OBJECTIVES: We propose a YOLOv11-TDSP model for improving the accuracy of dental abnormality detection on panoramic oral X-ray images. METHODS: The SHSA single-head attention mechanism was integrated with C2PSA in the backbone layer to construct a new C2PSA_SHSA attention mechanism. The computational redundancy was reduced by applying single-head attention to some input channels to enhance the efficiency and detection accuracy of the model. A small object detection layer was then introduced into the head layer to correct the easily missed and false detections of small objects. Two rounds of structured pruning were implemented to reduce the number of model parameters, avoid overfitting, and improve the average precision. Before training, data augmentation techniques such as brightness enhancement and gamma contrast adjustment were employed to enhance the generalization ability of the model. RESULTS: The experiment results showed that the optimized YOLOv11-TDSP model achieved an accuracy of 94.5%, a recall rate of 92.3%, and an average precision of 95.8% for detecting dental abnormalities. Compared with the baseline model YOLOv11n, these metrics were improved by 6.9%, 7.4%, and 5.6%, respectively. The number of parameters and computational cost of the YOLOv11-TDSP model were only 12% and 13% of those of the high-precision YOLOv11x model, respectively. CONCLUSIONS The lightweight YOLOv11-TDSP model is capable of highly accurate identification of various dental diseases on panoramic oral X-ray images.
Radiography, Panoramic/methods* ; Humans ; Algorithms ; Tooth Abnormalities/diagnostic imaging*

OBJECTIVES: This study aimed to investigate the clinical characteristics of deciduous fused teeth and their inherited permanent-tooth performance type by using panoramic radiographs. METHODS: A total of 14 404 panoramic radiographs of 3- to 6-year-old children with deciduous dentition were collected from January 2023 to July 2024. The incidence of deciduous fused teeth was observed, and the abnormality of permanent teeth was recorded. SPSS 24.0 software was used for statistical analysis. RESULTS: The incidence of deciduous fused teeth was 3.06% (441/14 404). The order of dental position was as follows: mandibular deciduous incisors and cusp teeth fused (58.18%) > mandibular deciduous central and lateral incisors fused (30.91%) > maxillary deciduous central and lateral incisors fused (8.89%) > deciduous incisors and supernumerary teeth fused (2.02%). Deciduous fused teeth were found in 226 boys and 215 girls, with no significant difference between the sexes (P>0.05). We observed one pair (87.76%, 387/441) and two pairs (12.24%, 54/441) of fused teeth (54/441), respectively. A total of 287 pairs of fusion teeth on the right side more than 208 pairs on the left side, and the difference between them was statistically significant (P<0.01). More fusion teeth existed in mandibular deciduous teeth (443 pairs) than in maxillary ones (54 pairs), and the difference between them was statistically significant (P<0.01). More unilateral deciduous teeth (387 subjects) were found than bilateral ones (54 subjects), and the difference between them was statistically significant (P<0.01). Three types of deciduous fused teeth with inherited permanent teeth were observed as follows: 1) 49.49% (245/495) of inherited permanent teeth was absent, 2) 46.67% (231/495) of inherited permanent teeth was not absent, and 3) the number of fused permanent teeth accounted for 3.84% (19/495). CONCLUSIONS The incidence of deciduous fused teeth was 3.06%, mostly occurring in the lower anterior teeth region, with no gender difference. One pair of fused teeth is commonly observed, more often on the right than the left. These fusions occur more frequently in the mandible than the maxillary, and unilateral cases are more common than bilateral ones. Deciduous fused teeth had a certain impact on inherited permanent teeth. Pediatric dentists should pay attention to and closely observe whether any abnormality exists in the permanent dentition for early detection to prevent the harm caused by deciduous fused teeth.
Humans ; Tooth, Deciduous/abnormalities* ; Male ; Child ; Female ; Child, Preschool ; Dentition, Permanent ; Radiography, Panoramic ; Fused Teeth/diagnostic imaging* ; Incisor/diagnostic imaging* ; Tooth, Supernumerary/diagnostic imaging* ; Incidence ; Mandible

OBJECTIVES: This study aimed to investigate the incidence, imaging characteristics, and clinical manifestations of the eruption failure of deciduous molars using panoramic radiographs to provide a foundation for diagnosis and treatment in this population. METHODS: This study retrospectively reviewed panoramic radiographs of children aged 4-8 years obtained from Stomatology Hospital, Zhejiang University School of Medicine between January 2021 and December 2023. A total of 31 331 subjects were included for the radiographic assessment of the tooth eruption failure of deciduous molars. Incidence, radiographic characteristics, and associated complications were documented. Statistical analysis was performed using SPSS 26.0. RESULTS: The incidence of the eruption failure of deciduous molars among children aged 4-8 years was 0.94% (296/31 331). The rate was 1.55 times higher in females than in males, demonstrating a significant gender difference (P<0.001). Among the affected deciduous molars, mandibular first deciduous molars accounted for 76.4%, followed by the mandibular second deciduous molars (13.8%), and the maxillary deciduous molars collectively comprised 9.8%. The severity of eruption disorders was significantly associated with the mesial and distal tilting of adjacent teeth and elongation of the antagonist (P<0.001). CONCLUSIONS The incidence of the eruption failure of deciduous molars in children aged 4-8 years was 0.94%, with a high prevalence in females and a predilection for the mandible, particularly the mandibular first deciduous molar. For deciduous molars with severe eruption failure, early intervention is crucial to mitigate complications such as malocclusion and space loss.
Humans ; Child ; Child, Preschool ; Tooth, Deciduous/diagnostic imaging* ; Female ; Molar/physiopathology* ; Male ; Retrospective Studies ; Tooth Eruption ; Radiography, Panoramic ; Incidence

OBJECTIVES: This study aims to evaluate the short- to medium-term clinical efficacy of demineralized dentin matrix (DDM) particles applied during the immediate implantation of alveolar bone defects in the posterior region. METHODS: A total of 76 patients with 110 simple taper retentive implants were included in the conducted study and divided into Groups A and B in accordance with the bone grafting materials. Cone beam computed tomography and panoramic radiographs were taken immediately after implant surgery, immediate crown repair, and final follow-up time. The average follow-up time for Groups A and B was recorded. The primary observed clinical indicators were overall survival rate of the implant, bone resorption of the mesial and distal margins of the implant, buccal bone width resorption at the platform level and 1 mm below the platform, and bone height of the implant. Implant complication was a secondary observed clinical indicator. RESULTS: During the 1-to-5-year follow-up observation period, the mean follow-up of Group A was 38.2 months while that of Group B was 39.9 months. In Group A, two implants failed, one of which fractured, and implant overall survival rate was 96.4%. Four implants failed in Group B due to peri-implantitis, and implant overall survival rate was 92.6%. No statistically significant difference in implant overall survival rate was found between the two groups (P>0.05). In Group A, the average bone resorption in the mesial and distal margins of the implants was (1.011±2.047) mm and (0.841±2.183) mm, respectively. In Group B, the average bone resorption of the mesial and distal margins of the implants was (1.546±1.778) mm and (1.431±1.909) mm, respectively. No statistically significant difference was noted between the two groups (P>0.05). In Group A, buccal bone width resorption at the platform level and 1 mm below the platform of the implant was (0.782±2.084) mm and (0.681±2.307) mm, respectively. In Group B, buccal bone width resorption at the platform level and 1 mm below the platform of implant was (1.071±1.474) mm and (0.949±1.909) mm, respectively. No statistically significant difference was found between the two groups (P>0.05). In Group A, the buccal bone height of resorption of the implant was (1.044±2.214) mm. In Group B, the buccal bone height of resorption of the implant was (1.075±1.456) mm. No statistically significant difference in bone height was observed between the two groups (P>0.05). CONCLUSIONS During the 1-to-5-year follow-up observation period, DDM particles can effectively increase the height and width of alveolar bone, and they can achieve the same effect of maintaining alveolar bone contour and bone augmentation compared with deproteinized inorganic calf bone. DDM particles can be used as a potential new bone grafting material for the treatment of bone defects in clinical practice.
Humans ; Follow-Up Studies ; Dentin ; Cone-Beam Computed Tomography ; Dental Implants ; Male ; Female ; Adult ; Alveolar Bone Loss/surgery* ; Middle Aged ; Bone Transplantation ; Radiography, Panoramic ; Dental Implantation, Endosseous/methods* ; Immediate Dental Implant Loading

For patients with partial jaw defects, cysts and dental implants, doctors need to take panoramic X-ray films or manually draw dental arch lines to generate Panorama images in order to observe their complete dentition information during oral diagnosis. In order to solve the problems of additional burden for patients to take panoramic X-ray films and time-consuming issue for doctors to manually segment dental arch lines, this paper proposes an automatic panorama reconstruction method based on cone beam computerized tomography (CBCT). The V-network (VNet) is used to pre-segment the teeth and the background to generate the corresponding binary image, and then the Bezier curve is used to define the best dental arch curve to generate the oral panorama. In addition, this research also addressed the issues of mistakenly recognizing the teeth and jaws as dental arches, incomplete coverage of the dental arch area by the generated dental arch lines, and low robustness, providing intelligent methods for dental diagnosis and improve the work efficiency of doctors.
Humans ; Radiography, Panoramic/methods* ; Cone-Beam Computed Tomography/methods* ; Head ; Image Processing, Computer-Assisted/methods*

Objective To evaluate the accuracy of different convolutional neural networks (CNN),representative deep learning models,in the differential diagnosis of ameloblastoma and odontogenic keratocyst,and subsequently compare the diagnosis results between models and oral radiologists. Methods A total of 1000 digital panoramic radiographs were retrospectively collected from the patients with ameloblastoma (500 radiographs) or odontogenic keratocyst (500 radiographs) in the Department of Oral and Maxillofacial Radiology,Peking University School of Stomatology.Eight CNN including ResNet (18,50,101),VGG (16,19),and EfficientNet (b1,b3,b5) were selected to distinguish ameloblastoma from odontogenic keratocyst.Transfer learning was employed to train 800 panoramic radiographs in the training set through 5-fold cross validation,and 200 panoramic radiographs in the test set were used for differential diagnosis.Chi square test was performed for comparing the performance among different CNN.Furthermore,7 oral radiologists (including 2 seniors and 5 juniors) made a diagnosis on the 200 panoramic radiographs in the test set,and the diagnosis results were compared between CNN and oral radiologists. Results The eight neural network models showed the diagnostic accuracy ranging from 82.50% to 87.50%,of which EfficientNet b1 had the highest accuracy of 87.50%.There was no significant difference in the diagnostic accuracy among the CNN models (P=0.998,P=0.905).The average diagnostic accuracy of oral radiologists was (70.30±5.48)%,and there was no statistical difference in the accuracy between senior and junior oral radiologists (P=0.883).The diagnostic accuracy of CNN models was higher than that of oral radiologists (P<0.001). Conclusion Deep learning CNN can realize accurate differential diagnosis between ameloblastoma and odontogenic keratocyst with panoramic radiographs,with higher diagnostic accuracy than oral radiologists.
Humans ; Ameloblastoma/diagnostic imaging* ; Deep Learning ; Diagnosis, Differential ; Radiography, Panoramic ; Retrospective Studies ; Odontogenic Cysts/diagnostic imaging* ; Odontogenic Tumors

OBJECTIVE: To evaluate the clinical effect of root canal obturation therapy using cold flowable gutta-percha on young permanent teeth after apexification. METHODS: Ninety cases of young permanent teeth with pulp necrosis or periapical periodontitis treated by apexification were randomly divided into two groups. The cases in each group were divided into single root canal and multiple root canal according to the number of the root canal, and divided into classifications Ⅰ, and Ⅱ/Ⅲ/Ⅳ according to Frank's classification of root development after apexification. Cold flowable gutta-percha and warm gutta-percha obturation techniques were used for root canal obturation of the two groups. The operation time was recorded, and the patients' therapy pain degree was evaluated by visual analog scale (VAS) immediately after operation. Periapical X-ray was performed after operation to evaluate the effect of the root canal filling. The total length of the root was divided into equal three parts on the X-ray film, and three-dimensional tightness of the apical, middle, and coronal region of the root canals were statistically analyzed respectively. Clinical examinations and X-ray examination were performed 6 and 12 months after the operation to evaluate the treatment success rate. RESULTS: The operation time of cold flowable gutta-percha group was significantly lower than that of the control group, which were 51 s and 74 s (P < 0.05); The percentages of pain and discomfort in the two groups were 26.67% and 40.00%, respectively. There were two cases of underfilling and no overfilling in both groups. The percentages of proper filling and tight three-dimensional obturation in the experimental and control groups were 71.11% and 60.00% respectively; and the percentages of tight three-dimensional obturation in the apical third areas were 86.67% and 66.67%, the difference was significant (P < 0.05). There was no significant difference in the three-dimensional tightness between the two groups in the middle and coronal third areas. The percentages of tight three-dimensional obturation in classification Ⅰ groups were 86.67%, 83.33%, 93.33% and 76.67%, 90.00%, 96.67% in experimental and control group, respectively; The percentages of classification Ⅱ/Ⅲ/Ⅳ groups were 86.67%, 86.67%, 100.00% and 46.67%, 86.67%, 100.00%, respectively, and the difference was significant (P < 0.05). There were no apical lesions that occurred in either group during the one-year review period. CONCLUSION The application of cold flowable gutta-percha on young permanent teeth root canal obturation after apexification can achieve good obturation effect. The root obturation effect in the apical third area is significantly better than that of warm gutta-percha obturation techniques. Cold flowable gutta-percha can shorten the clinical treatment time and ameliorate the patients' therapy comfort.
Apexification ; Dental Pulp Cavity ; Gutta-Percha ; Humans ; Radiography ; Root Canal Filling Materials ; Root Canal Obturation ; Root Canal Preparation

ABSTRACT Dental anomalies may occur due to the complex interactions among genetic, epigenetic, and environmental factors during dental development. The current study aimed to determine the prevalence and gender significance of developmental dental anomalies (DDA) in dental patients. This was a cross-sectional study of 260 subjects (123 males and 137 females) with an age range of 6–35 years old. Clinical and radiographic examinations were performed to determine the prevalence of anomalies in tooth number, shape, size, position, and structure. Descriptive statistics was performed, the chi-square test was used for analysis and p-value was set at 0.05. The findings showed that 203 subjects (78.1%) had DDA, which included 86 males (33.1%) and 117 females (45%). A significant gender difference was found regarding the prevalence of two anomalies (p < 0.05). The most prevalent anomaly was displacement 51.2%, followed by dilaceration 24.2%. A significant gender difference (p < 0.05) was found regarding hypodontia 16.5% and impaction 14.6%, with more predominant in females. Some anomalies were not observed such as microdontia, dentin dysplasia, ectopic eruption, gemination, and taurodontism. The study concluded that displacement and dilacerations were the common abnormalities. These findings may lead to various dental complications. Therefore, early diagnosis and follow-up observation are required to reduce the potential dental problems. In addition, it is helpful to increase the knowledge of practitioners with regards to DDA and its occurrence. Furthermore, it is good to highlight the importance of early diagnosis of DDA, especially in the mixed dentition, which can lead to reducing the complication of an orthodontic treatment plan.
Tooth Abnormalities ; Radiography, Dental, Digital ; Libya

During the automatic reconstruction of panoramic images, the effect of dental arch curve fitting will affect the integrity of the content of the panoramic image. Metal implants in the patient's mouth usually lead to a decrease in the contrast of the panoramic image, which affects the doctor's diagnosis. In this paper, an automatic oral panoramic image reconstruction method was proposed. By calculating key image areas and image extraction fusion algorithms, the dental arch curve could be automatically detected and adjusted on a small number of images, and the intensity distribution of teeth, bone tissue and metal implants on the image could be adjusted to reduce the impact of metal on other tissues, to generate high-quality panoramic images. The method was tested on 50 cases of cone beam computed tomography (CBCT) data with good results, which can effectively improve the quality of panoramic images.
Humans ; Radiography, Panoramic/methods* ; Cone-Beam Computed Tomography/methods* ; Tooth ; Algorithms ; Image Processing, Computer-Assisted/methods*

OBJECTIVE: To compare the effects of different imaging methods on radio-opacity. Digital imaging and traditional film imaging were used to determine the radio-opacity of dental composite resin materials. METHODS: Fourteen dental composite resins commonly used in clinic were prepared for disc samples with thickness of 1 mm and diameter of 15 mm respectively. The aluminum step wedge was used as the reference and the disc samples were irradiated with X-rays by the traditional film imaging, phosphor imaging plate and charge-coupled device(CCD) intra-oral X-ray sensor respectively. Exposure was set at 65 kV and 7 mA, with 300 mm focus to film distance and the exposure time was 0.25 s. After developing and fixing the film, the optical density of the image of the sample and that of each step of the aluminum step wedge were measured using the densitometer. The digital image file was exported to grey scale analysis software of Adobe Photoshop^® to measure the average grey value in the sample image and aluminum step wedge image. The curves were drawn corresponding to the optical density/gray value of each step of the aluminum step wedge and its thickness, and the equivalent thickness of the aluminum plate was calculated according to the optical density/gray value of the actual measured thickness of the sample, so as to evaluate the radio-opacity of dental composite resin material. RESULTS: For the same sample, the aluminum equivalent measured by traditional film imaging and two other digital imagings had significant differences among the 14 composite resins (P < 0.05), and the aluminum equivalent measured by the two digital imagings were greater than that of the traditional film. Moreover the aluminum equivalent measured by the two digital imagings was also different, and the aluminum equivalent measured by the CCD intra-oral X-ray sensor in most composite resins was larger than that measured by phosphor imaging plate. The same sample was photographed with the same imaging method, and the aluminum equivalent was different after three exposures. The standard deviation of aluminum equivalent measured by phosphor imaging plate was the largest, while that measured by CCD intra-oral X-ray sensor was the smallest. Among the 14 dental composite resin materials, the aluminum equivalent of Tetric N-Ceram and Te-Econom Plus measured by traditional film imaging and phosphor imaging plate was significantly higher than other composite resins. CONCLUSION Based on clinical significance, three kinds of sensors designed to measure the radio-opacity of dental composite resin, the value of aluminum equivalent will change according to different types of sensors. The aluminum equivalent measured by CCD intra-oral X-ray sensor was higher than that measured by phosphor imaging plate, and the aluminum equivalent measured by phosphor imaging plate was higher than that measured by traditional film imaging. Moreover, even though the same sensor was used, the aluminum equivalent measured by multiple exposures was different. The standard deviation of the aluminum equivalent measured by phosphor imaging plate was greater than that measured by traditional film imaging and CCD intra-oral X-ray sensor. The three sensors in this study could be used for evaluating the radio-opacity of dental composite resin materials. But no matter what kind of sensor was used to measure the radio-opacity of dental composite resin, it complied to ISO 4049: 2019 standard, the materials were suitable for clinical use.
Aluminum ; Composite Resins ; Radiography, Dental, Digital