Metal artifact reduction (MAR) in dental cone-beam computed tomography (CBCT) is critical for improving its clinical usefulness and remains a challenging problem. This study presents an elaborate sinogram normalization interpolation (SNI) method with contrast-to-noise ratio (CNR)-based metal segmentation to eliminate metal artifacts in dental CBCT. The proposed MAR method involves three main steps: (1) CNR-based segmentation of a metal trace in the sinogram domain; (2) generation of a residual artifact-reduced prior sinogram; and (3) sinogram completion using the prior sinogram, followed by filtered-backprojection (FBP)-based CBCT reconstruction and metal insertion processes. To verify the efficacy of the proposed method, simulations and experiments were performed using numerical and physical dental phantoms with several metal inserts. The quality of the resulting CBCT images was quantitatively evaluated using the structural similarity (SSIM) metric and compared to those obtained with other interpolation-based MAR methods. A tabletop setup for the micro-CT system was used in the experiment, which comprised an X-ray tube operated under tube conditions of 70 kV p and 5 mA and a flat-panel detector with a pixel size of 198 μm. Our results indicate that the CNR-based metal segmentation method precisely identified traces of metallic objects on the sinogram, and thereby, the proposed SNI-based MAR method considerably reduced metal artifacts in dental CBCT images without introducing any contrast anomalies. The SSIM values of the CBCT images obtained with the proposed MAR method were 0.99 and 0.95 for the simulation and experiment, respectively, which are approximately 11% and 9% greater than those with a simple threshold-based linear interpolation method, respectively, improving the image quality. The proposed MAR method can be applied to reduce metal artifacts in real-world dental CBCT systems.
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