Cone Beam Computed Tomography Research Articles

Evaluation of Secondary Alveolar Bone Grafting for Unilateral Complete Cleft Alveolus: A Retrospective Cone Beam Computed Tomography-Based Study.

Background: In patients with cleft lip and palate (CLP), secondary alveolar bone grafting (SABG) with particulate cancellous bone marrow (PCBM) is recommended. Objective: To compare bone graft outcomes in patients with unilateral CLP, when SABG is completed before or after canine tooth eruption (ACE or BCE), as measured by cone beam computed tomography (CBCT). Methods: Patients were allocated into two cohorts, ACE and BCE. The outcomes were evaluated using CBCT, followed by univariate and multifactorial analyses. Results: A total of 468 patients (age 11.61 ± 4.03 years; male/female 288/180) were analyzed, including 282 in the BCE group (9.41 ± 1.59 years, 175/107) and 186 in the ACE group (14.95 ± 4.31 years, 113/73). Although 5-level assessment revealed no significant difference in clinical success rate (>4 points) between the BCE and ACE groups (53.90% vs. 47.85%, p = 0.20), BCE group showed significantly higher rate of bone bridges formation (73.05% vs. 62.90%, p = 0.02), which can be attributed to variations in orthodontic participation and follow-up time. Independent predictors of graft failure were wide cleft, severe oronasal fistula, no palatal bone wall, and insufficient PCBM filling (p < 0.01). Conclusions: SABG should be performed before canine eruption with more aggressive PCBM filling and oral fistula management.

Does the outcome of graft materials at dental implant sites differ between patients with normal and compromised bone health?

To assess the outcome of bone graft material at alveolar bone augmentation sites combined with dental implants in postmenopausal women with compromised bone health by evaluating cone beam computed tomography (CBCT) scans at multiple time points. CBCT scans were analyzed on 55 postmenopausal women with compromised bone health status to determine the fate of alveolar bone augmentation. CBCT scans were taken immediately after surgery and 9 and 24 months post-operatively. The patient's medication regimens and durations were recorded, and the pixel intensity value (PIV) was measured and standardized using scoring criteria and visual assessment. Statistical analyses included two-sample t-tests for continuous variables and Fisher's exact tests for categorical variables. Among the normal patients, 73% received a grade 2 visual score, and 27% received a grade 1 visual score. After 24 months, 45% of patients received a grade 2 score, and 27% received a grade 3 score. In the osteoporotic group receiving medication, 77% of participants received a grade 1 visual score at the 9-month postoperative evaluation, while 23% received a grade 2 score. At the 24-month assessment, 55% of patients received a grade 1 score, 41% received a grade 2 score, and only 5% received a grade 3 score. Notably, although the graft material did not remodel into native bone, it was a scaffold for implants in controlled osteoporotic patients. The study's results show that the pixel intensity values of particulate graft materials are similar across the three different time points, suggesting that the graft material's pixel intensity value remains constant in postmenopausal women with osteoporosis. The study's limitations include a small sample size and a restricted 24-month follow-up period. This limited time frame may need to capture long-term changes or variations in graft materials adequately. Future research should include a larger sample size and have a longer follow-up duration to provide a more comprehensive understanding of the change in graft materials between patients with normal and compromised bone health.

Biomechanical behavior of implant retained prostheses in the posterior maxilla using different materials: a finite element study.

The aim of this study is to evaluate the biomechanical behavior of the mesial and distal off-axial extensions of implant-retained prostheses in the posterior maxilla with different prosthetic materials using finite element analysis (FEA). Three dimensional (3D) finite element models with three implant configurations and prosthetic designs (fixed-fixed, mesial cantilever, and distal cantilever) were designed and modelled depending upon cone beam computed tomography (CBCT) images of an intact maxilla of an anonymous patient. Implant prostheses with two materials; Monolithic zirconia (Zr) and polyetherketoneketone (PEKK) were also modeled .The 3D modeling software Mimics Innovation Suite (Mimics 14.0 / 3-matic 7.01; Materialise, Leuven, Belgium) was used. All the models were imported into the FE package Marc/Mentat (ver. 2015; MSC Software, Los Angeles, Calif). Then, individual models were subjected to separate axial loads of 300N. Von mises stress values were computed for the prostheses, implants, and bone under axial loading. The highest von Mises stresses in implant (111.6MPa) and bone (100.0MPa) were recorded in distal cantilever model with PEKK material, while the lowest values in implant (48.9MPa) and bone (19.6MPa) were displayed in fixed fixed model with zirconia material. The distal cantilever model with zirconia material yielded the most elevated levels of von Mises stresses within the prosthesis (105MPa), while the least stresses in prosthesis (35.4MPa) were recorded in fixed fixed models with PEKK material. In the light of this study, the combination of fixed fixed implant prosthesis without cantilever using a rigid zirconia material exhibits better biomechanical behavior and stress distribution around bone and implants. As a prosthetic material, low elastic modulus PEKK transmitted more stress to implants and surrounding bone especially with distal cantilever.

A 3D Evaluation of Condyle Position of Skeletal Class I and III Patients: A Cone-Beam Computed Tomography Technique

Purpose: The present study aims to assess the differences in the condyle position for two skeletal classes using Cone-Beam Computed Tomography (CBCT) reconstructions for both sides and genders.&#x0D; Materials and Methods: In this cross-sectional descriptive study, the CBCT images of 96 patients (20-60 years) were assessed. The participants were divided according to their Angle malocclusion classifications (Angle Classes I and III). The variables of the Anterior-Posterior position of the Condyle (APC), condylar angle in the axial plane (ACA), the Lateral Position of the Condyle in the axial plane (LPC), the Vertical Position of the Condyle (VPC), condylar angle in coronal dimension (CCA), and the difference of APC and VPC on both sides were measured. The measurements were analyzed using a one‑way ANOVA and Tukey’s post hoc test.&#x0D; Results: The variables of APC, LPC, ACA, VDC, and the difference of the APC on both sides in the two skeletal classes were similar. The VPC and CCA were greater in Class III than in Class I. All variables representing the 3D position of the condyle were similar in men and women, as well as on the right and left in both skeletal classes, I and III.&#x0D; Conclusion: Based on the 3D evaluation results of the condylar position, the skeletal classes III and I differed in the VPC and CCA; however, for the rest variables, there were no statistical differences.

Comparison of Nasal Dimensions According to the Facial and Nasal Indices Using Cone-Beam Computed Tomography

The nasal cavity constitutes the foremost portion of the respiratory system, composed of the anterior nasal aperture, nostrils, and choanae. It has an intricate anatomical structure since it has various functions, such as heat exchange, humidification, and filtration. Accordingly, clinical symptoms related to the nose, such as nasal congestion, snoring, and nasal septal deviation, are closely linked to the complex anatomical structure of the nasal cavity. Thus, the nasal cavity stands as a paramount structure in both forensic and clinical contexts. The majority of relevant studies have performed comparisons between sexes, with studies making comparisons according to the FI and NI only and examining relative percentages. Furthermore, the nasal cavity was measured in 2D, and not 3D, in most cases. In this study, we conducted a 3D modeling and anthropometric assessment of the nasal cavity using a 3D analysis software. Furthermore, we aimed to investigate whether the size of the nasal cavity differs according to sex, facial index (FI), and nasal index (NI). We retrospectively reviewed the cone-beam computed tomography (CBCT) data of 100 participants (50 males, 50 females) aged 20–29 years who visited the dental hospital of Dankook University (IRB approval no. DKUDH IRB 2020-01-007). Our findings showed that nasal cavity sizes generally differed according to sex, FI, and NI. These findings provide implications for performing patient-tailored surgeries in clinical practice and conducting further research on the nasal cavity. Therefore, we believe that our study makes a significant contribution to the literature.

A Novel Diagnostic and Treatment Approach to an Unusual Case of Dens Invaginatus in a Mandibular Lateral Incisor Using CBCT and 3D Printing Technology

Background: This case report demonstrates the use of three-dimensional (3D) models produced from a cone beam computed tomographic (CBCT) volume to develop a treatment strategy for a rare type of dens invaginatus (DI) in a mandibular incisor. Methods: A patient with DI Type IIIa presented for endodontic treatment. Following CBCT evaluation, the complex morphologic nature of the invagination required additional diagnostic tools for treatment planning. The fabrication of 3D models provided clarity regarding the treatment strategy. Treatment involved intracanal medication with calcium hydroxide Ca(OH)2, nonsurgical root canal therapy (NS-RCT) of the main canal, and endodontic surgery for the DI anomaly using mineral trioxide aggregate (MTA), bone graft, and platelet-rich fibrin (PRF) membrane. Results: The use of 3D models provided an invaluable guide for proper treatment. Complicating factors were diagnosed and planned for accordingly. Conclusions: It is difficult to appreciate the anatomical complexity, the extent, and the nature of the invagination of rare Type III DI morphology. CBCT imaging and 3D models played a critical role in the pre-treatment planning to ensure a predictable outcome. A 3D model is recommended as a diagnostic tool in treating complex cases where the DI morphology is wide, oblique, or the foraminal opening is irregular.

Identification and classification of pulp calcifications in posterior teeth according to dental condition using digital panoramic radiography and cone beam computed tomography.

To compare digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) in the detection and classification of pulp calcifications in posterior teeth in relation to tooth condition and its location. 250 patients with simultaneous DPR and CBCT scans were selected from a dental image bank. For each posterior tooth, its condition was registered (healthy, restored, or decayed). The presence of calcifications was assessed and classified according to location (coronal or radicular) and type (total obliteration, partial obliteration, narrowing, and no calcification). Chi-square and McNemar tests were used to compare DPR and CBCT results, with a significance level of 5%. DPR diagnostic values were calculated using CBCT as reference. Decayed and restored teeth showed a significantly (p < 0.001) higher prevalence of pulp calcifications than healthy teeth in both imaging exams. There was a significant discrepancy between the imaging modalities in the identification of calcifications (p < 0.001), especially for radicular calcifications of maxillary teeth (DPR = 55.2%; CBCT = 30.9%). In the case of coronal calcifications, there was a greater discrepancy between CBCT and DPR in the mandibular teeth (10.7%) than in the maxillary teeth (7.7%). Overall, DPR presents higher sensitivity (0.855) than specificity (0.483) for pulp calcifications detection. DPR considerably overestimates pulp calcifications in posterior teeth, as compared to CBCT. A higher prevalence of pulp calcifications is related to decayed and restored teeth.

PPA-SAM: Plug-and-Play Adversarial Segment Anything Model for 3D Tooth Segmentation

In Cone Beam Computed Tomography (CBCT) images, accurate tooth segmentation is crucial for oral health, providing essential guidance for dental procedures such as implant placement and difficult tooth extractions (impactions). However, due to the lack of a substantial amount of dental data and the complexity of tooth morphology in CBCT images, the task of tooth segmentation faces significant challenges. This may lead to issues such as overfitting and training instability in existing algorithms, resulting in poor model generalization. Ultimately, this may impact the accuracy of segmentation results and could even provide incorrect diagnostic and treatment information. In response to these challenges, we introduce PPA-SAM, an innovative dual-encoder segmentation network that merges the currently popular Segment Anything Model (SAM) with the 3D medical segmentation network, VNet. Through the use of adapters, we achieve parameter reuse and fine-tuning, enhancing the model’s adaptability to specific CBCT datasets. Simultaneously, we utilize a three-layer convolutional network as both a discriminator and a generator for adversarial training. The PPA-SAM model seamlessly integrates the high-precision segmentation performance of convolutional networks with the outstanding generalization capabilities of SAM models, achieving more accurate and robust three-dimensional tooth segmentation in CBCT images. Evaluation of a small CBCT dataset demonstrates that PPA-SAM outperforms other networks in terms of accuracy and robustness, providing a reliable and efficient solution for three-dimensional tooth segmentation in CBCT images. This research has a positive impact on the management of dentofacial conditions from oral implantology to orthognathic surgery, offering dependable technological support for future oral diagnostics and treatment planning.

Evaluation of Motion Artifact Correction Technique for Cone-Beam Computed Tomography Image Considering Blood Vessel Geometry

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

Differential diagnosis of cemento-osseous dysplasia and periapical cyst using texture analysis of CBCT

BackgroundRadiolucencies found at the root apex in patients with cemento-osseous dysplasia (COD) may be mistaken for periapical cysts (PC) of endodontic origin. The purpose of this study was to examine the utility of quantitative texture analysis using cone-beam computed tomography (CBCT) to differentiate between COD and PC.MethodsPatients who underwent CBCT at Wonkwang University Daejeon Dental Hospital between January 2019 and December 2022 and were diagnosed with COD and PC by clinical, radiologic, and, if necessary, histopathologic examination were included. Twenty-five patients each were retrospectively enrolled in the COD and PC group. All lesions observed on axial CBCT images were manually segmented using the open-access software MaZda version 4.6 to establish the regions of interest, which were then subjected to texture analysis. Among the 279 texture features obtained, 10 texture features with the highest Fisher coefficients were selected. Statistical analysis was performed using the Mann-Whitney U-test, Welch’s t-test, or Student’s t-test. Texture features that showed significant differences were subjected to receiver operating characteristics (ROC) curve analysis to evaluate the differential diagnostic ability of COD and PC.ResultsThe COD group consisted of 22 men and 3 women, while the PC group consisted of 14 men and 11 women, showing a significant difference between the two groups in terms of sex (p=0.003). The 10 selected texture features belonged to the gray level co-occurrence matrix and included the sum of average, sum of entropy, entropy, and difference of entropy. All 10 selected texture features showed statistically significant differences (p<0.05) when comparing patients with COD (n=25) versus those with PC (n=25), osteolytic-stage COD (n=11) versus PC (n=25), and osteolytic-stage COD (n=11) versus cementoblastic-stage COD (n=14). ROC curve analysis to determine the ability to differentiate between COD and PC showed a high area under the curve ranging from 0.96 to 0.98.ConclusionTexture analysis of CBCT images has shown good diagnostic value in the differential diagnosis of COD and PC, which can help prevent unnecessary endodontic treatment, invasive biopsy, or surgical intervention associated with increased risk of infection.

Cone beam computed tomography assessment of maxillary anterior teeth cervix dimensions in healthy adults for optimal anatomic healing abutments.

The abutments produced with circular symmetry failed to accurately replicate the natural teeth's cervical shapes. The purpose of this study was to measure cervical cross-sections of maxillary anterior teeth using cone beam computed tomography (CBCT) images to design anatomic healing abutments. CBCT data of 61 patients were analyzed using Ez3D Plus software. Measurements were taken at the cemento-enamel junction (CEJ) and 1 mm coronal to CEJ for maxillary central incisors, lateral incisors, and canines. Various parameters, including area, perimeter, and eight line segments in the distal (a), disto-palatal (b), palatal (c), mesio-palatal (d), mesial (e), mesio-labial (f), labial (g), and disto-labial (h) directions, were used to describe dental neck contours. The ratios (f/b and h/d) were analyzed, and differences based on sex and dental arch morphology were explored. Significant differences were found in area and perimeter between males and females, but not in f/b and h/d ratios. Differences in the f/b ratio were observed among dental arch morphologies for maxillary central incisors, lateral incisors, and canines. CBCT measurements of cervical cross-sections provide more accurate data for designing anatomic healing abutments. The fabrication of anatomical healing abutments needs to consider the influence of gender on cervical size and to explore the potential effect of arch shape on cervical morphology. The novel method provides detailed measurements for the description of dental cervical contours for patients with bilateral homonymous teeth missing. The measurements of this study could be utilized to design more accurate anatomic healing abutments to create desired morphology of peri-implant soft tissue.

Create virtual dentoskeletal model by superimposing digital dental cast into cone-beam computed tomography scan.

Many artifacts and obstacles associated with cone-beam computed tomography (CBCT) scan can obscure or distort the details of the teeth and occlusal surface, like distorted teeth, streak artifacts, noise, and some malocclusion cases with excessive overlapping between jaws cause decrease the interocclusal space, which can impact diagnosis and treatment planning, and the 3D reconstruction accuracy. Optimizing dental precision by Integrating CBCT scans with other imaging modalities, supply more information to enhance CBCT accuracy, mainly in dental areas with limited clarity. Performing the Structure-from-Motion (SfM) photogrammetry method, using phone camera and photograph studio setup using simple hardware, to digitize the dental casts and obtain an accurate digital dental model. Using this digital dental model to enhance dental precision in the CBCT data by performing the superimposition process, using a surface-based registration method and integration process to create a virtual dentoskeletal model. Evaluate the accuracy and quality of the superimposition results using qualitative (visual inspection) and quantitative measures. The differences between the virtual dentoskeletal model and the reference CBCT model are calculating by the 3D Euclidean distance, the mean ± SD are 0.212 ± 0.169mm and 0.26 ± 0.149mm for the maxilla and mandible, respectively. The color-coded map shows that the two surfaces are similar, but the extremist values are concentrated in the dental region due to the presence of the noise in the reference model and the gingiva in the virtual dentoskeletal model. The resulting virtual dentoskeletal model can be viewed and manipulated on a computer screen, allowing for a detailed analysis of the teeth and supporting structures. The 3D model generated by the SfM photogrammetry technique did well during the superimposition process, representing a reliable method for virtual-based processing such as orthognathic surgery planning and splint design.

Image quality evaluation of a new high-performance ring-gantry cone-beam computed tomography imager.

Newer cone-beam computed tomography (CBCT) imaging systems offer reconstruction algorithms including metal artifact reduction (MAR) and extended field-of-view (eFoV) techniques to improve image quality. In this study a new CBCT imager, the new Varian HyperSight CBCT, is compared to fan-beam CT and two CBCT imagers installed in a ring-gantry and C-arm linear accelerator, respectively.&#xD;&#xD;Approach: The image quality was assessed for HyperSight CBCT which uses new hardware, including a large-size flat panel detector, and improved image reconstruction algorithms. The decrease of metal artifacts was quantified (structural similarity index measure (SSIM) and root-mean-squared error (RMSE)) when applying MAR reconstruction and iterative reconstruction for a dental and spine region using a head-and-neck phantom. The geometry and CT number accuracy of the eFoV reconstruction was evaluated outside the standard field-of-view (sFoV) on a large 3D-printed chest phantom. Phantom size dependency of CT numbers was evaluated on three cylindrical phantoms of increasing diameter. Signal-to-noise (SNR) and contrast-to-noise (CNR) were quantified on an abdominal phantom.&#xD;&#xD;Main results: In phantoms with streak artifacts, MAR showed comparable results for HyperSight CBCT and CT, with MAR increasing the SSIM (0.97 to 0.99) and decreasing the RMSE (62 HU to 55 HU) compared to iterative reconstruction without MAR. In addition, HyperSight CBCT showed better geometrical accuracy in the eFoV than CT (Jaccard Conformity Index increase of 0.02-0.03). However, the CT number accuracy outside the sFoV was lower than for CT. The maximum CT number variation between different phantom sizes was lower for the HyperSight CBCT imager (~100HU) compared to the two other CBCT imagers (~200HU), but not fully comparable to CT (~50HU). &#xD;&#xD;Significance: This study demonstrated the imaging performance of the new HyperSight CBCT imager and the potential of applying this CBCT system in more advanced scenarios by comparing the quality against fan-beam CT.

The Stresses and Deformations in the Abfraction Lesions of the Lower Premolars Studied by the Finite Element Analyses: Case Report and Review of Literature

Background: The purpose of the study was to investigate the behavior of hard dental structures of the teeth with abfraction lesions when experimental occlusal loads were applied. Methods: A 65-year-old patient came to the dentist because she had painful sensitivity in the temporomandibular joints and the lower right premolars. The patient was examined, and cone-beam computed tomography (CBCT) of the orofacial area was indicated. The data provided from the CBCT were processed with Mimics Innovation Suite 17 software to create the desired anatomical area in 3D format. Then, the structural calculation module was used in order to perform a finite element analysis of the lower right premolar teeth. A focused review of articles published between 2014 and 2023 from specialty literature regarding the FEA of premolars with abfraction lesions was also conducted. Results: The parcel area and the cervical third of the analyzed premolars proved to be the most vulnerable areas under the inclined direction of occlusal loads. The inclined application of experimental loads induced 3–4 times higher maximum shears, stresses, and deformations than the axial application of the same forces. Conclusions: FEA can be used to identify structural deficiencies in teeth with abfractions, a fact that is particularly important during dental treatments to correct occlusal imbalances.

Osteoinductive effect of the nanoparticulate form of Cissus quadrangularis ethanolic extract on implant surface in experimental animals

BackgroundThe purpose of this study was to evaluate the effect of nanoparticles (NPs) of a plant extract on implant osseointegration in vivo. NPs of the Cissus quadrangularis (CQ) extract were synthesized. Twenty Wistar rats were included in the study. The test group (n = 5) had NPs-incorporated, the control group (n = 5) had no incorporation of NPs, and the sham group (n = 5) did not have implants placed. The toxicity profile of NPs was carried out by biochemical analysis before and after the implant placement. The rate of integration was assessed using Cone Beam Computed Tomography (CBCT), Digital X-ray, histology, and scanning electron microscopy (SEM) at intervals of 2, 4, and 6 weeks. Statistical significance between the groups was determined by Analysis of Variance (ANOVA) (p < 0.05) and the differences were uncovered with post hoc Tukey’s test.ResultsRadiographs showed that the bone density around implants with NPs was considerably higher than those without NPs. The osteoid seam along the implant surface was found to be considerably higher in the test group. A noteworthy increase was observed in the bone formation around the implants in bone samples belonging to the test group. Comparing the values at different time intervals, the highest serum Alkaline phosphatase (ALP) activity was noted in the test group after six weeks and the lowest serum Acid phosphatase (ACP) activity was documented in the test group after 6 weeks.ConclusionThe test group samples exhibited an osseointegration rate of less than 2 weeks thus demonstrating CQ NPs to be a potent osteoinductive agent.Graphical abstract

Study of the mandibular canal and its surrounding canals by multi-view cone-beam computed tomography

ObjectivesTo determine the mandibular anatomical structures by observing cone-beam computed tomography (CBCT) from multiple angles.Materials and methodsThis retrospective study analyzed 1593 consecutive CBCT images. Ultimately, 95 CBCTs met the inclusion criteria. The mandibular, inferior lingual, and bony canals at the tooth apex were studied by multi-angle observation CBCT. Descriptive statistics were used for statistical analysis.ResultsIt is beneficial to further observe the anastomosis of the mandibular, lingual, and mandibular canals when the course of the mandibular lingual canal is observed on CBCT cross-section. The frequency of the inferior lingual canal anastomosis with the mandibular canal was 43.2% (95% confidence interval (CI) 33, 53.3) in the sample. The mental foramen was located below the long axis of the tooth in a few samples, with an occurrence rate of 29.5% (95% CI 20.1, 38.8). The occurrence rate of various types of the bony canal at the apex of the tooth in canines, first premolars, second premolars, first molars, and second molars under the root apex was recorded through the multi-angle observation of the dental volume reformat (DVR) and three-dimensional (3D) levels in CBCT.ConclusionThis study demonstrates the utility of CBCT imaging in examining mandibular anatomy from multiple angles, providing valuable insights into anatomical variations, and enhancing our understanding of mandibular structures. This research emphasizes the crucial role of meticulous CBCT examination in precisely identifying and understanding key anatomical structures, ultimately reducing the risk of surgical complications.Critical relevance statementBy examining cone-beam computed tomography scans from various perspectives, it is possible to determine the precise position of anatomical structures within the jaw. This allows for a more accurate assessment, reducing the risk of harm to these structures during treatment.Key points• It is crucial to utilize image data effectively to enhance the comprehension of human anatomy.• We captured detailed images of the mandible from different angles and orientations utilizing cone-beam computed tomography (CBCT).• This study provides essential anatomical information for procedural planning to ensure optimal outcomes and patient safety.Graphical

Age estimation by volumetric analysis of teeth using cone beam computed tomography.

To evaluate the feasibility of using the pulp volume (Pv) to total volume (Tv) ratio (Pv:Tv), obtained from cone beam computed tomography (CBCT) scans of single-rooted teeth, for age estimation in a Brazilian population sample. After obtaining approval from the ethics committee, the study commenced by applying inclusion criteria to screen CBCT scans, resulting in a probability-based sample of participants aged 18years and older (ranging from 18 to 82years, with a mean age of 46.44years). A total of 517 single-rooted teeth, including maxillary central incisors (CI), mandibular canines (C), and mandibular first premolars (FP), were chosen based on excellent agreement values (> 0.9). Pv and Tv measurements were conducted using semi-automatic segmentation with ITK-SNAP 3.8 software. Statistical analysis was performed using Jamovi software, with a significance level set at 5% (α = 0.05). A strong negative correlation (r > -0.7) was observed between chronological age and the Pv:Tv ratio across all examined teeth. However, when conducting regression analysis with Pv:Tv data and chronological age as the independent variable, only the mandibular FP teeth exhibited a normal distribution. The resulting linear model demonstrated moderate predictive value (approximately 64%) in explaining the variance in chronological age, but caution should be exercised when interpreting these findings. The method of measuring individual tooth volume using CBCT to estimate chronological age via Pv:Tv has been demonstrated as effective and reproducible within the Brazilian population sample.

Autologous leucocyte and platelet rich in fibrin (L-PRF) – is it a competitive solution for bone augmentation in maxillary sinus lift? A 6-month radiological comparison between xenografts and L-PRF

Maxillary lateral sinus floor elevation, or external sinus lift, is a widespread surgical intervention in the dental field. Insertion of implants in the posterior region of the maxilla often requires reconstruction of the remaining native bone that has insufficient volume.&#x0D; Background and aims. Much of the research published involves using artificial products, like xenografts and resorbable collagen membranes, after a prior Cone Beam Computer Tomography (CBCT) investigation. Nowadays, more accessible access, less financial costs, a biological approach, and faster healing are objectives that surround this procedure. Leucocytes and platelets rich in Fibrin (L-PRF) are a natural component with a high concentration of growth factors. Due to its regenerative properties and lack of complications, it is used in several medical fields, like orthopedics, dermatology, and oral surgery. This retrospective study aims to compare results in bone height and volume obtained through external sinus lift, either by using xenografts or autologous plasma rich in fibrin, by evaluating the quantity of new bone formation from a radiological point of view.&#x0D; Methods. Fifty-eight Caucasian patients were included in this retrospective study; 48 were submitted to xenograft procedure, and 10 were selected for L-PRF grafting material with simultaneous implant placement. Lack of clinical and histological studies performed on patients with L-PRF surgeries limited us in choosing a larger group for the radiological analysis. CBCT evaluation was performed before surgery and 6 months after. All patients selected for the study presented good general and oral health, acute oral and sinus infections excluded; smoking and periodontal disease were also criteria of exclusion. Two operators performed the measurements in pre-established landmarks in different time frames. The two independent groups were compared with the Wilcoxon rank-sum test for quantitative data. Qualitative characteristics were described as counts and percentages. All analyses were performed in an R environment for statistical computing and graphics.&#x0D; Results. Mean bone height gain in the xenograft group in the regions was as follows: 7.44 for the anterior landmark, 12.14 for the median and 8.28 for the distal. The mean group height gained for the L-PRF group was 0.1 anteriorly, -0.18 for the median measurement, and 0.23 distally. We obtained excellent overall reliability for all the height measurements between the two operators.&#x0D; Conclusions. Further studies must be conducted to establish new sets of surgical protocols in case L-PRF alone is found to be a reliable, stable, biological alternative to the well-documented xenografts in external sinus lifts. Radiological results, although promising, must be further applied in long term clinical survival of the implants in the grafted sites. Also, studies combining L-PRF in conjunction with xenograft might bring improved clinical results in terms of reduced postoperative complications and accelerated healing. ng. &#x0D;  

The relation between persistent foramen tympanicum and degenerative bone alterations in temporomandibular joint region.

The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), the relationship of persistent foramen tympanicum (PFT) with degenerative changes in the temporomandibular joint (TMJ) and the presence of pneumatized glenoid fossae and articular eminences. Two experienced oral and maxillofacial radiologists evaluated 510 CBCT scans, from which 94 patients were divided into two groups: G1-patients with PFT and G2-control group. The location of the PFT, presence, or absence of degenerative TMJ changes and morphology were evaluated. Similarly, all images were evaluated for the presence of pneumatized articular eminence and glenoid fossa. The Chi-square test and Fisher's Exact test were used for the categorical variables. A multinomial logistic regression model was performed for subgroup analysis. To assess the estimation-chance occurrence of TMJ alterations the Odds Ratio analysis was used. Statistically significant results were found for erosion, planning, and subchondral cyst. Regarding TMJ morphology, significant results were found for: round, flat, and others. Moreover, it was possible to observe that patients who had the PFT were approximately 48 times more likely to manifest TMJ alterations and approximately 3 times more likely to manifest articular eminence pneumatization. Since individuals who have FTP have a greater chance of having TMJ and PEA changes, it is important for the dental radiologist to be aware of these signs in CBCT scans for a correct diagnosis. CAAE: 34328214.3.0000.0104 (11/30/2014).

The Evaluation of Condylar Position Change in the Asymmetric Mandible Following Sagittal Split Osteotomy.

The change of condyle position following orthognathic surgery affects the stability of treatments. This study aims to assess the correlation between the amount of condyles' position change and the severity of mandibular asymmetry following BSSO. This is a cross-sectional study. Subjects with asymmetric mandibular prognathism following BSSO were studied. Subjects were classified into 2 groups: group 1, subjects had mandibular asymmetry without occlusal cant and underwent BSSO. Group 2, subjects had mandibular asymmetry with occlusal cant and underwent BSSO+ Lefort I osteotomy. The condyle position was evaluated using cone-beam computer tomography (CBCT). Pearson's correlation test was used to assess any correlation between the condyle changes and the change in the mandible in sagittal and anterior-posterior directions. A total of 44 subjects were studied. In group 1, the condyle tilted outward in the deviated condyle and inward in the non-deviated condyle immediately after osteotomy. After 12 months, both condyles showed a rotation relative to the original position. In group 2, the condyles of the deviated sides and non-deviated sides moved inferiorly after surgery (condylar sagging), which was more significant in the non-deviated sides. The condyle rotation was similar to group 1. The severity of asymmetry and occlusal cant correlate with the condylar position change in the two groups. The severity of mandibular asymmetry correlates with the amount of condyles' position change immediately after BSSO. However, the condyles tend to return to their original position 12 months later.