Direct-Acting Oral Anticoagulant/Vitamin K Antagonists: Do They Affect the Trabecular and Cortical Structure of the Mandible?

BACKGROUND: This study aimed to evaluate the mandibular bone structure of patients using oral anticoagulants (OACs) vitamin K antagonist drugs (warfarin) and other OACs including direct oral anticoagulants [(DOACs) apixaban, rivaroxaban, dabigatran, edoxaban]. Analyses were based upon the fractal dimension (FD), the panoramic mandibular index (PMI) and the Klemetti index (KI), which is also known as the mandibular cortical index (MCI). METHODOLOGY: Ninety participants were divided into three groups: group 1: 30 systemically healthy individuals who had not used any anticoagulants before, group 2: 30 individuals using warfarin, and group 3: 30 individuals using DOACs. FD was used to analyze trabecular bone architecture in the condyle, angle, and two sites in the alveolar bone. PMI was used to evaluate the quantity of cortical bone and KI was used to evaluate the cortical bone quality. RESULTS: There was no difference between the groups regarding FD analysis and KI; however, a difference was found between groups 1, 2, and 3 in the PMI (P≤ 0.001). The PMI in group 1 was higher than in groups 2 and 3. CONCLUSION: Mandibular radiomorphometric indices can be used on panoramic radiographs to evaluate the quantity of mandibular cortical bone in patients using oral anticoagulants.

Determination of growth and developmental stages in hand-wrist radiographs : Can fractal analysis in combination with artificial intelligence be used?

PURPOSE: The goal of this work was to assess the classification of maturation stage using artificial intelligence (AI) classifiers. METHODS: Hand-wrist radiographs (HWRs) from 1067 individuals aged between 7 and 18 years were included. Fifteen regions of interest were selected for fractal dimension (FD) analysis. Five predictive models with different inputs were created (model 1: only FD; model 2: FD and Chapman sesamoid stage; model 3: FD, age, and sex; model 4: FD, Chapman sesamoid stage, age, and sex; model 5: Chapman sesamoid stage, age, and sex). The target diagnoses were accelerating growth velocity, very high growth velocity, and decreasing growth velocity. Four AI algorithms were applied: multilayer perceptron (MLP), support vector machine (SVM), gradient boosting machine (GBM) and C 5.0 decision tree classifier. RESULTS: All AI algorithms except for C 5.0 yielded similar overall predictive accuracies for the five models. In order from lowest to highest, the predictive accuracies of the models were as follows: model 1 < model 3 < model 2 < model 5 < model 4. The highest overall F1 score, which was used instead of accuracy especially for models with unbalanced data, was obtained for models 1, 2, and 3 based on SVM, for model 4 based on MLP, and for model 5 based on C 5.0. Adding Chapman sesamoid stage, chronologic age, and sex as additional inputs to the FD values significantly increased the F1 score. CONCLUSION: Applying FD analysis to HWRs is not sufficient to predict maturation stage in growing patients but can be considered a growth rate prediction method if combined with the Chapman sesamoid stage, age, and sex.

Retrospective radiological analysis of cemento-osseous dysplasia.

BACKGROUND: Osseous dysplasia (OD) is a form of fibro-osseous lesion located in the jaws that may interfere with the adjacent anatomical structures. OBJECTIVES: The aim of the present study was to evaluate the distribution of radiographic imaging features, the morphological characteristics and the lesion volume of OD with the use of cone-beam computed tomography (CBCT). MATERIAL AND METHODS: The study included radiologically diagnosed lesions followed up for at least 1 year. The prevalence and distribution of the OD types were defined in terms of age, sex, lesion location, teeth, relationship with the anatomical structures, and lesion volume. RESULTS: The mean age gradually increased from the periapical group to the florid group (p = 0.018). It was observed that the mandible was the most frequently affected bone (85.5%) (p < 0.05). The margins of the lesions were well defined, and had an irregular or circular shape. The buccal cortical bone was the most affected structure (84.5%), and the damage in the cortical bone increased with an increase in the lesion volume. With regard to teeth, the most frequent disorder was a discontinuous lamina dura (83.0%). CONCLUSIONS: Osseous dysplasia lesions affect a wide range of different anatomical areas, and show different volume and morphometric characteristics.

Prediction of root canal lengths and pulp volume of the maxillary permanent first molar based on stature, crown diameters, and facial morphometry.

This study purposed to develop statistical models to predict palatal (PRL), mesial (MRL), and distal (DRL) root canal length and pulp volume (PV) of the maxillary first permanent molar using stature, gender, mesiodistal (MD), and buccopalatal (BP) crown diameters and some facial morphometries. 57 individuals were included in the study. Cone beam computed tomography was used to measure root canal lengths and PV. The PV calculation was carried out using the software ITK-SNAP 3.4.0. PRL was positively correlated with BP, stature, middle facial height, interalar distance, and bicommissural distance (BCD) (p < 0.05). DRL was positively correlated with BP, MD, and stature (p < 0.05). MRL was positively correlated with BP, MD, stature, lower face height, bizygomatic distance, and BCD (p < 0.05). PV was negatively correlated with age and BCD (p < 0.05). Although all models have significant predictive power for the root lengths and PV, no model could explain variances greater than 30%. The highest and lowest predictive ability was obtained for PRL and DRL, respectively. While the most significant predictor was BP for PRL and DRL, it was the age for PV.

The effects of vitamin D deficiency on mandibular bone structure: a retrospective radiological study.

OBJECTIVE: The aim of the study was to evaluate the effects of vitamin D deficiency on the mandibular bone structure by fractal analysis and panoramic morphometric indices. METHODS: Ninety participants were divided into three groups as 30 individuals with severe vitamin D deficiency, 30 individuals with vitamin D deficiency, and 30 individuals with vitamin D sufficiency. Fractal dimension analysis (FD), panoramic mandibular index (PMI), mandibular cortical index (MCI), and mandibular cortical thickness measurement (CTM) were evaluated on panoramic radiographs. RESULTS: FD values of the patients with vitamin D deficiency were found to be statistically lower than the patients with vitamin D sufficiency (p < 0.05). FD value of supracortical area above the angulus mandible (FD2) in patients with severe vitamin D deficiency was significantly lower than FD values (p = 0.002). There was no statistically significant difference between the groups in the CTM (p > 0.05). PMI was significantly lower in patients with severe vitamin D deficiency (p < 0.001). There was a significant difference in MCI values between the groups (p < 0.05). CONCLUSION: Vitamin D deficiency causes a decrease in bone mineral density in the mandible, and an increase in alveolar porosity. FD analysis and radiomorphometric indices in panoramic radiographs can be used to assess osteoporotic changes in patients with vitamin D deficiency.

Comparison of trabecular bone structure in individuals with healthy periodontium and stage III/IV, grade C periodontitis by fractal analysis.

OBJECTIVE: The aim was to perform fractal analysis (FA) to compare differences in trabecular microarchitecture in interdental and antegonial regions on panoramic radiographs in periodontally healthy patients and those with stage III/IV, grade C periodontitis, and to compare the effects of patient age and sex on FA results. STUDY DESIGN: Clinical and radiographic records from 33 periodontally healthy individuals and 28 individuals with aggressive periodontitis were obtained from the faculty archives. Three regions of interest (ROIs) were chosen bilaterally from interdental bone around the mandibular first molar and canine and the antegonial region. The mean fractal dimension (FD) values of the ROIs were calculated. Significance of differences was established at P < .05. RESULTS: FD values of all 3 ROIs in the periodontitis group were significantly lower than values in the control group (P ≤ .004). FD was not affected by patient age (P = .357) or sex (P = .216). There were no significant correlations between FD and age in either group (P ≥ .093). FD values differed significantly between sexes in only one ROI. CONCLUSIONS: FA can effectively detect trabecular microarchitectural differences in patients with aggressive periodontitis compared to periodontally healthy individuals. This technique might be useful in predicting the susceptibility of patients to periodontal disease.

Evaluation of trabecular bone and mandibular cortical thickness in adults with different vertical facial types.

OBJECTIVES: This study investigated differences in trabecular structure and mandibular cortical thickness in adults related to vertical facial type (VFT), sex, and their interactions. STUDY DESIGN: Lateral cephalometric radiographs (LCRs) and panoramic radiographs (PRs) of 256 patients were reviewed. The VFT classification into low-angle, normal, and high-angle groups was determined using angular and linear measurements on LCRs. Fractal dimension (FD) values and mandibular radiomorphometric indices (RMIs) were calculated on PRs. RESULTS: Two-way analysis of variance revealed significant differences in FD overall among VFT groups in all sites (P < .001), with pairwise comparisons indicating the greatest values in the high-angle group in the condyle (P < .05) but in the low-angle group elsewhere (P < .001). RMIs were significantly different overall regarding VFT only in the posterior mandible (P = .004), with pairwise comparisons revealing low-angle and normal group values greater than high-angle group values (P < .05). Patient sex and the interaction of facial type and sex had no significant effect on any bone measurements. CONCLUSIONS: VFT had significant effects on trabecular structure at all measured sites, but cortical thickness was affected only in 1 location.

Assessment of bone quality of apical periodontitis treated with MTA plug and regenerative endodontic techniques.

Fractal analysis (FA) is a quantitative, objective and non-invasive method that facilitates the characterisation of the tissue architecture. This study aims to compare the periapical healing at 1-year follow-up by evaluating newly generated trabecular bone with FA after Mineral trioxide aggregate (MTA) plug and regenerative endodontic treatment (RET). A total of 55 asymptomatic teeth with a single-canal, open apex and periapical lesion, treated with MTA plug or RET, were evaluated retrospectively. After considering the inclusion/exclusion criteria, FA was conducted on 30 periapical images using the box-counting method. In both groups, a significant decrease was observed in the periapical lesion size at 1-year follow-up (p < 0.01). However, there was no significant difference between the MTA plug and RET (p > 0.01). Significantly higher fractal dimension values were detected at 1-year follow-up in both MTA plug and RET cases (p < 0.01). However, the difference was not significant between the groups (p > 0.01). Both procedures seem to improve periapical healing with a new resistant bone of similar density and complexity.

Evaluation of the relationship between tooth decay and trabecular bone structure in pediatric patients using fractal analysis: a retrospective study.

Purpose: The movement of chewing affects the growth and development of the stomatognathic system. Tooth decay, which is known to have effects on chewing, can affect the jaw bone due to its indirect effect on the mechanical forces transmitted to the jaw bone. This study aimed to evaluate the relationship between dental caries and jawbone trabeculation during the growth and development processes in children using fractal dimension (FD) analysis. Materials and methods: A total of 120 patients were divided into three groups. The groups were determined as follows: group 1: 40 patients without deep dentin caries/apical rarefying osteitis, group 2: 40 patients with deep dentin caries/apical rarefying osteitis on the right or left sides, and group 3: 40 patients with deep dentin caries/apical rarefying osteitis on both the right and left side. Digital panoramic images of the selected patients were evaluated using FD analysis. Results: There was no statistically significant difference in the FD analysis among the groups. Age and sex factors were not found statistically significant in the in-group evaluation (p>0.05). In group 3, FD values of the right condyle (r= -0.42, p<0.05), right ramus (r= -0.37, p<0.05) and left ramus (r= -0.45, p<0.05) were negatively correlated with age. Conclusion: There is no relationship between tooth decay and trabeculation of the jawbone in children aged 8-13 years.

Factors affecting the parental knowledge, beliefs, and attitudes towards pediatric dental X-rays.

OBJECTIVES: To investigate the knowledge, beliefs, and attitudes towards pediatric dental radiography and its associated factors among Turkish parents seeking dental care for their children. MATERIALS AND METHODS: This cross-sectional study enrolled 483 parents of children aged 6-15 years. Data were collected using the questionnaire including socio-demographic characteristics, knowledge, beliefs, and attitudes based on The Health Belief Model and planned behavior theory. Descriptive, bivariate, and multivariate statistics were performed. RESULTS: More than half of parents had correct knowledge on their rights to access health information, the radiation risk and exposure from dental X-rays, children's vulnerability to radiation, and using lead apron. Most parents (70.4%) perceived dental X-rays as valuable. They had limited knowledge regarding the permanent damage and negative attitudes regarding its safety and goodness. There were positive correlations between knowledge-attitudes, knowledge-perceived benefits, and attitudes-perceived benefits (all p values < 0.01). Having a previous dental X-ray (p = 0.014) and not having parents' information needs (p = 0.007) were associated with higher attitudes. Increasing education levels, having a educational need and higher perceived benefit were found to be predictors of higher parental knowledge. CONCLUSION: Turkish parents had some knowledge and positive attitudes towards pediatric dental X-rays but not at optimum levels. Parents' education levels, information needs, and beliefs were the most important factors affecting parental knowledge. Attitudes towards radiation safety and goodness should be improved. CLINICAL RELEVANCE: These findings may provide useful insight to clinicians when developing theory-driven health education interventions on pediatric dental X-rays and identifiying the parents with low knowledge.

Evaluation of endodontically treated teeth and related apical periodontitis using periapical and endodontic status scale: Retrospective cone-beam computed tomography study.

The purpose of this study was to evaluate the technical treatment quality and the status of apical pathology of endodontically treated teeth, as well as apical periodontitis (AP) prevalence, in a Turkish population using cone-beam computed tomography (CBCT). The CBCT images obtained between January 2018 and April 2020 were retrospectively examined. The quality of the endodontic treatments and the related periapical inflammatory lesions were classified according to the periapical and endodontic status scale (PESS). The data were statistically analysed using logistic regression, crosstabs and chi-square tests. AP was detected in 41% of 429 endodontically treated teeth. The prevalence of AP was significantly higher in teeth with inadequate root canal treatment compared with those with adequate treatment, 70.8% and 29.3%, respectively. Inadequate canal length and homogeneity, and complications were significantly associated with the prognostic periapical status scores of higher risk.

In vivo evaluation of mandibular trabecular and cortical bone quality in psoriasis vulgaris.

OBJECTIVE: The aim of this study was to evaluate the effects of psoriasis vulgaris on mandibular structure by calculating fractal dimension (FD) and radiomorphometric indices. STUDY DESIGN: Panoramic radiographs of 58 patients with psoriasis and 58 healthy participants were assessed. FD was used to analyze trabecular bone architecture in the condyle, angle, and 2 sites in the alveolar bone. Five radiomorphometric indices based on cortical thickness and the mandibular cortical index (MCI) for structure were used to assess cortical bone porosity. Comparisons were made between sites in trabecular and cortical bone. Quantitative and categorical data were statistically analyzed with the significance level at P < .05. RESULTS: FD was significantly lower in the patients with psoriasis than in the controls in the alveolar bone sites (P ≤ .035). Differences between measurement sites were insignificant in psoriasis (P ≥ .617), but the FD values of some measurement sides in the control group differed significantly (P ≤ .004). All quantitative radiomorphometric indices were significantly lower in patients with psoriasis (P ≤ .034) with significant differences between some sites in both groups. No significant difference was found in MCI frequency distribution between the groups (P = .782). CONCLUSIONS: Trabecular architecture and cortical thickness were negatively affected in patients with psoriasis, but no differences in cortical porosity were detected between groups.

Evaluation of mandibular morphologic measurements and trabecular structure among subgroups of impacted mandibular third molars.

OBJECTIVE: To investigate mandibular morphologic measurements and trabecular structures that may cause mandibular third molar (MM3) impaction according to MM3 subgroups. METHODS: A total of 150 MM3 of 2175 panoramic radiographs (PRs) were reviewed. MM3s according to Winter (vertical), Pell & Gregory Class 1 and group: A, B, C on PRs were included in the study group. Fractal dimensions (FD) and mandibular morphologic measurements were evaluated. Statistical analysis for parametric values was performed using one-way analysis of variance (ANOVA). Statistical analysis for non-parametric values was performed using the Kruskal-Wallis H test. RESULTS: Statistically, a significant difference was found only in terms of angle of impaction among the groups of MM3 (p < 0.05) [Winter (vertical), and Pell & Gregory Class 1 and group A, B, C]. There was no difference among groups A, B, C in mandibular morphology and trabecular structure, but group C showed different characteristics than the other groups only in terms of impaction angle. CONCLUSION: The trabecular structure and morphometric properties except for the angle of impaction do not affect impacted MM3s with adequate retromolar space and vertical angle.

Three-dimensional verification of the radiographic visibility of the root pulp used for forensic age estimation in mandibular third molars.

OBJECTIVES: The aim of this study was to assess the reliability of panoramic radiography (OPG) using age estimation method using cone beam computed tomography (CBCT) verification in the evaluation of radiographic visibility of root pulp (RPV) of mandibular third molars for age estimation. METHODS: CBCT and OPG images of 429 mandibular third molars from 290 patients were evaluated. RPV of fully mineralized mandibular third molars was evaluated as stages 0, 1, 2, and 3 for both imaging methods. Descriptive statistics were performed separately for stages by age for both genders. The consistency of these scores with chronological age was evaluated for both imaging methods. The reliability of OPG evaluation was also analyzed with CBCT scores.Results Spearman's rho correlation demonstrated a positive correlation between RPV and chronological age for both genders and for OPG and CBCT evaluation. Considering the minimum ages of both imaging methods, all stages were above the age of 18 except for the female group of Stage 2 and all Stage 0. For the comparison of OPG and CBCT RPV Staging scores, the κ score was found to be 0.312 (p < 0.001), indicating a fair agreement. CONCLUSION: In conclusion, the absence of Stage 3 at age of 18 and under might have a forensic value for RPV age estimation method. Considering the fair agreement in the verification of OPG scores, it is not possible to determine the exact age with the RPV detected in OPG images, the use of CBCT for the RPV evaluation is recommended to available cases.

Radioanatomic study of maxillary sinus palatal process pneumatization.

OBJECTIVES: To perform a detailed analysis of palatal process pneumatization (PPP) on cone beam computed tomography (CBCT) images. METHODS: This study consisted of 376 maxillary sinuses of 188 patients aged 22-88 years who had maxillary CBCT scans. The radioanatomy of the PPP was evaluated at distances 4, 8, 16, and 24 mm posterior to incisive foramen. The types of PPP were classified as follows: type I: maxillary sinus palatal process non-gasified; type II: palatal process gasification into the nasal floor, but not more than half of the width of the nasal floor; and type III: palatal process gasification into the nasal floor more than half of the width of nasal floor. Sinus opening angle (SOA), palatonasal recess angle (PNRA), palatal junction angle (PJA), and palatal depth measurement (PDM) were the evaluated parameters. RESULTS: Among the identified 1315 PPPs, type I PPP (880, 66.92%) was the most frequently observed, followed by type II (426, 32.4%), and the least observed was type III PPP (9, 0.68%). There was no significant difference between SOA and PJA according to the types of PPP (p > 0.05). The difference between PNRA and PDM of type I and type II PPP showed a statistically significant difference (p < 0.05). Type I PPP was the most encountered with the highest PDM, and PNRA was narrower in type III than in type II PPP. CONCLUSION: Physicians must be aware of these variations to prevent possible complications during surgery because 33.08% of the maxillary sinuses showed extensive pneumatization through the palatal process.

Effects of hyperlipidemia on trabecular and cortical structures of the mandible.

OBJECTIVES: To evaluate the mandibular bone structure of patients with hyperlipidemia by fractal dimension (FD) analysis and panoramic radiomorphometric indices including mandibular cortical thickness measurement, panoramic mandibular index (PMI), mandibular cortical index (MCI) and to compare with the healthy group. METHODS: In total, 60 panoramic radiographs were included, including panoramic radiographs of 30 individuals with hyperlipidemia and 30 individuals with systemically healthy. FD analysis in the mandibular condyle, angle of the mandible, the distal side of the second premolar and anterior to mental foramen, PMI, MCI, and mandibular cortical thickness measurements were evaluated on radiographs. Independent samples t-test was used for differences between healthy and hyperlipidemia groups with regard to age and PMI. Repeated measurement of variance with one within and one between factors in the comparison of four regions and two groups in terms of FD and cortical thickness measurements. Following this analysis, significant differences were detected by post-hoc Sidak test. Fisher-Freeman-Halton analysis was applied to determine the relationship between categorical variables. RESULTS: FD values of the hyperlipidemic patients were found to be lower than the healthy group. Between the hyperlipidemic and healthy groups, there was a difference in the angle of the mandible FD values (p = 0.020). There were no differences in the cortical thickness measurements and PMI between the groups (p > 0.05). There was a difference in MCI values between the groups (p < 0.05). CONCLUSION: The trabecular structure of the angle of the mandible and the cortical bone structure of the mandible were found to be negatively affected by hyperlipidemia.

Occipital spurs on lateral cephalometric radiographs: morphologic and morphometric features.

OBJECTIVE: To evaluate the presence of occipital spurs, morphologic/morphometric features, and the presence of ossification of ligamentum nuchae (ONL) on lateral cephalometric radiographs of individuals aged under and over 18 years. METHODS: Lateral cephalometric radiographs of 1430 individuals aged between 14-50 years were scanned. The presence of ONL and occipital spurs was evaluated in 1312 patients who met the inclusion criteria, and existing occipital spurs were measured and their types (flat/crest/spine) were recorded. RESULTS: Occipital spurs were detected in 63 patients aged over 18 years (63/120; 52.5%) and 57 patients aged under 18 years (57/120; 47.5%). When the spur length by age category and sex was evaluated, no statistically significant difference was observed. The spur types seen were flat (40.8%; 49/120), crest (30%; 36/120) and spine (29.2%; 35/120), respectively. Although there was no statistically significant difference between the spur types seen in terms of age, a significant difference was observed between the sexes in the total group (p < 0.001). Spine-type spurs (66.7%; 18/27) were the most common in females, and flat-type spurs (45.2%; 42/39) were the most common in males. ONL was detected in only three individuals. CONCLUSION: No relationship was found between the presence of occipital spurs and ONL. Although spur length was not affected by age and sex, spur types were found to vary according to sex. Occipital spurs are mostly asymptomatic and detected incidentally on lateral cephalometric radiographs. They are one of the important anatomic formations that should be diagnosed by physicians.

Artifact expression of polyetheretherketone in cone beam computed tomography: An in vitro study.

STATEMENT OF PROBLEM: Dental prosthetic materials can cause artifacts in cone beam computed tomography (CBCT) images, adversely affecting diagnostic quality, although the problem may be less with polyetheretherketone (PEEK). Studies evaluating the artifacts caused by frequently used prosthetic materials are lacking. PURPOSE: The purpose of this in vitro study was to compare the artifacts in CBCT images caused by PEEK, zirconia, cobalt-chromium (Co-Cr) alloy, and titanium (Ti). MATERIAL AND METHODS: A polymethylmethacrylate phantom (Ø4.0×4.0 cm) with a central cylindrical aperture (Ø0.5×0.5 cm) was produced. Co-Cr, Ti, zirconia, and PEEK cylinders (0.5×0.5 cm) were manufactured, and CBCT images of the empty phantom (control group) with the test cylinders inside were made 3 times. In all images, the axial sections passing through the middle of the materials were evaluated. Eight regions of interest (ROI) area were determined around the materials (0.5×0.5 cm). The presence of artifacts was evaluated by making gray value standard deviation (SD) calculations in these ROI areas. The average SD values of 8 ROI fields from the 3 CBCT scans were made, and the materials were compared with each other in terms of the presence of artifacts by using 1-way analysis of variance (α=.05). RESULTS: The difference between the SD values of the control and the PEEK cylinder was not statistically significant (P>.05). The SD values of both the control and PEEK groups were significantly lower than those of the zirconia, Co-Cr, and Ti groups (P<.05). CONCLUSIONS: Zirconia, Ti, and Co-Cr caused artifacts in CBCT images, but the artifacts with PEEK were similar to those in the control group, suggesting it was the optimal choice in terms of achieving diagnostic quality.