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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]

Background: European hedgehogs (Erinaceus europaeus) are small insectivorous mammals common in Europe. With increased urbanization, the species become more frequent in the cities and near other human dwellings. The anatomy of the species with the use of diagnostic imaging techniques along with the classical anatomical methodology has not been researched before. In addition to the description of this species' skull, the data may contribute to progress in hedgehog medicine, delivering a basis for diagnosing and treating head trauma in this species. Results: Cadavers of 30 European hedgehogs have been used to study the anatomy of the head of the species. Along with classical anatomical techniques – latex and corrosion cast specimens, x-ray, and cone-bean computed tomography scans were performed. The methods were then compared, and the detailed anatomy of the head was described. The skull of the Western European hedgehog was elongated and oval in shape, and could be divided into two distinct regions: one formed of neurocranial bones and the other of facial bones. The neurocranium was composed of the following bones: the occipital, interparietal, parietal, frontal, temporal, sphenoid, ethmoid, and pterygoid bones. The following facial bones were identified: the incisive, nasal, maxilla, zygomatic, palatine, vomer, and the mandible. The most important findings include the primitive tympanic bullae, the absence of a supraorbital foramen, and the lacrimal bones, which were indistinguishably fused with the maxillae. Conclusions: The results of the study may be used in future research on the comparative anatomy of the other members of the Eulipotyphla order. With the increase of hedgehogs in the cities, it is important to establish new diagnostic and treatment protocols for wildlife rehabilitation centers. Anatomical and radiological descriptions may be used as a base for such work. The anatomical features of the hedgehog skull described in the study may prove useful for further studies from a comparative anatomical perspective. Additionally, the data may serve as a basis for developing identification guidelines for archaeological studies and forensic research. [ABSTRACT FROM AUTHOR]

Introduction Purpose Materials and methods Results Conclusion Bidirectional vertical ridge augmentation in the posterior maxilla is very challenging.To evaluate the regenerative potential of micrografts, derived from periosteum or bone tissue, added to an anorganic xenograft in vertical reconstruction of the posterior maxilla, by a prospective, controlled study.After clinical selection and the analysis of CBCT scans, 24 posterior maxillary sites, in 19 patients, were treated by using Barbell Technique®. Sites requiring both inlay and onlay reconstruction were enrolled in the study. In the Control Group (CG, n = 8), a xenograft was used in the inlay site and for the onlay site, a 1:1 mix of xenograft and an autograft was used. In Test Group 1 (TG1, n = 8), both inlay and onlay sites were grafted with the xenograft associated with the micrografts derived from periosteum. In Test Group 2 (TG2, n = 8), both inlay and onlay sites were grafted with the xenograft associated with the micrografts derived from bone. Six months after the procedures, CBCT scans were obtained, and bone biopsy samples were harvested during implant placement surgery. The bone specimens were analyzed histomorphometrically, by measuring the percentages of vital mineralized tissue (VMT), non vital mineralized tissue (NVMT) and non mineralized tissue (NMT). Immunohistochemically, the levels of VEGF were categorized by a score approach.Histomorphometric analysis revealed, for the inlay grafts, no significant difference among the groups for VMT, NVMT and NMT. However, for onlay grafts, CG achieved a higher amount of VMT in comparison with TG2, and the opposite occurred for NMT values. In this regard, no statistical difference was observed between CG and TG1. Concerning immunohistochemistry, the VEGF values for CG and TG1 were slightly higher than those obtained by TG2 for both inlay and onlay grafts, but without statistical significance. CBCT analysis showed a similar level of gain for all groups, for both inlay and onlay bone augmentation sites. Clinically, one implant (in CG) within a total of 50 implants installed, had early failure and was replaced after 3 months. All patients received implant supported prosthesis.This study indicated that the clinical use of micrograft derived from periosteum may have some potential to increase bone formation in onlay reconstructions, unlike the micrograft derived from bone tissue. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusion Cone beam computed tomography (CBCT) provides critical anatomical information for adaptive radiotherapy (ART), especially for tumors in the pelvic region that undergo significant deformation. However, CBCT suffers from inaccurate Hounsfield Unit (HU) values and lower soft tissue contrast. These issues affect the accuracy of pelvic treatment plans and implementation of the treatment, hence requiring correction.A novel stacked coarse‐to‐fine model combining Denoising Diffusion Probabilistic Model (DDPM) and spatial‐frequency domain convolution modules is proposed to enhance the imaging quality of CBCT images.The enhancement of low‐quality CBCT images is divided into two stages. In the coarse stage, the improved DDPM with U‐ConvNeXt architecture is used to complete the denoising task of CBCT images. In the fine stage, the deep convolutional network model jointly constructed by fast Fourier and dilated convolution modules is used to further enhance the image quality in local details and global imaging. Finally, the accurate pseudo‐CT (pCT) images consistent with the size of the original data are obtained. Two hundred fifty paired CBCT‐CT images from cervical and rectal cancer, combined with 200 public dataset cases, were used collectively for training, validation, and testing.To evaluate the anatomical consistency between pCT and real CT, we have used the mean(std) of structure similarity index measure (SSIM), peak signal to noise ratio (PSNR), and normalized cross‐correlation (NCC). The numerical results for the above three metrics comparing the pCT synthesized by the proposed model against real CT for cervical cancer cases were 87.14% (2.91%), 34.02 dB (1.35 dB), and 88.01% (1.82%), respectively. For rectal cancer cases, the corresponding results were 86.06% (2.70%), 33.50 dB (1.41 dB), and 87.44% (1.95%). The paired t‐test analysis between the proposed model and the comparative models (ResUnet, CycleGAN, DDPM, and DDIM) for these metrics revealed statistically significant differences (p < 0.05). The visual results also showed that the anatomical structures between the real CT and the pCT synthesized by the proposed model were closer. For the dosimetric verification, mean absolute error of dosimetry (MAEdoes) values for the maximum dose (Dmax), the minimum dose (Dmin), and the mean dose (Dmean) in the planning target volume (PTV) were analyzed, with results presented as mean (lower quartile, upper quartile). The experimental results show that the values of the above three dosimetry indexes (Dmin, Dmax, and Dmean) for the pCT images synthesized by the proposed model were 0.90% (0.48%, 1.29%), 0.82% (0.47%, 1.17%), and 0.57% (0.44%, 0.67%). Compared with 10 cases of the original CBCT image by Mann–Whitney test (p < 0.05), it also proved that pCT can significantly improve the accuracy of HU values for the dose calculation.The pCT synthesized by the proposed model outperforms the comparative models in numerical accuracy and visualization, promising for ART of pelvic cancers. [ABSTRACT FROM AUTHOR]

Background: Regular disease monitoring with low-dose high-resolution (LD-HR) computed tomography (CT) scans is necessary for the clinical management of people with cystic fibrosis (pwCF). The aim of this study was to compare the image quality and radiation dose of LD-HR protocols between photon-counting CT (PCCT) and energy-integrating detector system CT (EID-CT) in pwCF. Methods: This retrospective study included 23 pwCF undergoing LD-HR chest CT with PCCT who had previously undergone LD-HR chest CT with EID-CT. An intraindividual comparison of radiation dose and image quality was conducted. The study measured the dose-length product, volumetric CT dose index, effective dose and signal-to-noise ratio (SNR). Three blinded radiologists assessed the overall image quality, image sharpness, and image noise using a 5-point Likert scale ranging from 1 (deficient) to 5 (very good) for image quality and image sharpness and from 1 (very high) to 5 (very low) for image noise. Results: PCCT used approximately 42% less radiation dose than EID-CT (median effective dose 0.54 versus 0.93 mSv, p < 0.001). PCCT was consistently rated higher than EID-CT for overall image quality and image sharpness. Additionally, image noise was lower with PCCT compared to EID-CT. The average SNR of the lung parenchyma was lower with PCCT compared to EID-CT (p < 0.001). Conclusion: In pwCF, LD-HR chest CT protocols using PCCT scans provided significantly better image quality and reduced radiation exposure compared to EID-CT. Relevance statement: In pwCF, regular follow-up could be performed through photon-counting CT instead of EID-CT, with substantial advantages in terms of both lower radiation exposure and increased image quality. Key Points: Photon-counting CT (PCCT) and energy-integrating detector system CT (EID-CT) were compared in 23 people with cystic fibrosis (pwCF). Image quality was rated higher for PCCT than for EID-CT. PCCT used approximately 42% less radiation dose and offered superior image quality than EID-CT. [ABSTRACT FROM AUTHOR]

Background: Accurate detection of Hepatocellular carcinoma (HCC) feeding vessels during transcatheter arterial chemoembolization (TACE) is important for an effective treatment, while limiting non-target embolization. This study aimed to investigate the feasibility and accuracy of pre-TACE three dimensional (3D) CT angiography for tumor-feeding vessels detection compared to DSA. Methods: Sixty-nine consecutive patients referred for TACE from May 2022 to May 2023 were included. (3D) CT images were reconstructed from the pre-TACE diagnostic multiphasic contrast enhanced CT images and compared with non-selective digital subtraction angiography (DSA) images obtained during TACE for detection of HCC feeding vessels. A "Ground truth" made by consensus between observers after reviewing all available pre-TACE CT images, and DSA and CBCT images during TACE to detect the true feeding vessels was the gold standard. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy and ROC curve with AUC were calculated for each modality and compared. Results: A total of 136 active HCCs were detected in the 69 consecutive patients included in the study. 185 feeding arteries were detected by 3D CT and DSA and included in the analysis. 3D CT detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV and accuracy of 91%, 71%, 98%, 36%, and 90%, respectively, with mean AUC = 0.81. DSA detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV, and accuracy of 80%, 58%, 96.5%, 16.5% and 78%, respectively, with mean AUC = 0.69. Conclusions: Pre-TACE 3D CT angiography has shown promise in improving the detection of HCC feeding vessels compared to DSA. However, further studies are required to confirm these findings across different clinical settings and patient populations. Trial registration: This study was prospectively registered at Clinicaltrials.gov with ID NCT05304572; Date of registration: 2-4-2022. [ABSTRACT FROM AUTHOR]

Purpose: The body contour of patients with cervical cancer is prone to change between radiotherapy sessions. This study aimed to investigate the effect of body contour changes on the setup and dosimetric accuracy of radiotherapy. Methods: 15 patients with cervical cancer after surgery were randomly selected for retrospective analysis. The body contours on the once-per-week cone-beam computed tomography (CBCT) were registered to the planning CT (pCT) for subsequent evaluation. A body contour conformity index (CIbody) was defined to quantify the variation of body changes. The body volume measured by CBCT was collected, and its relative difference in reference with the first CBCT was calculated and denoted by ΔVn. The relative setup errors, denoted by ΔSELR, ΔSEAP, ΔSESI, and ΔSEvec for left–right, anterior–posterior, superior–inferior, and vectorial shifts, respectively, were defined as the difference in measured setup errors between the reference and following CBCTs. The planned dose was calculated on the basis of virtual CT generated from CBCT and pCT by altering the CT body contour to fit the body on CBCT without deformable registration. The correlations between body contour changes and relative setup errors as well as dosimetric parameters were evaluated using Spearman’s correlation coefficient rs. Results: CIbody was found to be negatively correlated with the superior–inferior and vectorial relative setup errors ΔSESI (rs = −0.448, p = 0.001) and ΔSEvec (rs = −0.387, p = 0.002), and no significant correlation was found between relative setup errors and ΔVn. Moreover, ΔVn was negatively correlated with ΔD2 (rs = −0.829, p < 0.001), ΔD98 (rs = −0.797, p < 0.001), and ΔTVPIV (rs = −0.819, p < 0.001). ΔD2, ΔD98, and ΔTVPIV were negatively correlated with ΔVn (p < 0.005). No correlation was found for other examined dosimetric parameters. Conclusion: The body contour change of patients could be associated with the setup variability. The effect of body contour changes on dose distribution is minimal. The extent of body change could be used as a metric for radiation therapists to estimate the setup errors. [ABSTRACT FROM AUTHOR]

Objectives: The aim of our study is to determine the relationship between MPS maturation and CVM stage determined from CBCTs. Materials and methods: CBCT images of 130 individuals (75 females, 55 males) with a mean age of 15.04 ± 3.11 (9.56–25.05 years) were analyzed. Images were analyzed using the i-CAT Vision software program. The cephalometric images to be examined were also obtained from the same CBCT images with the ImageJ program. The correlation between MPS and CVM stages was evaluated using the Spearman correlation test. The relationship between the skeletal developmental stage and MPS maturation, as assessed by the CVM method, was evaluated with the positive likelihood ratio. Results: Significant correlations were found between CVM and MPS maturation stages. Positive LHR values of cervical vertebral stages were obtained to define the maturation stages of the midpalatal suture. LHR values greater than ten were found between CS2, CS5, and CS6 and maturation stages B, D, and E, respectively. A 15–30% correlation was observed between CS3 and CS4 maturation stages B and C, respectively. A positive correlation of 15% was found between CS3 and stage C. Conclusion: MPS fusion is more likely to occur after CS4. The correlation between the CVM and MPS maturation stages is significant (r = 0.858). CVM stages CS2, CS4, and CS6 can be a preliminary indicator for MPS stages B, D, and E, respectively. CS5 shows that MPS fusion has occurred partially or completely. Clinical relevance: A significant relationship exists between skeletal developmental stages and suture maturation. [ABSTRACT FROM AUTHOR]

Objectives Materials and methods Results Conclusions To reveal the force profiles recorded by haptic autonomous robotic force feedback during the transcrestal sinus floor elevation (TSFE) process, providing a reference for the surgery strategy during TSFE.A total of 42 maxillary sinus models with different angles of the sinus floor (30°, 40°, 50°, 60°, 70°, 80°, and 90°, compared to vertical plane) were 3D printed. Implant site preparation was performed using a robotic system, and the total force (Ft) and axial force along the drill (Fz) during the surgery were recorded by the haptic robotic arm. The actual initial breakthrough point (drill contacting sinus floor) and complete breakthrough point (drill penetrating the sinus floor) were defined visually (the actual IBP and the actual CBP). The theoretical initial breakthrough point (the theoretical IBP) and the theoretical complete breakthrough point (the theoretical CBP) defined by the robot‐guided system and the CBCT were determined by real‐time force feedback and imaging distance measurement, respectively. The distance from the bottom of the resin model to the actual IBP and the actual CBP was defined as Di and Dt, respectively.The difference in Fz began to increase significantly at 70°, while the difference in Ft became significant at 60°. When the angle was greater than 70°, there was no significant difference in the discrepancy between the actual and theoretical perforation points. Compared to judging the breakthrough point by CBCT, real‐time force feedback TSFE under robotic surgery achieved more accurate initial breakthrough point detection.The smaller the angle, the larger the breakthrough force for the drill. The real‐time force feedback of haptic robotic system during TSFE could provide reliable reference for dentists. More clinical studies are needed to further validate the application of robotic surgery assisted TSFE. [ABSTRACT FROM AUTHOR]

Aim: To investigate the root number and morphology of the maxillary second molars in the Syrian population besides bilateral symmetry, and the effect of gender. Methods: 250 Cone Beam Computed Tomography (CBCT) images (140 females, 110 males) were examined by two endodontists. The detailed analysis included the number of roots, the number of canals and their configurations, bilateral symmetry, and relation to gender. The evaluation was made according to Vertucci classification by analyzing the CBCT images at all levels (Axial, Coronal, Sagittal, Oblique, and 3D). The Chi-square statistical analysis was performed to compare the canals' morphologies and bilateral symmetry in both genders via SPSS. Result: The most common shape of the upper second molars is three roots (90.4%). There were significant differences between males and females regarding the symmetry of the number of roots (P < 0.05). The root canal configuration was mainly Vertucci type I classification in the Distobuccally (93.4%) and palatal root (99.6%). The most common type in the mesial root was type I (29.5%), showing all varieties of Vertucci classifications (except VII, and VIII) percentage of MB2 of 70.5%. The ratio of symmetry was (59.6%) with no significant statistical difference between the genders (P = 0.708). Conclusion: Most maxillary second molars in the examined Syrian population were types (II) (associated with MB2 cases with three roots and four canals). In terms of symmetry, the number of roots surpassed the canal configuration. Males had a greater symmetrical tendency in the number of roots than females. [ABSTRACT FROM AUTHOR]

Background: The use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnostics in pediatric dentistry is expanding and concerns have been raised about the radiation risks associated with this imaging modality, especially for children. Dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks (DIMITRA) is a multidisciplinary project focused on optimizing CBCT exposure for children and adolescents. This study aims to clarify the indications behind CBCT scans in children aligned with DIMITRA's recommendations. Methods: For each CBCT examination, data were collected on patient age at the time of the CBCT examination, gender, reason for request, referring department, CBCT-requested region, and the field of view (FOV) dimension of imaging. The CBCT indications were categorized under six headings according to an adaptation of the DIMITRA project recommendations: impacted teeth, dentoalveolar trauma, orofacial clefts, dental anomalies, bone pathology, syndromes. Indications not categorized in DIMITRA were recorded below the heading "other". Results: The most common indication was the "other" category (34.8%), which included implant, temporomandibular joint dysfunction, orofacial anomalies, foreign object and root canal morphology. The least common indication was "orofacial cleft" (1.9%) and no requests were made for cases related to syndromes. Detection of supernumerary tooth in dental anomalies (68.6%) was the most common CBCT indication, while dentigerous cysts (37.6%) were among the most common CBCT indication in bone pathologies and orofacial anomalies (68.1%) in the other category. The most common size was External Center (15 × 15 cm) (27%) and the least common size was Both Arches/small (8 × 8 cm) (0.4%) when the CBCT FOV was analysed. Conclusions: Although the option of a smaller FOV size was available, the larger FOV size that included the both jaws were most frequently used. When justifying CBCT requests, patient-specific radiation dose risks should be considered and specific guidelines should be followed. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to analyze changes in mandibular width and frontal view ramus inclination using cone beam CT in patients with skeletal class III malocclusion who underwent BSSRO, with the removal of bone interference between segments. Methods: For all 20 subjects, cone-beam CT imaging was performed prior to surgery (T1), immediately post-surgery (T2), and 6 months after surgery (T3). Reorientation was performed using R2GATE software (MegaGen, Seoul, Korea). The gonion and antegonial notch were used as reference points in the sagittal view, and the most lateral point of the condyle head was used as the reference point in the frontal view. All measurements were recorded in the frontal view. Results: Inter-gonial width decreased by 2.64 mm at T3-T2 (P <.001) and by 2.58 mm at T3-T1 (P <.05). Inter-antegonial width decreased by 1.75 mm at T3-T2 (P <.05) and by 3.5 mm at T3-T1 (P <.001). In the frontal view, the right ramus inclination based on the gonion increased by 2.07° at T3-T1 (P <.05). The left ramus inclination based on gonion increased by 2.45° at T2-T1 (P <.05) and by 3.94° at T3-T1 (P <.001). The right ramus inclination based on antegonial notch increased by 2.35° at T2-T1 (P <.05) and by 3.04° at T3-T1 (P <.01). The left ramus inclination based on antegonial notch increased by 2.73° at T2-T1 (P <.001) and by 3.18° at T3-T1 (P <.001). Conclusions: During bilateral sagittal split osteotomy, removing bone interference between the proximal and distal segments results in a reduction of postoperative mandibular width and an increase in frontal view ramus inclination. [ABSTRACT FROM AUTHOR]

Objective. This study describes geometry-based and intensity-based tools for quality assurance (QA) of automatically generated structures for online adaptive radiotherapy, and designs an operator-independent traffic light system that identifies erroneous structure sets. Approach. A cohort of eight head and neck (HN) patients with daily CBCTs was selected for test development. Radiotherapy contours were propagated from planning computed tomography (CT) to daily cone beam CT (CBCT) using deformable image registration. These propagated structures were visually verified for acceptability. For each CBCT, several error scenarios were used to generate what were judged unacceptable structures. Ten additional HN patients with daily CBCTs and different error scenarios were selected for validation. A suite of tests based on image intensity, intensity gradient, and structure geometry was developed using acceptable and unacceptable HN planning structures. Combinations of one test applied to one structure, referred to as structure-test combinations, were selected for inclusion in the QA system based on their discriminatory power. A traffic light system was used to aggregate the structure-test combinations, and the system was evaluated on all fractions of the ten validation HN patients. Results. The QA system distinguished between acceptable and unacceptable fractions with high accuracy, labeling 294/324 acceptable fractions as green or yellow and 19/20 unacceptable fractions as yellow or red. Significance. This study demonstrates a system to supplement manual review of radiotherapy planning structures. Automated QA is performed by aggregating results from multiple intensity- and geometry-based tests. [ABSTRACT FROM AUTHOR]

Statement of problem: The demand for immediate implant placement (IIP) in the esthetic zone is rapidly increasing. Despite the treatment's benefits, the sagittal root position often dictates implant angulation, commonly necessitating the use of cement-retained restorations. This study investigates the impact of angulated screw channel on IIP in the esthetic zone. Purpose: The purpose of this cone-beam computed tomography (CBCT) study was to determine the probability of IIP in the esthetic zone, using four different implant angulations. Materials and methods: A retrospective review of CBCT images was conducted and accessed on 9 June 2021. The midsagittal images of maxillary anterior teeth were input into an implant planning software (Implant Studio®). Bone Level X Straumann® implant (BLX 3.5, 3.75, 4.0, 4.5, 5.0 mm) and Bone Level Tapered implant (BLT 2.9, 3.3 mm) were selected for 3D implant planning of IIP in the esthetic zone. The frequency distribution and probability of IIP were recorded and compared among all maxillary anterior teeth. Results: CBCT images from 720 teeth (120 patient) were evaluated, revealing an overall probability of IIP in the esthetic zone is 76.11% (548/720). Different implant restoration type was evaluated in this study, with the following results; straight screw-retained prosthesis at 3.47% (19/548), cement-retained prosthesis at 14.59% (80/548) and angle screw-retained prosthesis at 85.40% (468/548). Conclusion: IIP with traditional straight screw-retained prosthesis demonstrated the lowest probability. Nevertheless, the use of angulated screw channels enhances the probability of achieving straight screw-retained prostheses. Clinical implications: The angulated screw channel is essential for increasing the probability of screw-retained prosthesis in IIP in the esthetic zone. However, limitation in screw angle correction still necessitate the use of cement-retained prostheses for numbers of patients undergoing IIP. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusion 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.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.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.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.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 Purpose Methods Results Conclusion 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.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).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.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.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: Incidental and screen-detected pulmonary nodules are common. The increasing capabilities of advanced diagnostic bronchoscopy will increase bronchoscopists' procedural volume necessitating optimization of procedural scheduling and workflow. Objectives: The objectives of this study were to determine total time in the procedure room, total bronchoscopy procedure time, and robotic-assisted bronchoscopy procedure time longitudinally and per specific procedure performed. Design: A single-center observational study of all consecutive patients undergoing shape-sensing robotic-assisted bronchoscopy (RAB) biopsy procedures for the evaluation of pulmonary lesions with variable probability for malignancy. Methods: Chart review to collect patient demographics, lesion characteristics, and procedural specifics. Descriptive and comparative statistics are reported. Results: Actual bronchoscopy procedure time may decrease with increased institutional experience over time, however, there is limited ability to reduce non-bronchoscopy related time within the procedure room. The use of cone beam computed tomography (CBCT), rapid on-site evaluation (ROSE), and performance of staging endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in a single procedure are each associated with additional time requirements. Conclusion: Institutional procedural block times should adapt to the nature of advanced diagnostic bronchoscopy procedures to allow for the accommodation of new modalities such as RAB combined with other technologies including radial endobronchial ultrasound, CBCT, ROSE, and staging linear EBUS. Identifying institutional median procedural times may assist in scheduling and ideal block time utilization. Plain language summary: Times necessary to perform robotic assisted bronchoscopy biopsy procedures at a single hospital Background: Lung lesions and nodules are commonly seen on computed tomography (CT) scans. With advances in technology, more of these lesions are being biopsied with robotic assisted bronchoscopy (RAB) procedures, leading to increased demand. Health care providers who perform these procedures have finite available time in which they must accommodate all their procedures. Understanding procedure times is necessary to fully utilize schedules. Methods and aims overview: We describe our experience of 5 pulmonologists performing 700 robotic assisted bronchoscopies at a single hospital. Our aim is to describe the time needed for the robotic bronchoscopies over time and with specific procedures. Results and conclusion: We find that as more robotic assisted bronchoscopies are performed, the overall procedure time may decrease. Using cone beam computed tomography during the procedure, having on- site pathology review of biopsies, and obtaining biopsies of lymph nodes may lengthen the procedure time. The time spent preparing the patient for the procedure excluding the bronchoscopy remained stable. Understanding the time necessary based on what is performed during the procedure will allow it to be scheduled for the appropriate amount of time. As a result, procedure days can be fully optimized, minimizing scheduling impacts on patients and health care workers. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Materials and Methods Results Conclusions Clinical Significance This in vitro study aimed to evaluate the effectiveness of a printed surgical guide for root sectioning in the socket‐shield technique.A typodont model of the maxilla with augmented filler was used for the upper right central incisor, and CBCT images were obtained. Two types of vertical root sectioning guides were tested: one with a buccal sleeve (Group A, n = 10) and another with a buccal orientation slit (Group B, n = 10). Control group (n = 10) performed freehand cuts on printed models. After crown cutting with diamond burs, root sectioning was conducted using an ultrasonic tip with the guides. Mean and standard deviation were calculated for the remaining root length, width, and volume. Data were analyzed using the Kruskal–Wallis test and Dunn's post hoc test.Statistical analysis showed significant differences in root width between the control group (2.0 mm) and both Groups A (2.655 mm; p < 0.0001) and B (2.460 mm; p < 0.0001). Group B (5.585 mm) also showed a significant difference in root remnant compared with the control (13.880 mm; p < 0.0043). Groups A and B did not differ significantly from each other.The socket shield technique is safe and effective, this study aimed to add improvements through the introduction of surgical guides, facilitating the root section, which is the critical phase so that the parameters that are requisite for success are achieved in terms of width, length, and volume of the root remnant. Both guided techniques effectively facilitated root sectioning, maintaining satisfactory root thickness and length.Sectioning the root is challenging for the correct angulation to remove the palatal portion in the socket shield technique. Therefore, modifying this technique with the use of the presented guides, it is possible to prevent damage to the soft tissues and to plan the surgery with the help of cone beam computed tomography (CBCT) scans to remove the root apex and maintain the root remnant with a thickness greater than 1.5 mm, making the socket‐shield technique more predictable. [ABSTRACT FROM AUTHOR]

Intratumoral injections have the potential for enhanced cancer treatment efficacy while reducing costs and systemic exposure. However, intratumoral drug injections can result in substantial off-target leakage and are invisible under standard imaging modalities like ultrasound (US) and x-ray. A thermosensitive poloxamer-based gel for drug delivery was developed that is visible using x-ray imaging (computed tomography (CT), cone beam CT, fluoroscopy), as well as using US by means of integrating perfluorobutane-filled microbubbles (MBs). MBs content was optimized using tissue mimicking phantoms and ex vivo bovine livers. Gel formulations less than 1% MBs provided gel depositions that were clearly identifiable on US and distinguishable from tissue background and with minimal acoustic artifacts. The cross-sectional areas of gel depositions obtained with US and CT imaging were similar in studies using ex vivo bovine liver and postmortem in situ swine liver. The gel formulation enhanced multimodal image-guided navigation, enabling fusion of ultrasound and x-ray/CT imaging, which may enhance targeting, definition of spatial delivery, and overlap of tumor and gel. Although speculative, such a paradigm for intratumoral drug delivery might streamline clinical workflows, reduce radiation exposure by reliance on US, and boost the precision and accuracy of drug delivery targeting during procedures. Imageable gels may also provide enhanced temporal and spatial control of intratumoral conformal drug delivery. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Key Points Plain Language Summary This study evaluates the long‐term stability and clinical outcomes of the reverse palatal pedicle graft (RPPG) technique in treating maxillary molar palatal recessions over a 3 to 4‐year follow‐up period.Three patients with palatal recession defects on maxillary molars were treated using the RPPG technique. Clinical parameters including recession depth, probing depth, and clinical attachment levels (CALs) were recorded at baseline, 2 months, and 3–4 years postoperatively. Healing outcomes, tissue perfusion, and soft tissue thickness were assessed through clinical examination, cone beam computed tomography (CBCT), and ultrasonography.All patients demonstrated significant CAL gain and partial root coverage. The RPPG technique resulted in significant improvements in attachment gain (41%–67%) and root coverage (44%–83%). In addition, a CBCT scan of one grafted site at a 4‐year follow‐up (Case 1) demonstrates a gain in soft tissue thickness and partial root coverage. Ultrasound imaging of another grafted site at a 4‐year follow‐up (Case 2) demonstrates a gain in soft tissue thickness and adequate graft perfusion. The outcomes suggest stable graft sites with some evidence of creeping attachment.The RPPG technique provides a viable option for treating maxillary molar palatal recessions, demonstrating promising long‐term stability and clinical improvements. Further studies with larger sample sizes and frequent follow‐ups are needed to better understand the dynamics of creeping attachment and refine clinical guidelines for palatal grafting. The reverse palatal pedicle graft (RPPG) is a surgical technique providing a viable solution for the treatment of maxillary molar palatal root coverage for a single recession site with 3–4 years of follow‐up demonstrating a degree of predictability. Clinical indications for the application of the RPPG technique include severe palatal recession with little to no interproximal attachment loss (RT1 or RT2), palatal root sensitivity, and a sufficient amount of keratinized tissue on the palatal aspect of adjacent teeth. The main limitations of the application of the RPPG technique include its ability to treat only one isolated recession site, the inability for coronal advancement of the flap, and the quality and thickness of the autogenous graft being patient‐dependent. The reverse palatal pedicle graft (RPPG) is a surgical technique providing a viable solution for the treatment of maxillary molar palatal root coverage for a single recession site with 3–4 years of follow‐up demonstrating a degree of predictability.Clinical indications for the application of the RPPG technique include severe palatal recession with little to no interproximal attachment loss (RT1 or RT2), palatal root sensitivity, and a sufficient amount of keratinized tissue on the palatal aspect of adjacent teeth.The main limitations of the application of the RPPG technique include its ability to treat only one isolated recession site, the inability for coronal advancement of the flap, and the quality and thickness of the autogenous graft being patient‐dependent.This study explores the reverse palatal pedicle graft (RPPG) technique, a method used to treat gum recession in the palate around the upper posterior teeth. The research followed three patients over a period of 3–4 years after they underwent the RPPG procedure. This technique involves using a piece of tissue from the roof of the mouth and repositioning it to cover the receded gum area. All patients showed significant improvement in gum attachment and coverage of the exposed roots. The grafts remained stable, and there was continued growth of the gum tissue, further covering the exposed roots over time. These promising results suggest that RPPG could be a reliable and effective option for treating severe gum recession on the roof of the mouth. However, further studies with larger patient groups are needed to confirm these findings and refine the technique. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusion Patients may undergo anatomical changes during radiotherapy, leading to an underdosing of the target or overdosing of the organs at risk (OARs).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.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.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.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 Purpose Methods Results Conclusions Cone beam computed tomography (CBCT) image segmentation is crucial in prostate cancer radiotherapy, enabling precise delineation of the prostate gland for accurate treatment planning and delivery. However, the poor quality of CBCT images poses challenges in clinical practice, making annotation difficult due to factors such as image noise, low contrast, and organ deformation.The objective of this study is to create a segmentation model for the label‐free target domain (CBCT), leveraging valuable insights derived from the label‐rich source domain (CT). This goal is achieved by addressing the domain gap across diverse domains through the implementation of a cross‐modality medical image segmentation framework.Our approach introduces a multi‐scale domain adaptive segmentation method, performing domain adaptation simultaneously at both the image and feature levels. The primary innovation lies in a novel multi‐scale anatomical regularization approach, which (i) aligns the target domain feature space with the source domain feature space at multiple spatial scales simultaneously, and (ii) exchanges information across different scales to fuse knowledge from multi‐scale perspectives.Quantitative and qualitative experiments were conducted on pelvic CBCT segmentation tasks. The training dataset comprises 40 unpaired CBCT‐CT images with only CT images annotated. The validation and testing datasets consist of 5 and 10 CT images, respectively, all with annotations. The experimental results demonstrate the superior performance of our method compared to other state‐of‐the‐art cross‐modality medical image segmentation methods. The Dice similarity coefficients (DSC) for CBCT image segmentation results is 74.6±9.3$74.6 \pm 9.3$ %, and the average symmetric surface distance (ASSD) is 3.9±1.8mm$3.9\pm 1.8\;\mathrm{mm}$. Statistical analysis confirms the statistical significance of the improvements achieved by our method.Our method exhibits superiority in pelvic CBCT image segmentation compared to its counterparts. [ABSTRACT FROM AUTHOR]

Background: Relapses following orthognathic surgery have been reported to exceed 2% to 50%, depending on multiple factors. This study aimed to analyze the stability after orthognathic surgery in patients with mandibular ramus height asymmetry through 3D reconstruction using Cone-beam CT. Methods: This retrospective cohort study investigated patients who underwent mandibular setback surgery using bilateral sagittal split ramus osteotomy. Three-dimensional CT scans were taken at three different time points. Evaluation of the postoperative stability involved measuring changes in the x, y, and z axes as well as roll and yaw rotations of the mandible at specific landmarks (B point, mental foramen) on 3D CT scans obtained immediately after surgery and 6–12 months postoperatively. They were categorized into four groups based on bilateral mandibular height asymmetry through Asymmetry index (AI). The one-way ANOVA was implemented to compare the intergroup differences and Tukey's post hoc test was employed. Additionally, the Pearson correlation coefficient was also calculated. Results: A total of 24 patients were included in this study. The corresponding AI, representing the degree of asymmetry in both mandibles, were calculated as Group 1 was 1.25 ± 0.64%, Group 2 was 2.89 ± 0.47%, Group 3 was 5.03 ± 0.51%, and Group 4 was 9.40 ± 1.99%. The x-axis change in Group 4 was significantly larger at 1.71 mm compared to Group 1 at 0.64 mm. The mandibular roll, Group 4 showed a statistically significant increase at 1.33° compared to Group 1 at 0.35°. And there was a significant positive correlation observed between x-axis change and AI (p = 0.019), as well as between mandibular roll and AI (p = 0.025). Conclusion: After orthognathic surgery, stability was influenced by numerous factors, with the findings of this study suggesting that the degree of ramus height asymmetry in the mandible can be considered one contributing factor. [ABSTRACT FROM AUTHOR]

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]

Purpose: This study evaluates a deep learning-based denoising algorithm to improve the trade-off between radiation dose, image noise, and motion artifacts in TIPSS procedures, aiming for shorter acquisition times and reduced radiation with maintained diagnostic quality. Methods: In this retrospective study, TIPSS patients were divided based on CBCT acquisition times of 6 s and 3 s. Traditional weighted filtered back projection (Original) and an AI denoising algorithm (AID) were used for image reconstructions. Objective assessments of image quality included contrast, noise levels, and contrast-to-noise ratios (CNRs) through place-consistent region-of-interest (ROI) measurements across various critical areas pertinent to the TIPSS procedure. Subjective assessments were conducted by two blinded radiologists who evaluated the overall image quality, sharpness, contrast, and motion artifacts for each dataset combination. Statistical significance was determined using a mixed-effects model (p ≤ 0.05). Results: From an initial cohort of 60 TIPSS patients, 44 were selected and paired. The mean dose-area product (DAP) for the 6 s acquisitions was 5138.50 ± 1325.57 µGy·m2, significantly higher than the 2514.06 ± 691.59 µGym2 obtained for the 3 s series. CNR was highest in the 6 s-AID series (p < 0.05). Both denoised and original series showed consistent contrast for 6 s and 3 s acquisitions, with no significant noise differences between the 6 s Original and 3 s AID images (p > 0.9). Subjective assessments indicated superior quality in 6 s-AID images, with no significant overall quality difference between the 6 s-Original and 3 s-AID series (p > 0.9). Conclusions: The AI denoising algorithm enhances CBCT image quality in TIPSS procedures, allowing for shorter scans that reduce radiation exposure and minimize motion artifacts. [ABSTRACT FROM AUTHOR]

Background: Computed tomography to body divergence (CTBD) is one of the main barriers to bronchoscopic techniques for the diagnosis of peripherally located lung nodules. Cone-beam CT (CBCT) guidance is being rapidly adopted to correct for this phenomenon and to potentially increase diagnostic outcomes. In this trial, we hypothesized that the addition of mobile CBCT (m-CBCT) could improve the rate of tool in lesion (TIL) and the diagnostic yield of shape-sensing robotic-assisted bronchoscopy (SS-RAB). Methods: This was a prospective, single-arm study, which enrolled patients with peripheral lung nodules of 1–3 cm and compared the rate of TIL and the diagnostic yield of SS-RAB alone and combined with mCBCT. Results: A total of 67 subjects were enrolled, the median nodule size was 1.7 cm (range, 0.9–3 cm). TIL was achieved in 23 patients (34.3%) with SS-RAB alone, and 66 patients (98.6%) with the addition of mCBCT (p < 0.0001). The diagnostic yield of SS-RAB alone was 29.9% (95% CI, 29.3–42.3%) and it was 86.6% (95% CI, 76–93.7%) with the addition of mCBCT (p < 0.0001). There were no pneumothoraxes or any bronchoscopy-related complications, and the median total dose–area product (DAP) was 50.5 Gy-cm2. Conclusions: The addition of mCBCT guidance to SS-RAB allows bronchoscopists to compensate for CTBD, leading to an increase in TIL and diagnostic yield, with acceptable radiation exposure. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the pathological factors and anatomical variations in the maxillary sinus in patients undergoing dental implant treatment using cone beam computed tomography (CBCT). CBCT, as a key imaging technique in dentistry, offers high-resolution images to assess bone morphology and quality, crucial for preoperative dental implant planning. Material and methods: The study included a cohort of 200 patients recommended for CBCT as part of their preoperative evaluation. The methodology involved detailed CBCT image analysis to identify and document various anatomical variations due to pneumatization, exostosis, hypoplasia, polyps, cysts, foreign bodies, and anthroliths within the maxillary sinus. Results: Pneumatization was the most common variation, present in 77.5% of subjects. Polypoid lesions were found in 17.5% of patients, with a higher prevalence in younger age groups (57.1% in ages 20–35). Cysts and polyps affected 17.5% of subjects, predominantly males (65.7%). Anthroliths were observed in a minimal percentage (2%), and foreign bodies were found in 1.5% of the patients. Positive correlations were observed between the patient's age and both mucosal thickness and polypoid lesions and between the patient's gender and bone thickening (p-values < 0.05). Conclusions: The study concluded that CBCT is essential in the preoperative assessment of the maxillary sinus in dental implant candidates due to its superior imaging capabilities, allowing for the identification of critical anatomical variations and pathologies. This thorough evaluation is imperative to ensure the success of implant placement and to mitigate potential complications. However, further research with larger, more diverse populations is recommended to confirm these findings. [ABSTRACT FROM AUTHOR]

Cone-beam computed tomography (CBCT) has emerged as a promising tool for the analysis of the upper airway, leveraging on its ability to provide three-dimensional information, minimal radiation exposure, affordability, and widespread accessibility. The integration of artificial intelligence (AI) in CBCT for airway analysis has shown improvements in the accuracy and efficiency of diagnosing and managing airway-related conditions. This review aims to explore the current applications of AI in CBCT for airway analysis, highlighting its components and processes, applications, benefits, challenges, and potential future directions. A comprehensive literature review was conducted, focusing on studies published in the last decade that discuss AI applications in CBCT airway analysis. Many studies reported the significant improvement in segmentation and measurement of airway volumes from CBCT using AI, thereby facilitating accurate diagnosis of airway-related conditions. In addition, these AI models demonstrated high accuracy and consistency in their application for airway analysis through automated segmentation tasks, volume measurement, and 3D reconstruction, which enhanced the diagnostic accuracy and allowed predictive treatment outcomes. Despite these advancements, challenges remain in the integration of AI into clinical workflows. Furthermore, variability in AI performance across different populations and imaging settings necessitates further validation studies. Continued research and development are essential to overcome current challenges and fully realize the potential of AI in airway analysis. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this study was to evaluate incidental findings in the mandible after the placement of dental implants using a new cone–beam computed tomography (CBCT) software. Methods: The initial sample consisted of 2872 CBCT scans of patients of both sexes. The parameters evaluated in this study were the location of the implants in the mandible, implant length, anatomical relationship of the implant with the mandibular canal, presence or absence of damage to the adjacent teeth, presence or absence of implant fractures, and presence or absence of bone support. Fisher's exact test was performed to compare the variables. The significance level was set at p = 0.05. Results: Out of 2872 CBCT scans, 214 images of patients with an average age of 44.5 years were included. The most frequent location of the implants was the posterior region (93.5%), with 54% of the implants having a length between 9 and 14 mm. It was found that 92% of the implants were positioned above the mandibular canal. Damage to adjacent teeth was observed, with no correlation with the implant positioning (p = 1.000). In 100% of cases of implants in the anterior region, there was bone support. Fracture was observed in 1.7% of implants with a length between 9 and 14 mm. Conclusions: The installation of implants in the mandible occurs more frequently in the posterior region, with a high presence of bone support and a low incidence of damage to adjacent teeth, anatomical structures, and fractures. [ABSTRACT FROM AUTHOR]

The inferior alveolar nerve (IAN), contained within the mandibular canal (MC), is a structure prone to damage in clinical and surgical procedures on the mandible. This study aimed to analyze the MC morphology and its anatomical variants in a Chilean subpopulation using cone beam computed tomography (CBCT). In total, 342 images from patients with the following parameters were observed: 120 kV, 9 mA, field of view 12 × 9 MC, and voxel size 0.12 mm. The average length of the MC recorded a mean value of 70.493 ± 4.987 mm on the right side and 70.805 ± 5.177 mm on the left side. The location of the mental foramen (MF) was most frequently found between the mandibular first and second premolar. The greatest bone thickness was found at the level of the basilar border of the 2MPM. The root closest to the MC was distal from the mandibular second molar. The lowest thickness was in the lingual area at 1MM. The prevalence of the anterior loop (AL) (61.5%) and the retromolar canal (RC) (17.5%) showed no significant differences between men and women. The results obtained showed that the morphology of the MC in the Chilean subpopulation can vary. [ABSTRACT FROM AUTHOR]

Objective: To apply the more accurate technique for mandibular superimposition and provide a valuable reference for the assessment of mandibular tooth movement and condylar remodeling before and after orthodontic treatment. Methods: This retrospective study involved 38 adult patients who underwent two cone beam computer tomography (CBCT) scans at different stages of treatment at Fujian Provincial People’s Hospital between September, 2020 and December, 2022. The software Dolphin was used for mandible segmentation, enabling voxel‐based mandibular superimposition with the mandibular ramus as the reference region. The Geomagic Wrap software was employed to process surface‐based mandibular superimposition with the mandibular ramus as a reference. Additionally, the voxel and surface‐based methods were compared for precision, with the mandibular ramus being the reference. Results: After voxel‐based mandibular superimposition using the mandibular ramus as a reference, with all measurement errors (< 0.20 mm). In contrast, the results of surface‐based mandibular superimposition with the same reference, and the measurement errors were all less than 0.10 mm. The Wilcoxon signed‐rank test revealed statistically significant differences between AS1 and BS1, AS2 and BS2, AS3 and BS3, and AS4 and BS4 (all r< 0.05). Moreover, the absolute mean distances of AS1-AS4 were all greater than those of BS1-BS4. Conclusion: All mandibular superimposition procedures, including the voxel‐ and surface‐based ones using the mandibular ramus as a reference, have acceptable surface errors (< 0.20 mm), indicating the good reliability of these techniques. Under the specified conditions, surface‐based mandibular superimposition appears to yield a higher degree of precision compared with the voxel‐based technique. [ABSTRACT FROM AUTHOR]

Aim: Post‐operative pain may occur after non‐surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post‐operative pain and analgesics intake after NSRCT using a sealer‐based obturation technique (SBO) with single‐cone gutta‐percha and calcium silicate sealer (CSS) versus a warm‐vertical compaction (WVC) technique with gutta‐percha and a resin‐based sealer (RBS). Methodology: This study was designed as a parallel‐two arm, double‐blind, randomized superiority clinical trial registered at www.clinicaltrials.gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre‐operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm‐vertical compaction with RBS. Post‐operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non‐parametric Mann–Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. Results: The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post‐operative pain or analgesic intake existed between the two groups at any time point (p >.05). Age, pre‐operative pain, apical diagnosis and post‐operative analgesic intake were significantly related to post‐operative pain (p <.05). Conclusions: Sealer‐based obturation technique with CSS was associated with similar post‐operative pain levels and analgesics intake as WVC with RBS. Regarding post‐operative pain, SBO with CSSs may be a suitable clinical alternative. [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinical and radiographic outcome of endodontic microsurgery in through‐and‐through periapical lesions at 1‐year and 5‐year follow‐up with adjunct use of platelet‐rich plasma (PRP). Methodology: Thirty‐two patients with large through‐and‐through periapical lesions were randomized in platelet‐rich plasma (PRP) group and control group. Two‐dimensional (2D) healing was evaluated with Molven's criteria and three‐dimensional (3D) healing with modified PENN 3D criteria. Healing at resection plane (R), apical area (A), buccal cortex (BC), palatal cortex (PC) and overall bone healing (B) was assessed using CBCT scans. The volume of lesion was measured using ITK‐Snap software. The analysis included comparison of 1‐ to 5‐year intragroup (Friedman test/McNemar test) and intergroup scoring (Chi‐square/ Mann–Whitney test). Logistic regression analysis was performed to determine the effect of various factors on healing at 5 years. Results: Out of 32 patients/59 teeth evaluated after 1‐year of endodontic microsurgery, 24 patients/44 teeth reported at 5 ‐ year follow‐up. Healing assessment with modified PENN 3D criteria revealed improvement in overall success rate of 66.7% at 1 year to 83.3% at 5 years, with no deterioration in any healing category. PRP group exhibited significantly better 3D healing than control group; both at 1 year (84.6% vs. 45.5%) and 5 years (100% vs. 63.6%). A significantly higher number of completely healed teeth were observed in PRP group than the control group at 5 years with respect to R, BC and B parameters. A volume reduction of 88% (91.4% PRP, 84% control) was depicted at 1 year and 94% (97.1% PRP, 91.1% control) at 5 years. None of the recorded factors including age, gender, size of lesion, preoperative swelling and sinus, histology of lesion, use of PRP, tooth location, preoperative buccal bone had significant effect on 3D healing at 5 years. Conclusions: This 5‐year study suggested improvement in 3D radiographic healing of large through‐and‐through periapical lesions from 1 to 5 years with no deterioration in any healing parameter in both control and PRP groups. The additional use of PRP led to significantly better healing in such lesions. RACB index using CBCT allows better estimation of healing at resected, apical and cortical plane over modified PENN 3D or Molven's criteria. [ABSTRACT FROM AUTHOR]

This work aims to evaluate the effect of acquisition parameters of the abdominal computed tomography protocol on image quality and dose, including the contrast-to-noise ratio (CNR), noise, spatial resolution (SR) as well as volumetric computed tomography dose index (CTDIvol). The measurements have been performed on a 16-slice HITACHI scanner using the polymethylmethacrylate phantom for CTDIvol and Catphan 500 for image quality. Two tube voltages of 120 kVp and 100 kVp have been analyzed while varying the tube current settings from 100 to 300 (mA) to measure image quality quantities and dose (CTDIvol). The scanning with 100 kVp compared to 120 kVp has led to a dose reduction up to 38% at mAs ranging from 100 to 300, a decrease in CNR by 28%, with a slight decrease in spatial resolution accompanied by an increase in noise. This work has shown that despite the increase in noise at 100 kVp, it is possible to reduce the dose without affecting the quantities of spatial resolution and the contrast/noise ratio by lowering the tube voltage from 120 kVp to 100 kVp. [ABSTRACT FROM AUTHOR]

Present knowledge of patient setup and alignment errors in image guided radiation therapy (IGRT) relies on voluntary reporting, which is thought to underestimate error frequencies. A manual retrospective patient-setup misalignment error search is infeasible owing to the bulk of cases to be reviewed. We applied a deep learning–based misalignment error detection algorithm (EDA) to perform a fully automated retrospective error search of clinical IGRT databases and determine an absolute gross patient misalignment error rate. The EDA was developed to analyze the registration between planning scans and pretreatment cone beam computed tomography scans, outputting a misalignment score ranging from 0 (most unlikely) to 1 (most likely). The algorithm was trained using simulated translational errors on a data set obtained from 680 patients treated at 2 radiation therapy clinics between 2017 and 2022. A receiver operating characteristic analysis was performed to obtain target thresholds. DICOM Query and Retrieval software was integrated with the EDA to interact with the clinical database and fully automate data retrieval and analysis during a retrospective error search from 2016 to 2017 and from 2021 to 2022 for the 2 institutions, respectively. Registrations were flagged for human review using both a hard-thresholding method and a prediction trending analysis over each individual patient's treatment course. Flagged registrations were manually reviewed and categorized as errors (>1 cm misalignment at the target) or nonerrors. A total of 17,612 registrations were analyzed by the EDA, resulting in 7.7% flagged events. Three previously reported errors were successfully flagged by the EDA, and 4 previously unreported vertebral body misalignment errors were discovered during case reviews. False positive cases often displayed substantial image artifacts, patient rotation, and soft tissue anatomy changes. Our results validated the clinical utility of the EDA for bulk image reviews and highlighted the reliability and safety of IGRT, with an absolute gross patient misalignment error rate of 0.04% ± 0.02% per delivered fraction. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) is a common modality employed for musculoskeletal imaging. Conventional CT techniques are useful for the assessment of trauma in detection, characterization and surgical planning of complex fractures. CT arthrography can depict internal derangement lesions and impact medical decision making of orthopedic providers. In oncology, CT can have a role in the characterization of bone tumors and may elucidate soft tissue mineralization patterns. Several advances in CT technology have led to a variety of acquisition techniques with distinct clinical applications. These include four-dimensional CT, which allows examination of joints during motion; cone-beam CT, which allows examination during physiological weight-bearing conditions; dual-energy CT, which allows material decomposition useful in musculoskeletal deposition disorders (e.g., gout) and bone marrow edema detection; and photon-counting CT, which provides increased spatial resolution, decreased radiation, and material decomposition compared to standard multi-detector CT systems due to its ability to directly translate X-ray photon energies into electrical signals. Advanced acquisition techniques provide higher spatial resolution scans capable of enhanced bony microarchitecture and bone mineral density assessment. Together, these CT acquisition techniques will continue to play a substantial role in the practices of orthopedics, rheumatology, metabolic bone, oncology, and interventional radiology. [ABSTRACT FROM AUTHOR]

Background and Objective: Robotic‐assisted bronchoscopy (RAB) is an emerging modality to sample pulmonary lesions. Cone‐beam computed tomography (CBCT) can be incorporated into RAB. We investigated the magnitude and predictors of patient and staff radiation exposure during mobile CBCT‐guided shape‐sensing RAB. Methods: Patient radiation dose was estimated by cumulative dose area product (cDAP) and cumulative reference air kerma (cRAK). Staff equivalent dose was calculated based on isokerma maps and a phantom simulation. Patient, lesion and procedure‐related factors associated with higher radiation doses were identified by logistic regression models. Results: A total of 198 RAB cases were included in the analysis. The median patient cDAP and cRAK were 10.86 Gy cm2 (IQR: 4.62–20.84) and 76.20 mGy (IQR: 38.96–148.38), respectively. Among staff members, the bronchoscopist was exposed to the highest median equivalent dose of 1.48 μSv (IQR: 0.85–2.69). Both patient and staff radiation doses increased with the number of CBCT spins and targeted lesions (p < 0.001 for all comparisons). Patient obesity, negative bronchus sign, lesion size <2.0 cm and inadequate sampling by on‐site evaluation were associated with a higher patient dose, while patient obesity and inadequate sampling by on‐site evaluation were associated with a higher bronchoscopist equivalent dose. Conclusion: The magnitude of patient and staff radiation exposure during CBCT‐RAB is aligned with safety thresholds recommended by regulatory authorities. Factors associated with a higher radiation exposure during CBCT‐RAB can be identified pre‐operatively and solicit procedural optimization by reinforcing radiation protective measures. Future studies are needed to confirm these findings across multiple institutions and practices. [ABSTRACT FROM AUTHOR]

To evaluate structural damage and loosening of abutments placed on narrow diameter implants after cyclic fatigue. Sixty Morse taper narrow diameter implants (Neodent, Brazil) received two types of abutments (1PA- one-piece abutment or 2PA- two-piece abutment), which were randomly divided into 3 fatigue experiments (n = 10). The implants were placed into a customized supporting holder and a software-assisted digital torque wrench secured the manufacturer recommended torque for each abutment. Cone beam computed tomography (CBCT) scans were acquired, before and after fatigue, and post-processed (software e-Vol DX) to assess damage and abutment displacement. The boundary fatigue method was adapted to use 2 × 106 cycles, 2 Hz of frequency and constant peak load of 80 N (first experiment) that varied according to the failure rate of previous specimens (second and third experiments). Failure was evaluated using CBCT scans and removal torque values. Data were used to estimate long-term torque degradation, probability of failure and Weibull modulus (software ALTA PRO9). All 2PA specimens became loosen independently of the applied fatigue load, and structural bending was observed in 14 abutments. Eight 1PA got loosen during the fatigue experiment. The Weibull analysis showed a lower modulus (m = 1.0; 0.7, 1.4) for 1PA than for 2PA (m = 2.6; 2, 3.4) resulting in longer predicted lifetimes and slower torque degradation for 1PA than for 2PA specimens. 1PA showed greater long-term survival probability than 2PA. Predicting the lifetime and mechanical behavior of implant-abutment systems are useful information to clinicians during the decision-making process of oral rehabilitations. • The abutment type influences the survival probability of the implant-abutment system. • The applied method can predict the lifetime and long-term behavior of the systems. • Improved CBCT images can assist on diagnosing loosening and damage of implant-abutment. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the clinical utility of fully-automated 3D organ segmentation in assessing hepatic steatosis on pre-contrast and post-contrast CT images using magnetic resonance spectroscopy (MRS)-proton density fat fraction (PDFF) as reference standard. Materials and methods: This retrospective study analyzed 362 adult potential living liver donors with abdominal CT scans and MRS-PDFF. Using a deep learning-based tool, mean volumetric CT attenuation of the liver and spleen were measured on pre-contrast (liver(L)_pre and spleen(S)_pre) and post-contrast (L_post and S_post) images. Agreements between volumetric and manual region-of-interest (ROI)-based measurements were assessed using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. Diagnostic performances of volumetric parameters (L_pre, liver-minus-spleen (L-S)_pre, L_post, and L-S_post) were evaluated for detecting MRS-PDFF ≥ 5% and ≥ 10% using receiver operating characteristic (ROC) curve analysis and compared with those of ROI-based parameters. Results: Among the 362 subjects, 105 and 35 had hepatic steatosis with MRS-PDFF ≥ 5% and ≥ 10%, respectively. Volumetric and ROI-based measurements revealed ICCs of 0.974, 0.825, 0.992, and 0.962, with mean differences of −4.2 HU, −3.4 HU, −1.2 HU, and −7.7 HU for L_pre, S_pre, L_post, and S_post, respectively. Volumetric L_pre, L-S_pre, L_post, and L-S_post yielded areas under the ROC curve of 0.813, 0.813, 0.734, and 0.817 for MRS-PDFF ≥ 5%; and 0.901, 0.915, 0.818, and 0.868 for MRS-PDFF ≥ 10%, comparable with those of ROI-based parameters (0.735–0.818; and 0.816–0.895, Ps = 0.228–0.911). Conclusion: Automated 3D segmentation of the liver and spleen in CT scans can provide volumetric CT attenuation-based parameters to detect and grade hepatic steatosis, applicable to pre-contrast and post-contrast images. Clinical relevance statement: Volumetric CT attenuation-based parameters of the liver and spleen, obtained through automated segmentation tools from pre-contrast or post-contrast CT scans, can efficiently detect and grade hepatic steatosis, making them applicable for large population data collection. Key Points: • Automated organ segmentation enables the extraction of CT attenuation-based parameters for the target organ. • Volumetric liver and spleen CT attenuation-based parameters are highly accurate in hepatic steatosis assessment. • Automated CT measurements from pre- or post-contrast imaging show promise for hepatic steatosis screening in large cohorts. [ABSTRACT FROM AUTHOR]

To evaluate the prevalence of single root with a single root canal and four-root configurations in the maxillary first and second molars, and analyze how geographic region, ethnicity, sex, and age impact these outcomes. Researchers from 44 nations examined 26,400 maxillary molars using cone-beam computed tomography scans to gather data on the proportions of single roots with single canals and four-root configurations. All observers underwent prior calibration regarding the step-by-step assessment protocol and anatomical concepts to ensure consistent evaluations across all assessed locations. Tests were conducted to evaluate the intraobserver and interobserver reliability. Demographic data including ethnicity, gender, and age were collected for each participant. The potential impact of imaging voxel size and field-of-view on bias was also assessed. The primary results were depicted as odds ratios and untransformed proportion forest plots with 95% confidence intervals. Additionally, a meta-analysis was performed to compare various subgroups and identify sources of variation among them. Statistical significance was set at 5%. The prevalence of single-rooted with a single canal and four-rooted configurations in the maxillary first molar was 0.16% and 0.28%, respectively, while in the maxillary second molar, it was 2.56% and 0.83%. Males tended to exhibit lower percentages of single roots with a single canal (P <.05) and higher percentages of four-rooted configurations (P >.05) in the second molar, whereas the African subgroup displayed lower proportions for both configurations. Additionally, in both teeth, single roots with a single canal were more prevalent among older patients. Voxel size and field-of-view did not significantly influence the results (P >.05). The proportions of single-rooted with a single canal and four-rooted configurations were low, and demographic factors such as geographic region, ethnicity, sex, and age may have influenced the outcomes for the maxillary second molar. [ABSTRACT FROM AUTHOR]

Occlusal and percussion pain may manifest occasionally following endodontic treatment, influencing retreatment decisions. Two cases of periapical neuropathic pain, classified as post-traumatic trigeminal neuropathic pain according to the International Classification of Orofacial Pain, are presented. Although mirogabalin is effective in managing neuropathic pain, there is a lack of clinical reports on its use for occasional post-traumatic trigeminal neuropathic pain after endodontic treatment. These cases highlight clinical symptoms and successful treatment with mirogabalin for post-traumatic trigeminal neuropathic pain after endodontic treatment, providing clinicians a "take-away" lesson for improving patient condition. The patients, referred by their primary dentist due to postendodontic abnormal pain, found no relief with antibiotics or nonsteroidal anti-inflammatory drugs. Although no findings including swelling or periapical radiolucency were observed around the tooth, they experienced occlusal and percussion pain. Local anesthetic testing showed that the pain originated from the peripheral area around the tooth rather than from central sensitization. Dental radiography and cone-beam computed tomography revealed no abnormal findings. Root canal retreatment was performed by a specialist in endodontic treatment. Although endodontic retreatment drastically decreased visual analog scale pain score, pain persisted. Based on the International Classification of Orofacial Pain criteria, diseases other than post-traumatic trigeminal neuropathic pain were excluded. Mirogabalin (10 mg/d) was prescribed once daily before bedtime. Visual analog scale scores gradually and drastically decreased 2 weeks after mirogabalin therapy. Several months later, no recurrence of postendodontic pain was observed after tapering off and discontinuing mirogabalin. These findings suggest the possibility of a new treatment method for post-traumatic trigeminal neuropathic pain after endodontic treatment. [ABSTRACT FROM AUTHOR]

In dental clinical practice, cone-beam computed tomography (CBCT) is commonly used to assist practitioners to recognize the complex morphology of root canal systems; however, because of its resolution limitations, certain small anatomical structures still cannot be accurately recognized on CBCT. The purpose of this study was to perform image super-resolution (SR) processing on CBCT images of extracted human teeth with the help of a deep learning model, and to compare the differences among CBCT, super-resolution computed tomography (SRCT), and micro-computed tomography (Micro-CT) images through three-dimensional reconstruction. The deep learning model (Basicvsr++) was selected and modified. The dataset consisted of 171 extracted teeth that met inclusion criteria, with 40 maxillary first molars as the training set and 40 maxillary first molars as well as 91 teeth from other tooth positions as the external test set. The corresponding CBCT, SRCT, and Micro-CT images of each tooth in test sets were reconstructed using Mimics Research 17.0, and the root canal recognition rates in the 3 groups were recorded. The following parameters were measured: volume of hard tissue (V1), volume of pulp chamber and root canal system (V2), length of visible root canals under orifice (VL-X, where X represents the specific root canal), and intersection angle between coronal axis of canal and long axis of tooth (∠X, where X represents the specific root canal). Data were statistically analyzed between CBCT and SRCT images using paired sample t-test and Wilcoxon test analysis, with the measurement from Micro-CT images as the gold standard. Images from all tested teeth were successfully processed with the SR program. In 4-canal maxillary first molar, identification of MB2 was 72% (18/25) in CBCT group, 92% (23/25) in SRCT group, and 100% (25/25) in Micro-CT group. The difference of hard tissue volume between SRCT and Micro-CT was significantly smaller than that between CBCT and Micro-CT in all tested teeth except 4-canal mandibular first molar (P <.05). Similar results were obtained in volume of pulp chamber and root canal system in all tested teeth (P <.05). As for length of visible root canals under orifice, the difference between SRCT and Micro-CT was significantly smaller than that between CBCT and Micro-CT (P <.05) in most root canals. The deep learning model developed in this study helps to optimize the root canal morphology of extracted teeth in CBCT. And it may be helpful for the identification of MB2 in the maxillary first molar. [ABSTRACT FROM AUTHOR]

Automated segmentation of 3-dimensional pulp space on cone-beam computed tomography images presents a significant opportunity for enhancing diagnosis, treatment planning, and clinical education in endodontics. The aim of this systematic review was to investigate the performance of artificial intelligence-driven automated pulp space segmentation on cone-beam computed tomography images. A comprehensive electronic search was performed using PubMed, Web of Science, and Cochrane databases, up until February 2024. Two independent reviewers participated in the selection of studies, data extraction, and evaluation of the included studies. Any disagreements were resolved by a third reviewer. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias. Thirteen studies that met the eligibility criteria were included. Most studies demonstrated high accuracy in their respective segmentation methods, although there was some variation across different structures (pulp chamber, root canal) and tooth types (single-rooted, multirooted). Automated segmentation showed slightly superior performance for segmenting the pulp chamber compared to the root canal and single-rooted teeth compared to multi-rooted ones. Furthermore, the second mesiobuccal (MB2) canalsegmentation also demonstrated high performance. In terms of time efficiency, the minimum time required for segmentation was 13 seconds. Artificial intelligence-driven models demonstrated outstanding performance in pulp space segmentation. Nevertheless, these findings warrant careful interpretation, and their generalizability is limited due to the potential risk and low evidence level arising from inadequately detailed methodologies and inconsistent assessment techniques. In addition, there is room for further improvement, specifically for root canal segmentation and testing of artificial intelligence performance in artifact-induced images. [ABSTRACT FROM AUTHOR]

Cone beam computed tomography (CBCT) frequently captures unexpected structural abnormalities unrelated to the original intent of the diagnostic test. Once identified by dentists, these findings often require appropriate clinical referral for further investigation. This study reviewed recent literature using a comprehensive search to identify and curate common CBCT incidental findings (1Fs). Studies were included if they reported CBCT IFs and included more than 10 cases. The review included 16 primary studies in addition to 4 studies described in recent relevant systematic reviews. A total of 51 descriptive terms used to describe key IFs across studies were identified, and terms were organized semantically into 15 core finding categories. Recommendations for management and referral acuity were derived from otolaryngologic clinical practice guidelines and input from practicing otolaryngologists, and the results were integrated into a clinical management algorithm for acuity of referral. This comprehensive review offers practical recommendations to facilitate appropriate clinical management of CBCT IFs via otolaryngologic referral. [ABSTRACT FROM AUTHOR]

the aim of this paper, is to propose a new reference line: the Frontozygomatic-Infraorbital Line (FZ-IOL). This reference line can guide the surgical team planning mandibular angle harmonization, based on the patient's skeletal proportion. The Frontozygomatic-Infraorbital Line has been adopted for symmetrization surgery, masculinization surgery, and in unsatisfactory results of previous orthognathic surgery. From March 2021 to December 2022, 3 patients were treated for severe facial asymmetry affecting mainly the lower third of the face. All cases were planned with the reference FZ-IOL. Patients were treated in the same center, at the Orthognathic Surgery Department of the Instituto Portugues da Face, Lisbon, Portugal. The Frontozygomatic-Infraorbital Line is designed virtually using software to reconstruct a 3D image from a digital imaging and communications in medicine (DICOM) file obtained from a cone beam computer tomography (CBCT). , connecting the two orbital rims. Then, a vertical line, the frontozygomatic line perpendicular to the IOL and passing through the outmost lateral portion of the frontozygomatic suture is drawn. The proposed line demonstrated how establishing appropriate reference lines is crucial for the success of the surgery. The selection of reference lines should be based on the patient's anatomy, the symmetrization process's complexity, and the surgery's desired outcome. The Frontozygomatic-Infraorbital Line represents an adequate reference line for managing mandibular angle lateral projection, improving lower third of the face symmetrization. [ABSTRACT FROM AUTHOR]

The authors aim to present an updated protocol for mandibular reconstruction in nongrowing patients with Pruzansky/Kaban type IIb/III congenital craniofacial microsomia with customized temporomandibular joint (TMJ) prosthesis to reduce facial nerve (FN) damage and improve surgical accuracy. This is illustrated (using 3 cases) and is based on preoperative mapping of the FN using MRI for better virtual surgical planning of custom-made TMJ prosthesis. Intraoperative FN mapping and monitoring, as well as verification of the final result with intraoperative cone-beam computed tomography (CBCT) and 3D-reconstructed images is also achieved. All 3 patients presented mild transient postoperative facial palsy due to surgical soft tissue stretching which resolved within 2 months of surgery. All patients presented proper occlusion and mouth opening without pain, with an average incisal opening of 38.8 mm (range 35.5–42 mm) at two months of follow-up. Moreover, superposition of intraoperative and preoperative 3D reconstruction images ensured surgical accuracy and avoided the need for a potential reintervention. In conclusion, the proposed surgical protocol for mandibular reconstruction with customized alloplastic TMJ prosthesis in nongrowing patients with type IIb/III Pruzansky-Kaban congenital mandibular hypoplasia may reduce FN morbidity, improve surgical accuracy and final outcomes. [ABSTRACT FROM AUTHOR]