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Epidemiologic studies measuring the prevalence and severity of dental caries have used modified versions of Klein and colleagues decayed, missing, and filled (DMF). Keywords: Int Dent J. The recall results of the D1/D2/D3 lesions were 0.765, 0.652, and 0.918, respectively. << Details of nnU-Net architecture and implementation details in caries segmentation. The performance of the test dataset in the trained nnU-Net and DenseNet121 models was compared with the results of six expert dentists in terms of the intersection over union (IoU), Dice coefficient, accuracy, precision, recall, negative predictive value (NPV), and F1-score metrics. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis: United States, 1988-1994 and 1999-2002. /Contents 43 0 R Domejean S, White JM, Featherstone JD. Approximal cavitation related to bite-wing image and caries activity in adolescents. ICDAS: an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Structure of dopamine receptors. D4. The criteria consist of 4 scores. Most of these lesions would be classified assound in epidemiologic studies. x][sF~wqL&3_+@S"eGS[_@StEhht>}.9}Q%LI%EZ,,Rm$> !,O. Cervical and root includes any smooth surface lesion above or below the anatomical crown that is accessible through direct visual/tactile examination. Today, much more is known about the caries disease process and how to most . << %%EOF American Dental Association Council on Scientific Affairs, Eugenio Beltran-Aguilar,DMD, DrPH, DABDPH. Some evidence suggests that these receptors affect behavior indirectly through their regulatory effects on the D2-like receptors. 20 distal surface, approximal origin, moderate extent, active (2 bitewing radiographs taken 1 year apart support the clinical judgment of active based on progression of caries lesion displayed on the bitewings and consistent with the moderate extent based on the, The approximal site is frequently not accessible for direct examination due to contact with the adjacent tooth; therefore, other factors for making clinical treatment decisions may be useful. Careers. D1- initial caries, no detectable loss of substance, white spot D2- enamel caries, loss of substance but no soft floor, no cavitation D3- caries of dentin, detectably soft floor, explorer must enter a lesion with certainty D4- pulpal involvement Intracellularly, dopamine receptors interact with either stimulatory or inhibitory G-proteins. We use cookies on our website to enhance user experience and to analyze site usage so we can further improve our website and marketing. D2 Clinically detectable cavities in enamel 3. Caries classification system under study. Benn DK, Cooper RL, Nunn ME, Edwards SE, Rocha-Sanchez SM. The criteria can be used on coronal, root caries and caries around restorations. https://doi.org/10.1016/j.adaj.2014.11.018, The American Dental Association Caries Classification System for Clinical Practice, International Caries Detection and Assessment System, View Large sharing sensitive information, make sure youre on a federal /StemH 0 D1 lesions are clin-ically detectable enamel caries with a sound sur-face. Acta Pharmacol Toxicol. This is a preview of subscription content, access via your institution. Br J Psychiatry. 1999;186:630633. >> /Parent 23 0 R This ability to block the D2 receptor is not uniform throughout the dopaminergic system. D3. /Type/Catalog Comparing the groups of children on healthy enamel surfaces / d1 or d2 caries lesions we found a statistically significant difference.Dental caries is the most common chronic disease of childhood. Ui-&KN2Y?eMUe{VWF$ZuF&R5M_ypYUuOBzu!G@H*u6:|u5k;_V6 Tz,-hrl/~":>Q#AVdn.CG#Yb$X`R5 *NxxR -" Farde L, Wiesel FA, Hall H, et al. A total of 1160 dental panoramic films were evaluated by three expert dentists. Thisfactor should be considered when assigning caries risk status. https://doi.org/10.1007/978-3-030-16967-1_7, DOI: https://doi.org/10.1007/978-3-030-16967-1_7. Cover D0 & 1 D2 & D3 D4 Root Cause Analysis Human Factor D5 Objective Evidence D6 D7 D8 Source Rev History Cover . /Subtype/TrueType The https:// ensures that you are connecting to the Present and future approaches for the control of caries. You will then receive an email that contains a secure link for resetting your password, If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password. eCollection 2022. In 1992, Pitts and Rimmer. For caries depth classification, DenseNet121 showed an overall accuracy of 0.957 for D1 lesions, 0.832 for D2 lesions, and 0.863 for D3 lesions. Clinical application of the ADA CCS relies upon examinations conducted on a clean tooth with compressed air, adequate lighting, and the use of a rounded explorer or ball-end probe. The identity and physico-chemical properties of D3, D4, D5, D6 and HMDS are summarised in Table 1 and 2, respectively. Thompson V, Schenkel A, Penugonda B, et al. D2 comprises of cavitated lesions within enamel that are clinically detectable. eCollection 2020. << In the last three years, seven distinct dopamine receptors have been identified. 3 occlusal surface, pit and fissure origin, advanced extent, active; no. Nature. 0000002004 00000 n 29 0 obj Antipsychotic action and extrapyramidal side effects of classical neuroleptics are a function of dopamine D2-like receptor blockade. /BaseFont/KRFMMB+TimesNewRoman,BoldItalic enlarged cavity with at least one cusp undermined and need protection from occlusal load. Part of Springer Nature. Much attention has focused recently on the interaction between dopamine and serotonin neurons in mediating psychosis, negative symptoms and the extrapyramidal side effects of neuroleptics. Caries Res. Established early cavitated, shallow cavitation, or microcavitation, Spread/disseminated, late cavitated, deep cavitation, Lesion is not in a plaque stagnation area, Lesion is in a plaque stagnation area (pit/fissure, approximal, gingival area), All teeth and tooth surfaces should be visually inspected for lesions and can be scored using the table below (CCS). Baron JC, Martinot JL, Cambon H, et al. Despite progress, the profession still primarily uses the G.V. 2013;41:e4152. J Am Dent Assoc. This order requires the WhatsApp application. Community Dent Oral Epidemiol. 1992;49:560-568.2. Caries Res. D1B or D5. 2009;21:20916. Oral Surg Oral Med Oral Pathol Oral Radiol. Each site of visible change can be scored as inactive (I) or active (A). Note that activity cannot be determined by radiographic appearance except in situations in which it is possible to compare sequential radiographic images of the same caries lesion exposed over an appropriate span of time. Black and William Bibb, circa 1896. These initial lesions are considered noncavitated and, with remineralization, are reversible. << Accuracy of the DIAGNOcam and bitewing radiographs in the diagnosis of cavitated proximal carious lesions in primary molars. Login with your ADA username and password. Evidence of lesion activity over time, based on changes (or lack thereof) in the radiolucency (progression or arrest) could have a direct impact on clinical treatment decisions. /FontBBox[-547 -305 1203 1031] The site is secure. D3 is soft bone, while D4 is very soft bone. 8600 Rockville Pike >> Takahashi N, Nyvad B. Caries ecology revisited: microbial dynamics and the caries process. Ondansetron (Zofran), the only clinically approved 5-HT3 receptor antagonist (for chemotherapy-induced nausea), is being tested for its antipsychotic properties. An invivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth. affecting gingival 1/3 of facial or lingual surfaces of anterior or posterior teeth. Serotonin also can inhibit the firing of dopaminergic neurons in limbic structures such as the nucleus accumbens. 2022;56(3):171-178. doi: 10.1159/000525193. Arch Gen Psychiatry (letter). The visual and tactile examination of the teeth is enhanced when the clinician cleans and dries the pits and fissures while recording findings tooth-by-tooth to determine if each pit or fissure is sound, or, if a caries lesion is present, noting the lesion extent (initial, moderate, or advanced as [, Next, the smooth surfaces are examined by drying the facial aspect and proceeding around the dentition (as a practitioner would when performing periodontal probing), eventually transitioning to the lingual surfaces, again recording tooth-by-tooth the status of each lesion (, Lastly, the approximal surfaces are examined using the visual and tactile method where possible. In combination, these four increasing macroscopic densities constitute four bone categories described by Misch (D1, D2, D3, and D4) located in the edentulous areas of the maxilla and mandible (Figure 7-11). Dopamine receptor subtypes and arousal. The Caries Assessment Spectrum and Treatment (CAST) index: rationale and development. D1 (Moderate Drought) D2 (Severe Drought) D3 (Extreme Drought) D4 (Exceptional Drought) No Data; Authors. endobj Psychiatr Ann. To learn more about how we use cookies, view our Privacy Policy. Unauthorized use of these marks is strictly prohibited. Community Dent Oral Epidemiol. J Dent Educ. Research has reported a lack of reliability in detecting early lesions among classification systems used in practice. Ann Med Psychol (Paris). Recent research suggests that the stimulation of D1 receptors has a synergistic effect on the D2 receptor motor response to dopamine. % Study with Quizlet and memorize flashcards containing terms like how are caries classified?, Mount-Hume classification system, Site-stage (SI/STA) classification system and more. Established and active lesions may be white or brown and enamel has lost its gloss. Dopamine agonist treatment of fluctuating parkinsonism. This feature set will not be varied with the distance from the camera to the face, therefore we can assume that these faeature are depended only on the face type. /FontFile2 29 0 R 1992.25. PET analysis of central D1 and D2 receptor occupancy in patients treated with classical neuroleptics and clozapine. X5=`k5V;5 1-R`mA.Y !e=p8w x?tK@fqF= aXo\u%Ij%)90.wP f}lV_`Vi84>/ExtGState<>>> Reviewed 2011 (unchanged from 2005). Automatic segmentation and detection of ectopic eruption of first permanent molars on panoramic radiographs based on nnU-Net. /Length 189 Classification C BLOK 8 - Introduction Ortho dan Terminologi - Sefalometri - Prosedur Diagnosis Orthodonti - Orthodontic Study Model BLOK 9 Modul 1: Prose Analisa perhitungan ruang dalam perawatan ortodonti salah satu sumber informasi penting untuk menentukan diagnosis ortodonti Diagnos BLOK 9 1. Classification of Dental Caries and Nomenclature Term 1 / 42 How are caries classified? Correlating the appearance of pit-and-fissure caries lesions relative to suspected histologic dentin penetration may be useful in clinical decision-making. Sokoloff P, Levesque D, Martres MP, et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Detection and Assessment of Dental Caries, https://doi.org/10.1007/978-3-030-16967-1_7, Shipping restrictions may apply, check to see if you are impacted, Tax calculation will be finalised during checkout. No clinically detectable lesions, Dental hard tissue appears normal in color, translucency and gloss. Berechnung 10.01.2023 Longbottom CL, Huysmans MC, Pitts NB, Fontana M. Glossary of key terms. 2021 Dec;132(6):715-726. doi: 10.1016/j.oooo.2021.02.014. Epub 2022 Jun 10. Date Competition Elo-Wert Opponent Opponent Elo-Wert Gewinnw. *Ismail AI, Tellez M, Pitts NB, et al. Klasifikasi Penyakit Periodontal (AAP 1999) 2. Kidd EA, Ricketts DN, Beighton D. Criteria for caries removal at the enamel-dentine junction: a clinical and microbiological study [see comments]. Would you like email updates of new search results? doi: 10.1371/journal.pone.0242013. 2023 Feb 12;13(4):689. doi: 10.3390/diagnostics13040689. Arch Gen Psychiatry. Dividing the dentin into . %PDF-1.3 Such calculations, based on clinical data collected at 2 different times with an appropriate interim between these clinical observations, improve trending the data to track the progression or regression of periodontal or caries lesions over time. Caries prevention and reversal based on the caries balance. 0000043062 00000 n affecting pits and fissures on occlusal molars and premolars, occlusal 2/3 of molars and premolars Buccal & Lingual surfaces, and Lingual surfaces of anterior teeth. Psychiatr Times. -. Ehrinnger H, Hornykiewicz o. Verteilung von Noradrenilin and Dopamine im Gehirn des Menschen und ihr Verhalten bei Erkrankungen des extrapyramidalen System. Detection of Proximal Caries Lesions on Bitewing Radiographs Using Deep Learning Method. Young DA, Novy BB, Zeller GG, et al. Moderate mineral loss resultsin a deeper demineralization with some possibility of enamel surface microcavitation, early shallow cavitation, and/or dentin shadowing visible through theenamel, which indicates the likelihood of dentin involvement (for example, microcavitation with visible dentin staining). endobj Risk assessment: can we achieve consensus?. Objectives: D1 is very hard bone, while D2 is hard bone. The role of cocaine in dopamine use and abuse. Ekstrand KR, Zero DT, Martignon S, Pitts NB. In the healthy state, the surface is sound, and there is no clinically detectable lesion. Dr. Zeller is the associate dean for clinical affairs, and a professor, oral health practice, College of Dentistry, University of Kentucky, Lexington, KY. Dr. Hale is a colonel, Dental Corps, a commander, US Army Dental and Trauma Research Detachment, and the director, craniomaxillofacial research, US Army Institute of Surgical Research, San Antonio, TX. Also at this time researchers discovered that dopamine depletion in the striatum played a role in Parkinson's disease. Detecting caries lesions of different radiographic extension on bitewings using deep learning. D3 lesion occur in dentin and are detected clinically as macroscopic cavities. /H [ 833 283 ] D2. Disclaimer. 2000;131(7):88799. Pitts N. ICDASan International System for Caries Detection and Assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. In the absence of an electronic dental record, the practitioner can easily implement the ADA CCS using a paper form and manual calculations regarding caries lesion progression over time. 1952;110:112-117.7. Serotonin's effects on dopamine can be mediated by 5-HT2, 5-HT1A and 5-HT3-receptor systems. /Encoding/MacRomanEncoding 2009;21:63-90. Assessing patients caries risk. /LastChar 121 endobj Community Dent Oral Epidemiol. PLoS One. 1988;45:71-78.11. - 38.242.221.65. For caries depth classification, DenseNet121 showed an overall accuracy of 0.957 for D1 lesions, 0.832 for D2 lesions, and 0.863 for D3 lesions. Epub 2021 Feb 23. In step 1,, Description of how caries lesions were classified into D1/D2/D3 lesions. A classification system to categorize the location, site of origin, extent, and when possible, activity level of caries lesions consistently over time is necessary to determine which clinical treatments and therapeutic interventions are appropriate to control and treat these lesions. American Dental Association Caries Classification System tooth surface site definitions. Young, DDS, EdD, MBA, MS, Brian B. Nov, DDS, Gregory G. Zeller, DDS, MS, Robert Hale, DDS, Thomas C. Hart, DDS, PhD, Edmond L. Truelove, DDS, MSD Kim R. Ekstrand, DDS, PhD, John D.B. References1. Community Dent Oral Epidemiol. Gingrich JA, Caron MG. 2011;39(10):70915. How do dental students determine patients caries risk level using the caries management by risk assessment (CAMBRA) system? (2019). The .gov means its official. Would you like email updates of new search results? official website and that any information you provide is encrypted 1993;16:299-321.13. government site. Other commonly used siloxanes are listed in Table 3 (Section 1.2). Dopamine agonists, such as amantadine (Symmetrel), bromocriptine and other amines currently are being investigated as potential relapse-prevention treatments. 173 0000083563 00000 n 1992;160(suppl 170):22-29.19. Wong DF, Wagner HN, Tune LE, et al. The American Dental Association Caries Classification System (ADA CCS). 4. Date Competition Elo-Wert Opponent Opponent Elo-Wert Gewinnw. D2: Classification Men (Prognose) D1: Platzierung Woman: 247: Platzierung Gesamt: 3723: Ageclass: O70: Fr dieses Ranglistendatum sind keine Eintrge vorhanden. % Not all carious lesions are active. Dr. Young is a professor, Department of Dental Practice, University of the Pacific, San Francisco, San Francisco, CA. Neal Chamberlain, PhD. Scientists are embarking on an exciting period in understanding the dopaminergic system. It categorizes lesions according to severity and activity. Clinicians are beginning to realize the possible benefits from gaining a more complete understanding of the dopaminergic system. Published by Elsevier Inc. All rights reserved. b'Gq=oZf^ x~Wxz`%k (@bN, cXD.y2 ~NM. Ekstrand KR, Zero DT, Martignon S, Pitts NB. Int Rev Neurobiol. Methods: The authors also would like to thank Chi Tran, DDS, for his assistance with the radiographs in Table2. There has been an explosion of interest and information regarding dopamine receptors in the human brain. Klin Wochenschr. Purple circle indicates D3 lesions, green circle indicates D2 lesions and red circle indicates D1 lesions. Available at: www.icdas.org/uploads/Rationale%20and%20Evidence%20ICDAS%20II%20September%2011-1.pdf. It is anticipated that entry of the ADA CCS examination data may be most easily and effectively accomplished using electronic dental records configured with appropriate user-friendly data entry workflow that offers drop-down pick lists or other straightforward data selection methods. This article is intended as the clinician's practical guide to the current understanding of dopamine receptors and their role in neuropsychiatric illness. 0000001771 00000 n Approximal cavitation related to bite-wing image and caries activity in adolescents. 1988;244:685-693.16. /Widths[250 0 0 0 0 0 0 0 0 0 0 0 250 0 250 0 500 500 500 0 500 0 0 0 0 0 0 333 0 0 0 0 0 667 667 667 722 0 667 0 0 0 0 667 0 889 722 0 0 0 667 0 611 0 667 889 0 0 0 0 0 0 0 0 0 500 500 444 500 444 333 500 556 278 0 500 278 778 556 500 500 0 389 389 278 556 0 0 0 444] 1991;350:610-614.26. Br. However, only the most likely site of origin would be recorded for that lesion. A D1-D3 Non-cavitated. This information does not replace dental/medical consultation, but is intended for EDUCATIONAL purposes only. /Type/FontDescriptor 0000001322 00000 n Lee S, Oh SI, Jo J, Kang S, Shin Y, Park JW. Rationale and evidence for the International Caries Detection and Assessment System (ICDAS II). 0000109883 00000 n ), #R0,RA-1-RA-3, RB4, and RC5-RC6 is the ICCMS radiographic scoring system (RC-6 = into pulp; https://www.icdas.org/uploads/ICCMS-Guide_Full_Guide_US.pdf . All metric values, including accuracy, precision, recall, NPV, and F1-score values, were proven to be no different from those of the experienced dentists. Dopamine plays an important role in controlling movement, emotion and cognition. 0000021720 00000 n Utilization therapeutique psychiatrique d'une phenothiazine d'action centrale elective. /Ascent 891 E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (inner half of enamel), D1 (outer third of dentin), D2 (middle third of dentin), and D3 (inner third of dentin); Gingival status (if lesion is near the gingiva), The anatomic pits or fissures (clefts or valleys in the tooth surface) of the teeth at the occlusal, facial or lingual surfaces of posterior teeth OR the lingual surfaces of the maxillary incisors or canines. /L 170463 This web site does not constitute a medical diagnosis; seek advice from a dentist/physician (if you are not one yourself) before making a diagnosis and/or undertaking any of the treatments suggested here. Detection criteria for tooth surface sites of origin are defined in, In the ADA CCS system, smooth, cervical, and root surfaces receive similar considerations because they share many similar characteristics and are accessible forvisible and tactile clinical examination (. None of the contributors to this web site assume liability for any use or misuse of the information provided here. No D2 receptor increase in PET study of schizophrenia. Clinically, a lag exists between the discontinuation of a neuroleptic and the resolution of extrapyramidal symptoms. /Name/F1 Duration of clozapine trial in neuroleptic-resistant schizophrenia. Volume 146, Issue 2, Pages 79-86 (February 2015) DOI: 10.1016/j.adaj.2014.11.018. The ADA Council on Scientific Affairs ultimately opted to create a new system that takes existing caries classification approaches into consideration, adds additional perspectives, and harmonizes these ideas into a single usable system. Sci Rep. 2021 Aug 19;11(1):16807. doi: 10.1038/s41598-021-96368-7. High-level dopamine receptor blockade occurs within 24 hours after initiation of neuroleptic treatment, yet the antipsychotic effects take days to achieve. Featherstone, MSc, PhD, Margherita Fontana, DDS, PhD, Amid Ismail, BDS, MPH, DrPH, MBA, John Kuehne, DDS, MS, Chris Longbottom, BDS, PhD, Nigel Pitts, BDS, PhD, David C. Sarrett, DMD, MS, Tim Wright, DDS, MS, Anita M. Mark, Eugenio Beltran-Aguilar, DMD, DrPH, DABDPH. The site is secure. The dopamine D4 receptor appears pharmacologically similar to D2 and D3 receptors but has a 10-times-greater affinity for the atypical antipsychotic clozapine, suggesting that D4 receptors may be the . Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. 1993;365:441-445.24. Gingivi Analisis Pengukuran Ruang dalam Perawatan orthodonti, DENTSIVE: materi dan soal kedokteran gigi, arrested: incipient lesions that never develop into frank caries, remineralized: stronger and more resistant to demineralization. Ismail AI, Tellez M, Pitts NB, et al. Furthermore, electronic entry of the caries lesion data elements will support calculations that, over a time span, will enable practitioners to trend progression or regression of caries lesions. Finally, D4 lesions in . 0000040291 00000 n Caries management pathways preserve dental tissues and promote oral health. stream Classification Machine Learning Algorithms Part I - K Nearest Neighbors Classifier Problem. doi: 10.1016/j.jdent.2015.02.009. /Filter[/FlateDecode] A convolutional neural network, called nnU-Net, was applied to detect caries lesions, and DenseNet121 was applied to classify the lesions according to their depths (dentin lesions in the outer, middle, or inner third D1/2/3 of dentin). 2015;79(3):27885. These are the earliest detectable lesions compatible with net mineral loss. Tooth Type Enhanced Transformer for Children Caries Diagnosis on Dental Panoramic Radiographs. 2013;41:e6470. They initiated an important advance in the treatment of schizophrenia without a clear understanding of the mechanisms underlying the drug's therapeutic effect. In 1979, Kebabian and Calne determined that at least two dopamine receptors mediated this system, and for the next decade the actions of dopamine were viewed as being mediated by two dopamine receptors, D1 and D2. D5Pzc&NSMO6 FSnLl9sv>7'%~SP k'I%Q@6LAX! Radiolucency extends into the inner one-third of the dentin. Recent advances in molecular genetics have revealed the two-receptor model to be a gross oversimplification. However, it is important to note that these data only consider D3 and D4 lesions. This receptor is linked to stimulatory G-proteins that activate adenylate cyclase. Step 2 shows nnU-Net and how it works in caries lesion segmentation. government site. J Pharm Exper Therap. Lesion activity Ameasurement of dental caries prevalence and treatment service for deciduous teeth. Create. Zhou X, Yu G, Yin Q, Yang J, Sun J, Lv S, Shi Q. Diagnostics (Basel). The authors declare no conflict of interest. Dr. Nov is the director of practice improvement, DentaQuest Institute, Westborough, MA, and an adjunct associate professor, Department of Restorative Dentistry, Loma Linda University, Loma Linda, CA. lebih dari separuh enamel tanpa mengenai dentin, Kena DEJ, kurang dari separuh jarak ke pulpa. 2011;90(3):294303. Featherstone, MSc, PhD; Margherita Fontana, DDS, PhD; Amid Ismail, BDS, MPH, DrPH, MBA; John Kuehne, DDS, MS; Chris Longbottom, BDS, PhD; Nigel Pitts, BDS, PhD; David C. Sarrett, DMD, MS; Tim Wright, DDS, MS; Anita M. Mark; and Eugenio Beltran-Aguilar, DMD, DrPH, DABDPH. Caries risk assessment in an educational environment. 0000040500 00000 n Atypical neuroleptics have been shown to cause fewer extrapyramidal symptoms, which, in the case of clozapine, may be secondary to decreased blockade of D2 receptors in the striatum compared with classical neuroleptics (See Figure 5). The D1 receptors are found in high concentration in the substantia nigra pars reticulata, caudate, putamen, nucleus accumbens, olfactory tubercle, and frontal and temporal cortex. caries defined as an infectious microbiologic disease that results in progressive loss of tooth mineral followed by bacterial invasion into the demineralized tooth. Subjects. A radiographic method for distinguishing noncavitated from cavitated proximal carious lesions: A proof of concept clinical trial. A Novel Deep Learning-Based Approach for Segmentation of Different Type Caries Lesions on Panoramic Radiographs. Because the caries lesion has different forms of clinical presentation during the disease process, clinicians need a classification system that supports appropriate treatment decisions using available nonsurgical and surgical approaches. Caries detection with tooth surface segmentation on intraoral photographic images using deep learning.

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