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    Accuracy of different dental age estimation methods for determining the legal majority of 18 years in the Turkish population
    (Springer Heidelberg, 2022) Akman, Hayri; Surme, Koray; Cimen, Tansu; Ayyildiz, Halil
    Objectives Radiographic evaluation of the third molar maturation is used to estimate dental age, especially in adolescence. This study aimed to assess the application of three age estimation methods (Cameriere's third molar maturity index (I-3M), Demirjian's maturation stages, and The London Atlas) to determine whether an individual is 18 years or older (adult) or younger than 18 years (minor). Materials and methods The dental age was estimated using the I-3M, Demirjian's maturation stages, and The London Atlas methods on panoramic radiograms of a total of 500 Turkish individuals aged 14-22 years. A logistic model was derived with an individual's adult or minor status as the dependent variable, and each method and sex as predictive variables. The adult status was determined using dental age estimation methods and the performance of these methods in differentiating adults from minors was evaluated. The three methods were compared case-wise for their accuracy in predicting adult status. Results Logistic regression analysis showed that sex and each estimation method were statistically significant in discriminating adults and minors (p < 0.05). In the case-wise comparison for estimate adulthood, both Demirjian's stages and I-3M methods tended to perform better than the London Atlas method, with this trend reaching statistical significance (p < 0.05). Conclusions Cameriere's I-3M and Demirjian's development stages are useful methods for adult age assessment in the tested population.
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    Comparison of Play Dough and Bread Dough with Ballistic Gel as Soft Tissue Simulator: An Ex-Vivo Study with Sheep's Head as the Gold Standard
    (Pera Yayincilik Hizmetleri, 2025) Cimen, Tansu; Saka, Yunus Yigit; Gulsen, Ibrahim Tevfik; Kose, Mehmet Numan; Satir, Samed
    Objective: This study aims to test the usability of bread dough, play dough, and ballistic gel in soft tissue simulations by comparing them with a sheep's head as the gold standard. Cone beam computed tomography (CBCT) images of the sheep's head was obtained as the gold standard. Methods: The sheep's head was re-covered with ballistic gel, play dough, and bread dough, respectively. Two different CBCT images (protocol A-FOV: 8x15cm, 90kVp, 6.3mA, 4.5s, 0.35mm-voxel size, 574 mGy cm(2); protocol B-FOV: 13x15cm, 90kVp, 5mA, 8.1s, 0.30mm-voxel size, 823 mGy cm(2)) were obtained from the gold standard and each simulation model. The Hounsfield unit (HU) feature in the software of the CBCT was used to evaluate gray values. Pearson Correlation Coefficient was used to examine the relationship between variables that comply with normal distribution, and Spearman's rho Correlation Coefficient was used to examine the relationship between variables that do not comply with normal distribution. The significance level was taken as p < 0.05. Results The highest positively significant correlation with the gold standard in the mandible was with bread dough (r = 0.944, p < 0.001), while in the maxilla it was with play dough (r = 0.879, p < 0.001). The highest positive significant correlation with the gold standard in gray values selected from teeth and bone was with ballistic gel (r = 0.762, p=0.004; r = 0.638, p=0.008, respectively), while in pulp it was with play dough (r = 0.874, p < 0.001). A very high, positive, and significant correlation was found between protocols A and B of all simulation models. The highest positive significant correlation of the gold standard protocol A was found with the ballistic gel simulation protocol B (r = 0.893, p < 0.001). Conclusion: Play-dough can be an alternative soft tissue simulator to ballistic gel, especially in ex vivo studies on pulp morphology.
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    Diagnosing Pathological Changes in the Non-thickening Sinus Mucosa: A Retrospective CBCT Study with Psudocolor Imaging
    (Galenos Publ House, 2023) Satir, Samed; Cimen, Tansu; Gulsen, Ibrahim Tevfik; Saka, Yunus Yigit
    Objective: The aim of this study is to test the utility of pseudocolor imaging in the diagnosis and evaluation of the maxillary sinus mucosa, which has a suspicion of pathological change even though no thickening pattern is formed.Methods: Patients with healthy teeth without apical lesions from premolars and molars adjacent to the right and left maxillary sinus on one side (control) and tooth/teeth with apical lesions on the other side (study) were selected (n=17) and included in the study. Cochran's Q test was used to compare distribution of color anterior (A), medial (M) and posterior (P). Post-hoc analysis was performed using Bonferroni correction.Results: The rate of multicolor in the anterior and medial side of the pathological side (52.9% and 47.1%) was higher than the healthy side (35.3% and 29.4%), and it was not statistically significant (p=0.300 and p=0.290). Independently of the groups (n=34), the ratio of multicolor in color A (44.1%) was significantly higher than in color P (20.6%) (p=0.047). On the pathological side (n=17), the ratios of multicolor in color A and M (52.9% and 47.1%, respectively) were higher than in color P (23.5%), but this difference was not statistically significant (p=0.148).Conclusion: In implant surgery planning, pseudocolor imaging can be an alternative as a non-invasive adjunctive diagnostic method, especially in the evaluation of the sinus mucosa of maxillary posterior edentulous region in patients with unknown dental history.
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    Effects of Crest Morphology on Lingual Concavity in Mandibular Molar Region: an Observational Study
    (Uab Stilus Optimus, 2023) Cimen, Tansu; Asar, Neset Volkan; Goyushov, Samir; Duruel, Onurcem; Toezuem, Tolga Fikret
    Objectives: The aim of this radiological study is to evaluate the lingual concavity dimensions and possible implant length in each posterior tooth region according to posterior crest type classification by using cone-beam computed tomography. Material and Methods: According to inclusion criteria, 836 molar teeth regions from 209 cone-beam computed tomography images were evaluated. Posterior crest type (concave, parallel, or convex), possible implant length, lingual concavity angle, width, and depth were recorded. Results: In each posterior tooth region, concave (U-type) crest was detected most frequently while convex (C-type) was the lowest. Possible implant length values were higher in second molar regions than first molars. Lingual concavity width and depth were decreasing from second molars to first molars for both sides. Additionally, lingual concavity angle showed higher values in second molar sites than first molars. In all molar teeth regions, lingual concavity width values were the highest in concave (U-type) crest type while they were the lowest in convex (C-type) crest type (P < 0.05). Lingual concavity angle values were recorded as the highest in concave (U-type) and the lowest in convex (C-type) crest type at the left first molar and right molars (P < 0.05). Conclusions: The lingual concavity dimensions and possible implant length may vary according to crest type and edentulous tooth region. Due to this effect, the surgeons should examine crest type clinically and radiologically. All parameters in the present study are decreasing while moving from anterior to posterior as well as from concave (U-type) to convex (C-type) morphologies.
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    Evaluation of Cortical Thicknesses and Bone Density Values of Mandibular Canal Borders and Coronal Site of Alveolar Crest
    (Uab Stilus Optimus, 2023) Ataman-Duruel, Emel Tugba; Beycioglu, Zehra; Yilmaz, Dogukan; Goyushov, Samir; Cimen, Tansu; Duruel, Onurcem; Yilmaz, Hasan Guney
    Objectives: The objectives of this retrospective study are to measure the amount of the alveolar crest cortication and cortication around the mandibular canal, and to evaluate bone density values of alveolar crest, cortication around mandibular canal, and possible implant placement area for edentulous sites.Material and Methods: Six hundred forty-two cone-beam computed tomography scans from 642 subjects were evaluated in four centers. Cortical thicknesses of alveolar crest and mandibular canal cortical borders (buccal, lingual, apical, and coronal) in each mandibular posterior teeth region were measured. Bone density of alveolar crest and mandibular canal cortical borders (buccal, lingual, apical, and coronal) in each mandibular posterior teeth region were recorded. The correlations between numeric variables were investigated using Pearson's correlation test.Results: The largest cortical border of the canal was measured 1.1 (SD 0.71) mm at the left second molar area and in coronal side of the mandibular canal (MC). Left and right first premolar regions showed higher bone density values compared to the other sites in all bone density values evaluations. The buccal side of the canal at the right first premolar region showed the highest bone density values (832.32 [SD 350.01]) while the coronal side of the canal at the left second molar region showed the lowest (508.75 [SD 225.47]). The bone density of possible implant placement area at the both left (692.25 [SD 238.25]) and right (604.43 [SD 240.92]) edentulous first premolar showed the highest values. Positive correlations between the bone density values of alveolar crest and the coronal side of MC were found in molar and left second premolar regions (P < 0.05).Conclusions: Results may provide information about the amount of cortication and bone densities tooth by tooth for posterior mandible to surgeons for planning the treatment precisely.
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    Evaluation of masseter muscle thickness of mouth breathing patients using ultrasonography
    (Bmc, 2025) Kose, Mehmet Numan; Cimen, Tansu
    Background Chronic mouth breathing negatively affects the growth of the craniofacial complex and creates problems on the dental structures and adjacent skeletal muscle structures. In this study, it was aimed to investigate the possible effects of this situation on the muscles in the chewing system by evaluating the masseter muscle thickness in mouth-breathing individuals by ultrasonography. Materials and methods A total of 50 patients (26 males and 24 females) between the ages of 18-65 years were included in the study and constituted the mouth breathing group, while a total of 50 patients (24 males and 26 females) constituted the control group. The masseter muscles of the patients were monitored both at rest and during contraction, separately on the right and left sides for both groups, and thickness measurements were made by ultrasonography imaging. Results According to the data obtained, the masseter muscle thickness values of the mouth breathing male patient group were found to be significantly lower than the control male group according to the variables of side and contraction status (p < 0.05), while no significant value was observed in the comparison of the female patient group and the control group (p > 0.05). While no difference was observed in the evaluation of the patient and control groups according to age factors (p > 0.05), the muscle thicknesses of male patients were significantly higher than those of female patients on both sides and in both positions in the gender variable (p < 0.05). Conclusion It can be stated that mouth breathing causes a negative effect on masticatory functions by creating an obstacle to normal physiology in the masticatory system and reduces the activation of the masseter muscle, which is one of the main elements of masticatory function.
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    Evaluation of symphysis donor site quantity by cone-beam computed tomography and its relation to anterior loop of mental foramen: an observational study
    (Bmc, 2025) Cimen, Tansu; Saka, Yunus Yigit; Ataman-Duruel, Emel Tugba; Duruel, Onurcem; Yilmaz, Hasan Guney; Tozum, Tolga Fikret
    ObjectiveFor severely atrophic alveolar ridges, block grafting procedures are usually decided to use for reliable results. Various intraoral donor sites for autogenous block graft are presented in the literature. However, vital anatomic structures can limit intraoral bone block graft surgeries, and they must be evaluated in detail. The aim of this study is to evaluate the dimensions and volume of the maximum potential symphysis block graft donor site and their relations to the anterior loop of mental foramen.Materials and methodsAccording to inclusion criteria, 408 cone beam computed tomography (CBCT) images were evaluated. Mental foramen diameter, anterior loop length, the maximum potential symphysis graft dimensions (height, width, and length) and volume were measured.ResultsPrevalence of anterior loop of mental foramen was calculated 30.15% (123 patients) for right and 29.66% (121 patients) for left sides. The length of anterior loop of mental foramen was measured for right and left side 4.470 +/- 1.355 and 5.223 +/- 1.599, respectively. The maximum potential symphysis graft height, width, length, and volume were 13.253 +/- 3.261 mm, 12.694 +/- 1.711 mm, 34.353 +/- 2.944 mm, and 3.102 +/- 1.013 cm 3, respectively. Presenting anterior loop has no significant effect on the maximum potential symphysis graft height (P = 0.560) and width (P = 0.242). However, the maximum potential symphysis block graft length (P = 0.017) and volume (P = 0.026) were decreased by increasing number of anterior loops of mental foramen.ConclusionThe mandibular symphysis bone block graft can be reliably selected as the donor site for a number of different augmentation procedures. However, there are restrictions owing to surrounding anatomical structures such as mental foramen and anterior loop. These vital structures should be considered using accurate CBCT evaluation. Presenting anterior loop of mental foramen is limiting symphysis bone block graft length and volume.
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    Inferior alveolar nerve topography and its bifurcation features: a cone beam computed tomography evaluation
    (Edizioni Minerva Medica, 2022) Asar, Neset, V; Cimen, Tansu; Duruel, Onurcem; Goyushov, Samir; Karabulut, Erdem; Tozum, Tolga F.
    BACKGROUND: Mandibular canal (MC) is the most important vital structure in mandible to prevent from complications such as bleeding and paresthesia. The aims of the present study were to inform the features (diameter, distances to the mandibular borders, and distance to tooth apex) of the MC for each posterior tooth region, and to present the bifurcation features of the MC. METHODS: Four-hundreds-eighteen MC images of 209 patients were evaluated. The parameters were recorded from right and left hemi-mandibles for each posterior teeth region: 1) MC diameter; 2) MC and mandibular basis distance; 3) MC and crest distance; 4) MC and tooth apex distance; 5) MC and buccal plate distance; 6) MC and lingual plate distance; and 7) possible implant length (the distance between 2 mm coronal of the MC and 1 mm apical of the crest). Additionally, MC bifurcation type and bifid mandibular canal length were noted for right and left sides. RESULTS: While higher MC diameter values were recorded at molars, MC diameter in first premolars bilaterally were the lowest. In premolars, MC and mandibular basis distance showed higher values than molars. There was a trend of decrease in MC and crest distance from molars to premolars. The highest MC and tooth apex distance was measured in second molar; however, the lowest was in the first premolar. Additionally, MC and buccal plate distances were higher in molars, while MC and lingual plate distances were higher in premolars. Possible implant length in first premolar was the lowest, when it was the highest in second molars. CONCLUSIONS: For simulating overall MC topography, it extended bucco-coronally from molars to premolars. Due to this topography, possible implant length increased from premolars to molars.
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    The effect of cone beam computerized tomography voxel size and the presence of root filling on the assessment of middle mesial canals in mandibular molar teeth
    (Springer Heidelberg, 2024) Cimen, Tansu; Duzgun, Salih; Akyuz, Ipek Eraslan; Topcuoglu, Hueseyin Sinan
    Introduction The study aims to compare the detection of the middle mesial canal (MMC) in mandibular molar teeth using cone beam computed tomography (CBCT) with different voxel sizes when the mesiobuccal (MB) and mesiolingual (ML) canals have three distinct phases (unpreparation, preparation and obturation and the removal of the obturation and repreparation). Methods Two hundred forty-two extracted human mandibular molars were collected and kept in a physiological saline solution prior to use. 0.2-, 0.28- and 0.35-mm voxel sizes CBCT (n = 242) were performed in three phases (Ph): Ph1, no MB and ML canal preparation or obturation; Ph2, after MB and ML canals preparation and obturation; and Ph3, after the removal of the obturation of MB and ML canals and canals repreparation. Images were analyzed using OnDemand3D (R) software. After the CBCT acquisition in Ph3, all the samples were clarified to visualize the presence of the MMC directly. A blinded, previously calibrated examiner analyzed all the images. Results The MMC was detected in 15 of the 242 teeth after the clearing technique. The lowest MMC detection rate was observed at 0.35-mm voxel size regardless of the ML and MB canal condition, while the highest was observed at 0.2-mm voxel size (P < 0.05). There is no statistically significant difference between 0.2-mm and 0.28-mm voxel sizes (P > 0.05). In all voxel sizes, the highest rate of detectability of the MMC was seen in Phase 1, while the lowest was in Phase 2. Conclusions It may be appropriate to take a 0.20-mm voxel size CBCT image, especially after the removal of root canal filling. Clinical relevance An appropriate CBCT voxel size and the absence of root canal filling in the root canal system help to detect the missing MMC.
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    The Radiological Evaluation of Mandibular Canal Related Variables in Mandibular Third Molar Region: a Retrospective Multicenter Study
    (Uab Stilus Optimus, 2022) Yilmaz, Dogukan; Ataman-Duruel, Emel Tugba; Beycioglu, Zehra; Goyushov, Samir; Cimen, Tansu; Duruel, Onurcem; Tozum, Tolga Fikret
    Objectives: The aim of this retrospective study was to investigate anatomical structure of mandibular canal and the factors those increase the possibility of inferior alveolar nerve damage in mandibular third molar region of Turkish population. Material and Methods: Overall 320 participants with 436 mandibular third molars were included from four different study centers. Following variables were measured: type and depth of third molar impaction, position of mandibular canal in relation to third molars, morphology of mandibular canal, cortication status of mandibular canal, possible contact between the third molars and mandibular canal, thickness and density of superior, buccal, and lingual mandibular canal wall, bucco-lingual and apico-coronal mandibular canal diameters on cone-beam computed tomography scans. Results: Lingual mandibular canal wall density and thickness were decreased significantly as the impaction depth of mandibular third molar was increased (P = 0.045, P = 0.001 respectively). Highest buccal mandibular canal wall density and thickness were observed in lingual position of mandibular canal in relation to mandibular third molar (P = 0.021, P = 0.034 respectively). Mandibular canal with oval/round morphology had higher apico-coronal diameter in comparison to tear drop and dumbbell morphologies (P = 0.018). Additionally, mandibular canals with observed cortication border and no contact with mandibular third molar had denser and thicker lingual mandibular canal wall (P = 0.003, P = 0.001 respectively). Conclusions: Buccal and lingual mandibular canal wall density, thickness and mandibular canal diameter may be related with high-risk indicators of inferior alveolar nerve injury.