ABSTRACT Objective This methodological study aimed to evaluate the technical feasibility and accuracy of a semi-automatic cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) registration technique for the anatomical classification of TMJ disc displacement. Method A total of 61 patients (122 TMJ images) with existing clinical indications for both CBCT (suspected osseous pathology) and MRI examinations were included. Images were processed using a semi-automatic registration system (3D Slicer version 5.2.1, integrated with the Insight Segmentation and Registration Toolkit), combining rigid and elastic transformation algorithms with mutual information metrics. Manual adjustments were required in cases where automatic registration did not meet predefined accuracy thresholds. Diagnostic performance was evaluated by comparing fused CBCT–MRI images with traditional MRI-only assessments. Result The registration accuracy showed high precision, with a Dice similarity coefficient of 0.89 ± 0.04 (range 0.85–0.95) and target registration error of 0.72 ± 0.14 mm (range 0.45–0.79 mm). Manual adjustment was required in 18% of cases to achieve these accuracy levels. The fused images demonstrated superior diagnostic performance, with a sensitivity of 95%, specificity of 93% and area under the receiver operating characteristic curve (AUC) of 0.94, significantly outperforming the MRI-only diagnosis (sensitivity 80%, specificity 89%, AUC 0.82; p < 0.05). Based on the disc–condyle angle and disc–condyle distance, the proposed four-grade classification system showed excellent inter-observer consistency (Cohen’s Kappa = 0.85) and an intraclass correlation coefficient of 0.88. Conclusion This methodological study demonstrates the technical feasibility of semi-automatic CBCT–MRI registration for the anatomical characterisation of TMJ disc displacement. Although the technique offers improved anatomical visualisation and measurement objectivity compared with single-modality imaging, its clinical implementation requires careful consideration of radiation exposure (particularly in young patients), cost–benefit analysis and alignment with current evidence indicating that clinical symptoms rather than disc position primarily guide TMD treatment decisions. This approach may have utility in research settings, complex diagnostic scenarios or surgical planning, where both osseous and soft tissue visualisation is already clinically indicated; however, it should not be adopted as routine diagnostic practice for patients with TMD.

Surgical scarring has long been hypothesized to contribute to maxillary hypoplasia in patients with cleft lip and palate (CLP), often leading to a need for orthognathic surgery (OGS). This study aimed to identify clinical and surgical factors associated with maxillary hypoplasia in skeletally mature patients with CLP using cephalometric analysis. A retrospective review was performed of CLP patients aged ≥16 years with available cone beam CT scans. Cephalometric measurements were obtained using Mimics software. Patient records were reviewed for cleft morphology, number and type of cleft-related surgeries (ages 0-16), surgical timing, demographics, and history of OGS. Linear and logistic regressions were used to evaluate predictors of maxillary hypoplasia and OGS. Among 106 patients, 47.2% had bilateral CLP and 49.1% underwent OGS. The average number of cleft-related surgeries was 4.28. BCLP patients demonstrated significantly reduced maxillary width compared to UCLP (-2.87 mm, p = 0.001). Increasing total number of surgeries was significantly associated with decreased SNA, ANB, and facial convexity angles (p < 0.001). Surgeries performed between ages 0-5 were significantly associated with decreased SNA, facial convexity angle, and alveolar length (p < 0.02). Linear regression showed that each surgery beyond three predicted a 1.94° reduction in SNA, 0.81° reduction in ANB, and 2.82° reduction in facial convexity angle. Surgical burden was not predictive of OGS. Greater number of cleft-related surgeries, particularly in early childhood, correlates directly with maxillary growth restriction. These findings highlight the importance of optimizing surgical timing and minimizing additional interventions when feasible.

Ultra-low-dose cone-beam CT for cleft and craniofacial deformity surgery: radiation reduction and clinical applicability.

Introduction Accurate dose calculation is essential in breast cancer radiotherapy. This study aimed to evaluate the feasibility and accuracy of cone-beam CT (CBCT) images with HU–relative electron density (HU-RED) correction for dose calculation in left-sided breast cancer radiotherapy. Methods Twenty postoperative patients receiving adjuvant radiotherapy at Subei People’s Hospital of Jiangsu Province (Yangzhou, China) from January 2022 to December 2024 were retrospectively enrolled. A patient-specific HU-RED calibration curve was generated using an improved density override method. Treatment plans created on planning CT (pCT) were transferred to CBCT for dose recalculation with identical optimization parameters. Dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) were compared. Two-dimensional gamma analysis was performed to assess dose consistency. Equivalence between CBCT- and pCT-based dose calculations was further evaluated using the two one-sided tests (TOST), Lin’s concordance correlation coefficient (CCC), intraclass correlation coefficient (ICC), and Bland–Altman analysis. Results Differences in PTV dosimetric indices (D2, D50, D98, Dmean, HI, CI) between CBCT- and pCT-based plans were small, with mean deviations &amp;lt;1.3% and no statistically significant differences ( P &amp;gt; 0.05). OAR parameters, including cardiac Dmean, V20, V30, V50 and lung Dmean, V20, V30, also showed minimal variation (&amp;lt;1.5%), with the largest deviation observed in cardiac V20 (2.1% in a single case). Gamma analysis revealed high agreement between both plans, with passing rates exceeding 90% for both the 3%/3 mm and 2%/2 mm criteria. Equivalence testing demonstrated statistical equivalence between CBCT- and pCT-based dose calculations for all PTV parameters and most OAR metrics. All 90% confidence intervals fell entirely within predefined equivalence margins (Δ), and all TOST P -values were &amp;lt;0.05. Lin’s CCC and ICC(A,1) exceeded 0.96 for all parameters, indicating excellent consistency, while Bland–Altman analyses showed minimal bias and narrow limits of agreement. Discussion CBCT images corrected with HU-RED calibration achieved highly consistent dose calculation results compared with pCT in left-sided breast cancer radiotherapy. This method is feasible for clinical dose verification and may support future adaptive radiotherapy strategies, particularly with the integration of artificial intelligence techniques.

Guidelines recommend non-surgical biopsy for indeterminate pulmonary lesions > 8 mm. Shape-sensing robotic-assisted bronchoscopy (ssRAB) is growing in use to biopsy small pulmonary nodules; however current literature is limited to single center studies with limited follow-up. This study, PRECIsE, assessed safety and performance of the first ssRAB iteration across multiple sites and nascent users. Prospective, multicenter, observational study evaluating ssRAB without cone-beam CT guidance in patients with nodules 10-30 mm located in or beyond the sub-segmental airways. Patients were followed for 2 years; the primary endpoint was sensitivity for malignancy with diagnostic yield, and safety as secondary endpoints. Multilevel logistic regression models were used to control for factors associated with sensitivity and diagnostic yield. A total of 305 procedures were performed across 6 centers. Median nodule size was 17.0 mm (IQR: 14.0-23.0) with bronchus sign present in 37% of cases. Sensitivity for malignancy through 2 years was 81.3% (95% CI: 75.7, 86.1). Multi-level modelling demonstrated female sex, smaller nodule size, lower lobe location, semi-solid density, and higher body-mass-index were associated with lower sensitivity. Diagnostic yield was 74.1% (95% CI: 68.8, 78.9) according to the ATS/ACCP criteria and 77.5% [95% CI: 72.4, 81.8] according to the intermediate criteria. Multi-level modeling demonstrated a non-significant site/center level effect on ATS/ACCP diagnostic yield (P = .36). Pneumothorax requiring intervention was 1.6% (5/305); bleeding was 1.0% (3/305) with two (2) Nashville grade 2 and one (1) Nashville grade 3 events. The first iteration of ssRAB demonstrated encouraging performance and a strong safety profile among nascent users for the biopsy of small peripheral nodules.

The aim of this study was to evaluate trabecular bone structure in periodontal disease using fractal dimension (FD) and lacunarity analysis (LA) in cone-beam computed tomography (CBCT). A total of 120 CBCT images from the archives of our college were collected after applying inclusion and exclusion criteria. Regions of interest were preprocessed and subjected to fractal analysis and LA using the ImageJ software and statistical comparisons were performed between healthy individuals and periodontitis patients. Lacunarity values were significantly greater (p &lt; 0.001) and FD values were significantly lower in patients with periodontitis than in healthy controls. Differences by gender were noted, with larger lacunarity values seen in females in the periodontitis group. In cases of periodontitis, FD and lacunarity were found to be inversely correlated by Kendall's tau correlation. Increased heterogeneity and decreased trabecular bone complexity are linked to periodontitis. Even before severe bone loss is radiographically apparent, FD and LA on CBCT images can identify modest trabecular alterations. In the context of periodontal care, these measures can be sensitive supplementary instruments for early diagnosis, disease surveillance, and treatment planning.

AI-driven gingival segmentation on CBCT: Validation using delineation by intraoral scanning and CBCT-based cotton roll separation.

The match 2 study: Robotic assisted bronchoscopy with integrated imaging with assessment of digital tomosynthesis (DT) and augmented fluoroscopy (AF): Three-Dimensional accuracy as confirmed by cone beam computed tomography (CBCT).

Diagnostic imaging is essential in veterinary practice, and cone-beam computed tomography (CBCT) has emerged as a promising tool to complement radiography. This study aimed to optimize the image quality of a novel multimodality veterinary X-ray prototype integrating direct digital radiography, fluoroscopy and CBCT, and to assess its potential clinical applications, focusing on the CBCT component. The study was conducted in three phases: optimization of CBCT image quality using postmortem samples, comparison of CBCT and 16-slice multidetector CT (MDCT) images of four cadavers (two dogs and two cats), and potential clinical applications in 24 live patients. Comparative evaluation in postmortem scans revealed that CBCT achieved equal quality in 65% of bone compared to MDCT and a slightly inferior quality in 90% of soft-tissue structures using the bone reconstruction protocol, with beam hardening as the main limiting factor. Clinical validation showed that CBCT was particularly useful for identifying small fractures and mineralized structures, providing diagnostic information not clearly visible on radiographs. Integration of radiography, fluoroscopy, and CBCT in a single device facilitated workflow and allowed a more precise diagnosis in most of the patients examined with the prototype, which demonstrated promising diagnostic performance in small-animal and exotic veterinary practice.

Introduction: Digital impressions are dental scans captured using Three-dimensional (3-D) scanning technology. Scanning deeper areas can affect the accuracy and completeness of the digital impression, potentially leading to inaccuracies in the final restoration. Scanning post spaces at greater depths and narrower diameters can pose significant challenges for digital scanning. Aim: To compare the volume of post space impressions made using the digital impression technique (Primescan/Dentsply Sirona) with the volume obtained from Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: The present in-vitro study was conducted between January and April 2025 in the Department of Conservative Dentistry and Endodontics at DAPM RV Dental College, Bengaluru, Karnataka, India. A total of 15 extracted single-canal, single-rooted permanent teeth were collected for this in-vitro study. All the teeth were cut coronally to maintain an equal length of 22 mm. Endodontic treatment was performed on all the teeth, followed by post space preparation, leaving behind 5 mm of gutta-percha. Group A: A CBCT reference scan was performed for all the samples; the volume of the post space was measured using on-demand software for each tooth, which served as a control. Group B: The same samples were subjected to a digital impression (Primescan/Dentsply Sirona), and the volume of the post space was recorded using Exocad software. Group B values were compared with the corresponding group A reference values. Results: The intraoral scanned images (group B) recorded a slightly smaller volume than that obtained from CBCT. Although the mean difference between the two methods was 0.7384 mm3 , it was shown to be statistically significant (p&lt;0.001). Conclusion: Based on the analysis of the study results, it can be concluded that the mean difference in volume between CBCT and Primescan was 0.738 mm3 , with the Primescan recording 97.82% of the volume. The Primescan demonstrates clinically acceptable accuracy in scanning the post space.

Effectiveness of automated segmentation of maxillofacial structures in cone-beam computed tomography images using artificial intelligence: A systematic review.

Abstract Background: Missed root canals are a common cause of endodontic failure and are often related to complex root canal anatomy that cannot be adequately visualized using conventional radiography. Cone-beam computed tomography (CBCT) allows three-dimensional assessment and improves the detection of untreated canals. Aim: The aim of this study was to determine the prevalence of missed canals in endodontically treated mandibular first molars in a Central Indian population and to evaluate their association with extra roots. Materials and Methods: This retrospective cross-sectional study evaluated 400 CBCT scans of endodontically treated mandibular first molars obtained from government and private imaging centers in Central India. Canals appearing unfilled from the cementoenamel junction to the apex were recorded as missed canals. The presence of extra roots was also assessed. Data were analyzed using the Chi-square and Fisher’s exact tests, with statistical significance set at P &lt; 0.05. Results: Missed canals were detected in 88 teeth, representing a prevalence of 22.0%. Extra roots were identified in 15 (3.75%) teeth, of which 11 (73.3%) exhibited missed canals. Teeth with extra roots showed a significantly higher prevalence of missed canals compared to those without extra roots (73.3% vs. 20.0%; χ 2 = 20.92, P &lt; 0.001), with an 11-fold increased odds (odds ratio = 11.0). No significant association was observed between gender and missed canals ( P = 1.00). Conclusion: CBCT revealed a high prevalence of missed canals in mandibular first molars, with extra roots significantly increasing the risk. These findings emphasize the clinical value of CBCT in detecting anatomical complexities and preventing endodontic treatment failure.

FDA-Recon: Feature and data alignment reconstruction for sparse-view CBCT.

Comparative analysis of five AI platforms for mandibular canal segmentation on CBCT images.

Abstract Aim: The aim of this study was to perform a two-dimensional (2D) and three-dimensional (3D) comparative evaluation of bone regeneration using autologous platelet-rich fibrin (PRF) versus calcium phosphosilicate-based bone putty in large periapical lesions before and after endodontic surgery. Materials and Methods: Fifty patients with a history of dental trauma and periapical pathology involving the maxillary and mandibular anterior and premolar tooth regions were randomly allocated into two groups, with 25 patients in each group. All patients underwent endodontic surgery following root canal treatment. Bony defects were managed with autologous PRF in Group I and bone putty in Group II. After a 1-year follow-up period, 2D healing was assessed using intraoral periapical radiographs (IOPARs), and area calculation was performed using ImageJ software. 3D healing was evaluated using cone-beam computed tomography (CBCT), and volumetric analysis was conducted using ITK-SNAP software. Results: Patients in Group II exhibited a significantly greater reduction in lesion volume (95.017% ±5.809%) and area (98.376% ± 2.916%) compared to those in Group I (volume reduction: 72.449% ± 14.264% and area reduction: 87.868% ± 11.048%). Bone healing assessed through CBCT and volumetric analysis using ITK-SNAP (83.733 ± 15.668%) was found to be more accurate than 2D area evaluation (93.122 ± 9.598) using IOPAR. Conclusion: Calcium phosphosilicate-based bone putty demonstrated significantly faster bone regeneration than PRF. CBCT-based volumetric assessment (3D) provides a more objective and accurate evaluation of bone healing than conventional IOPAR-based area assessment (2D) and may serve as a valuable tool for assessing treatment outcomes in complex endodontic surgeries.

Radiation therapist led treatment of lung stereotactic ablative body radiation therapy patients in the absence of the radiation oncologist - An image matching consistency comparison study.

Comparative Evaluation of Photon-Counting Detector CT and Cone-Beam CT in the Assessment of Simulated Mandibular Trauma.

An artificial intelligence-assisted automated quantitative evaluation system for condylar morphological changes of temporomandibular joint.

Abstract Aim: To evaluate periapical healing following nonsurgical root canal treatment of large periapical lesions using three bioactive materials, assessed using cone-beam computed tomography (CBCT) at 6 months and 1 year. Materials and Methods: A total of 40 teeth were taken for this retrospective study with single or multirooted teeth and periapical pathology of 4–8 mm in diameter, present with preoperative and follow-up CBCT scans available. All the cases considered underwent endodontic treatment using one of three bioactive materials (mineral trioxide aggregate, Biodentine, and bioceramics). Assessment of healing was done based on radiographic CBCT scans and CBCT–periapical index (PAI) criteria. The teeth were divided into healing, healed, or diseased based on the changes in the CBCT-PAI score after 6 months and 1 year. All the data were recorded in a tabular form and sent for statistical analysis using Chi-square test, t-test, and Friedman’s test. Results: While there was a statistically significant difference in individual teeth after 6 months ( P = 0.01) and 1 year ( P = 0.004), with maxillary incisors showing the highest percentage of healing after 1 year (29.6%), no significant difference was seen between the use of the three bioactive materials after 6 months ( P = 0.97) or 1 year ( P = 0.78), respectively. There was no statistically significant difference in age-wise ( P = 0.27; 0.82) or gender-wise ( P = 0.82; 0.39) distribution. Conclusion: Among all the teeth assessed, single-rooted maxillary teeth showed the highest amount of healing. All three bioactive materials showed a favorable outcome for the treatment regardless of the material used. In addition, healing outcomes were not significantly influenced by patient age or gender.

Impact of orthodontic forces on masseter muscle morphology and function: A CBCT and electromyographic study.