Title Participants Abstract "Diagnostic accuracy of CBCT versus intraoral imaging for assessment of peri-implant bone defects" "Dandan Song, Sohaib Shujaat, Constantinus Politis, Reinhilde Jacobs" "BACKGROUND: Early detection of marginal bone loss is vital for treatment planning and prognosis of teeth and implant. This study was conducted to assess diagnostic accuracy of CBCT compared to intra-oral (IO) radiography for detection, classification, and measurement of peri-implant bone defects in an animal model. METHODS: Fifty-four mandible blocks with implants were harvested from nine male health adult beagle dogs with acquisition of IO, CBCT and micro-CT images from all samples. Peri-implant bone defects from 16 samples were diagnosed using micro-CT and classified into 3 defect categories: dehiscence (n = 5), infrabony defect (n = 3) and crater-like defect (n = 8). Following training and calibration of the observers, they asked to detect location (mesial, distal, buccal, lingual) and shape of the defect (dehiscence, horizontal defect, vertical defect, carter-like defect) utilizing both IO and CBCT images. Both observers assessed defect depth and width on IO, CBCT and micro-CT images at each side of peri-implant bone defect via CT-analyzer software. Data were analyzed using SPSS software and a p value of" "[Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 2: diagnostic pathways and current therapeutic concepts]." "Michael Bornstein" "Proper localization of supernumerary teeth is very important for the diagnosis, treatment planning, and prior to any surgical intervention. Traditionally, supernumerary teeth were diagnosed and located using two-dimensional (2D) radiographic methods such as panoramic views, cephalometric imaging, and also intraoral (also often occlusal) radiographs. With the introduction of cone beam computed tomography (CBCT) in dental medicine, this three-dimensional (3D) imaging technique is now more and more used for the exact localisation of supernumerary teeth and the diagnosis of root resorption of adjacent teeth. Treatment planning depends on various factors such as the time of diagnosis, the age of the patient, the position of the supernumerary tooth and possible complications. In the present second part of this review article on supernumerary teeth in the maxilla and mandible, the diagnostic workflow and current treatment concepts will be presented and critically discussed." "A deep learning approach for radiological detection and classification of radicular cysts and periapical granulomas" "Constantinus Politis" "OBJECTIVES: Dentists and oral surgeons often face difficulties distinguishing between radicular cysts and periapical granulomas on panoramic imaging. Radicular cysts require surgical removal while root canal treatment is the first-line treatment for periapical granulomas. Therefore, an automated tool to aid clinical decision making is needed. METHODS: A deep learning framework was developed using panoramic images of 80 radicular cysts and 72 periapical granulomas located in the mandible. Additionally, 197 normal images and 58 images with other radiolucent lesions were selected to improve model robustness. The images were cropped into global (affected half of the mandible) and local images (only the lesion) and then the dataset was split into 90% training and 10% testing sets. Data augmentation was performed on the training dataset. A two-route convolutional neural network using the global and local images was constructed for lesion classification. These outputs were concatenated into the object detection network for lesion localization. RESULTS: The classification network achieved a sensitivity of 1.00 (95% C.I. 0.63-1.00), specificity of 0.95 (0.86-0.99), and AUC (area under the receiver-operating characteristic curve) of 0.97 for radicular cysts and a sensitivity of 0.77 (0.46-0.95), specificity of 1.00 (0.93-1.00), and AUC of 0.88 for periapical granulomas. Average precision for the localization network was 0.83 for radicular cysts and 0.74 for periapical granulomas. CONCLUSIONS: The proposed model demonstrated reliable diagnostic performance for the detection and differentiation of radicular cysts and periapical granulomas. Using deep learning, diagnostic efficacy can be enhanced leading to a more efficient referral strategy and subsequent treatment efficacy. CLINICAL SIGNIFICANCE: A two-route deep learning approach using global and local images can reliably differentiate between radicular cysts and periapical granulomas on panoramic imaging. Concatenating its output to a localizing network creates a clinically usable workflow for classifying and localizing these lesions, enhancing treatment and referral practices." "Diagnosis and interdisciplinary treatment of a botryoid odontogenic cyst in the posterior mandible: Report of a case" "Michael Bornstein" "Botryoid odontogenic cysts (BOC) are considered to be rare polycystic variants of lateral periodontal cysts characterized by a multilocular growth pattern. The most frequent location of BOC is the mandible, predominantly the premolar-canine area, followed by the anterior region of the maxilla. The cyst shows a slight female predilection. This case report of a BOC demonstrates a treatment with initial fenestration and decompression of the cyst in order to prevent damage to adjacent structures such as the inferior alveolar nerve. The present case report emphasizes the importance of accurate clinical, radiographic, and histologic diagnostic procedures of unspecific radiolucent lesions in the jaws to establish a firm diagnosis and avoid inappropriate treatment strategies." "Influence of voxel size on the diagnostic ability of cone-beam computed tomography to evaluate simulated root perforations" "Olivia Nackaerts" "Objectives: This study aimed to assess the use of different voxel sizes of a cone-beam computed tomography (CBCT) unit for detecting root perforations of different sizes and locations ex vivo and to compare the diagnostic possibilities of CBCT with those of periapical radiography (PR). Methods: The study included 36 recently extracted intact human mandibular one-rooted teeth with developed apices. Root perforations of 0.2, 0.3, or 0.4 mm in diameter were drilled on the buccal and lingual sides at the cervical, middle, and apical thirds. A total of 216 portions were obtained. One tooth at a time was placed in a dry human mandible in an artificially created alveolus. Cross-sectional CBCT images were obtained using voxel resolutions of 0.4, 0.3, 0.25, and 0.2 mm. PRs were obtained using the paralleling technique in three directions in the horizontal plane: direct view, mesial angulation, and distal angulation with a 20 angle. Results: There were no significant differences in sensitivity between 0.4/0.3 and 0.25/0.2-mm voxel resolutions. Significant differences were found between voxel sizes of 0.4/0.25, 0.4/0.2, 0.3/0.25, and 0.3/0.2 mm. The observers failed to diagnose any of the perforations using PR. Conclusions: CBCT is a reliable imaging system for detecting root perforations that are not detectable with PR. A 0.2-mm voxel resolution was the best choice for diagnostic use in this study. Neither perforation location nor size influenced the diagnostic abilities of CBCT, except that it was harder to detect a root perforation in the apical part of the root. © 2013 Japanese Society for Oral and Maxillofacial Radiology and Springer Japan." "Cone beam computed tomography artefacts around dental implants with different materials influencing the detection of peri-implant bone defects" "Martina Schriber, Andy Wai Kan Yeung, Valerie GA Suter, Daniel Buser, Yiu Yan Leung, Michael Bornstein" "OBJECTIVES: To investigate the diagnostic accuracy of cone beam computed tomography (CBCT) for the diagnosis of peri-implant bone defects of titanium (Ti), zirconium dioxide (ZrO2 ) or titanium-zirconium (Ti-Zr) alloy implants. MATERIALS AND METHODS: Ti, Ti-Zr or ZrO2 implants with two diameters (3.3 mm, 4.1 mm) and one length (10 mm) were inserted in the angle of the mandible of six fresh defrosted pig jaws. Out of the 12 implants inserted, 6 served in the test group with standardized buccal peri-implant bone defects, whereas 6 served as control without bone defects. CBCTs were performed with three acquisition protocols (standard, high and low dose) using two devices. Four observers analysed CBCTs as follows: (a) presence of a peri-implant defect; (b) presence of peri-implant artefacts and impact on defect diagnosis; and (c) linear measurements of buccal peri-implant defect including height and width (in mm). RESULTS: CBCT device, CBCT settings, implant material, implant diameter and observer background did not significantly influence diagnostic accuracy. The sensitivity and specificity values were high for defect detection. ZrO2 led to a lower than average diagnostic accuracy (0.781). The linear measurements of peri-implant defect were underestimated by" "Osteomyelitis, osteoradionecrosis, or medication-related osteonecrosis of the jaws? Can CBCT enhance radiographic diagnosis?" "Constantinus Politis, Reinhilde Jacobs" "OBJECTIVE: To attempt defining differential radiographic diagnostic characteristics for osteonecrotic lesions using 2D as opposed to 3D images. MATERIALS AND METHODS: This was a cross-sectional study. Subjects presenting mandibular osteonecrotic lesions (osteomyelitis, osteoradionecrosis, and medication-related osteonecrosis of the jaws) were selected and compared to a group of age- and gender-matched controls, all having both cone-beam computed tomographic images (CBCT) and panoramic radiographs (PANO). Both imaging modalities (predictor variables) were evaluated by two radiologists that scored lesion presence, eight additional radiological features, and a composite severity index (outcome variables). For each pathologic condition, characteristic features were assessed in PANO and CBCT by the Wilcoxon signed-rank test. Regression tree analysis revealed the predictive value of PANO and CBCT (α = 5%). RESULTS: Overall, the predictive value of PANO reached 74%, while for CBCT it became 90%. Regarding the composite severity index, CBCT enabled to detect more subtle lesions. Also, CBCT imaging allowed showing more distinct radiographic diagnostic features as compared to PANO imaging, more specifically when distinguishing osteomyelitis from both other lesions. CONCLUSIONS: Cone-beam computed tomography enabled showing more differences in radiological features between distinct osteonecrosis disease entities. CBCT imaging might be a better contributor for the detection of early lesions and to monitor further pathological developments in the mandible." "Selecting the skeletal mandibular identifiers with the strongest potential for human identification on panoramic radiographs" "Anca Iliescu, Cezar Capitaneanu, Debora Hürter, Steffen Fieuws, Jannick De Tobel, Patrick Thevissen" "Background: The gold standard of odontological identification relies on dental treatment, morphology and morphometry comparisons between ante-mortem and post-mortem dental files (1). However, the decrease in dental restorations reduces the occurrence of unique dental identifiers (2). Nevertheless, dental radiographs contain more than just dental information. For instance, panoramic radiographs depict the entire mandible. Therefore, the current study aimed to select the best mandibular morphological traits with a strong identifying capacity. Material and methods: One hundred eighty-five digital panoramic radiographs (94 males and 91 females; age range 16-66 years) were retrospectively collected from a private dental clinic in Brussels, Belgium, and imported into image enhancement software. Four landmarks were located on the mandible, namely the most superior point of the condyle right/left (CONR/L), the most superior point of the coronoid right/left (CORR/L), the most superior point of the mandibular lingula right/left (LINR/L) and the most mesial point of the mental foramen right/left (MMFR/L). Based on the landmarks 5 linear measurements were performed bilaterally. Using the linear measurements, 6 angles and 10 ratios were calculated. In order to determine and quantify the identifying capacity, three groups of statistics were considered: [1] inter- observer agreement quantified by intra-class correlation (ICC) and within-subject coefficient of variation (WSCV) (3); [2] mean “potential set”, which represents the percentage of subjects in the ante-mortem reference dataset you at least need to consider in order to detect the target, i.e. the unknown subject; [3] Spearman correlation between parameters. Based on those statistics, a selection of parameters was conducted to establish a three-step univariate cascade (high caseload, e.g. mass disaster) as well as a multivariate cascade (low caseload). The cascades provide the user with an easy and practical application of the selected parameters, with the benefit of further narrowing down the ante-mortem dataset as the user progresses through the steps of the cascade. Results: In the univariate setting, the following parameters proved to have the best identifying capacity: ratio 3 on the right side (between lines CONR – CORR and LINR – MMFR) with ICC 0.90, WSCV 4.8% and mean potential set 13%; ratio 4 (between lines CONR/L - CORR/L and MMFR - MMFL) with ICC 0.92, WSCV 8.9% and mean potential set 13%; and angle 4 on the left side (between landmarks LINL, MMFL and MMFR) with ICC 0.91, WSCV 1.2% and mean potential set of 18% The correlation coefficients between angle 4 and ratios 3 and 4 ranged from 0.01 to 0.33, indicating that they provide complementarity rather than overlapping identifying information. Combining parameters in the multivariate setting, the identifying capacity improved drastically: all ratios combined (mean potential set 1.3%) and all angles combined (mean potential set 2.6%). Conclusions: Specific univariate and multivariate cascades were provided to select the parameters with the best identifying capacity, based on morphometric mandibular traits. In high caseload assignments, a single ratio or a single angle already narrows down the set of potential matches, but the mean potential set remains relatively large. Combining all ratios or all angles drastically increases the certainty of the match, and is therefore recommended, especially in low caseload assignments." "[Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 1: epidemiology, etiology, classification and associated complications]." "Michael Bornstein" "Supernumerary teeth develop in addition to the normal dentition and are a therapeutic challenge for pedodontists, orthodontists and oral surgeons alike. Therefore, interdisciplinary treatment concepts are needed for the benefit of the patient. In the present, two-parted literature review on supernumerary teeth, current classification, associated complications, diagnostic steps and different therapeutic approches are presented and discussed. Supernumerary teeth are diagnosed in the primary and permanent dentition. Supernumerary incisors, canines, premolars, and molars, as well as distomolars and mesiodentes can be seen according to the location of the supernumerary teeth. Furthermore, based on the morphology of the supernumeraries four different types can be differentiated: conical, tuberculate, supplemental, and odontoma. Supernumerary teeth often remain asymptomatic, and are only diagnosed incidentally during a routine dental visit on radiographs (often intraoral). Nevertheless, various complications have been reported in the literature for supernumerary teeth such as disturbed eruption, malpositioning/rotation, root resorption of neighbouring teeth, and development of dentigerous cysts in impacted supernumeraries. Root resorption of neighbouring teeth can be radiographically diagnosed in up to 22.8% of the cases." "Impact of cone-beam computed tomography scan mode on the diagnostic yield of chemically simulated external root resorption" "Karla De Faria Vasconcelos" "INTRODUCTION: The aim of this in-vitro study was to evaluate the influence of cone-beam computed tomography scans on the diagnosis of chemically simulated external root resorption. METHODS: One hundred extracted anterior teeth were selected. Subsurface demineralization was induced on a limited area of the apical third of the root of 49 teeth. Each tooth was placed in an empty socket of a partially edentulous dry mandible. Cone-beam computed tomography images were obtained according to 3 protocols: (1) half scan, 0.40-mm voxel size; (2) full scan, 0.40-mm voxel size; and (3) full scan, 0.125-mm voxel size. Three observers evaluated the images. Sensitivity, specificity, accuracy, and area under the curve were compared with the Cochran Q and Mann-Whitney U tests. RESULTS: Protocol 3 had the highest sensitivity (81.63%), accuracy (80.67%), and area under the curve (0.807). There were statistically significant differences between protocol 3 and the other 2 protocols (P "