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Panoramic radiography carried out perfectly. The dark space between the two dental arches represented by the occlusal plane shows a mild upper concavity, since the Frankfort and occlusal planes tend to converge posteriorly.
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Objectives: A panoramic radiograph (PAN) is the most frequently diagnostic imaging
technique carried out in dentistry and oral surgery. The correct performance of image acquisition is crucial to obtain adequate image quality. The aim of the present study is to (i) review the principles of PAN image acquisition and (ii) describe positioning errors a...
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Context 1
... inclination of the occlusal plane is strictly related to the position of the Frankfort plane, since the two planes tend to converge posteriorly [24,25]. When a PAN is correctly performed, the X-ray beam is parallel to the Frankfort plane, which causes the posterior areas to be placed in a higher position than the anterior ones (Figure 7) [15]. If a patient's head is nodded down-teeth anterior to the focal trough-the concavity of the occlusal plane appears increased ( Figure 5). ...
Context 2
... inclination of the occlusal plane is strictly related to the position of the Frankfort plane, since the two planes tend to converge posteriorly [24,25]. When a PAN is correctly performed, the X-ray beam is parallel to the Frankfort plane, which causes the posterior areas to be placed in a higher position than the anterior ones (Figure 7) [15]. If a patient's head is nodded down-teeth anterior to the focal trough-the concavity of the occlusal plane appears increased ( Figure 5). ...
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The development of radiology, rapid prototyping techniques, and the increasingly common use of 3D printing in dentistry inspires the use of these techniques to improve diagnostic and therapeutic processes. This study aimed to conduct a retrospective comparative analysis of dental panoramic radiographs, cone-beam computed tomography, and 3D printing...
Citations
... PRs are often taken immediately after PAN to complement the initial assessment. PAN is utilized in numerous practices and has been shown to be useful in different applications, including orthodontics, surgery, and periodontology [9]. However, its role in endodontic assessment, particularly in diagnosing periapical lesions and other endodontic conditions, remains controversial due to its limited diagnostic accuracy [10,11]. ...
Background/Objectives: The purpose of this preliminary study was to evaluate the diagnostic performance of an AI-driven platform, Diagnocat (Diagnocat Ltd., San Francisco, CA, USA), for assessing endodontic treatment outcomes using panoramic radiographs (PANs). Materials and Methods: The study included 55 PAN images of 55 patients (15 males and 40 females, aged 12–70) who underwent imaging at a private dental center. All images were acquired using a Hyperion X9 PRO digital cephalometer and were evaluated using Diagnocat, a cloud-based AI platform. The AI system assessed the following endodontic treatment features: filling probability, obturation adequacy, density, overfilling, voids in filling, and short filling. Two human observers independently evaluated the images, and their consensus served as the reference standard. The diagnostic accuracy metrics were calculated. Results: The AI system demonstrated high accuracy (90.72%) and a strong F1 score (95.12%) in detecting the probability of endodontic filling. However, the system showed variable performance in other categories, with lower accuracy metrics and unacceptable F1 scores for short filling and voids in filling assessments (8.33% and 14.29%, respectively). The accuracy for detecting adequate obturation and density was 55.81% and 62.79%, respectively. Conclusions: The AI-based system showed very high accuracy in identifying endodontically treated teeth but exhibited variable diagnostic accuracy for other qualitative features of endodontic treatment.
... 9 The advantages of this imaging technique are its availability in many clinical settings, providing an overall overview of dental and jaw conditions, and low radiation exposure. 10,11 In panoramic radiographs, the difficulty of third molar surgery can be evaluated, and the proximity of the third molar root to vital structures such as the IAN in the mandible and the maxillary sinus in the maxilla can be examined. 9,12 However, because of the two-dimensional nature of panoramic radiography, anatomical structures overlap in many situations, making image interpretation challenging. ...
Purpose: This study aimed to assess the performance of the ResNet-50 deep learning algorithm in classifying panoramic images to determine contact between mandibular third molars and inferior alveolar nerve (IAN), comparing its performance with newly graduated dentists and oral and maxillofacial surgery specialists.
Methods: Panoramic radiographs of mandibular third molars were retrieved from the Radiology Department, School of Dentistry, Kashan University of Medical Sciences. The images were independently classified as "contact" or "none-contact" by the ResNet-50 model, three newly graduated dentists, and three oral and maxillofacial surgery specialists. A maxillofacial radiologist sets the gold standard using cone beam-CT. The accuracy, precision, recall, specificity, and dice coefficient were calculated for each group, with inter-rater reliability assessed using Cohen's kappa value.
Results: Of the 548 images retrieved, 15% were allocated as the testing dataset, amounting to 82 images. The deep learning model showed the highest performance metrics, with an accuracy of 87.80%, precision of 78.57%, recall of 84.61%, specificity of 89.28%, and dice coefficient of 81.48%. Conversely, novice dentists had the lowest performance metrics (accuracy: 74.39% ± 2.99%, precision: 57.75% ± 4.33%, recall: 74.36% ± 1.81%, specificity: 74.4% ± 4.46%, and dice coefficient: 64.87% ± 2.69%). Specialists demonstrated accuracy of 84.96% ± 1.52%, precision of 72.65% ± 2.78%, recall of 84.61% ± 3.14%, specificity of 85.12% ± 2.23%, and dice coefficient of 78.11% ± 1.99%.
Conclusion: Deep learning algorithms can achieve comparable outcomes with oral and maxillofacial specialists and may outperform novice clinicians in diagnosing contact between third molars and IAN.
K E Y W O R D S machine intelligence, mandibular nerve injuries, neural network, panoramic radiography, third molar, vision system
... Regarding radiographic diagnosis, orthopantomography (OPG) is a diagnostic tool frequently used in dental practice. It provides a broad view of the maxillofacial structures, including dental arches, alveolar bones, temporomandibular joints, and facial bones, and depicts them in one image [16]. Managing MTMI poses complications such as postoperative bleeding, alveolitis, mandibular angle fracture, transient inferior alveolar nerve damage, and a permanent loss of nerve sensation. ...
... As a routine diagnostic tool, OPG is used to visualize MTMI [16]. Although it has limitations in magnification, superimposition, and the inadequate sharpness of delicate structures, it assists in mapping out the position of MTMI and providing insight into its associated pathologies and the effect on nearby structures [31]. ...
Panoramic radiography (OPG) evaluates mandibular third molar impaction (MTMI). This systematic review aimed to investigate the diagnostic accuracy of OPG in detecting bone loss distal to the lower second molars. The associated bone loss with different impaction positions and the most prevalent positions of MTMI were investigated as secondary outcomes. In January 2023, PubMed, Scopus, and Cochrane were searched to identify studies published between January 2012 and January 2023. Two examiners blindly selected the eligible studies for data extraction and quality assessment. Of 427 studies, 8 were suitable for data extraction. All studies reported bone loss distal to the second molar using OPG, ranging from 4.9 to 62.9%. The most frequent position of MTMI is mesioangular. The distal bone loss in the vertical and horizontal positions is statistically significant compared to typically positioned third molars and those that are fully erupted or impacted, but in a normal orientation (p-value 0.005 and 0.02, respectively). Bone loss was not statistically significant in the mesioangular position compared to other impacted positions (p-value 0.14). The risk of bias ranges between 66 and 88%. Despite its limitations, OPG is still considered a valuable tool to assess bone loss distal to the lower second molar in cases of an impacted mandibular third molar.
... Intra-oral periapical radiography and panoramic radiography are the most commonly used types of radiography for determining ABL in dental practice. However, these two radiography techniques have drawbacks such as only providing information on the mesial and distal sites of the teeth due to their two dimensional imaging of the three-dimensional structure of the periodontal tissue, which prevents assessment of buccal and lingual ABL [17]. Moreover, it has been reported that periapical radiography is usually associated with underestimation of ABL of approximately 1.41 ± 2.58 mm [17], whereas panoramic radiography leads to magnification and does not provide accurate detail of the structure, especially in the anterior region, due to overlapping of teeth and other anatomical structures [18]. ...
... However, these two radiography techniques have drawbacks such as only providing information on the mesial and distal sites of the teeth due to their two dimensional imaging of the three-dimensional structure of the periodontal tissue, which prevents assessment of buccal and lingual ABL [17]. Moreover, it has been reported that periapical radiography is usually associated with underestimation of ABL of approximately 1.41 ± 2.58 mm [17], whereas panoramic radiography leads to magnification and does not provide accurate detail of the structure, especially in the anterior region, due to overlapping of teeth and other anatomical structures [18]. It is important to acknowledge that minute changes in correctly identifying the cemento-enamel junction and alveolar bone crest will significantly influence the prevalence and severity of periodontal diseases in a population [19]. ...
Periodontal disease is a site-specific disease affecting the supporting tissues of the teeth. It is useful for the clinician to have information about the prevalence and severity of alveolar bone loss (ABL) according to the site, location, and position of the teeth for a better treatment plan and expected prognosis. This study aimed to assess the prevalence and severity of ABL at mesial, distal, buccal and lingual sites of teeth in different locations, positions and sides of the dentition. The ABL of 20,620 sites of 5155 teeth in 212 patients was assessed using cone-beam computed tomography from the cemento-enamel junction to the crest of the alveolar bone. The prevalence of ABL was higher in the interproximal sites as well as anterior and mandibular teeth compared to their counterparts. Buccal sites and anterior teeth revealed higher ABL levels than the other tooth sites and posterior teeth, respectively. Furthermore, associations in the severity of ABL were observed between distal and mesial sites, buccal and lingual sites, maxillary and mandibular teeth, anterior and posterior teeth, and right and left sides. This study showed that the prevalence and severity of ABL differ from one tooth site to another and according to the tooth’s location in the dentition. Higher prevalences were found in the interproximal sites, anterior teeth and mandibular teeth; higher ABL was found in buccal and distal sites, with the strongest associations between distal and mesial sites, buccal and lingual sites, and right and left sides.
... Unlike the traditional intraoral radiography, panoramic imaging offers a broad perspective, essential for a holistic assessment of dental health. It is particularly invaluable in identifying problems in areas such as tooth positioning, impacted teeth, and the development of tumors [3][4][5][6]. Moreover, in orthodontic treatments, tooth extractions, and pre-surgical planning, panoramic images offer clinicians a clear and detailed view, crucial for designing precise orthodontic appliances, assessing surgical risks, and formulating effective treatment plans, thereby significantly enhancing patient care [7,8]. ...
In this paper, we introduce a novel deep learning method for dental panoramic image segmentation, which is crucial in oral medicine and orthodontics for accurate diagnosis and treatment planning. Traditional methods often fail to effectively combine global and local context, and struggle with unlabeled data, limiting performance in varied clinical settings. We address these issues with an advanced TransUNet architecture, enhancing feature retention and utilization by connecting the input and output layers directly. Our architecture further employs spatial and channel attention mechanisms in the decoder segments for targeted region focus, and deep supervision techniques to overcome the vanishing gradient problem for more efficient training. Additionally, our network includes a self-learning algorithm using unlabeled data, boosting generalization capabilities. Named the Semi-supervised Tooth Segmentation Transformer U-Net (STS-TransUNet), our method demonstrated superior performance on the MICCAI STS-2D dataset, proving its effectiveness and robustness in tooth segmentation tasks.
... Dental panoramic radiography is a widely used diagnostic tool [4] to assess the maxilla, the mandible, and the teeth and any lesions in these structures [5]. However, its image quality and diagnostic value can be limited by artefacts resulting from factors such as improper tongue placement or dental implants [6]. In this context, photon counting detectors could provide significant advantages by allowing the calculation of virtual monoenergetic or material-decomposed panoramic images [7]. ...
Modern photon counting detectors allow the calculation of virtual monoenergetic or material decomposed X-ray images but are not yet used for dental panoramic radiography systems. To assess the diagnostic potential and image quality of photon counting detectors in dental panoramic radiography, ethics approval from the local ethics committee was obtained for this retrospective study. Conventional CT scans of the head and neck region were segmented into bone and soft tissue. The resulting datasets were used to calculate panoramic equivalent thickness bone and soft tissue images by forward projection, using a geometry like that of conventional panoramic radiographic systems. The panoramic equivalent thickness images were utilized to generate synthetic conventional panoramic radiographs and panoramic virtual monoenergetic radiographs at various energies. The conventional, two virtual monoenergetic images at 40 keV and 60 keV, and material-separated bone and soft tissue panoramic equivalent thickness X-ray images simulated from 17 head CTs were evaluated in a reader study involving three experienced radiologists regarding their diagnostic value and image quality. Compared to conventional panoramic radiographs, the material-separated bone panoramic equivalent thickness image exhibits a higher image quality and diagnostic value in assessing the bone structure (p < .001) and details such as teeth or root canals (p < .001). Panoramic virtual monoenergetic radiographs do not show a significant advantage over conventional panoramic radiographs. The conducted reader study shows the potential of spectral X-ray imaging for dental panoramic imaging to improve the diagnostic value and image quality.
... Astfel, la etapa actuală, CBCT-ul se consideră a fi standardul "de aur" în vizualizarea raportului molarilor trei inferiori cu structurilor anatomice învecinate. CBCT-ul este tot mai des utilizat în practica medicală, datorită dozei mai reduse de radiaţie comparativ cu CT-ul convenţional, posibilitatea vizualizării în format tridimensional a imaginii, precum și costul mai redus comparativ cu alte metode imagistice performante [6]. Totuși realizarea CBCT-ului are indicaţii bine definite în cazul patologiilor molarilor de minte, fiind necesar în acele situaţii clinice când ortopantomografia convenţională nu oferă suficiente date referitor la poziţia anatomică, raportul cu structurile anatomice și riscul operator. ...
... Nowadays, the CBCT is considered to be the "gold" standard in visualizing the relationship of the third lower molars with the neighboring anatomical structures. CBCT is increasingly used in medical practice, due to the lower dose of radiation compared to conventional CT, the possibility of viewing the image in three-dimensional format, as well as the lower cost compared to other performing imaging methods [6]. However, performing CBCT has well-defined indications in the case of wisdom molar pathologies, being necessary in those clinical situations when conventional orthopantomography does not provide sufficient data regarding the anatomical position, the relationship with the anatomical structures and the operative risk. ...
Odontectomy of the inferior wisdom teeth is considered to be one of the most frequently performed dental surgeries. It is certain that in order to prevent possible complications, the oral surgeon must have extensive knowledge regarding the anatomy of the region, possible intra– and postoperative risks, as well as treatment methods that would minimize the occurrence of complications. Of course, a key aspect in choosing the treatment technique and method is represented by the paraclinical investigations, and currently CBCT is considered to be the “golden” standard in visualizing the relationship of the third inferior molars to the neighboring anatomical structures, a fact that significantly contributes to the optimization the provision of dental surgical assistance. The purpose of this study was to reveal the role of the CBCT paraclinical radiological examination in the pre–surgical evaluation of the anatomical relationships of the roots of the lower third molars with the neighboring anatomical elements for the prophylaxis of postextractional complications. Material and methods. The prospective clinical study was based on the visualization of tomographic sections of 116 CBCTs, with a total of 160 inferior wisdom teeth, analyzing various study variables such as the relationship of the inferior wisdom teeth roots to the mandibular canal, to the lingual bony plate, root morphology, etc., with their subsequent statistical analysis. Results and discussion. The extraction of the lower wisdom teeth can be associated with the occurrence of various complications such as the association of postoperative infection, dislodging the teeth into the neighboring spaces, nerve damage. It is important to use preoperatively both the predictability scale of the difficulty of extraction of inferior third molar and the three–dimensional paraclinical investigations in order to plan a treatment plan involving low risks of intra– and postoperative complications. Conclusions. The use of three–dimensional paraclinical investigations such as CBCT are absolutely necessary both for visualizing the relationship between anatomical structures and for planning complex clinical cases.
... However, the field of oral radiology has undergone a remarkable transformation in recent years, characterized by the emergence of innovative technologies and techniques that have revolutionized the way dental imaging is conducted. 1,2 It is imperative for dental students, as the future custodians of oral health, to remain abreast of these cutting-edge developments in oral radiology. The traditional methods of radiography, such as intraoral and panoramic radiographs, have been supplemented, and in some cases, supplanted, by state-ofthe-art advancements like cone-beam computed tomography (CBCT), digital radiography, 3D imaging, and artificial intelligenceassisted radiological interpretation. ...
Background: Oral radiology plays a crucial role in dental practice, with emerging trends such as 3D imaging, artificial intelligence (AI) integration, and tele-dentistry reshaping the field. This study aimed to assess the knowledge and awareness of these trends among dental students. Methods: A cross-sectional survey was conducted among 104 dental students in Chennai, using a structured questionnaire. The participants included undergraduate and postgraduate students. Data were collected through online platforms and analysed using PSPP 3.0 software
... It is useful for general dental and orthodontic evaluations. It is also less prone to image distortions from movement than CBCT [9]. ...
Objectives: This study aimed to examine the impact of demographic variables on mandibular condyle morphology, a critical factor in orthodontic treatment and maxillofacial surgery. The investigation focuses on the relationship between gender, age, and skeletal class with the morphological dimensions of the condyle, utilizing panoramic radiography as a diagnostic tool.
Methodology: A retrospective analysis was conducted on 150 panoramic radiographs from individuals stratified into six groups according to gender and skeletal class. Skeletal classes were determined using Steiner and McNamara cephalometry. The Kodak Carestream software (Rochester, NY: Carestream Health) was employed to measure condylar height, width, and morphology. Statistical evaluations included ANOVA, correlation assessments, and multivariate binary logistic regression to discern the differences and associations among the variables studied.
Results: The findings revealed notable differences in condylar dimensions between genders across different skeletal classes, with males typically presenting larger condylar dimensions than females. The data also showed a moderate positive correlation between condyle height and width. Round-shaped condyles were the most common form found, with significant gender differences observed in certain skeletal classes. Additionally, logistic regression analysis identified significant associations between gender, age, and condylar width and shape.
Conclusions: The study concludes that demographic factors, such as gender and age, significantly affect mandibular condyle morphology. These factors should be carefully considered in clinical evaluations using panoramic radiography to enhance the precision of diagnoses and the effectiveness of subsequent orthodontic and maxillofacial treatments. The results provide valuable insights for healthcare professionals in regions where more advanced imaging techniques may not be readily available.
... Patients with clear suspicion of jaw deformity or tumor based on the images were excluded. The image quality of panoramic radiograph was assessed by Izetti et al. [19]. Synmetry, inclination of the occlusal plane, localization of mandibular condyles, aspect of upper teeth root apexes, and position of the cervical spine were assessed. ...
Background: Oral frailty is associated with systemic frailty. The vertical position of the hyoid bone is important when considering the risk of dysphagia. However, dentists usually do not focus on this position. Purpose: To create an AI model for detection of the position of the vertical hyoid bone. Methods: In this study, 1830 hyoid bone images from 915 panoramic radiographs were used for AI learning. The position of the hyoid bone was classified into six types (Types 0, 1, 2, 3, 4, and 5) based on the same criteria as in our previous study. Plan 1 learned all types. In Plan 2, the five types other than Type 0 were learned. To reduce the number of groupings, three classes were formed using combinations of two types in each class. Plan 3 was used for learning all three classes, and Plan 4 was used for learning the two classes other than Class A (Types 0 and 1). Precision, recall, f-values, accuracy, and areas under the precision–recall curves (PR-AUCs) were calculated and comparatively evaluated. Results: Plan 4 showed the highest accuracy and PR-AUC values, of 0.93 and 0.97, respectively. Conclusions: By reducing the number of classes and not learning cases in which the anatomical structure was partially invisible, the vertical hyoid bone was correctly detected.
