1%), benign tumors or neoplasms (10.3%), and dysplasia and cancerous conditions (7.6%). Biopsy was the most frequent test performed at consultation. CONCLUSIONS: Patients with oral conditions often see more than one doctor, before being referred to an OM expert and typically travel twice the distance to the expert compared with that between their home and the referring doctor. Equal efforts should be made to increase awareness of the importance of the specialty of OM among dentists, physicians, and the public.

Mammalian target of rapamycin inhibitor-associated stomatitis in hematopoietic stem cell transplantation patients receiving sirolimus prophylaxis for graft-versus-host disease.

The mammalian target of rapamycin (mTOR) inhibitor sirolimus is effective in reducing incidence of graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). Agents that inhibit the mTOR pathway are known to be associated with significant and potentially dose-limiting toxicities, including stomatitis. The objective of this study was to report the clinical features and management outcomes of sirolimus-associated oral ulcers in the context of post-HSCT prophylaxis of GVHD. Seventeen patients, from a study cohort of 967, who were treated with sirolimus as prophylaxis for GVHD after allogeneic HSCT at the Dana-Farber/Brigham and Women's Cancer Center developed oral ulcers and were referred to the oral medicine clinic for evaluation and treatment over a period of 6 years. Clinical characteristics (appearance, anatomic site, size) and therapeutic outcomes (time to complete resolution) were documented. Median time to onset of oral ulceration was 55 days after allogeneic HSCT (range, 6 to 387 days); 92.9% of ulcers were located on nonkeratinized mucosa, with the ventrolateral tongue the most common site of involvement. Thirteen patients were treated with topical corticosteroid therapy; 12 of these patients also required intralesional corticosteroid injections. Clinical improvement (resolution of the lesions and improvement of symptoms) was noted in all cases, with no reported adverse events. Median time to complete resolution after onset of therapy was 14 days (range, 2 to 70 days). Patients receiving sirolimus for GVHD prophylaxis may develop painful oral ulcerations, which can be effectively managed with topical steroid treatment. Further prospective studies are needed to better elucidate the incidence of this complication, identify risk factors, and evaluate the effectiveness of interventions.