Full virtual patient generated by artificial intelligence-driven integrated segmentation of craniomaxillofacial structures from CBCT images.

OBJECTIVES: To assess the performance, time-efficiency, and consistency of a convolutional neural network (CNN) based automated approach for integrated segmentation of craniomaxillofacial structures compared with semi-automated method for creating a virtual patient using cone beam computed tomography (CBCT) scans. METHODS: Thirty CBCT scans were selected. Six craniomaxillofacial structures, encompassing the maxillofacial complex bones, maxillary sinus, dentition, mandible, mandibular canal, and pharyngeal airway space, were segmented on these scans using semi-automated and composite of previously validated CNN-based automated segmentation techniques for individual structures. A qualitative assessment of the automated segmentation revealed the need for minor refinements, which were manually corrected. These refined segmentations served as a reference for comparing semi-automated and automated integrated segmentations. RESULTS: The majority of minor adjustments with the automated approach involved under-segmentation of sinus mucosal thickening and regions with reduced bone thickness within the maxillofacial complex. The automated and the semi-automated approaches required an average time of 1.1 min and 48.4 min, respectively. The automated method demonstrated a greater degree of similarity (99.6 %) to the reference than the semi-automated approach (88.3 %). The standard deviation values for all metrics with the automated approach were low, indicating a high consistency. CONCLUSIONS: The CNN-driven integrated segmentation approach proved to be accurate, time-efficient, and consistent for creating a CBCT-derived virtual patient through simultaneous segmentation of craniomaxillofacial structures. CLINICAL RELEVANCE: The creation of a virtual orofacial patient using an automated approach could potentially transform personalized digital workflows. This advancement could be particularly beneficial for treatment planning in a variety of dental and maxillofacial specialties.

Risk of healing impairment following tooth extraction in patients administered with antiresorptive and non-antiresorptive polypharmacy.

INTRODUCTION: Lack of evidence existed related to the essential role by which anticancer medications alone or in combination with other polypharmacy would be accountable for wound healing impairment post-dental extraction. The following study was conducted to assess the influence of antiresorptive (AR) and non-antiresorptive (non-AR) drugs and other patient-related risk factors on wound healing status following tooth extraction. MATERIAL AND METHODS: A total of 353 patients (age range: 40-90 years, average age: 67.4 years, clinical and radiological follow-up) were recruited. All the patients were divided into three groups, which included, patients used polypharmacy with non-AR drugs, polypharmacy with a combination of AR + non-AR drugs, and the control group. Based on time of healing, the outcome was defined as, normal healing, delayed healing, and Medication-related osteonecrosis of the jaw (MRONJ). The polypharmacy score was categorized depending on the sum of the number of administered medications. RESULTS: The odds of delayed healing were significantly higher in 80+ years old patients (OR=6.98, 95 %CI:2.45-19.88, p = < 0.001) administered with AR+ non-AR drugs (OR=14.68, 95 %CI:4.67-46.14, p = < 0.001), having a major polypharmacy score (OR= 15.37, 95 %CI:4.83-48.91, p = < 0.001). On the contrary, patient administered with non-AR drugs (OR=11.52, 95 %CI: 4.45-29.83, p = < 0.001) with hyper polypharmacy (OR=58.86, 95 %CI:25.03-138.40, p = < 0.001) were significantly more likely to develop MRONJ. Smoking and extraction sites showed no significant impact on wound healing impairment. DISCUSSION: Wound healing status in patients administered with both non-AR and AR+ non-AR polypharmacy was significantly impaired following tooth extraction. Other risk factors, such as increased age and high polypharmacy scoring, also significantly contributed towards the occurrence of delayed healing and MRONJ.

Are medication-induced salivary changes the culprit of osteonecrosis of the jaw? A systematic review.

Purpose: This systematic review was performed to assess the potential influence of medication-induced salivary changes on the development of medication-related osteonecrosis of the jaw (MRONJ). Methods: An electronic search was conducted using PubMed, Web of Science, Cochrane, and Embase databases for articles published up to June 2023. A risk of bias assessment was performed according to the modified Newcastle-Ottawa Scale (NOS). Due to the heterogeneity of the selected studies in relation to the type of medications and outcomes evaluated, a meta-analysis could not be performed. Results: The initial search revealed 765 studies. Only 10 articles were found to be eligible based on the inclusion criteria that reported on the impact of salivary changes on MRONJ following the administration of different medications. A total of 272 cases of MRONJ (35% women, 32% men, and 32% with no gender reported) with a mean age of 66 years at the time of diagnosis were included. Patients administered with bisphosphonates, steroids, chemotherapy, thalidomide, interferon, and hormone therapy had a significantly higher association between decreased salivary flow and MRONJ occurrence. In addition, bisphosphonates, denosumab, and other bone-modifying agents showed a significantly higher risk of developing MRONJ owing to the changes in salivary microbiome profiles, cytokine profiles, interleukins, hypotaurine, and binding proteins. Conclusion: The reduction in salivary flow and changes in the concentration of salivary proteins were associated with the development of MRONJ. However, due to the availability of limited evidence, the findings of the review should be interpreted with caution. Prospero review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022327645.

Non-antiresorptive drugs associated with the development of medication-related osteonecrosis of the jaw: a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review was to provide evidence related to the association between non-antiresorptive medications and MRONJ. MATERIALS AND METHODS: The following three electronic databases were screened: PubMed, EMBASE, and Web of Science from December 2020 until April 2021. Two reviewers independently performed the study selection, data extraction, and quality assessment of the included studies. The Newcastle-Ottawa Scale (NOS) was used for assessing the risk of bias. A meta-analysis was performed for assessing the relationship between MRONJ and non-antiresorptive medications. RESULTS: The search strategy retrieved 996 articles. Following removal of duplicates, title, and abstract screening and full-text reading, 58 publications were eligible to be included in the review. A total of 867 cases of MRONJ were included (33% female, 55% male, 12% no gender reported). The mean age of the patients when MRONJ was diagnosed was 61 years (range 19-100 years) and the average time of diagnosis was 10 months following non-antiresorptive drug therapy. Patients with a history of corticosteroids (0.61, 95% CI 0.39, 0.82, p = < 0.001) and chemotherapy (0.59, 95% CI 0.51, 0.67, p = < 0.001) showed the highest significant effect size (ED) compared to the control group for MRONJ occurrence. CONCLUSION: A significant association existed between MRONJ and non-antiresorptive drugs. However, considering limited evidence, findings should be interpreted with caution. CLINICAL RELEVANCE: The non-antiresorptive drugs might allow the dentist to apply the principle of "drug holiday" following concurrence from the drug prescribing clinician. PROSPERO REGISTRATION NUMBER: CRD42020173891.

Image quality assessment of pre-processed and post-processed digital panoramic radiographs in paediatric patients with mixed dentition.

PURPOSE: To determine the impact of an image processing technique on diagnostic accuracy of digital panoramic radiographs for the assessment of anatomical structures in paediatric patients with mixed dentition. MATERIALS AND METHODS: The study consisted of 50 digital panoramic radiographs of children aged from 6 to 12 years, which were later on processed using a dedicated image processing method. A modified clinical image quality evaluation chart was used to evaluate the diagnostic accuracy of anatomical structures in maxillary and mandibular anterior and maxillary premolar region of processed images. RESULTS: A statistically significant difference was observed between pre and post-processed evaluation of anatomical structures (P<0.05) in the maxillary and mandibular anterior region. The anterior region was found to be more accurate in post-processed images. No significant difference was observed in the maxillary premolar region (P>0.05). The Inter-observer and intra-observer reliability of both pre and post processed images were excellent (>0.82) for anterior region and good (>0.63) for premolar region. CONCLUSION: The application of image processing technique in digital panoramic radiography can be considered a reliable method for improving the quality of anatomical structures in paediatric patients with mixed dentition.