Background: The purpose of this investigation was to develop a computer-assisted detection system based on a deep convolutional neural network (CNN) algorithm and to evaluate the accuracy and usefulness of this system for the detection of alveolar bone loss in periapical radiographs in the anterior region of the dental arches. We also aimed to evaluate the usefulness of the system in categorizing the severity of bone loss due to periodontal disease. Method: A data set of 1724 intraoral periapical images of upper and lower anterior teeth in 1610 adult patients were retrieved from the ROMEXIS software management system at King Saud bin Abdulaziz University for Health Sciences. Using a combination of pre-trained deep CNN architecture and a self-trained network, the radiographic images were used to determine the optimal CNN algorithm. The diagnostic and predictive accuracy, precision, confusion matrix, recall, F1-score, Matthews Correlation Coefficient (MCC), Cohen Kappa, were calculated using the deep CNN algorithm in Python. Results: The periapical radiograph dataset was divided randomly into 70% training, 20% validation, and 10% testing datasets. With the deep learning algorithm, the diagnostic accuracy for classifying normal versus disease was 73.0%, and 59% for the classification of the levels of severity of the bone loss. The Model showed a significant difference in the confusion matrix, accuracy, precision, recall, f1-score, MCC and Matthews Correlation Coefficient (MCC), Cohen Kappa, and receiver operating characteristic (ROC), between both the binary and multi-classification models. Conclusion: This study revealed that the deep CNN algorithm (VGG-16) was useful to detect alveolar bone loss in periapical radiographs, and has a satisfactory ability to detect the severity of bone loss in teeth. The results suggest that machines can perform better based on the level classification and the captured characteristics of the image diagnosis. With additional optimization of the periodontal dataset, it is expected that a computer-aided detection system can become an effective and efficient procedure for aiding in the detection and staging of periodontal disease.

Background: The clinical attachment level (CAL) and radiographically assessed bone levels are used to assess the loss of periodontal tissue support in periodontitis, a chronic, multifactorial inflammatory disease of the periodontium. However, few studies have been done to study the relationship between these two parameters. According to our knowledge, this is the first study investigating the relationship between the two measurements using intraclass correlation analysis.Aim: The aim of the study is to investigate the relationship between CAL and radiographically assessed bone level in teeth affected with periodontitis.Methods: A retrospective cross‐sectional study was conducted by selecting a sample of 880 periodontal sites in 104 periodontitis patients, aged 25–60 years. CAL and peri‐apical radiographs of the selected sites were obtained from the computerized patient records. The distance from the cemento‐enamel junction (CEJ) to the base of the alveolar bone level (ABL) was measured. The data was analyzed using SPSS.Results: Intraclass correlation analysis (ICC) revealed a moderate degree of reliability between CAL and CEJ to ABL measurements. The average ICC was 0.68 with a 95% confidence interval of 0.53–0.77 (p < .001) indicating moderate to good reliability. Comparing the types of teeth, the central incisors, particularly the lower central incisors showed the highest ICC values (ICC: 0.822, CI: 0.77–0.86) indicating good reliability while the premolar and molars showed poor to moderate agreement (Maxillary premolars ICC: 0.464, CI: −0.18–0.74; maxillary first molar ICC: 0.516, CI: −0.154–0.772; mandibular first premolar ICC: 0.662, CI: 0.269–0.782; mandibular first molar ICC: 0.625, CI: 0.31–0.82). A moderate correlation existed between the radiographic and the clinical assessments (r = 0.5, p < .001).Conclusion: Despite the fact that significant varying levels of reliability has been found between CAL and radiographic bone level, both the clinical and radiographic examinations should be performed for the accuracy of diagnosis.

The aim of this article is to shed light on coronavirus disease 2019 (COVID-19) and its oral effects and risk of nosocomial transmission to update the knowledge of dental health care workers. A thorough literature search of the PubMed/Embase/Web of Science/Cochrane central database was conducted to identify the impact of COVID-19 on oral health. We reviewed the recommendations on the recent guidelines set by the Centers for Disease Control and Prevention infection control practices for dentistry, American Dental Association, and the World Health Organization. According to the available evidence, COVID-19 may have a negative impact on the oral health due to the infection itself and due to various other consequences such as therapeutic measures, xerostomia, and other complications of the COVID-19. In light of the above facts, dentists should be wary of the disease, its identification, mode of spread and impacts on the oral health. The dental personnel have been identified as at the highest risk of getting COVID-19 due to cross infection from contact with their patients and aerosols generated in routine dental procedures. As such, they should be aware of the modifications that need to be made to the practice to prevent transmission of the disease. It is evident that COVID-19 has a negative impact on the oral health and at the same time a significant transmission risk to the dental personnel and patients who visit the clinic. If the recommendations issued by the regulatory authorities are meticulously followed, the risk of disease transmission can be lessened.

Objectives: The aim of the present study was to measure the thickness of the palatal mucosa in a Jordanian (Middle Eastern) population as well as identify possible factors that may influence the thickness of palatal mucosa.Material and Methods: Sixty period on tally healthy subjects (29 males and 31 females) were selected. Fifteen measurement points were defined on the palate. The mucosal thickness in the hard palate was determined by “bone sounding” with a Hu‐Friedy® round periodontal probe.Results: The overall mean thickness of the palatal masticatory mucosa was 3.23 ± 0.47 mm.The mean thickness increased from the gingival margin to a more apical position irrespective of the tooth measured or side of the mouth in the following sequence: canine, second molar, first premolar, second premolar and lastly, the first molar. No significant difference between gender, smoking status, gingival phenotype andsides of the mouth with the thickness of palatal masticatory mucosa was determined. A significant difference between palatal shape and palatal gingival thickness was found.Conclusions: The most appropriate site for graft harvesting is the canine‐premolar area 8‐13 mm from the mid‐palatal aspect of each respective tooth in a Jordanian population. Except for the palatal shape, the side of the mouth, smoking, gender or gingival phenotype does not affect the graft harvest.Clinical Relevance: Scientific Rationale for Study: Knowledge on the thickness of the masticatory mucosa is crucialin making decisions for surgical treatment modality and may affect surgical outcome. We measured the thickness of the palatal mucosa in a Jordanian population and identified possible influencing factors.Principal Findings: The thickness varied according to the teeth and the canine to premolar region was found to be the appropriate donor site.Practical Implications: This information on safe zone for graft harvest can guide the periodontist to make appropriate incisions and choose the appropriate location to obtain a graft of adequate thickness and dimensions.

The objective of this study is to evaluate the effectiveness of discontinuing high-dose antiresorptive (AR) therapy in reducing the risk of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with AR medications and undergoing dentoalveolar surgery or tooth extractions. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A literature search was conducted using the databases MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception till the 1st of April, 2022. Both observational and interventional studies that evaluated the effect of AR drug holiday in the development of MRONJ in patients receiving AR medications and who require dentoalveolar surgical procedures were included. Trials published as abstracts, case reports, case series, non-systematic reviews, and others were excluded. All findings were reported as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the methodological quality assessment, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to evaluate the quality of the evidence. Eight articles (6808 subjects) were included for analysis. Of the participants, 4847 cases (drug holiday group) were compared to 1961 controls (non-drug holiday group). Based on the random effects model, the pooled summary OR was 0.73 (95% CI: 0.51-1.06) for the drug holiday group compared to the non-drug holiday group. In other words, the drug holiday group was not significantly different from the non-drug holiday group in the development of MRONJ following a tooth extraction procedure (p = 0.10). The statistical heterogeneity was low across all studies (I² = 13%, p = 0.33). Within the limits of the available evidence, our findings revealed that drug holidays with AR will not minimize the risk of MRONJ and thus cannot be advised. It may be possible to arrive at more definitive conclusions from large prospective studies and randomized trials of good quality.

Objective: This study aims to evaluate three types of manual toothbrushes [Cross action (CA), Flat trim (FT), and orthodontic type (OT)] in terms of efficacy in plaque removal in patients undergoing fixed orthodontic treatment.Background: Manual toothbrushes are an essential part of oral hygiene for primary prevention. Plaque control, however, can be influenced by a number of individual and material-related factors. Individual factors include the presence of fixed orthodontic appliances on tooth surfaces, such as brackets and bands, which create difficulties with oral hygiene and lead to plaque formation. The evidence for the effectiveness of advanced bristle designs (multilevel, criss-cross) of the manual toothbrush alone in removing plaque in patients undergoing orthodontic therapy is limited.Methods: The experiment followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This was a three treatment, three-period crossover clinical trial with a single brushing exercise. Thirty subjects were randomized to one of the three treatment sequences of different bristle designs: (CA, FT, and OT). The primary outcome measure was the difference in the plaque scores (baseline minus post-brushing) at each study period, as determined by the Turesky-Modified Quigley–Hein Plaque Index.Results: Of the thirty-four subjects enrolled in the study, thirty of the subjects met the inclusion criteria and completed all three periods of the study. The mean age was 19.5 ± 1.52 years, with a range of 18–23 years. The differences between treatments in plaque score reduction after brushing were statistically significant (p-value < .001). The treatment differences were statistically significant (p-value < .001) favoring the FT toothbrush over the OT and CA types of toothbrush designs. On the contrary, the difference between the OT and CA types was not statistically significant.Conclusions: Plaque was significantly removed by the conventional FT toothbrush after a single brushing compared to the OT and CA types.