Cone Beam Computed Tomography Research Articles

A radiation therapy platform to enable upright cone beam computed tomography and future upright treatment on existing photon therapy machines

AbstractBackgroundThe conventional lying down position for radiation therapy can be challenging for patients due to pain, swallowing or breathing issues. To provide an alternative upright treatment position for these patients, we have developed a portable rotating radiation therapy platform which integrates with conventional photon treatment machines. The device enables cone‐beam computed tomography (CBCT) imaging of patients in an upright position, and the future delivery of therapeutic radiation.PurposeTo design, manufacture, and test a device for upright radiation therapy. A collaborative partnership between physicists, engineers, radiation therapists, radiation oncologists, implementation researchers and consumers was established, to create a device that meets both the clinical and technical requirements of upright radiation therapy. The device is central to a clinical trial (ACTRN12623000498695) which will evaluate upright image quality in the context of future image guided radiation therapy for patients with lung cancer or head and neck cancer.MethodsThe weight and physical constraints of the device were assessed with respect to the American civilian population. The final design was evaluated with a series of tests to characterize the angular accuracy of the platform rotation and the reproducibility of the platform setup position in a radiation treatment room. To acquire an upright CBCT, the platform movement system was synchronized to the kilo‐voltage fluoroscopic imaging on an existing treatment machine. The accuracy of the synchronization was evaluated by assessing the positional reproducibility of upright CBCT imaging of a chest phantom.ResultsThe platform has a weight limit of up to 125 kg which is suitable for approximately 90% of males and 95% of females. The platform has physical constraints that accommodate approximately 95.6% of males and 99.6% of females: a maximum seated height of 97.5 cm, a maximum hip breadth of 63.0 cm, and maximum elbow to knuckle length of 46.5 cm. The angular accuracy of the motion system is within ±0.15° over a full rotation, which is within the guidelines for machine movement accuracy in radiation therapy (1 mm/1°). The platform is a portable device and can be reproducibly positioned in a radiation therapy treatment room with a translational range within ±0.04 mm and a rotational range within ±0.025°. The CBCT imaging can reproducibly detect the position of a chest phantom with a translational uncertainty of ±0.07 mm and a rotational uncertainly of ±0.22°, when imaging is acquired following a strict procedure.ConclusionThe upright radiation therapy platform is suitable for the evaluation of CBCT imaging in the context of image guided radiation therapy. The platform will allow the investigation of open questions in upright radiation therapy in the areas of patient experience, positional stability, anatomical changes, and treatment delivery. Improvements to the materials in the radiation beam line, synchronization with the existing treatment machine, and increasing the device weight limit are suggested prior to delivery of future upright treatments.

First-in-human trial using mixed-reality visualization for patient setup during breast or chest wall radiotherapy

Abstract Background The purpose of this study is to assess the feasibility of mixed-reality (MixR) visualization for patient setup in breast and chest wall radiotherapy (RT) by performing a first-in-human clinical trial comparing MixR with a 3-point alignment. Methods IRB approval was granted for a study incorporating MixR during the setup process for patients undergoing proton (n = 10) or photon (n = 8) RT to the breast or chest wall. For each patient, MixR was utilized for five fractions and compared against another five fractions using 3-point alignment. During fractions with MixR, the patient was aligned by at least one therapist wearing a HoloLens 2 device who was able to guide the process by simultaneously and directly viewing the patient and a hologram of the patient’s surface derived from their simulation CT scan. Alignment accuracy was quantified with cone-beam CT (CBCT) for photon treatments and CBCT plus kV/kV imaging for proton treatments. Registration time was tracked throughout the setup process as well as the amount of image guidance (IGRT) utilized for final alignment. Results In the proton cohort, the mean 3D shift was 0.96 cm using 3-point alignment and 1.18 cm using MixR. An equivalence test indicated that the difference in registration accuracy between the two techniques was less than 0.5 cm. In the photon cohort, the mean 3D shift was 1.18 cm using 3-point alignment and 1.00 cm using MixR. An equivalence test indicated that the difference in registration accuracy was less than 0.3 cm. Minor differences were seen in registration time and the amount of IGRT utilization. Conclusions MixR for patient setup for breast cancer RT is possible at the level of accuracy and efficiency provided by a 3-point alignment. Further developments in marker tracking, feedback, and a better understanding of the perceptual challenges of MixR are needed to achieve a similar level of accuracy as provided by modern surface-guided radiotherapy (SGRT) systems. Trial registration ClinicalTrials.gov, UFHPTI 2015-BR05: Improving Breast Radiotherapy Setup and Delivery Using Mixed-Reality Visualization, NCT05178927.

Assessment of Vidian canal morphology in axial section and its associated structures using cone beam computed tomography: A descriptive study

The Vidian Nerve (VN), a branch of the trigeminal nerve, passes by the Vidian Canal (VC), located at the base of the skull. The VC branches into the greater petrosal nerve and the VN in the pterygopalatine fossa, where the greater petrosal nerve carries parasympathetic fibers to the lacrimal glands and nasal mucosa, and the VN carries sensory fibers from the nasopharynx, nasal cavity, and palate. In this study, 60 subjects of both sexes who underwent cone beam computed tomography (CBCT) were selected by a convenient sampling technique. The data were subjected to statistical analysis following the examination of the various parameters in the axial sections. Among the various morphological characteristics appraised in the axial section, there was no significant sexual dimorphism, except for the angle between the VC and the medial wall of the maxillary sinus, which shows statistical significance. The present study aims to investigate morphometric analysis and its associated structures, offering insightful information about the complex structure of the Vidian canal (VC), which provides adequate knowledge for surgeons to plan with more caution complex skull base procedures, and eventually to lower the therapeutical risks associated with it.

Evaluation of a compact cone beam CT concept with high image fidelity for point-of-care brain imaging.

Cone beam computed tomography (CBCT) has potential advantages for developing portable, cost-effective point-of-care CT systems for intracranial imaging, such as early stroke diagnosis, hemorrhage detection, and intraoperative navigation. However, large volume imaging with flat panel detector based CBCT significantly increases the scattered radiation fluence which reduces its image quality and utility. To address these issues, a compact CBCT concept with enhanced image quality was investigated for intracranial imaging. The new system features a novel antiscatter collimator and data correction method to address the challenges in imaging large volumes with CBCT. A benchtop CBCT prototype was constructed. Imaging studies with anthropomorphic phantoms showed that soft tissue visualization, Hounsfield Unit (HU) accuracy, contrast, and spatial resolution increased significantly with the proposed CBCT concept, and they were comparable to the values measured in the gold standard multidetector-row CT (MDCT) images. Contrast-to-noise ratio (CNR) in CBCT images was within 12-31% of the CNR in MDCT images. These findings indicate that a compact CBCT system integrated with effective scatter suppression techniques may have increased utility in the context of brain imaging, and the proposed approach may enable the development of point-of-care CT systems for head imaging based on flat panel detector based CBCT technology.

A CBCT study of changes in temporomandibular joint morphology with immediate implant placement and immediate loaded full-arch fixed dental prostheses.

Dental implants are becoming a popular treatment of choice. Immediate implant placement with immediate loaded full-arch fixed dental prostheses (IPILFFDP) presents an attractive solution for edentulous and partially edentulous patients because of its high success rate, reduction in overall treatment time, and improved esthetics. However, whether it can minimize the risk of temporomandibular disorder (TMD) has not been previously studied. To quantitatively evaluate the temporomandibular joint (TMJ) morphology changes before and after IPILFFDP, using cone beam computed tomography (CBCT). Twelve participants without TMJ symptoms undergoing IPILFFDP were included in the study. Preoperative and 1-year postoperative assessment of CBCT scans were performed on 18 items related to TMJ and vertical dimensions. Mimics software was used for data analysis. T-test, Pearson, and Spearman correlation analyses were performed. There were no significant differences in bilateral joints between pre and post IPILFFDP. Compared with pre-treatment CBCT, post-treatment CBCT showed a significant increase in posterior joint space. There was an approximately 2mm increase in the vertical dimension after IPILFFDP, which is correlated with an increase in the medial joint space. For patients without TMJ-related signs and symptoms, the IPILFFDP could keep the neuromuscular memory of patient's facial muscles and occlusion, and use adapted centric posture as a guide, which led to more precise restoration of the original jaw position and may shed light in future related clinical studies.

Visibility of alveolar bone thicknesses on CBCT images-a study on minimum bone requirements using various reconstruction techniques, viewing modes, and resolutions.

To evaluate at which thickness marginal bone becomes visible to the observer on cone-beam computed tomography (CBCT) images and how reconstruction technique and viewing mode affect assessment. Fourteen anterior teeth from six human mandibles were examined with two CBCT resolution protocols: standard- and high-resolution. Distance from the cementoenamel junction to the visible marginal bone level (MBL) was measured in three groups of reconstructed CBCT images: multiplanar reformation (MPR) with grey scale, MPR with inverted grey scale, and 3D rendering. These measurements were used to identify the bone level where marginal bone width should be measured on histological photographs of sliced teeth. Gold standards comprised measurements of bone thickness at the superior MBL on histological photographs. MPR grey scale images exposed at high-resolution settings yielded highest validity: bone widths of 0.173mm (buccal) and 0.356mm (lingual) were necessary for visibility on a CBCT image. 3D-rendered lingual surfaces exposed with high-resolution settings had lowest validity. Intra-observer agreement for all CBCT and histological measurements was high. The best CBCT resolution protocol, reconstruction technique, and viewing mode for analyzing buccal and lingual surfaces of the alveolar bone margin are images exposed with a high-resolution protocol, reconstructed using MPR, and viewed in grey scale. Bone thickness required to be visualized was twice lingually compared to buccally. The visualization of bone thickness in CBCT requires a greater thickness on the lingual side compared to the buccal side. 3D-rendered reconstructions should be avoided when evaluating thin bony structures.

Integration of cone beam computed tomography for interdisciplinary diagnosis and treatment planning

Cone-beam computed tomography (CBCT) has revolutionized dental imaging by providing precise three-dimensional visualization of hard tissue structures with minimal radiation exposure compared to conventional CT. This review explores the integration of CBCT in interdisciplinary diagnosis and treatment planning across various fields of dentistry. CBCT offers versatile applications including assessment of impacted teeth, airway analysis, temporomandibular joint evaluation, detection of jaw pathologies, and precise diagnosis of dento-maxillofacial fractures. Its ability to generate static and rotational 3D images aids in surgical planning and treatment outcome prediction. Furthermore, CBCT plays a crucial role in orthodontics for localization of impacted teeth and evaluation of craniofacial anomalies such as cleft lip and palate. In periodontics and implantology, CBCT facilitates detailed assessment of periodontal structures, bone defects, and precise implant placement. Additionally, CBCT assists in maxillofacial prosthetics by enabling virtual surgical planning and custom prosthetic fabrication. This paper underscores CBCT as an indispensable tool in modern dental practice, enhancing diagnostic accuracy, treatment precision, and patient outcomes across diverse clinical scenarios.

Evaluating sagittal condylar inclination: a comparative analysis of various digital workflow measures.

This study aims to compare sagittal condylar inclination (SCI) measurements derived from three workflows: intraoral scan (IOS) aligned with cone-beam computed tomography (CBCT), IOS aligned with facial scan (FS), and a jaw motion analyzer (JMA) system, in a cohort of young individuals with established normal occlusion. Additionally, the study aims to identify sources contributing to variance in these measurement approaches. Twenty-four healthy individuals exhibiting normal occlusion were enrolled in this clinical trial. The SCI was delineated using a virtual articulator (VA) by aligning IOS with both CBCT and FS, creating two distinct workflows labeled CBCT-IOS and FS-IOS, respectively. Concurrently, SCI measurements were also acquired using a JMA. The normality of data distribution for the difference in bilateral SCI measurements within each workflow was tested using the Shapiro-Wilk test. Depending on the outcomes of this test, we utilized either a paired-sample T-test or Wilcoxon test for bilateral SCI comparisons. The inter-workflow differences were assessed using the Kruskal-Wallis H test. Bland-Altman plots were assess the interchangeability and consistency across each pair of digital methods and to evaluate the aggregate consistency among the trio of digital approaches. The analysis revealed that the CBCT-IOS workflow yielded the lowest average SCI measurements, whereas the JMA workflow produced the highest values. No significant differences were found in the SCI measurements between the left and right sides obtained by CBCT-IOS and JMA (P > .05), with the exception of the FS-IOS workflow (P = .002). Additionally, inter-flow comparisons revealed no significant differences in SCI measurements (P > .05), except when contrasting the SCI as measured by CBCT-IOS and JMA (P = .0131). The Bland-Altman plots demonstrated a high degree of consistency and 95% limits of agreement across the three digital workflows. SCI measurements obtained from the three digital workflows exhibit a high degree of consistency and are interchangeable, affirming their clinical applicability for precise SCI assessment in young individuals with normal occlusion.

A comparative evaluation of the displacement and stress distribution of Kilroy spring, ballista spring and temporary anchorage devices during traction of palatally impacted canine using a 3 dimensional finite element analysis

The above study comprises a comparative evaluation of the displacement and stress distribution of Kilroy spring, Ballista spring and Temporary anchorage devices during traction of palatally impacted canine using a 3 dimensional finite element analysis. Palatally impacted canine is a common phenomenon occuring in around 8% of individuals. The Finite Element Analysis/Finite Element method (FEA/FEM) is the most intricate and dependable study that significantly revolutionized the world of dentistry and biomechanical research. Stresses and displacements can be precisely located using this type of numerical analysis. The orthodontist can better comprehend the physiological reactions that take place within the dentoalveolar complex because of the quantitative information it gives them. A Cone Beam Computed Tomography (CBCT)scan of the maxilla was obtained from a patient who reported to the Department of Orthodontics and Dentofacial Orthopaedics after he satisfied the inclusion and exclusion criterion. Finite element 3-D models of Kilroy spring, Ballista spring, Cantilever spring, miniscrew, lingual button, 0.022-inch-slot brackets, 0.019x0.025-inch SS archwire, stainless steel bands with molar tubes were constructed using a three-dimensional computer-aided design program (SolidWorks 2017; Solid Works K.K., Tokyo, Japan). All these components were imported and individually assembled in the ANSYS Software (Version 2021 R2, ANSYS, Canonsburg, Pa) and stress analysis was carried out. On the basis of this study following conclusion were drawn: The maximum amount of impacted canine displacement, with initial simulation, wasobserved with Kilroy spring followed by Ballista spring and miniscrew assisted Cantilever spring and the maximum amount of displacement of adjacent teeth i.e. lateral incisor and 1st premolar is observed with Ballista spring followed by kilroy spring and miniscrew assisted Cantilever spring. Furthurmore stress concentration on the canine is highest in case of ballista spring followed by Kilroy spring and miniscrew assisted Cantilever spring. Over all, miniscrew assisted Cantilever spring can be an efficient treatment option for traction of a palatally impacted canine.

Effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy

To investigate the effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy for temporomandibular joint anterior disc displacement (ADD). A clinical data of 30 patients (45 sides) with temporomandibular joint ADD, who met selective criteria and were admitted between September 2022 and February 2024, was retrospectively analyzed. Among them, 15 patients (23 sides) were treated with temporomandibular joint disc reduction and suture via small incision (open operation group), and 15 patients (22 sides) with modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy (arthroscopy group). There was no significant difference in gender, age, disease duration, affected side, Wilkes-Bronstein stage, preoperative visual analogue scale (VAS) score, maximal interincisal opening (MIO), and temporomandibular joint dysfunction index (DI), craniomandibular index (CMI), palpation index (PI), and other baseline data between groups ( P>0.05). VAS score, MIO, and temporomandibular joint function indicators (PI, DI, CMI) of patients were recorded at 3 months after operation, and the difference (change value) of the above indicators between pre- and post-operation was calculated. At 1 week after operation, MRI was performed to evaluate the reduction of the articular disc compared to the preoperative image. The results were classified as excellent, good, and poor, with excellent and good being considered effective reduction. The condition of condyle process repair was observed by cone beam CT (CBCT) at 3 months after operation. All incisions healed by first intention in the two groups. All patients were followed up 3-18 months (mean, 8.2 months). Facial nerve injury occurred in 3 cases in the open operation group and 1 case in the arthroscopy group, all of which returned to normal after physiotherapy and drug treatment. At 3 months after operation, MIO and VAS scores of both groups significantly improved when compared with those before operation ( P<0.05), and temporomandibular joint function indicators (PI, DI, CMI) significantly decreased ( P<0.05). The change values of MIO and temporomandibular joint function indicators in arthroscopy group were significantly higher than those in open operation group ( P<0.05). There was no significant difference in the change value of VAS score between groups ( P>0.05). There was no recurrence during follow-up. Postoperative MRI review showed that the effective reduction rate of joint disc was 95.65% (22/23) in the open operation group and 95.45% (21/22) in the arthroscopy group, with no significant difference between groups ( P>0.05). Postoperative CBCT found that early and timely effective reduction of joint disc was conducive to condyle process repair and reconstruction. Modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy has a clear effect in the treatment of ADD, with less trauma, fewer postoperative complications, and good early effectiveness.

DynaCT biliary reconstruction via a 3D C-arm cholangiography system: clinical application in hepatolithiasis.

Dyna computed tomography (DynaCT) is an innovative clinical imaging tool used to obtain three-dimensional (3D) images of biliary structures via the Artis Zee DSA system (SIEMENS Company, Germany). DynaCT is a type of 3D cone beam computed tomography (CBCT) reconstruction produced from a two-dimensional (2D) cholangiography system by rotating the C-arm without moving the patient. The aim of this study was to evaluate the technical approach and application value of DynaCT to diagnosis hepatolithiasis and biliary stenosis. This was a retrospective single-centre series of 37 hepatolithiasis patients with tubes receiving one-step percutaneous transhepatic cholangioscopic lithotripsy (one-step PTCSL) between October 2021 and October 2022: twenty-one patients were guided by CT (CT group) and sixteen by DynaCT biliary reconstruction (DynaCT group). We compared DynaCT biliary reconstruction technology with computed tomography (CT) in the application of bile ducts. DynaCT biliary reconstruction was successfully performed in 37 patients. Biliary stenosis, including anatomy, morphology, and size, was visualized via DynaCT. Compared with the CT group, the DynaCT group was characterized by significantly more target biliary branches with stones (92 vs. 48, P < 0.05), a higher percentage of secondary stenosis (75.76% vs. 24.24%, p < 0.05), a greater percentage of biliary infection (37.5% vs. 9.5%, P = 0.041), a shorter overall stone clearance time (26.38 ± 13.49 vs. 52.67 ± 30.10, P = 0.001), and a lower rate of reoperation for residual stones (25.00% vs. 66.67%, P = 0.012). DynaCT had a lower contrast agent (25.61 ± 5.13 vs. 42.69 ± 11.15, p < 0.05). However, DynaCT increased radiation exposure (38.12 ± 10.59 vs. 25.79 ± 4.76, p < 0.05). There were no significant differences between the two groups regarding the clearance ratio of the calculus or several postoperative complications. DynaCT for biliary reconstruction has the potential to be a powerful evaluation tool for one-step PTCSL surgery and could lead to new possibilities for hepatobiliary surgery. DynaCT was used for the first time in patients with hepatolithiasis and biliary stenosis. Compared with CT, DynaCT for biliary reconstruction results in higher-quality 3D biliary, blood vessel and liver images. On the basis of the DynaCT biliary model, one-step PTCSL has the potential to improve the stone clearance ratio and shorten the stone clearance time and reoperation ratio.

Dual-encoder architecture for metal artifact reduction for kV-cone-beam CT images in head and neck cancer radiotherapy.

During a radiotherapy(RT) course, geometrical variations of target volumes, organs at risk, weight changes (loss/gain), tumor regression and/or progression can significantly affect the treatment outcome. Adaptive RT has become the effective methods along with technical advancements in imaging modalities including cone-beam computed tomography (CBCT). Planning CT (pCT) can be modified via deformable image registration (DIR), which is applied to the pair of pCT and CBCT. However, the artifact existed in both pCT and CBCT is a vulnerable factor in DIR. The dose calculation on CBCT is also suggested. Missing information due to the artifacts hinders the accurate dose calculation on CBCT. In this study, we aim to develop a deep learning-based metal artifact reduction(MAR) model to reduce the metal artifacts in CBCT for head and neck cancer RT. To train the proposed MAR model, we synthesized the kV-CBCT images including metallic implants, with and without metal artifacts (simulated image data pairs) through sinogram image handling process. We propose the deep learning architecture which focuses on both artifact removal and reconstruction of anatomic structure using a dual-encoder architecture. We designed four single-encoder models and three dual-encoder models based on UNet (for an artifact removal) and FusionNet (for a tissue restoration). Each single-encoder model contains either UNet or FusionNet, while the dual-encoder models have both UNet and FusionNet architectures. In the dual-encoder models, we implemented different feature fusion methods, including simple addition, spatial attention, and spatial/channel wise attention. Among the models, a dual-encoder model with spatial/channel wise attention showed the highest scores in terms of peak signal-to-noise ratio, mean squared error, structural similarity index, and Pearson correlation coefficient. CBCT images from 34 head and neck cancer patients were used to test the developed models. The dual-encoder model with spatial/channel wise attention showed the best results in terms of artifact index. By using the proposed model to CBCT, one can achieve more accurate synthetic pCT for head and neck patients as well as better tissue recognition and structure delineation for CBCT image itself.

Evaluation of Alveolar Bone Destruction Patterns in the Posterior Region of the Maxilla Through Cone Beam Computer Tomography on 361 Consecutive Patients: Effect of Age and Gender.

The aim of this retrospective study is to evaluate the effect of age and gender on the alveolar bone destruction pattern with cone beam computed tomography (CBCT) in the posterior region of the maxilla. The study group included CBCT image records of 361 consecutive patients (180 males and 181 females) aged 20 years and older. Alveolar crest morphology in the maxillary right and left first and second molar teeth on retrospective images was classified as a horizontal or vertical defect (one-walled, two-walled, three-walled, and combined bone defect) on four surfaces (mesial, distal, buccal, and palatinal). Bone crater defects were defined, and furcation involvements and combined periodontal-endodontic lesions (CPELs) were placed in another category. In 361 patients, 1444 teeth were evaluated from adults between 20 and 63 years of age; 49.9% of the patients were male and 50.1% were female. Female patients had a considerably greater rate of one-walled horizontal damage in the right molar teeth than male patients (p = 0.002; p < 0.05). Patients with combined horizontal destruction in the right and left molar teeth, horizontal destruction in the palatinal, and horizontal three-walled destruction had a significantly higher mean age than patients without these periodontal destructions (p = 0.000; p < 0.05). Males were shown to have statistically higher frequencies of horizontal defects when defects were combined or distally and palatally located. Age and gender affect the alveolar bone loss pattern. Except for single-walled destructions, it has been found that the frequency of horizontal destruction increases with age. Horizontal destruction in the palatinal along with horizontal three-walled destruction increased with age.

Comparative Study of 3D Contact Area Percentage Between Zygomatic Implant and Bone in Different Surgical Approaches: Clinical and Biomechanical Perspectives.

Zygomatic implants, either alone or in combination with dental implant placement, have emerged as a viable surgical option for elderly patients with severe bone atrophy for occlusal restoration. This study aims to examine the biomechanical impact of the three-dimensional contact area between zygomatic implants and bone on biomechanics under different surgical methods. Using Cone Beam Computed Tomography (CBCT) images from 10 patients with severe bone atrophy, we reconstructed 3D maxillary bone models and created corresponding 3D zygomatic implant models. Two distinct surgical methods (extramaxillary or intrasinus approaches) were employed based on the position and angle of the zygomatic implant for each patient. The 3D bone-to-implant contact percentage (BIC%) was calculated, and finite element analysis with nonlinear contact was conducted to assess the relationship between 3D BIC% and surrounding bone stress for both surgical methods. The 3D BIC% of extramaxillary approach (57.63%) and intrasinus approach (56.49%) for total bone (including cortical and cancellous bone) was similar (P=0.425) in zygomatic implant surgery. In contrast, the intrasinus method exhibited higher 3D BIC% in cortical bone contact (28.08%) compared to the extramaxillary approach (21.92%) (P=0.011). The correlation between 3D BIC% and high bone stress was stronger in the intrasinus approach, likely due to increased contact area in cortical bone. The intrasinus approach led to lower bone stress and a more robust correlation between bone stress and 3D BIC%, particularly in cortical bone contact. Importantly, the coverage area of cortical bone surrounding the zygomatic implant significantly influenced biomechanical performance of the zygomatic implants.

Radiological assessment of Sella Turcica morphology correlates with skeletal classes in an Austrian population: an observational study.

This study aimed to analyze variations in the sella turcica (ST) concerning its size, shape, and bridging, providing first reference values in Austrian individuals. Additionally, it assessed associations between these morphological and demographic parameters and their correlation with patients' skeletal class. 208 lateral cephalometric radiographs (154 female, 54 male; age 8-58 years) from DPU Dental Clinic (Austria) were included. Size, skeletal class, shape, age, and gender of ST were tested for significance in correlation using, (M)ANOVA, and chi-square. Linear dimensions of ST ranged from 11.1 to 12.9mm across readers, with a standard deviation of 2.0-2.2mm. Normal ST (49.76%) and round ST (58.77%) were the most frequent. ST bridging was detected in 6.97%. Skeletal class I appeared most frequently (54.8%). Statistical significance was observed between age, gender, and ST length, with further significant age effects on ST shape. Moreover, age showed significant modification of ST shape, while skeletal parameters appeared unaffected by other ST parameters. These preliminary findings define normal ST dimensions in an Austrian population, offering reference values for clinical interpretation and broadening the available European data. Clear associations between morphological and demographic parameters were detected. Additionally, these findings may contribute to diagnostic and therapeutic strategies in orthodontics and craniofacial pathology. Future studies employing cone beam computed tomography (CBCT) along a larger sample size could enhance the generalizability of these findings.

The Effect of Platelet-Rich Fibrin (PRF) in Accelerating Periodontal Regeneration: A Randomized Controlled Clinical Trial

ABSTRACT Background: Regeneration of periodontal tissues is an essential component in treating periodontal disease, and there is an increasing focus on biological agents that might improve the healing process. Materials and Methods: The randomized controlled clinical study included a cohort of 60 individuals diagnosed with chronic periodontitis. Each participant was randomly allocated to one of two groups: the experimental group (n = 30), which underwent PRF in combination with traditional open flap debridement (OFD), and the control group (n = 30), which received OFD alone. Clinical criteria such as probing pocket depth (PPD), clinical attachment level (CAL), and bone fill percentage were assessed at baseline and after 6 months. Furthermore, cone-beam computed tomography (CBCT) was used to evaluate bone regrowth radiographically. Results: Following a period of 6 months, the experimental group had a notable decrease in postpartum depression (mean decrease of 4.2 mm) and an increase in central artery ligation (mean increase of 3.5 mm) compared to the control group, which had a mean decrease in postpartum depression of 2.8 mm and a mean increase in central artery ligation of 2.1 mm. The test group had a notably greater proportion of bone fill (45%) in comparison to the control group (30%). Further radiographic study verified enhanced bone regeneration in the areas treated with PRF. Conclusion: The use of Platelet-Rich Fibrin (PRF) in combination with traditional periodontal surgery greatly expedites the process of periodontal regeneration, as shown by notable enhancements in clinical indicators and bone regeneration.

Cone Beam Computed Tomography Evaluation of Socket Healing After Third Molar Germ Extraction: A Case Series Study Including Adolescents with Osteogenesis Imperfecta Type I Treated with Bisphosphonates and Healthy Age-Matched Subjects

Bisphophonates (BPs) are widely used in Osteogenesis imperfecta (OI). Cone Beam Computed Tomography (CBCT) shows clinical usefulness in evaluating impacted teeth and adjacent structure relationships, extraction socket healing, bone mineral density (BMD) and BP-related jaw osteonecrosis (BRONJ). The aim of the study was to compare alveolar sockets and the adjacent bone area before and after third molar extraction in OI type I (OI-I) adolescents treated with BPs and age-matched healthy subjects (HSs) by CBCT. Methods: Five adolescents with genetically proven OI-I treated with BPs (three males and two females, mean age: 15.2 ± 1.78 years) and four age-matched healthy subjects (two males and two females, mean age: 15.5 ± 1.29 years) were included in this study. Eight Regions of Interest (ROIs) were evaluated: between 3.7 and 3.8 (ROI-1) and 4.7 and 4.8 (ROI-2); after 3.8 (ROI-3) and 4.8 (ROI-4); alveolar sockets 3.8 (ROI-5) and 4.8 (ROI-6); left (ROI-7) and right (ROI-8) cortical bone. Results: ROIs were evaluated on both sides of the mandible for all the subjects except one OI patient in which CBCTs were performed pre- and-post third molar extraction only on the right side. CBCT was performed 12.8 ± 4.60 and 11.5 ± 2.51 days before and 8.0 ± 1.41 and 7.7 ± 0.5 months after extraction in OI-I and HSs, respectively. BPs were discontinued 62.0 ± 36.5 months before extraction. None of the OI-I adolescents developed BRONJ. Statistically significant greater values were observed in OI-I for ROI-1 and -2 (p = 0.0464), ROI-3 and -4 (p = 0.0037) and ROI-7 and -8 (p = 0.0079) after extraction. Conclusions: This descriptive study confirms that, in OI-I adolescents treated with BPs, third molar extraction is safe, and socket healing occurs properly. In addition, it demonstrates that, if the same device and imaging conditions are used and comparisons to predetermined standard values are avoided, CBCT can be used to monitor BMD changes. The significant greater BMD observed for different ROIs in OI-I could reflect the increased secondary mineralization related to the BP-dependent reduction in bone turnover.

Characteristics of Temporomandibular Joint Osteoarthritis Patients With Condylar Erosion: A Retrospective Cross-Sectional Study.

Condylar erosion (CE) may indicate an active progressive stage of temporomandibular joint osteoarthritis (TMJOA), but no studies have analysed the characteristics of this population. This cross-sectional study analysed the characteristics of TMJOA patients with CE. A total of 267 patients were included. The severity of CE of all joints was evaluated using cone beam computed tomography (CBCT) and scored using a four-point rating scale (0-III). Patients were categorised into mild (grade I), moderate (grade II) and severe (grade III) groups. Demographic and clinical characteristics were summarised and stratified by age and erosion severity. Univariate and multivariate logistic regression analyses were performed based on the assignment of the variables. The proportion of patients under 30 years old is much higher than other age groups. Compared to adults (≥ 20 years old), a higher proportion of adolescent patients (10-19 years old) choose orthodontics department for their first consultation (p < 0.01). And adolescent patients have a higher proportion of temporomandibular joint (TMJ) noise (p < 0.05) and a lower proportion of arthralgia (p < 0.001). Significant differences exist in CE severity between adolescents and adults (p < 0.001). The severe group had the youngest patients (p < 0.05) and the highest proportion of mandibular deviation and abnormal postural habits. Patients under 30 years of age constitute a significant proportion of TMJOA cases with CE. Compared to adults, adolescent patients have more severe CE and less arthralgia. Due to obvious dental and maxillofacial deformities and milder TMJ symptoms, adolescent patients may not be aware that they have TMJ disease, potentially leading to delayed treatment.

PREVENÇÃO E TRATAMENTO DA COMUNICAÇÃO BUCO-SINUSAL EM PROCEDIMENTOS ODONTOLÓGICOS: REVISÃO DE TÉCNICAS CIRÚRGICAS E BIOMATERIAIS

Oroantral communication (OAC) is a frequent complication in dental procedures, especially in extractions of upper posterior teeth due to the anatomical proximity to the maxillary sinus. This review addresses the main surgical techniques and the use of biomaterials in the treatment of OAC, based on articles published between 2010 and 2024, found in databases such as PubMed and Scielo. Risk factors like the proximity of dental roots to the floor of the maxillary sinus and advanced age increase the likelihood of OAC, with cone-beam computed tomography (CBCT) being an effective tool in preoperative evaluation. Minimally invasive surgical techniques, such as controlled osteotomy and piezosurgery, have been effective in preventing perforations, while biomaterials like collagen membranes and bone grafts are widely used in treating larger perforations, promoting bone regeneration and healing. The combination of appropriate sutures and biomaterials is essential to avoid postoperative complications such as chronic sinusitis and fistulas. The review concludes that despite advances in surgical techniques and the use of biomaterials, gaps remain in the literature regarding the management of complex perforations, highlighting the need for more comparative studies to optimize OAC treatment. An integrated approach—including preoperative evaluation, appropriate surgical techniques, and postoperative follow-up—is crucial for treatment success and the reduction of long-term complications.

Bilateral TMJ Changes Secondary to Unilateral Condylar Hyperplasia

Background: Patients with unilateral condylar hyperplasia (UCH) may present with TMJ symptoms, rather than concerns or recognition of asymmetry. Localization of TMJ pain may be on the affected (long) side, unaffected side, or both. Flattening, severe erosion and internal derangement on the opposite side can be appreciated radiologically. This can be a red herring, shielding the true diagnosis of UCH from the contralateral side. We hypothesize that excessive growth of the ipsilateral condylar neck and head on the side of UCH results in an upward and backward force on the opposite side TMJ, with resultant symptoms and findings (condylar flattening, anterior disk displacement, eminence changes). The purpose of this paper is to highlight the bilateral TMJ findings in UCH, and address potential treatment strategies. Methods: This is a retrospective study involving radiologic and biographical data from subjects with TMJ UCH, as well as controls. Patient details and high quality Cone beam CT (CBCT) scans (1 mm slices or less) were analyzed. CT scans were digitized and morphometric points were placed using Planmeca software (Hoffman Estates, Illinois). Linear and volumetric measures were taken in reference to the eminence, TMJ space, condylar position, and neck lengths. Volumetric analysis of the condylar head and neck was done using Analyze 14.0 software (Overland Park, KS, USA). Results were assessed using univariate analysis (T-Wilcoxon test). Results: Forty patients were included (29 with UCH, 11 controls). The condylar head was flatter and erosive appearing on the contralateral UCH side compared to both ipsilateral side in the same subject, and compared to controls. Analysis between the affected and unaffected sides in patients with UCH showed a significant difference in condylar head and neck length ( P = .0019) and volume ( P = .0030); anterior glenoid space ( P = .035) and vertical height of condylar eminence ( P = .00044). The difference in ramus length was not significant ( P = .6533). Between the controls and the UCH patients, there was a significant difference in the variance in condylar head and neck length ( P = 1.98e-07) and volume between the 2 sides ( P = 1.94e-08) but not ramus length ( P = 1). The vertical height of the condylar eminence was smaller on the affected side than in the controls ( P = .0018) and the anterior glenoid space was significantly smaller on the unaffected side compared to the controls ( P = .0053). Conclusion: This study highlights TMJ morphological differences in patients with UCH. These differences in condylar and glenoid morphology are consistent and should be used to aid and underpin the diagnosis and direct treatment. Importantly, patients who present with TMJ pain and erosion on one side, should be assessed for opposite side UCH, as the underlying culprit.