Background: To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters.Methods: In this cross‐sectional, retrospective 2‐ to 4‐year study involving 45 patients treated with maxillary anterior single‐tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single‐tooth implants.Results: All 45 anterior maxillary single‐tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri‐implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 ± 1.18 (range: 11 to 18). The mean total PES of 7.8 ± 0.88 (range: 6 to 9) documents favorable overall peri‐implant soft tissue conditions. The two PES variables facial mucosa curvature (1.9 ± 0.29) and facial mucosa level (1.8 ± 0.42) had the highest mean values, whereas the combination variable root convexity/soft tissue color and texture (1.2 ± 0.53) proved to be the most difficult to fully satisfy. Mean scores were 1.6 ± 0.5 for the mesial papilla and 1.3 ± 0.5 for the distal papilla. A mean value of 6.9 ± 1.47 (range: 4 to 10) was calculated for WES.Conclusions: This study demonstrated that anterior maxillary single‐tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single‐tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.

In implant dentistry, three-dimensional (3D) imaging can be realised by dental cone beam computed tomography (CBCT), offering volumetric data on jaw bones and teeth with relatively low radiation doses and costs. The latter may explain why the market has been steadily growing since the first dental CBCT system appeared two decades ago. More than 85 different CBCT devices are currently available and this exponential growth has created a gap between scientific evidence and existing CBCT machines. Indeed, research for one CBCT machine cannot be automatically applied to other systems. Supported by a narrative review, recommendations for justified and optimized CBCT imaging in oral implant dentistry are provided. The huge range in dose and diagnostic image quality requires further optimization and justification prior to clinical use. Yet, indications in implant dentistry may go beyond diagnostics. In fact, the inherent 3D datasets may further allow surgical planning and transfer to surgery via 3D printing or navigation. Nonetheless, effective radiation doses of distinct dental CBCT machines and protocols may largely vary with equivalent doses ranging between 2 to 200 panoramic radiographs, even for similar indications. Likewise, such variation is also noticed for diagnostic image quality, which reveals a massive variability amongst CBCT technologies and exposure protocols. For anatomical model making, the so-called segmentation accuracy may reach up to 200 μm, but considering wide variations in machine performance, larger inaccuracies may apply. This also holds true for linear measures, with accuracies of 200 μm being feasible, while sometimes fivefold inaccuracy levels may be reached. Diagnostic image quality may also be dramatically hampered by patient factors, such as motion and metal artefacts. Apart from radiodiagnostic possibilities, CBCT may offer a huge therapeutic potential, related to surgical guides and further prosthetic rehabilitation. Those additional opportunities may surely clarify part of the success of using CBCT for presurgical implant planning and its transfer to surgery and prosthetic solutions. Hence, dental CBCT could be justified for presurgical diagnosis, preoperative planning and peroperative transfer for oral implant rehabilitation, whilst striving for optimisation of CBCT based machine-dependent, patient-specific and indication-oriented variables.

Objectives: Analysis of dental radiographs is an important part of the diagnostic process in daily clinical practice. Interpretation by an expert includes teeth detection and numbering. In this pro...

Objectives: To investigate the current clinical applications and diagnostic performance of artificial intelligence (AI) in dental and maxillofacial radiology (DMFR). Methods: Studies using applications related to DMFR to develop or implement AI models were sought by searching five electronic databases and four selected core journals in the field of DMFR. The customized assessment criteria based on QUADAS-2 were adapted for quality analysis of the studies included. Results: The initial electronic search yielded 1862 titles, and 50 studies were eventually included. Most studies focused on AI applications for an automated localization of cephalometric landmarks, diagnosis of osteoporosis, classification/segmentation of maxillofacial cysts and/or tumors, and identification of periodontitis/periapical disease. The performance of AI models varies among different algorithms. Conclusion: The AI models proposed in the studies included exhibited wide clinical applications in DMFR. Nevertheless, it is still necessary to further verify the reliability and applicability of the AI models prior to transferring these models into clinical practice.

Michael M. Bornstein, PD Dr Med Dent/William C. Scarfe, BDS, FRACDS, MS/Vida M. Vaughn/Reinhilde Jacobs, DDS, MSc, PhD, Dr hc: Purpose: The aim of the paper is to identify, review, analyze, and summarize available evidence in three areas on the use of cross-sectional imaging, specifically maxillofacial cone beam computed tomography (CBCT) in pre- and postoperative dental implant therapy: (1) Available clinical use guidelines, (2) indications and contraindications for use, and (3) assessment of associated radiation dose risk. Materials and Methods: Three focused questions were developed to address the aims. A systematic literature review was performed using a PICO-based search strategy based on MeSH key words specific to each focused question of English-language publications indexed in the MEDLINE database retrospectively from October 31, 2012. These results were supplemented by a hand search and gray literature search. Results: Twelve publications were identified providing guidelines for the use of cross-sectional radiography, particularly CBCT imaging, for the pre- and/or postoperative assessment of potential dental implant sites. The publications discovered by the PICO strategy (43 articles), hand (12), and gray literature searches (1) for the second focus question regarding indications and contraindications for CBCT use in implant dentistry were either cohort or case-controlled studies. For the third question on the assessment of associated radiation dose risk, a total of 22 articles were included. Publication characteristics and themes were summarized in tabular format. Conclusions: The reported indications for CBCT use in implant dentistry vary from preoperative analysis regarding specific anatomic considerations, site development using grafts, and computer-assisted treatment planning to postoperative evaluation focusing on complications due to damage of neurovascular structures. Effective doses for different CBCT devices exhibit a wide range with the lowest dose being almost 100 times less than the highest dose. Significant dose reduction can be achieved by adjusting operating parameters, including exposure factors and reducing the field of view (FOV) to the actual region of interest.