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Purpose: This study assessed the accuracy of linear measurements and dental implant selection performed in a smartphone application compared to a computer software. Materials and Methods: Forty-four DICOM files from the posterior mandible in partially edentulous patients were evaluated by three trained and calibrated examiners. Images were analyzed using three visualization methods: cross-sectional view (CScr) and coronal (CSco) plane using the CS 3D Imaging software, and coronal (DRco) plane using the DroidRender smartphone application. For standardization, bone width and height measurements were taken in the edentulous posterior mandible, 10 mm posterior to the mental foramen. Implants were selected according to the 2022/2023Straumann Standard implant catalog. Linear measurements were compared using repeated-measures ANOVA, and implant selection was compared using Friedman test. Statistical analysis was performed using SPSS software, with a significance level of 5%. Results: Linear measurements showed a statistically significant difference for bone width (P = .030), but not for height (P = .685). The choice of implant was not influenced by the visualization method (P = .614). Conclusions: It is possible to suggest the use of smartphone applications as an additional diagnostic tool for DICOM evaluation and implant planning in the posterior mandible. Smartphone applications allow an assessment not limited to 2D images or to static environments. Therefore, information exchange and diagnostic opinion in emergency situations may be facilitated. [ABSTRACT FROM AUTHOR]

We have grown and characterized (110)-oriented YBa2Cu3O7−x (YBCO)/PrBa2(Cu0.8Ga0.2)3O7−x (PBCGO) bilayer and YBCO/PBCGO/YBCO trilayer heterostructures, which were deposited by pulsed laser deposition technique for the nanofabrication of (110)-oriented YBCO-based superconductor (S)/insulator (I)/superconductor (S) tunneling vertical geometry Josephson junction and other superconductor electronic devices. The structural properties of these heterostructures, investigated through various x-ray diffraction techniques (profile, x-ray reflectivity, pole figure, and reciprocal mapping), showed (110)-oriented epitaxial growth with a preferred c-axis-in-plane direction for all layers of the heterostructures. The atomic force microscopy measurement on the top surface of the heterostructures showed crack-free and pinhole-free, compact surface morphology with about a few nanometer root mean square roughness over the 5 × 5 μm2 region. The electrical resistivity measurements on the (110)-direction of the heterostructures showed superconducting critical temperature (Tc) values above 77 K and a very small proximity effect due to the interfacial contact of the superconducting YBCO layers with the PBCGO insulating layer. Raman spectroscopy measurements on the heterostructures showed the softening of the Ag-type Raman modes associated with the apical oxygen O(4) and O(2)-O(3)-in-phase vibrations compared to the stand-alone (110)-oriented PBCGO due to the residual stress and additional two Raman modes at ∼600 and ∼285 cm−1 frequencies due to the disorder at the Cu–O chain site of the PBCGO. The growth process and structural, electrical transport, and Raman spectroscopy characterization of (110)-oriented YBCO/PBCGO bilayer and YBCO/PBCGO/YBCO trilayer heterostructures are discussed in detail. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between the structural parameters of trabecular bone obtained from CBCT imaging and the primary stability of dental implants. Materials and Methods: Sixty patients underwent implant placement followed by primary stability evaluation via measurement of the insertion torque (IT) and the implant stability quotient (ISQ). Gray values (GV) and the fractal dimension (FD) were also measured using pretreatment CBCT images. Results: FD values showed a positive and significant relationship with ISQ and IT values (P = .017 and P = .004, respectively). Additionally, there was a positive and significant correlation between GV and IT (P = .004) as well as between GV and ISQ (P = .010). FD and GV showed a considerable difference between the maxillary and mandibular jaws and were higher in the mandible. Only FD was significantly different between men and women and was higher in men. In the two age groups (older and younger than 45 years), only GV was considerably higher in people older than 45 (P < .05). Conclusions: Both fractal dimension and gray values obtained from CBCT are efficient methods for predicting the primary stability of the implant due to their relationship with ISQ and IT values. [ABSTRACT FROM AUTHOR]

In this position paper, the state of the art in immediate implant placement (IIP) at incisor-cuspid-premolar sites is described. The literature supports that the following prerequisites need to be simultaneously met for a predictable outcome: (1) there must be no acute infection; (2) there must be apical and palatal/lingual bone for implant anchorage; (3) the tooth must be inside the bone envelope; (4) the alveolar socket must have a favorable morphology (type I, IIa, IIb avoiding wide dehiscences); (5) there must be no midfacial recession; (6) the right implant must be selected; and (7) the surgeon needs to be experienced and skilled. A preoperative CBCT is required for IIP because multiple aforementioned prerequisites (2, 3, and 4) can only be assessed on the basis of 3D imaging. The final prerequisite relates to the importance of a perfect implant position, preferably leaving a horizontal gap of at least 2 mm between the implant shoulder and buccal bone wall. Guided surgery is preferred over free-hand surgery to accomplish this. Flapless surgery, socket grafting, connective tissue graft (CTG), and immediate provisionalization have been shown to contribute to hard and/or soft tissue stability. When the previously mentioned prerequisites are fulfilled, IIP may be considered over alternative treatment concepts (eg, early implant placement [EIP] and delayed implant placement [DIP]) based on time gain, minimal invasiveness, and similar outcomes in the literature. Given very strict selection criteria, clinicians should primarily screen patients for IIP before considering other treatment options with wider indications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate via CBCT the anatomical variations of the maxillary teeth and associated major anatomical cavities, the maxillary sinus and nasal fossa. Material and Methods: CBCT scans of 221 patients were used to examine maxillary sinus variations, the posterior superior alveolar artery (PSAA) course, nasal septum variations, middle and inferior conchameatus variations, canalis sinuosus, infraorbital ethmoid cell, infraorbital canal, anterior nasal spina, and nasopalatine canal. Results: The incidence of anatomical variations was 32.6% for maxillary sinus septa, 50.9% for PSAA, 23.1% for nasal septum deviation, 6.3% for nasal septum spur and pneumatization, 3.6% for paradoxical middle concha, 14.9% for middle concha hypertrophy, 39.6% for middle concha bullosa, 0.45% for bifid inferior concha, 0.9% for paradoxical inferior concha, 60.1% for inferior conch hypertrophy, 1.8% for inferior concha bullosa, and 40.3% for the infraorbital ethmoid cell. The study mainly observed group 2 anterior nasal spina with a rate of 35.7%, group 1 nasopalatine canal with a rate of 37.1%, and infraorbital duct type 2 with a rate of 70%. In 20.4% and 47% of cases, canalis sinuosus was located in the right and left sides of the maxilla, respectively. Conclusions: Maxillary sinus variations, PSAA prevalence and localization, nasal septum and concha variations, anterior nasal spina subgroups, nasopalatine canal subgroups, canalis sinuosus prevalence, and localization and infraorbital ethmoid cell prevalence were found to be consistent with the literature. Moreover, a rare case of the lower bifid concha was identified. The nasomaxillary complex and related dental structures, which are a multidisciplinary study area, should be carefully examined in the presence of pain of unknown origin and the planning of surgical procedures. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the performance of low‐dose cone beam computed tomography (CBCT) protocols with regard to linear bone measurements in the posterior mandible for implant planning compared with higher dose protocols. Materials and Methods: Forty‐two edentulous posterior sites in human cadaveric mandibles were imaged in three CBCT scanners using three or four protocols with varying exposure parameters to achieve lower dose. Co‐registration was performed to generate sagittal and cross‐sectional image sections representative of the implant site. Three observers measured bone height, from the alveolar crest to the mandibular canal, and width, three mm from the top of the alveolar crest. Intra‐ and interobserver reproducibility were assessed for the cases rated as nonmeasurable as well as for completed measurements. The measurements were analyzed using paired t‐tests for differences among the CBCT protocols and the frequency distribution of nonmeasurable cases with a Pearson Chi‐square test. Results: Reproducibility for registering nonmeasurable cases varied among observers; however, no consistent significant differences were found in the frequency distribution of these cases among observers, units, and protocols. Intraclass correlation coefficients (ICC) were >0.9 for all measurements of bone height and width. Mean differences of <0.5 mm were found regardless of protocol; however, one observer did in some cases produce larger differences. Conclusion: Linear bone measurements did not differ significantly and could be performed with excellent reliability, using low‐dose CBCT protocols compared with standard and high‐resolution ones. Varying approaches for rating nonmeasurable cases were found, indicating differences in diagnostic strategies related to implant planning among observers. [ABSTRACT FROM AUTHOR]

Innovation in image-guided procedures has been driven by advances in robotic Cone Beam Computed Tomography (CBCT) systems. A fundamental challenge for CBCT imaging is metal artifacts arising from surgical tools and implanted hardware. Here, we outline how two universal non-circular imaging orbits, optimized for metal artifact reduction, can be implemented in real-time on clinical robotic CBCT systems. Demonstrating potential clinical utility, the universal orbits were implemented during a pedicle screw cervical spine fixation and hip arthroplasty performed on a porcine and ovine cadaver respectively. In both procedures, the universal non-circular orbits noticeably reduced the metal artifacts surrounding the implanted orthopedic hardware, revealing anatomy and soft tissue obscured in current conventional CBCT imaging. This work represents a key step in clinically translating universal orbits, unlocking high quality in-room procedural verification to increase broader use of robotic CBCT systems and reduce the occurrence of secondary corrective surgeries. [ABSTRACT FROM AUTHOR]

Background: The first commercially available photon‐counting‐detector CT (PCD‐CT) has been introduced for clinical use. However, its spectral performance on single‐ and dual‐contrast imaging tasks has not been comprehensively assessed. Purpose: To evaluate the spectral imaging performance of a clinical PCD‐CT system for single‐contrast material [iodine (I) or gadolinium (Gd)] and dual‐contrast materials (I and Gd) in comparison with a dual‐source dual‐energy CT (DS‐DECT). Methods: Iodine (5, 10, and 15 mg/mL) and gadolinium (3.3, 6.6, and 9.9 mg/mL) samples, and their mixtures (I/Gd: 5/3.3 and 10/6.6 mg/mL) were prepared and placed in two torso‐shaped water phantoms (lateral dimensions: 30 and 40 cm). These phantoms were scanned on a PCD‐CT (NAEOTOM Alpha, Siemens) at 90, 120, and 140 kV. The same phantoms were scanned on a DS‐DECT (SOMATOM Force, Siemens) with 70/Sn150, 80/Sn150, 90/Sn150, and 100/Sn150 kV. The radiation dose levels were matched [volume CT dose index (CTDIvol): 10 mGy for the 30 cm phantom and 20 mGy for the 40 cm phantom] across all tube voltage settings and between scanners. Two‐material decomposition (I/water or Gd/water) was performed on iodine or gadolinium samples, and three‐material decomposition (I/Gd/water) on both individual samples and mixtures. On each decomposed image, mean mass concentration (± standard deviation) was measured in circular region‐of‐interests placed on the contrast samples. Root‐mean‐square‐error (RMSE) values of iodine and gadolinium concentrations were reported based on the measurements across all contrast samples and repeated on 10 consecutive slices. Results: For all material decomposition tasks on the DS‐DECT, the kV pairs with greater spectral separation (70/Sn150 kV and 80/Sn150 kV) yielded lower RMSE values than other DS‐DECT and PCD‐CT alternatives. Specifically, for the optimal 70/Sn150 kV, RMSE values were 1.2 ± 0.1 mg/mL (I) for I/water material decomposition, 1.0 ± 0.1 mg/mL (Gd) for Gd/water material decomposition, and 4.5 ± 0.2 mg/mL (I) and 3.7 ± 0.2 mg/mL (Gd), respectively, for I/Gd/water material decomposition. On the PCD‐CT, the optimal tube voltages were 120 or 140 kV for I/water decomposition with RMSE values of 2.0 ± 0.1 mg/mL (I). For Gd/water decomposition on PCD‐CT, the optimal tube voltage was 140 kV with gadolinium RMSE values of 1.5 ± 0.1 mg/mL (Gd), with the 90 kV setting on PCD‐CT generating higher RMSE values for gadolinium concentration compared to all DS‐DECT and PCD‐CT alternatives. For three material decomposition, both imaging modalities demonstrated substantially higher RMSE values for iodine and gadolinium, with 90 kV being the optimal tube potential for Gd/I quantitation on PCD‐CT [5.4 ± 0.3 mg/mL (I) and 3.9 ± 0.2 mg/mL (Gd)], and DS‐DECT at 100/Sn150 kV having larger RMSE values for both materials compared to the alternatives for either modality. Conclusion: Optimal tube voltage for material decomposition on the clinical PCD‐CT is task‐dependent but inferior to DS‐DECT using 70/Sn150 kV or 80/Sn150 kV in two‐material decomposition for single‐contrast imaging (iodine/water or gadolinium/water). Three material decomposition (iodine/gadolinium/water) in dual‐contrast imaging yields substantially higher RMSE for both imaging platforms. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy of the prostate and the pelvic lymph nodes (LN) is a part of the standard of care treatment for high‐risk prostate cancer. The independent translational and rotational (i.e., six‐degrees‐of‐freedom, [6DoF]) motion of the prostate and LN target during and between fractions can perturb the dose distribution. However, no standard dose reconstruction method accounting for differential 6DoF target motion is available. Purpose: We present a framework for monitoring motion‐induced dose perturbations for two independently moving target volumes in 6DoF. The framework was used to determine the dose perturbation for the prostate and the LN target caused by differential 6DoF motion for a cohort of high‐risk prostate cancer patients. As a potential first step toward real‐time dose‐guided high‐risk prostate radiotherapy, we furthermore investigated if the dose reconstruction was fast enough for real‐time application for both targets. Methods: Twenty high‐risk prostate cancer patients were treated with 3‐arc volumetric modulated arc therapy (VMAT). Kilovoltage intrafraction monitoring (KIM) with triggered kilovoltage (kV) images acquired every 3 throughout 7–10 fractions per patient was used for retrospective 6DoF intrafraction prostate motion estimation. The 6DoF interfraction LN motion was determined from a pelvic bone match between the planning CT and a post‐treatment cone beam CT (CBCT). Using the retrospectively extracted motion, real‐time 6DoF motion‐including dose reconstruction was simulated using the in‐house developed software DoseTracker. A data stream with the 6DoF target positions and linac parameters was broadcasted at a 3‐Hz frequency to DoseTracker. In a continuous loop, DoseTracker calculated the target dose increments including the specified motion and, for comparison, without motion. The motion‐induced change in D99.5% for the prostate CTV (ΔD99.5%) and in D98% for the LN CTV (ΔD98%) was calculated using the final cumulative dose of each fraction and averaged over all imaged fractions. The real‐time reconstructed dose distribution of DoseTracker was benchmarked against a clinical treatment planning system (TPS) and it was investigated whether the calculation speed was fast enough to keep up with the incoming data stream. Results: Translational motion was largest in cranio‐caudal (CC) direction (prostate: [‐5.9, +8.4] mm; LN: [‐9.9; +11.0] mm) and anterior–posterior (AP) direction (prostate:[‐5.6; +6.9] mm; LN: [‐9.6; +11.0] mm). The pitch was the largest rotation (prostate: [‐22.5; +25.2] deg; LN: [‐3.9; +5.5] deg). The prostate CTV ΔD99.5% was [‐16.2; +2.5]% for single fractions and [‐3.0; +1.7]% when averaged over all imaged fractions. The LN CTV ΔD98% was [‐19.8; +1.2]% for single fractions and [‐3.1; +0.9]% after averaging. Mean (Standard deviation) absolute dose errors in DoseTracker of 107.8% (Std: 1.9%) for the prostate and 105.5% (Std:1.4%) for the LN were corrected during dose reconstruction by automatically calculated normalization factors. It resulted in accurate calculation of the motion‐induced dose errors with relative differences between DoseTracker and TPS dose calculations of ‐0.1% (Std: 0.5%) (prostate CTV ΔD99.5%) and ‐0.2% (Std: 0.5%) (LN CTV ΔD98%). The DoseTracker calculation was fast enough to keep up with the incoming inputs for all but two out of 107 184 dose calculations. Conclusion: Using the developed framework for dose perturbation monitoring, we found that the differential 6DoF target motion caused substantial dose perturbation for individual fractions, which largely averaged out after several fractions. The framework was shown to provide reliable dose calculations and a sufficiently high‐dose reconstruction speed to be applicable in real‐time. [ABSTRACT FROM AUTHOR]

Background: Patients may undergo anatomical changes during radiotherapy, leading to an underdosing of the target or overdosing of the organs at risk (OARs). Purpose: This study developed a deep‐learning method to predict the tumor response of patients with nasopharyngeal carcinoma (NPC) during treatment. This method can predict the anatomical changes of a patient. Methods: The participants included 230 patients with NPC. The data included planning computed tomography (pCT) and routine cone‐beam CT (CBCT) images. The CBCT image quality was improved to the CT level using an advanced method. A long short‐term memory network‐generative adversarial network (LSTM‐GAN) is proposed, which can harness the forecasting ability of LSTM and the generation ability of GAN. Four models were trained to predict the anatomical changes that occurred in weeks 3–6 and named LSTM‐GAN‐week 3 to LSTM‐GAN‐week 6. The pCT and CBCT were used as input, and the tumor target volumes (TVs) and OARs were delineated on the predicted and real images (ground truth). Finally, the models were evaluated using contours and dosimetry parameters. Results: The proposed method predicted the anatomical changes, with a dice similarity coefficient above 0.94 and 0.90 for the TVs and surrounding OARs, respectively. The dosimetry parameters were close between the prediction and ground truth. The deviations in the prescription, minimum, and maximum doses of the tumor targets were below 0.5 Gy. For serial organs (brain stem and spinal cord), the deviations in the maximum dose were below 0.6 Gy. For parallel organs (bilateral parotid glands), the deviations in the mean dose were below 0.8 Gy. Conclusion: The proposed method can predict the tumor response to radiotherapy in the future such that adaptation can be scheduled on time. This study provides a proactive mechanism for planning adaptation, which can enable personalized treatment and save clinical time by anticipating and preparing for treatment strategy adjustments. [ABSTRACT FROM AUTHOR]

Background: Although cone beam computed tomography (CBCT) has lower resolution compared to planning CTs (pCT), its lower dose, higher high‐contrast resolution, and shorter scanning time support its widespread use in clinical applications, especially in ensuring accurate patient positioning during the image‐guided radiation therapy (IGRT) process. Purpose: While CBCT is critical to IGRT, CBCT image quality can be compromised by severe stripe and scattering artifacts. Tumor movement secondary to respiratory motion also decreases CBCT resolution. In order to improve the image quality of CBCT, we propose a Lung Diffusion Model (L‐DM) framework. Methods: Our proposed algorithm is based on a conditional diffusion model trained on pCT and deformed CBCT (dCBCT) image pairs to synthesize lung CT images from dCBCT images and benefit CBCT‐based radiotherapy. dCBCT images were used as the constraint for the L‐DM. The image quality and Hounsfield unit (HU) values of the synthetic CTs (sCT) images generated by the proposed L‐DM were compared to three selected mainstream generation models. Results: We verified our model in both an institutional lung cancer dataset and a selected public dataset. Our L‐DM showed significant improvement in the four metrics of mean absolute error (MAE), peak signal‐to‐noise ratio (PSNR), normalized cross‐correlation (NCC), and structural similarity index measure (SSIM). In our institutional dataset, our proposed L‐DM decreased the MAE from 101.47 to 37.87 HU and increased the PSNR from 24.97 to 29.89 dB, the NCC from 0.81 to 0.97, and the SSIM from 0.80 to 0.93. In the public dataset, our proposed L‐DM decreased the MAE from 173.65 to 58.95 HU, while increasing the PSNR, NCC, and SSIM from 13.07 to 24.05 dB, 0.68 to 0.94, and 0.41 to 0.88, respectively. Conclusions: The proposed L‐DM significantly improved sCT image quality compared to the pre‐correction CBCT and three mainstream generative models. Our model can benefit CBCT‐based IGRT and other potential clinical applications as it increases the HU accuracy and decreases the artifacts from input CBCT images. [ABSTRACT FROM AUTHOR]

Purpose: To provide detailed reports on radiation doses during transarterial chemoembolization (TACE) in the cone-beam computed tomography (CBCT) era and to identify the associated factors. Methods: This retrospective study included 385 consecutive patients who underwent initial conventional TACE for hepatocellular carcinoma (HCC) between January 2016 and December 2017. In most cases, CBCT was performed at the common hepatic artery or celiac axis to confirm the location of the tumor and the three-dimensional hepatic artery anatomy. Superselective TACE was performed for all technically feasible cases. Information on total dose area product (DAP), total cumulative air kerma (CAK), fluoroscopy time, and DAP and CAK of each digital subtraction angiography (DSA) and CBCT scan was recorded. Multiple linear regression analysis was performed to identify the factors associated with increased DAP during TACE. Results: The mean values of total DAP and CAK were 165.2 ± 81.2 (Gy·cm²) and 837.1 ± 571.0 (mGy), respectively. The mean fluoroscopy time was 19.1 ± 10.3 min. The mean DAP caused by fluoroscopy, DSA, and CBCT was 51.8 ± 43.9, 28.0 ± 24.1, and 83.9 ± 42.1 Gy·cm², respectively. Male sex, a high body mass index, largest tumor size > 3 cm, presence of aberrant right and left hepatic arteries, and superselective TACE were identified as independent predictors of increased total DAP during TACE. Conclusion: We were able to provide detailed reports on radiation doses during TACE and associated factors. [ABSTRACT FROM AUTHOR]

Background: Medical imaging segmentation is the use of image processing techniques to expand specific structures or areas in medical images. This technique is used to separate and display different textures or shapes in an image. The aim of this study is to develop a deep learning-based method to perform maxillary sinus segmentation using cone beam computed tomography (CBCT) images. The proposed segmentation method aims to provide better image guidance to surgeons and specialists by determining the boundaries of the maxillary sinus cavities. In this way, more accurate diagnoses can be made and surgical interventions can be performed more successfully. Methods: In the study, axial CBCT images of 100 patients (200 maxillary sinuses) were used. These images were marked to identify the maxillary sinus walls. The marked regions are masked for use in the maxillary sinus segmentation model. U-Net, one of the deep learning methods, was used for segmentation. The training process was carried out for 10 epochs and 100 iterations per epoch. The epoch and iteration numbers in which the model showed maximum success were determined using the early stopping method. Results: After the segmentation operations performed with the U-Net model trained using CBCT images, both visual and numerical results were obtained. In order to measure the performance of the U-Net model, IoU (Intersection over Union) and F1 Score metrics were used. As a result of the tests of the model, the IoU value was found to be 0.9275 and the F1 Score value was 0.9784. Conclusion: The U-Net model has shown high success in maxillary sinus segmentation. In this way, fast and highly accurate evaluations are possible, saving time by reducing the workload of clinicians and eliminating subjective errors. [ABSTRACT FROM AUTHOR]

Investigation of the biological sex of human remains is a crucial aspect of physical anthropology. However, due to varying states of skeletal preservation, multiple approaches and structures of interest need to be explored. This research aims to investigate the potential use of distances between bifrontal breadth (FMB), infraorbital foramina distance (IOD), nasal breadth (NLB), inter-canine width (ICD), and distance between mental foramina (MFD) for combined sex prediction through traditional statistical methods and through open-access machine-learning tools. Ethical approval was obtained from the ethics committee, and out of 100 cone beam computed tomography (CBCT) scans, 54 individuals were selected with all the points visible. Ten extra exams were chosen to test the predictors developed from the learning sample. Descriptive analysis of measurements, standard deviation, and standard error were obtained. T-student and Mann–Whitney tests were utilized to assess the sex differences within the variables. A logistic regression equation was developed and tested for the investigation of the biological sex as well as decision trees, random forest, and artificial neural networks machine-learning models. The results indicate a strong correlation between the measurements and the sex of individuals. When combined, the measurements were able to predict sex using a regression formula or machine learning based models which can be exported and added to software or webpages. Considering the methods, the estimations showed an accuracy rate superior to 80% for males and 82% for females. All skulls in the test sample were accurately predicted by both statistical and machine-learning models. This exploratory study successfully established a correlation between facial measurements and the sex of individuals, validating the prediction potential of machine learning, augmenting the investigative tools available to experts with a high differentiation potential. [ABSTRACT FROM AUTHOR]

An Al₂O₃–13% TiO₂ coating was applied to M2 high-speed steel using the d-gun process. The surface properties were compared between uncoated samples, coated samples before cryogenic treatment (CBCT), and coated samples after cryogenic treatment (CACT). The mean particle size was ~17.07 μm, with average coating thicknesses of 212 μm for CBCT and 196 μm for CACT. CACT exhibited 3.19% and 24.65% higher microhardness than CBCT and uncoated samples, respectively. All samples exhibited hydrophilic wettability, with CBCT showing 59.41% and 67.43% higher Ra values, along with 56.03% and 59.70% higher Rz values than CACT and uncoated samples. CBCT also exhibited 32.96% and 98.14% higher porosity than CACT and uncoated samples. CACT showed reduced abrasion loss by 54.05% and 36.25% compared to CBCT and uncoated samples. CBCT has better corrosion resistance of 90.25% and 95.89% than CACT and uncoated samples. The Raman shift revealed increased particle size formation in CACT than other samples. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the prevalence and configuration of C‐shaped canal morphology in maxillary molars in an Iranian population residing in Kermanshah Province of Iran using cone‐beam computed tomography (CBCT). Materials and Methods: This cross‐sectional study was conducted on 2290 CBCT scans of 804 maxillary first molars, 1049 maxillary second molars, and 437 maxillary third molars. The Maxillary Upper‐C Classification System was used for the detection of C‐shaped canal morphology, and the classification by Jo et al. was used for assessment of the configuration of C‐shaped canals. Data were analyzed by the Chi‐square test (α = 0.05). Results: The prevalence of C‐shaped canals in the maxillary first, second, and third molars was 1%, 7%, and 9%, respectively. Type III other types (B‐P) was the most frequent configuration followed by type I subtype C (MB‐DB). The prevalence of C‐shaped canal morphology was not significantly different among different age groups (p > 0.05); however, its prevalence in females was almost twice that in males (p < 0.05). The prevalence of C‐shaped canals was not significantly different in the right and left quadrants (p = 0.099). The most frequent configuration was type I subtype B (DB‐P) in males, and type III other types (B‐P) in females (p = 0.364). Conclusion: The prevalence of C‐shaped canals in maxillary first, second, and third molars was 1%, 7%, and 9%, respectively. C‐shaped canals were more common in females, and type III other types (B‐P) was the most frequent configuration in our study population. [ABSTRACT FROM AUTHOR]

To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries. [ABSTRACT FROM AUTHOR]

Background: This study aimed to conduct a systematic review and meta-analysis to summarize the available evidence comparing the diagnostic accuracy of periapical radiography (PA) and cone-beam computed tomography (CBCT) for detection of vertical root fractures (VRFs). Methods: A search was conducted in PubMed, Scopus, and Web of Science for articles published regarding all types of human teeth. Data were analyzed by Comprehensive Meta-Analysis statistical software V3 software program. The I2 statistic was applied to analyze heterogeneity among the studies. Results: Twenty-three articles met the criteria for inclusion in the systematic review and 16 for the meta-analysis. The sensitivity and specificity for detection of VRFs were calculated to be 0.51 and 0.87, respectively for PA radiography, and 0.70 and 0.84, respectively for CBCT. Conclusions: The sensitivity of CBCT was higher than PA radiography; however, difference between the specificity of the two modalities was not statistically significant. [ABSTRACT FROM AUTHOR]

To evaluate the dosimetric benefits and clinical feasibility of deep inspiratory breath-hold (DIBH) combined with volumetric modulated arc therapy (VMAT) in left-sided postmastectomy radiotherapy (PMRT). Eligible patients with left-sided breast cancer undergoing DIBH-based PMRT were prospectively included. Chest wall, supra/infraclavicular fossa, and/or internal mammary node irradiation (IMNI) were planned with a prescription dose of 43.5 Gy in 15 fractions. VMAT plans were designed on free breathing (FB)—and DIBH-CT to compare dosimetric parameters in heart, left anterior descending artery (LAD) and lung. Cone-beam computed tomography (CBCT) was performed before and after treatment to evaluate inter- and intra-fractional setup errors. Heart position and dose variations during treatment were estimated by fusing CBCT with DIBH-CT scans.Twenty patients were included with 10 receiving IMNI. In total, 193 pre-treatment and 39 pairs pre- and post-treatment CBCT scans were analyzed. The Dmean, Dmax, and V5−40 of the heart, LAD, and left lung were significantly lower in DIBH than FB (p < 0.05 for all), except for V5 of LAD (p = 0.167). The cardiopulmonary dosimetric benefits were maintained regardless of IMNI. The inter- and intra-fractional setup errors were < 0.3 cm; and the overall estimated PTV margins were < 1.0 cm. During treatment, the mean dice similarity coefficient of heart position and the mean ratio of heart Dmean between CBCT and DIBH-CT plans was 0.95 (0.88–1.00) and 100% (70.6–119.5%), respectively. DIBH-VMAT could effectively reduce the cardiopulmonary doses with acceptable reproducibility and stability in left-sided PMRT regardless of IMNI. [ABSTRACT FROM AUTHOR]

Objective. Cachexia is a devastating condition, characterized by involuntary loss of muscle mass with or without loss of adipose tissue mass. It affects more than half of patients with lung cancer, diminishing treatment effects and increasing mortality. Cone-beam computed tomography (CBCT) images, routinely acquired during radiotherapy treatment, might contain valuable anatomical information for monitoring body composition changes associated with cachexia. For this purpose, we propose an automatic artificial intelligence (AI)-based workflow, consisting of CBCT to CT conversion, followed by segmentation of pectoralis muscles. Approach. Data from 140 stage III non-small cell lung cancer patients was used. Two deep learning models, cycle-consistent generative adversarial network (CycleGAN) and contrastive unpaired translation (CUT), were used for unpaired training of CBCT to CT conversion, to generate synthetic CT (sCT) images. The no-new U-Net (nnU-Net) model was used for automatic pectoralis muscle segmentation. To evaluate tissue segmentation performance in the absence of ground truth labels, an uncertainty metric (UM) based on Monte Carlo dropout was developed and validated. Main results. Both CycleGAN and CUT restored the Hounsfield unit fidelity of the CBCT images compared to the planning CT (pCT) images and visually reduced streaking artefacts. The nnU-Net model achieved a Dice similarity coefficient (DSC) of 0.93, 0.94, 0.92 for the CT, sCT and CBCT images, respectively, on an independent test set. The UM showed a high correlation with DSC with a correlation coefficient of −0.84 for the pCT dataset and −0.89 for the sCT dataset. Significance. This paper shows a proof-of-concept for automatic AI-based monitoring of the pectoralis muscle area of lung cancer patients during radiotherapy treatment based on CBCT images, which provides an unprecedented time resolution of muscle mass loss during cachexia progression. Ultimately, the proposed workflow could provide valuable information for early intervention of cachexia, ideally resulting in improved cancer treatment outcome. [ABSTRACT FROM AUTHOR]

Background: The extraction of impacted supernumerary teeth requires precision and accuracy to mitigate iatrogenic damage to crucial anatomical structures during dental surgical procedures, thereby enhancing postoperative healing outcomes. Dynamic navigation systems (DNS) have been applied in dentistry in maxillofacial fractures, orthognathic surgery, root canal treatment, and endodontic surgery. Case Report: A 22-year-old female patient visited our department to assess and manage unerupted third molars. An initial cone beam computed tomography (CBCT) scan was obtained. Radiographic and clinical examinations showed the presence of a supernumerary tooth impacted on the lingual side between the root of the lower second premolar and the lower first molar and bilateral lower impacted third molars. The patient agreed to removal of these teeth. To perform the treatment planning of this case and to guide the surgeon intraoperatively, a dynamic surgical navigation system was recommended for surgical extraction of a supernumerary tooth and the impacted third molars. Conclusions: The dynamic navigation system coupled with a high-speed contra-angle handpiece for the extraction of supernumerary teeth is a personalized, digitally-driven, precise, minimally invasive, and efficient treatment approach. In this case, the DNS and the high-speed contra-angle handpiece were seamlessly integrated to facilitate visualization of the surgical procedure, thereby safeguarding of surrounding vital anatomical structures while enhancing patient comfort. [ABSTRACT FROM AUTHOR]

Total neoadjuvant therapy (TNT) of rectal cancer improves rates of pathological complete remission and progression-free survival. With improved clinical response rates, interest grew in a non-operative approach/watch and wait (WaW) for this disease. In 2020, the working groups of ACO/AIO/ARO published a consensus statement on the use of TNT, including a non-operative approach. However, the best combination scheme remains unclear. Despite the increasing use of TNT, there is a lack of comprehensive data on its current implementation and practices. To address this knowledge gap, a multicenter survey was conducted to capture the use of TNT protocols in German-speaking radiotherapy departments. At the beginning of 2023, a GDPR-compliant online survey was conducted in Germany, Austria, and German-speaking Switzerland. The questionnaire comprised 43 questions covering various aspects of TNT, including chemotherapy and WaW concepts. Most respondents (98.4%) confirmed awareness of the consensus on TNT for rectal cancer. Institutions treated an average of 30.22 rectal cancer patients annually. Most respondents (76.2%) reported treating over 80% of patients neoadjuvantly. Regarding TNT, 33.3% treated 21–50% with such a protocol. No significant association was found between the institution type and TNT application. In 62/63 cases, tumor board discussion was standard before offering TNT. VMAT was the predominant technique (82.5%). For rectal cancer dosing, the 50/50.4Gy scheme was most common, followed by 45Gy with a boost and the 5 × 5Gy scheme. Dosing schemes for TNT varied slightly, with more participants reporting the use of 5 × 5Gy compared to radiation therapy for rectal cancer in general. CBCT was the primary IGRT method (88.9%). Larger hospitals typically administered chemotherapy themselves, while private practices collaborated with medical oncologists (p < 0.0001). The most common concurrent chemotherapy drugs were 5-fluorouracil/capecitabine (64.4%) and oxaliplatin (37.3%). A WaW strategy was reported to be institutional implemented by 63.8%. The timing of offering WaW was split, with 50% offering it after radiochemotherapy and 47% during the informed consent talk. For planned WaW, 62% prefer normofractionated TNT. TNT appears to be widely implemented in the German-speaking radio-oncological community, regardless of the type of institution. Image-guided therapy, multidisciplinary team decisions, and internal guidelines play an important role. TNT seems to have already altered treatment protocols for rectal cancer toward an organ-preserving approach in selected cases. In these WaW cases, normofractionation appears to be preferred over hypofractionation. [ABSTRACT FROM AUTHOR]

Background/Objectives: Degenerative joint disease (DJD) of the TMJ can impact patients' quality of life and complicate orthodontic treatment. Stabilizing splints are a common conservative treatment in managing TMDs symptoms, although their long-term effects on condylar morphology are poorly studied. This study aimed to assess the impact of stabilizing splints on condyle morphology using cone-beam computed tomography (CBCT) in patients with various stages of DJD. Forty-two condyles with pre- (T1) and post- (T2) splint therapy scans were analyzed. Methods: CBCT scans were sectioned into sagittal and coronal slices for condyle classification and measurement. T1 and T2 CBCTs were superimposed before linear and area measurements at different poles. Results: Our results indicate that condyles in the normal group remain unchanged after splint therapy. The majority of subjects in the degenerative groups remained in the same classification group: six out of fourteen degenerative-active patients became degenerative-repair, while three out of twenty-two degenerative-repair patients progressed to degenerative-active. There is no significant remodeling of condylar width pre- and post-splint therapy. On average, there is more bone deposition than reduction in condylar height after splint therapy, although individual variation exists. Conclusions: Stabilizing splints offer a low-risk intervention for managing DJD and may contribute to favorable adaptive changes in the condyles. [ABSTRACT FROM AUTHOR]

Introduction: Apical periodontitis (AP) is an inflammatory disease of the periapical tissues that is often asymptomatic and diagnosed through radiographic examination. A challenge in traditional endodontics is disinfection of the root canal system (RCS), which anatomically presents numerous variations, often leading to persistent infections. Antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) offer promising adjuncts, due to their antimicrobial and tissue-healing properties. Objective: The aim of this article was to report five cases of teeth with pulp necrosis and asymptomatic apical periodontitis (AAP) treated with aPDT and PBMT protocols. Materials and Methods: Five cases of pulp necrosis and AAP were treated with conventional endodontic therapy supplemented with aPDT and PBMT. The treatment protocol included chemomechanical preparation (CMP), aPDT using a 660 nm diode laser (DL) with methylene blue (MB) as a photosensitizer (5 min pre-irradiation time), and PBMT using a 940 nm DL. Treatment results were evaluated through cone-beam computed tomography (CBCT)-based evaluation over 1 year of clinical follow-up. Results: All cases showed significant bone regeneration and tissue healing, demonstrating the efficacy of the combination of aPDT and PBMT. Post-operative pain did not occur in any of the patients, suggesting a possible analgesic effect of PBMT. Conclusions: The combination of aPDT and PBMT in endodontic therapy promoted tissue recovery and improved the prognosis of AAP. Further research and randomized control trials are needed to optimize treatment protocols and evaluate the long-term effects. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the differential positional changes of the proximal and distal segments during mandibular setback surgery relapse. Thirty patients with mandibular prognathism who underwent bilateral sagittal split ramus osteotomy were included. Skull models from pretreatment, postsurgery, and post-treatment cone-beam computed tomography were superimposed to evaluate condylar displacement and rotational changes, and to determine the center of rotation (CRot) in the proximal and distal segments. During postsurgical relapse, the proximal segment rotated 2.4 ± 2.1° counterclockwise, with the CRot located near the mandibular condyle. The distal segment rotated 2.0 ± 2.3° counterclockwise, resulting in forward and upward movement of the chin. The displaced condyle partially returned to its original position during postsurgical orthodontic treatment. A vertical bony step (VBS) between the proximal and distal segments commonly occurs during mandibular setback surgery. As the VBS increases, the CRot of the distal segment shifts posterosuperiorly, following a predictable pattern outlined by regression equations. These findings suggest that relapse after mandibular setback surgery consistently occurs in an anterosuperior direction, with translatory movement becoming more prominent as the VBS increases. Including these regression equations in presurgical planning can enhance the precision of relapse simulations and help clinicians more accurately anticipate postsurgical relapse. [ABSTRACT FROM AUTHOR]

Background: To plan optimal treatment, obtain satisfactory outcomes, and avoid undesirable clinical errors, surgeons need to have efficient tools for providing a complete and prompt diagnosis. The aim of this study was to establish the sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate of the "air sign" (AS) within soft tissues as an indirect radiological indicator of mandibular body and angle fractures. Methods: A retrospective analysis of preoperative computed tomography (CT) and cone beam computed tomography (CBCT) scans was performed on patients with mandibular fractures within a three-year period. Two fracture types were analyzed: open and closed fractures. Results: Forty-three patients with a total of 71 mandibular fractures were included in the study. The mean age of the patients was 35 years, and the majority were male (83.7%). The sensitivity of the AS was 92.2%, specificity = 90.0%, positive predictive value = 95.9%, negative predictive value = 81.8%, false positive rate = 10.0%, and false negative rate = 7.8%. Higher values were observed for open fractures compared to closed fractures. Conclusions: The sensitivity and specificity of AS are lower than those of OPG, CT, and CBCT. However, AS offers an important additional radiological indicator that can effectively reduce the risk of misdiagnosing mandibular body and angle fractures. [ABSTRACT FROM AUTHOR]

Background: Monkeys are an appropriate model for periodontal research owing to their similar dental anatomy and physiology unlike humans. Extensive literature exists on pathological periodontitis in monkeys and humans, although concerns regarding whether healthy middle-aged monkeys and humans display the same periodontal and oral microbial status remains unclear. Aims and objectives: The current study aimed to compare alveolar bone resorption, gingival inflammatory infiltrate, and salivary microbiota profile in periodontally healthy middle-aged humans and monkeys. Methods: CBCT examination and histological analysis were performed to compare the periodontal status in middle-aged healthy humans and monkeys. Oral saliva16S rRNA sequencing was performed to analyze the oral microbial profile. Results: The alveolar resorption was compared between humans and monkeys, to determine the periodontal health. The percentage attachment of attachment loss was more around the posteriors teeth in humans when compared to monkeys (p<0.05). The degree of gingival inflammation was analyzed in both the groups, the expression of CD 34,45was higher in humans. 16S rRNA analysis demonstrated less diversity of salivary microorganisms in humans than in monkeys. The relative abundance of Aggregatibacter, Haemophilus, Gemella, and Porphyromonas at the genus level was significantly less in humans than in monkeys (p(<0.05). Conclusion: The periodontally healthy middle-aged humans and monkeys display different alveolar bone resorption and gingival inflammatory infiltrate levels. Furthermore, the salivary microbiota profile showed distinctly different oral microbiomes in these two primates. Our results suggest that the difference in alveolar bone status and gingival inflammatory infiltrate in healthy humans and monkeys might be associated with the diversity of the oral microbiome. [ABSTRACT FROM AUTHOR]

Background: Maxillofacial complex automated segmentation could alternative traditional segmentation methods to increase the effectiveness of virtual workloads. The use of DL systems in the detection of maxillary sinus and pathologies will both facilitate the work of physicians and be a support mechanism before the planned surgeries. Objective: The aim was to use a modified You Only Look Oncev5x (YOLOv5x) architecture with transfer learning capabilities to segment both maxillary sinuses and maxillary sinus diseases on Cone-Beam Computed Tomographic (CBCT) images. Methods: Data set consists of 307 anonymised CBCT images of patients (173 women and 134 males) obtained from the radiology archive of the Department of Oral and Maxillofacial Radiology. Bilateral maxillary sinuses CBCT scans were used to identify mucous retention cysts (MRC), mucosal thickenings (MT), total and partial opacifications, and healthy maxillary sinuses without any radiological features. Results: Recall, precision and F1 score values for total maxillary sinus segmentation were 1, 0.985 and 0.992, respectively; 1, 0.931 and 0.964 for healthy maxillary sinus segmentation; 0.858, 0.923 and 0.889 for MT segmentation; 0.977, 0.877 and 0.924 for MRC segmentation; 1, 0.942 and 0.970 for sinusitis segmentation. Conclusion: This study demonstrates that maxillary sinuses can be segmented, and maxillary sinus diseases can be accurately detected using the AI model. [ABSTRACT FROM AUTHOR]

Background: This observational study aims to establish the feasibility of using x-ray images of radio-opaque chemoembolisation deposits in patients as a method for real-time image-guided radiation therapy of hepatocellular carcinoma. Methods: This study will recruit 50 hepatocellular carcinoma patients who have had or will have stereotactic ablative radiation therapy and have had transarterial chemoembolisation with a radio-opaque agent. X-ray and computed tomography images of the patients will be analysed retrospectively. Additionally, a deep learning method for real-time motion tracking will be developed. We hypothesise that: (i) deep learning software can be developed that will successfully track the contrast agent mass on two thirds of cone beam computed tomography (CBCT) projection and intra-treatment images (ii), the mean and standard deviation (mm) difference in the location of the mass between ground truth and deep learning detection are ≤ 2 mm and ≤ 3 mm respectively and (iii) statistical modelling of study data will predict tracking success in 85% of trial participants. Discussion: Developing a real-time tracking method will enable increased targeting accuracy, without the need for additional invasive procedures to implant fiducial markers. Trial registration: Registered to ClinicalTrials.gov (NCT05169177) 12th October 2021. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to study the potential for an online fully automated daily adaptive radiotherapy (RT) workflow for bladder cancer, employing a focal boost and fiducial markers. The study focused on comparing the geometric and dosimetric aspects between the simulated automated online adaptive RT (oART) workflow and the clinically performed workflow. Methods: Seventeen patients with muscle-invasive bladder cancer were treated with daily Cone Beam CT (CBCT)-guided oART. The bladder and pelvic lymph nodes (CTVelective) received a total dose of 40 Gy in 20 fractions and the tumor bed received an additional simultaneously integrated boost (SIB) of 15 Gy (CTVboost). During the online sessions a CBCT was acquired and used as input for the AI-network to automatically delineate the bladder and rectum, i.e. influencers. These influencers were employed to guide the algorithm utilized in the delineation process of the target. Manual adjustments to the generated contours are common during this clinical workflow prior to plan reoptimization and RT delivery. To study the potential for an online fully automated workflow, the oART workflow was repeated in a simulation environment without manual adjustments. A comparison was made between the clinical and automatic contours and between the treatment plans optimized on these clinical (Dclin) and automatic contours (Dauto). Results: The bladder and rectum delineated by the AI-network differed from the clinical contours with a median Dice Similarity Coefficient of 0.99 and 0.92, a Mean Distance to Agreement of 1.9 mm and 1.3 mm and a relative volume of 100% and 95%, respectively. For the CTVboost these differences were larger, namely 0.71, 7 mm and 78%. For the CTVboost the median target coverage was 0.42% lower for Dauto compared to Dclin. For CTVelective this difference was 0.03%. The target coverage of Dauto met the clinical requirement of the CTV-coverage in 65% of the sessions for CTVboost and 95% of the sessions for the CTVelective. Conclusions: While an online fully automated daily adaptive RT workflow shows promise for bladder treatment, its complexity becomes apparent when incorporating a focal boost, necessitating manual checks to prevent potential underdosage of the target. [ABSTRACT FROM AUTHOR]

Purpose: The position and orientation of the head is maintained to be relatively similar during the CT / MR imaging process. However, the position / orientation dissimilarities present in the resulting images between patients, or between different scans of the same patient, do not allow for direct comparison of the images themselves or features / metrics extracted from them. This paper introduces a method of defining a coordinate system which is consistent between patients and modalities (CT and MR) for images of the temporal bone, using easily identifiable landmarks within the semicircular canals. Methods: Cone Beam CT and high resolution MRI (T2) images of the temporal bone from 20 patients with no cochlear or temporal bone pathology in either modality were obtained. Four landmarks within the semicircular canals were defined that can be identified in both modalities. A coordinate system was defined using these landmarks. Reproducibility of landmark selection was assessed using intra- and inter-rater reliability (for three expert raters and two repeats of the landmark selection). Accuracy of the coordinate system was determined by comparing the coordinates of two additional landmarks in CT and MR images after their conversion to the proposed coordinate system. Results: Intraclass Correlation Coefficients at a 95% level of confidence showed significant agreement within and between raters as well as between modalities. The differences between selections, raters, and modalities (as measured using mean, standard deviation, and maximum) were low and acceptable for clinical applications. Conclusion: The proposed coordinate system is suited for use in images of the temporal bone and inner ear. Its multi-modal nature enables the coordinate system to be used in tasks such as image co-registration. [ABSTRACT FROM AUTHOR]

Introduction: Variations in the Mandibular Canal (MC) can be categorised based on shape (oval, round, or pear-shaped) and may include various accessory canals, such as bifid, trifid, or temporal crest canals. These variations are clinically significant because if, they are overlooked, they can lead to various complications. While both 2 Dimensional (2D) and 3D imaging modalities can evaluate these variations, Cone Beam Computed Tomography (CBCT) offers superior resolution, reduced radiation exposure, and a comprehensive 3D view. Aim: To analyse the prevalence and variations of the MC, as well as its diameter and length among the Indian population. Materials and Methods: A retrospective observational study was conducted in the Department of Oral Medicine and Radiology at Rajarajeswari Dental College and Hospital, Ramohalli Cross, Mysuru Road, Bengaluru, Karnataka, India over a period of six months from October 2023 to April 2024. Total of 190 CBCT images were randomly collected from the CBCT archives, spanning ages 16 to 75 years. The length and diameter of the MC were measured using CBCT tools. The prevalence of variations in the MC was determined according to the classification provided for bifid and trifid canals. The Chisquare test was employed to compare the anatomical variations of the MC based on age and gender, while an independent Student's t-test was used to compare the mean length and mean diameter based on age groups and gender. Results: The mean age of the study population was 37.96±14.63 years. Among the 190 images, 105 (55.3%) belonged to males and 85 (44.7%) belonged to females. The frequency of bifid canals was comparatively higher than that of trifid and temporal crest canals, with incidence rates of 14.7%, 3.7%, and 5.3%, respectively, showing no significant association with age or gender. Females exhibited a bilateral reduction in vertical diameter (mean difference of 0.37 mm compared to males at 0.40 mm). The mean length of the MC was notably longer on the left-side among males (mean MC length on the left-side: 69.36 mm compared to the right-side: 67.64 mm). Conclusion: The present study highlights the importance of understanding variations in the MC. CBCT imaging enhances the comprehension of MC anatomy, facilitating accurate diagnostic and treatment strategies in dentistry and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Introduction: The complete removal of Calcium Hydroxide {Ca(OH)2} using various techniques remains a challenge in root canal therapy. One of the most commonly used methods for removing calcium hydroxide is by using a Master Apical File (MAF) along with sodium hypochlorite and Ethylenediaminetetracetic Acid (EDTA). Various new modalities, like Canal Brush, NaviTip and file systems, have emerged to tackle the residual calcium hydroxide in the canal; but none of these methods have been able to completely remove it from the canal. Aim: To evaluate and compare the efficacy of H-files, NaviTip FX and Canal Brushes in removing calcium hydroxide intracanal medicament from root canals. Materials and Methods: This in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from December 2023 to March 2024. To standardise the length at 14 mm, 30 mandibular premolar teeth (n=30) with a single root were decoronated at the Cementoenamel Junction (CEJ). The working length was determined, followed by the cleaning and shaping of all specimens using ProTaper Rotary Files. Intracanal medicament (Metapex) was placed and the canals were sealed with Glass Ionomer Cement (GIC). The specimens were then placed at 37±1°C and 100% relative humidity for 30 days. The medicament was subsequently removed by three different protocols: H-file, NaviTip FX and Canal Brush (n=10 each). The residual volumes in the mesial, distal and apical thirds were assessed, referring to the volume of medicament left in the canal, which was measured using Cone-beam Computed Tomography (CBCT). The recorded variables were analysed using one-way Analysis of Variance (ANOVA) post-hoc tests (p<0.05). Results: The Canal Brush removed the maximum amount of Metapex in the apical third (0.108) of the roots of the premolars, followed by NaviTip FX and then H-file. In the middle third of the root, NaviTip FX removed more Metapex than the Canal Brush, followed by H-files. A comparison of retrieval between and within the groups it showed that none of the techniques were capable of removing all the Metapex from the specimens, with p>0.05. Conclusion: The present study demonstrated that the Canal Brush showed superior results in retrieving Metapex from the apical third of the root and the distal side (middle third), whereas NaviTip FX removed more Metapex from the mesial side (middle third) of the root, but H-file exhibited the least efficacy in the retrieval of Metapex. Total removal of calcium hydroxide from the entire canal is not possible regardless of the technique used. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy plays a key role in the multidisciplinary management of oesophageal cancers across neoadjuvant, definitive and palliative settings. Improved precision in radiotherapy planning and delivery techniques have allowed treating disease with tighter margins reducing toxicity. In this study, we examine the appropriateness of current practice in defining the planning target volume (PTV). Methods: This is a single institutional retrospective study of patients who received radiotherapy for oesophageal cancers using volumetric modulated arc therapy (VMAT) during 2020. All cone‐beam computerised tomography (CBCT) scans were reviewed to assess whether PTV expansions appropriately accounted for tumour motion and interfractional variation. Results: Of the 27 patients, 2 (7%), 5 (19%) and 20 (74%) had cervical, thoracic and distal/gastro‐oesophageal junction (GOJ) disease, respectively. 16 (59%) had adenocarcinoma and 9 (33%) had squamous cell carcinoma. 9 of 20 distal/GOJ patients were planned and treated according to the institutional stomach filling protocol. 521/528 (98.7%) CBCTs demonstrated adequate target coverage. Cervical, thoracic and GOJ regions demonstrated adequate target coverage in 57/58, 96/97 and 368/373 CBCTs with median PTV expansions of 5, 7 and 7 mm, respectively. In four patients with GOJ disease, CBCT review identified five episodes where the target volume was insufficiently covered during the treatment course. Conclusion: In this single institutional retrospective study, for the vast majority of patients, our institutional practice of defining PTV margins achieved satisfactory target treatment. The interfractional variations observed in patients with GOJ tumours due to target motion and variable gastric volume, highlights the role of further refinements to motion management techniques in this cohort. [ABSTRACT FROM AUTHOR]

This retrospective clinical study aimed to compare the sensitivity of cone-beam computed tomographic (CBCT) images and periapical (PA) radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures (VRFs). Methods The authors included 98 patients (98 teeth) diagnosed with a longitudinal tooth fracture (LTF) (cracked tooth, split tooth, VRF) through direct visualization after extraction and with comprehensive clinical and radiographic records. They collected demographic, clinical, and radiographic data. The authors evaluated PA radiographs and CBCT images to identify fractures, fracture lines, and the different patterns of bone loss associated with these teeth. They used the McNemar test to compare PA radiographs and CBCT scans when assessing bone loss. They used the Fisher test to determine statistical relationships between fracture types and demographic, clinical, and radiologic traits. They used an analysis of variance test to compare patient age with fracture types. Results CBCT images were significantly more effective (P < .05) in detecting bone loss patterns associated with LTFs than with PA radiographs, with 71 % of cases detected via CBCT images compared with 42% via radiographs. Mean age was significantly greater (P < .05) in patients with teeth with VRFs than in patients with split teeth. A significant relationship was observed between the type of fracture and the following variables: root canal treatment (split, VRF, P = .002), deep probing depth (> 5 mm) (VRF, P = .026), and having more than 8 teeth extracted from the mouth (VRF, P = .032). Overall, there was a significant difference (P < .001) between the visualization of fracture lines (45% on PA radiographs, 65% on CBCT images). Conclusions CBCT scans provided more information on LTFs than PA radiographs, particularly in the identification of periradicular bone changes. Practical Implications CBCT imaging can assist in making the clinical diagnosis of LTFs through observation of bone loss patterns, providing more information than PA radiographs. [ABSTRACT FROM AUTHOR]

Background/Objectives: In this article, we present a literature review of methods used to measure the shaping ability of endodontic rotary files, including the selection of endodontic sample type (extracted teeth versus simulated blocks) and an imaging evaluation method. This review was conducted as background research to identify concerns that arise when designing research studies in this domain and propose how the field can plan more systematic studies going forward. Methods: A literature search was conducted using PubMed, MEDLINE, Embase, ScienceDirect, Scopus, and e B-on databases, including studies published in English from January 2010 to June 2024. Only studies that specified in vitro or ex vivo methods for evaluating the endodontic performance of NiTi rotary files on canal transportation and centering ability were considered. Results: A total of 86 studies met the inclusion criteria from an initial pool of 651. Of these, 67 studies used extracted teeth, while 20 utilized simulated root canals in resin blocks. For evaluation methods, 55 studies employed Micro-Computed Tomography and Cone-Beam Computed Tomography (MCT + CBCT), 30 used Double Digital Images/Radiographs/Photographs (DDIR + DDIP) with software analysis, 1 used both DDIR and MCT, 1 used high-precision nano-CT, and 1 used a digital single-lens reflex (DSLR) camera. Conclusions: The findings indicate that the MCT method and its advanced variations appear superior in many cases for evaluating the quality of root canal instrumentation due to their ability to provide detailed three-dimensional images. We also discuss the pros and cons of other evaluation methods, including CBCT and DDIR. Finally, we identify important factors to consider for optimizing future cross-study comparisons. This work highlights the importance of being familiar with shaping ability assessment methods as new instruments are introduced to the market. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study compared the accuracy and efficiency of different surgical-guide (SG)-assisted and freehand drilling techniques for removing fiber posts from maxillary anterior teeth performed by differently experienced operators. Methods: A fiber post was bonded to the root canal of 54 extracted maxillary anterior teeth. After mounting the teeth in the jaw models, SGs were designed by integrating cone-beam computed tomography (CBCT) and intraoral scanner data. Each SG included a custom sleeve. An experienced or inexperienced operator drilled the post using three different techniques: (i) SG-assisted incremental drilling at 2–3 mm (SG1), (ii) SG-assisted one-time drilling to a predetermined depth (SG2), and (iii) freehand incremental drilling without SG (FH; n = 9 in each group). Deviations in coronal, sagittal, and horizontal planes and the angle of deviation were measured. Results: The SG1 and SG2 groups showed significantly smaller sagittal and horizontal deviations than the FH group, regardless of the operator's experience. The SG2 group had a significantly shorter working time than the SG1 and FH groups. In the FH group, the experienced operator required a significantly shorter working time than the inexperienced operator. Conclusions: SG-assisted drilling techniques enhanced the accuracy and efficiency of removing fiber posts from the anterior teeth, irrespective of the operator's experience. [ABSTRACT FROM AUTHOR]

The characteristics of the temporomandibular joint (TMJ) are essential in orthodontic and prosthetic treatments. Previous studies have suggested an association between articular eminence inclinations (AEI) and occlusal plane characteristics using radiographs, but no bilateral analysis has been conducted using cone beam computed tomography (CBCT). Objective: This study aimed to investigate the specific characteristics of the occlusal plane inclinations associated with unilateral and bilateral AEI using CBCT. Methods: We conducted a cross-sectional study to evaluate 200 temporomandibular joints (TMJs) from 100 records obtained at the orthodontic department. We evaluated the association between the AEI, and occlusal plane characteristics like the cant of the occlusal angle, occlusal plane angles, inclination of the upper incisor to the Frankfort plane and palatal plane using both bivariate and multivariate analyses both unilaterally and bilaterally. Results: Our findings suggested statistically significant associations (p < 0.050) between AEI (bilateral) and occlusal inclination parameters, including the cant of the occlusal plane (Coef. −0.38; 95%CI −0.70:−0.06; p = 0.017), occlusal plane angle (Coef. −0.39; 95%CI −0.740:−0.05; p = 0.024), and position of the upper incisor relative to the palatal plane (Coef. −0.34; 95%CI −0.63:−0.06; p = 0.016). Conclusion: This study suggests an association between dental inclinations and AEI, which reflects the anatomical characteristics of TMJ and its related dental structures. [ABSTRACT FROM AUTHOR]

The aim of the current study was to evaluate the pharyngeal airway dimensions of individuals with different skeletal patterns in a cohort of the Emirati population. The specific aim was to assess the relationship between pharyngeal airway dimensions and anterior facial height in relation to different skeletal patterns. This retrospective study was conducted on a sample of 103 CBCT scans of adult Emirati subjects categorized into three groups according to their skeletal classification as indicated by the ANB angle: Class I (n = 35), Class II (n = 46), and Class III (n = 22). All CBCT scans were taken using an i-CAT CBCT imaging machine (Imaging Sciences, Hatfield, PA, USA). The age range of the patients was 19 to 68 years (62 women and 41 men). ANOVA, t-tests, Kruskal–Wallis, and Mann–Whitney tests were employed for comparing means among groups. The correlation coefficient was used to evaluate the association between variables. A p-value of less than 0.05 was considered statistically significant. This study revealed significant associations between various airway parameters and cephalometric measurements. Positive correlations were observed between nasal cavity volume and nasopharynx volume, as well as anterior facial height. Oropharynx volume exhibited positive correlations with hypopharynx volume and total airway volume, and negative correlations with overjet, ANB angle, and patient age. Hypopharynx volume correlated positively with total airway volume and the most constricted area of the airway (MCA). Total airway volume showed positive correlations with MCA and anterior facial height. MCA had negative correlations with ANB angle and patient age. Nasopharynx volume was significantly larger in the skeletal Class I group than in the Class II or Class III groups, while the other airway parameters showed no significant differences among the groups (p > 0.05). Several airway parameters showed a correlation with anterior facial height among the different skeletal patterns. Nasopharyngeal airway volume was significantly larger in the skeletal Class I group than in Class II and III groups in the studied sample. [ABSTRACT FROM AUTHOR]

Implant stability can be compromised by factors such as inadequate bone quality and infection, leading to potential implant failure. Ensuring implant stability and longevity is crucial for patient satisfaction and quality of life. In this multicenter, randomized, double-blind clinical trial, we assessed the impact of a bone bioactive liquid (BBL) on the Galaxy TS implant's performance, stability, and osseointegration. We evaluated the impact stability, osseointegration, and pain levels using initial stability quotient (ISQ) measurements, CBCT scans, and pain assessment post-surgery. Surface analysis was performed using scanning electron microscopy (SEM) and atomic force microscopy (AFM). In vitro studies examined the BBL's effects on dental pulp pluripotent stem cells' (DPPSCs') osteogenesis and inflammation modulation in human macrophages. All implants successfully osseointegrated, as demonstrated by the results of our clinical and histological studies. The BBL-treated implants showed significantly lower pain scores by day 7 (p < 0.00001) and improved stability by day 30 (ISQ > 62.00 ± 0.59, p < 8 × 10−7). By day 60, CBCT scans revealed an increased bone area ratio in BBL-treated implants. AFM images demonstrated the BBL's softening and wettability effect on implant surfaces. Furthermore, the BBL promoted DPPSCs' osteogenesis and modulated inflammatory markers in human primary macrophages. This study presents compelling clinical and biological evidence that BBL treatment improves Galaxy TS implant stability, reduces pain, and enhances bone formation, possibly through surface tension modulation and immunomodulatory effects. This advancement holds promise for enhancing patient outcomes and implant longevity. [ABSTRACT FROM AUTHOR]

Unmet needs in the treatment of chronic otitis media and Eustachian tube dysfunction (ETD) triggered the development of stents for the Eustachian tube (ET). In this study, for the first time, stents were placed in an artificially blocked ET to evaluate stent function. Eight adult female sheep were injected with stabilized hyaluronic acid (HA) on both sides to induce ETD. Subsequently, a tapered nitinol ET stent was inserted on one side, and animals were examined bilaterally by endoscopy, tympanometry, cone beam computed tomography, and final histology. Seven of the stents were placed in the desired cartilaginous portion of the ET. At the end of the study, one stented side appeared slightly open; all other ET orifices were closed. Tympanometry revealed re-ventilation of the middle ear in four out of seven correctly stented animals within 3 to 6 weeks after stent insertion. The major amount of HA was found at the pharyngeal orifice of the ET anterior to the stent. Thus, the stent position did not completely align with the HA position. While a functional analysis will require refinement of the experimental setup, this study provides first promising results for stent insertion in a sheep model of ETD. [ABSTRACT FROM AUTHOR]

The development of the finite element method (FEM) combined block polynomial interpolation with the concepts of finite difference formats and the variation principle. Because of this combination, the FEM overcomes the shortcomings of traditional variation methods while maintaining the benefits of current variation methods and the flexibility of the finite difference method. As a result, the FEM is an advancement above the traditional variation methods. The purpose of this study is to experimentally highlight the thermal behavior of two stomatognathic systems, one a control and the other presenting orthodontic treatment by means of a fixed metallic orthodontic appliance, both being subjected to several thermal regimes. In order to sustain this experimental research, we examined the case of a female subject, who was diagnosed with Angle class I malocclusion. The patient underwent a bimaxillary CBCT investigation before initiating the orthodontic treatment. A three-dimensional model with fully closed surfaces was obtained by using the InVesalius and Geomagic programs. Like the tissues examined in the patient, bracket and tube-type elements as well as orthodontic wires can be included to the virtual models. Once it is finished and geometrically accurate, the model is exported to an FEM-using program, such as Ansys Workbench. The intention was to study the behavior of two stomatognathic systems (with and without a fixed metallic orthodontic appliance) subjected to very hot food (70 °C) and very cold food (−18 °C). From the analysis of the obtained data, it was concluded that, following the simulations carried out in the presence of the fixed metallic orthodontic appliance, significantly higher temperatures were generated in the dental pulp. [ABSTRACT FROM AUTHOR]

Background and Objectives: The most popular surgical procedures among orthognathic surgeries for Class II and III patients are Le Fort 1 osteotomy for the maxilla and bilateral sagittal split ramus osteotomy (BSSRO) for the mandible. Keeping the condyle in its proper place during fixation is one of the difficulties of orthognathic surgery. One of the worst post-orthognathic surgery consequences in the temporomandibular joint (TMJ) area may be condylar resorption. Condylar remodeling refers to a group of processes that occur in reaction to forces and stress placed on the temporomandibular joint in order to preserve morphological, functional, and occlusal balance. A systematic review of the literature was performed with the aim of identifying the mandibular condylar component of TMJ changes after orthognathic surgery in class II and III patients. Materials and Methods: An electronic search was carried out using the PubMed, Cochrane Library, and Google Scholar, databases. The inclusion criteria included trials in non-growing patients upon whom orthognathic surgery was performed due to Angle II or Angle III classes malocclusion; in addition, a CT or cone beam computed tomography (CBCT) scan was performed before and after surgery to track the mandibular condylar component of TMJ changes. The quality of the studies was evaluated by two independent authors. The risk of bias was assessed by using the Downs and Black checklist. Results: The electronic and manual literature search yielded 12 studies that fulfilled all necessary inclusion criteria. Observed studies were evaluated as good (3), fair (8), and poor (1) quality. Two studies evaluated class II patients, six studies observed class III patients, and four studies were comparative. Most of the studies evaluated condyle angle and space changes, and the condylar surface and volume changes were also observed. However, the methodology of evaluation in the publications differs. Conclusions: Reduction of bone density, especially in class II patients, and morphological condyle reshaping, with the apposition of the bone, is the main adaptive mechanism after orthognathic surgery. However, all of the studies we examined were conducted using different methods of evaluation, measurement, and reference points. [ABSTRACT FROM AUTHOR]