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

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

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

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

Cemento-osseous dysplasia is a subgroup of fibro-osseous dysplasia commonly invading the tooth-bearing regions of the mandible quite often. These bony pathologies are asymptomatic and are seen on radiographs as an incidental finding. Accurate diagnosis of periapical cemento-osseous dysplasia is very crucial as it will help in the proper management of the patient as the incorrect diagnosis can lead to the unnecessary endodontic treatment of the concerned teeth as it may be misdiagnosed as a periapical pathology. We describe a case of periapical cemento-osseous dysplasia in which a 52-year-old woman had been experiencing discomfort in the right mental area of her mandible for the previous 6 months and had finally sought help at the outpatient department. This case study aims to highlight the significance of making an accurate diagnosis of cemento-osseous dysplasias in the tooth-bearing area. [ABSTRACT FROM AUTHOR]

This study aimed to identify the prevalence and association of periodontitis and pulp stone (PS) along with the clinical variables. This study assessed the cone-beam computed tomography (CBCT) records to identify the presence of PS and clinical periodontitis records were used to determine the stages of periodontitis. The Chi-square test was used to evaluate the relationship between study parameters. Logistic regression was used to determine the association between PS and periodontitis. A total of 228 CBCT records were conveniently selected for this study based on the inclusion and exclusion criteria. Cohen's kappa analysis showed near to perfect scores for both examiners. The Chi-square test showed that CBCT records from the age range 41–50 years, male patients, and stage II of periodontitis prevalently showed pulp stones; however, there were no significant differences observed between the PS and clinical variables. However, gender, involvement of tooth, and stages of periodontitis showed significant distribution of the PS. Logistic regression showed that the stages of periodontitis showed no significant association with PS in patients with periodontitis. Moreover, multivariate odds ratio adjustment did not alter the outcome. Periodontitis is not associated with the presence of PS in the current population. [ABSTRACT FROM AUTHOR]

Background: Alveolar ridge preservation (ARP) is a technique that aims to maintain bone volume and minimize resorption after tooth extraction. Objective: This study aimed to compare the effectiveness of injectable platelet‐rich fibrin (I‐PRF) versus hyaluronic acid (HA) in combination with xenografts for ARP. Methods: This randomized controlled trial included 36 patients (20 females and 16 males) who required implant placement in the upper arch. The patients were randomly allocated to one of three groups (n = 12 each): I‐PRF with xenografts, HA with xenografts, or xenografts alone. All patients underwent ARP, and the extraction sockets were sealed with a free gingival graft harvested from the palate, a total of 36 implants were inserted. Cone‐beam CT scans were performed before and 4 months postoperatively to measure radiographic bone gain as the primary outcome. Clinical parameters, including soft tissue thickness and clinical bone width, were evaluated preoperatively, and at 4 months and 1 year postoperatively. Additionally, histological assessment of core bone biopsies was performed 4 months postoperatively using histomorphometric analysis to determine the percentages of newly formed bone, mature bone, and residual grafts. Results: Regarding the radiographic bone gain 4 months postoperative the HA group exhibited the highest value (9.78 ± 0.87), which was significantly greater than the values observed in the I‐PRF and control groups (8.60 ± 1.27 and 7.99 ± 0.89, respectively) (one‐way ANOVA, p = 0.007). Crestal bone loss was significantly higher in the control group (−0.98 ± 0.18) than in the I‐PRF group (−0.53 ± 0.11) and HA group (−0.33 ± 0.15) groups (one‐way ANOVA, p < 0.001). In the histomorphometric analysis, the mean area fraction of newly formed bone trabeculae was significantly higher in the HA group (56.66 ± 7.35) than in the I‐PRF group (28.74 ± 5.15) and the control group (24.05 ± 3.64) (repeated measures ANOVA, p < 0.001). Additionally, the mean area fraction of residual graft material was higher in the I‐PRF group (6.76 ± 2.59), followed by the control group (2.71 ± 1.24), while the HA group had the lowest value (2.63 ± 1.27) (Repeated measures ANOVA, p < 0.001). Conclusion: The combination of HA with xenografts yielded better radiographic and histological outcomes in terms of new bone formation and degree of bone maturation than the I‐PRF and control groups. Furthermore, I‐PRF improved soft tissue thickness. Please note that clinical trial registration was not completed prior to participant recruitment and randomization. The registration link for this trial is https://clinicaltrials.gov/ct2/show/NCT05781529. [ABSTRACT FROM AUTHOR]

Introduction: The present investigation compared the stability and volumetric changes of two different grafting material used for lateral window sinus floor augmentation (LWSFA). Methods: Sixteen patients with a total 20 maxillary sinuses in need of LWSFA were included in the present study. The sinuses were grafted with either 100% anorganic bovine bone mineral (ABBM) alone (Group 1) or a mixture (0.8:1 ratio) of ABBM and mineralized cortical allograft (MCA) (Group 2). Cone beam computer tomography (CBCT) was obtained pre‐operatively, and at 2‐weeks, and 6‐months after LWSFA to perform linear measurements including lateral window dimensions, sinus anatomy, residual bone height/thickness (RBH/RBT), and Schneiderian membrane thickness (SMT), among others. Three‐dimensional segmentation analysis was used to evaluate changes of bone graft volume/height (GV/GH). Results: A total of 10 sinuses per group were included in the analysis. No statistically significant difference was found in between groups regarding mean reduction of GV (Group 1: 14.87% ± 16.60%, Group 2: 18.06% ± 9.81%, p = 0.33). Among the linear measurements, only SMT revealed a significant increase after 2‐weeks more pronounce in Group 1 (8.70 mm) when compared with Group 2 (5.70 mm) with plausible effect upon LWSFA outcomes. Sinus width showed weak positive correlation with GH reduction after 6 months. Conclusion: This study demonstrated that both ABBM alone and ABBM + MCA represent suitable alternatives for LWSFA with adequate graft stability as they revealed similar volumetric and linear dimensional changes 6 months postoperatively. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcome of the transalveolar approach with the small segmentation method for inclined maxillary sinus floor elevation. Methods: Sixty‐one patients with an inclined maxillary sinus floor (tilt angle ≥ 10°) and insufficient residual bone height in the posterior maxilla were included and grouped according to the tilt angle of the sinus floor, with group A having patients with the tilt angle ≥ 10° and ≤ 30° and group B having patients with the tilt angle > 30°. After completing sinus membrane elevation and bone augmentation using bone substitute materials, the implants were inserted at the same appointment, and the restoration was completed after 5–6 months of osseointegration. The preoperative sinus floor level and sinus floor elevation achieved postoperatively were assessed and recorded. At pre‐ and post‐operative timepoints, the sagittal plane of the cone beam computed tomography was used to evaluate the bone height changes at the peak, middle and valley points in the slope segment intended for implant implantation. Results: Osseointegration was evident in all 61 patients, and the final restoration was completed with functional loading. After assessing the normality and homogeneity of variance, two‐sample t‐test or nonparametric tests were employed to estimate the differences in the bone height changes. The degrees of freedom (df) for this analysis were 59. The elevation attained at the middle point in groups A and B were 6.71 ± 1.38 and 5.75 ± 1.56 mm, respectively, demonstrating a significant difference (p < 0.05). Furthermore, at the peak and valley points, group A exhibited bone height changes of 5.79 ± 1.74 and 6.06 ± 1.45 mm, respectively, compared to group B with changes measuring 4.63 ± 2.18 and 5.58 ± 2.39 mm, respectively, with no significant difference in the two groups (p ≥ 0.05). The prevalence of intraoperative sinus membrane perforation was assessed using the chi‐square test. It was found that four cases in group A and five cases in group B experienced sinus membrane perforation, with no significant difference in the two groups (p ≥ 0.05, df = 1). Conclusion: The transalveolar approach using the small segmentation method suggests a promising approach for elevating the inclined maxillary sinus floor. [ABSTRACT FROM AUTHOR]

Objectives: Lateral ridge augmentation (LRA) is a surgical technique to gain bone prior to implant placement. Performing cone‐beam computed tomography (CBCT) pre‐ and post‐surgery allows for quantitative comparison of the buccal–lingual width and the vertical height of the edentulous ridges. This study used CBCT images to evaluate the bone regeneration following surgery. Methods: A total of 30 cases from adult patients who underwent LRA and had high‐quality CBCT images taken pre‐ and post‐surgery from the same CBCT scanner were available for the retrospective study. Study data included linear measurements of the bone ridge width and height obtained from the middle of the edentulous ridge and a volumetric measurement of bone growth at the edentulous site observed on the CBCT scan. Results: The reliability of the measurements was excellent as indicated by Intra‐Class Coefficient values of 0.974 or higher. There was a significant mean bone increase from pre‐surgery compared to post‐surgery for both the linear and volumetric measurements. The linear bone gain ranged from 1.5 to 2.5 mm and volumetric gain from 250 to 750 mm3. However, two patients did not gain any bone. Multivariate regression showed the strongest predictors of bone gain post‐surgery were the pre‐surgery bone volume and a surgical site being in the mandible. For maxillary surgical sites, particularly anterior areas, the LRA surgeries were the least successful. Conclusions: LRA before implant placement helped to increase bone for the majority of patients, particularly for surgical sites in the mandible. The quantitative analyses in the CBCT images showed excellent intra‐examiner agreement. [ABSTRACT FROM AUTHOR]

Objectives: The main purpose of this retrospective study was to assess the difference in the incidence of peri‐zygomatic complications (PZCs) when zygomatic implants (ZIs) penetrate or do not penetrate the external surface of zygoma. Materials and Methods: This study included 32 patients with edentulous maxillae or potentially edentulous maxillae undergo zygomatic implantation. The patients were divided into the penetration group (P‐group) and the non‐penetration group (N‐group) according to whether the apex of implants penetrated the external surface of zygoma in postoperative CBCT. The extension length, the penetration section of the implants, and the skin thickness at the corresponding position were simultaneously measured. Clinical follow‐up was conducted regularly until 2 years after surgery. The occurrence of PZCs (including peri‐zygomatic infection, skin numbness, non‐infectious pain, and foreign body sensation) was recorded. A mixed effect logistic model was used to compare the difference of complication rate between the P‐group and the N‐group, and odds ratio (OR) was calculated. Then identify the impact of the extension length, penetration section and skin thickness in P‐group with the same model. Results: A total of 71 ZIs were implanted in 32 patients, including 37 implants in the P‐group and 34 implants in the N‐group. During the 2‐year follow‐up, a total of 13 implants occurred PZCs, with an overall complication rate of 18.3%. Thereinto, the incidence rate was 29.7% in the P‐group, and 5.9% in the N‐group (OR = 6.77). In P‐group, there was a significant difference in complication rate of different extension lengths, while the penetration section and skin thickness had no statistical significance on the complication rate. Conclusion: Under the limitation of this study, to minimize the risk of PZCs, ZI should be placed in a manner that avoids the apex penetrating the external surface of the zygoma. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the ridge alterations and esthetic outcome 1 year after immediate implant placement using the dual‐zone (DZ) technique versus the bone shielding concept in patients with intact thin‐walled sockets in the esthetic zone. Material and Methods: This randomized clinical trial included 26 patients with nonrestorable maxillary teeth in the esthetic zone who were randomly assigned to two groups (n = 13 each) to receive immediate implants using either the bone shielding concept or DZ. Definitive restorations were delivered after 2 months. Pink esthetic scores (PESs), vertical soft tissue alterations, and bucco‐palatal ridge dimensional changes were measured and assessed using intra‐oral digital scans at baseline and 1 year post‐procedure. Labial bone thickness was measured using cone beam computed tomography scans at baseline and after 1 year. Results: The bone shielding group provided bucco‐palatal ridge thickness stability after 1 year (9.43 mm) compared to baseline values (9.82 mm), while DZ showed a significant loss in the bucco‐palatal ridge thickness after 1 year (7.83) compared to baseline values (9.49). No significant difference was reported in the baseline bucco‐palatal ridge thickness between the two groups (p = 0.6). After 1 year, the bone shielding group demonstrated 0.38 mm ridge shrinkage which was statistically significant (p = 0.0002) compared to 1.67 mm ridge shrinkage in the DZ group. In addition, the average total PES in the bone shielding group was 12.04 versus 10.28 in the DZ group. No significant difference was reported in the mesial papilla length between the DZ and the bone shielding group after 1 year (p > 0.05). However, the midfacial gingival margin (p = 0.026) and distal papilla were significantly higher in the DZ group (p = 0.0025). There was no significant difference in the mean ± SD mm bone gain at the apical level between the two studied groups after 1 year (p = 0.06) showing 0.85 ± 0.23 and 0.64 ± 0.32 mm, respectively. However, the bone shielding concept showed a statistically significant more bone gain mm (p < 0.001) at the (0.56 ± 0.43) and crestal (0.03 ± 0.8) levels after 1 year compared to DZ which revealed 0.18 ± 0.5 and 0.38 ± 0.29 mm bone loss, respectively. Conclusion: The bone shielding concept might offer a reliable alternative for restoring thin‐walled sockets by minimizing postextraction ridge dimensional alterations effect following immediate implant placement in the esthetic zone. Nevertheless, the study suffers from confounding bias since there are two systematic differences between the groups, the barrier membrane type, and the level of bone filling. "This clinical trial was not registered prior to participant recruitment and randomization." Clinical Trial Registration: NCT05381467. [ABSTRACT FROM AUTHOR]

Background: Radiation therapy (RT) is an integral and commonly used therapeutic modality for primary lung cancer. However, radiation-induced lung injury (RILI) limits the irradiation dose used in the lung and is a significant source of morbidity. Disruptions in iron metabolism have been linked to radiation injury, but the underlying mechanisms remain unclear. Purpose: To utilize a targeted radiation delivery approach to induce RILI for the development of a model system to study the role of radiation-induced iron accumulation in RILI. Methods: This study utilizes a Small Animal Radiation Research Platform (SARRP) to target the right lung with a 20 Gy dose while minimizing the dose delivered to the left lung and adjacent heart. Long-term pulmonary function was performed using RespiRate-x64image analysis. Normal-appearing lung volumes were calculated using a cone beam CT (CBCT) image thresholding approach in 3D Slicer software. Quantification of iron accumulation was performed spectrophotometrically using a ferrozine-based assay as well as histologically using Prussian blue and via Western blotting for ferritin heavy chain expression. Results: Mild fibrosis was seen histologically in the irradiated lung using hematoxylin and eosin-stained fixed tissue at 9 months, as well as using a scoring system from CBCT images, the Szapiel scoring system, and the highest fibrotic area metric. In contrast, no changes in breathing rate were observed, and median survival was not achieved up to 36 weeks following irradiation, consistent with mild lung fibrosis when only one lung was targeted. Our study provided preliminary evidence on increased iron content and ferritin heavy chain expression in the irradiated lung, thus warranting further investigation. Conclusions: A targeted lung irradiation model may be a useful approach for studying the long-term pathological effects associated with iron accumulation and RILI following ionizing radiation. [ABSTRACT FROM AUTHOR]

Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are induced by dysbiotic microbiota resulting in the inflammatory destruction of peri-implant tissue. Nonetheless, there has yet to be an established protocol for the treatment of these diseases in a predictable manner, although many clinicians and researchers have proposed various treatment modalities for their management. With the increase in the number of reports evaluating the efficacy of various treatment modalities and new materials, the use of multiple decontamination methods to clean infected implant surfaces is recommended; moreover, the use of hard tissue laser and/or air abrasion techniques may prove advantageous in the future. Limited evidence supports additional effects on clinical improvement in antimicrobial administration for treating peri-implantitis. Implantoplasty may be justified for decontaminating the implant surfaces in the supracrestal area. Surgical treatment is employed for advanced peri-implantitis, and appropriate surgical methods, such as resection therapy or combination therapy, should be selected based on bone defect configuration. This review presents recent clinical advances in debridement methods for contaminated implant surfaces and regenerative materials for treating peri-implant bone defects. It also proposes a new flowchart to guide the treatment decisions for peri-implant disease. [ABSTRACT FROM AUTHOR]

Purpose: The anatomical position of the lingula is clinically very important to prevent injuries during sagittal split ramus osteotomy. Our study aims to evaluate the localisation of the lingula by cone beam computed tomography (CBCT) and to compare the localisation of the lingula between malocclusion, gender, and lingula types. Methods: A retrospective study was conducted to evaluate the shape and location of the lingula using CBCT. A total of 250 CBCT images were included in this study. The lingula was classified as nodular, assimilated, truncated, or triangular type. Six defined distances from the top of the lingula were measured: anterior border of the ramus (L-A), posterior border of the ramus (L-P), internal oblique ridge (L-IOR), mandibular notch (L-N), and distal surface of the mandibular second molar (L-M2) and occlusal plane (L-OP). The measured distances were compared between gender, malocclusion, and lingula types. Results: The most common type of lingula was nodular (32.4%). The L-N, L-P, L-M2, and L-OP distances between genders were statistically higher in male patients than in female patients. The L-IOR, L-M2, and L-OP distances exhibited statistically significant differences found between malocclusions. No statistically significant difference was found when the distances of the lingula to the anatomical points were compared between the lingula types. Conclusion: These variations in positioning of the lingula depending on the dysmorphoses are developing towards a systematic 3D examination before any mandibular osteotomy to precisely visualize the position and shape of the lingula. [ABSTRACT FROM AUTHOR]

Purpose: Despite the combination of chalkboard lectures and cadaveric models, the ear remains a complex anatomical structure that is difficult for medical students to grasp. The aim of this study was to evaluate the contribution of a 3D-printed ear model for educating undergraduate medical students by comparing it with a conventional cadaveric model. Methods: Models of the ear comprising the outer ear, tympanic membrane, ossicles and inner ear were modeled and then 3D-printed at 6:1 and 10:1 scales based on cadaveric dissection and CT, cone-beam CT and micro/nano CT scans. Cadaveric models included two partially dissected dry temporal bones and ossicles. Twenty-four 3rd year medical students were given separate access to cadaveric models (n = 12) or 3D-printed models (n = 12). A pre-test and two post-tests were carried out to assess knowledge (n = 24). A satisfaction questionnaire focusing solely on the 3D-printed model, comprising 17 items assessed on a 5-point Likert scale, was completed by all study participants. A 5-point Likert scale questionnaire comprising four items (realism, color, quality and satisfaction with the 3D-printed ear model) was given to three expert anatomy Professors. Results: The test scores on the first post-test were higher for the students who had used the 3D-printed models (p < 0.05). Overall satisfaction among the students and the experts was very high, averaging 4.7 on a 5-point Likert-type satisfaction scale. Conclusion: This study highlights the overall pedagogical value of a 3D-printed model for learning ear anatomy. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to conduct a bibliometric analysis of trends in the description items within the literature published from 2019 to 2021 with "maxillary sinus septum" in the title or subtitle. Methods: Electronic data from PubMed (MEDLINE), Google Scholar, and ScienceDirect were searched from 2019 to 2021. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to select 21 of 243 articles and examined their studies. Statistical calculations from data recorded by the authors were performed using the Chi-square, Mann–Whitney, and independent tests. Significance was set at P < 0.05. Results: The number of articles decreased annually. The highest number of publications was from Asia (64.3%), accounting for 71.4% of publications. The features of the septum were described for eight items, with one septum (70.14%) mentioned significantly more frequently, followed by on one side (65.89%) or the right side (62.22%). Location was mentioned significantly more frequently in the middle (55.22%) and for those aged 45 years and older (50.38%). No significant differences were observed in prevalence, age, height, or width between sexes; the patients' ages ranged from 18 to 90 years. Septa were significantly more prevalent in dentulous (45.38%) and partially edentulous (48.58%) patients, with significantly more patients exhibiting buccopalatal orientation (82.39%). Conclusions: This study focused primarily on anatomical features using CBCT examination, and analyses of male–female differences and the origin of the sinus septum are necessary for the future. [ABSTRACT FROM AUTHOR]

The treatment of osseous defects around teeth is a fundamental concern within the field of periodontology. Over the years, the method of grafting has been employed to treat bone defects, underscoring the necessity for custom-designed scaffolds that precisely match the anatomical intricacies of the bone cavity to be filled, preventing the formation of gaps that could allow the regeneration of soft tissues. In order to create such a patient-specific scaffold (bone graft), it is imperative to have a highly detailed 3D representation of the bone defect, so that the resulting scaffold aligns with the ideal anatomical characteristics of the bone defect. In this context, this article implements a workflow for designing 3D models out of patient-specific tissue defects, fabricated as scaffolds with 3D-printing technology and bioabsorbable materials, for the personalized treatment of periodontitis. The workflow is based on 3D modeling of the hard tissues around the periodontal defect (alveolar bone and teeth), scanned from patients with periodontitis. Specifically, cone beam computed tomography (CBCT) data were acquired from patients and were used for the reconstruction of the 3D model of the periodontal defect. The final step encompasses the 3D printing of these scaffolds, employing Fused Deposition Modeling (FDM) technology and 3D-bioprinting, with the aim of verifying the design accuracy of the developed methodοlogy. Unlike most existing 3D-printed scaffolds reported in the literature, which are either pre-designed or have a standard structure, this method leads to the creation of highly detailed patient-specific grafts. Greater accuracy and resolution in the macroarchitecture of the scaffolds were achieved during FDM printing compared to bioprinting, with the standard FDM printing profile identified as more suitable in terms of both time and precision. It is easy to follow and has been successfully employed to create 3D models of periodontal defects and 3D-printed scaffolds for three cases of patients, proving its applicability and efficiency in designing and fabricating personalized 3D-printed bone grafts using CBCT data. [ABSTRACT FROM AUTHOR]

(1) Background: This study assessed the spatial position and anatomical features associated with impacted third molars through a map-reading strategy employing cone-beam computed tomography (CBCT). (2) Methods: The positioning of impacted third molars on CBCT was assessed using Winter's and Pell and Gregory's classifications. External root resorption in mandibular second molars was categorized according to Herman's classification. Additionally, the relationship between the mandibular third molar root apex and the mandibular canal was examined. Comparative statistical analysis was conducted using Fisher's exact test, with a significance level considered as 5%. (3) Results: The results indicated that, based on Winter's classification, 48.06 % of impacted teeth were positioned mesioangularly. Employing Pell and Gregory's classification, 43.22% of the impacted molars fell into positions B and C, with 54.2% classified as Class II. A notable 69.7% of teeth exhibited no contact between the root apex and the mandibular canal, and external root resorption in the distal aspect of the second molar was absent in 88.7% of cases. (4) Conclusions: Utilizing the map-reading strategy with CBCT scans to assess the anatomical positions and characteristics of impacted third molars enhances professional confidence and sets a standard for quality and safety in the surgical procedure for patients. [ABSTRACT FROM AUTHOR]

Purpose: Determining the cause of interstitial lung disease (ILD) remains challenging. While surgical lung biopsy remains the gold standard approach, risks associated with it may be prohibitive. Transbronchial lung cryobiopsy (TBLC) is a minimally invasive alternative with an improved safety profile and acceptable diagnostic accuracy. We retrospectively assessed whether the use of Cone Beam computed tomography guidance for TBLC (TBLC-CBCT) improves safety and diagnostic yield compared to performing TBLC with fluoroscopic guidance (TBLC-F). Methods: A retrospective cohort review of 120 patients presenting for evaluation of newly diagnosed ILD was performed. Demographic data, pulmonary function test values, chest imaging pattern, procedural information, and final multidisciplinary discussion (MDD) diagnosis were recorded. Results: 62 patients underwent TBLC-F and 58 underwent TBLC-CBCT. Patients undergoing TBLC-CBCT were older (67.86 ± 10.97 vs 61.45 ± 12.77 years, p = 0.004) and had a higher forced vital capacity percent predicted (73.80 ± 17.32% vs 66.00 ± 17.45%, p = 0.03) compared to the TBLC-F group. The average probe-to-pleura distance was 5.1 ± 2.3 mm in the TBLC-CBCT group with 4.0 ± 0.3 CBCT spins performed. Pneumothorax occurred more often in the TBLC-F group (n = 6, 9.7%) compared to the TBLC-CBCT group (n = 1, 1.7%, p = 0.06). Grade 2 bleeding only occurred in the TBLC-F group (n = 4, 6.5%). A final MDD diagnosis was obtained in 89% (n = 57) of TBLC-F patients and 95% (n = 57) of TBLC-CBCT patients. Conclusions: TBLC-CBCT appears to be safer compared to TBLC-F with both approaches facilitating an MDD diagnosis. Further studies from multiple institutions randomizing patients to each modality are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

The article provides a review of the year 2023 for the journal LUNG. The journal experienced growth and progress, with a rise in impact factor and strong numbers of article downloads. The field of cough was a focus, with articles covering various aspects of cough and antitussive drug development. Other topics covered in the journal included sarcoidosis, bronchiectasis, obstructive airways disease, lung cancer, COVID-19, pulmonary infectious diseases, lung transplantation, critical care, and preclinical and translational research. The editorial team is motivated to continue improving the journal and expanding its readership. [Extracted from the article]

Background: Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. Methods: Early breast cancer patients after partial mastectomy were equally randomized into two arms– external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. Results: The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21–45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. Conclusion: External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. Trial registration: NCT06007118. [ABSTRACT FROM AUTHOR]

Purpose: To compare primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in displaced intra-articular calcaneal fractures (DIACFs), based on clinical outcome and 2D and 3D geometrical analyses obtained from weight-bearing (WB) cone-beam CT images. Materials and methods: In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary's angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires. Results: Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary's angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (– 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied. Conclusion: Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established. [ABSTRACT FROM AUTHOR]

Objective: Optimal implant planning and placement allows the prosthesis to be well designed to achieve a satisfactory aesthetic and functional outcome. We aimed to compare deviations between implant planning and placement with the assistance of dynamic computer‐assisted implant surgery (d‐CAIS) or autonomous robotic computer‐assisted implant surgery (r‐CAIS) methods in a clinical setting. Methods: The retrospective analysis of medical records between 2021 July and 2022 December was conducted to compare the implantation accuracy of the d‐CAIS and r‐CAIS system in partially edentulous patients through cone‐beam computed tomography. Patient‐reported outcomes (PROs) were recorded using a visual analogue scale (VAS). The Kolmogorov–Smirnov test was used to check the data distribution. Student's t‐test or Mann–Whitney U‐test was used as appropriate, with a defined significant difference (p <.05). Results: Seventy‐seven patients were analysed (124 implants), with 38 patients (62 implants) in the d‐CAIS group and 39 patients (62 implants) in the r‐CAIS group. The differences between d‐CAIS and r‐CAIS were 4.09 ± 1.79° versus 1.37 ± 0.92° (p <.001) in angular deviation; 1.25 ± 0.54 versus 0.68 ± 0.36 mm (p <.001) in coronal global deviation; 1.39 ± 0.52 versus 0.69 ± 0.36 mm (p <.001) in apical global deviation; the results of the PROMs showed no statistical difference between the two groups. Conclusions: r‐CAIS allows more accurate implant placement than the d‐CAIS technology. And both groups achieved overall satisfactory outcomes via VAS (Chinese Clinical Trial Registry ChiCTR2300072004). [ABSTRACT FROM AUTHOR]

Aim: To compare measurements on images obtained by magnetic resonance imaging (MRI) and cone beam CT (CBCT) for height, width, and area in alveolar bone sites in human jaw specimens. Material and Methods: Forty edentulous alveolar posterior sites in human cadaver specimens were imaged using CBCT scanners, and with zero‐echo‐time MRI (ZTE‐MRI). Semi‐automatic volume registration was performed to generate representative coronal sections of the sites related to implant planning. ZTE‐MRI sections were also presented after grayscale inversion (INV MRI). Three observers measured bone height, bone width 5 mm from the alveolar crest, and bone area stretching from the width measurement to the top of the alveolar crest in the images. Interobserver agreement was assessed by intra‐class correlation coefficients (ICC). The measurements were analyzed using two‐way repeated measures ANOVA factoring observer and image type. Results: ICC was >0.95 for bone height, width, and bone area. No significant differences among observers (p = 0.14) or image type (p = 0.60) were found for bone height. For bone width, observer (p = 0.14) was not a significant factor, while ZTE‐MRI produced width estimates that were significantly different and systematically smaller than CBCT‐based estimates (p ≤ 0.001). Observer (p = 0.06) was not a significant factor regarding the bone area measurements, contrary to the imaging type where ZTE‐MRI led to significantly smaller area estimates than CBCT (p ≤ 0.001). Conclusion: Bone height measurements were essentially equivalent using CBCT and MRI. This was found regardless of grayscale choice for the MRI. However, ZTE‐MRI resulted in smaller estimates of bone width and area. [ABSTRACT FROM AUTHOR]

Objectives: To assess in a prospective randomized trial two phycogenic bone substitutes—biphasic calcium phosphate (BCP) versus almost pure hydroxyapatite (HA)—for their volume stability and clinical implications after sinus floor elevation (SFE). Materials and Methods: Twenty patients requiring lateral‐window SFE 6 months prior to implant surgery were randomized to a BCP or HA group. As primary outcome, the grafts were analyzed for volume stability, using four cone‐beam computed tomography scans obtained immediately/6/12/24 months after SFE. Secondary outcomes were implant survivval, success, periotest values, oral‐health‐related quality of life (OHIP‐G14), and pain (VAS). Results: Kolmogorov–Smirnov goodness‐of‐fit test revealed normal distribution of samples (p =.200). At 6/12/24 months, the augmented volumes decreased to 96/92/90% (HA) or 99/96/96% (BCP). Volume changes were significantly a factor of time (p <.001; generalized linear model with repeated measures) and reached significantly lower values in HA group (p =.018). Significant intergroup difference in volume losses was notable at 24 months (p =.021; t‐test for independent samples). Periotest values decreased from −3/−4.1 (HA/BCP) after implant placement to −6.3/−4.5 (HA/BCP) after 6 months. OHIP scores diverged at 2 months (HA: 9.5; BCP: 5.2) and largely resolved by 24 months (HA: 1.3; BCP: 1.9). VAS scores were comparable, 2.2 at 1 week after SFE being their highest mean level. Conclusions: After 2 years, both groups experienced no biological or technical complications, demonstrating a consistent healing trajectory without notable symptoms. Although no significant differences were observed in implant stability and survival, BCP demonstrated higher volume stability than HA. [ABSTRACT FROM AUTHOR]

Background: Stereotactic Body Radiotherapy (SBRT) is as a standard treatment for prostate cancer (PCa). Tight margins and high dose gradients are needed, and the precise localization of the target is mandatory. Our retrospective study reports our experience regarding the evaluation of intrafraction prostate motion during LINAC-based SBRT evaluated with a novel electromagnetic (EM) tracking device. This device consists of an integrated Foley catheter with a transmitter connected to a receiver placed on the treatment table. Methods: We analyzed 31 patients who received LINAC-based SBRT using flattening filter-free (FFF) volumetric modulated arc therapy (VMAT). The patients were scheduled to be treated for primary (n = 27) or an intraprostatic recurrent PCa (n = 4). A simulation CT scan was conducted while the patients had a filled bladder (100–150 cc) and an empty rectum, and an EM tracking device was used. The same rectal and bladder conditions were employed during the treatment. The patients received 36.25 Gy delivered over five consecutive fractions on the whole prostate and 40 Gy on the nodule(s) visible via MRI, both delivered with a Simultaneous Integrated Boost approach. The CTV-to-PTV margin was 2 mm for both the identified treatment volumes. Patient positioning was verified with XVI ConeBeam-CT (CBCT) matching before each fraction. When the signals exceeded a 2 mm threshold in any of the three spatial directions, the treatment was manually interrupted. A new XVI CBCT was performed if this offset lasted >20 s. Results: We analyzed data about 155 fractions. The median and mean treatment times, calculated per fraction, were 10 m31 s and 12 m44 s (range: 6 m36 s–65 m28 s), and 95% of the fractions were delivered with a maximum time of 27 m48 s. During treatment delivery, the mean and median number of XVI CBCT operations realized during the treatment were 2 and 1 (range: 0–11). During the treatment, the prostate was outside the CTV-to-PTV margin (2 mm), thus necessitating the stoppage of the delivery +/− a reacquisition of the XVI CBCT for 11.2%, 8.9%, and 3.9% of the delivery time in the vertical, longitudinal, and lateral direction, respectively. Conclusions: We easily integrated an EM-transmitter-based gating for prostate LINAC-based SBRT into our normal daily workflow. Using this system, a 2 mm CTV-to-PTV margin could be safely applied. A small number of fractions showed a motion exceeding the predefined 2 mm threshold, which would have otherwise gone undetected without intrafraction motion management. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the difference of three-dimensional (3D) reconstructed palatal morphology between subjects with skeletal Class III and skeletal Class I in different vertical patterns using cone beam computed tomography (CBCT). Methods: In this study, 89 subjects with skeletal Class III (49 females, 40 males; 25.45 ± 3.81 years) and 85 subjects with skeletal Class I (45 females, 40 males; 23.95 ± 4.45 years) were collected retrospectively and divided into hyperdivergent, normodivergent and hypodivergent groups. Dolphin software was used to reorient the CBCT images of these subjects. After segmenting 3D object of maxilla from the 3D skull by ProPlan software, Geomagic Studio was used to reconstruct 3D palatal morphology and establish an average 3D palatal morphology for each group. The differences of 3D palatal morphology between different groups were compared by deviation patterns on 3D colored map analysis. Results: 3D colored map analysis showed the posterior part of male's palate was higher and wider than that of female's palate in skeletal Class III subjects. In skeletal Class III subjects, males with hyperdivergent pattern had a higher and narrower palate compared with hypodivergent subjects, while females with hyperdivergent had a higher but not obviously narrower palate compared with hypodivergent subjects. In the similar vertical patterns, skeletal Class III subjects had a flatter but not narrower palate compared with skeletal Class I subjects, along with a smaller palate volume. Conclusions: This method allows more intuitive between-group comparisons of the differences of 3D palatal morphology. In skeletal Class III subjects, as the vertical dimension increased, the palate tends to be higher and narrower. Therefore, the influence of vertical patterns on the palatal morphology should be fully considered in the orthodontic and orthognathic treatment of skeletal Class III subjects. [ABSTRACT FROM AUTHOR]

Background: To assess the feasibility of CBCT-based adaptive intensity modulated proton therapy (IMPT) using automated planning for treatment of head and neck (HN) cancers. Methods: Twenty HN cancer patients who received radiotherapy and had pretreatment CBCTs were included in this study. Initial IMPT plans were created using automated planning software for all patients. Synthetic CTs (sCT) were then created by deforming the planning CT (pCT) to the pretreatment CBCTs. To assess dose calculation accuracy on sCTs, repeat CTs (rCTs) were deformed to the pretreatment CBCT obtained on the same day to create deformed rCT (rCTdef), serving as gold standard. The dose recalculated on sCT and on rCTdef were compared by using Gamma analysis. The accuracy of DIR generated contours was also assessed. To explore the potential benefits of adaptive IMPT, two sets of plans were created for each patient, a non-adapted IMPT plan and an adapted IMPT plan calculated on weekly sCT images. The weekly doses for non-adaptive and adaptive IMPT plans were accumulated on the pCT, and the accumulated dosimetric parameters of two sets were compared. Results: Gamma analysis of the dose recalculated on sCT and rCTdef resulted in a passing rate of 97.9% ± 1.7% using 3 mm/3% criteria. With the physician-corrected contours on the sCT, the dose deviation range of using sCT to estimate mean dose for the most organ at risk (OARs) can be reduced to (− 2.37%, 2.19%) as compared to rCTdef, while for V95 of primary or secondary CTVs, the deviation can be controlled within (− 1.09%, 0.29%). Comparison of the accumulated doses from the adaptive planning against the non-adaptive plans reduced mean dose to constrictors (− 1.42 Gy ± 2.79 Gy) and larynx (− 2.58 Gy ± 3.09 Gy). The reductions result in statistically significant reductions in the normal tissue complication probability (NTCP) of larynx edema by 7.52% ± 13.59%. 4.5% of primary CTVs, 4.1% of secondary CTVs, and 26.8% tertiary CTVs didn't meet the V95 > 95% constraint on non-adapted IMPT plans. All adaptive plans were able to meet the coverage constraint. Conclusion: sCTs can be a useful tool for accurate proton dose calculation. Adaptive IMPT resulted in better CTV coverage, OAR sparing and lower NTCP for some OARs as compared with non-adaptive IMPT. [ABSTRACT FROM AUTHOR]

Objective. To create two non-coplanar, stereotactic ablative radiotherapy (SABR) lung patient treatment plans compliant with the radiation therapy oncology group (RTOG) 0813 dosimetric criteria using a simple, isocentric, therapy with kilovoltage arcs (SITKA) system designed to provide low cost external radiotherapy treatments for low- and middle-income countries (LMICs). Approach. A treatment machine design has been proposed featuring a 320 kVp x-ray tube mounted on a gantry. A deep learning cone-beam CT (CBCT) to synthetic CT (sCT) method was employed to remove the additional cost of planning CTs. A novel inverse treatment planning approach using GPU backprojection was used to create a highly non-coplanar treatment plan with circular beam shapes generated by an iris collimator. Treatments were planned and simulated using the TOPAS Monte Carlo (MC) code for two lung patients. Dose distributions were compared to 6 MV volumetric modulated arc therapy (VMAT) planned in Eclipse on the same cases for a Truebeam linac as well as obeying the RTOG 0813 protocols for lung SABR treatments with a prescribed dose of 50 Gy. Main results. The low-cost SITKA treatments were compliant with all RTOG 0813 dosimetric criteria. SITKA treatments showed, on average, a 6.7 and 4.9 Gy reduction of the maximum dose in soft tissue organs at risk (OARs) as compared to VMAT, for the two patients respectively. This was accompanied by a small increase in the mean dose of 0.17 and 0.30 Gy in soft tissue OARs. Significance. The proposed SITKA system offers a maximally low-cost, effective alternative to conventional radiotherapy systems for lung cancer patients, particularly in low-income countries. The system's non-coplanar, isocentric approach, coupled with the deep learning CBCT to sCT and GPU backprojection-based inverse treatment planning, offers lower maximum doses in OARs and comparable conformity to VMAT plans at a fraction of the cost of conventional radiotherapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lingual movable wing is a new type of lingual orthodontic technique and the different stretching lengths of the wring affect the torque control effect of anterior teeth. However, there is yet no related biomechanical research. OBJECTIVE: To investigate the displacement trend of dentition during adduction of mandibular anterior teeth and the effect of different wing stretching lengths on the biomechanical effect of mandibular anterior teeth. METHODS: The data of the mandible and lower dentition were collected by cone-beam CT and reconstructed using Mimics software to establish a three-dimensional finite element model of mandibular anterior teeth adducted by the lingual movable wing. The ANSYS software was used to analyze the initial displacement of the mandibular anterior teeth under the following conditions: A, 2 mm stretching length; B, 2.5 mm stretching length; C, 3 mm stretching length; and D, 3.5 mm stretching length. RESULTS AND CONCLUSION: The trend of initial displacement of lower dentition: The central incisors moved lingually with depression, the lateral incisors and canines moved mildly lingually with mesial lingual torsion, the second premolar was tilted distally with a marked lingual inclination and the first molar showed an overall mesial inclination with mesial crown eversion. Therefore, in the adduction cases of mandibular tooth extraction, attention should be paid to the lingual movement of the second premolar, which could be offset by corresponding techniques in clinic. The trend of anterior tooth displacement in all directions: from condition A to condition D, in the sagittal direction, the difference value in crown-root displacement of central incisors changed from -11.891 μm to -5.757 4 μm, indicating that the central incisor changes from oblique movement to overall movement. The difference value in crown-root displacement of lateral incisors changed from -11.828 1 μm to -6.711 45 μm, and that of canines changed from -7.572 3 μm to -4.695 5 μm, indicating that the oblique movement of the lateral incisors and canines is also changing to an overall movement. In the vertical direction, from condition A to condition D, the reduction of incisors was gradually increased, while that of canines was gradually decreased. These findings indicate that the stretching length of the wing can affect the oblique movement trend of the anterior teeth. As the wing continues to stretch, the torque control of the lower anterior teeth will become better. [ABSTRACT FROM AUTHOR]

Background: Application of pulp regenerative cell therapy for mature teeth with periapical lesions is a critical clinical challenge. The bacterial infection in inaccessible location within the root canal system and in the periapical lesions could cause resistance and impediment, leading to limitations in successful therapy. Thus, the aim of this study was to examine the effect of residual bacteria on the outcome of pulp regeneration in mature teeth with apical periodontitis in dogs. Methods: Periapical lesions were induced in 32 root canals of 4 dogs in two different models in severities, model A and model B. Model A (moderate infection): the canal exposed to the oral cavity for 2 weeks and then closed for 2 weeks. Model B (severe infection): the canal exposed to the oral cavity for 2 months and then closed for 5 months. All root canals were irrigated with 6% sodium hypochlorite, and 3% EDTA and further with 0.015% levofloxacin-containing nanobubbles, which was also used as an intracanal medicament. The aseptic conditions were examined by bacterial anaerobic culture and/or PCR analyses. The root canal treatment was repeated several times, and allogeneic dental pulp stem cells were transplanted into the root canals. The radiographic evaluation of periapical lesions was performed by cone-beam computed tomography before the first treatment, just after cell transplantation, and after 2 months and 6 months in both model A, model B, respectively. The animals were then sacrificed and the jaw blocks were harvested for histological and histobacteriological evaluations of pulp regeneration and periapical tissue healing. Furthermore, the DiI-labelled DPSCs were transplanted into the root canals after complete disinfection (n = 4) or without root canal treatment (n = 4) in the apical periodontitis model (model A) in one dog, and cell localization was compared 72 h after transplantation. Results: In 8 out of 12 canals from model A, and 10 out of 15 canals from model B, pulp regeneration with good vascularization, innervation, and a significant reduction in the radiolucent area of the periapical lesions were observed. However, in the other 4 canals and 5 canals from model A and model B, respectively, no pulp tissue was regenerated, and inflammation in the periapical tissue, and external resorption or healed external resorption were detected. The presence of residual bacteria in the periapical tissues and severe inflammation were significantly associated with inhibition of regenerated pulp tissue in these 9 unsuccessful canals (P < 0.05, each) (OR = 0.075, each) analyzed by multiple logistic regression analysis. For cellular kinetics, transplanted cells remained in the disinfected root canals, while they were not detected in the infected root canals, suggesting their migration through the apical foramen under the influence of inflammation. Conclusions: A true pulp-dentin complex was regenerated in the root canal by the pulp regenerative therapy in mature teeth with apical lesions. The successful pulp regeneration was negatively associated both with residual bacteria and inflammation in the periapical tissue. [ABSTRACT FROM AUTHOR]

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

The objective of this study was to explore the feasibility of current 3D reconstruction in assessing the position of maxillary impacted canines from 2D panoramic X-rays. A dataset was created using pre-treatment CBCT data from a total of 123 patients, comprising 74 patients with impacted canines and 49 patients without impacted canines. From all 74 subjects, we generated a dataset containing paired 2D panoramic X-rays and pseudo-3D images. This pseudo-3D image contained information about the location of the impacted canine in the buccal/lingual, mesial/distal, and apical/coronal positions. These data were utilized to train a deep-learning reconstruction algorithm, a generative AI. The location of the crown of the maxillary impacted canine was determined based on the output of the algorithm. The reconstruction was evaluated using the structure similarity index measure (SSIM) as a metric to indicate the quality of the reconstruction. The prediction of the impacted canine's location was assessed in both the mesiodistal and buccolingual directions. The reconstruction algorithm predicts the position of the impacted canine in the buccal, middle, or lingual position with 41% accuracy, while the mesial and distal positions are predicted with 55% accuracy. The mean SSIM for the output is 0.71, with a range of 0.63 to 0.84. Our study represents the first application of AI reconstruction output for multidisciplinary care involving orthodontists, periodontists, and maxillofacial surgeons in diagnosing and treating maxillary impacted canines. Further development of deep-learning algorithms is necessary to enhance the robustness of dental reconstruction applications. [ABSTRACT FROM AUTHOR]

The presence of high-density and high-atomic number materials results in the generation of artifacts in cone beam computed tomographic (CBCT) images. To minimize artifacts in CBCT images, the metal artifact reduction (MAR) tool was developed. This study aims to quantitatively evaluate the effectiveness of the MAR algorithm in CBCT images of teeth with stainless steel orthodontic brackets with or without arch wires in buccal and lingual positions obtained using the Galileos Sirona CBCT scanner. In this in vitro study, 20 stainless steel brackets were attached to the maxillary dentition from the right second premolar to the left second premolar teeth of a human skull. In the first group, 10 brackets were bonded to the buccal surface, and in the second group, 10 brackets were bonded to the palatal surface of these teeth. CBCT scans were obtained for each group with or without orthodontic stainless steel wires using a Galileos Sirona CBCT scanner with exposure parameters of 85 kVp and 21 mAs. CBCT images were obtained two times with and two times without MAR activation. The DICOM format of the CBCT images was imported to ImageJ software (version 1.54), and the contrast-to-noise ratio (CNR) was calculated and compared for each bracket in 15 and 20 mm distances and 20, 40, and 90 degrees on each side. Statistical analysis was performed using the t test (α = 0.05). CNR values of different distances and different teeth were not significantly different between the two MAR modes (p > 0.05). MAR activation had a significant impact in increasing CNR and reducing artifacts only when brackets were in palatal (p = 0.03). In the other bracket and wire positions, the effect of the MAR algorithm on CNR was not significant (p > 0.05). In conclusion, MAR activation significantly increased CNR, but only when the brackets were in a palatal position. In the other bracket and wire positions, the effect of the MAR algorithm is not significant. [ABSTRACT FROM AUTHOR]

Objective: This retrospective, cross-sectional analytical study investigated the incidence of tooth agenesis in cleft lip and palate (CLP) patients. Cone Beam Computed Tomography (CBCT) radiographs of the CLP children were examined for congenitally missing teeth. Method: This study was conducted at three radiology centers in Lahore, namely, the Pakistan Jinnah MRI and Body Scan Centre, the University of Lahore Radiology Centres, and Fatima Memorial Hospital, from September 2021 to August 2022. The CLP patients were divided into four groups based on the location of the cleft: Cleft Lip and Palate Right (CLPR), Cleft Lip and Palate Left (CLPL), Bilateral Cleft (CLPB), and Midline Cleft (CLPM), inside and outside the cleft region. Two-way ANOVA was employed to compare the means of agenesis. Tukey's test was utilized to ascertain where the difference lies. The significance level was set at p ≤ 0.05. Results: Moreover, a significant number of missing teeth were found inside the cleft. This study observed the CLPL (42.3%) and CLPR (13.6%) types more in number. Maxillary first premolars were found more missing outside the cleft region in CLPL and CLPB types. Although CLPB and CLPM types revealed a pattern of missing teeth, only a few cases were found in this study. Moreover, mean tooth agenesis was highest (4.5 SD.71) in the CLPM group, followed up by CLPB (2.75 SD 2.49), CLPR (1.23 SD 1.27), and CLPL Group (1.15 SD 1.12). Conclusions: Unilateral cleft lip and palate patients reported significant agenesis patttern compared to bilateral and median cleft cases. [ABSTRACT FROM AUTHOR]

This study measured and analyzed chronological changes in temporomandibular joint space volume by compartment following transoral vertical ramus osteotomy (TOVRO) using reconstructed 3-dimensional (3D) images of patients with mandibular prognathism. It included 70 joints of 35 patients who underwent TOVRO between January 2018 and December 2021. Computed tomography (CT) or cone-beam CT (CBCT) was performed before surgery (T0) and at 3 days (T1), 6 months (T2), and 12 months postoperatively (T3). These scans were then analyzed using 3D software. The volumes of the overall (Vjs), anterior (Vajs), posterior (Vpjs), medial (Vmjs), and lateral (Vljs) joint spaces were calculated at each time point. A linear mixed model and repeated-measures covariance pattern with unstructured covariance were used to evaluate significant changes in joint space volume over time. Vjs significantly increased to 134.54 ± 34.28 mm3 at T3 compared to T0 (p < 0.001). Vpjas and Vljs increased by 130.72 ± 10.07 mm3 and 109.98 ± 7.52 mm3 at T3 compared to T0, respectively (p < 0.001). However, no significant difference was observed between T0 and T2 in Vajs and Vmjs (p = 0.9999). The observed volume increases in Vpjs and Vljs appeared to contribute to the overall Vjs increase. [ABSTRACT FROM AUTHOR]

Background: Training senior radiation therapists as "adapters" to manage influencers and target editing is critical in daily online adaptive radiotherapy (oART) for cervical cancer. The purpose of this study was to evaluate the accuracy and dosimetric outcomes of automatic contouring and identify the key areas for modification. Methods: A total of 125 oART fractions from five postoperative cervical cancer patients and 140 oART fractions from five uterine cervical cancer patients treated with daily iCBCT-guided oART were enrolled in this prospective study. The same adaptive treatments were replanned using the Ethos automatic contours workflow without manual contouring edits. The clinical target volume (CTV) was subdivided into several separate regions, and the average surface distance dice (ASD), centroid deviation, dice similarity coefficient (DSC), and 95% Hausdorff distance (95% HD) were used to evaluate contouring for the above portions. Dosimetric results from automatic oART plans were compared to supervised oART plans to evaluate target volumes and organs at risk (OARs) dose changes. Results: Overall, the paired CTV had high overlap rates, with an average DSC value greater than 0.75. The uterus had the largest consistency differences, with ASD, centroid deviation, and 95% HD being 2.67 ± 1.79 mm, 17.17 ± 12 mm, and 10.45 ± 5.68 mm, respectively. The consistency differences of the lower nodal CTVleft and nodal CTVright were relatively large, with ASD, centroid deviation, and 95% HD being 0.59 ± 0.53 mm, 3.6 ± 2.67 mm, and 5.41 ± 4.08 mm, and 0.59 ± 0.51 mm, 3.6 ± 2.54 mm, and 4.7 ± 1.57 mm, respectively. The automatic online-adapted plan met the clinical requirements of dosimetric coverage for the target volume and improved the OAR dosimetry. Conclusions: The accuracy of automatic contouring from the Ethos adaptive platform is considered clinically acceptable for cervical cancer, and the uterus, upper vaginal cuff, and lower nodal CTV are the areas that need to be focused on in training. [ABSTRACT FROM AUTHOR]

Objective. This study aims at investigating a novel super resolution CBCT imaging approach with a dual-layer flat panel detector (DL-FPD). Approach. With DL-FPD, the low-energy and high-energy projections acquired from the top and bottom detector layers contain over-sampled spatial information, from which super-resolution CT images can be reconstructed. A simple mathematical model is proposed to explain the signal formation procedure in DL-FPD, and a dedicated recurrent neural network, named suRi-Net, is developed based upon the above imaging model to nonlinearly retrieve the high-resolution dual-energy information. Physical benchtop experiments are conducted to validate the performance of this newly developed super-resolution CBCT imaging method. Main Results. The results demonstrate that the proposed suRi-Net can accurately retrieve high spatial resolution information from the low-energy and high-energy projections of low spatial resolution. Quantitatively, the spatial resolution of the reconstructed CBCT images from the top and bottom detector layers is increased by about 45% and 54%, respectively. Significance. In the future, suRi-Net will provide a new approach to perform high spatial resolution dual-energy imaging in DL-FPD-based CBCT systems. [ABSTRACT FROM AUTHOR]

To assess the accuracy of CBCT in implant-supported prostheses and to evaluate metal artifacts with and without implants or implant prostheses. Accuracy and artifacts were assessed in the dried mandible at three points on the buccal and lingual cortical plates on the mandible's body near the crest and the base. On the buccal cortical plate, these points were labelled as A, B and C near the crest and D, E and F near the base of the body of the mandible. Similarly, points a to f were marked on the lingual cortical plate corresponding to points A to F. The study had two control groups, C0 for physical linear measurement (PLM) and C1 for radiographic linear measurement (RLM) and artifact assessment. There were seven test groups, TG 1 to 7, progressing from a single implant to implant full-arch prosthesis. For accuracy assessment, PLM was compared to RLM. CBCT artifacts were investigated in images integrated at 0.25 mm, 10 mm, and 20 mm at regions of interest on concentric circles at different intersecting angles by comparing grayscale values at C1 and TG1 to 7. The data were collected and statistically analyzed. A significant difference was observed between C0 and C1, and RLM in test groups at the superior axial plane. Similarly, PLM and test RLM in the sagittal plane at A-B, B-C, and D-E were statistically significant. A significant difference between PLM and RLM was also observed in the vertical plane at A-D, B-E, and C-F. Quantification of CBCT artifacts in the presence of implants or prostheses revealed that full-arch prostheses had the highest mean grayscale value, whereas single implants with a prosthesis had the lowest. The mean grayscale change was greatest around the implant and implant prosthesis. The mean grayscale value was maximum at 20 mm voxel integration scales (VIS) and lowest at 0.25 mm. CBCT is a clinically reliable device. Metal in implants or implant-supported prostheses prevents true assessment of the peri-implant area; therefore, lower VIS is suggested in the presence of implants or implant prostheses. [ABSTRACT FROM AUTHOR]

Jaw cysts commonly affect the oral and maxillofacial region, involving adjacent tooth roots. The management of these teeth, particularly regarding root canal therapy and apicoectomy, lacks consensus. This study introduces a novel treatment concept and refined surgical approach to preserve pulp viability in teeth involved in jaw cysts. The objective was to investigate the effectiveness and potential benefits of this approach over a 36-month follow-up period. A conservative management approach prioritized vitality preservation, reserving root canal treatment and apicectomy for cases with post-operative discomfort. A comprehensive follow-up of 108 involved teeth from 36 jaw cyst cases treated with the modified method was conducted. Clinical observation, X-ray imaging, cone-beam computed tomography (CBCT), and pulp vitality testing assessed changes in cyst size, tooth color, pulp vitality, root structure, and surrounding alveolar bone. After 36 months, our modified surgical approach successfully preserved tooth vitality in 84 involved teeth. Adverse symptoms in 19 teeth, such as redness, swelling, fistula, and pain, resolved with postoperative root canal therapy. Follow-up was lost for five teeth in two cases. No cyst recurrences were observed, and in 34 cases, the bone cavity gradually disappeared, restoring normal bone density during long-term follow-up. Our modified surgical method effectively preserves tooth vitality in jaw cysts. This innovative approach has the potential to improve the management of teeth involved in jaw cysts. [ABSTRACT FROM AUTHOR]

Background: Our study aimed to use three-dimensional (3D) spatial morphological measurement methods to compare the influence of Twin-Block and clear functional aligners on the temporomandibular joint (TMJ) of adolescent Class II division 1 malocclusion mandibular retraction patients. We also aimed to explore the similarities and differences in the effects on the TMJ upon using Twin-Block and clear functional aligner. Methods: Cone-beam computed tomography (CBCT) data of 49 patients with Class II division 1 malocclusion (Twin-Block group: 24; clear functional aligner group: 25) were collected before and after functional orthodontic treatment, and a 3D model of the TMJ was reconstructed using MIMICS 21.0 software. Eighteen measurement parameters, including the anterior, superior, and posterior joint spaces, were measured and compared using the 3D model. Results: After the two groups underwent functional appliance treatment, the height, volume, and surface area of the condyle, length of the mandibular ramus and mandibular length increased; The retro-displaced condyle moved to the middle position of the articular fossa, while the rest of the condylar position did not change significantly. Remodeling of the articular fossa after treatment was not evident. The superior joint space of the clear functional aligner group increased, but there was no significant change after Twin-Block appliances treatment. Conclusions: Both appliances promote condylar growth and sagittal and vertical development of the mandible in adolescent Class II division 1 malocclusion mandibular retraction patients. The length of the mandibular ramus showed a more significant increase following treatment with the Twin-Block appliances than with clear function aligners. [ABSTRACT FROM AUTHOR]

Cone-beam computed tomography was used to understand the possible correlation between the prevalence of distolingual root (DLR) in permanent mandibular first molars (MFMs) and the associated complicated mandibular incisor's root canal morphology (MIs) in an Indian population. A total of 400 scans were evaluated for MFMs and MIs. The prevalence of DLRs and root canal anatomy of MIs were assessed based on Vertucci's classification, and then the sample were grouped according to age, sex and side. Statistical analysis was used to evaluate the possible correlation between the presence of DLRs in the first molar and root canal morphology of incisors. Chi square test was used to evaluate the correlation between the root canal configurations of MIs with the existence of DLRs in MFMs. There was no statistically significant difference between sexes or ages for the prevalence of DLRs in the first molars (p > 0.05), which was 6.62%, with the right side having a greater frequency of DLRs (7.8%) than the left (5.5%). Vertucci Type I canal configuration was most common for the mandibular central (66.75%) and lateral incisors (58.62%). Vertucci Type III was the most common complicated canal morphology, followed by Types V, II, and IV for MIs, with no statistically significant difference in the studied sample's age and sex. (p < 0.05). No association was observed between the presence of DLRs in first molars and complicated root canal configurations in MIs. Taken together, the possibility of complicated root canal configuration in MIs was lesser in the presence of DLRs in MFMs among the Indian population. [ABSTRACT FROM AUTHOR]

The feasibility of full-scan, offset-detector geometry cone-beam CT has been demonstrated for several clinical applications. For full-scan acquisition with offset-detector geometry, data redundancy from complementary views can be exploited during image reconstruction. Envisioning an upright breast CT system, we propose to acquire short-scan data in conjunction with offset-detector geometry. To tackle the resulting incomplete data, we have developed a self-supervised attenuation field network (AFN). AFN leverages the inherent redundancy of cone-beam CT data through coordinate-based representation and known imaging physics. A trained AFN can query attenuation coefficients using their respective coordinates or synthesize projection data including the missing projections. The AFN was evaluated using clinical cone-beam breast CT datasets (n = 50). While conventional analytical and iterative reconstruction methods failed to reconstruct the incomplete data, AFN reconstruction was not statistically different from the reference reconstruction obtained using full-scan, full-detector data in terms of image noise, image contrast, and the full width at half maximum of calcifications. This study indicates the feasibility of a simultaneous short-scan and offset-detector geometry for dedicated breast CT imaging. The proposed AFN technique can potentially be expanded to other cone-beam CT applications. [ABSTRACT FROM AUTHOR]

The process of creating virtual models of dentomaxillofacial structures through three-dimensional segmentation is a crucial component of most digital dental workflows. This process is typically performed using manual or semi-automated approaches, which can be time-consuming and subject to observer bias. The aim of this study was to train and assess the performance of a convolutional neural network (CNN)-based online cloud platform for automated segmentation of maxillary impacted canine on CBCT image. A total of 100 CBCT images with maxillary canine impactions were randomly allocated into two groups: a training set (n = 50) and a testing set (n = 50). The training set was used to train the CNN model and the testing set was employed to evaluate the model performance. Both tasks were performed on an online cloud-based platform, 'Virtual patient creator' (Relu, Leuven, Belgium). The performance was assessed using voxel- and surface-based comparison between automated and semi-automated ground truth segmentations. In addition, the time required for segmentation was also calculated. The automated tool showed high performance for segmenting impacted canines with a dice similarity coefficient of 0.99 ± 0.02. Moreover, it was 24 times faster than semi-automated approach. The proposed CNN model achieved fast, consistent, and precise segmentation of maxillary impacted canines. [ABSTRACT FROM AUTHOR]

Background: Different imaging techniques, such as multi-detector computed tomography (MDCT) scan and cone beam computed tomography(CBCT), are used to check the structure of the nose before rhinoplasty. This study aimed to evaluate the accuracy of two imaging techniques, MDCT scan, and CBCT, in diagnosing structural Variations in rhinoplasty for the first time. Methods: This diagnostic accuracy study was conducted on 64 rhinoplasty candidates who complained of snoring and sleep apnea or had a positive result in the examination with Cottle's maneuver or modified Cottle technique between February 2021 and October 2022 at 15- Khordad Hospital affiliated to Beheshti University of Medical Sciences. Before rhinoplasty, patients were randomly assigned to one of the CT and CBCT techniques with an equal ratio. Scans were assessed for the presence of Nasal septum deviation (NSD), Mucocele, Concha bullosa, and nasal septal spur by two independent radiologists. The findings of the two methods were evaluated with the results during rhinoplasty as the gold standard. Results: NSD was the most common anatomical variation based on both imaging techniques. The accuracy of CBCT for diagnosing Nasal Septum Deviation and Mucocele was 80% and 75%, respectively. The sensitivity, specificity, and accuracy of CBCT in detecting Concha bullosa were 81.3% and 83.3%, respectively. The Kappa coefficient between CBCT and intraoperative findings for diagnosing NSD and Concha Bullosa was 0.76 and 0.73, respectively (p < 0.05). Conclusion: CBCT can be considered a suitable method with high accuracy and quality to evaluate the anatomical variations before rhinoplasty. [ABSTRACT FROM AUTHOR]

Background: To determine the optimal planning target volume (PTV) margins for adequate coverage by daily iterative cone-beam computed tomography (iCBCT)-guided online adaptive radiotherapy (oART) in postoperative treatment of endometrial and cervical cancer and the benefit of reducing PTV margins. Methods: Fifteen postoperative endometrial and cervical cancer patients treated with daily iCBCT-guided oART were enrolled in this prospective phase 2 study. Pre- and posttreatment iCBCT images of 125 fractions from 5 patients were obtained as a training cohort, and clinical target volumes (CTV) were contoured separately. Uniform three-dimensional expansions were applied to the PTVpre to assess the minimum margin required to encompass the CTVpost. The dosimetric advantages of the proposed online adaptive margins were compared with conventional margin plans (7–15 mm) using an oART emulator in another cohort of 125 iCBCT scans. A CTV-to-PTV expansion was verified on a validation cohort of 253 fractions from 10 patients, and further margin reduction and acute toxicity were studied. Results: The average time from pretreatment iCBCT to posttreatment iCBCT was 22 min. A uniform PTV margin of 5 mm could encompass nodal CTVpost in 100% of the fractions (175/175) and vaginal CTVpost in 98% of the fractions (172/175). The margin of 5 mm was verified in our validation cohort, and the nodal PTV margin could be further reduced to 4 mm if ≥ 95% CTV coverage was predicted to be achieved. The adapted plan with a 5 mm margin significantly improved pelvic organ-at-risk dosimetry compared with the conventional margin plan. Grade 3 toxicities were observed in only one patient with leukopenia, and no patients experienced acute urinary toxicity. Conclusion: In the postoperative treatment of endometrial and cervical cancer, oART could reduce PTV margins to 5 mm, which significantly decrease the dose to critical organs at risk and potentially lead to a lower incidence of acute toxicity. [ABSTRACT FROM AUTHOR]

Root resorption is a process that results in the loss of dental hard tissues as a result of odontoclastic action. One of the types of external resorption is external cervical resorption, which usually manifests itself in the cervical aspect of the teeth. Clinically, external root resorption is usually asymptomatic. When external cervical resorption occurs, cervical cavitation, gingival contour irregularity, or pink discoloration of the overlying enamel can often be observed. This case report describes the clinical and radiologic diagnosis (cone beam computed tomography) and treatment of external cervical resorption according to the current guidelines of the European Society of Endodontology. After 4 years, the tooth remained functional and the esthetic effect was satisfactory. [ABSTRACT FROM AUTHOR]

The unique structure of human teeth limits dental repair to custom-made solutions. The production process requires a lot of time and manpower. At present, artificial intelligence (AI) has begun to be used in the medical field and improve efficiency. This study attempted to design a variety of dental restorations using AI and evaluate their clinical applicability. Using inlay and crown restoration types commonly used in dental standard models, we compared differences in artificial wax-up carving (wax-up), artificial digital designs (digital) and AI designs (AI). The AI system was designed using computer calculations, and the other two methods were designed by humans. Restorations were made by 3D printing resin material. Image evaluations were compared with cone beam computed tomography (CBCT) by calculating the root mean squared error. Surface truth results showed that AI (68.4 µm) and digital-designed crowns (51.0 µm) had better reproducibility. Using AI for the crown reduced the time spent by 400% (compared to digital) and 900% (compared to wax-up). Optical microscopic and CBCT images showed that AI and digital designs had close margin gaps (p < 0.05). The margin gap of the crown showed that the wax-up group was 4.1 and 4.3 times greater than those of the AI and digital crowns, respectively. Therefore, the utilization of artificial intelligence can assist in the production of dental restorations, thereby enhancing both production efficiency and accuracy. It is expected that the development of AI can contribute to the reproducibility, efficiency, and goodness of fit of dental restorations. [Display omitted] • Artificial intelligence-designed dental restorations exhibit similar external shapes as those designed by human experts. • Artificial intelligence can reduce the manufacturing time of dental restorations. • The use of artificial intelligence can improve the marginal adaptation. • AI-designed dental restorations may become potential options for clinical selection. [ABSTRACT FROM AUTHOR]

Recent innovations in image guidance, treatment delivery, and adaptive radiotherapy (RT) have created a new paradigm for planning target volume (PTV) margin design for patients with prostate cancer. We performed a review of the recent literature on PTV margin selection and design for intact prostate RT, excluding post-operative RT, brachytherapy, and proton therapy. Our review describes the increased focus on prostate and seminal vesicles as heterogenous deforming structures with further emergence of intra-prostatic GTV boost and concurrent pelvic lymph node treatment. To capture recent innovations, we highlight the evolution in cone beam CT guidance, and increasing use of MRI for improved target delineation and image registration and supporting online adaptive RT. Moreover, we summarize new and evolving image-guidance treatment platforms as well as recent reports of novel immobilization strategies and motion tracking. Our report also captures recent implementations of artificial intelligence to support image guidance and adaptive RT. To characterize the clinical impact of PTV margin changes via model-based risk estimates and clinical trials, we highlight recent high impact reports. Our report focusses on topics in the context of PTV margins but also showcase studies attempting to move beyond the PTV margin recipes with robust optimization and probabilistic planning approaches. Although guidelines exist for target margins conventional using CT-based image guidance, further validation is required to understand the optimal margins for online adaptation either alone or combined with real-time motion compensation to minimize systematic and random uncertainties in the treatment of patients with prostate cancer. [ABSTRACT FROM AUTHOR]