Search Results (551)

Background/Objectives: Exercise-based interventions are strongly recommended for managing temporomandibular disorders (TMDs). However, conventional approaches have limited capacity to address symptoms associated with mandibular kinematic abnormalities and often lack sufficient logical clarity for reproducible clinical applications. Furthermore, although current diagnostic criteria and imaging modalities primarily assess static anatomical conditions, traditional three-dimensional motion analysis is difficult to implement in routine practice. This study aimed to evaluate the effectiveness of a personalized, exercise-based intervention optimized to patients’ lateral excursion (LE) characteristics using an artificial intelligence (AI)-assisted motion analysis system. Methods: An AI-based two-dimensional motion analysis platform was used to quantify maximum mouth opening (MMO) and LE in three patients with TMD. Individualized interventions—including massage, stretching, resistance exercises, coordination training, and breathing exercises—were provided over 3 weeks based on each patient’s clinical presentation and movement patterns identified through the kinematic analysis. Results: All three patients successfully completed the intervention. Average pain intensity declined across all cases. Mandibular function improved: the mean MMO increased by 38.92% on average, and LE decreased by −1.55 mm on average. Conclusions: This study demonstrates that a personalized, exercise-based intervention guided by AI-assisted mandibular kinematic analysis was associated with reductions in pain and improvements in dynamic mandibular function. This approach provides a logically clear and objective framework that may support physical therapy in TMD management, advancing beyond conventional static assessment methods. Full article

Recurrent canine cervical sialocele is most often caused by incomplete excision of the mandibular–sublingual gland complex, leading to anatomical distortion and concealment of residual tissue. This case describes the multimodal management of a repeatedly recurrent cervical sialocele in a young, small-breed dog following multiple previous revision surgeries. A stepwise bridging strategy was adopted before definitive salvage surgery. Oral phenobarbital was instituted, resulting in partial reduction in fluid accumulation and improved comfort. Ultrasound-guided intracavitary sclerotherapy with OK-432 was then performed, inducing a localized fibrotic response but without durable cure. Final resolution was achieved only after salvage ventral paramedian (VPM) sialoadenectomy, which provided wide exposure for complete excision of deeply concealed sublingual remnant tissue within a fibrotic pseudocapsule. Histology confirmed a cervical sialocele. Transient neuropraxia resolved within 3 weeks, and no recurrence was observed at 6 months postoperatively. To the authors’ knowledge, this is the first report describing intracavitary OK-432 sclerotherapy as part of a staged multimodal strategy for canine cervical sialocele. This case illustrates the feasibility of integrating medical salivary suppression and minimally invasive sclerotherapy as bridging measures before salvage VPM surgery for refractory cervical sialocele. Full article

Persistent Idiopathic Dentoalveolar Pain (PIDAP) is a persistent idiopathic toothache that frequently remains unresponsive to medical therapy. Precise targeting of the infraorbital nerve is essential for successful intervention, yet anatomical variability often limits the consistency of conventional radiofrequency ablation (RFA). This report describes a medial-to-lateral ultrasound- and computed tomography-guided approach, intended to align with the natural orientation of the infraorbital canal and potentially enhance electrode–nerve contact. A 48-year-old woman with refractory maxillary incisor pain underwent RFA after only transient benefit from a diagnostic nerve block. Ultrasound enabled accurate identification of the infraorbital foramen and confirmed the canal’s medial-to-lateral course, which then guided CT-assisted needle advancement into the orbitomaxillary segment. The patient experienced immediate analgesia. Pain reduction was maintained at the one-month follow-up. At the two-month assessment, although a mild symptom rebound was observed, no procedure-related complications were noted. This trajectory-based medial-to-lateral technique offers an anatomically grounded alternative for infraorbital nerve RFA and may represent a valuable option for refractory PIDAP. Full article

Atlantoaxial instability (AAI) in toy- and small-breed dogs remains a significant clinical challenge, as the restricted anatomical space and risk of complications complicate the selection of implants. This study aimed to compare three patient-specific Ti-6Al-4V stabilizers for the C1–C2 region: a clinically used ventral C1–C3 plate, a shortened ventral C1–C2 plate, and a dorsal C1–C2 implant. Computed tomography, segmentation, virtual reduction, CAD/CAM design, and finite element analysis were employed to evaluate the linear-static mechanical behavior of each construct under loading ranging from 5 to 25 N, with a focus on displacements, von Mises stresses, and peri-screw bone strains. Additionally, cadaver procedures were performed in nine small-breed dogs using custom drill guides and additively manufactured implants to evaluate procedural feasibility and implantation time. Finite element models demonstrated that all stabilizers operated within material and biological safety limits. The C1–C3 plate exhibited the highest implant stresses, while the C1–C2 plate demonstrated an intermediate response, and the dorsal implant minimized implant stresses, albeit by increasing bone stresses. Cadaver experiments revealed that dorsal fixation required less implantation time than ventral fixation. Collectively, the findings indicate that all evaluated constructs represent safe stabilization options, and the choice of implant should reflect the preferred load-transfer pathway as well as anatomical or surgical constraints that may limit ventral access. Full article

Patients with severe structural tooth wear present significant restorative challenges, including compromised oral function and the loss of essential anatomical landmarks such as marginal ridges, incisal edges, cusps, occlusal planes, and vertical dimension of occlusion (VDO). Successful management requires meticulous diagnosis, comprehensive treatment planning, and careful selection of restorative materials with appropriate biomechanical properties. Digital technologies have become integral to this process, particularly for enhancing diagnostic accuracy, material selection, and tooth preparation design within a fully digital workflow. This clinical case report illustrates a complete digital approach, beginning with an initial intraoral scan merged with a digital wax-up STL file featuring varying translucency dimensions to guide tooth preparation. This workflow enabled precise planning of tooth reduction, accurate assessment of available interocclusal space, and determination of material thickness requirements prior to irreversible procedures. Additionally, the integration of digital visualization improved patient communication, treatment predictability, and interdisciplinary collaboration. Overall, this case highlights the value of CAD/CAM technology in supporting complex oral rehabilitation for patients with advanced tooth wear, demonstrating its capacity to enhance efficiency, precision, and outcome quality in full-mouth zirconia ceramic restorations. Full article

Tissue-mimicking phantoms that accurately replicate human tissue are crucial for validating and optimizing elastography systems and developing new treatment methods. The use of waste-based fibrous structures has the dual benefits of waste reduction and economic viability, mitigating the environmental consequences associated with the textile industry and, thus, posing a particularly interesting avenue of research in today’s ever-more environmentally conscious society. This work explores the development of elastography phantoms through the use of textile waste for sustainable valorization. Two cotton-short fiber-based and two polyester-nonwoven-based phantoms were produced by impregnating these textile structures with animal-origin gelatin. These materials were characterized by scanning electron microscopy (SEM), revealing that the diameter of the waste-based fibers (15.28 ± 6.18–22.40 ± 5.78 μm) falls within the typical size range of scatterers used in acoustic phantoms. It was observed that these fibers provided phantoms with intrinsic acoustic scattering properties, resulting in ultrasound images similar to those obtained in biological tissues. Shear wave elastography (SWE) was used to assess the stiffness of the phantoms, which produced realistic ultrasound images with shear wave speed (SWS) values ranging from 1.87 m s⁻¹ to 8.39 m s⁻¹, closely resembling those in different anatomical structures. This research presents an innovative methodology for producing low-cost and sustainable tissue-mimicking materials, underscoring the potential of textile industry waste for phantom production. Full article

Objectives: Against common belief, mandibular condyle fractures are not that rare, with morbidity rates ranging from 19 to 52%, depending on actual literature sources. Practitioners try to improve the surgical techniques applied to obtain the most satisfactory anatomical and functional effect. The purpose of this study is to identify the relationships that affect bone loss around screws and plates in mandibular condylar process fractures treated surgically using the Open Reduction and Internal Fixation (ORIF) technique. Materials and Methods: Our research covered 276 fractures of the base, low and high neck of the condylar process. No formal sample size calculation was performed; the study enrolled patients treated at the Department during the last 4 years, based on informed consent granted both prospectively and retrospectively compares to the actual treatment time. The study group was selected based on injury type and the ability to implement surgical treatment. The imaging modality selected for the study was computed tomography (CT), which was assessed in each case by the same operator. Therefore, there was no need to account for inter-rater variability in the results. Based on CT scans, we studied various parameters, including bone healing in the fracture area, bone loss in the screws and plates area, change in the length of the mandibular ramus following osteosynthesis and on the opposite side after 12 months, as well as deformities of the mandibular head. Results: Using screws and plates is the gold standard for treating mandibular condylar process fractures. The number of screws used affects the bone loss ratio around head of the screw. Another factor that impacts the results achieved is the distance from the plate edge to the lateral pole of the mandibular head. Statistical evaluation indicated that proximity to the lateral pole is a risk factor for bone resorption at the plate edge. Conclusions: Based on the collected data, it is possible to predict bone loss, determine the location and selection of plates and screws, as well as to plan the procedure, achieving the lowest possible loss rates. Full article

Patent foramen ovale (PFO) is present in roughly one quarter of adults and is over-represented among younger patients with cryptogenic ischemic stroke. The past decade has produced compelling evidence from randomized trials showing that PFO closure is beneficial than medical therapy in preventing recurrent ischemic stroke in appropriately selected patients. Despite this, anticoagulation continues to be used when closure is not feasible, declined, contraindicated, or considered after recurrent events. The observation that some patients experience “breakthrough” stroke or transient ischemic attack (TIA) despite therapeutic anticoagulation raises a critical question: why does medical therapy fail in PFO-associated stroke, and why does closure appear superior? This narrative review synthesizes the latest evidence on the pathophysiology of PFO-associated stroke, with attention to mechanisms that remain incompletely addressed by anticoagulation. It analyzes randomized trial data comparing antiplatelet therapy, anticoagulation, and transcatheter closure. It examines the role of high-risk PFO anatomical characteristics, the Risk of Paradoxical Embolism (RoPE) score, and the PFO-Associated Stroke Causal Likelihood (PASCAL) classification in understanding medical therapy failure. Additionally, the review explores whether PFO “type” predicts anticoagulation failure and highlights future research directions needed to further optimize therapy. In conclusion, in appropriately selected patients with high-risk PFO features, closure provides greater stroke risk reduction than medical therapy alone, albeit with small absolute risk differences and a procedural risk of atrial fibrillation. Full article

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by repeated upper airway collapse during sleep, significantly impacting quality of life. Orthodontists are increasingly recognized for their role in screening and managing anatomical factors contributing to airway obstruction. One such intervention is rapid maxillary expansion (RME), originally developed to address transverse maxillary deficiencies but now also studied for its influence on nasal and oropharyngeal airway dimensions. This literature review evaluates the effects of maxillary palatal expansion on airway volume and respiratory function. Evidence consistently shows increases in nasal cavity volume and reductions in nasal airway resistance, particularly in patients treated before the peak of skeletal growth. Some studies reported improvements in sleep outcomes and enhanced oxygen saturation following MARPE in adults with OSA. Results regarding changes in oropharyngeal volume were more variable, with several studies showing significant expansion. Factors influencing outcomes include patient age, skeletal maturity, appliance type, and aging modality. Hybrid and bone-borne expanders generally demonstrated greater skeletal effects compared to tooth-borne devices, though statistical significance was not always reached. While MARPE has shown promising results in non-obese adults with OSA, long-term stability of airway improvements and translation into consistent functional respiratory benefits remain uncertain. Overall, maxillary expansion demonstrates measurable skeletal and airway changes, with the greatest respiratory improvements in growing patients and selected adult populations. Incorporating patient-reported outcomes and standardized polysomnographic measures in future trials will be critical to determine whether these structural gains consistently translate into durable improvements in sleep-disordered breathing and quality of life. Full article

Background/Objectives: Computed tomography remains the reference standard for assessing lumbar interbody fusion, yet significant methodological heterogeneity, documented across more than 250 different assessment combinations, directly impacts treatment decisions and outcome reporting. The main challenge is applying uniform criteria to technique-specific anatomical configurations that generate distinct bridging patterns. Methods: This narrative review synthesizes evidence from 2000 to 2025 through PubMed and Google Scholar searches, examining imaging protocols, radiographic criteria validated against surgical exploration and reliability studies, and classification systems with emphasis on clinical application. Results: Modern protocols that incorporate iterative metal artifact reduction and dual-energy imaging substantially improve visualization of the hardware–bone interface. Zone-based evaluation shows that bridging patterns primarily reflect cage configuration and graft placement strategy rather than the surgical approach alone—a key distinction that affects assessment methodology. Validation studies confirm higher inter-observer reliability for extracage zones (ICC 0.79–0.84) compared to intracage regions (ICC 0.70–0.79). Evidence supports three main bridging patterns: graft-dependent consolidation, ungrafted-zone bridging, and accessibility-dependent variation. Assessment at 12 months captures most successful fusions, although 15–16% show delayed progress and require longer follow-up. Conclusions: This review synthesizes current evidence on technical optimization and temporal healing patterns, proposing a principle-based interpretive framework that accommodates technique-specific differences instead of strict categorical criteria. This framework allows personalized assessment correlated with surgical documentation, addressing the documented heterogeneity while enhancing diagnostic consistency. Full article

The response of cocoa (Theobroma cacao L.) to low oxygen availability in the soil and the possibility of recovery after stress relief are associated with the plasticity capacity of each genotype; however, studies evaluating the influence of rootstock on stress response are scarce. Thus, in the northern region of the state of Espírito Santo, municipality of São Mateus, the physiological, biochemical, and anatomical responses and recovery capacity of cocoa PS-1319 grafted onto the rootstocks TSH-1188, Cepec-2002, Pará, Esfip-02, and SJ-02 were evaluated under flooded conditions. The plants were subjected to flooding for 60 days, and their recovery capacity was assessed after this period. The gas exchange, relative chlorophyll content, stem and leaf anatomy, photosynthetic pigments, and carbohydrates were evaluated. All genotypes showed reductions in net photosynthetic assimilation, stomatal conductance, and transpiration rate in the flooded environment compared to the non-flooded environment. All pigments were degraded, with average values of Chl a, Chl b, total Chl, and total carotenoids of 9.33, 10.418, 19.75, and 590.75 μg.mL⁻¹ in the non-flooded environment and 6.43, 7.69, 14.12, and 500.33 μg.mL⁻¹ in the flooded environment. The rootstocks Cepec-2002 and Esfip-02 showed the highest carotenoid accumulation, with 585.78 and 650.47 μg.mL⁻¹, respectively, when compared to SJ-02 (474.03 μg.mL⁻¹), Pará (491.58 μg.mL⁻¹), and TSH-1188 (525.86 491.58 μg.mL⁻¹). The Pará rootstock did not show differences in stomatal density between environments, with values of 32.25 in flooding, 34.83 in non-flooding, and 31.61 in recovery. During flooding, lenticels formed in all rootstocks. After recovery, all rootstocks normalized their gas exchange, carbohydrate levels, and anatomy, showing that the root system was able to re-establish its functions, making these rootstocks suitable for areas at risk of flooding. Full article

Background/Objectives: Managing large midline olfactory groove meningiomas is especially difficult in elderly patients who have limited physiological reserves. Here we describe a unique and dangerous geriatric case where we used new quantifiable anatomical measurements and developed a structured multidisciplinary preoperative and postoperative protocol to assist in all aspects of surgery. Case Presentation: A 68-year-old male with fronto-lobe syndrome and disability (astasia-abasia; Tinetti Balance Score of 4/16 and Gait Score of 0/12) as well as cognitive dysfunction (MoCA score of 12/30) and blindness bilaterally. Imaging prior to surgery demonstrated a very large olfactory groove meningioma which severely compressed both optic pathways at the level of the optic canals (up to 71% reduction in cross-sectional area of the optic nerves) and had complex vascular relationships with the anterior cerebral artery complex (210° contact surface). Due to significant cardiovascular disease and liver disease, his care followed a coordinated optimization protocol for the perioperative period. He underwent bifrontal craniotomy, initial early devascularization and then staged ultrasonic internal decompression (approximately 70% reduction in tumor volume) and finally microsurgical dissection of the tumor under multi-modal monitoring of neurophysiology. Discussion: We analyzed his imaging data prior to surgery using a standardized measurement protocol to provide quantitative measures of the degree of compression of the optic pathways (traction-stretch index = 1.93; optic angulation = 47.3°). These quantitative measures allowed us to make a risk-based evaluation of the anatomy and to guide our choices of corridors through which to dissect and remove the tumor. Following surgery, imaging studies demonstrated complete removal of the tumor with significant relief of the frontal lobe and optic apparatus from compression. His pathology showed that he had a WHO Grade I meningioma with an AKT1(E17K) mutation identified on molecular profiling. Conclusions: This case is intended to demonstrate the feasibility of integrating quantitative anatomical measurements into a multidisciplinary, protocol-based perioperative pathway to maximize the safety and effectiveness of the surgical removal of a complex and high-risk skull-base tumor. While the proposed quantitative indices are experimental and require additional validation, the use of a systematic approach such as this may serve as a useful paradigm for other complex skull-base cases. Full article

Cone beam computed tomography (CBCT) allows for rapid and accessible acquisition of three-dimensional images with a lower radiation dose compared to conventional computed tomography (CT) scans. However, the quality of CBCT images is limited by a variety of artifacts. This systematic review attempts to explore different artificial intelligence-based solutions for enhancing the quality of CBCT scans and reducing different types of artifacts in these three-dimensional images. PubMed, Web of Science, Scopus, Embase, Cochrane, and Google Scholar were searched up to March 2025. Risk of bias of included studies was assessed using the QUADAS-II tool. Extracted data included bibliographic information, aim, imaging modality, anatomical site of interest, artificial intelligence modeling approach and details, data and dataset details, qualitative and quantitative performance metrics, and main findings. A total of 27 papers from 2018 to 2025 were included. These studies focused on five areas: metal artifact reduction, scatter correction, image reconstruction improvement, motion artifact reduction, and noise reduction. Artificial intelligence models mainly used U-Net variants, though hybrid and transformer-based models were also explored. The thoracic region was the most analyzed, and the structural similarity index measure and peak signal-to-noise-ratio were common performance metrics. Data availability was limited, with only 26% of studies providing public access and 15% sharing model source codes. Artificial intelligence-driven approaches have demonstrated promising results for CBCT artifact reduction. This review highlights a wide variability in performance assessments and that most studies have not received diagnostic validation, limiting conclusions on the true clinical impact of these artificial intelligence-based improvements. Full article

This systematic review evaluated the effectiveness of iterative reconstruction (IR) and deep learning reconstruction (DLR) in reducing radiation dose in computed tomography (CT) while preserving diagnostic image quality. We systematically searched PubMed, Scopus, and Web of Science (last search 22 March 2025); the protocol was registered in the OSF (DOI: 10.17605/OSF.IO/TUQDS). Eligible studies were English-language adult (≥18 years) investigations published between 2020 and 2025 that used IR or DLR and reported radiation-dose outcomes; studies on paediatric, phantom, cadaver, cone-beam, and spectral CT were excluded. In accordance with PRISMA 2020 guidelines, 4371 records were identified, and 30 met the inclusion criteria. Risk of bias was assessed using the NIH Quality Assessment Tool; most studies were deemed to be at low risk. Data were narratively synthesised and structured by a reconstruction approach and anatomical region. Across the 30 studies, IR achieved a dose reduction of 24–50% (mean ≈ 45%) and a DLR reduction of 34–89% (mean ≈ 58%); several DLR protocols enabled reductions of ≥75% without impairing diagnostic quality. Thirty studies in total were included (total N = 2581; range 24–289). It was determined that both approaches substantially reduce radiation exposure while maintaining diagnostic image quality; DLR generally demonstrates greater noise suppression and dose efficiency, especially in ultra-low-dose applications. However, heterogeneity in methods, designs, and scanner technologies limits the ability to draw uniform conclusions. Standardised protocols, multi-vendor prospective studies, and long-term evaluations are needed. Full article

Background: Vascular malformations (VMs) are congenital anomalies of the vascular system—capillary, venous, lymphatic, arteriovenous, or combined—frequently associated with notable morbidity and reduced quality of life. Electrochemotherapy (ECT), a locoregional treatment that combines chemotherapeutic agents (most commonly bleomycin) with electroporation, has emerged as a promising alternative in managing therapy-resistant or anatomically challenging lesions. Methods: A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to January 2025 for studies reporting on the efficacy and/or safety of ECT for vascular malformations. Data extraction encompassed study design, patient demographics, VM type, ECT protocols, outcomes, follow-up duration, and adverse events. Studies that lacked relevant outcome data or focused solely on other therapeutic approaches were excluded. Results: Twelve primary studies met the inclusion criteria and were analyzed. These covered diverse VMs, including venous, slow-flow, high-flow malformations, aggressive hemangiomas, and composite lesions in adult and pediatric populations. ECT protocols usually combined bleomycin (or occasionally other agents such as pingyangmycin or polidocanol foam) with various electroporation parameters. Across studies, ECT resulted in meaningful lesion-size reduction (50–97% in most cohorts), symptom relief (e.g., reduced pain and bleeding), and favorable cosmetic outcomes. While side effects (local edema, hyperpigmentation, procedure-related discomfort) were occasionally reported, they were typically mild and transient. Conclusions: ECT represents a valuable minimally invasive option in the therapeutic armamentarium for vascular malformations. Despite consistent demonstrations of efficacy and acceptable toxicity profiles, future high-quality, multicenter studies are warranted to confirm outcomes, refine treatment guidelines, and potentially expand its use as a standard of care. Full article