Automated detection of anterior crossbite on intraoral images and videos utilizing deep learning.

AIM: Malocclusion has emerged as a burgeoning global public health concern. Individuals with an anterior crossbite face an elevated risk of exhibiting characteristics such as a concave facial profile, negative overjet, and poor masticatory efficiency. In response to this issue, we proposed a convolutional neural network (CNN)-based model designed for the automated detection and classification of intraoral images and videos. MATERIALS AND METHODS: A total of 1865 intraoral images were included in this study, 1493 (80%) of which were allocated for training and 372 (20%) for testing the CNN. Additionally, we tested the models on 10 videos, spanning a cumulative duration of 124 seconds. To assess the performance of our predictions, metrics including accuracy, sensitivity, specificity, precision, F1-score, area under the precision-recall (AUPR) curve, and area under the receiver operating characteristic (ROC) curve (AUC) were employed. RESULTS: The trained model exhibited commendable classification performance, achieving an accuracy of 0.965 and an AUC of 0.986. Moreover, it demonstrated superior specificity (0.992 vs. 0.978 and 0.956, P < 0.05) in comparison to assessments by two orthodontists. Conversely, the CNN model displayed diminished sensitivity (0.89 vs. 0.96 and 0.92, P < 0.05) relative to the orthodontists. Notably, the CNN model accomplished a perfect classification rate, successfully identifying 100% of the videos in the test set. CONCLUSION: The deep learning (DL) model exhibited remarkable classification accuracy in identifying anterior crossbite through both intraoral images and videos. This proficiency holds the potential to expedite the detection of severe malocclusions, facilitating timely classification for appropriate treatment and, consequently, mitigating the risk of complications.

The design, development and usability testing of a smartphone-based mobile system for management of children's oral health.

The aim of the study was to design and develop a mobile system for better management of children's oral health by using the internet technology. This study was followed in a three-step approach. (1) Design stage: participatory design (including patients, dentists and computer scientists) was taken in order to adapt the system to the clinical practice of dentistry; (2) Development stage: dentists and computer scientists were involved in this stage to develop the system by using internet technology; (3) Usability testing stage: the quality (MARS), usability (SUS) and satisfaction of the system were assessed by children's caregivers. The system contains patient-side app, doctor-side app and Web side program for manager. Children and their caregivers could acquire many useful services through the app, such as oral healthcare education, brushing management, dietary record, online consultation, online appointment, feedback of adverse events. The overall value of SUS was 67.75. The final quality mean score was 3.44 ± 0.95, with the highest mean score of functionality. The majority of caregivers were satisfied with the system. They expressed the system could improve the current medical services and their oral health literacy.

The chronification mechanism of orofacial inflammatory pain: Facilitation by GPER1 and microglia in the rostral ventral medulla.

Background: Chronic orofacial pain is a common and incompletely defined clinical condition. The role of G protein-coupled estrogen receptor 1 (GPER1) as a new estrogen receptor in trunk and visceral pain regulation is well known. Here, we researched the role of GPER1 in the rostral ventral medulla (RVM) during chronic orofacial pain. Methods and Results: A pain model was established where rats were injected in the temporomandibular joint with complete Freund's adjuvant (CFA) to simulate chronic orofacial pain. Following this a behavioral test was performed to establish pain threshold and results showed that the rats injected with CFA had abnormal pain in the orofacial regions. Additional Immunostaining and blot analysis indicated that microglia were activated in the RVM and GPER1 and c-Fos were significantly upregulated in the rats. Conversely, when the rats were injected with G15 (a GPER1 inhibitor) the abnormal pain the CFA rats were experiencing was alleviated and microglia activation was prevented. In addition, we found that G15 downregulated the expression of phospholipase C (PLC) and protein kinase C (PKC), inhibited the expression of GluA1, restores aberrant synaptic plasticity and reduces the overexpression of the synapse-associated proteins PSD-95 and syb-2 in the RVM of CFA rats. Conclusion: The findings indicate that GPER1 mediates chronic orofacial pain through modulation of the PLC-PKC signal pathway, sensitization of the RVM region and enhancement of neural plasticity. These results of this study therefore suggest that GPER1 may serve as a potential therapeutic target for chronic orofacial pain.

Associations Between Oral Health Status, Perceived Stress, and Neuropsychiatric Symptoms Among Community Individuals With Alzheimer's Disease: A Mediation Analysis.

Community individuals with Alzheimer's disease (AD) experience oral disease alongside neuropsychiatric symptoms (NPS) with disease progression. Despite growing evidence for the link between oral health and cognitive status, few studies have investigated the associations between oral health and NPS, especially based on individuals' experience of AD. The primary aim of this study was to examine (a) the difference in oral health-related stressors among individuals with AD, mild cognitive impairment (MCI), and subjective cognitive decline (SCD); and (b) the associations of these stressors with NPS under the framework of the stress process model (SPM). A cross-sectional study was conducted among individuals diagnosed with AD (n = 35), MCI (n = 36) or SCD (n = 35), matched for age, sex education, and body mass index (BMI). Multiple regression and mediation model analyses were performed to explore predictors and their relationships with NPS based on the SPM. Data collection comprised four sections: (a) individual context; (b) oral health-related stressors, including dental caries, periodontal status, oral hygiene, the geriatric oral health assessment index (GOHAI), oral salivary microbiota, pro-inflammatory cytokines, and oral health behavior; (c) subjective stressors (i.e., perceived stress [PS]); and (d) NPS. Decayed, missing, and filled teeth (DMFT), missing teeth (MT), loss of attachment (LoA), plaque index (PLI), PS, oral health behavior, GOHAI, pro-inflammatory cytokines, and salivary bacterial composition were significantly different among the three groups; these parameters were poorer in the AD group than SCD and/or MCI group. LoA, PLI, PS, and pain or discomfort in the GOHAI were directly associated with NPS. PLI, LoA, and psychosocial function in the GOHAI indirectly affected NPS, and this relationship was mediated by PS. Individuals with AD reported greater oral health-related stressors. This study identifies direct and indirect associations linking oral health-related stressors and PS with NPS in individuals with AD. Our findings suggest that targeted dental care and oral-related stressor control may be valuable for managing NPS.

Smartphone and medical application use among dentists in China.

BACKGROUND: With the development of information technology, an increasing number of healthcare professionals are using smartphones and mobile medical applications (apps) in their clinical practice. The objective of this study was to survey the use of smartphone-based medical apps among dentists in China and determine dentists' perceptions of such apps. METHODS: All data were collected using anonymous questionnaires. The questionnaires for this cross-sectional study were randomly sent to dentists by email, and 379 dentists responded. Dentists' demographics and perceptions of WeChat, QQ (the most popular social media apps in China) and other medical apps were assessed; the questionnaire including questions on the purpose, frequency, daily use, and opinion of the apps they used. Questions were answered using a Likert scale (1 = strongly agree, 2 = agree, 3 = not sure, 4 = disagree, and 5 = strongly disagree). RESULTS: A total of 379 valid responses were received; the respondents had a median age of 33.6 years old (63.3% female). All subjects (100%) owned a smartphone, and all of them installed and used WeChat or QQ in their clinical practice. Only 76% of subjects installed medical apps (other than WeChat and QQ) on their smartphones. Male dentists were more likely to install medical apps than female dentists (p < 0.05). With increasing age, the percentage of dentists who installed medical apps decreased (p < 0.001). The frequency and daily use were higher for WeChat and QQ than for medical apps. Medical apps were positively perceived, with dentists reporting that they recommend these medical apps to their peers (Likert score: 1.67 ± 0.68). CONCLUSION: Medical apps were perceived to have a positive impact on clinical practice, education and patient care in dentistry by providing relevant medical information. However, there will still be much room for improvement in the future.

[Prevalence of dental caries and associated factors among 10-12-year-old students in Chongqing].

OBJECTIVE: To investigate the caries status of the first permanent molars in urban and rural children aged 10-12 in Chongqing and analyze the related factors in order to provide a theoretical basis for the prevention and treatment of children's caries and targeted suggestions for oral health education. METHODS: A multi-stage, stratified, cluster, and random sampling method was used to extract 5 057 children from 18 schools in three districts and three counties in Chongqing for oral health examination and questionnaire survey from March to May 2018. RESULTS: The total caries rate of the first permanent molar was 39.2%. The decayed-missing-filled tooth was 0.84±1.20. The rate of filling teeth was 3.4%. The rate of pit and fissure sealing was 6.1%. The prevalence of the first permanent molars was significantly different between men and women, between urban and rural areas, between only children and non-only children, and between ethnic minorities and Han nationality (P<0.001). The gap between the pit and fissure sealing was significantly different between urban and rural areas (P<0.001). Multiple logistic regression analysis showed that many independent factors influence the occurrence of caries, including the frequency of brushing teeth every day, the frequency of eating desserts, the habit of eating dessert/drinking milk before going to bed, whether only-children or not, and parents' education background, among others. CONCLUSIONS: The first permanent molars of children aged 10-12 in Chongqing have a high rate of caries but low rates of pit and fissure sealing and dental caries filling. The difference between urban and rural areas is large, children's oral health knowledge is scarce, and children have bad oral hygiene behaviors and eating habits. Children's oral health education must be strengthened, oral health preaching must be implemented in schools, the oral health knowledge of children in school must be improved, and urban-rural differences must be minimized.

Comparative evaluation of the vertical fracture resistance of endodontically treated roots filled with Gutta-percha and Resilon: a meta-analysis of in vitro studies.

BACKGROUND: Teeth treated endodontically are more susceptible to vertical root fracture (VRF). Some studies have suggested that obturating the root canals with Gutta-percha or Resilon can reinforce endodontically treated teeth, but a few others have presented conflicting results. These inconsistent results cannot guide clinicians in determining clinical approaches. The objective of this meta-analysis is to evaluate and compare the vertical fracture resistance of endodontically treated root canals obturated with Gutta-percha/AH plus and the Resilon system. METHODS: Comprehensive literature searches were performed in the PubMed, Cochrane Library, ScienceDirect, Web of Science and Embase databases. The titles and abstracts of all of the retrieved articles were independently assessed by two authors according to predefined selection criteria. Data in the included articles were independently extracted. Statistical analyses were conducted using Review Manager 5.3 and Stata 12.0 software. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for the outcome indicators. The level of statistical significance was set at p < 0.05. The Cochran Q test (I2 test) was used to test for heterogeneity among studies. RESULTS: Fourteen randomized controlled in vitro trials were included in the meta-analysis. The results demonstrated that the vertical root fracture resistance of unprepared and unfilled roots was significantly higher than that of roots obturated with Gutta-percha/AH plus (SMD = - 0.69, 95% CI = - 1.34 to - 0.04, p = 0.04) or the Resilon system (SMD = - 0.54, 95% CI = - 1.07 to - 0.00, p = 0.05). The differences in fracture resistance between the roots filled with Gutta-percha/AH plus and the prepared unfilled root canals was not significant (SMD = 0.59, 95% CI = - 0.02 to 1.21, p = 0.06). Roots obturated with Resilon had higher fracture resistance than instrumented unfilled roots (SMD = 0.83, 95% CI = 0.44 to 1.22, p < 0.0001) or roots filled with Gutta-percha/AH plus (SMD = 0.62, 95% CI = 0.01 to 1.23, p = 0.05). CONCLUSIONS: The present study suggests that filling with Gutta-percha/AH plus dose not reinforce endodontically treated roots, whereas obturating with the Resilon system can increase vertical root fracture resistance of prepared roots. As this meta-analysis was based on in vitro studies, it should be careful to extrapolate its conclusion to the clinical context.

Influence of low-intensity pulsed ultrasound on osteogenic tissue regeneration in a periodontal injury model: X-ray image alterations assessed by micro-computed tomography.

OBJECTIVE: This study was conducted to evaluate, with micro-computed tomography, the influence of low-intensity pulsed ultrasound on wound-healing in periodontal tissues. METHODS: Periodontal disease with Class II furcation involvement was surgically produced at the bilateral mandibular premolars in 8 adult male beagle dogs. Twenty-four teeth were randomly assigned among 4 groups (G): G1, periodontal flap surgery; G2, periodontal flap surgery+low-intensity pulsed ultrasound (LIPUS); G3, guided tissue regeneration (GTR) surgery; G4, GTR surgery plus LIPUS. The affected area in the experimental group was exposed to LIPUS. At 6 and 8weeks, the X-ray images of regenerated teeth were referred to micro-CT scanning for 3-D measurement. RESULTS: Bone volume (BV), bone surface (BS), and number of trabeculae (Tb) in G2 and G4 were higher than in G1 and G3 (p<0.05). BV, BS, and Tb.N of the GTR+LIPUS group were higher than in the GTR group. BV, BS, and Tb.N of the LIPUS group were higher than in the periodontal flap surgery group. CONCLUSION: LIPUS irradiation increased the number, volume, and area of new alveolar bone trabeculae. LIPUS has the potential to promote the repair of periodontal tissue, and may work effectively if combined with GTR.

[Research on ultrasonic permeability of low intensity pulsed ultrasound through PTFE membrane and Bio-Gide collagen membrane].

The aim of the present study was to detect the transmission rate of ultrasonic low intensity pulsed ultrasound (LIPUS) through polytetrafluoroethylene (PTFE) membrane (Thickness: 0.01 mm) and Bio-Gide collagen membrane, and to provide the basis for the barrier membrane selection on the study of LIPUS combined with guided tissue regeneration (GTR). The ultrasonic (LIPUS, frequency 1.5 MHz, pulse width 200 micros, repetition rate 1.0 kHz) transmission coefficient of the two kinds of barrier membrane were detected respectively through setting ten groups from 10 to 100mW/cm2 every other 10 mW/cm2. We found in the study that the ultrasonic transmission coefficient through 0.01 mm PTFE membrane was 78.1% to 92.%, and the ultrasonic transmission coefficient through Bio-Gide collagen membrane was 43.9% to 55.8%. The ultrasonic transmission coefficient through PTFE membrane was obviously higher than that through Bio-Gide collagen membrane. The transmission coefficient of the same barrier membrane of the ultrasonic ion was statistically different under different powers (P < 0.05). The results showed that the ultrasonic transmittance rates through both the 0.01 mm PTFE membrane and Bio-Gide collagen membrane were relatively high. We should select barrier membranes based on different experimental needs, and exercise ultrasonic transmission coefficient experiments to ensure effective power.

[Low intensity pulsed ultrasound irradiating combined with guided bone regeneration for promoting the repair effect of periodontal bone defect].

OBJECTIVE: To study the repair effect of low intensity pulsed ultrasound (LIPUS) irradiating combined with guided bone regeneration (GBR) on the defect of Beagle dog canines periodontal bone. METHODS: Four canine teeth of every beagle dog (8 beagle dogs) were randomly distributed: Group 1 (LIPUS disposal + GBR+ autogenous bone graft group), group 2 (LIPUS disposal + autogenous bone graft group), group 3 (GBR + autogenous bone graft group), blank control group. The model of periodontal bone defect was established in the 1/3 part of the root buccal area. According to the group division, autogenous bone were grafted, group 1 and group 2 were disposed by LIPUS 20 min x d(-1). The intensity of ultrasound were 30 mW x cm(-2). Group 1 and group 3 were injected with Bio-Gide collagen membrane. The beagle dogs were executed at 6 and 8 weeks of the disposal of LIPUS and then Micro-CT test and analysis were conducted to periodontal bone defect area of each group. RESULTS: By clinical observation, there were different degrees of shrinkages of the area of periodontal bone defect in each group. The Micro-CT test analysis indicated that there was a statistical difference among the number, the thickness as well as the size of bone trabecula of each group (P < 0.05). However, there was no statistical difference (P > 0.05) in terms of bone issue measurement index between 6 to B weeks of each group. Group 1 had the most new bone. CONCLUSION: LIPUS has the potential to promote the repair of periodontal bone defect. Therefore the combination of LIPUS and GBR may be more conducive to the repair and regeneration of periodontal bone defect.

[Three-dimensional finite element analysis of stress distribution in mandible advanced with Forsus].

OBJECTIVE: To construct a three-dimensional finite element model of mandible and to analyze the stress distribution in mandible advanced with Forsus. METHODS: One growing patient with mandibular retrusion was selected. After leveling and aligning with MBT (Mclaughlin Bennett Treriri) straight-wire appliance to achieve the request of forsus with the spiral CT, a three-dimensional finite element model was constructed and the stress distribution in mandible after advancing at 1 second, 15 seconds and 300 seconds was analyzed. RESULTS: The three-dimensional finite element model included MBT straight-wire appliance. The stress concentration areas were located in the front side of the condylar process, the sigmoid notch and mandibular molar areas at 15 seconds and 300 seconds after mandibular advancement. The maximum stress values were 34.47 MPa and 34.45 MPa, respectively. With the extension of loading time, the largest displacement increased from 3.30 x 10(-2) mm to 1.15 mm and the region of the largest displacement extended backwards along the body of mandible. However, the displacement of condyle reduced from 1.65 x 10(-2) mm at 1 second to 3.27 x 10(-5) mm at 300 seconds after mandibular advancement. CONCLUSIONS: The three-dimensional finite element model considered the viscoelasticity and viscoelasticity of mandibular. The result suggested that the stress distribution in the mandible gradually became stable after the application of Forsus and the appliance caused downward and forward mandibular modification.