O objetivo deste estudo foi avaliar os resultados radiográficos obtidos pelas analises de subtração radiográfica digital e linear de implantes dentários com superfície SLA e SLActive submetidos a carga funcional e sobrecarga oclusal precoce restaurados com reconstruções em cantilever (pôntico suspenso). Cinco cães beagle tiveram seus pré-molares mandibulares extraídos bilateralmente. Após três meses, retalhos foram elevados e seis implantes (três SLA e três SLActive) foram instalados em um desenho de boca dividida e aleatorização por blocos. Após quatro semanas, os implantes foram restaurados em cada lado da mandíbula da seguinte forma: uma coroa unitária com contatos oclusais estáveis (OE), uma coroa e uma unidade de cantilever com contatos oclusais excessivos (SO), e um implante protegido pela unidade em cantilever que não recebeu carga funcional (NR). Os cães foram mantidos em um programa de controle de placa periódico, durante o período do experimento. Radiografias padronizadas foram tomadas utilizando-se guias radiográficas individualizadas e padronizadas em dois momentos: na instalação das próteses e 24 semanas após o carregamento. Análises de subtração radiográfica digital e medições lineares (entre um plano projetado entre os ombros do implante e o primeiro contato implante-osso) foram realizadas. As análises estatísticas, ANOVA para medidas repetidas, ANOVA para dados equilibrados e teste t de Bonferroni foram utilizados para identificar diferenças entre as médias, entre os seis grupos avaliados: SLA OE, SLA SO, SLA NR, SLActive OE, SLActive SO e SLActive NR. Achados gerais similares foram observados para os grupos SLA e SLActive (todos os grupos OE, NR e SO) em relação ao nível ósseo peri-implantar e as dimensões das áreas indicando alterações de densidade óssea ao redor dos implantes. As mensurações lineares variaram de 1,61 mm (grupo SLActive SO) a 1,94 mm (grupo SLA SO) no tempo 0 (antes da aplicação das cargas funcionais) e 2,00 mm (grupo SLA SO) a 2,99 mm (grupo SLActive NR) na avaliação após 24 semanas, sem diferenças estatisticamente significativas dentro ou entre-grupos (p = 0,672). Com relação à área de mudança de densidade óssea, esta variou de 0,91 mm2 (grupo SLA OE) para 1,40 mm2 (grupo SLA SO), mas sem diferenças significativas entre os grupos (p = 0,568). Por outro lado, um ganho de densidade óssea estatisticamente significativa foi encontrado para o grupo SLA com sobrecarga oclusal (p = 0,012). Nenhuma diferença significativa na alteração de densidade óssea foi detectada entre os outros cinco grupos (p> 0,05). Em conclusão, a sobrecarga oclusal precoce aplicada sobre implantes restaurados com reconstruções em cantilever, não levou a mudanças significativas na altura óssea peri-implantar após 24 semanas. No entanto, a densidade óssea ao redor de implantes SLA com sobrecarga oclusal, foi significativamente maior que nos outros grupos. / The objective of this study was to evaluate the radiographic outcomes of SLA and SLActive dental implants submitted to functional load and early occlusal overload restored with cantilever reconstructions. Five beagle dogs had their mandibular premolars extracted bilaterally. After three months, flaps were raised and six implants (three SLA and three SLActive) were installed in a block-randomized split-mouth design. After four weeks, implants were restored on each side of the mandible as follows: one single crown with stable occlusal contacts (OE), one crown and a cantilever unit with overt occlusal contacts (SO), and an implant protected by the cantilever unit not submitted to functional load (NR). The dogs were maintained in a strict and periodic plaque control program during the period of the experiment. Standardized radiographies were taken using standardized and individualized radiographic stents in two distinct moments: at prostheses installation and 24-weeks after loading. Digital subtraction radiography analyses and linear measurements were performed. Statistical analyses used repeated measures ANOVA and ANOVA for balanced data and the Bonferroni Student t test to identify differences between the means of the six evaluated groups: SLA OE, SLA SO, SLA NR, SLActive OE, SLActive SO and SLActive NR. Similar findings were found for SLA and SLActive groups regarding the peri-implant bone level and the area of bone density change around implants. Baseline linear measurements ranged from 1.61 mm (SLActive SO group) to 1.94 mm (SLA SO group) at baseline, and from 2.00 mm (SLA SO group) to 2.99 mm (SLActive NR group) at the 24-week evaluation, with no statistically significant differences within- or between-groups (p=0.672). With respect to the areas of bone density change, they ranged from 0.91 mm2 (SLA OE group) to 1.40 mm2 (SLA SO group), but without significant differences between groups (p=0.568). On the other hand, a statistically significant bone density gain was found for the overloaded SLA group (p=0.012). No significant differences in bone density change were detected between the other five groups (p>0.05). In conclusion, the early occlusal overload applied to implants restored with cantilever reconstructions did not lead to significant changes in the peri-implant bone height. However, bone density around overloaded SLA implants was significantly higher than in the other groups.

O objetivo deste estudo foi avaliar os resultados radiográficos obtidos pelas analises de subtração radiográfica digital e linear de implantes dentários com superfície SLA e SLActive submetidos a carga funcional e sobrecarga oclusal precoce restaurados com reconstruções em cantilever (pôntico suspenso). Cinco cães beagle tiveram seus pré-molares mandibulares extraídos bilateralmente. Após três meses, retalhos foram elevados e seis implantes (três SLA e três SLActive) foram instalados em um desenho de boca dividida e aleatorização por blocos. Após quatro semanas, os implantes foram restaurados em cada lado da mandíbula da seguinte forma: uma coroa unitária com contatos oclusais estáveis (OE), uma coroa e uma unidade de cantilever com contatos oclusais excessivos (SO), e um implante protegido pela unidade em cantilever que não recebeu carga funcional (NR). Os cães foram mantidos em um programa de controle de placa periódico, durante o período do experimento. Radiografias padronizadas foram tomadas utilizando-se guias radiográficas individualizadas e padronizadas em dois momentos: na instalação das próteses e 24 semanas após o carregamento. Análises de subtração radiográfica digital e medições lineares (entre um plano projetado entre os ombros do implante e o primeiro contato implante-osso) foram realizadas. As análises estatísticas, ANOVA para medidas repetidas, ANOVA para dados equilibrados e teste t de Bonferroni foram utilizados para identificar diferenças entre as médias, entre os seis grupos avaliados: SLA OE, SLA SO, SLA NR, SLActive OE, SLActive SO e SLActive NR. Achados gerais similares foram observados para os grupos SLA e SLActive (todos os grupos OE, NR e SO) em relação ao nível ósseo peri-implantar e as dimensões das áreas indicando alterações de densidade óssea ao redor dos implantes. As mensurações lineares variaram de 1,61 mm (grupo SLActive SO) a 1,94 mm (grupo SLA SO) no tempo 0 (antes da aplicação das cargas funcionais) e 2,00 mm (grupo SLA SO) a 2,99 mm (grupo SLActive NR) na avaliação após 24 semanas, sem diferenças estatisticamente significativas dentro ou entre-grupos (p = 0,672). Com relação à área de mudança de densidade óssea, esta variou de 0,91 mm2 (grupo SLA OE) para 1,40 mm2 (grupo SLA SO), mas sem diferenças significativas entre os grupos (p = 0,568). Por outro lado, um ganho de densidade óssea estatisticamente significativa foi encontrado para o grupo SLA com sobrecarga oclusal (p = 0,012). Nenhuma diferença significativa na alteração de densidade óssea foi detectada entre os outros cinco grupos (p> 0,05). Em conclusão, a sobrecarga oclusal precoce aplicada sobre implantes restaurados com reconstruções em cantilever, não levou a mudanças significativas na altura óssea peri-implantar após 24 semanas. No entanto, a densidade óssea ao redor de implantes SLA com sobrecarga oclusal, foi significativamente maior que nos outros grupos. / The objective of this study was to evaluate the radiographic outcomes of SLA and SLActive dental implants submitted to functional load and early occlusal overload restored with cantilever reconstructions. Five beagle dogs had their mandibular premolars extracted bilaterally. After three months, flaps were raised and six implants (three SLA and three SLActive) were installed in a block-randomized split-mouth design. After four weeks, implants were restored on each side of the mandible as follows: one single crown with stable occlusal contacts (OE), one crown and a cantilever unit with overt occlusal contacts (SO), and an implant protected by the cantilever unit not submitted to functional load (NR). The dogs were maintained in a strict and periodic plaque control program during the period of the experiment. Standardized radiographies were taken using standardized and individualized radiographic stents in two distinct moments: at prostheses installation and 24-weeks after loading. Digital subtraction radiography analyses and linear measurements were performed. Statistical analyses used repeated measures ANOVA and ANOVA for balanced data and the Bonferroni Student t test to identify differences between the means of the six evaluated groups: SLA OE, SLA SO, SLA NR, SLActive OE, SLActive SO and SLActive NR. Similar findings were found for SLA and SLActive groups regarding the peri-implant bone level and the area of bone density change around implants. Baseline linear measurements ranged from 1.61 mm (SLActive SO group) to 1.94 mm (SLA SO group) at baseline, and from 2.00 mm (SLA SO group) to 2.99 mm (SLActive NR group) at the 24-week evaluation, with no statistically significant differences within- or between-groups (p=0.672). With respect to the areas of bone density change, they ranged from 0.91 mm2 (SLA OE group) to 1.40 mm2 (SLA SO group), but without significant differences between groups (p=0.568). On the other hand, a statistically significant bone density gain was found for the overloaded SLA group (p=0.012). No significant differences in bone density change were detected between the other five groups (p>0.05). In conclusion, the early occlusal overload applied to implants restored with cantilever reconstructions did not lead to significant changes in the peri-implant bone height. However, bone density around overloaded SLA implants was significantly higher than in the other groups.

Objectif: Suite aux traitements avec aligneurs, une insuffisance de contacts postérieurs est souvent notée cliniquement: existe-t-elle réellement, se corrige-t-elle spontanément? Cette étude vise à comparer la qualité de l’occlusion statique chez des patients ayant été traités avec boitiers conventionnels ou par aligneurs, dès la dépose des appareils orthodontiques et après six mois de mise en place fonctionnelle. Matériel and Méthodes: La mise en place fonctionnelle de l’occlusion chez des sujets traités par boitiers conventionnels (GB, n=25) ou par aligneurs (GA, n=14) et par a été évaluée par un système d’analyse occlusale informatisée (T-scan 9), au moment de la dépose (T0), puis à 3 et 6 mois de contention (T3 et T6). Les sujets (41% de filles, âge moyenne de 19,38 ± 5,98 ans), étaient traités sans extractions, ni chirurgie, avec pour contention des fils collés ou appareils sans recouvrement occlusal. La symétrie et la simultanéité des contacts ainsi que la position antéro-postérieure du centre de forces (CF) étaient évalués. Résultats : À tout moment (T0, T3, T6), aucune différence statistiquement significative n’a été observée quant à la position antéro-postérieure du CF (p=0,854), la répartition ou la simultanéité des contacts, quelle que soit la modalité de traitement. Le CF était situé antérieurement chez les patients de sexe féminin à tout temps (p=0,002). La mise en place fonctionnelle semblait être terminée dès trois mois pour les deux groupes. Conclusion: La qualité de l’occlusion était comparable dans les deux groupes six mois après la dépose des appareils orthodontiques, signifiant l’absence d’influence du type de traitement à court terme. Le sexe féminin pourrait être associé à un CF plus antérieur même après six mois de mise en place fonctionnelle. / Objective: Following aligner therapy, a lack of posterior contacts is common and is expected to resolve with settling. The aim of the study was to compare the quality of occlusion and settling, immediately after treatment and during a retention period of six months, in patients treated with fixed appliance therapy or clear aligners. Materials and Methods: 25 patients treated with fixed appliances and 14 patients treated with aligners were evaluated by a digital occlusal analysis (T-Scan 9) at time of debonding (T0) and 3 and 6 months later (T3 and T6). Subjects (41% female, average age 19.38 ± 5.98) were treated without extraction or maxillofacial surgery using either bonded wires or removable appliances without occlusal coverage as retainers. Contact symmetry, simultaneity and the antero-posterior position of the Center of Force (COF) were assessed at the time of debonding, and after 3 and 6 months of retention. Results: At all times of evaluation, the COF position was not statistically different for both treatment modalities (p=0.854), but was located more anteriorly in female patients when compared to male patients (p= 0.002). Settling appeared to be completed by 3 months in both groups. Conclusion: The quality of the occlusion was comparable after 6 months of settling when treated with either treatment modality indicating no short-term effect of treatment type. Females maintained a more anterior COF after six months of retention.

A Síndrome da Apneia Obstrutiva do Sono (SAOS) é caracterizada por episódios repetitivos de obstrução da Via Aérea Superior (VAS) e sua patogênese está relacionada a anormalidades anatômicas da VAS. Algumas alterações esqueléticas da face favorecem a perda de permeabilidade da VAS, incluindo a inclinação do plano oclusal maior que a norma. A Cirurgia de Avanço Maxilomandibular (CAMM) já teve sua eficácia comprovada no tratamento da SAOS. O objetivo deste trabalho foi avaliar a influência da rotação anti-horária do plano oclusal na CAMM para tratamento de indivíduos portadores da SAOS e quantificar as alterações morfométricas produzidas na VAS e seus efeitos na SAOS. O método adotado foi o ensaio clínico prospectivo, com uma amostra composta por 38 participantes, sendo 23 homens (60,5%) e 15 mulheres (39,5%) com idades entre 21,7 e 55,4 anos (37,4 ± 9,2). Os indivíduos foram divididos em dois grupos: CAMM com rotação do plano oclusal CR (n=19) e CAMM sem rotação do plano oclusal SR (n=19). Todos os participantes realizaram uma tomografia computadorizada (TC) da VAS e polissonografia de noite toda, no pré e pós-operatório. No Grupo CR, a relação da influência da rotação anti-horária do plano oclusal no movimento do ponto B no eixo X mostrou forte correlação (r=0,78). A regressão linear foi estatisticamente significante (p<0,0001) e mostrou proporção de 0,71mm de avanço para cada grau de rotação anti-horária do ângulo do plano oclusal. A avaliação dos índices polissonográficos mostrou diferença na condição tempo pré e pós-cirúrgico, porém não houve diferença estatística entre os grupos. O volume total aumentou 44,7% no Grupo CR e 30,3% no Grupo SR. O volume retropalatal e volume retrolingual aumentaram 49% e 40,9% no Grupo CR e 42,9% e 15,2% no Grupo SR, respectivamente. A menor área axial no Grupo CR aumentou 91,7% na região RP e 97,4% na região RL; no Grupo SR, o aumento foi de 76,4% e 31%, respectivamente. A altura da via aérea diminuiu 5,9% e 2,6% nos grupos CR e SR, respectivamente. O Grupo CR, com rotação anti-horária do plano oclusal na CAMM, obteve melhores resultados em relação ao Grupo SR em todos os parâmetros morfométricos analisados: volume, área e medidas lineares na faringe, principalmente na região retrolingual. No sentido sagital, a cada grau de rotaçãoanti-horária do plano oclusal ocorreu a projeção de 0,71mm da mandíbula, justificando a maior abertura da região retrolingual da faringe, bem como uma maior redução do IAH, IA e IH / Obstructive Sleep Apnea Syndrome (OSAS) is characterized by repetitive episodes of upper airway (UAW) obstruction, and its pathogenesis is related to anatomical abnormalities of the UAW. Some skeletal changes in the face favor the loss of UAW permeability, including inclination of the occlusal plane greater than the norm. Maxillomandibular Advancement Surgery (MMAS) has already proven its efficacy in the treatment of OSAS. The objective of this study was to evaluate the influence of the counterclockwise rotation of the occlusal plane in the MMAS for treatment of individuals with OSAS, and to quantify the morphometric changes produced in the UAW and its effects on OSAS. The method used was the prospective clinical trial, with a sample composed of 38 participants, of which 23 were men (60.5%) and 15 were women (39.5%), between 21.7 and 55.4 years of age (37.4% ± 9.2). The individuals were divided into two groups: MMAS with rotation of the occlusal plane CR (n=19) and MMAS without rotation of the occlusal plane SR (n=19). All par-ticipants performed a UAW computed tomography (CT) and all-night polysomnography, pre and postoperatively. In the CR group, the relation of the influence of the counterclockwise rotation of the occlusal plane on the movement of point B on the X axis showed a strong correlation (r=0.78). The linear regression was statistically significant (p<0.0001) and showed a proportion of 0.71 mm of advance for each degree of counterclockwise rotation of the angle of the occlusal plane. The evaluation of polysomnographic indices showed a difference in pre and postsurgical time, but there was no statistical difference between the groups. The total volume increased 44.7% in the CR group and 30.3% in the SR group. The retropalatal (RP) volume and retrolingual (RL) volume increased 49% and 40.9% in the CR group and 42.9% and 15.2% in the SR group, respectively. The smaller axial area in the CR group increased 91.7% in the RP region and 97.4% in the RL region; in the SR group the increase was 76.4% and 31%, respectively. The airway height decreased 5.9% and 2.6% in the CR and SR groups, respectively. The CR group obtained better results in relation to the SR group in all the morphometric parameters analyzed: volume, area and linear measurements in the pharynx, mainly in the RL region. In the sagittal sense, at each degree of counterclockwise rotation of the occlusal plane, the projection of 0.71 mm of themandible occurred, justifying the greater opening of the RL region of the pharynx, as well as a greater reduction of AHI, IA and HI

Le but de ce travail était la mise en place d’une chaîne méthodologique de planification virtuelle d’une ostéotomie sagittale des branches mandibulaires (OSBM) et son transfert au bloc opératoire. Dans la première partie, les méthodes classiques de planification et de transfert sont exposées. Habituellement réalisées à partir de modèles en plâtre sur articulateur, la planification et la production de guides occlusaux chirurgicaux souffrent d’une imprécision potentiellement à l’origine de troubles fonctionnels temporo-­‐mandibulaires. Le contrôle per-­‐opératoire du condyle mandibulaire lors de l’OSBM est un élément de stabilité squelettique dont dépend la qualité du résultat fonctionnel. Une évaluation des pratiques professionnelles des chirurgiens maxillo-­‐faciaux a été réalisée sur ce point. Une méthode de positionnement condylien utilisant un dispositif, moins fréquemment utilisée que la méthode empirique, est proposée comme présentant le meilleur rapport bénéfice/risque. Cette méthode a été reproduite virtuellement à travers les différents maillons de la chaîne méthodologique. Des techniques innovantes informatisées d’acquisition, de conception et modélisation, et d’impression en 3 dimensions ont été utilisées. Dans la seconde partie, la méthodologie de chacun des maillons de la chaîne a été présentée et évaluée, soit sur sujets cadavériques, soit sur patients. L’objectif était de démontrer la faisabilité de la chaîne. Le maillon « acquisition et extraction de surface » a mis en exergue le problème des artéfacts dus aux matériaux métalliques dentaires ou orthodontiques. Dans 90% des cas le maillage obtenu était satisfaisant, permettant de s’affranchir des modèles en plâtre. Le maillon « planification chirurgicale virtuelle » a montré une valorisation par rapport à la technique classique en terme de prévention des interférences des pièces osseuses déplacées. Le maillon « modélisation et impression du guide chirurgical » a décrit les étapes d’invention d’un guide de positionnement occlusal et condylien (OCPD : occlusal and condylar positionning device). Ses caractéristiques techniques, ses modalités de production par impression 3D ainsi que son utilisation peropératoire, ont été précisées. Enfin le maillon « évaluation de l’OCPD » a permis de montrer la faisabilité de la méthode et l’équivalence clinique, technique et biologique de ce dispositif médical sur mesure par rapport à ceux utilisés dans la méthode classique. Enfin le positionnement condylien obtenu grâce à ce dispositif a été évalué de manière préliminaire et comparé aux données de la littérature. Grâce à l’OCPD, nous avons montré la possibilité de transférer au bloc opératoire la planification virtuelle d’une OSBM contrôlant la position des condyles / The purpose of this work was the implementation of a methodological chain for bilateral sagittal split osteotomy (BSSO) virtual planning and its transfer in the operating room. In the first part of the work, usual methods for planning BSSO are exposed. Usually realized from plaster models on articulator, the planning and the occlusal surgical guides production are at risk of temporo-­‐mandibular functional disorders. The quality of the functional result depends on the correct positioning of the mandibular condyle, considered as a skeletal stability element. An assessment of the maxillofacial surgeons practices was realized regarding intra-­‐operative condyle positioning. Using a condylar positioning device (CPD),less frequently employed than the empirical method, meets an acceptable benefit/risk balance. This method was virtually reproduced through various steps of the methodological chain described. Computerized innovative techniques for three-­‐dimensional acquisition, design and manufacturing were used. In the second part of the work, the methodology of each step of the chain was presented and estimated, either on cadaveric subjects, or on patients. The aim was to demonstrate the feasibility of the whole chain. The “acquisition and surface extraction” step pointed the issue of artefacts due to dental or orthodontic metallic devices. Ninety % of the obtained meshes were satisfactory, allowing not to use plaster models. The “virtual surgical planning” step allowed reproducing the usual method and showed great interest in bone interferences prevention. The “modelling and printing of the surgical guide” step described the stages of occlusal and condylar positioning device (OCPD) invention. Its technical characteristics, its methods of manufacturing by 3D printing, and its intraoperative use were specified. The step “OCPD evaluation” showed the method feasibility and the clinical, technical and biological equivalence of this custom-­‐made medical device as compared to those used in the usual method. Finally the condylar position obtained with this device was estimated in a preliminary clinical study and compared with the literature. Thanks to the OCPD, we showed the possibility of transferring in the operating room an OSBM virtual planning controlling condyles position.

Indiana University-Purdue University Indianapolis (IUPUI) Indiana University School of Dentistry Master Degree Thesis. / Detection of caries at an early stage is unequivocally essential for early preventive intervention. Longitudinal assessment of caries lesions, especially under the opaque preventive sealant, would be of utmost importance to the dental community. OBJECTIVES: The aim of this two-part in-vitro study is to evaluate the performance of multiple detection methods: The International Caries Detection and Assessment System (ICDAS); two quantitative light-induced fluorescence systems QLF; Inspektor™ Pro and QLF-D Biluminator™2 (Inspektor Research Systems B.V.; Amsterdam, The Netherlands); and photothermal radiometry and modulated luminescence (PTR/LUM) of The Canary System® (Quantum Dental Technologies; Toronto, Canada). All these are to be evaluated on their detection of caries on posterior human permanent teeth for 1) of primary occlusal lesions, and 2) under the sealant of primary occlusal lesions. METHODS: One hundred and twenty (N = 120) human posterior permanent teeth, selected in compliance with IU-IRB “Institutional Review Board” standards, with non-cavitated occlusal lesions ICDAS (scores 0 to 4) were divided into two equal groups. The second group (N = 60) received an opaque resin dental sealant (Delton® Light-Curing Pit and Fissure Sealant Opaque, Dentsply, York, PA). All lesions were assessed with each detection method twice in a random order except for ICDAS, which was not used following the placement of the sealant. Histological validation was used to compare methods in regard to sensitivity, specificity, % correct, and the area under receiver- operating characteristic curve (AUC). Intra-examiner repeatability and inter-examiner agreement were measured using intraclass correlation coefficient (ICC). RESULTS: 1) Of primary occlusal lesions, sensitivity, specificity, and AUC values were respectively: 0.82, 0.86 and 0.87 (ICDAS); 0.89, 0.60 and 0.90 (Inspektor Pro); 0.96, 0.57 and 0.94 (QLF-D Biluminator 2); and 0.85, 0.43 and 0.79 (The Canary System). Intra-examiner repeatability and inter-examiner agreement were respectively: 0.81 to 0.87: 0.72 (ICDAS); 0.49 to 0.97: 0.73 (Inspektor Pro); 0.96 to 0.99: 0.96 (QLF-D Biluminator 2); and 0.33 to 0.63: 0.48 (The Canary System). 2) Of primary occlusal lesions under the opaque dental sealants, sensitivity, specificity, and AUC values were respectively: 0.99, 0.03 and 0.67 (Inspektor Pro); 1.00, 0.00 and 0.70 (QLF-D Biluminator 2); and 0.54, 0.50 and 0.58 (The Canary System). Intra-examiner repeatability and inter-examiner agreement were respectively: 0.24 to 0.37: 0.29 (Inspektor Pro); 0.80 to 0.84: 0.74 (QLF-D Biluminator 2); and 0.22 to 0.47: 0.01 (The Canary System). CONCLUSION: Limited to these in-vitro conditions, 1) ICDAS remains the method of choice for detection of early caries lesion due to its adequately high accuracy and repeatability. QLF systems demonstrate potential in longitudinal monitoring due to an almost perfect repeatability of QLF-D Biluminator 2. The Canary System performance and repeatability were not acceptable as a valid method of early caries detection. 2) None of the methods demonstrated acceptable ability in detecting of occlusal caries under the opaque sealant. However, QLF-D Biluminator 2, with limitation to these in-vitro conditions and Delton opaque sealant, demonstrated a fair accuracy AUC (0.70) in detecting of caries under sealants at an experimental threshold of 12.5% ΔF.

Stains and stained incipient lesions can be challenging to differentiate with established clinical tools. New diagnostic techniques are required for improved distinction to enable early noninvasive treatment. This in vitro study evaluates the performance of artificial intelligence (AI)-based classification of hyperspectral imaging data for early occlusal lesion detection and differentiation from stains. Sixty-five extracted permanent human maxillary and mandibular bicuspids and molars (International Caries Detection and Assessment System [ICDAS] II 0–4) were imaged with a hyperspectral camera (Diaspective Vision TIVITA® Tissue, Diaspective Vision, Pepelow, Germany) at a distance of 350 mm, acquiring spatial and spectral information in the wavelength range 505–1000 nm; 650 fissural spectra were used to train classification algorithms (models) for automated distinction between stained but sound enamel and stained lesions. Stratified 10-fold cross-validation was used. The model with the highest classification performance, a fine k-nearest neighbor classification algorithm, was used to classify five additional tooth fissural areas. Polarization microscopy of ground sections served as reference. Compared to stained lesions, stained intact enamel showed higher reflectance in the wavelength range 525–710 nm but lower reflectance in the wavelength range 710–1000 nm. A fine k-nearest neighbor classification algorithm achieved the highest performance with a Matthews correlation coefficient (MCC) of 0.75, a sensitivity of 0.95 and a specificity of 0.80 when distinguishing between intact stained and stained lesion spectra. The superposition of color-coded classification results on further tooth occlusal projections enabled qualitative assessment of the entire fissure’s enamel health. AI-based evaluation of hyperspectral images is highly promising as a complementary method to visual and radiographic examination for early occlusal lesion detection.