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Objectives New tools aid in the diagnosis of diseases and thus help in advancing patient care. “Fractal Analysis” is a versatile method of applying nontraditional mathematics to patterns that are beyond understanding with traditional Euclidean concepts. This analysis can be used on radiographic and non-radiographic images in dentistry. In this review we aim to identify the usefulness of fractal analysis in dentistry in radiographic images, its applications and future scope. Materials and Methods Articles published between 1992 and 2024 were retrieved through an electronic search of Medline via PubMed, Scopus, and Google Scholar databases. The search, which was limited to articles published in English, aimed to identify relevant studies by employing the following keywords: “fractal analysis,” “dental radiographs,” “mandibular,” “panoramic radiographs,” and “radiography.” Ultimately, 76 articles that addressed the application of fractal analysis in dental radiographs were selected. Results Fractal analysis can reveal alterations in bone and in images of morphologically altered tissue, however no set values exist which could be used as a standard for diagnosing various conditions. Conclusion Fractal Analysis can potentially be used as an adjunct to diagnostic tests as it is shown to identify alterations in bony and trabeculae patterns.

The Greater Palatine Foramen (GPF), is a vital anatomical landmark for palatal nerve blocks. Hence imaging of this structure to understand its anatomy is important. Our study aimed to explore the radiomorphometric parameters of the greater palatine canal and pterygopalatine fossa using CBCT images in different age groups and gender. 100 CBCT images showing both right and left maxillary sinus region were analysed for length of the greater palatine canal, the upper and lower opening diameters, and the intra-canal curvature. The recorded values were statistically analysed. The right greater palatine canal length was significantly shorter in individuals >25 years (Mean = 31.72 mm, SD = 4.30 mm, p-value = 0.021). The left upper opening diameter increased significantly with age (Mean = 5.90 mm, SD = 1.47 mm, p-value = 0.006). Males exhibited longer canals (Avg. length mean = 33.23 mm, SD = 4.19 mm, p-value = 0.095). And larger lower opening diameters (Avg. mean = 5.69 mm, SD = 1.18 mm, p-value = 0.073) than females. Canal curvature was predominantly curved across both the age groups, but age group 18-25 years showed a significantly higher prevalence of curved canals on both sides. The present study showed significant variations in the morphology of the greater palatine foramen and canal curvature with respect to age and sex. Variations in GPC length, diameter, and curvature can influence the success of palatal nerve blocks, that reduce the risk of injury to the greater palatine nerve. Recognizing these differences through preoperative CBCT enables accurate anesthesia delivery, safer flap design, and precise osteotomy planning.

Thyroid hormones have a catabolic effect on bone mineral homeostasis. Hypothyroid patients have shown changes in bone mineral density with increased risk for osteoporosis and bone fractures. Radiomorphometric parameters on panoramic images are good indicators of bone mineral density. The aim of the study was to compare the radiomorphometric parameters in dental panoramic images of patients diagnosed with hypothyroidism with age- and gender-matched control populations. Panoramic radiographs of 47 patients diagnosed with hypothyroidism were measured for radio morphometric indices like mental index (MI), The inferior panoramic mandibular index (PMI), antegonial index (AGI), gonial Index (GI) and mandibular cortical Index (MCI). The measurements were compared with age and gender matched 50 healthy controls. The mean values of MI (3.11), PMI (0.28), and GI (1.38) were lower in hypothyroidism than in 50 healthy controls which was 3.17, 0.30 and 1.33, respectively. However, only AGI (3.14) showed statistically significant differences (p = 0.03). This study showed radiomorphometric parameters like MI, PMI, GI and AGI are valuable indicators of bone changes in mandible of patients with systemic diseases like hypothyroidism. Although statistically significant difference was seen only in AGI compared to healthy controls. Further studies with larger samples can provide substantial data. Applying newer technologies like machine learning can also help us determine whether mandibular morphometric parameters can predict changes in bone mineral density in hypothyroid cases.

Background Dental radiology has significantly benefited from cone-beam computed tomography (CBCT) because of its compact size and low radiation exposure. Canal tracking is an important application of CBCT for determining the relationship between the inferior alveolar nerve and third molar. Usually, canal tacking is performed manually, which takes a lot of time. This study aimed to develop an artificial intelligence (AI) model to automate classification of the mandibular canal in relation to the third molar. Methods This retrospective study was conducted using 434 CBCT images. 3D slicer software was used to annotate and classify the data into lingual, buccal, and inferior categories. Two convolution neural network models, AlexNet and ResNet50, were developed to classify this relationship. The study included 262 images for training and 172 images for testing, with the model performance evaluated by sensitivity, precision, and F1 score. Results The performance of the two models was evaluated using a 3 × 3 confusion matrix, with the data categorized into 3 clases: lingual, buccal, and inferior. The mandibular canal and third molar have a close anatomical relationship, highlighting the need for precise imaging in dental and surgical settings. To accurately classify the mandibular canal in relation to the third molar, both AlexNet and ResNet50 demonstrated high accuracy, with F1 scores ranging from 0.64 to 0.92 for different classes, with accuracy of 81% and 83%, respectively, for accurately classifying the mandibular canal in relation to the third molar. Conclusion The present study developed and evaluated AI models to accurately classify and establish the relationship between the mandibular canal and third molars using CBCT images with a higher accuracy rate.

Aim: This comparative study evaluated the effectiveness and safety profile of topical amlexanox and triamcinolone for the management of erosive oral lichen planus (EOLP). Materials and Methods: This prospective, observational study included 21 patients diagnosed clinically and histopathologically with EOLP and categorized into two groups. Subjects in the two groups were prescribed topical amlexanox and triamcinolone, respectively, for 4 weeks. The area of the erosive lesion and burning sensation was measured at baseline, at the end of the first, 2second, and fourth week. These outcome measures were documented and statistically analyzed. The statistical analyses were performed using the IBM SPSS Statistics version 22. Analysis for age distribution was done by independent sample t test. Analysis of sex distribution was done by chi-square test. Variations within a single group for both the outcome parameters were calculated by Wilcoxon signed rank test. (P < 0.05 statistically significant). Results: A total of 30 erosive sites were evaluated in 21 patients over a 4-week duration. The most common site was the buccal mucosa in both groups (23 of 30; 76.67% of total lesions assessed), followed by the tongue (5 of 30; 16.67% of total lesions assessed), the palate (1 of 30; 3.33% of total sites assessed), and the maxillary attached gingiva (1 of 30; 3.33% of total sites assessed). Group 1 (amlexanox) was comprised of 11 subjects, whereas Group 2 (triamcinolone) was comprised of 10 subjects. Pre and posttreatment comparison revealed no statistically significant difference (P = 0.756; 0.512, respectively), for the area of the erosion and burning sensation. Intragroup analysis showed that in Groups 1 and 2, there was a statistically significant reduction in the measures posttreatment (P < 0.05). Conclusions: Amlexanox provides an earlier onset of pain relief in the treatment of EOLP, whereas providing a comparable reduction in the erosive area compared with triamcinolone. Topical amlexanox appears to be as effective as triamcinolone and is a promising alternative in the management of the erosive lichen planus with minimal adverse effects.

Background: Lingual plate thickness, density, and proximity to the tooth are linked as risk factors for various complications associated with third molar extraction. The present study aimed to assess the lingual plate thickness, and density in the mandibular third molar region using cone beam computed tomography and to estimate its correlation with type and level of impaction, number of roots, age, and gender as the risk factors Methods: This was a retrospective study on CBCT images of 648 mandibular third molars. The lingual plate thickness at three different root levels--cervical, mid-root, and apex along with the position of the tooth, number of roots, density of lingual plate, age, and gender were evaluated. The measurements were done on Invivo 5-Anatomage software. Statistical comparison of the categorical variables was done by Chi-square test, and Fisher's exact test, and univariate and multivariate analysis were done using binomial logistic regression. Results: Lingual plate thickness of the third molars at the cervical, mid root, and apex were 1.28 mm, 1.42 mm and .01 mm (mean). A significantly higher proportion of subjects with thin lingual plates at mid-root (p-value=0.01) and apex (p- value=0.05) were in the 21-30 age group. Lingual bone density was significantly associated with the thickness of the lingual plate at the mid- root. A significantly higher proportion of thinner lingual plates at the mid-root level were associated with Mesio-angularly placed third molars (p-value=0.002). Conclusion: Our study presented that lingual plate thickness has a strong association with age, angulation, and the number of roots. Knowledge about these risk factors is imperative during the management of third molar impactions. Keywords: lingual plate, third molar, bone density, mandible, cone-beam computed tomography

Oral cancer is increasing in prevalence and its treatment is associated with high degree of morbidity and mortality. Thus, prevention of oral cancer is of utmost importance. Chemoprevention is the use of natural, synthetic, or biologic compounds to halt, reverse, or prevent the initial phases of carcinogenesis or the progression of neoplastic cells to cancer. This modality has been extensively researched in the last two decades for the prevention of oral cancer with the emergence of new information. Retinoids were the first chemopreventive agents to be tested in clinical settings. Since then, a number of new agents such as COX2 inhibitors, EGFR inhibitors, p53 targeted agents, thiazolidinediones and several natural agents have shown promise in oral cancer prevention. Chemopreventive trials in oral cancer tend to be long term studies and are thus challenging. This review article looks into the clinical evidence for the application of chemopreventive agents in clinical settings and also highlights the recent trends in oral cancer chemopreventive trials.

Background Pediatric oncology patients are highly susceptible to oral complications during chemotherapy. Awareness amongst parents and oral hygiene practices play a crucial role in preventing and managing these issues. Aim To assess parental knowledge and awareness about the oral hygiene practices and reported oral manifestations associated with chemotherapy in pediatric oncology patients. Materials and methods This was a questionnaire-based cross-sectional study conducted in the Department of Pediatric Oncology over one year. Parents of 66 children aged 0–18 years completed a structured questionnaire covering dental care utilization, oral hygiene practices, awareness regarding oral health, pre-treatment dental status, and self-reported oral side effects after therapy. Results Only 25.7% of children had ever visited a dentist, and 12.1% underwent dental evaluation before oncology treatment. While 57.6% brushed once daily, 51.5% required assistance, and 63.6% consumed snacks between meals. Parental awareness regarding the impact of diet and oral health on general health was low (30.3%). More than half of parents (57.6%) reported oral changes after the initiation of therapy, with oral ulcers (40.9%), difficulty eating (30.3%), and taste alteration (27.3%) being most common. Despite these symptoms, only 3% underwent dental treatment post-therapy initiation. Conclusion The study reveals inadequate dental care utilization, suboptimal oral hygiene practices, and lack of awareness amongst parents of pediatric oncology patients. Routine dental screening, structured oral hygiene education, and multidisciplinary collaboration is essential to minimize oral complications and improve oral health during chemotherapy.

Dental age estimation using third molars is a reliable method for estimating the age of individuals. Recently, magnetic resonance imaging (MRI) of the head and neck has been found to be applicable for age estimation of third molar teeth. In the present study, we aimed to apply the Modified Demirjian method of age estimation to magnetic resonance (MR) image sections for dental age estimation by determining the mineralization patterns of the maxillary third molars. MRI scans of the patients were performed using SIGNA™ 3.0Tesla MRI GE Healthcare (Chicago, USA) with a moving, multifunctional coil. Two expert radiologists with more than three years of experience independently analyzed the image sections using the open-source Digital Imaging and Communications in Medicine (DICOM) viewer software. The age and sex of the patients whose images were included in the study were recorded using a specially designed proforma. The stage of development of the maxillary third molars was determined using the modified Demirjian method. Inter observer agreement was calculated using the intra class correlation coefficient. Simple linear regression analysis was used to predict the actual age at the third molar development stage. There was excellent agreement between observers (ICC =0.99 (95% CI = 0.98-0.99)). There was also a significant association between the maxillary third molar tooth development stage and chronological age of the individual (P=0.001; B=1.54; 95% CI = 0.71-2.37). The findings from the present study establish that the Modified Demirjian method can also be reliably applied for dental age assessment in MR sections.

Context: Sella turcica or pituitary fossa is a saddle-shaped concavity housing the pituitary gland and seen clearly on lateral cephalogram. This makes it a good source of additional diagnostic information related to pathology of the pituitary gland or to various syndromes that affect the craniofacial region. Aims: The aim of this retrospective study was to determine the average dimensions and morphological variations of the sella turcica in different age groups and to evaluate any difference in size between males and females in the study population. Settings and Design: All the lateral cephalograms were taken by trained radiographic technicians using Planmeca Promax Ceph X-ray Machine, Finland, Inc., in a standardized manner using the same cephalostat. Materials and Methods: Four hundred and eighty lateral cephalograms were obtained under standardized conditions. With age range between 7 and 43 years, all the radiographs were distributed according to skeletal class and gender. Size and morphology of sella turcica were recorded and compared with age, gender, and skeletal class. Statistical Analysis Used: A Student's t-test, one-way ANOVA test, and Pearson's correlation coefficient were used. Results: The mean age of the study population was found to be 16.8 years comprising 48.6% males and 51.3% females. There was a gradual increase in linear dimensions of sella turcica with the advancement of age. The normal sella was observed in 20.6%, whereas 79.35% showed variation in morphology. Oblique anterior wall was a most common abnormal variant, whereas pyramidal shaped dorsum was rarest. Conclusions: There was no statistically significant difference in linear dimensions or morphological variations with age, gender, or type of malocclusion.