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Background/Objective: Atherosclerosis is becoming increasingly common in modern society. Owing to the increasing number of complex angioplasty procedures, there is an increasing need for training in cases where the risk of periprocedural complications is high. Methods: A procedure was developed to obtain three-dimensional (3D) models and printing of blood vessels. The mechanical and optical properties of the printed materials were also examined. Angioplasty and stent implantation were tested, and the phantom was compared with the clinical data of patients who underwent interventional treatment. Both laser techniques and cone-beam computed tomography of the phantoms were used for comparison. Results: The printed material exhibited mechanical parameters similar to those of blood vessel walls. The refractive index of 1.473 ± 0.002 and high transparency allowed for non-invasive laser examination of the interior of the print. The printed models behaved similarly to human arteries in vivo, allowing training in treatment procedures and considering vessel deformation during the procedure. Models with stents can be analyzed using laser and cone-beam computed tomography to compare stents from different manufacturers. Conclusions: The developed methodology allows for simple and time-efficient production of personalized vessel phantoms. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate through analysis using CBCT the transverse and axial diameters of the mandibular condyles in subjects affected by juvenile idiopathic arthritis (JIA) and compare them with those of healthy subjects. Methods: The study was conducted on CBCT scans from the digital archive of the Department of Biomedical Surgical and Dental Sciences, University of Milan, including patients with JIA and using healthy subjects as controls. Inclusion criteria: aged between 7 and 25 years old at the time of the CBCT examination; Caucasian ethnicity; diagnosis of JIA according to the International League of Associations for Rheumatology (ILAR) criteria documented in patients' records; TMJ involvement; good quality CBCTs covering our region of interest (ROI), from the glabella to the mandibular inferior border; no previous orthodontic/orthopedic treatment; no history of craniofacial trauma or congenital birth defects involving the craniofacial area. Each CBCT scan underwent examination using 3Diagnosys® software. Since data were normally distributed, parametric tests were used for analysis. The sample was divided into three groups: (1) bilateral JIA subjects, (2) unilateral JIA subjects, and (3) healthy controls. Results: We found a statistically significant reduction (p < 0.0001) in the transverse diameter (TR-Diam) of the affected condyles by an average of 1.7 mm, while the axial diameter (AX-Diam) again showed a slight reduction, on average by 0.1 mm, with a non-statistically significant value. Another comparison was made between the unaffected condyles of patients with unilateral JIA and the healthy condyles of the control group. The unilateral unaffected condyles were found to be slightly smaller than those of healthy patients, but without statistically significant differences. We found that in both JIA males and females, the condylar growth tends to stop earlier than the healthy ones. Conclusions: The transverse diameter was found to be more affected than the axial one, causing typical bone resorption and condylar shape. Moreover, we showed that the pathology, in the case of unilateral JIA, does not compromise only the affected condyles; the corresponding condyle that seems to be healthy is actually partially compromised. In addition, we observed that the growth of affected condyles of JIA subjects tends to stop earlier than the condyles of the healthy controls. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular disorders are common conditions characterized by discomfort within the temporomandibular joints, acoustic changes, and restricted mandibular movement. Accurate diagnosis and subsequent treatment rely heavily on clinical examination, but it is often necessary to add radiological examinations to the diagnostics. Magnetic Resonance Imaging (MRI) is the gold standard for visualizing the disc, while cone-beam computed tomography (CBCT) is primarily used for evaluating condylar morphology. Ultrasound (US) serves as a real-time imaging modality for soft tissues. The objective of the present study was to explore the association between clinical manifestations observed in patients with temporomandibular joint disorders and corresponding radiographic findings. Methods: A total of 63 adult patients (51 female and 12 male) with temporomandibular joint disorders were included in this cross-sectional study. Each patient underwent a clinical examination, followed by appropriate radiological examinations (MRI, CBCT, or US). The level of statistical significance was set at an alpha of 0.05. The Shapiro–Wilk test assessed the normality of numerical variables. The Wilcoxon rank sum test compared two independent groups with non-normally distributed data. Relationships between categorical variables were evaluated using the Pearson chi-square test or Fisher's exact test. The Kendall tau (τ) method analyzed the correlation between two binary variables. Results: The analysis included 63 patients with TMD, predominantly females (80.95%). Ages ranged from 18 to 74 years with a median of 39 years. In the CBCT study, we observed rarefied changes in the left bone structures in patients with bruxism (p = 0.010). MRI and ultrasound imaging revealed changes in patients with limited jaw opening: erosions in the right mandibular head on ultrasound (p = 0.008) and abnormal right bone structures on MRI (p = 0.009). In CBCT, asymmetry in the left joint space was correlated with a high incidence of right side muscle tension (p = 0.004). Additionally, both CBCT and ultrasound showed a correlation between muscle tension and erosion (p = 0.040 in ultrasound, p = 0.020 in CBCT). Acoustic changes, when compared with radiological imaging, were evident in all three studies, like temporomandibular joint pain or palpation. Conclusions: Our study compared three radiographic imaging methods with clinical examinations to assess their correlation with clinical symptoms. Each imaging technique provided unique insights depending on the specific symptoms presented. The observed correlations varied, highlighting the unique contributions of each modality to the diagnostic process. This underscores the importance of employing multiple diagnostic approaches for a thorough assessment of the temporomandibular joint. However, a limitation of our study is the small sample size and the uneven distribution of participants among the groups. Additionally, not all patients underwent every imaging modality. [ABSTRACT FROM AUTHOR]

Background: As implant treatment cases increase, many cases of failure/side effects also occur. Generally, dental clinics determine the density of the jawbone using cone beam CT (CBCT). Considering the known potential role of this tool for bone assessment in primary osteoporosis, this study evaluated patients with secondary endocrine causes of low bone mass. Methods: The study included 83 patients with endocrine causes of osteoporosis who were evaluated by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and mental foramen (MF) region CBCT. The following CBCT indices were measured: anterior (A)—thickness of inferior mandibular cortex 10 mm anterior from MF; molar (M)—thickness of inferior mandibular cortex 10 mm posterior from MF; posterior (P)—thickness of inferior mandibular cortex 25 mm posterior from MF; symphysis (S)—thickness of inferior mandibular cortex equidistant from the centers of right and left MF. Results: The highest correlation coefficient in the secondary causes group was between the A index and the lumbar BMD (r = 0.375, p = 0.001) and the P index and the femoral neck BMD (r = 0.38, p = 0.001). Hypercortisolism seems to be the most predictable cause of secondary osteoporosis using the A, M, and P indices. The A, M, and P indices showed predictive values of the bone micro-architecture that was evaluated using TBS score, and were statistically significant. The symphysis index does not significantly predict osteoporosis or impaired bone micro-architecture. Conclusions: These findings support the potential usefulness of A, M, and P CBCT-derived radiomorphometric mandibular indices in secondary osteoporosis, underlining the well-known effects of these pathologies on bone micro-architecture rather than bone quantity. [ABSTRACT FROM AUTHOR]

Background/Objectives: To define and evaluate a radiation dose optimization process for chest computed tomography (CT) imaging. Methods: Data from unenhanced and enhanced chest CT acquisitions performed between June 2018 and January 2020 in adult patients were included in the study. Images were acquired on a Siemens SOMATOM® Definition Edge CT. Dose values, including Dose.Length Product (DLP) and Volume CT Dose Index (CTDIvol), were collected. Low doses (LDs, 25th percentiles), achievable doses (ADs, 50th percentiles), and diagnostic reference levels (DRLs, 75th percentiles) were calculated before and after parameter modifications. A process was defined and applied to patient data. For unenhanced chest CT, data were differentiated according to three groups: high dose (HD), optimized dose (OD), and ultra-low dose (ULD). Dosimetric changes between protocols were expressed as mean CTDIvol % (CI95%). A Mann and Whitney statistical test was used. The diagnostic quality score (DQS) of a subset of 70 randomly selected CT examinations was evaluated by one radiologist. The DQS was scored according to a three-point Likert scale: (1) poor (definite diagnosis impossible), (2) fair (evaluation of major findings possible), and (3) excellent (exact diagnosis possible). Results: Data were collected from 1929 patients. For unenhanced chest CT protocols, only one process loop was run. A dose comparison between the chest CT protocol before the use of the process and the three groups showed a decrease of −38.3% (9.7%) and −93.4% (24.2%) for OD and ULD, respectively, and an increase of +29.4% (4.7%) for HD. For the enhanced chest CT protocol, two optimization loops were performed, and they resulted in a mean dose reduction of −50.0% (2.6%) compared to the pre-optimization protocol. For all protocols, the DQS was greater than or equal to 2. Conclusions: We proposed a radiation dose optimization process for chest CT that could significantly reduce the dose without compromising diagnosis. [ABSTRACT FROM AUTHOR]

Background: Guided bone regeneration (GBR) is a reliable technique used in vertical and horizontal bone defects. The posterior mandibular region is an area limited by anatomic constraints. The use of resorbable membranes with a cortical component could compensate for the lack of rigidity of resorbable membranes without the complications of non-resorbable membranes. The aim of this study was to evaluate the mean bone gains of a xenogeneic cortical membrane in horizontal and vertical bone defects in comparison with other membranes in the literature. Methods: A porcine cortical membrane was used to perform 7 GBR in the posterior mandibular region of five patients. Preoperative (T0) and six months postoperative (T1) cone beam computed tomography were superimposed to measure the horizontal and vertical bone gain. Implants were positioned at all sites, six months after GBR. Complications and bone resorption around the implants were also documented. Results: The mean horizontal and vertical bone gains were 3.83 ± 1.41 mm and 4.17 ± 1.86 mm, respectively. The analysis of repeatability was 0.997. As many as 40% of patients experienced pain refractory to analgesics. No exposure or infectious phenomenon was observed. Conclusions: This xenogeneic cortical membrane seemed to provide interesting results in the regeneration of horizontal and vertical bone defects. Comparative and prospective studies are necessary to validate the effectiveness of this membrane. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aims to summarize the evidence on the use and applicability of AI in impacted mandibular third molars. Methods: Searches were performed in the following databases: PubMed, Scopus, and Google Scholar. The study protocol is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202460081). The retrieved articles were subjected to an exhaustive review based on the inclusion and exclusion criteria for the study. Articles on the use of AI for diagnosis, treatment, and treatment planning in patients with impacted mandibular third molars were included. Results: Twenty-one articles were selected and evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) evidence quality scale. Most of the analyzed studies dealt with using AI to determine the relationship between the mandibular canal and the impacted mandibular third molar. The average quality of the articles included in this review was 2+, which indicated that the level of evidence, according to the SIGN protocol, was B. Conclusions: Compared to human observers, AI models have demonstrated decent performance in determining the morphology, anatomy, and relationship of the impaction with the inferior alveolar nerve canal. However, the prediction of eruptions and future horizons of AI models are still in the early developmental stages. Additional studies estimating the eruption in mixed and permanent dentition are warranted to establish a comprehensive model for identifying, diagnosing, and predicting third molar eruptions and determining the treatment outcomes in the case of impacted teeth. This will help clinicians make better decisions and achieve better treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Maxillar atrophy is a prevalent condition associated with diminished bone volume, which precludes the conventional placement of dental implants. Sinus floor lift is a surgical procedure that aims to address this atrophy through the insertion of a graft within the sinus cavity. A multitude of techniques have been documented in the international literature for the management of the sinus bone window, though each approach has its own set of advantages and disadvantages. Methods: The present study is a retrospective analysis of traditional sinus floor lift surgery, comparing the outcomes of two surgical approaches: placement of a collagen membrane over the maxillary lateral bone window with or without bone tacks. The study enrolled a total of 48 consecutive patients. Twenty-four patients underwent sinus floor lift surgery, with the placement of a collagen membrane over the maxillary lateral bone window without bone tacks (control group). The remaining 24 patients underwent the same procedure, but with bone tacks (study group). All patients received an amoxicillin 875 mg + clavulanic acid 125 mg administration for six days and underwent Cone Beam Computed Tomography (CBCT) before the sinus floor lift surgery and six months later before the implant surgery. The parameters measured on the preoperative Cone Beam Computed Tomography (CBCT) scan included residual bone, the preoperative thickness of the lateral bone in the center, and the distance between the lateral wall and the medial wall of the sinus. Only the bone height increment was measured on the postoperative CBCT scan. Postoperative complications and the visual analogue scale (VAS) score were also recorded. A statistical analysis was performed, and the correlation between the parameters was evaluated using Pearson's correlation coefficient. A comparison of the mean of the parameters between the treatment group and the control group was conducted using the t-test. Results and Conclusions: The study group was found to have superior outcomes in terms of bone height increment (p = 0.001) and VAS after 7 days (p = 0.11) compared to the control group. The novel application of bone tacks on the collagen membrane over the bone window following sinus elevation surgery was associated with superior outcomes in terms of bone height and reduced pain at seven days, as measured by the VAS, with no postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study is to identify a more reliable reference point in three-dimensional cephalometric analysis to replace the Porion point used in two-dimensional analysis, enhancing the accuracy of assessments. Methods: The methodology assessed potential alternative landmarks for three-dimensional cephalometric analysis. Utilizing a segmenting technique, anatomical landmarks were accurately pinpointed from the external acoustic meatus of 26 Cone Beam Computed Tomography (CBCT) scans. These landmarks were chosen for their clear and unambiguous detectability. To assess reproducibility, each landmark was replicated twice with a one-week interval by a master's student. Reproducibility was quantitatively evaluated by analyzing the absolute difference per axis. Results: Five possible candidate landmarks were identified: the most anterior, posterior, superior, and inferior points of the external acoustic meatus (EAM) and a notch delineating the epitympanic recess. The reproducibility of pinpointing these landmarks ranged from 0.56 mm to 2.2 mm. The absolute mean differences between measurements were 0.46 mm (SD 0.75) for the most anterior point, 0.36 mm (SD 0.44) for the most posterior point, 0.25 mm (SD 0.26) for the most superior point, 1.11 mm (SD 1.03) for the most inferior point, and 0.78 mm (SD 0.57) for the epitympanic notch. Conclusions: The most superior point of the EAM might successfully replace the Porion as an anatomical reference. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this study was to assess the diagnostic accuracy of the AI-driven platform Diagnocat for evaluating endodontic treatment outcomes using cone beam computed tomography (CBCT) images. Methods: A total of 55 consecutive patients (15 males and 40 females, aged 12–70 years) referred for CBCT imaging were included. CBCT images were analyzed using Diagnocat's AI platform, which assessed parameters such as the probability of filling, adequate obturation, adequate density, overfilling, voids in filling, short filling, and root canal number. The images were also evaluated by two experienced human readers. Diagnostic accuracy metrics (accuracy, precision, recall, and F1 score) were assessed and compared to the readers' consensus, which served as the reference standard. Results: The AI platform demonstrated high diagnostic accuracy for most parameters, with perfect scores for the probability of filling (accuracy, precision, recall, F1 = 100%). Adequate obturation showed moderate performance (accuracy = 84.1%, precision = 66.7%, recall = 92.3%, and F1 = 77.4%). Adequate density (accuracy = 95.5%, precision, recall, and F1 = 97.2%), overfilling (accuracy = 95.5%, precision = 86.7%, recall = 100%, and F1 = 92.9%), and short fillings (accuracy = 95.5%, precision = 100%, recall = 86.7%, and F1 = 92.9%) also exhibited strong performance. The performance of AI for voids in filling detection (accuracy = 88.6%, precision = 88.9%, recall = 66.7%, and F1 = 76.2%) highlighted areas for improvement. Conclusions: The AI platform Diagnocat showed high diagnostic accuracy in evaluating endodontic treatment outcomes using CBCT images, indicating its potential as a valuable tool in dental radiology. [ABSTRACT FROM AUTHOR]

Background: Blunt carotid injury (BCI) in pediatric trauma is quite rare. Due to the low number of cases, only a few reports and studies have been conducted on this topic. This review will discuss how frequent BCI/blunt cerebrovascular injury (BCVI) on pediatric patients after blunt trauma is, what routine diagnostics looks like, if a computed tomography (CT)/computed tomography angiography (CTA) scan on pediatric patients after blunt trauma is always necessary and if there are any negative health effects. Methods: This narrative literature review includes reviews, systematic reviews, case reports and original studies in the English language between 1999 and 2020 that deal with pediatric blunt trauma and the diagnostics of BCI and BCVI. Furthermore, publications on the risk of radiation exposure for children were included in this study. For literature research, Medline (PubMed) and the Cochrane library were used. Results: Pediatric BCI/BCVI shows an overall incidence between 0.03 and 0.5% of confirmed BCI/BCVI cases due to pediatric blunt trauma. In total, 1.1–3.5% of pediatric blunt trauma patients underwent CTA to detect BCI/BCVI. Only 0.17–1.2% of all CTA scans show a positive diagnosis for BCI/BCVI. In children, the median volume CT dose index on a non-contrast head CT is 33 milligrays (mGy), whereas a computed tomography angiography needs at least 138 mGy. A cumulative dose of about 50 mGy almost triples the risk of leukemia, and a cumulative dose of about 60 mGy triples the risk of brain cancer. Conclusions: Given that a BCI/BCVI could have extensive neurological consequences for children, it is necessary to evaluate routine pediatric diagnostics after blunt trauma. CT and CTA are mostly used in routine BCI/BCVI diagnostics. However, since radiation exposure in children should be as low as reasonably achievable, it should be asked if other diagnostic methods could be used to identify risk groups. Trauma guidelines and clinical scores like the McGovern score are established BCI/BCVI screening options, as well as duplex ultrasound. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate the hearing characteristics and causes of sudden sensorineural hearing loss (SSNHL) in patients aged from 15 to 40 years, focusing on audiological outcomes one year after the diagnosis. Methods: The medical records of individuals with SSNHL who were referred to our tertiary-level audiologic center were reviewed. All patients had undergone comprehensive diagnostic evaluations, including high-resolution 3D-FLAIR delayed magnetic resonance imaging (MRI), cone beam computed tomography (CBCT), and screening for coagulation, infectious, and autoimmune diseases. Results: Overall, 56 patients (mean age 28.1 ± 7.6 years) were included in the study. The hearing threshold in the affected ear improved significantly from 56.0 ± 18.0 dB at the diagnosis to 46.9 ± 22.3 dB after one year (p = 0.02). The degree of hearing loss, audiometric configurations, hearing improvements, and adherence to hearing treatments showed considerable variability among patients. Aural fullness, tinnitus, and hyperacusis were the predominant symptoms associated with SSNHL, and their prevalence decreased significantly over time. The diagnostic protocol led to the identification of the specific cause of SSNHL in 75% (42/56) of patients. The known etiology was found to be otological (39.3%), infectious (21.4%), autoimmune (7.1%), vascular (5.4%), or neoplastic (1.8%). In particular, Menière's disease (n = 12), isolated cochlear endolymphatic hydrops (n = 6), HSV-1 (n = 5), and EBV (n = 4) infections were the most frequent causes of SSNHL. Conclusions: The identification of the specific etiology of SSNHL may facilitate a more personalized approach to management and treatment. [ABSTRACT FROM AUTHOR]

Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to develop a practical staging method for reporting external carotid artery calcifications (ECACs) using cone-beam computed tomography (CBCT) imaging, specifically to standardize reporting for oral and maxillofacial radiologists. Methods: This retrospective study evaluated 489 CBCT scans for the presence of ECACs. Two calibrated evaluators assessed the scans in all three orthogonal planes, using the axial plane to develop the staging system. Calcifications were graded on a scale from 0 to 5. Results: ECACs were found in 170 out of 489 scans (34.7%). There was a statistically significant increase in ECAC distribution with age progression. The prevalence of ECACs was similar between genders. Grade 1 calcifications were most common in the 51–60 age group, Grade 2 in the 61–70 and 71–80 groups, and Grades 3 and 4 in the 81–90 group. No Grade 5 calcifications were observed in any age group. The inter-rater reliability showed an excellent correlation in the identification and grading of ECACs. Conclusions: The proposed grading system enables oral and maxillofacial radiologists to quantitatively report ECACs, facilitating timely referrals to physicians for further evaluation and early intervention, thereby potentially reducing the risk of cardiovascular events [ABSTRACT FROM AUTHOR]

Background/Objectives: Anterior open bite (AOB) is characterized by the absence of occlusal contact between the maxillary and mandibular anterior teeth, while the posterior teeth are in contact when occluded. Here, we aimed to clarify the difference in maxillary alveolar bone morphology in adult patients with and without AOB. Methods: This cross-sectional study was conducted on 50 adults aged 18–39 years: 25 patients without AOB (control group; 13 males and 12 females; age: mean ± standard deviation [SD], 22.2 ± 4.5 years) and 25 patients with AOB (9 males and 16 females; age: 24.2 ± 6.4 years). Using cone-beam computed tomography images, the height of the maxillary alveolar bone crest in the anterior and posterior teeth and thickness of the alveolar cortical bone on the labial and palatal sides were measured and compared between the two groups. An independent t-test and Pearson's correlation analysis were used to examine statistical significance (p < 0.05). Results: The AOB group showed a significantly longer (p = 0.016) posterior alveolar crest and thinner cortical bone on the buccal (p < 0.001) and lingual (p = 0.009) sides of the anterior region and the buccal (p = 0.006) sides of the posterior region than the control group did. Moreover, a significant negative correlation (p = 0.046; r = −0.403) was observed between bite force and cortical bone thickness on the buccal side of the posterior region in the AOB group. Conclusions: It is suggested that the absence of occlusal contact in the anterior area influences the alveolar bone morphology of the maxilla. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to investigate the influence of the root canal morphology and various treatment variables on the outcomes of root canal treatments (RCTs) in mandibular second molars, assessed through cone-beam computed tomography (CBCT) imaging. Methods: A total of 150 CBCT images were examined, comprising 100 cases of persistent endodontic infections and 50 of previously treated root canals with normal apices in the mandibular second molars. CBCT was utilized to evaluate the root canal configuration, the radiographic quality of coronal restorations and treated canal systems, and the presence of periapical lesions. Statistical analyses were performed to explore the correlations between these factors. Results: The presence of a C-shaped root canal configuration did not demonstrate a significant correlation with periapical lesions (p = 0.05). Factors influencing endodontic treatment outcomes included missing canals (p = 0.018), underfilling or overfilling (p = 0.045), and inadequate coronal restoration (p = 0.006). Missing a canal was identified as the variable most significantly associated with periapical lesions (OR = 3.103). Inhomogeneous root canal obturation was more commonly observed in C-shaped root canals (p < 0.001). Conclusions: Regardless of the root canal morphology of mandibular second molars, successful RCT depends on thorough disinfection to eliminate any untreated canals, precise three-dimensional filling of the canals at the correct working length, and a securely sealed coronal restoration to prevent leakage. [ABSTRACT FROM AUTHOR]

Background: Bone-anchored maxillary protraction (BAMP) aims to correct midfacial deficiencies, with proven positive skeletal changes without potential unwanted side effects. However, the influence of BAMP treatment on facial soft tissues, particularly in subjects with complete unilateral cleft lip, alveolus, and palate (CUCLAP), remains unclear. Methods: This single-center longitudinal cohort study examined the effects of 1.5 years of BAMP treatment on facial soft tissues in growing subjects with complete unilateral cleft lip, alveolus, and palate. The sample consisted of 25 patients, age range 9.7 to 12.6 years. Three-dimensional surface models derived from CBCT scans were superimposed on stable structures of the anterior cranial base and on the occipital area posterior of the foramen magnum to assess three-dimensional changes due to growth and BAMP therapy. Results: The results revealed a moderate positive correlation (Pearson's correlation coefficient from 0.203 to 0.560) between changes in hard tissue and soft tissue; some correlations were found to be weak (<0.300). Linear changes in soft tissue following BAMP were in the same direction as skeletal changes, showing downward, forward, and outward displacement. The only exception was in the vertical dimension. The lower facial third showed a slight but significant reduction, mainly in lip length (−1.2 mm), whereas the middle facial third showed a small increase (1.1 mm). Conclusions: It was concluded that during BAMP, soft tissue changes occur in the same direction as skeletal changes, although with a larger variability and less pronounced effects. [ABSTRACT FROM AUTHOR]

Background: The aim of this investigation was to assess the apical extrusion potential of sodium hypochlorite (NaOCl) in agarose-embedded mandibular first premolars employing four final agitation procedures. Methods: Based on CBCT confirmation of single oval-shaped canals, one hundred extracted mandibular first premolars were chosen. Using 5.25% NaOCl, the teeth were prepared using the XP Endo Shaper and divided into experimental and control groups. The following were the experimental groups: Group 1 comprised the XP-Endo Finisher, Group 2 the Ultrasonic Activation, Group 3 the Gentle File Finisher Brush, and Group 4 the 27-gauge side-vented needle. To test extrusion, the teeth were placed in a 0.2% agarose gel that contained the pH-sensitive dye m-cresol purple, allowing pixel quantification via ImageJ software (version 1.54i). Results: The XP Endo Finisher featured the most pixels, depicting higher apical extrusion (p < 0.01), followed by the side-vented needle, Gentle File Finisher Brush, and PUI, while the Control Group endured no extrusion. Conclusions: The effective irrigation method for root canal therapy is critical, especially in situations of open apices, resorption, or perforation. According to in vitro experiments, the XP-Endo Finisher has the maximum sodium hypochlorite extrusion, which is determined by parameters such as apical preparation size and irrigation system. [ABSTRACT FROM AUTHOR]

Background/Objectives: Periapical lesions (PLs) are frequently detected in dental radiology. Accurate diagnosis of these lesions is essential for proper treatment planning. Imaging techniques such as orthopantomogram (OPG) and cone-beam CT (CBCT) imaging are used to identify PLs. The aim of this study was to assess the diagnostic accuracy of artificial intelligence (AI) software Diagnocat for PL detection in OPG and CBCT images. Methods: The study included 49 patients, totaling 1223 teeth. Both OPG and CBCT images were analyzed by AI software and by three experienced clinicians. All the images were obtained in one patient cohort, and findings were compared to the consensus of human readers using CBCT. The AI's diagnostic accuracy was compared to a reference method, calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and F1 score. Results: The AI's sensitivity for OPG images was 33.33% with an F1 score of 32.73%. For CBCT images, the AI's sensitivity was 77.78% with an F1 score of 84.00%. The AI's specificity was over 98% for both OPG and CBCT images. Conclusions: The AI demonstrated high sensitivity and high specificity in detecting PLs in CBCT images but lower sensitivity in OPG images. [ABSTRACT FROM AUTHOR]

Background/Objectives: Advancements in oral imaging technology are continually shaping the landscape of dental diagnosis and treatment planning. Among these, photon-counting computed tomography (PCCT), introduced in 2021, has emerged as a promising, high-quality oral technology. Dental imaging typically requires a resolution beyond the standard CT systems achievable with the specialized cone-beam CT. PCCT can offer up to 100 µm resolution, improve soft-tissue contrast, and provide faster scanning times, which are crucial for detailed dental diagnosis and treatment planning. Using semiconductor detectors, PCCT produces sharper images and can potentially reduce the number of scans required, thereby decreasing patient radiation exposure. This review aimed to explore the potential benefits of PCCT in dental imaging. Methods: This review analyzed the literature on PCCT in dental imaging from January 2010 to February 2024, sourced from PubMed, Scopus, and Web of Science databases, focusing on high-resolution, patient safety, and diagnostic efficiency in dental structure assessment. We included English-language articles, case studies, letters, observational studies, and randomized controlled trials while excluding duplicates and studies unrelated to PCCT's application in dental imaging. Results: Studies have highlighted the superiority of PCCT in reducing artifacts, which are often problematic, compared to conventional CBCT and traditional CT scans, due to metallic dental implants, particularly when used with virtual monoenergetic imaging and iterative metal artifact reduction, thereby improving implant imaging. This review acknowledges limitations, such as the potential for overlooking other advanced imaging technologies, a narrow study timeframe, the lack of real-world clinical application data in this field, and costs. Conclusions: PCCT represents a promising advancement in dental imaging, offering high-resolution visuals, enhanced contrast, and rapid scanning with reduced radiation exposure. [ABSTRACT FROM AUTHOR]

Background: The anterior maxilla is challenging regarding aesthetic rehabilitation. Current bone augmentation techniques are complex and 3D-printed bioceramic bone grafts can simplify the intervention. Aim: A four-teeth defect in the anterior maxilla was reconstructed with a 3D-printed synthetic patient-specific bone graft in a staged approach for dental implant delivery. Methods: The bone graft was designed using Cone-Beam Computed Tomography (CBCT) images. The bone graft was immobilized with fixation screws. Bone augmentation was measured on CBCT images at 11 days and 8 and 13 months post-surgery. A biopsy sample was retrieved at reentry (10 months post-augmentation) and evaluated by histological and micro-computed tomography assessments. The definitive prosthesis was delivered 5 months post-reentry and the patient attended a visit 1-year post-loading. Results: A total bone width of 8 mm was achieved (3.7 mm horizontal bone gain). The reconstructed bone remained stable during the healing period and was sufficient for placing two dental implants (with an insertion torque > 35 N·cm). The fractions of new bone, bone graft, and soft tissue in the biopsy were 40.77%, 41.51%, and 17.72%, respectively. The histological assessment showed no signs of encapsulation, and mature bone was found in close contact with the graft, indicating adequate biocompatibility and suggesting osteoconductive properties of the graft. At 1-year post-loading, the soft tissues were healthy, and the dental implants were stable. Conclusions: The anterior maxilla's horizontal ridge can be reconstructed using a synthetic patient-specific 3D-printed bone graft in a staged approach for implant placement. The dental implants were stable and successful 1-year post-loading. [ABSTRACT FROM AUTHOR]

The position and inclination of the incisors play a crucial role in achieving optimal outcomes in orthodontic and orthognathic surgical treatment, given their impact on facial aesthetics. Background/objectives: Due to numerous distorting factors that affect the reliability of the ANB angle, the aim of the present work is to evaluate a more constant parameter over time, the anterior nasal spine (ANS), and explore whether aligning the incisal margin of the upper incisors with the anterior nasal spine could be a reliable indicator for achieving appropriate labial support in pre-surgical orthodontic preparation. Methods: From a pool of 500 cone beam computed tomography (CBCT) scans, 50 CBCT examinations displaying a Class 1 skeletal pattern (ANB = 2° ± 2°) with an intermediate (3.2–4 mm) or mixed (4–6 mm) sagittal maxillary position (MX), as determined by the 3D multiplanar total face approach (TFA), were selected and compared with CBCT examinations randomly chosen from the initial pool. Moreover, 12 landmarks were identified, and measurements were automatically obtained, using software, and recorded. Mean and standard deviation values were calculated for each sample. A comparison was made between the two samples, aligning the results with the morphological analysis of the anterior nasal spine and the sagittal position of the upper maxilla. Results: In Class 1 subjects, the distance between the incisal margin and the plane passed in relation to the anterior nasal spine should range between −1 mm and 1 mm, aligned with or slightly ahead of the anterior nasal spine or slightly ahead of this limit. Conclusions: The anterior nasal spine can serve as a reliable reference point for planning the position of the upper incisors, with excessive proclination or retroclination from this reference point deemed unacceptable. [ABSTRACT FROM AUTHOR]

(1) Objectives: This study aimed to compare a collagen matrix to a hemostatic gelatin sponge as a socket seal in alveolar ridge preservation (ARP). (2) Methods: Systemically healthy patients planned for ARP at two sites with more than 50% of the buccal bone wall remaining after tooth extraction were eligible for inclusion. ARP involved socket grafting using collagen-enriched deproteinized bovine bone mineral. Sites were then randomly assigned to the test group (collagen matrix) or the control group (hemostatic gelatin sponge). The primary outcome was soft tissue thickness in the center of the site at 4 months, analyzed on cone-beam computed tomography. Secondary outcomes included the buccal and lingual soft tissue heights, horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and Socket Wound Healing Score (SWHS). (3) Results: In total, 18 patients (12 females, 6 males) with a mean age of 57.3 years (SD 11.1) were included. Four months after ARP, the soft tissue thickness in the center of the site amounted to 2.48 mm (SD 0.70) in the test group and 1.81 mm (SD 0.69) in the control group. The difference of 0.67 mm (95% CI: 0.20–1.14) in favor of the collagen matrix was statistically significant (p < 0.009). The buccal soft tissue height was also statistically significantly higher for the collagen matrix (0.72 mm; 95% CI: 0.06–1.38; p = 0.034). A trend favoring the collagen matrix was found for the lingual soft tissue height (p = 0.066). No significant differences between the groups in terms of horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and the SWHS were found. (4) Conclusions: The absence of significant differences in hard tissue outcomes suggests that both the collagen matrix and hemostatic gelatin sponge effectively sealed the extraction socket and supported bone preservation. However, the collagen matrix better maintained soft tissue dimensions. The clinical relevance of this finding with respect to the necessity for adjunctive soft tissue augmentation at the time of implant placement is yet to be studied. [ABSTRACT FROM AUTHOR]

Background: In this study, we present a quantitative method to evaluate the motion artifact correction (MAC) technique through the morphological analysis of blood vessels in the images before and after MAC. Methods: Cone-beam computed tomography (CBCT) scans of 37 patients who underwent transcatheter chemoembolization were obtained, and images were reconstructed with and without the MAC technique. First, two interventional radiologists selected the blood vessels corrected by MAC. We devised a motion-corrected index (MCI) metric that analyzed the morphology of blood vessels in 3D space using information on the centerline of blood vessels, and the blood vessels selected by the interventional radiologists were quantitatively evaluated using MCI. In addition, these blood vessels were qualitatively evaluated by two interventional radiologists. To validate the effectiveness of the devised MCI, we compared the MCI values in a blood vessel corrected by MAC and one non-corrected by MAC. Results: The visual evaluation revealed that motion correction was found in the images of 23 of 37 patients (62.2%), and a performance evaluation of MAC was performed with 54 blood vessels in 23 patients. The visual grading analysis score was 1.56 ± 0.57 (radiologist 1) and 1.56 ± 0.63 (radiologist 2), and the proposed MCI was 0.67 ± 0.11, indicating that the vascular morphology was well corrected by the MAC. Conclusions: We verified that our proposed method is useful for evaluating the MAC technique of CBCT, and the MAC technique can correct the blood vessels distorted by the patient's movement and respiration. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this retrospective study was to radiographically evaluate the endo-sinus bone gain (ESBG) following osseodensification procedures using CBCT and compare the results to more conventional sinus lifting techniques. Methods: A total of 72 patients underwent crestal sinus floor elevation procedures and were provided with 102 implants with a sand-blasted and acid-etched surface with microthreads (Medentika® Microcone Implants, Hugelsheim, Germany). Patients were divided into two groups; the osseodensification group (OD; n = 36) and the osseodensified augmentation group (ODA; n = 36). Results: The mean residual bone height (RBH) was 5.71 (1.77) and 4.30 (0.94) mm in the OD and ODA groups, respectively. An ESBG of 3.45 (1.18) and 5.74 (1.31) mm was observed in the OD and ODA groups, respectively, and as compared to the baseline RBH, the ESBG was statistically significant in both groups after 6 months (p < 0.001). Conclusions: Within the limits of this retrospective study, crestal sinus lifting with the osseodensification technique seems to be a fast, effective, and safe method. Longer follow-up studies with full intrasinus bone topography and structure analyses are needed to prove the success rate of endo-sinus bone gain. [ABSTRACT FROM AUTHOR]

(1) Background: External cervical resorption causes dental hard tissue destruction that may reduce the fracture resistance of affected teeth. By using a compressive strength test, this study aimed to evaluate the fracture resistance of teeth with simulated external cervical resorption cavities that have different three-dimensional classifications. (2) Methods: In total, 170 teeth with simulated external cervical resorptions were divided into 16 experimental groups (n = 10) and 1 control group (n = 10) based on the three-dimensional classification: 1Ap, 1Bp, 1Cp, 1Dp, 2Ap, 2Bp, 2Cp, 2Dp, 3Ap, 3Bp, 3Cp, 3Dp, 4Ap, 4Bp, 4Cp, 4Dp and a control group. Defects were restored with mineral trioxide aggregate. The fracture resistances of the samples were statistically analyzed using two-way repeated ANOVA and the Bonferroni correction for multiple comparisons at a significance level of p < 0.05. (3) Results: The lowest resistance to fracture was observed in samples with vertical height level "4" and circumferential spread of "D" (p < 0.001). In the groups with circumferential spreads "B", "C" and "D", there were significant differences between the samples with vertical height levels "1", "2", "3" and "4" regarding fracture resistance (p < 0.001). (4) Conclusions: The circumferential spread and vertical height of the external cervical resorption influenced the fracture resistance of the affected teeth. [ABSTRACT FROM AUTHOR]

Aim: To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam computed tomography (CBCT). Methodology: One hundred and fifty teeth that received endodontic microsurgery were clinically and radiographically examined (PA and CBCT scans) after 1 and 2 years. Two calibrated endodontists evaluated the radiographic healing based on a six-point outcome classification. The outcome was classified using both strict (healed) and loose (healing) criteria. The success rates were calculated, and several outcome prognostic factors were assessed. Results: One hundred and fifty teeth were assessed with both radiographic systems. When "loose" success criteria were applied using PA, 90% (n = 135) of teeth were assessed as having had a favourable outcome (90%; 95% CI: 85.2–94.8%), whereas 90.7% (n = 136) of teeth showed a successful outcome when assessed with CBCT (90.7%; 95% CI: 86.0–95.3%). When "strict" success criteria were applied, there was a statistically significant difference (p = 0.018) between the success rates of mineral trioxide aggregate (MTA) (63.7%) and Biodentine (95.5%). Conclusions: Within the limitations of this study, endodontic microsurgery showed a high success rate. Among all the demographic and clinical variables assessed, in the multiregression analysis, only the use of Biodentine was associated with a higher proportion of "complete" healings compared to MTA or Intermediate Restorative Material (IRM) when assessed using CBCT. MTA and Biodentine performed similarly when "incomplete" healings were regarded as successful outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Osseodensification is a non-extraction technique using specially designed drills to increase bone density while extending an osteotomy, allowing bone to be preserved and condensed by compacting autograft during osteotomy preparation, increasing bone density around implants, and improving mechanical stability. Aim: The objective of this study is to compare conventional osteotomy and osseodensification protocols in implant placement and analyze whether there are differences in bone density. Materials and Methods: Study variables were defined, namely, osseodensification technique, conventional osteotomy technique, bone density, sex, area of location, implant dimensions, implant dimensions, and implant stability. Eligibility and exclusion criteria were defined. A step-by-step surgical protocol was developed. The surgeon and radiologist underwent intra-examiner calibration. A total of 15 patients were selected according to the eligibility criteria, and a total of 41 implants were inserted, 20 implants by conventional osteotomy and 21 by osseodensification. A cone beam computed tomography was performed one year after prosthetic rehabilitation to estimate bone density. Data were collected and recorded, and in the analysis of the association of variables, non-parametric tests were applied. Results: Significant statistical results were found in bone density values, with higher values being obtained with the osseodensification technique, that is, median density values of 1020, and median density values of 732 for the bone drilling technique. The results of the correlation between bone density in both techniques and sex, primary implant stability, implant dimensions and location area were statistically non-significant. Conclusions: Within the limitations of this study, there are differences in bone density between conventional osteotomy and osseodensification protocols. Bone density is increased with osseodensification over a study period of one year. [ABSTRACT FROM AUTHOR]

Background: Incisor retraction is often a crucial phase in ongoing orthodontic treatment, with significant implications for alveolar remodeling mechanisms. There are two prevailing theories which seek to explain this. According to the first, teeth move with the bone, while according to the second, teeth move within the bone. This systematic review seeks to assess morphometric changes in the maxillary alveolar process resulting from incisor retraction following premolar extraction and to evaluate the potential for bone remodeling associated with orthodontic movement. Methods: The study was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following electronic databases were searched: PubMed, Google Scholar, Web of Science EMBASE and the Cochrane Central Register of Controlled Trials. The databases were searched using the following keywords: "Bone remodeling and retraction of incisors", "Alveolar bone and incisor retraction", "Bone thickness and incisor retraction", and "Bone changes and orthodontic treatment". Search filters were utilized to identify relevant papers and articles written in English and published during the last 10 years. Based on the information provided in their abstracts, papers and articles were selected according to the following criteria: randomized clinical trials (RCTs), controlled clinical prospective trials (CCTs), and retrospective studies. Articles unrelated to the study's scope or failing to meet inclusion criteria were excluded. These generally comprised individual case reports, case series reports, literature reviews, experimental studies, studies with limited data (including conference abstracts and journal writings), studies involving an unrepresentative group of patients (less than 10 patients), studies concerning patients with syndromes, and animal experiments. The remaining articles which were deemed relevant underwent comprehensive reference review and such journals as the American Journal of Orthodontics, Dentofacial Orthopedics, International Orthodontics, Journal of Clinical Orthodontics, and Angle Orthodontist were manually searched. Results: Seven articles meeting the inclusion criteria articles were selected for final evaluation, with a total of 284 participants, including 233 women and 51 men. During the analysis of the results included in the publications, a lack of homogeneity was observed, rendering a reliable statistical analysis and heterogeneity assessment unobtainable. Noteworthy disparities in methodologies and measurements posed a risk of drawing inappropriate conclusions. Consequently, emphasis was placed on qualitative analysis, emphasizing the need for standardization in future studies of a similar nature, to enable valid and comparable analyses. Conclusions: The research findings incorporated in this review demonstrate that significant bone loss occurs because of incisor retraction, which diminishes distance between the bone surface and the root surface on the palatal aspect. The magnitude of this change may vary, contingent upon both the extent of incisor displacement and alterations in their inclination, thereby affecting the positioning of the root tips. This change is significantly higher in adults than in growing adolescents. The rationale behind this assertion lies in the widely recognized phenomenon of declining cellular activity with advancing age. The decrease in the speed and intensity of cellular changes may explain the diminished capacity for remodeling as patient age increases. There is ongoing discourse regarding alterations in the volume of bone on the labial aspect of the alveolar process. Further research is necessary to measure whether bone remodeling during orthodontic movement is contingent upon other factors, such as the speed and biomechanics of retraction, the level of applied orthodontic force, and the patient age. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint disorder (TMD) is a common medical condition. Cone beam computed tomography (CBCT) is effective in assessing TMD-related bone changes, but image noise may impair diagnosis. Emerging deep learning reconstruction algorithms (DLRs) could minimize noise and improve CBCT image clarity. This study compares standard and deep learning-enhanced CBCT images for image quality in detecting osteoarthritis-related degeneration in TMJs (temporomandibular joints). This study analyzed CBCT images of patients with suspected temporomandibular joint degenerative joint disease (TMJ DJD). Methods: The DLM reconstructions were performed with ClariCT.AI software. Image quality was evaluated objectively via CNR in target areas and subjectively by two experts using a five-point scale. Both readers also assessed TMJ DJD lesions. The study involved 50 patients with a mean age of 28.29 years. Results: Objective analysis revealed a significantly better image quality in DLM reconstructions (CNR levels; p < 0.001). Subjective assessment showed high inter-reader agreement (κ = 0.805) but no significant difference in image quality between the reconstruction types (p = 0.055). Lesion counts were not significantly correlated with the reconstruction type (p > 0.05). Conclusions: The analyzed DLM reconstruction notably enhanced the objective image quality in TMJ CBCT images but did not significantly alter the subjective quality or DJD lesion diagnosis. However, the readers favored DLM images, indicating the potential for better TMD diagnosis with CBCT, meriting more study. [ABSTRACT FROM AUTHOR]

Background: The aim was to assess three-dimensionally mandibular and maxillary changes in growing Class II patients treated with removable functional appliances followed by fixed appliances. Methods: Twenty-four Class II patients (age range: 9 to 14, mean: 12.1 ± 1.1 years) treated with removable functional appliances followed by fixed appliances (functional appliance group—FAG) were retrospectively selected and compared to an age-matched control group (CG) treated with fixed appliances only. To be included in the study, pre- and post-treatment CBCT scans had to be available. The CBCTs were used to analyze, in 3D, the changes following treatment and growth. Results: Before treatment, overjet (FAG: 9 mm ± 2.8 (mean ± standard deviation); CG: 4 mm ± 1.7), ANB (FAG: 5.7° ± 2.0; CG: 3.2° ± 1.4), and effective mandibular length (FAG: 113.0 mm ± 4.1; CG: 116.6 mm ± 5.9) were statistically significantly different between the two groups. After treatment, overjet (FAG: −6.8 mm ± 2.8; CG: −1.8 mm ± 1.8) and effective mandibular length (FAG: 6.3 mm ± 2.6; CG: 3.9 mm ± 2.6) statistically significantly changed. There was a significant difference in the treatment effect between the FAG and the CG in overjet, ANB, and effective mandibular length. Conclusions: The results indicate that functional appliances are effective in correcting Class II malocclusions. The growth modification in the FAG resulted in an increase in mandibular length. Yet, the final length of the mandible in the FAG was smaller when compared to the CG. [ABSTRACT FROM AUTHOR]

Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of "Definitely present". The data suggested that CBCT outperformed PR when using a less stringent criterion ("Definitely present" or "Probably present"), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong's test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients. [ABSTRACT FROM AUTHOR]

(1) Background: External beam radiotherapy (EBRT) and concurrent chemotherapy, followed by brachytherapy (BT), offer a standard of care for patients with locally advanced cervical carcinoma. Conventionally, large safety margins are required to compensate for organ movement, potentially increasing toxicity. Lately, daily high-quality cone beam CT (CBCT)-guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Thus, online treatment plans can be adapted to the current position of the tumor and the adjacent organs at risk (OAR), while the patient is lying on the treatment couch. We sought to evaluate the potential of this new technology, including a weekly shuttle-based 3T-MRI scan in various treatment positions for tumor evaluation and for decreasing treatment-related side effects. (2) Methods: This is a prospective one-armed phase-II trial consisting of 40 patients with cervical carcinoma (FIGO IB-IIIC1) with an age ≥ 18 years and a Karnofsky performance score ≥ 70%. EBRT (45–50.4 Gy in 25–28 fractions with 55.0–58.8 Gy simultaneous integrated boosts to lymph node metastases) will be accompanied by weekly shuttle-based MRIs. Concurrent platinum-based chemotherapy will be given, followed by 28 Gy of BT (four fractions). The primary endpoint will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher (CTCAE v5.0). Secondary outcomes include clinical feasibility, quality of life, and imaging-based response assessment. [ABSTRACT FROM AUTHOR]

Background: To infer the optimal angulation and height level of mini-implant insertion in the anterior nasal spine (ANS) region from alveolar bone depth (BD) and labial cortical bone thickness (CBT) through cone-beam computed tomography (CBCT), the influences of sex, age, and growth pattern on BD, CBT, and the starting point of the ANS were examined. Material and methods: BD and CBT were measured on CBCT median sagittal images at specific angles (0, 15, 30, 45, and 60 degrees) to simulate the angulation of insertion. The height level of the first axial image with obvious bone ridge was recorded as the start of ANS. Results: The average height of ANS start was 9.42 mm from the alveolar bone crest between the central incisors. The variations in height level and insertion angle combined, or either of them individually, significantly influenced BD and CBT, demonstrating overall decreasing trends (p < 0.001). BD was not influenced by sex, age, or growth pattern (p > 0.05). However, CBT was found to be correlated with sex and growth pattern, while the height level of ANS start was associated only with growth pattern, particularly in hypodivergent patients (p < 0.05). Conclusion: The recommended insertion height level is 14–16 mm from the alveolar bone crest and the recommended angulation is 30–45°. An innovative inequity in the relationship between a certain height level and the insertion angulation is proposed. [ABSTRACT FROM AUTHOR]

Pre-op spinal arterial mapping is crucial for complex aortic repair. This study explores the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping to identify the Adamkiewicz artery (AKA) in patients undergoing open or endovascular repair of the descending thoracic or thoracoabdominal aorta at risk of spinal cord ischemia. Pre-operative non-selective dual-phase CBCT after intra-aortic contrast injection was performed in the aortic segment to be treated. The origin of detected AKA was assessed based on image fusion between CBCT and pre-interventional computed tomography angiography. Then, the CBCT findings were compared with the incidence of postoperative spinal cord ischemia (SCI). Among 21 included patients (median age: 68 years, 20 men), AKA was detected in 67% within the explored field of view, predominantly from T7 to L1 intercostal and lumbar arteries. SCI occurred in 14%, but none when AKA was not detected (p < 0.01). Non-selective CBCT for AKA mapping is deemed safe and feasible, with potential predictive value for post-surgical spinal cord ischemia risk. The study concludes that non-selective aortic CBCT is a safe and feasible method for spinal arterial mapping, providing promising insights into predicting post-surgical SCI risk. [ABSTRACT FROM AUTHOR]

Background: This study investigated whether patient-specific condylar positioning devices (CPDs) are beneficial compared to the conventional manual positioning of the condyles. Methods: In this prospective, randomized trial, patients undergoing orthognathic surgery with a bilateral sagittal split osteotomy of the mandible were included. The ascending ramus was positioned with computer-aided designed and computer-aided manufactured (CAD/CAM) patient-specific devices in the CPD group and manually in the control group. Postoperatively, cone-beam computed tomography (CBCT) was performed to align the virtually planned position with the postoperative result. Results: Thirty patients were enrolled in the study, with 14 randomized to the CPD group and 16 to the control group. In the CPD group, the ascending ramus differed in the postoperative CBCT scan from the virtually planned position by 0.8 mm in the left/right, 0.8 mm in the front/back, and 1.3 mm in the cranial/caudal direction. The corresponding control-group values were 1.1 mm, 1.3 mm, and 1.6 mm. CPD and controls differed significantly for the left/right movement of the rami (p = 0.04) but not for the other directions or rotations (p > 0.05). Conclusions: The results demonstrate that both methods are accurate, and postoperative results matched the virtually planned position precisely. It can be assumed that the described CPDs are beneficial when a condylar position different from the preoperative is desired. [ABSTRACT FROM AUTHOR]

The article discusses the advancements and breakthroughs in oral and maxillofacial surgery. These developments have greatly improved surgical procedures, precision, and patient outcomes. The use of technologies such as surgical simulation software, 3D printing, and advanced imaging techniques has revolutionized diagnosis, treatment planning, and surgical interventions. The article also highlights the importance of managing patients with odontogenic infections and adverse reactions to new drugs. Additionally, the COVID-19 pandemic has led to the emergence of telemedicine and virtual consultations, enhancing safety measures and patient care. The research emphasizes the relevance of these breakthroughs in improving routine care for various diseases and the need for a patient-specific approach in oral and maxillofacial surgery. [Extracted from the article]

Well-defined, faintly radiopaque lesions are occasionally observed in the antrum of the maxillary sinus in asymptomatic patients during maxillary sinus floor elevation. These lesions are treated as antral pseudocysts (AP) based on the clinical diagnosis in some cases, and maxillary sinus floor elevation is performed without enucleating these lesions. However, further surgery is required after implant placement if the lesion is a mucocele, odontogenic cyst, or tumour. This comprehensive clinical review aimed to identify an appropriate approach for maxillary sinus floor elevation in patients with well-defined, faintly radiopaque lesions in the antrum based on our clinical experience. [ABSTRACT FROM AUTHOR]

The aim of this validation study was to comprehensively evaluate the performance and generalization capability of a deep learning-based periapical lesion detection algorithm on a clinically representative cone-beam computed tomography (CBCT) dataset and test for non-inferiority. The evaluation involved 195 CBCT images of adult upper and lower jaws, where sensitivity and specificity metrics were calculated for all teeth, stratified by jaw, and stratified by tooth type. Furthermore, each lesion was assigned a periapical index score based on its size to enable a score-based evaluation. Non-inferiority tests were conducted with proportions of 90% for sensitivity and 82% for specificity. The algorithm achieved an overall sensitivity of 86.7% and a specificity of 84.3%. The non-inferiority test indicated the rejection of the null hypothesis for specificity but not for sensitivity. However, when excluding lesions with a periapical index score of one (i.e., very small lesions), the sensitivity improved to 90.4%. Despite the challenges posed by the dataset, the algorithm demonstrated promising results. Nevertheless, further improvements are needed to enhance the algorithm's robustness, particularly in detecting very small lesions and the handling of artifacts and outliers commonly encountered in real-world clinical scenarios. [ABSTRACT FROM AUTHOR]

Background: As implant treatment cases increase, many cases of failure/side effects also occur. Generally, dental clinics determine the density of the jawbone using cone beam CT (CBCT). Considering the known potential role of this tool for bone assessment in primary osteoporosis, this study evaluated patients with secondary endocrine causes of low bone mass. Methods: The study included 83 patients with endocrine causes of osteoporosis who were evaluated by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and mental foramen (MF) region CBCT. The following CBCT indices were measured: anterior (A)—thickness of inferior mandibular cortex 10 mm anterior from MF; molar (M)—thickness of inferior mandibular cortex 10 mm posterior from MF; posterior (P)—thickness of inferior mandibular cortex 25 mm posterior from MF; symphysis (S)—thickness of inferior mandibular cortex equidistant from the centers of right and left MF. Results: The highest correlation coefficient in the secondary causes group was between the A index and the lumbar BMD (r = 0.375, p = 0.001) and the P index and the femoral neck BMD (r = 0.38, p = 0.001). Hypercortisolism seems to be the most predictable cause of secondary osteoporosis using the A, M, and P indices. The A, M, and P indices showed predictive values of the bone micro-architecture that was evaluated using TBS score, and were statistically significant. The symphysis index does not significantly predict osteoporosis or impaired bone micro-architecture. Conclusions: These findings support the potential usefulness of A, M, and P CBCT-derived radiomorphometric mandibular indices in secondary osteoporosis, underlining the well-known effects of these pathologies on bone micro-architecture rather than bone quantity.

Objective: This systematic review aims to summarize the evidence on the use and applicability of AI in impacted mandibular third molars. Methods: Searches were performed in the following databases: PubMed, Scopus, and Google Scholar. The study protocol is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202460081). The retrieved articles were subjected to an exhaustive review based on the inclusion and exclusion criteria for the study. Articles on the use of AI for diagnosis, treatment, and treatment planning in patients with impacted mandibular third molars were included. Results: Twenty-one articles were selected and evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) evidence quality scale. Most of the analyzed studies dealt with using AI to determine the relationship between the mandibular canal and the impacted mandibular third molar. The average quality of the articles included in this review was 2+, which indicated that the level of evidence, according to the SIGN protocol, was B. Conclusions: Compared to human observers, AI models have demonstrated decent performance in determining the morphology, anatomy, and relationship of the impaction with the inferior alveolar nerve canal. However, the prediction of eruptions and future horizons of AI models are still in the early developmental stages. Additional studies estimating the eruption in mixed and permanent dentition are warranted to establish a comprehensive model for identifying, diagnosing, and predicting third molar eruptions and determining the treatment outcomes in the case of impacted teeth. This will help clinicians make better decisions and achieve better treatment outcomes.

Background/Objectives: The aim of this study was to assess the diagnostic accuracy of the AI-driven platform Diagnocat for evaluating endodontic treatment outcomes using cone beam computed tomography (CBCT) images. Methods: A total of 55 consecutive patients (15 males and 40 females, aged 12–70 years) referred for CBCT imaging were included. CBCT images were analyzed using Diagnocat’s AI platform, which assessed parameters such as the probability of filling, adequate obturation, adequate density, overfilling, voids in filling, short filling, and root canal number. The images were also evaluated by two experienced human readers. Diagnostic accuracy metrics (accuracy, precision, recall, and F1 score) were assessed and compared to the readers’ consensus, which served as the reference standard. Results: The AI platform demonstrated high diagnostic accuracy for most parameters, with perfect scores for the probability of filling (accuracy, precision, recall, F1 = 100%). Adequate obturation showed moderate performance (accuracy = 84.1%, precision = 66.7%, recall = 92.3%, and F1 = 77.4%). Adequate density (accuracy = 95.5%, precision, recall, and F1 = 97.2%), overfilling (accuracy = 95.5%, precision = 86.7%, recall = 100%, and F1 = 92.9%), and short fillings (accuracy = 95.5%, precision = 100%, recall = 86.7%, and F1 = 92.9%) also exhibited strong performance. The performance of AI for voids in filling detection (accuracy = 88.6%, precision = 88.9%, recall = 66.7%, and F1 = 76.2%) highlighted areas for improvement. Conclusions: The AI platform Diagnocat showed high diagnostic accuracy in evaluating endodontic treatment outcomes using CBCT images, indicating its potential as a valuable tool in dental radiology.

Objective: The aim of the present study is to identify a more reliable reference point in three-dimensional cephalometric analysis to replace the Porion point used in two-dimensional analysis, enhancing the accuracy of assessments. Methods: The methodology assessed potential alternative landmarks for three-dimensional cephalometric analysis. Utilizing a segmenting technique, anatomical landmarks were accurately pinpointed from the external acoustic meatus of 26 Cone Beam Computed Tomography (CBCT) scans. These landmarks were chosen for their clear and unambiguous detectability. To assess reproducibility, each landmark was replicated twice with a one-week interval by a master’s student. Reproducibility was quantitatively evaluated by analyzing the absolute difference per axis. Results: Five possible candidate landmarks were identified: the most anterior, posterior, superior, and inferior points of the external acoustic meatus (EAM) and a notch delineating the epitympanic recess. The reproducibility of pinpointing these landmarks ranged from 0.56 mm to 2.2 mm. The absolute mean differences between measurements were 0.46 mm (SD 0.75) for the most anterior point, 0.36 mm (SD 0.44) for the most posterior point, 0.25 mm (SD 0.26) for the most superior point, 1.11 mm (SD 1.03) for the most inferior point, and 0.78 mm (SD 0.57) for the epitympanic notch. Conclusions: The most superior point of the EAM might successfully replace the Porion as an anatomical reference.

Background: Down syndrome (DS) is a genetic condition characterized by an extra copy of chromosome 21, resulting in various physical and cognitive features. This study aimed to comprehensively analyze the dental and craniofacial morphology of individuals with DS using Cone Beam Computed Tomography (CBCT). Methods: Six individuals with DS, comprising five males and one female aged 17 to 35 years, underwent CBCT scanning. Radiographic assessments included dentition, occlusion, paranasal sinuses, airway, skull bones, and suture calcification. Linear and angular cephalometric measurements were performed, and airway analysis was conducted using Dolphin 3D imaging software v.11. Results: The study revealed prognathic maxilla in five patients, prognathic mandible in four, and bimaxillary protrusion in two. Dental findings included microdontia, enamel hypoplasia, and congenitally missing teeth, with maxillary and mandibular third molars most commonly absent. Sinus abnormalities, delayed suture closure, and cervical spine anomalies were also observed. Conclusion: These findings contribute to a deeper understanding of DS-related craniofacial characteristics and emphasize the importance of considering these morphometric features in clinical management strategies for individuals with DS. This study’s limited sample size underscores the significance of radiographic assessment in planning interventions such as cosmetic reconstructions, prosthetic rehabilitation, or orthodontic treatment for individuals with DS.

Purpose: to evaluate the clinical impact of a protocol for the image-guided percutaneous microwave ablation (MWA) of hepatocellular carcinoma (HCC) that includes cone-beam computed tomography (CBCT), fusion imaging and ablation volume prediction in patients with hepatocellular carcinoma unsuitable for standard ultrasound (US) guidance. Materials and Methods: this study included all patients with HCC treated with MWA between January 2021 and June 2022 in a tertiary institution. Patients were divided into two groups: Group A, treated following the protocol, and Group B, treated with standard ultrasound (US) guidance. Follow-up images were reviewed to assess residual disease (RD), local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Ablation response at 1 month was also evaluated according to mRECIST. Baseline variables and outcomes were compared between the groups. For 1-month RD, propensity score weighting (PSW) was performed. Results: 80 consecutive patients with 101 HCCs treated with MWA were divided into two groups. Group A had 41 HCCs in 37 patients, and Group B had 60 HCCs in 43 patients. Among all baseline variables, the groups differed regarding their age (mean of 72 years in Group A and 64 years in Group B, respectively), new vs. residual tumor rates (48% Group A vs. 25% Group B, p < 0.05) and number of subcapsular tumors (56.7% Group B vs. 31.7% Group A, p < 0.05) and perivascular tumors (51.7% Group B vs. 17.1% Group A, p < 0.05). The protocol led to repositioning the antenna in 49% of cases. There was a significant difference in 1-month local response between the groups measured as the RD rate and mRECIST outcomes. LTP rates at 3 and 6 months, and IDR rates at 1, 3 and 6 months, showed no significant differences. Among all variables, logistic regression after PSW demonstrated a protective effect of the protocol against 1-month RD. Conclusions: The use of CBCT, fusion imaging and ablation volume prediction during percutaneous MWA of HCCs provided a better 1-month tumor local control. Further studies with a larger population and longer follow-up are needed. [ABSTRACT FROM AUTHOR]

The aim of the study was to try to obtain more information on diagnostic samplings and biomarkers using dual-layer spectral CT in lung biopsies. Lung biopsies were performed by merging images obtained with CBCT with those from spectral CT to use them as functional guidance, experimenting with double sampling to determine the difference between the area with a higher Z-effective number and that with a lower Z-effective number. Ten patients with large lung lesions on spectral CT were selected and underwent percutaneous transthoracic lung mass biopsy. Technical success was calculated. The percentage of neoplastic, inflammatory, fibrotic, necrotic cells, or non-neoplastic lung parenchyma was reported. The possibility of carrying out immunohistochemical or molecular biology investigations was analyzed. All lesions were results malignant in 10/10 samples in the Zmax areas; in the Zmin areas, malignant cells were found in 7/10 samples. Technical success was achieved in 100% of cases for Zmax sampling and in 70% for Zmin sampling (p-value: 0.2105). The biomolecular profile was detected in 9/10 (90%) cases in Zmax areas, while in 4/10 (40%) cases in Zmin areas (p-value: 0.0573). The advantage of Z-effective imaging would be to identify a region of the lesion that is highly vascularized and probably richer in neoplastic cells, thus decreasing the risk of obtaining a non-diagnostic biopsy sample. [ABSTRACT FROM AUTHOR]

This study aimed to assess the diagnostic accuracy of a mobile application by comparing its diagnoses to those of Orofacial Pain and Oral Medicine specialists and further imaging results (CBCT and MRI) in 500 patients with temporomandibular disorder (TMD). The research focused on three diagnostic categories: the initial specialist diagnoses, the final diagnoses after imaging, and the mobile app's diagnoses. The concordance rates, sensitivities, specificities, and positive predictive values of the diagnoses were examined, with further imaging serving as the gold standard. The mobile app demonstrated a high concordance rate compared to both the final (0.93) and the initial specialists' diagnoses (0.86). The sensitivities, specificities, and positive predictive values also indicated strong reliability, affirming the app's diagnostic validity. Although the concordance rate was slightly lower when comparing the app's diagnoses to the imaging results (CBCT and MRI), the specialists' diagnoses yielded similar results. The study suggests that user-friendly diagnostic mobile applications, based on the diagnostic criteria for TMD, could enhance the clinical management of TMD. Given the reliability of mobile applications for diagnostic purposes, their wider implementation could facilitate the provision of appropriate and timely treatments for patients with TMD. [ABSTRACT FROM AUTHOR]

Vertical ridge augmentation is a demanding and technique-sensitive surgical procedure. In the present case series, cone beam CT (CBCT) scans from the clinical routine of patients treated using a novel approach for vertical bone augmentation were assessed. All patients showed a single-tooth class 5 defect and were treated using a modification of the original shell technique. Cortical bone plates were replaced with a lamina composed of a partially demineralized porcine xenograft. CBCT scans of six consecutive patients were treated with the lamina and particulate bone from the mandibular ramus prior to a single tooth implant in the anterior maxilla were included. Pre- and postsurgical CBCT data sets were superimposed and analyzed digitally using surface matching and Boolean subtraction. The volume of the grafted area was calculated with and without the xenograft. The vertical gain of the ridge height measured in this case series varied from 7 to 11.3 mm. The mean vertical gain was 8.97 mm. The mean volume including the xenograft was 382.59 mm3 (SD 73.39) and 250.84 mm3 (SD 53.67) without the lamina. The modified shell technique used in this case series for the vertical augmentation of single-tooth class 5 defects provided sufficient bone for single implant restorations. [ABSTRACT FROM AUTHOR]

Digital workflows have become integral in orthodontic diagnosis and therapy, reducing risk factors and chair time with one-visit protocols. This study assessed the transfer accuracy of fully digital planned insertion guides for orthodontic mini-implants (OMIs) compared with freehanded insertion. Cone-beam computed tomography (CBCT) datasets and intraoral surface scans of 32 cadaver maxillae were used to place 64 miniscrews in the anterior palate. Three groups were formed, two using printed insertion guides (A and B) and one with freehand insertion (C). Group A used commercially available customized surgical templates and Group B in-house planned and fabricated insertion guides. Postoperative CBCT datasets were superimposed with the planning model, and accuracy measurements were performed using orthodontic software. Statistical differences were found for transverse angular deviations (4.81° in A vs. 12.66° in B and 5.02° in C, p = 0.003) and sagittal angular deviations (2.26° in A vs. 2.20° in B and 5.34° in C, p = 0.007). However, accurate insertion depth was not achieved in either guide group; Group A insertion was too shallow (−0.17 mm), whereas Group B insertion was deeper (+0.65 mm) than planned. Outsourcing the planning and fabrication of computer-aided design and computer-aided manufacturing insertion guides may be beneficial for certain indications; particularly, in this study, commercial templates demonstrated superior accuracy than our in-house–fabricated insertion guides. [ABSTRACT FROM AUTHOR]

Purpose: The present study aims to evaluate the effectiveness and safety of the anti-reflux microcatheter during DEB-TACE with DC Bead LUMITM (radiopaque beads) for the treatment of hepatocellular carcinoma (HCC). Methods: We performed an observational longitudinal prospective monocentric study to analyze all patients with HCC who underwent to DEB-TACE with DC Bead LUMITM and anti-reflux microcatheter. Technical success, the presence of residual disease, and clinical success were evaluated. The performance of the anti-reflux microcatheter on the basis of the percentage of tumor covered and the non-target embolization (NTE) was also evaluated. Results: Twenty patients underwent DEB-TACE with DC Bead LUMITM and an anti-reflux microcatheter. Technical success was achieved in all cases. Residual disease in the target tumor was observed in 11/20 (55%) of cases and no residual disease was found in 9/20 (45%) of cases. The clinical response at 1-month follow-up was of PD 4/20 (20%), SD 7/20 (35%), and CR 9/20 (45%). No major complications were recorded, and 10% of cases had minor complications. The distribution of beads on post-procedural CBCT, classified according to the percentage of target nodule coverage, was ≥50% in 70% (14/20) of cases and between 30–50% in 30% of cases (6/20). NTE was never registered. [ABSTRACT FROM AUTHOR]