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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 May 2026) | Viewed by 10801

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Prof. Dr. Jòzsef Piffkó

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Department of Oral and Maxillofacial Surgery, University of Szeged, Albert Szent-Györgyi Medical Centre, Szeged, Hungary
Interests: complex face and oral cavity injuries; head, neck and oral cavity tumors; developmental deformities; microsurgical reconstructions; implantology
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Dr. Agnes Janovszky

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Department of Oral and Maxillofacial Surgery, University of Szeged, Albert Szent-Györgyi Medical Centre, Szeged, Hungary
Interests: experimental microsurgery; microsurgery; fluorescence; aesthetic surgery; oral and maxillofacial surgery; maxillofacial surgery; plastic and reconstructive surgery; temporomandibular joint disorder; medication-related osteonecrosis of the jaw
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue highlights the newest advancements in oral and maxillofacial imaging, showcasing cutting-edge research and technological breakthroughs. It covers diagnostic enhancements, treatment planning tools, and clinical applications, empowering professionals to stay at the forefront of this dynamic field. It also explores the following areas:

Technological Advancements: The latest imaging modalities, including high-resolution scans, 3D reconstructions, and AI-assisted analysis, enhancing diagnostic precision and efficiency.
Diagnostic Insights: Radiographic manifestations of diverse oral and maxillofacial pathologies, facilitating early detection and accurate diagnosis.
Treatment Planning and Evaluation: The role of imaging in pre-operative planning, intraoperative guidance, and post-treatment assessment, ensuring personalized and effective care.
Clinical Case Studies: Real-world applications through compelling case reports, bridging the gap between theory and practice.

As the field of oral and maxillofacial imaging continues to evolve, this Special Issue underscores the importance of staying abreast of the latest developments. It fosters international collaboration, inspiring further innovations that improve patient outcomes and advance the discipline as a whole.

Prof. Dr. Jòzsef Piffkó
Guest Editor

Dr. Agnes Janovszky
Guest Editor Assistant

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Keywords

technological advancements
diagnostic imaging
treatment planning
clinical applications
oral and maxillofacial surgery
radiology

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Published Papers (9 papers)

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16 pages, 2235 KB

Open AccessArticle

Adjacent Maxillary Bone Microarchitecture in Patients with Asymmetric Bilateral Lund–Mackay Scores: A Pilot Retrospective Within-Subject Analysis Using CBCT

by Ersen Bilgili and Kaan Orhan

Diagnostics 2026, 16(14), 2270; https://doi.org/10.3390/diagnostics16142270 - 20 Jul 2026

Viewed by 288

Abstract

Background/Objectives: The study aims to investigate whether lateral asymmetry in the inflammatory burden of the maxillary sinus is associated with measurable differences in adjacent non-alveolar maxillary bone structure, as observed on cone-beam computed tomography (CBCT) images. Additionally, this study aims to examine the relationship between sinus inflammation severity and trabecular bone characteristics using microarchitectural parameters. Methods: A total of 100 patients with asymmetric bilateral Lund–Mackay scores were included, yielding 200 maxillary sinuses and exceeding an a priori power requirement of 184 sinuses. Standardized cubic volumes of interest were sampled from the zygomatic process of the maxilla, outside the alveolar process, and analyzed using ImageJ 1.54p and BoneJ+ 0.0.12. Evaluated parameters were trabecular thickness, trabecular separation, bone volume fraction, connectivity, connectivity density, degree of anisotropy, cortical porosity, cortical thickness, and ellipsoid factor. Paired comparisons were performed between the less severe and more severe sinus sides. Generalized estimating equation models were used to assess associations with LM score, age, sex, and etiology of the inflammation as odontogenic or rhinosinusitis. Results: Compared to the less severe side, the more severe side showed significantly lower Tb.Th, BV/TV, Cort.Th, and EF and significantly higher Tb.Sp and cortical porosity (all p ≤ 0.05). However, Conn., Conn.D, and DA did not differ significantly. An increasing LM score was associated with lower Tb.Th, BV/TV, DA, and EF, as well as higher cortical porosity. Odontogenic and non-odontogenic inflammatory patterns were both associated with less favorable bone characteristics compared to non-inflamed sides. However, the magnitude and distribution of the effects differed across parameters. Conclusions: Greater sinus inflammatory burden was associated with measurable alterations in adjacent non-alveolar maxillary bone architecture across multiple morphometric domains. Although not a validated index, the cortical porosity score may reflect the resorptive effects of maxillary sinusitis on the adjacent cortex. The findings support the idea that sinus inflammation may have an osseous correlate beyond the sinus cavity. Further validation in larger, clinically phenotyped cohorts is warranted. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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14 pages, 4080 KB

Open AccessArticle

Three-Dimensional Correlation Between Impacted Maxillary Canine Angulation and Root Resorption of Adjacent Lateral Incisors: A CBCT Study

by Raed J. Abualfaraj and Hanadi Sabban

Diagnostics 2026, 16(13), 2086; https://doi.org/10.3390/diagnostics16132086 - 3 Jul 2026

Viewed by 359

Abstract

Background: Impacted maxillary canines frequently cause external root resorption of adjacent lateral incisors, a complication that may compromise tooth survival and orthodontic outcomes. Cone-beam computed tomography (CBCT) enables precise three-dimensional assessment of canine position and resorption severity, yet the quantitative relationship between canine angulation and resorption remains incompletely characterized. Objectives: The objectives were to quantify the correlation between impacted maxillary canine angulation relative to the vertical reference line and the severity of adjacent lateral incisor root resorption using CBCT and to evaluate the influence of crown position on resorption prevalence. Materials and Methods: This retrospective cross-sectional study was conducted at the Department of Oral Radiology, King Abdulaziz University Dental Hospital (KAUDH), Jeddah, Saudi Arabia, using CBCT scans acquired between January 2018 and December 2023. CBCT scans of 262 patients with impacted maxillary canines were analyzed. A total of 108 impacted canines from 88 patients were evaluated. Canine angulation was measured as the acute angle between the canine long axis and a vertical reference line on coronal CBCT sections. Crown position was classified as palatal, buccal, or center. Lateral incisor root resorption was graded using the modified Kaley and Phillips classification (Grade 0–4), where Grade 4 represents side resorption. Statistical analyses included Spearman rank correlation, Mann–Whitney U test, chi-square test, and Kruskal–Wallis test with post hoc comparisons (α = 0.05). Results: Lateral incisor root resorption was detected in 17 of 108 canines (15.7%). Mean canine angulation was significantly higher in the resorption group (45.5° ± 21.4°) compared with the no-resorption group (32.7° ± 18.0°; Mann–Whitney U = 809.5, p = 0.019). Spearman correlation revealed a significant positive association between angulation and resorption grade (ρ = +0.243, p = 0.019). Canines angled ≥ 45° exhibited a 3.5-fold higher resorption rate (32.1% vs. 9.2%; OR = 4.66, Fisher’s Exact p = 0.012). Palatal crown position was associated with significantly higher resorption prevalence (25.5%) compared with center (5.1%) and buccal (11.1%) positions (χ² = 7.258, p = 0.027). Unilateral impaction was associated with significantly higher resorption prevalence than bilateral (22.4% vs. 4.9%; p = 0.031). Conclusions: Larger canine angulation from the vertical reference line is significantly correlated with increased severity of adjacent lateral incisor root resorption. Palatal crown position, angulation ≥ 45°, and unilateral impaction pattern are important risk indicators. CBCT-based angulation measurement provides clinically relevant quantitative data to inform early intervention and treatment planning. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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17 pages, 1732 KB

Open AccessArticle

Osteoporosis Diagnostics in Dental Radiology (Panoramic Radiograph): The Mini Osteoporosis Pre-Screening (MOPS)

by Margrit-Ann Geibel, Amina Maria Geibel, Meinrad Beer, Tilmann Blasenbrey and Daniela Kildal

Diagnostics 2026, 16(11), 1728; https://doi.org/10.3390/diagnostics16111728 - 4 Jun 2026

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Abstract

Background/Objectives: Osteoporosis is highly relevant to dentistry, oral surgery, and implantology. Because panoramic radiographs are routinely acquired in dental practice, they may enable opportunistic pre-screening. This pilot study evaluated established radiomorphometric indices on orthopantomograms (OPGs) and introduced a new qualitative index, the Mini Osteoporosis Pre-Screening (MOPS) index, based on the appearance of the cervical vertebral bodies visible on panoramic radiographs. Methods: This retrospective study analyzed 40 pseudonymized patient datasets, each including both OPG and dual-energy X-ray absorptiometry (DXA) examinations. DXA findings served as the reference standard in the study group. In addition 80 OPG scans from a control group of young adults without clinical or anamnestic evidence of osteoporosis were assessed. Two independent examiners with backgrounds in radiology and dentistry evaluated four indices: mandibular cortical width (MCW), panoramic mandibular index (PMI), mandibular cortical index (MCI), and MOPS. Results: Relative to the reference standard, MOPS demonstrated diagnostic accuracy ranging from 83% to 100% across selected groups. In women, accuracy ranged from 90% to 100%, with a sensitivity of 1.0 and specificity of 0.9. MCI and MOPS were more robust than MCW, whereas PMI showed limited applicability in routine clinical images. Conclusions: Panoramic radiographs can show osteoporosis-related changes in the mandible and cervical spine. MOPS offers a rapid, cost-neutral pre-screening method and may help dentists identify patients who warrant DXA referral. Larger prospective studies are needed to confirm its clinical utility. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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16 pages, 1199 KB

Open AccessArticle

Fully Digital vs. Conventional Planning in Bimaxillary Orthognathic Surgery: Effects on 3D Accuracy and Surgical Efficiency

by Petrică Florin Sava, Bogdan Radu Dragomir, Ilie Cristian Drochioi, Otilia Boișteanu, Andrei Nicolau, Daniela Șulea, Ștefan Gherasimescu and Victor Vlad Costan

Diagnostics 2026, 16(9), 1365; https://doi.org/10.3390/diagnostics16091365 - 30 Apr 2026

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Abstract

Background: Accurate transfer of the surgical plan is essential in bimaxillary orthognathic surgery, where small discrepancies between planned and postoperative skeletal positions may influence functional and aesthetic outcomes. This study compared the three-dimensional (3D) accuracy and time efficiency of conventional and fully digital planning workflows using CBCT-based evaluation. Methods: This retrospective comparative study included 100 adult patients with skeletal Class II or III malocclusion treated by Le Fort I osteotomy combined with bilateral sagittal split osteotomy (BSSO). Patients were allocated to conventional planning (n = 50) or fully digital planning using IPS CaseDesigner (n = 50). Planned and postoperative CBCT datasets were superimposed using voxel-based cranial base registration. Linear deviations at A-point and Pogonion, total RMS error, planning time, and operative time were analyzed. Results: Mean deviations were lower in the digital group at A-point (1.28 ± 0.28 mm vs. 1.63 ± 0.36 mm) and Pogonion (1.49 ± 0.42 mm vs. 1.95 ± 0.44 mm) (p < 0.001). Total RMS deviation was reduced in the digital workflow (1.39 ± 0.39 mm vs. 1.80 ± 0.54 mm; p < 0.001). Planning and operative times were significantly shorter in the digital group (p < 0.001). Moderate correlations were observed between time variables and 3D deviations. Conclusions: Fully digital planning showed improved 3D accuracy and significantly reduced planning and operative times compared with conventional methods, while maintaining clinically acceptable deviations. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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12 pages, 1154 KB

Open AccessArticle

Three-Dimensional CBCT Analysis of Second Mesiobuccal Canal Anatomy in Maxillary Molars

by Hanadi Sabban, Maysoon Albahiti and Suha S. Maddah

Diagnostics 2026, 16(9), 1299; https://doi.org/10.3390/diagnostics16091299 - 27 Apr 2026

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Abstract

Background: This study aimed to evaluate the prevalence, morphology, and influencing factors of the second mesiobuccal (MB2) canal in maxillary molars and the middle-mesial canal in mandibular molars using cone-beam computed tomography (CBCT). Methods: A total of 146 CBCT scans acquired between 2023 and 2025 were retrospectively analyzed at the Oral Radiology Division, King Abdulaziz University Dental Hospital. Canal prevalence, morphometric dimensions, symmetry, and Vertucci configurations were recorded and correlated with age, sex, and voxel size. Results: MB2 canals were detected in 64.4% of maxillary first molars and 29.6% of second molars, while middle-mesial canals were found in 17.8% of mandibular first molars and 6.4% of second molars. Detection rates declined with increasing voxel size and patient age (p < 0.05). Bilateral symmetry was strong for MB2 (κ = 0.78) but moderate for mandibular canals (κ = 0.29). Vertucci Type I and II were most common in maxillary roots, and Type IV predominated in mandibular mesial roots. Conclusions: These findings confirm CBCT as a reliable tool for identifying complex canal systems and emphasize the importance of voxel resolution and anatomical understanding in enhancing endodontic diagnosis and treatment success. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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13 pages, 1737 KB

Open AccessArticle

Ex Vivo Quantitative Evaluation of Beam Hardening Artifacts at Various Implant Locations in Cone-Beam Computed Tomography Using Metal Artifact Reduction and Noise Reduction Techniques

by Cengiz Evli, Merve Önder, Ruben Pauwels, Mehmet Hakan Kurt, İsmail Doruk Koçyiğit, Gökhan Yazıcı and Kaan Orhan

Diagnostics 2025, 15(24), 3201; https://doi.org/10.3390/diagnostics15243201 - 15 Dec 2025

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Abstract

Purposes: Beam hardening artifacts caused by dental implants remain one of the most significant limitations of cone-beam computed tomography (CBCT), often compromising the evaluation of peri-implant bone and potentially masking critical diagnostic findings. Although metal artifact reduction (MAR) and noise-optimization filters such as the Adaptive Image Noise Optimizer (AINO) are widely available in commercial CBCT systems, their effectiveness varies depending on implant configuration and scanning parameters. A clearer understanding of how implant positioning influences artifact severity—together with how MAR and AINO perform under different conditions—is essential for improving diagnostic reliability. Materials and Methods: A fresh frozen cadaver head, with dental implants inserted using two configurations (C1 and C2), was scanned using different scan parameters, with and without metal artifact reduction and image optimization filters. The percentages of gray value alteration due to artifacts were evaluated, using registered pre-implant scans as a control. Regions of interest were defined by an experienced researcher. For the two implant conditions, ROIs were placed as follows: C1—lingual, buccal and mesial to the mesial implant; lingual, buccal and distal to the distal implant; and an additional ROI between the implants (n = 7); C2—lingual, buccal, mesial and distal to each implant (n = 8). For each ROI, the mean gray value was measured in five consecutive axial slices, and rescaled according to calibration points in air and soft tissue. Results: Significant differences were found in gray values across configurations and scan modes. In the C2 configuration, combined MAR and AINO restored gray values in certain ROIs from 1.227 (OFF) to 1.223 (MAR+AINO), closely matching the control (1.227). In contrast, C1 showed limited improvement; for example, buccal ROI gray values decreased from 3.978 (OFF) to 3.323 (AINO) compared to the control (3.273), with no significant benefit from additional MAR. Conclusion: Artifacts from implants can be significantly affected by their (relative) position and the use of MAR and AINO. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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13 pages, 1039 KB

Open AccessArticle

Is Mandibular Cortical Bone and Trabecular Microarchitecture Altered by Masseter Botox Treatment? A Quantitative Perspective

by Ibrahim Burak Yuksel, Fatma Altiparmak, Serkan Bahrilli, Fatma Ucan Yarkac, Dilek Ozkan Sen and Kaan Orhan

Diagnostics 2025, 15(17), 2201; https://doi.org/10.3390/diagnostics15172201 - 29 Aug 2025

Viewed by 3637

Abstract

Background/Objectives: Bruxism is a prevalent parafunctional activity that induces masticatory muscle hypertrophy and physiological mandibular bone alterations. While botulinum toxin type A (BTX-A) injections effectively reduce muscle hyperactivity, objective radiological assessment of their skeletal effects remains limited. This study aimed to quantitatively evaluate the impact of BTX-A on mandibular trabecular bone structure by assessing potential reductions in fractal dimension (FD) in bruxism patients compared to controls. Methods: This retrospective matched-pair study included 42 bruxism patients (39 females, 3 males) receiving 50 U of BTX-A in masseter muscles and 32 age-matched non-bruxism controls (30 females, 2 males). Pre- and 6-month post-treatment panoramic radiographs were analyzed. FD values were calculated from bilateral condylar neck, ramus, and angulus regions. Results: Statistically significant reductions in FD values were observed in the angulus regions post-treatment (Right: 1.3856 to 1.2995; Left: 1.3718 to 1.2529, p < 0.001). Postoperative FD values in the BTX-A group showed no significant differences when compared to the control group (p > 0.05). Conclusions: BTX-A administration leads to measurable, region-specific reductions in mandibular trabecular bone fractal dimension, particularly in the angulus. The postoperative similarity to the control group suggests a potential normalization of bone structure following treatment. These findings highlight the clinical utility of fractal analysis for monitoring osseous adaptations in neuromuscular interventions. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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15 pages, 978 KB

Open AccessArticle

Examination of the Frequency of Soft Tissue Ossification and Calcifications in Panoramic Radiographs: A Retrospective Study

by Sumeyye Celik Ozsoy, Taha Zirek, Serkan Bahrilli, Ibrahim Burak Yuksel and Ali Altindag

Diagnostics 2025, 15(16), 2013; https://doi.org/10.3390/diagnostics15162013 - 12 Aug 2025

Cited by 5 | Viewed by 2272

Abstract

Background: This retrospective study aimed to assess the prevalence and distribution of common soft tissue ossifications and calcifications in the head and neck area, such as tonsilloliths, calcified lymph nodes, atherosclerotic plaques, stylohyoid ligament calcifications, and laryngeal cartilage calcifications, using panoramic radiographs (PRs) from a Turkish population. A secondary objective was to analyze these findings based on age and gender, ultimately seeking to enhance clinicians’ awareness of these incidental findings and their potential diagnostic significance. Methods: PRs of 1207 patients applying to the Department of Oral and Maxillofacial Radiology at Necmettin Erbakan University Faculty of Dentistry between 2021 and 2022 were reviewed. Out of these, 1193 images meeting quality criteria and showing distinct anatomical details were included. Patients with prior diagnosed bone metabolic disorders were excluded. Two radiologists independently assessed the images for the presence of soft tissue calcifications and ossifications. Inter-observer reliability was quantified using Cohen’s Kappa coefficient, which was found to be 0.78, indicating substantial agreement (95% CI: [0.72–0.83], p < 0.001). The calcifications and ossifications were categorized according to age, gender, and type. Data were analyzed employing descriptive statistical methods and Chi-square tests, with a significance level set at p < 0.05. Results: Soft tissue calcification or ossification was observed in 122 (10.22%) of the 1193 retrospectively evaluated PRs. The most common findings included stylohyoid ligament ossifications (n = 31), laryngeal cartilage calcifications (n = 28), tonsilloliths (n = 25), calcified atherosclerotic plaques (n = 18), and calcified lymph nodes (n = 18). Two antroliths were also identified. Arteriosclerosis, phleboliths, and sialoliths were not detected in this cohort. Although some types of calcification showed numerical variations across age groups and genders (e.g., higher prevalence of most anomalies in patients aged 31 years and older; more frequent laryngeal cartilage calcification in women and tonsilloliths in men), Chi-square analyses revealed no statistically significant association between the presence of these calcifications or ossifications and either age group (p = 0.284) or gender (p = 0.122). Conclusions: PRs serve as an effective initial screening instrument for identifying soft tissue calcifications within the head and neck region, owing to their widespread availability, cost-effectiveness, and minimal radiation exposure. The detection of such findings is of paramount importance, as they may indicate underlying systemic conditions necessitating further diagnostic evaluation. While clinicians should remain vigilant to these anomalies, definitive diagnosis typically requires supplementary imaging modalities such as cone-beam computed tomography (CBCT), ultrasound, or histopathological analysis. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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11 pages, 37733 KB

Open AccessCase Report

Multimodal Imaging of Oncocytic Lipoadenoma Arising from the Parotid Deep Lobe with Medial Extension into the Parapharyngeal Space: A Case Report with Histopathologic Findings and Literature Review

by Jong-Uk Lee, Hye Jin Baek, Kwang Ho Choi, Eun Cho and Hyo Jung An

Diagnostics 2026, 16(9), 1366; https://doi.org/10.3390/diagnostics16091366 - 30 Apr 2026

Viewed by 462

Abstract

Background: Oncocytic lipoadenoma is an exceptionally rare benign fat-containing salivary gland tumor that most commonly arises in the parotid gland. Previous case reports have largely focused on histopathology with limited or single-modality imaging documentation; therefore, practical preoperative radiological characterization remains challenging. Case Presentation: A 46-year-old male presented with a 2-year history of a slowly enlarging right-sided parotid mass. Computed tomography and magnetic resonance imaging showed a well-circumscribed fat-containing mass with a discrete medially enhancing solid component, mild diffusion restriction and small cystic foci without aggressive features. Ultrasonography revealed a heterogeneously hypoechoic parotid mass; however, limited acoustic penetration hindered evaluation of the deep portion. A core-needle biopsy was inconclusive, and an atypical lipomatous tumor could not be excluded. Subsequent surgical excision confirmed an oncocytic lipoadenoma, a biphasic tumor comprising mature adipose tissue and cytokeratin 7-positive oncocytic epithelial nests. The patient has remained recurrence-free for 7 years after surgery. Conclusions: Fat-containing parotid tumors can be diagnostically challenging because imaging findings are often nonspecific, and biphasic lipoepithelial entities are rarely encountered. This case highlights that awareness of the pattern of macroscopic fat with a discrete enhancing non-fat component, interpreted alongside histopathological findings, may help narrow the differential diagnosis, guide management, and reduce diagnostic uncertainty. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Imaging)

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