Cone Beam Computed Tomography Study Research Articles

Exploring age and gender variations in root canal morphology of maxillary premolars in Saudi sub population: a cross-sectional CBCT study

BackgroundIn complex teeth like maxillary premolars, endodontic treatment success depends on a complete comprehension of root canal anatomy. The research on mandibular premolars’ root canal anatomy has been extensive and well-documented in existing literature. However, there appears to be a notable gap in available data concerning the root canal anatomy of maxillary premolars. This study aimed to explore the root canal morphology of maxillary premolars using cone-beam computed tomography (CBCT) imaging, considering age and gender variations.MethodsFrom 500 patient CBCT scans, 787 maxillary premolar teeth were evaluated. The sample was divided by gender and age (10–20, 21–30, 31–40, 41–50, 51–60, and 61 years and older). Ahmed et al. classification system was used to record root canal morphology.ResultsThe most frequent classifications for right maxillary 1st premolars were 2MPM1 B1 L1 (39.03%) and 1MPM1 (2.81%), while the most frequent classifications for right maxillary 2nd premolars were 2MPM1 B1 L1 (39.08%) and 1MPM1 (17.85%). Most of the premolars typically had two roots (left maxillary first premolars: 81.5%, left maxillary second premolars: 82.7%, right maxillary first premolars: 74.4%, right maxillary second premolars: 75.7%). Left and right maxillary 1st premolars for classes 1MPM1 and 1MPM1–2−1 showed significant gender differences. For classifications 1MPM1 and 1MPM1–2−1, age-related changes were seen in the left and right maxillary first premolars.ConclusionThis study provides novel insights into the root canal anatomy of maxillary premolars within the Saudi population, addressing a notable gap in the literature specific to this demographic. Through CBCT imaging and analysis of large sample sizes, the complex and diverse nature of root canal morphology in these teeth among Saudi individuals is elucidated. The findings underscore the importance of CBCT imaging in precise treatment planning and decision-making tailored to the Saudi population. Consideration of age and gender-related variations further enhances understanding and aids in personalized endodontic interventions within this demographic.

Anatomical Bone Characteristics of the Buccal Step Insertion Site for Mini-Screw Placement in Orthodontic Treatment: A CBCT Study

Background: To analyze the anatomical characteristics of a posterior area in the mandible localized distally to the second molars and extending in the vestibular direction toward the bony step, which we define as “buccal step”, in a patient with different skeletal patterns for mini-screw insertion. Methods: The sample included 85 CBCT (cone beam computed tomography) records selected from the digital archive. Analysis focused on the buccal step area. Sections were obtained in axial view using reference lines, and measurements of cortical and total bone were taken at specific points M0 (starting point, 6 mm apical from CEJc—cementoenamel junction crest), M2 (located 2 mm posterior to M0 in the apical direction), and M4 (positioned 4 mm posterior to M0 in the apical direction) in both directions. Six measurements were recorded for each scan root plane, assessing cortical and total bone depth. Results: The thickness of the bone increases toward the inside of the mouth at all tested sites (M0, M2, M4), which is good for placing mini-screws. Cortical bone thickness decreases toward the inside of the mouth, with no significant differences among the sites except for M0 vs. M4. People with a particular jaw shape (hypo-divergent) have a thicker cortical bone, indicating that facial structure affects bone thickness. Conclusions: The posterior buccal step insertion site has biomechanical advantages and reduces the risk of damaging roots during mini-screw insertions.

A Cross-Sectional Cone-Beam Computed Tomography Study of Root Canal Morphology and Configuration of Mandibular Premolars in Saudi and Sudanese Subpopulations

Abstract Objective To evaluate and compare the root canal morphology of mandibular premolars in Saudi and Sudanese subpopulations and between males and females within each group using cone-beam computed tomography (CBCT). Materials and Methods A cross-sectional study was done between May 2022 and July 2023. Six hundred premolars from Saudi and Sudanese subpopulations were evaluated using CBCT for their number of roots, type of root canal configuration based on Vertucci's classification, and average canal length measured from the buccal cusp tip to the root end. Statistical Analysis Statistical comparisons were made between males and females within each subpopulation and the two subpopulations using the chi-square test for root number and type of root canal configuration and an independent sample t-test for the canal length. Results Most mandibular premolars in both subpopulations had a single root, with type I root canal configuration. However, Sudanese showed various canal configurations (I, II, III, IV, and V) compared with Saudis, which was statistically significant in the first canal of the first mandibular premolar (p < 0.05). Also, there were statistically significant differences in canal length between Saudi males and females (p < 0.05) and between Saudis and Sudanese (p < 0.05) in the first and second premolars. Conclusion Although most mandibular premolars in Saudi and Sudanese subpopulations exhibited a single root and type I canal configuration, variations exist between and within the groups, highlighting ethnic and gender differences and emphasizing the need for dentists' attention.

Correlation between oral cavity volume and upper airway changes in skeletal Class III patients undergoing bimaxillary orthognathic surgery: a pilot cone-beam computed tomography study

ABSTRACT Objectives To evaluate changes of the upper airway and oral cavity volumes in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery, and to analyze the correlation between postoperative upper airway decrease and the amount of jaw movement and oral cavity volume reduction. Materials and Methods Thirty patients (16 males and 14 females) undergoing bimaxillary surgery were included. Three-dimensional reconstruction of the upper airway and oral cavity were performed using preoperative (T0) and postoperative (T1) (6 months) cone-beam computed tomography scans. Results The volume, sagittal area and minimum cross-sectional area of the upper airway were diminished (P < .001). The decrease in volume and minimum cross-sectional area in the oropharyngeal region of the upper airway were weakly correlated with B-point posterior movement (P < .05). Total oral cavity volume was decreased, with maxillary oral volume increasing and mandibular oral volume decreasing (P < .001). Upper airway decrease was highly correlated with total oral volume reduction and mandibular oral volume reduction, with the most significant correlation being with total oral volume reduction (P < .001). Conclusions Class III bimaxillary surgery reduced the volume, sagittal area, and minimum cross-sectional area of the upper airway as well as oral cavity volume. Upper airway changes were weakly correlated with anterior-posterior mandibular movement but significantly correlated with oral cavity volume changes. Thus, oral cavity volume reduction is a crucial factor of upper airway decrease in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery.

The Use of a New Safe Angle Concept for Immediate Implant Placement in the Anterior Maxilla: A Cross-sectional Cone Beam Computed Tomography Study.

The current cross-sectional study aims to introduce a new method for the labiopalatal positioning and angulation of immediately placed dental implants in the anterior maxilla with relation to the type of abutment used (straight/angled abutment). Cone beam computed tomography scans from the database of a private practice were searched for patients who received immediate implants in anterior maxilla. After superimposition of the initial and post-operative scans, incisal/root angle (IRA), incisal/implant angle (IIA) and the difference between both angles were measured. Furthermore, assessment of whether the implant position would be lying within the safe angle or not. Age, gender, tooth/implant site and type of prosthetic abutment (straight/angled) were retrieved from patients' records. Seventy-four patients with a total of 95 immediate implants were selected for analysis. In regard to the type of abutment, 76 (80%) were straight, while 19 abutments (20%) were angled. Regardless of abutment type, 72 implants (75.8%) lay within the safe angle while 23 implants (24.2%) did not lie within the safe angle. All 19 implants with angled abutments were not lying within the safe angle. There was a statistically significant association between type of abutment, IRA, difference between IIA and IRA, gender and lying within the safe angle (P-value <0.001, OR = 19, P-value <0.001, Effect size = 0.904, P-value <0.001, Effect size = 1.209 and P-value <0.001, OR = 2.995 respectively). There was no statistically significant association between IIA, site or age and lying within the safe angle (P-value = 0.757, Effect size = 0.063, P-value = 0.200, Effect size = 0.184 and P-value = 0.387 Effect size = 0.208, respectively). There was a statistically significant association between IRA, difference between IIA and IRA and type of abutment (P-value = 0.001, Effect size = 0.762, P-value <0.001, Effect size = 1.056, respectively). The Safe Angle Concept can be used as a reliable planning tool to choose the correct IIP position in the anterior maxilla. Applying the safe angle concept will decrease the use of angled abutment for prosthetic correction.

Morphometric analysis of the relationship between maxillary posterior teeth and maxillary sinus floor in central Indian population: A cone-beam computed tomography study

Abstract Background: The relationship between the maxillary sinus (MS) and the root apices of posterior teeth is of significant clinical relevance as it influences the diagnosis and treatment planning when operating in the posterior areas of the maxilla. The aim of this study, therefore, is to assess this anatomic relationship and evaluate the propensity of roots of posterior maxillary teeth to be intruded into the MS space using cone-beam computed tomography (CBCT) scanning. Materials and Methods: One thousand CBCT scans of patients, aged 20 years or above, were analyzed in the study. The distance from the MS floor to the root apices of the posterior teeth was measured and the relationship between the MS and the posterior teeth roots were recorded, based on Kwak’s and Didilescu’s classification. Results: Based on Kwak’s classification, type I configuration was frequently observed in the maxillary posterior teeth, followed by type II. Based on Didilescu’s classification, the longest distance, among premolars, was observed between the palatal root of the left 1st premolar and MS, i.e., 8.2467 mm. Among molars, the longest distance was observed between mesiobuccal root of the right first molar and MS, i.e., 5.8966 mm. The shortest distance, among premolars, was observed between the buccal root of the left second premolar and MS, i.e., 3.5500 mm, and among molars, the shortest distance was between the mesiobuccal root of the left second molar and MS, i.e., 1.3556 mm. Conclusion: From the present study, it may be concluded that, among the central Indian population, mesiobuccal root of the second molars and buccal root of the second premolars show the closest proximity to the MS floor. Therefore, any surgical or endodontic intervention in the vicinity of these roots must be performed with utmost care.

Bizygomatic distance and Bimastoid diameter as predictors for age and sex determination in an Egyptian sample: A cone-beam computed tomography study

Bizygomatic distance and Bimastoid diameter as predictors for age and sex determination in an Egyptian sample: A cone-beam computed tomography study

Mandibular Incisive Canal Morphometry: A Cone-Beam Computed Tomography Study in Jordan

Mandibular Incisive Canal Morphometry: A Cone-Beam Computed Tomography Study in Jordan

A CBCT Study Comparing the Outcomes of Volumetric Bone Mass and Mini-Implant Success with Different Types of Malocclusions

Objective: The present study aimed to determine the favorable site for orthodontic mini-implant insertion in both the maxilla andmandible in terms of cortical and trabecular bone thickness and density in different types of skeletal malocclusion using cone-beamcomputed tomography (CBCT).&#x0D; Methods: In this study, seventy-five CBCT examinations that were requested for different purposes were used, twenty-five in eachmalocclusion group (class I, class II and class III), class I (ANB: 2°-4°), class II (ANB &gt; 4°), and class III (ANB &lt; 2°) groups. RadiAntDicom Viewer was utilized, measurements were done at different sites in the jaws using standardized orientations, and the threemalocclusion groups were compared for cortical bone thickness and density as well as the density of trabecular bone, using the Kruskal-Wallis and Mann-Whitney test for non-parametric data and one-way ANOVA for parametric data.&#x0D; Results: The highest cortical bone thickness was between 1st and 2nd molars at a 6 mm distance from the alveolar crest ranging from1.03 mm to 1.2 mm in maxilla and 2.13 mm to 2.26 mm in the mandible. The difference between groups was only noticed betweencanine and 1st premolar which showed less buccal cortical bone thickness in class II cases with 1.07 mm. Cortical bone density wasnot significantly different between the three groups with maximum density between canine and 1st premolar with a density of 997.9 to1078 HU in the maxilla and the mandible 1245.4 to 1329.3 HU. The trabecular bone density was also highest between canine and 1stpremolar of both jaws, in maxilla 422.13 to 564.15 HU and mandible 509.81 to 799.04 HU. The difference between the groups wasonly in the anterior location between canine and 1st premolars which was less in class III cases with 509.81 HU.&#x0D; Conclusions: Skeletal relations can have an impact on the thickness of the cortical bone, although all skeletal classes have the samepattern in the maxilla, in the mandible between the canine and the 1st premolar, variations in bone thickness and trabecular densitymay be seen in various skeletal malocclusions. So, it is important to properly consider the placement of mini-implants with the skeletalrelation to achieve the maximum primary stability. Further researches are recommended, with long term follow up, on stability of mini-implants and its correlation with bone thickness and density.

Immediate implant placement in the anterior mandible: a cone beam computed tomography study

BackgroundThe placement of implants into the alveolar socket right after tooth extraction is called immediate implant placement (IIP). This approach has its particularities depending on which region of the jaws is involved. The anterior mandible region is peculiar due to the presence of mandibular incisors, which have the shortest roots among all permanent teeth.PurposeThis study aimed to investigate the factors that could be associated with the risk of either cortical bone wall perforation or invasion of the 2 mm secure distance from the surrounding anatomical structures (defined as unsafe implant placement), with IIP in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study.Materials and methodsCBCT exams from 239 eligible subjects were investigated. Implants were virtually placed in two distinct positions: prosthetically-driven (along the long axis of the existing tooth) and bone-driven position (according to the available bone and with regard to nearby anatomical structures). Correlation between several variables was tested, and binary logistic regression analysis in order to assess of the possible associations between covariates and unsafe placement was performed.ResultsSafe placing implants was significantly higher for the bone-driven in comparison to the prosthetically-driven position (22.2% vs. 3.3%, respectively), and the 2-mm secure distance from anatomical structures was not possible to respect in the majority of cases (77.6% vs. 82.9%, respectively). Covariates associated with a higher risk of unsafe placement were tooth region (CI in relation to IL and CA), decrease of labial concavity angle (LCA), decrease of mandible basal bone height (MBBH), and decrease in mandibular bone thickness at the tooth apex level (MBT0).ConclusionThe possibility of safely placing immediate implants in the anterior mandible is significantly higher for bone-driven than in prosthetically driven position. Presurgical virtual planning with CBCT is a great tool for minimizing the risk of implant unsafe placement with regards to the anatomical conditions in the mandible.

Three-dimensional evaluation of interproximal contacts of permanent dentition: a cone beam computed tomography study.

To assess the various patterns of the inter-proximal contact areas of the permanent dentition using the available cone beam computed tomography (CBCT) images. A retrospective cross-sectional study was performed on existing CBCT images from a University hospital and teaching department. Three thousand two hundred and fifty inter-proximal contacts were assessed from 125 existing CBCT scans of patients (age range: 14years 3months-29years 9months) who had matched the eligibility criteria. The types of inter-proximal contacts of the permanent dentition were scored at occlusal, middle, and cervical thirds, according to the OXIS inter-proximal contacts classification. Chi-square test was used to assess the contacts and gender/arches. The most prevalent contact was type I for the posterior teeth contacts, and types S1 and S2 for the anterior teeth contacts. Statistical significance was not observed between the contacts on the left and right sides (P > 0.05), while statistical significance was observed between the inter-proximal contacts of the maxilla and mandible (P < 0.05). The CBCT-based three-dimensional assessment of the inter-proximal contact areas of the permanent dentition is representative of the OXIS classification. The occlusal level contact was predominantly representative of the overall type of the contact.

Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study

ObjectiveTo investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases. Study designOne-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05). ResultsThere was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05). ConclusionMaxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it. Clinical relevanceThere is an association between dental implants’ perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.

Exploring the effect of disc displacement on the risk and severity of condylar erosion in adult temporomandibular disorder patients: A CBCT and MRI study.

The objective of the study was to investigate the relationship between types of disc displacement (DD) diagnosed by magnetic resonance imaging (MRI), and the risk (presence or absence) and severity of condylar erosion (CE) graded using cone-beam computed tomography (CBCT) in adult Temporomandibular disorders (TMD) patients. A total of 353 TMD patients (283 females, 70 males) underwent MRI scans to categorise DD as normal (NA), anterior displacement with reduction (ADDR), or anterior displacement without reduction (ADDNR). CE severity was graded on a scale of 0-3 (absence, mild, moderate or severe) using CBCT. To establish the plausibility and cut-off points for CE diagnosis, the severity of CE was then further divided into three classifications: Grade 0 versus 1 + 2 + 3; Grades 0 + 1 versus 2 + 3; Grades 0 + 1 + 2 versus 3. Logistic regression analysis was performed, adjusting for age, gender and joint correlation. ADDNR significantly increased the risk of CE compared with NA (OR = 10.04, 95% CI: [6.41, 15.73]) and showed a significant increase in CE severity across all classifications (ORs = 10.04-18.95). The effects of ADDNR were significant in both genders (p < .001) and had a greater impact in females. ADDR was predominantly associated with mild CE. ADDNR significantly increased the risk and severity of CE independent of gender when compared to NA, whereas ADDR was mainly associated with mild CE. Slight cortical discontinuity may represent a subclinical diagnosis requiring further investigation.

Relationship of Maxillary Sinus Volume and Nasal Septum Deviation: A Cone Beam Computed Tomography Study.

The present study was designed to test the hypothesis that there would be a correlation between nasal septum deviation (NSD) and a decreased maxillary sinus volume (MSV) in a Colombian population, using Cone Beam Computed Tomography (CBCT); other sinusal anatomical structures found during the reading were described and analyzed. A retrospective analysis of 537 CBCT scans of adult patients taken between January 2014 and January 2017 included measuring the maxillary sinus diameter in the vertical, horizontal, and sagittal planes. NSD was quantified and related to MSV using the same field of view (FOV). The volume of the right and left maxillary sinuses showed a median and interquartile range (IQR) of 8.18 mm3 (IQR: 6.2-10.33) and 8.3 mm3 (IQR: 6.4-10.36). Statistically significant differences were observed between sex and right and left MSV (p = 0.000), with higher MSV in men. The presence of NSD was observed in 96.81% of the sample and was evaluated in degrees, observing a median of 11° (IQR: 7-16) where 40% of the sample had moderate angles (9-15°). There was no correlation between NSD and a decreased MSV in the population studied. Detailed CBCT analysis with a large FOV is crucial for the analysis of anatomical structures before performing surgical procedures that involve the MS as a preventive diagnostic and therapeutic step for appropriate treatment.

Assessment of the root and canal morphology in the permanent dentition of Saudi Arabian population using cone beam computed and micro-computed tomography – a systematic review

IntroductionRoot canal treatment procedures require a thorough understanding of root and canal anatomy. The purpose of this systematic review was to examine the morphological differences of teeth root and their canals assessed using cone-beam computed and micro-computed tomography in Saudi Arabian population.MethodologyAn electronic search was conducted in PubMed / Medline, Scopus, Google Scholar, and Web of Science databases until January 2023 to retrieve related studies. “Root canal morphology,” “Saudi Arabia,” “Micro-CT,” and “cone-beam computed tomography” were used as keywords. A modified version of previously published risk of bias assessment tool was used to determine the quality assessment of included studies.ResultsThe literature search revealed 47 studies that matched the criteria for inclusion, out of which 44 studies used cone beam computed tomography (CBCT) and three were micro-computed tomography (micro-CT) studies. According to the modified version of risk of bias assessment tool, the studies were categorized as low, moderate, and high risk of bias. A total of 47,612 samples were included which comprised of either maxillary teeth (5,412), or mandibular teeth (20,572), and mixed teeth (21,327). 265 samples were used in micro-CT studies while 47,347 teeth samples were used in CBCT studies. Among the CBCT studies, except for three, all the studies were retrospective studies. Frequently used imaging machine and software were 3D Accuitomo 170 and Morita’s i-Dixel 3D imaging software respectively. Minimum and maximum voxel sizes were 75 and 300 μm, Vertucci’s classification was mostly used to classify the root canal morphology of the teeth. The included micro-CT studies were in-vitro studies where SkyScan 1172 X-ray scanner was the imaging machine with pixel size ranging between 13.4 and 27.4 μm. Vertucci, Ahmed et al. and Pomeranz et al. classifications were applied to classify the root canal morphology.ConclusionThis systematic review revealed wide variations in root and canal morphology of Saudi population using high resolution imaging techniques. Clinicians should be aware of the common and unusual root and canal anatomy before commencing root canal treatment. Future micro-CT studies are needed to provide additional qualitative and quantitative data presentations.

Multilevel Modeling Analysis of Odontogenic Risk Factors and Nasal Septum Deviation Associated with Maxillary Sinus Mucosal Thickening: A Cone-Beam Computed Tomography Study.

(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted.

SADMFR guidelines for the use of Cone-Beam Computed Tomography/ Digital Volume Tomography

Cone-Beam Computed Tomography (CBCT) has been introduced in 1998. This radiological imaging procedure has been provided for dentistry and is comparable to computed tomography (CT) in medicine. It is expected that CBCT will have the same success in dental diagnostic imaging as computed tomography had in medicine. Just as CT is responsible for a significant rise in radiation dose to the population from medical X-ray diagnostics, CBCT studies will be accompanied by a significant increase of the dose to our patients by dentistry. Because of the growing concern for an uncritical and consequently rapidly increasing use of CBCT the Swiss Society of Dentomaxillofacial Radiology convened a first consensus conference in 2011 to formulate indications for CBCT, which can be used as guidelines. In this meeting, oral and maxillofacial surgery, orthodontics and temporomandibular joint disorders and diseases were treated and the most important and most experienced users of DVT in these areas were asked to participate. In general, a highly restrictive use of CBCT is required. Justifying main criterion for CBCT application is that additional, therapy-relevant information is expected that should lead to a significant benefit in patient care. All users of CBCT should have completed a structured, high-level training, just like that offered by the Swiss Society of Dentomaxillofacial Radiology.

Bone Trabecular Pattern Analysis in Odontogenic Cysts Using Cone Beam Computed Tomography: A Clinical Retrospective Study.

Introduction The cysts of the maxillofacial region account for one of the most common pathologies of the head and neck region after the mucosal pathologies. Radiography provides an essential clue in early diagnosis and triaging, but it continues further as it is used to evaluate the post-treatment outcome. However, manual analysis is prone to errors. In this scenario, fractal analysis (FA) in radiographs uses mathematical methods to analyse the changes in grey scales in a given radiographic image. FA in odontogenic cysts is used to characterise their complexity, uncover hidden patterns, monitor treatment response, and potentially provide prognostic information. This paper aimed to assess the fractal characteristics of the radicular cyst (RC), dentigerous cyst (DC), and odontogenic keratocyst (OKC) using cone beam computed tomography (CBCT). The objective was to calculate fractal dimension (FD) values expressed in each of these cysts, which could prove to be a radiological adjunct in diagnosing the above cysts. Materials and methods As this is a retrospective study, the archives of CBCT images from June 2021 to December 2023 were obtained from patients diagnosed and confirmed with a histopathological diagnosis with RC, DC, and OKC. The FA was performed using Image J Software(Ver 1.51, National Institute ofHealth Bethesda, Fiji). The cortical and cancellous bones were segmented using thresholding techniques and converted to binary images. The mean FD of the three planes was then compared to establish the distinctive fractal characteristic for the specific odontogenic cysts. A one-way ANOVA was performed using the Statistical Product and Service Solutions (SPSS) (version 23.0; IBM SPSS Statistics for Windows, Armonk, NY) to determine the difference between FD values of RC, DC, and OKC with a significance level less than 0.05. Results The FD values of DC, RC, and OKC were 1.33 ± 0.17, 1.08 ± 0.16, and 1.65 ± 0.12, respectively. The results indicated that OKC had higher FD values than DC and RC, which means that OKC had lesser bone destruction compared to DC and RC. Inferential statistics showed that the one-way ANOVA was used to compare the means of the three groups of FD data. When calculated for the three groups, the F-statistic value was at 7.29, which yielded a P value of 0.03, making it statistically significant for a 95% confidence interval (p<0.05). Conclusion Our CBCT study on bone trabecular pattern analysis using FD and FAin odontogenic cysts reveals distinct alterations in bone parameters among different cyst types. The probability of higher FD values in OKC is because of lesser cortical bone destruction in OKC compared to the other cyst types. These findings have potential implications for diagnosing, treating, and prognosticating odontogenic cysts.

Clinical Super-Resolution Computed Tomography of Bone Microstructure: Application in Musculoskeletal and Dental Imaging

PurposeClinical cone-beam computed tomography (CBCT) devices are limited to imaging features of half a millimeter in size and cannot quantify the tissue microstructure. We demonstrate a robust deep-learning method for enhancing clinical CT images, only requiring a limited set of easy-to-acquire training data.MethodsKnee tissue from five cadavers and six total knee replacement patients, and 14 teeth from eight patients were scanned using laboratory CT as training data for the developed super-resolution (SR) technique. The method was benchmarked against ex vivo test set, 52 osteochondral samples are imaged with clinical and laboratory CT. A quality assurance phantom was imaged with clinical CT to quantify the technical image quality. To visually assess the clinical image quality, musculoskeletal and maxillofacial CBCT studies were enhanced with SR and contrasted to interpolated images. A dental radiologist and surgeon reviewed the maxillofacial images.ResultsThe SR models predicted the bone morphological parameters on the ex vivo test set more accurately than conventional image processing. The phantom analysis confirmed higher spatial resolution on the SR images than interpolation, but image grayscales were modified. Musculoskeletal and maxillofacial CBCT images showed more details on SR than interpolation; however, artifacts were observed near the crown of the teeth. The readers assessed mediocre overall scores for both SR and interpolation. The source code and pretrained networks are publicly available.ConclusionModel training with laboratory modalities could push the resolution limit beyond state-of-the-art clinical musculoskeletal and dental CBCT. A larger maxillofacial training dataset is recommended for dental applications.

A cone-beam computed tomography study of canalis sinuosus and its accessory canals in a South African population

Abstract Objectives Canalis sinuosus (CS) is a clinically relevant structure in the anterior maxilla. The present study aimed to determine the prevalence and distribution of CS and its accessory canals (ACs) in the South African population and describe its anatomical variations. Methods In total, 500 cone-beam computed tomography (CBCT) scans of the anterior maxilla were assessed for prevalence, sidedness, diameter, and distribution of CS. The frequency, number, diameter, configuration, and point of termination of ACs were also recorded. Statistical analysis was performed using analysis of variance, Kruskal–Wallis, chi-squared, and Fisher Exact tests with P &lt; 0.05. Results CS was present in most cases (99.6%), and commonly occurred bilaterally (98.8%). The mean diameter of CS was 1.08 mm (range: 0.50 mm–2.39 mm). Sex, population group, and age had no significant effect on the prevalence or sidedness of CS. Additionally, 535 ACs were observed in 58.8% of the sample, with 42.9% of ACs found bilaterally and 57.1% unilaterally. The mean diameter of the ACs was 0.86 mm on the left and 0.87 mm on the right (range; 0.50 mm–1.52 mm). The majority of ACs maintained a straight vertical configuration (72.3%). ACs most commonly terminated in the anterior palatal region of the maxilla (57.2%). No significant differences were found in any groups mentioned (P &gt; 0.05). Conclusions A high prevalence of CS as well as ACs were observed in the sample population. Due to their clinical significance, surgical planning with the aid of high quality CBCT scans of the anterior maxilla is advisable.