Search Results (1,208)

Background: The pterygomaxillary region is a complex anatomical area formed by the junction of the maxillary, palatine, and sphenoid bones and contains critical neurovascular structures. Accurate assessment of this region during Le Fort I osteotomy is essential, particularly to prevent hemorrhage and nerve injury that may occur during the pterygomaxillary separation phase. This study aims to investigate the morphometric characteristics of the pterygomaxillary region using cone-beam computed tomography (CBCT) and to evaluate the effects of age, sex, and laterality on these anatomical parameters. Materials and Methods: In this retrospective study, CBCT scans of 200 individuals (100 males and 100 females) aged 20–80 years were analyzed. Axial measurements included distances between the piriform rim, the descending palatine artery, the pterygomaxillary osteotomy line, and the pterygomaxillary fissure. Additionally, the thickness and width of the pterygomaxillary region and pterygoid process, lengths of the medial and lateral pterygoid laminae, and the distance between the greater palatine canal and the medial pterygoid lamina apex were recorded. Measurements were statistically evaluated by sex, age group, and laterality. Results: The following parameters demonstrated statistically significant differences based on the conducted measurements: The distance between the piriform rim and the descending palatine artery was significantly greater on the left side (p < 0.001). The length of the lateral pterygoid lamina increased with advancing age (p = 0.048). The thickness of the pterygomaxillary region was significantly greater in females (p = 0.014). Additionally, the distance between the greater palatine canal and the terminal point of the medial pterygoid lamina was significantly higher in males (p < 0.001). Conclusions: The pterygomaxillary region exhibits anatomical variations that may lead to serious complications during Le Fort I osteotomy. Detailed preoperative evaluation of this area using CBCT can guide surgical planning and help prevent potential vascular and neural complications. Full article

Objectives: To assess the utility of Microsoft Copilot, a generative AI tool, in providing meaningful differential diagnosis and management strategies comparable with those generated by a board-certified radiologist using cone beam computed tomography (CBCT) studies in maxillofacial disease and thus assess its potential utility to help with the initial provisional diagnostic process. Study Design: A pilot project designed as a single-center, retrospective study using a convenient sample was conducted. De-identified data collected from patient charts in a consistent format was fed to Microsoft 365 Copilot (MCP) to generate a list of meaningful differential diagnosis (DD) and management protocols. Scores ranging of 0–3 were given for 0–3 matches in DD and management protocols, respectively. Results: Proportional analysis showed that the radiologist and Copilot agreed on the DD in 75.2% of cases and 94.6% of cases in management protocols. For biopsy recommendations, the radiologist and Copilot advised biopsy in 33 (89.2%) cases while they did not recommend biopsy in 23 (41.8%) cases. Conclusions: Generative AI platforms at this point may have value in generating DD and management protocols based on maxillofacial CBCT findings. However, the radiologist’s judgement based on clinical context, feature recognition, and critical analysis seemed to outperform MCP. Larger studies with statistical validation are warranted. Full article

The objective of the present study was to investigate whether orthodontic treatment alters the morphology and bone mineral density (BMD) distribution of the mandibular condyle in growing adolescent patients. Cone-beam computed tomography (CBCT) images were retrospectively analyzed for 29 patients (10 males and 19 females, aged 12.5 to 17.0 years) treated with full fixed orthodontic appliances. The right and left mandibular condyles were digitally isolated. For the internal control sample, the basal cortical bone (CB) at both mandibular first molar sites was also digitally dissected. A frequency plot of the CBCT gray values, proportional to BMD, was analyzed to calculate the mean and the 5th percentile of low and high gray values (Low₅ and High₅). Morphological changes in the condylar surface were assessed based on temporomandibular joint osteoarthritis (TMJOA) counts. Lateral cephalometric radiographs were used to measure facial morphology parameters and classify skeletal patterns. The cervical vertebral gray values of the same patients were compared. No radiographic signs of TMJ disorder were observed with no significant difference in TMJOA counts between before and after treatment (p = 0.56). The volume, mean and Low₅ gray values of the mandibular condyle, facial morphology parameters, and cervical vertebral gray values significantly increased following orthodontic treatment (p < 0.05). Skeletal Class II patients exhibited greater changes in mean, Low₅, and High₅ mandibular condyle gray values compared to their Class I patients (p < 0.05), whereas cervical vertebral gray values were not significantly influenced by skeletal classification (p > 0.19). The findings suggest that orthodontic treatment, combined with natural patient growth, contributes to nonpathological condylar alterations in adolescent patients. Full article

Background: Dens invaginatus is a rare developmental tooth anomaly that can occur in permanent, primary, and supernumerary teeth, with a tendency to affect the maxillary second incisors. It develops during odontogenesis due to the invagination of the enamel organ into the dental papilla. Methods: This study describes the endodontic management of a 24-year-old patient with a type IIIb invaginated tooth in the mandibular second molar. Clinical examination revealed no response to thermal and electrical stimuli, no response to vertical and horizontal percussion, and no pathological mobility. The depth of the gingival pocket was 8 mm. Root canal therapy was performed over three sessions. The patient remained asymptomatic during the treatment and follow-up visits. Results: Radiographs at 4-, 6-, and 9-month post-treatment showed healing of the periapical lesion. Conclusions: Due to the complex canal anatomy of invaginated teeth, confirming the diagnosis with cone-beam computed tomography (CBCT) is essential. Treating invaginated teeth presents significant challenges for clinicians, requiring a thorough understanding of the dental anatomical variability, advanced manual skills, and the use of specialized equipment. Full article

This case report describes mandibular distraction osteogenesis (DO) in a six-year-old patient with first and second branchial arch syndrome and obstructive sleep apnea, in whom 3D surgical planning was combined with ultrasonography (US) for postoperative monitoring. The aim was to illustrate how patient-specific 3D modeling and a structured ultrasonography protocol can support safe mandibular advancement while limiting radiation exposure in a pediatric patient with complex craniofacial deformity. Preoperatively, a 3D-printed model of the mandible, generated from a cone beam computed tomography (CBCT) scan, was used to guide precise osteotomy planning and vector orientation. The surgical procedure was conducted using a Risdon approach and piezoelectric tools to ensure minimal trauma. Postoperative monitoring incorporated serial panoramic radiography and US at predefined time points to assess gap size, callus formation, and vascularity during distraction and consolidation. US identified early callus formation, progressive cortical bridging, and preserved callus vascularity, and, together with radiographic findings, guided the timing of distraction termination and distractor removal at 16 weeks. This case adds to the limited literature on pediatric mandibular DO by demonstrating the feasibility of integrating patient-specific 3D virtual planning with US-based follow-up to improve the safety, precision, and radiation-conscious management of DO in pediatric patients with complex craniofacial deformities. Full article

Panoramic radiography remains a cornerstone diagnostic tool in dentistry; however, its two-dimensional nature limits the visualisation of complex maxillofacial anatomy. Three-dimensional reconstruction from single panoramic images addresses this limitation by computationally generating spatial representations without additional radiation exposure or expensive cone-beam computed tomography (CBCT) scans. This systematic review and conceptual study traces the evolution of 3D reconstruction approaches, from classical geometric and statistical shape models to modern artificial intelligence-based methods, including convolutional neural networks, generative adversarial networks, and neural implicit fields such as Occudent and NeBLa. Deep learning frameworks demonstrate superior accuracy in reconstructing dental and jaw structures compared to traditional techniques. Building on these advancements, this paper proposes HoloDent3D, a theoretical framework that combines AI-driven panoramic reconstruction with real-time holographic visualisation. The system enables interactive, radiation-free volumetric inspection for diagnosis, treatment planning, and patient education. Despite significant progress, persistent challenges include limited paired 2D–3D datasets, generalisation across anatomical variability, and clinical validation. Continued integration of multimodal data fusion, temporal modelling, and holographic visualisation is expected to accelerate the clinical translation of AI-based 3D reconstruction systems in digital dentistry. 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

Background: Orofacial myofunctional therapy (OMT) is an emerging adjunctive treatment for obstructive sleep apnea (OSA), but its effects on upper airway structural support, particularly the hyoid complex, are not well defined. This study assessed the short-term effects of OMT on hyoid bone position and sleep-related indices in adults with mild to moderate OSA. Methods: In this assessor-blinded randomized controlled trial (ClinicalTrials.gov Identifier: NCT06079073), 13 adults with mild to moderate OSA were randomized to a 12-week web-based OMT program (n = 9) or a waitlist control group (n = 4). Cone-beam computed tomography (CBCT) and three-night home sleep testing were performed at baseline and follow-up. The primary outcome was change in axis-based cephalometric hyoid position measures; secondary outcomes included sleep parameters such as the apnea–hypopnea index (AHI). Results: No significant within- or between-group differences were observed in AHI, oxygen desaturation index, or mean nocturnal SpO₂ after 12 weeks (all p > 0.05). However, several cephalometric variables showed significant between-group differences. The waitlist group exhibited greater posterior–inferior hyoid displacement than the OMT group, with large effect sizes across multiple vector measures (all p ≤ 0.045; r = 0.56–0.66). Posterior and inferior hyoid displacement was associated with higher AHI and lower SpO₂, whereas increased lower pharyngeal airway width was associated with lower AHI. Conclusions: Short-term OMT did not improve sleep-disordered breathing indices but was associated with stabilization of hyoid bone position. These findings suggest that structural stabilization may precede functional improvement and highlight the clinical relevance of vector-based hyoid analysis. Full article

Background: The maxillary canine is considered a cornerstone tooth that plays an important role in aesthetics and function. This study compared the morphometric measurements and morphology of maxillary canines between Saudi and Spanish populations using cone-beam computed tomography (CBCT). Methods: A total of 100 CBCT scans (50 patients from King Khalid University, Saudi Arabia, and 50 patients from University of Barcelona Dental Hospital, Spain) were analyzed in this retrospective cross-sectional study conducted between May and September 2025. The study examined root length, mesiodistal and buccopalatal dimensions, root canal curvatures, apical foramen position, and canal morphology. Results: Canines from the Spanish population were significantly longer than those from the Saudi population (16.9 ± 2.2 mm vs. 13.2 ± 2.5 mm, p < 0.0001). No significant differences were observed in mesiodistal and buccopalatal dimensions. Both groups primarily exhibited mild root canal curvatures and buccally placed foramina. However, the prevalence of palatal foramina (20% vs. 8%, p = 0.04) and oval/ribbon morphologies (52%/12% vs. 22%/6%, p = 0.01) was higher in the Spanish population. The Saudi population showed a greater prevalence of round or irregular canals. The Spanish group was identified as an independent predictor of root length (β = +3.7 mm, p < 0.001), oval canal morphology (odds ratio = 3.8, p = 0.005), and palatal foramina (relative risk ratio = 2.5, p = 0.04). Conclusion: The Spanish population exhibited longer canine roots, associated with oval or ribbon-shaped canal morphologies. In contrast, the Saudi canines displayed shorter length, with more rounded or irregular morphologies. Full article

Background and Objectives: This study aimed to assess the pattern and quantity of bone regeneration after mandibular setback surgery using a novel modification of the low Z plasty (NM-Low Z plasty) technique by measuring bone density (Hounsfield unit) at the osteotomy site over a 12-month postoperative period using cone-beam computed tomography (CBCT). Materials and Methods: This retrospective cohort study included six patients with skeletal Class III deformity who underwent bilateral sagittal split osteotomy (BSSO) setback using the NM-Low Z plasty technique between 2021 and 2023 at Thammasat University Hospital. CBCT images were obtained preoperatively and at 1 month, 6 months, and 12 months postoperatively. Bone density at the buccal, cancellous, and lingual aspects of the osteotomy gap was measured using Blue Sky Plan 4 software. The intraclass correlation coefficient was used to determine reliability. Descriptive statistics, repeated-measures analysis of variance and multiple linear regression analysis were performed for comparisons. Results: At 12 months postoperatively, bone density in all measured regions was not significantly different compared to the postoperative measurements, indicating sufficient bone regeneration. The cancellous and lingual cortical regions exhibited earlier recovery than the buccal cortex. No postoperative complications such as wound infection, delayed union, or non-union were reported. Conclusions: BSSO using the NM-Low Z plasty technique offers reliable bone healing outcomes with stable bone regeneration, thereby providing a viable alternative to conventional BSSO techniques. Radiographic evidence confirmed its clinical applicability and potential to reduce the incidence of postoperative complications. 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/Objectives: The aim of this study is to evaluate pretreatment osseous changes in the temporomandibular joint (TMJ) in orthognathic surgery patients using cone-beam computed tomography (CBCT) and to determine the distribution of the findings according to sagittal skeletal malocclusion groups. Methods: CBCT images of 103 patients (206 condyles) were retrospectively analyzed. Patients were classified as Class I, II, and III based on ANB angles. Condylar morphology was assessed for flattening, sclerosis, erosion, osteophyte formation, and subchondral bone cysts. All evaluations were performed by a single investigator (κ = 0.87). Group differences were analyzed using the chi-square test with Bonferroni correction (p < 0.05). Results: The most frequent alteration was flattening (29.6%), followed by sclerosis (11.2%), erosion (10.7%), osteophyte formation (8.3%), and subchondral bone cysts (4.4%). No significant sex-related differences were found (p > 0.05). A significant difference was observed only in sclerosis (p = 0.049), which was more prevalent in Class I than Class III. Flattening predominated in all groups, while erosion and osteophytes were more common in Class II, and sclerosis was more frequent in Class I. Conclusions: This study demonstrated that condylar flattening was the most common morphological alteration in orthognathic patients across all skeletal malocclusion groups. The higher prevalence of sclerosis in Class I compared with Class III suggests that mandibular positioning may influence adaptive and degenerative remodeling processes of the TMJ. This study emphasizes the importance of CBCT evaluation for detecting osseous changes in TMJ before orthognathic surgery and demonstrates that pre-existing alterations may impact surgical stability and postoperative functional outcomes. Full article

Background: Impaired mucus drainage from the paranasal sinuses is often associated with nasal obstruction and reduced airway function in growing patients. Orthopedic maxillary protraction and expansion techniques can enhance airway dynamics, but their underlying fluid–structure mechanisms remain insufficiently understood. Objective: To validate that the Right Angle Maxillary Protraction Appliance (RAMPA), combined with a semi-rapid maxillary expansion (sRME) intraoral device gHu-1, improves mucus drainage by enhancing nasal airflow through nasal cavity expansion. Methods: The effects of RAMPA therapy were analyzed using computational fluid dynamics (CFD) for single-phase (air) and two-phase (air–mucus) flows within the nasal cavity, employing the unsteady RANS turbulence model. Finite element method (FEM) results from prior studies were synthesized to assess changes in the center and radius of maxillary rotation induced by RAMPA-assisted sRME. A male patient (aged 8 years 7 months to 11 years 7 months) treated with extraoral RAMPA and the intraoral appliance (gHu-1) underwent pre- and post-treatment cone-beam computed tomography (CBCT) and ear, nose, and throat (ENT) evaluation. Results: FEM analysis revealed an increased radius and elevated center of maxillary rotation, producing expansion that was more parallel to the palatal plane. CFD simulations showed that nasal cavity expansion increased airflow velocity and pressure drop, enhancing the suction effect that promotes mucus clearance from the frontal sinus. Clinically, nasal passages widened, paranasal opacities resolved, and occlusal and intermolar widths improved. Conclusions: RAMPA combined with sRME improves nasal airflow and maxillary skeletal expansion, facilitating paranasal mucus clearance and offering a promising adjunctive approach for enhancing upper airway function in growing patients. Full article

Background/Objectives: The sella turcica (ST) is a central craniofacial and endocrinological landmark whose morphology reflects both local skeletal development and systemic influences. Alterations in its form have been observed in various genetic syndromes, including trisomy 21 (Down syndrome, DS). Considering the characteristic craniofacial morphology of DS, this review aimed to evaluate whether individuals with DS present distinctive morphometric features and shape variants of the ST compared with non-syndromic populations and to discuss their diagnostic and clinical relevance. Methods: A systematic literature search was carried out in PubMed, the Cochrane Library, Web of Science, Wiley, MDPI, and Google Scholar on 8 May 2024. Search terms included “sella turcica,” “Down syndrome,” and “morphology.” Studies employing lateral cephalograms, cone-beam computed tomography (CBCT), or computed tomography (CT) to assess ST morphology were included when quantitative or qualitative comparisons with control groups were available. The review followed the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42024580071). Results: Only six studies fulfilled the inclusion criteria. Increased ST dimensions and a predominance of U-shaped and J-shaped variants in individuals with DS compared with controls were most frequently reported. Although the studies differed in methodology, the findings consistently indicated characteristic enlargement and remodeling of the ST in trisomy 21. Conclusions: Individuals with Down syndrome exhibit distinctive sella turcica morphology characterized by increased size and specific shape variants. The evidence base remains small and heterogeneous, with few observational studies and mixed age groups and imaging modalities, which limits the strength and generalizability of the conclusions. The present study aims to provide a modern, updated systematic review of current evidence on sella turcica morphology in patients with Down syndrome, to identify reported patterns of variation, and to explore their clinical and diagnostic significance. Recognition of these features enhances diagnostic accuracy in craniofacial evaluation, facilitates comprehensive orthodontic, endocrine, and oncological assessment, and advances understanding of cranial base development within the context of genetic syndromes. Full article

Background/Objectives: Artificial intelligence (AI) systems may enhance diagnostic accuracy in cone-beam computed tomography (CBCT) analysis. However, most validations focus on isolated tooth-level tasks rather than clinically meaningful full-mouth assessment outcomes. To evaluate the diagnostic accuracy of a commercial AI platform for detecting dental treatment features on CBCT images at both tooth and full-scan levels. Methods: In this retrospective single-center study, 147 CBCT scans (4704 tooth positions) were analyzed. Two experienced readers annotated treatment features (missing teeth, fillings, endodontic treatments, crowns, pontics, orthodontic appliances, implants), and consensus served as the reference. Anonymized datasets were processed by a cloud-based AI system (Diagnocat Inc., San Francisco, CA, USA). Diagnostic metrics—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1-score—were calculated with 95% patient-clustered bootstrap confidence intervals. A “Perfect Agreement” criterion defined full-scan level success as an entirely error-free full-mouth report. Results: Tooth-level AI performance was excellent, with accuracy exceeding 99% for most categories. Sensitivity was highest for missing teeth (99.3%) and endodontic treatments (99.0%). Specificity and NPV exceeded 98.5% and 99.7%, respectively. Full-scan level Perfect Agreement was achieved in 82.3% (95% CI: 76.2–88.4%), with errors concentrated in teeth presenting multiple co-existing findings. Conclusions: The evaluated AI platform demonstrates near-perfect accuracy in detecting isolated dental features but moderate reliability in generating complete full-mouth reports. It functions best as an assistive diagnostic tool, not as an autonomous system. Full article