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Öğe Assessment of deep learning technique for fully automated mandibular segmentation(Mosby-Elsevier, 2025) Yurdakurban, Ebru; Süküt, Yağızalp; Duran, Gökhan SerhatIntroduction: This study aimed to assess the precision of an open-source, clinician-trained, and user-friendly convolutional neural network-based model for automatically segmenting the mandible. Methods: A total of 55 cone-beam computed tomography scans that met the inclusion criteria were collected and divided into test and training groups. The MONAI (Medical Open Network for Artificial Intelligence) Label active learning tool extension was used to train the automatic model. To assess the model's performance, 15 cone-beam computed tomography scans from the test group were inputted into the model. The ground truth was obtained from manual segmentation data. Metrics including the Dice similarity coefficient, Hausdorff 95%, precision, recall, and segmentation times were calculated. In addition, surface deviations and volumetric differences between the automated and manual segmentation results were analyzed. Results: The automated model showed a high level of similarity to the manual segmentation results, with a mean Dice similarity coefficient of 0.926 +/- 0.014. The Hausdorff distance was 1.358 +/- 0.466 mm, whereas the mean recall and precision values were 0.941 +/- 0.028 and 0.941 +/- 0.022, respectively. There were no statistically significant differences in the arithmetic mean of the surface deviation for the entire mandible and 11 different anatomic regions. In terms of volumetric comparisons, the difference between the 2 groups was 1.62 mm3, which was not statistically significant. Conclusions: The automated model was found to be suitable for clinical use, demonstrating a high degree of agreement with the reference manual method. Clinicians can use open-source software to develop custom automated segmentation models tailored to their specific needs. (Am J Orthod Dentofacial Orthop 2025;167:242-9)Öğe Innovative use of the snowplow technique in orthodontics: Evaluation of its effect on the accuracy and manipulation time in clear aligner attachment reproduction(Elsevier Sci Ltd, 2025) Demir, Gizem Boztaş; Görgülü, Serkan; Topsakal, Kübra Gülnur; Duran, Gökhan SerhatObjective: In this study, we evaluated the effectiveness of the snowplow technique, commonly used in restorative dentistry, in clear aligner therapy, focusing on manipulation time and the accuracy of attachment-shape transfer from the 3D-designed model (i.e., attachment-reproduction accuracy). Methods: Rectangular, ellipsoidal, and customized attachments were placed on the first premolar teeth, and different attachment-reproduction methods were evaluated. The study groups included high-viscosity (HV) and low-viscosity (LV) composites, as well as two variations of the snowplow techniques (S1 and S2). The manipulation time was recorded, and a highly detailed 3D comparison methodology (sigma, arithmetic mean, and deviation label) was used to assess attachment-reproduction accuracy. Results: Manipulation time differed significantly across all groups, with the LV group exhibiting the shortest time, followed by the S1 group (p < .001). For surface deviation, the S1 group demonstrated the lowest sigma values, particularly for rectangular attachment designs (p < .001). Conclusions: Using the LV composite allowed the shortest application time, while the S1 technique required less manipulation time than did the HV composite. The S1 technique also achieved superior attachment accuracy, making it an effective technique for reproducing attachments with intricate surface details. Clinical Significance: The improved accuracy facilitated by the S1 technique may positively influence clinical outcomes by enhancing successful execution of planned tooth movements, thereby potentially improving the overall efficacy of clear aligner therapy.Öğe Effect of post-curing parameters and material thickness on the color stability of 3D-printed dental resins: An in vitro study(Elsevier Masson Sas Editeur, 2025) Topsakal, Kübra Gülnur; Aksoy, Merve; Sukut, Yağızalp; Duran, Gökhan SerhatObjective > To assess the effect of variations in post-curing temperatures and times on the colour stability of 3D-printed resins used in orthodontics and paediatric dentistry applications and the effect of material thickness on colour properties was also examined. Methods > The two different disk samples (15.00 x 1.0 mm, n = 90; 15.00 x 2.00, n = 90; diameter and height, respectively) were designed and printed from biocompatible resin with SLA technology. These samples were subjected to various post-curing temperatures and times (60 degrees C and 30 min, 60 degrees C and 90 min, 60 degrees C and 120 min, 60 degrees C and 60 min, 40 degrees C and 60 min, 80 degrees C and 60 min). The values of L, a, and b of the 3D-printed resin samples were evaluated under D65 illumination conditions in the centre of the samples using a spectrophotometer. The same researcher recorded the average values after the measurements were performed three times for each sample. Results > The results indicated significant differences in colour stability (L, a, b values) among samples subjected to different post-curing conditions. Variations in post-curing time and temperature significantly affected the colour of the resins. The study found that certain post-curing conditions could lead to acceptable colour values that are similar to natural teeth. Conclusions > The study concluded that the time and temperature of post-curing significantly affected the colour properties of 3D-printed clear resins used in orthodontic applications. It suggests that a 30-minute post-curing time can yield acceptable colour values, highlighting the importance of selecting appropriate post-curing conditions based on clinical requirements. Additionally, an increase in material thickness was found to correlate with increased yellowness in the samples. Clinical significance > The changes in post-curing temperature and time may impact colour properties. Clinicians should consider this situation when manufacturing with 3D printing.Öğe Evaluation of dentists' malpractice fears and defensive dentistry attitudes: a scale development(Bmc, 2025) Eser Mısır, Selcen; Uğrak, Ugur; Topsakal, Kübra Gülnur; Dalgalı, Perihan; Duran, Gökhan Serhat; Görgülü, SerkanObjectives To develop and design the Defensive Dentistry Attitude Scale (DDAS) to evaluate the relationship between defensive dentistry and fear of malpractice among dentists in T & uuml;rkiye. Methods The Defensive Dentistry Assessment Scale (DDAS) questions were determined based on expert opinions and a literature review. Based on these results, a questionnaire including the 13-item DDAS and the malpractice fear scale was sent to 3513 dentists in T & uuml;rkiye by email between 3.11.2023 and 10.1.2024. A total of 369 dentists returned. The questionnaire consisted of 26 questions with two VAS scales related to the frequency of complications and detailed anamnesis. During the development of DDAS, the Content Validity Index (CVI), Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA) were utilized. The Mann-Whitney U and Kruskal-Wallis tests were employed for group comparisons. In examining the relationships between variables, path analysis within the structural equation modeling (SEM) framework was conducted. Results The DDAS developed in the study was a valid and reliable measure with two dimensions and eight items. DDAS (Median = 29) and malpractice fear scores (Median = 21) were high in dentists. Malpractice fear scores of dentists aged 29-35 years (Median = 21) were found to be statistically significantly higher than those of dentists aged 36 years and older (p < 0.05). The levels of malpractice fears (Median = 22) and defensive dentistry attitudes (Median = 31) of dentists with 6-10 years of experience were statistically significantly higher than those of dentists with 11 years of experience and over (respectively (Median = 20), (Median = 28), p < 0.05). A statistically significant and high-level positive correlation was found between dentists' fear of malpractice and their tendency to adopt defensive dentistry practices (beta = 0.56, p < 0.001). Conclusions According to the results of this study, the DDAS was found to be a valid and reliable measure of negative and positive defensive dentistry. Specifically, a significant and strong positive correlation was identified between dentists' fear of malpractice and their engagement in defensive dentistry practices. This finding indicates that the tendency to adopt defensive dental behaviors increases as malpractice fear increases.Öğe Evaluation of composite materials with different viscosities on the accuracy of in-office aligner attachments(Elsevier Inc., 2025) Yıldız Erkuş, Kübra; Topsakal, Kübra Gülnur; Duran, Gökhan Serhat; Görgülü, SerkanIntroduction: To evaluate the accuracy of two different composites with low and high viscosity in different attachment designs, in-office clear aligner therapy was used. Methods: The study consisted of two main groups: the flowable composite group (n = 60) and the nanofilled composite group (n = 60), and in each group, five attachments (rectangular, beveled, ellipsoid, pentagon, and concave) (n = 12, per group) were used. The typodont model was scanned with an intraoral scanner to obtain a stereolithography file. The stereolithography data was transferred to the software, and attachments were placed on the teeth. A total of five models with attachments and 60 models without attachments were obtained with digital light processing technology. Attachments were applied to test models using two different types of composites with guide plates. Models with attachments applied were scanned with an intraoral scanner, and the attachments on the models were separated through the software. As a result of the comparison, the root mean square and the depth, width, and height linear dimensional measurements of the attachments were obtained. The 1-way analysis of variance test was used to compare attachment shapes, and the Tukey test was used in post-hoc comparisons. Results: According to the 3-dimensional digital comparison data, there is a statistically significant difference between flowable composite and nanofilled composite groups in root mean square values and width, height, and depth measurements (P = 0.034, P <0.001, P = 0.007, and P = 0.001, respectively). Conclusions: Although the flowable composite used in this study provides more accurate results compared with the nanofilled composite, both composite types have clinically applicable accuracy. © 2024 American Association of OrthodontistsÖğe Evaluation of the reliability of palatal rugae as a reference area in digital superimposition after slow maxillary expansion treatment(Elsevier Inc., 2025) Gökmen, Şule; Topsakal, Kübra Gülnur; Duran, Gökhan Serhat; Görgülü, SerkanIntroduction: This study aimed to evaluate the stability of palatal rugae patterns after slow maxillary expansion (SME) treatment and the reliability of the rugae region as a reference region in digital superimposition. Methods: The SME group comprised 21 subjects with Angle Class I or Class II dental malocclusion with unilateral or bilateral crossbite and constricted maxilla and were selected before the pubertal peak. Intraoral scans were captured via the intraoral scanner iTero Element software (version 1.13; Align Technology, San Jose, Calif) before treatment and after completion of 12 rotations of the screw in the expansion appliance. Patients rotated the screw once a week by the established protocol. The digital data of the impressions were analyzed using GOM Inspect 3D analysis software (version 2018; GOM GmbH, Braunschweig, Germany). Dimensional changes in rugae after SME were measured with MeshLab software (version 2022.02, the Visual Computing Lab of CNR-ISTI, Italy). For the statistical analysis, the Shapiro-Wilk test was used to assess normality, whereas the Kruskal-Wallis and Mann-Whitney U tests were applied for group comparisons. Results: According to digital superimposition data, the root mean square value of the rugae region in the SME group was found to be 0.195 ± 0.086 mm. The greatest dimensional change was found in the third rugae (1.70 ± 0.42 mm, P <0.001). Post-hoc pairwise comparisons revealed a statistically significant difference between the dimensional changes of the first and third rugae (P <0.05). No statistically significant difference was found as a result of pairwise comparisons of the right and left rugae points (P = 0.083 and P = 0.200, respectively). Conclusions: The observed transverse dimensional changes in the rugae, particularly in the third rugae, indicate that caution should be exercised in using the rugae region as a reference in superpositions after SME treatment. © 2024 American Association of OrthodontistsÖğe Evaluating the Impact of Different Education Methods on Cleft Lip and Palate Anatomy Training(Sage Publications Inc, 2024) Dalgalı, Perihan; Topsakal, Kübra Gülnur; Mısır, Selcen Eser; Ergüven, Sara Samur; Duran, Gökhan Serhat; Görgülü, SerkanObjective To compare the effects of different educational methods on short and long-term learning outcomes and to investigate the satisfaction and perception of cleft lip and palate (CLP) education among dental students.Design The theoretical exam on CLP to determine their baseline level of knowledge was taken by the participants(T0). After the exam, the students were randomly divided into three groups and all students attended a lecture-based traditional education on CLP. Students in the first group (n = 40) received no additional teaching (Group A). Students in the second group (n = 38) received model teaching with 3D-printed models (Group B). The third group (n = 39) was trained in e-learning-supported education (Group C). The theoretical exam was repeated immediately after the education (T1/short-term learning), one week later (T2/early long-term learning), and one month later (T3/late long-term learning), and the effect of the education methods on information level was assessed. In addition, a post-training satisfaction questionnaire was administered to participants of Group B and Group C.Results Both 3D model-based and e-learning-supported approaches significantly improved immediate knowledge of CLP. However, no significant differences were found in knowledge retention over time between the all methods. A majority of students favored the incorporation of both methods in orthodontic education.Conclusions While both 3D models and e-learning effectively enhance short-term CLP knowledge among dental students, their long-term educational impacts are comparable. However, student preferences indicated that the use of 3D-printed models and e-learning strategies may be useful augmentations to traditional lecture education.Öğe Three-dimensional soft tissue evaluation after rapid maxillary expansion and mandibular midline distraction osteogenesis(Allen Press Inc., 2021) Özturk, Seyit Ahmet; Malkoç, Sıddık; Yolcu, Ümit; İleri, Zehra; Güler, Özge ÇelikObjectives: To evaluate the effects of rapid maxillary expansion (RME) and mandibular midline distraction osteogenesis (MMDO) on facial soft tissues using three-dimensional (3D) images. Materials and Methods: A total of 20 patients (average age 15.86 +/- 2.17 years) were treated with RME and MMDO using tooth-borne distractors. Three-dimensional photographs of each patient were taken with a stereophotogrammetry system at baseline (T0), at the end of the distraction period (T1), and at the end of the consolidation period (T2). All data were analyzed using a dependent-samples t-test at a significance level of 5%. Results: Total and lower face height increased after MMDO (P < .05). Nasal and mouth width increased after RME as compared with baseline (P < .05). The labiomental angle increased at T1 and decreased at T2 (P < .05). After MMDO, the convexity angle increased while the mandibular angle decreased (P < .05). Upper and lower lip angles increased after RME (P < .05). The distance from the lower lip to the E plane increased after MMDO and decreased after RME (P < .05). Conclusions: The MMDO and RME procedures provide an efficient nonextraction treatment alternative for transverse maxillomandibular deficiency. MMDO may improve the facial soft tissue profile in the transverse and vertical axis of the mandibular region.Öğe Nano-hydroxyapatite incorporated quince seed mucilage bioscaffolds for osteogenic differentiation of human adipose-derived mesenchymal stem cells(Elsevier B.V., 2022) Çetin Genç, Çiğdem; Yılmaz, Hilal Deniz; Karaca, Burak; Kıran, Fadime; Arslan, Yavuz EmreIn this study, the therapeutic hydrocolloid quince seed mucilage (QSM) from Cydonia oblonga Miller fruit is enriched with needle-like nano-hydroxyapatite (nHAp) crystals to fabricate a novel biomimetic osteogenic bioscaffold. The molecular weight (Mw) of water-based extracted QSM was measured with GPC (8.67 × 105 g/mol), and the composite blend was prepared at a ratio of 1:1 (w/w) QSMaq and nHAp. The porous bioscaffolds were manufactured by the freeze-drying method, and evaluated in-depth with advanced analyses. The XRD, ATR-FTIR, SEM-EDX, and elemental mapping analyses revealed a uniform coated semi-crystalline structure with no covalent bindings between QSM and nHAp. Moreover, due to the hydrocolloid backbone, a supreme swelling ratio (w/w, 6523 ± 190%) with suitable pore size (208.12 ± 99.22 μm) for osteogenic development was obtained. Further, the cytocompatible bioscaffolds were evaluated for osteogenic differentiation in vitro using human adipose-derived mesenchymal stem cells (hAMSCs). The immuno/histochemical (I/HC) staining revealed that the cells with the spherical morphology invaded the pores of the prepared bioscaffolds. Also, relatively early up-regulated osteogenic markers were observed by the qRT-PCR analyses. Overall, it is believed that the QSM-nHAp bioscaffolds might be favorable in non-load bearing applications, especially in the cranio-maxillofacial region, due to their regenerative, bendable, and durable features.Öğe Evaluation of the Perspectives of Orthodontists and Laypersons About the Effect of Orthodontic Treatment on Facial Aesthetics of Young Turkish Patients(SAGE Publications, 2021) Fidancıoğlu, Ahmet; Malkoç, Sıddık; Güler, Özge ÇelikAim: To compare the perspective of orthodontists and laypersons on the effects of orthodontic treatment on facial aesthetics in young Classes I, II, and III Turkish patients. Materials and Methods: In this cross-sectional study, a total of 60 patients (30 males and 30 females, 9 to 17 years of age) was included using randomization in strata and then divided equally (n = 15) into four groups according to the Angle classification. Photographs during frontal and lateral resting and also smiling were obtained from each patient before and after orthodontic treatment. A panel consisting 50 laypersons and 50 orthodontists was invited for the evaluation of the initial and final photos by using the visual analogue scale and a five-point scale to determine similarities and differences of their perspectives in the effects of orthodontic treatment on facial aesthetics. The data were analyzed by independent t-test, one-way analysis of variance, and Pearson’s correlation test. Results: The evaluation of facial aesthetics and treatment changes were not affected by the age and gender of the panel members (P<.05). Angle Class III patients were given lower scores by both orthodontists (P<.001) and laypersons (P<.05), but no significant differences were found between any of other classes (P>.05). Orthodontists reported greater improvement for Class III than in Class II Division 1 (P<.05) however laypersons did not notice the changes after orthodontic treatment for any of Angle classes (P>.05). Conclusion: Class III patients received lower scores for aesthetics from both panels. Laypersons may not be concerned about the effects of orthodontic treatment on facial aesthetics in patients with any Angle class. Orthodontists have seen more facial aesthetic changes after orthodontic treatment in Class III patients.
