Search Results (1,324)

Computer-assisted surgical simulation (CASS) in craniomaxillofacial (CMF) surgery is traditionally performed using a computer interface (CI) with a two-dimensional monitor, while the adoption of immersive virtual reality (VR) remains limited. This study examined how low-dose (LD) and high-dose (HD) cone beam computed tomography (CBCT) imaging modes influence image quality and usability across both CI and VR environments. Five CMF radiologists rated CBCT views and 3D-segmented models on a 0–4 Likert scale, and intra- and interobserver agreement was calculated. VR usability was further assessed using the NASA Task Load Index and follow-up interviews. LD imaging performed comparably to HD in both interfaces, with slightly higher scores for CBCT views in LD mode. For 3D models, HD scored marginally higher in CI, whereas LD performed slightly better in VR. Observer agreement ranged from fair to excellent, and VR demonstrated reliability like CI. NASA-TLX results indicated reductions in mental and temporal demand, along with decreased effort and frustration during VR use, suggesting diminishing cognitive and emotional strain over time. In this pilot study, the findings suggest that LD CBCT may be feasible for selected CMF CASS applications and that VR offers an immersive and user-friendly alternative without compromising diagnostic reliability, supporting its potential role in future surgical planning. Full article

Objectives: The aim of this study was to compare the diagnostic accuracy of the Diagnocat system (DGNCT LLC, Miami, Florida, USA), based on artificial intelligence algorithms, with clinical assessments performed by three dentists. Materials and Methods: The analysis was based on data obtained from cone-beam computed tomography (CBCT), focusing on the detection of carious lesions. The inclusion of three specialists with comparable levels of knowledge and professional experience increased the reliability of the results. The dentists classified teeth with carious lesions solely on the basis of CBCT imaging, physical examination, and their own clinical knowledge, under single-blind conditions, without awareness of the subsequent comparative analysis. Results: The results demonstrated a variable level of agreement between the Diagnocat system and the dentists’ assessments, depending on factors such as tooth location, as well as patient age and gender. The lowest level of agreement was observed in premolars, which may be attributed to their complex morphology. Higher diagnostic accuracy was noted in molars and incisors, particularly in younger patients. Conclusions: Further research should focus on the integration of various diagnostic modalities, including diagnostic imaging, intraoral scans, and photographic documentation, which may significantly enhance diagnostic precision, especially in cases of early-stage lesions. According to the results, the Diagnocat system demonstrates potential as a supportive tool in the diagnostic process in dental practice, as well as a screening tool enabling preliminary evaluation of imaging studies. Full article

Alveolar ridge preservation (ARP) aims to reduce post-extraction bone resorption and facilitate implant placement. Among alloplastic grafts, β-tricalcium phosphate (β-TCP) is widely used due to its osteoconductive properties and complete resorbability. This systematic review evaluated the clinical effectiveness of β-TCP for ARP, focusing on ridge dimensional changes assessed by cone–beam computed tomography (CBCT). Electronic searches were performed in major scientific databases up to April 2026. Randomized controlled trials (RCTs) reporting CBCT-based dimensional outcomes after at least 4 months were included. Five RCTs met the inclusion criteria. Considerable heterogeneity was observed in biomaterial formulations, socket management, and outcome assessment. When used alone, β-TCP showed variable results, ranging from greater ridge resorption compared with xenograft to outcomes comparable with those of freeze-dried bone allograft. More consistent findings were reported when β-TCP was used in combination with other biomaterials, with outcomes generally comparable to those of deproteinized bovine bone mineral (DBBM). Overall, β-TCP may have a potential role in alveolar ridge preservation; however, evidence remains limited and heterogeneous. Differences between β-TCP alone and composite formulations should be carefully considered, and no definitive conclusions can be drawn regarding its comparative predictability versus xenografts. Further RCTs are needed to clarify its clinical effectiveness and identify optimal applications. Full article

Background: Investigation of craniofacial growth and maturation, particularly of structures such as the spheno-occipital synchondrosis (SOS) and mandibular condyle cortication (MCC), provides valuable insight into late adolescent development. These markers may serve as valuable tools in age assessment, especially in legal and forensic contexts, where accurate determination of the 18-year threshold is critical. In addition, understanding their maturation can support more accurate assessment of skeletal development and improve clinical decision-making in growth-related dental treatments. Methods: This retrospective observational cross-sectional study was conducted to evaluate the stage of SOS and MCC maturation on a group of 230 individuals aged 14–22 years. Data was acquired from the mid-sagittal and sagittal sections of CBCT images representing, respectively, the SOS and the condyles. MCC was assessed bilaterally using a three-type system (Types I–III), and SOS fusion was evaluated using a four-stage system (Stages 0–3). Statistical analysis was performed to evaluate the association and correlation between the variables. Results: The Kruskal–Wallis test showed statistically significant differences in the age distribution of right and left MCC types, as well as SOS fusion stages (p < 0.001). Statistically significant differences were found in age distributions between all four SOS fusion stages in the MCC Type II groups of both condyles in both sexes, as well as Type III groups of the right condyle in both sexes and the left condyle in females (p < 0.001). Statistically significant differences were not observed in the MCC Type I group of the right and left condyle in both sexes and in the Type III group of the left condyle in males (p > 0.05). Spearman’s correlation analysis showed that the correlation between SOS fusion stages and MCC types was positive and statistically significant both between the parameters and with chronological age between sexes (r_s = 0.461–0.534, p < 0.001). Conclusions: This study revealed a statistically significant association and correlation between the maturation of the SOS, the MCC and chronological age. Simultaneous MCC Type III and SOS Stage 3 maturation was predominantly observed in individuals aged 18 years or older, although a small number of cases were identified below this threshold. SOS fusion and MCC may serve as skeletal parameters for age assessment; thus, they could be used as an adjunct method in a multifactorial age assessment procedure. Full article

Background/Objectives: Skeletal Class II malocclusion due to mandibular retrusion is frequently treated with functional appliances, yet their impact on temporomandibular joint (TMJ) structures, specifically the articular disc, remains debated. This systematic review aimed to critically assess quantitative morphological and positional TMJ changes (disc, condyle and glenoid fossa) evaluated with CBCT or MRI in growing skeletal Class II patients treated with functional appliances and to explore whether these changes are associated with the onset or prevention of temporomandibular disorders (TMDs). Methods: The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251028803). Electronic searches were performed in PubMed, Scopus, Web of Science, Cochrane Library, and Embase from inception to December 2025, complemented by manual screening. Inclusion criteria comprised controlled clinical studies in patients aged 8–16 years with skeletal Class II malocclusion due to mandibular deficiency, treated with removable or fixed functional appliances, with pre- and post-CBCT/MRI quantitative TMJ assessment. Risk of bias was evaluated using RoB 2 (RCTs) and ROBINS-I (non-randomized studies); overall certainty was appraised with GRADE. Results: From 937 records, 8 studies met the inclusion criteria. Articular disc outcomes were reported in fewer studies: disc position/morphology was generally stable, and when changes were observed they were favourable (partial improvement/normalization in selected cases). Importantly, no included study reported new treatment-induced disc displacement or new-onset TMD symptoms at the end of treatment. Across studies, the most consistent findings concerned condylar adaptations, commonly described as anterior and/or superior positional changes and remodelling of the condyle–fossa unit. Evidence certainty was limited by heterogeneity and methodological constraints, resulting in low to very low confidence for several outcomes. Conclusions: Functional appliance therapy in growing skeletal Class II patients may be associated with TMJ adaptations, predominantly involving the mandibular condyle, while limited available data may suggest disc stability and no reported short-term clinical TMD onset in included controlled studies. However, due to the limited and heterogeneous evidence base, these findings should be interpreted cautiously, and well-designed prospective studies with standardized 3D imaging outcomes and longer follow-up are needed, particularly for disc-specific endpoints. Full article

Background: The primary goal of root canal treatment is the prevention and healing of apical periodontitis through the meticulous elimination of pathogenic bacteria and infected tissues. Within this framework, apical patency remains a fundamental yet debated clinical concept. Objectives: This review aims to evaluate the clinical significance of maintaining apical patency, its influence on postoperative discomfort, and the technical strategies required for predictable negotiation. Methods: We performed a comprehensive review of existing literature, including clinical studies and recent meta-analyses, focusing on the correlation between patency maneuvers and postoperative pain, the role of preoperative CBCT imaging, and the efficacy of specialized negotiation instruments and motor kinematics. While patency facilitates thorough debridement, evidence regarding its impact on postoperative pain is conflicting, with recent meta-analyses suggesting it may actually alleviate discomfort intensity. Preoperative CBCT was identified as essential for identifying complex anatomy, such as the MB2 canal. Furthermore, the use of specialized files and reciprocating motor modes enhances the predictability of glide path establishment. Conclusions: Although failure to achieve patency does not always dictate a negative outcome, it is associated with improved long-term healing. Clinicians should prioritize “Anatomical Patency”—respecting original morphology—over forceful “Operative Patency” to ensure procedural integrity and clinical success. Full article

Introduction: Odontogenic sinusitis (ODS) is an underrecognized cause of maxillary sinus inflammation and is frequently associated with dental, periodontal, endodontic, and iatrogenic factors. Accurate identification of the odontogenic source is essential for appropriate treatment planning. Cone-beam computed tomography (CBCT) allows detailed evaluation of the maxillary sinus, adjacent teeth, alveolar bone, and periodontal structures, and may improve the radiologic differentiation of ODS. Materials and Methods: This retrospective observational study analyzed radiologic data from patients evaluated and treated by the authors for suspected odontogenic sinusitis between 2019 and 2026. The final study group included 85 patients with CBCT-based evidence of odontogenic pathology affecting the maxillary sinus. CBCT scans were reviewed to identify tooth-related and treatment-related etiologic factors associated with ODS. Based on the radiologic findings, the authors developed a CBCT-based classification of odontogenic etiologies and proposed an imaging-guided management algorithm. Results: CBCT identified a broad spectrum of odontogenic factors associated with maxillary sinus disease. The most relevant radiologic patterns included endodontic and periapical pathology, periodontal or combined endo-periodontal disease, post-extraction inflammatory changes, odontogenic cysts, oro-antral communication or fistula, retained roots or teeth, displaced endodontic materials, and grafting or implant-related complications. These findings were organized into 16 radiologic categories reflecting the principal etiologic pathways of ODS. The proposed classification facilitated correlation between radiologic presentation and the recommended dental, surgical, and otolaryngologic treatment approach. Conclusions: CBCT is a valuable imaging modality for identifying odontogenic causes of maxillary sinus inflammation and provides more precise diagnostic information than conventional radiography alone. A structured CBCT-based evaluation may improve etiologic diagnosis, support multidisciplinary decision-making, and help guide individualized management of patients with ODS. Full article

Background: Mandibular second molars show notable variability in root canal structures and C-shaped morphology, with possible differences among populations. Methods: This retrospective cross-sectional CBCT study included 500 patients attending the Department of Dentistry at IRCCS Ospedale San Raffaele (Milan, Italy) with bilateral mandibular second molars and was reported according to STROBE guidelines. CBCT scans (Hyperion X5; voxel size 0.125 mm) were assessed by two endodontists using standardized criteria. Root-based canal configurations were classified according to Vertucci in cases with complete bilateral coding of homologous mesial and distal roots; C-shaped morphology was classified using Fan’s system and analyzed separately because Vertucci coding is not applicable to C-shaped systems. Categorical variables were analyzed using χ² or Fisher’s exact test, continuous variables with parametric or non-parametric tests, and right–left comparisons with paired-sample tests (p < 0.05). Results: Complete bilateral Vertucci coding was feasible in 494/500 patients (98.8%), yielding 988 mesial and 988 distal roots for analysis. C-shaped canal configuration was detected in 1.2% of patients (6/500; 95% CI 0.44–2.59%); females showed a higher proportion than males (2.0% vs. 0.4%), with no evidence of a sex association (Fisher’s exact test, p = 0.216). Fan subtype annotation was available for 5/6 patients and 7 teeth; C1, C3, and C4 patterns were observed. In the Vertucci dataset, mesial roots most frequently exhibited Types II (52.0%) and IV (26.5%), whereas distal roots were predominantly Type I (62.4%), followed by Type III (29.8%). Contralateral symmetry was observed in 27.3% of mesial roots (135/494; 95% CI 23.4–31.5%) and 59.1% of distal roots (292/494; 95% CI 54.6–63.5%). Mean pulp chamber roof-to-floor distance was 2.623 ± 0.263 mm on the right and 2.567 ± 0.343 mm on the left (paired p < 0.001; mean difference 0.056 mm; 95% CI 0.023–0.089 mm). Conclusions: In this cohort, C-shaped morphology was rare, and no evidence of a sex association was found, although the small number of cases limits statistical power. Mesial roots showed more variability than distal roots, and contralateral symmetry was moderate and greater for distal roots than for mesial roots, supporting contralateral anatomy as a helpful—rather than predictive—clinical reference. Full article

Background: We evaluated whether mandibular trabecular microarchitecture, measured via fractal dimension (FD), influences Stafne bone cavity (SBC) development. Methods: In this study, 14 images (0.56%) containing SBC were identified among 2500 retrospectively reviewed cone-beam computed tomography (CBCT) images. Among the detected SBCs, those with panoramic radiographs in the archive were included in the study. Two groups were formed based on panoramic images: an SBC group and a control group consisting of individuals without SBC, with a similar sample size. FD analysis was performed using ImageJ version 1.3 software (National Institutes of Health, Bethesda, MD, USA) on the panoramic radiographs of these two groups. Post hoc power analysis and Cohen’s effect size were calculated to evaluate the robustness of the results. Results: No significant difference existed between the mean FDs of the SBC and control groups (p > 0.05). Mean FD values were slightly lower in SBC regions (1.18 ± 0.22), compared to other mandibular regions (~1.23–1.30). While FD averages were lower within SBC regions, effect size analysis showed negligible differences (d < 0.21) in posterior regions, indicating structural similarity. However, a large effect size (d = −0.85) in the canine–lateral region suggested a localized trend. Conclusions: Within the limitations of this pilot study, SBC does not appear to disrupt the surrounding trabecular structure of the mandible. The findings support the static and developmental nature of SBC. Full article

Background/Objectives: A marked anteroposterior gradient of nasal fossa pneumatisation over the posterior maxillary alveolar base has been documented at the second premolar level, yet whether this gradient extends to the second upper molar (M2)—the primary site for posterior implant rehabilitation—remains uncharacterised. We aimed to quantify this gradient by classifying pneumatisation patterns above the maxillary alveolar base at M2 (Type 1: pure antral; Type 2: antral with palatine recess; Type 3: Big Nose pattern with combined antral and nasal involvement), assess bilateral symmetry and sex distribution, and compare findings with published second premolar data. Methods: A retrospective study was conducted on 165 cone-beam computed tomography scans (330 sides) from a Romanian population. Patterns were classified as Type 1 (pure antral), Type 2 (antral with palatine recess), or Type 3 (Big Nose pattern). Bilateral symmetry was assessed using Cohen’s kappa, and sex differences using Fisher’s exact test. Results: Type 1 was observed in 93.3% of sides, Type 2 in 4.2%, and Type 3 in 2.4%. Bilateral symmetry was 98.8% (kappa = 0.904), with all Type 3 cases occurring bilaterally. No significant sex difference was found (p = 0.363), although Type 3 showed a non-significant male predominance (OR = 4.55; p = 0.305). The Big Nose pattern was 6.8-fold less prevalent at M2 than at the second premolar level. Conclusions: A 6.8-fold reduction in Big Nose prevalence from the second premolar (16.2%) to M2 (2.4%) confirms a pronounced anteroposterior gradient in nasal fossa involvement over the posterior maxillary alveolar base—the central finding of this study. At M2, the maxillary sinus dominates exclusively in 97.6% of sides, rendering standard sinus floor elevation highly predictable. The invariable bilaterality of the Big Nose pattern at M2 supports contralaterally symmetrical surgical planning. These findings provide a gradient-based clinical framework: nasal-floor-aware augmentation planning is essential anteriorly (premolar region), whereas standard sinus augmentation protocols are reliably applicable at M2. Full article

Background/Objectives: This study aims to evaluate the diagnostic performance of radiomic features derived from cone-beam computed tomography (CBCT) images in differentiating radicular cysts (RC) from periapical granulomas (PG). The study also compares the performance of traditional machine learning (ML) algorithms with a novel deep learning (DL) model, Radiomics Cyst Convolutional Neural Network (RadC-CNN). Methods: CBCT images of 98 patients (55 RC, 43 PG), confirmed by histopathological diagnosis, were retrospectively analyzed. Lesions were semi-automatically segmented in 3D Slicer, and 48 radiomic features were extracted. Features with high inter-observer agreement (Intraclass Correlation Coefficient ICC ≥ 0.80) were included in the analysis. Statistical tests and classification models (Decision Tree, K-Nearest Neighbors, Support Vector Machine) were used, and performance was compared to that of the proposed RadC-CNN architecture. Results: Among the 34 features with sufficient reliability, 18 showed statistically significant differences between RC and PG (p < 0.05). Shape, first-order, and texture-based features, including the Gray Level Co-occurrence Matrix (GLCM), Gray Level Run Length Matrix (GLRLM), Gray Level Size Zone Matrix (GLSZM), and Neighboring Gray Tone Difference Matrix (NGTDM), were extracted. The RadC-CNN model demonstrated superior classification performance with an accuracy of 90%, sensitivity of 90%, and precision of 91.3%, outperforming all traditional ML algorithms. Conclusions: CBCT-based radiomic analysis, particularly when combined with DL techniques like RadC-CNN, offers a promising non-invasive approach to distinguish RC from PG. Full article

The range of possible inflammatory changes in the oral cavity and in the maxillary and mandibular bones may present with diverse patterns and characteristics in both clinical and radiological evaluation. In most cases, a standard radiological examination, such as dental panoramic radiograph (DPR), has significant limitations in assessing early or complex bone changes associated with chronic bone inflammation. Advanced imaging with multidetector computed tomography or cone-beam computed tomography (MDCT or CBCT) can improve lesion characterization and surgical planning when a detailed evaluation of tooth-bearing structures, tooth apices, cortical plates, and cancellous bone is required. Such imaging allows more detailed assessment of alterations in medullary bone morphology and architecture, as well as identification of possible periosteal reactions adjacent to chronic bone inflammation. Osteomyelitis of the jaws comprises a heterogeneous group of inflammatory bone disorders characterized by variable clinical presentations and a broad spectrum of radiological appearances. Depending on disease chronicity, host factors, and microbial burden, mandibular osteomyelitis may mimic odontogenic tumors, fibro-osseous lesions, or malignant bone pathologies. Quite often, dental treatment affects bone status and condition, leading to unwanted events such as bone inflammation. Imaging plays a central role in diagnosis; however, radiographic findings are often nonspecific, particularly in early or chronic stages. Each case of osteomyelitis underscores the importance of correlating imaging findings with clinical history and highlights the role of repeated imaging in distinguishing inflammatory bone disease from aggressive jaw lesions. This study aims to characterize diverse patterns of chronic mandibular osteomyelitis associated with various prior treatment modalities using CBCT. By presenting a series of illustrative cases from heterogeneous clinical settings, the authors highlight the nonspecific radiographic features and diagnostic challenges inherent in chronic bone inflammation. The focus remains on the interpretation of complex imaging findings rather than a comparative analysis of technical protocols. Full article

Background: Testicular irradiation presents technical challenges due to the temperature-dependent cremasteric reflex causing positional variability, yet detailed immobilization protocols addressing this issue and cone-beam computed tomography (CBCT)-based setup data remain lacking. This formative and preliminary single-patient descriptive technical report describes a temperature-controlled immobilization technique and reports preliminary setup observations from its clinical application. Methods: A 74-year-old male with primary testicular diffuse large B-cell lymphoma (DLBCL) received prophylactic contralateral testicular irradiation. The immobilization protocol combined a custom thermoplastic device with infrared warming to maintain the scrotal surface temperature at 36–36.5 °C, intended to facilitate a relaxed scrotal position prior to and during each fraction under temperature-controlled conditions. Treatment was delivered using a three-field three-dimensional conformal radiotherapy (3D-CRT) technique (30.6 Gy in 17 fractions), and seven CBCT scans were used to document interfraction setup measurements. Results: The treatment was completed as planned with adequate target coverage (clinical target volume [CTV] D97% = 100%) and minimal organ-at-risk (OAR) doses. Setup measurements showed a CTV root-mean-square displacement (RMS) of 3.8 mm and a mean Dice similarity coefficient (DSC) of 0.85, while the testis alone showed an RMS of 5.2 mm and a mean DSC of 0.73. Conclusions: The temperature-controlled immobilization technique was feasibly implemented, and the setup measurements observed during its application showed a CTV RMS of 3.8 mm and a mean DSC of 0.85. These findings may provide a practical reference for institutions encountering this rare clinical scenario. Full article

Background: Cone Beam Computed Tomography (CBCT) is widely used in image-guided radiotherapy because it provides on-board volumetric imaging at relatively low doses, but its clinical utility for synthetic CT (sCT) generation remains limited by noise, scatter, artifacts, and reduced Hounsfield Unit (HU) fidelity. Conditional diffusion models (CDMs) have recently emerged as a promising alternative to earlier deep learning approaches because their iterative denoising process may better preserve anatomical structure and model uncertainty. Objective: This systematic review evaluates the use of conditional diffusion models for CBCT-to-CT synthesis, with particular attention to architectural strategies, reported quantitative outcomes, and potential clinical relevance. A systematic search was conducted in PubMed, Web of Science, Scopus, IEEE Xplore, and Google Scholar for studies published between 2013 and 2024. Eleven studies met the eligibility criteria and were analyzed to address three questions: (1) Which conditional diffusion strategies have been used? (2) What outcomes have been reported? and (3) What clinical implications have been discussed? Results: Across the included studies, CDMs frequently showed promising image quality performance, especially when incorporating anatomical priors, spatial-frequency guidance, hierarchical refinement, or latent representations. However, the evidence base remains small and highly heterogeneous with respect to anatomy, dimensionality, supervision strategy, and evaluation metrics, limiting the strength of direct comparative claims. The reviewed literature suggests that conditional diffusion models are a promising direction for CBCT-to-CT synthesis, but stronger dose-aware validation, standardized reporting, and broader multicenter evaluation are still needed before routine clinical deployment. This review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD42024619240. Full article

We evaluated global radiotherapy practices in the management of early-stage (AJCC/UICC 8th edition stages I-II) glottic cancer (ESGC). A cross-sectional online survey was conducted in March 2025 across centers worldwide. Data was collected on clinical practices, including staging, CT simulation, target volumes delineation, organs-at-risk contouring, radiotherapy techniques, dose and fractionation schedules, treatment delivery techniques, and image guidance practices. A total of 181 responses were received, primarily from Asia (41.4%) and Europe (24.3%). Most respondents were from non-academic public centers (44.2%), with multidisciplinary team involvement reported by 84.5%. Head and neck CT scan was the most used staging modality (80.1%). Intensity-Modulated Radiation Therapy was the most common planning technique (82.9%). Hypofractionated radiotherapy schedules predominated for T1 (84%) and T2 (72.4%) disease. T1a was typically treated with whole-larynx target volume (72.4%). Use of ipsilateral involved vocal cord irradiation varied by geographical region (p = 0.015), being most common in North America (44.8%) and Europe (38.6%). Accelerated fractionation for T2 also differed significantly (p < 0.001), with the highest use reported in North America (41.4%). Daily Cone-Beam Computed Tomography was acquired by (58.2%). In total, 70% of respondents expressed interest in the results of a future phase III randomized trial comparing stereotactic body radiation therapy to conventional radiotherapy. Significant global variations in radiotherapy practices for ESGC were observed, likely reflecting disparities in access and differences in institutional protocols. The development and implementation of standardized, evidence-based global guidelines are essential to harmonize care, minimize toxicity, and improve outcomes for patients with ESGC. Full article