Search Results (1,262)

Deep learning is increasingly integrated into oral rehabilitation workflows, particularly in implant planning, prosthodontic design automation, and peri-implant diagnosis. However, reported performance is heterogeneous and difficult to compare across tasks, modalities, and validation designs. The goal of this study was to critically analyze deep learning architecture families applied to oral rehabilitation and to provide task-driven selection guidance supported by an evidence table reporting dataset characteristics, validation strategy, and performance metrics. A focused narrative review was conducted using transparent, database-specific search criteria (final n = 10 included studies), emphasizing implant planning (cone–beam computed tomography [CBCT]-based segmentation), prosthodontic design (intraoral scan [IOS]/mesh inputs), and peri-implant diagnosis (periapical/panoramic radiographs). Evidence certainty for each clinical task was assessed using GRADE-informed ratings (High/Moderate/Low/Very Low). Extracted variables included clinical task, imaging modality, dataset size, architecture, validation strategy (internal vs. internal + external), split level, ground truth protocol, and performance metrics. A structured computational and hardware feasibility analysis was conducted for each architecture family to support real-world deployment planning. Encoder–decoder networks (U-Net/nnU-Net) dominate CBCT segmentation for implant planning, while detection architectures (Faster R-CNN, YOLO) support implant localization and peri-implant assessment on radiographs. Generative models (3D GANs, transformer-based point-to-mesh networks) enable crown design from three-dimensional scans. Hybrid CNN–Transformer architectures show promise for multimodal CBCT–IOS fusion, though direct evidence from the included studies remains limited to a single study. External validation remains uncommon yet essential given the risk of domain shift. In conclusion, architecture selection should be anchored to task geometry (2D vs. 3D), artifact burden, and required clinical output type. Reporting standards should prioritize dataset transparency, validation rigor, multi-center external testing, and uncertainty-aware outputs. Full article

The accessory carpal bone (ACB) is an important component of the equine carpus and a clinically relevant site of fracture, yet its detailed morphology and motion characteristics remain incompletely characterized. The objectives of this ex vivo study were to characterize the three-dimensional morphometry of the native ACB using computed tomography (CT), to assess its kinematics during carpal flexion and extension using dynamic 3D CT, and to evaluate fragment behavior following a standardized vertical fracture. Twelve equine forelimbs underwent CT imaging in the neutral carpal position, maximal flexion, and maximal extension before and after standardized osteotomy simulating a vertical plane fracture. Morphometric measurements included dorsopalmar width, lateromedial thickness, proximodistal length, and radii of medial concavity and lateral convexity. The ACB exhibited consistent geometry among specimens of comparable size. Dynamic imaging revealed independent physiological motion relative to the other carpal bones of the ACB, characterized by medial movement of its medial concave surface toward the caudal aspect of the radius during flexion. Following fracture creation, widening of the fracture gap and proximal displacement of the palmar fragment occurred predominantly in flexion, whereas the neutral carpal position and maximal extension promoted fracture gap closure and distal displacement. These findings improve understanding of ACB morphology and biomechanics and may have implications for fracture pathogenesis and surgical fixation strategies. Full article

Background/Objectives: Peptide receptor radionuclide therapy (PRRT) is an established treatment for metastatic neuroendocrine tumors (NETs), yet long-term disease control occurs only in a subset of patients. Predicting progression-free survival (PFS) could support individualized treatment planning. This study evaluates laboratory, imaging, and multimodal deep learning models for PFS prediction in PRRT-treated patients. Methods: In this retrospective, single-center study 116 patients with metastatic NETs undergoing [177Lu]Lu-DOTATOC were included. Clinical characteristics, laboratory values, and pretherapeutic somatostatin receptor positron emission tomography/computed tomographies (SR-PET/CTs) were collected. Seven models were trained to classify low- vs. high-PFS groups, including unimodal (laboratory, SR-PET, or CT) and multimodal fusion approaches. Performance was assessed via repeated 3-fold cross-validation with area under the receiver operating characteristic curve (AUROC) and area under the precision–recall curve (AUPRC). Explainability was evaluated by feature importance analysis and gradient based saliency maps. Results: Forty-two patients (36%) displayed short PFS (≤1 year) and 74 patients displayed long PFS (>1 year). Groups were similar in most characteristics, except for higher baseline chromogranin A (p = 0.003), elevated $\gamma$-GT (p = 0.002), and fewer PRRT cycles (p < 0.001) in short-PFS patients. The Random Forest model trained only on laboratory biomarkers reached an AUROC of 0.59 ± 0.02. Unimodal three-dimensional convolutional neural networks using SR-PET or CT performed worse (AUROC 0.42 ± 0.03 and 0.54 ± 0.01, respectively). A multimodal fusion model integrating laboratory values, SR-PET, and CT—augmented with a pretrained CT branch—achieved the best results (AUROC 0.72 ± 0.01, AUPRC 0.80 ± 0.01). Explainability analyses provided insights into model predictions, with explainability patterns in the fusion model appearing physiologically plausible and predominantly tumor-focused. Conclusions: Multimodal deep learning combining SR-PET, CT, and laboratory biomarkers outperformed unimodal approaches for PFS prediction after PRRT. Upon external validation, such models may support risk-adapted follow-up strategies. Full article

Intramyocardial coronary artery course is a rare anatomical variant that can be increasingly recognized with coronary computed tomography angiography (CCTA). We present the case of a 22-year-old male who underwent CCTA for evaluation of chest pain. Imaging demonstrated an unusual course of the left anterior descending artery (LAD), which traversed toward the right ventricular cavity over an approximately 21 mm segment. Multiplanar reconstructions and three-dimensional volume-rendered images clearly depicted the intramyocardial trajectory of the vessel. Although usually asymptomatic, recognition of this variant is important because intramyocardial coronary arteries may be vulnerable to injury during intracardiac procedures. This case highlights the role of CCTA in accurately characterizing a rare intracavitary LAD course with clear delineation of its intramyocardial-to-intracavitary trajectory toward the right ventricle using multiplanar and three-dimensional reconstructions. Full article

Background/Objectives: The sella turcica and sphenoid sinus are anatomically adjacent structures within the cranial base and may reflect variations related to craniofacial development. However, evidence regarding their three-dimensional characteristics in individuals with impacted canines remains limited. This study aimed to evaluate the morphological, linear, and volumetric characteristics of the sella turcica and sphenoid sinus in individuals with unilateral palatally impacted maxillary canines using cone-beam computed tomography (CBCT). Methods: This study included CBCT scans of individuals with unilateral palatally impacted maxillary canines and a control group. Linear measurements and morphology of the sella turcica were assessed. Sella turcica volume was calculated using both a geometric formula and voxel-based three-dimensional segmentation. Sphenoid sinus pneumatization patterns and volumes were also evaluated. Agreement between volumetric measurement methods was assessed using Bland–Altman analysis, and correlations between sella turcica and sphenoid sinus volumes were also analyzed. Results: Most morphological and volumetric parameters of the sella turcica and sphenoid sinus were comparable between groups. Among the linear measurements, only sella width was significantly greater in the control group, whereas other dimensions showed no significant differences. The distribution of sella turcica morphology and sphenoid sinus pneumatization patterns was similar in both groups. No significant differences were observed in sella turcica or sphenoid sinus volumes. Bland–Altman analysis demonstrated good agreement between geometric and voxel-based volumetric measurements. In addition, no significant correlation was identified between sella turcica and sphenoid sinus volumes. Conclusions: Unilateral palatally impacted maxillary canines were not associated with substantial morphological or volumetric alterations of the sella turcica or sphenoid sinus. These findings suggest that variations in these cranial base structures have limited value as indicators of unilateral palatal canine impaction. Full article

This systematic review aimed to assess whether the initial apical position of impacted maxillary canines, evaluated using cone-beam computed tomography [CBCT], influences three-dimensional root displacement during orthodontic traction. An extensive literature search was conducted in PubMed/MEDLINE, Web of Science, Embase, Scopus, and the Cochrane Library up to November 2025. Prospective and retrospective clinical studies including pre-treatment CBCT assessment and reporting either direct apical displacement or CBCT-derived three-dimensional position parameters were considered eligible. Study selection, data extraction, and quality appraisal were carried out independently by two reviewers. Seven studies met the inclusion criteria. Substantial heterogeneity was observed in imaging protocols, reference systems, traction mechanics, and outcome measures, precluding quantitative synthesis. Only two studies directly quantified three-dimensional apical displacement using CBCT–CBCT or CBCT–STL superimposition methods, predominantly suggesting bodily movement patterns; although, this is based on limited direct evidence, with velocities ranging from 0.29 to 0.84 mm/month. The remaining studies provided indirect evidence based on angular changes, positional parameters, or traction duration. Taken together, the available evidence suggests that unfavorable initial apical positions, including palatal or bicortical impactions and increased root angulation, may be associated with greater biomechanical complexity and longer traction duration. Although CBCT-based three-dimensional evaluation provides clinically relevant diagnostic information, standardized measurement protocols are required to improve comparability and reproducibility across studies. Full article

This Finite Element Analysis study evaluated the biomechanical responses associated with posterior tooth intrusion using clear aligners in conjunction with buccal and palatal mini-screw anchorage. Three-dimensional finite element models were reconstructed from cone beam computed tomography images obtained from patients without craniofacial anomalies. To assess the differential effects of buccal versus palatal attachment placement in combination with a mini-screw-supported closing coil spring, two configurations of the maxillary arch were created: Model A (right side) and Model B (left side). Biomechanical parameters—including stress distribution, patterns of tooth displacement, and anchorage stability—were systematically assessed using finite element analysis. Analysis of Model A revealed buccal crown inclination and moderate extrusion of the first premolar, whereas the first molar showed limited mesial displacement along with mild buccal tipping and extrusion. In contrast, Model B revealed palatal crown inclination of the first premolar, accompanied by buccal root torque and minor intrusion; the first molar demonstrated enhanced vertical control with palatal root torque. The incorporation of palatal mini-screw anchorage in Model A contributed to diminished stress levels and reduced tooth displacement, suggesting a tendency toward more favorable force distribution and anchorage stability under the simulated conditions. Conversely, Model B experienced increased mechanical loading and more pronounced displacement. Full article

Background: In children with cerebral palsy, bony acetabular deficiencies are common and may be associated with progressive hip subluxation, abnormal joint loading, and ultimately hip dislocation. Hip reconstruction surgery is typically performed to prevent dislocation, and this includes acetabular reshaping using acetabuloplasty. The location of acetabular deficiency may vary among individuals; however, only radiographs are used for planning and intraoperative correction in many centers. Precise reconstruction and preop planning are necessary for the accurate correction of acetabular coverage. This study compares conventional hip reconstruction with a 3D-guided technique using individual preop 3D planning and 3D-printed guides during surgery to determine which method allows for a more accurate correction. We hypothesize that the patient-specific 3D planning leads to more precise anatomical correction of acetabular coverage compared to conventional freehand osteotomy. Methods: This study was registered in the German Clinical Trial Register (DRKS-ID: DRKS00031356) on 14 July 2023. In a randomized controlled trial, various imaging-based parameters were used to assess the bony anatomy preoperatively and postoperatively. Preoperative and 6-week postoperative computed tomography (CT) scans are part of routine clinical care. Additionally, an immediate postoperative CT scan was performed. One hip was operated on using individualized 3D preoperative planning, while the other hip was corrected using a conventional surgical approach. A standardized subtrochanteric osteotomy was performed for the varisation, derotation, and shortening of the proximal femur. This osteotomy was followed by acetabuloplasty under fluoroscopic control. For the 3D-planned operation, patient-specific cutting and repositioning guides were produced based on preoperative CT imaging. Patients with bilateral cerebral palsy (GMFCS levels I–V), aged 4–18 years, with an open triradiate growth plate and a migration index ≥ 40% in at least one hip were included. In a preliminary retrospective part, this project reproduces the existing three-dimensional acetabular index (3-DAI) and compares it with established radiographic methods to determine the utility and reliability of a reconstructed 3D CT measurement technique. A further component of the retrospective part is the creation of an age-adjusted database of typically developed hips and the development of a 3D head coverage index (3D-HCI) as a new 3D parameter to express acetabular coverage; therefore, it will be used as a secondary parameter and correlated to the 3DAI in the prospective part. Conclusions: Improved precision may have meaningful clinical implications for long-term joint congruency, load distribution, pain, and mobility outcomes. Full article

Systemic lupus erythematosus (SLE) frequently presents joint pain and stiffness, yet clinicians lack an objective, rapid method to quantify joint inflammation at the point of care. We introduce the Lupus Optical Tomography Imaging System (LOTIS), a wearable near-infrared (NIR) device that performs real-time three-dimensional tomographic imaging of hemodynamic changes in finger joints. LOTIS was developed to address key limitations of our earlier Flexible Optical Imaging System (FOIS), including mechanical fragility, high noise levels, single-joint acquisition, and slow reconstruction times. The new system integrates modular, mechanically robust optical patches with on-sensor digitization and a computationally efficient, non-iterative multispectral reconstruction algorithm to produce frame-by-frame maps of hemoglobin concentration. In a preliminary study using a standardized venous-occlusion protocol, LOTIS differentiated SLE-affected joints from those of healthy controls. Diseased joints exhibited blunted and spatially diffuse hemodynamic responses, whereas healthy joints showed localized and robust changes. These results demonstrate that LOTIS provides an operator-independent, patient-friendly method for quantifying joint-specific hemodynamic changes in real time, offering strong potential as a clinical tool for objective assessment and longitudinal monitoring of lupus arthritis. Full article

Background/Objectives: Accurate preoperative assessment of renal tumor complexity is essential for surgical planning and for predicting perioperative outcomes after partial nephrectomy (PN). RENAL and PADUA nephrometry scores, traditionally derived from two-dimensional (2D) computed tomography (CT) imaging, are widely used to quantify renal tumor complexity and surgical risk. However, the introduction of hyperaccuracy three-dimensional (HA3D) models has enabled enhanced anatomical visualization, potentially improving the assessment of surgical difficulty and the prediction of postoperative complications. The aim of this study was to compare conventional CT-based RENAL and PADUA scores with HA3D-derived nephrometry scores in predicting perioperative complications in patients undergoing robot-assisted or laparoscopic PN. Methods: A total of 17 consecutive patients with intermediate- or high-complexity category renal tumors (RENAL ≥ 7) and moderate- or high-risk category tumors (PADUA ≥ 8) were prospectively enrolled. Preoperative demographic and clinical parameters, as well as intraoperative and postoperative data, were prospectively collected. Tumor characteristics were evaluated using both CT-based RENAL and PADUA scoring systems and HA3D nephrometry reconstruction. Associations between nephrometry scores and perioperative outcomes were assessed using Spearman’s correlation. Predictive performance for postoperative complications and early chronic kidney disease (CKD) was evaluated using receiver operating characteristic (ROC) analysis. Results: Overall, 41% and 35% of cases were downgraded according to three-dimensional (3D) RENAL and PADUA complexity–risk category assessment, respectively. Operative time demonstrated a moderate correlation with 3D RENAL (ρ = 0.57) and 3D PADUA (ρ = 0.49) scores. ROC curve analysis demonstrated numerical differences in area under the curve (AUC) values between 3D- and 2D-based nephrometry scores in predicting overall complications (RENAL: 0.61 vs. 0.54; PADUA: 0.69 vs. 0.46). 3D RENAL score demonstrated numerically higher AUC values for early postoperative CKD compared with 2D RENAL score (AUC: 0.72 vs. 0.67). Conclusions: HA3D-based nephrometry scores were associated with enhanced anatomical visualization, frequent downgrading of tumor complexity–risk categories, and numerical differences in predictive performance for postoperative complications and early renal functional decline compared with conventional CT-based scores. These findings suggest a potential role for HA3D modeling in preoperative planning for PN. However, given the limited sample size, these observations should be interpreted as exploratory and hypothesis-generating, and warrant validation in larger multicenter cohorts. Full article

Background and Objectives: Orbital exenteration performed for advanced malignancies often results in complex defects that are difficult to reconstruct, particularly in patients treated with adjuvant radiotherapy who subsequently develop osteoradionecrosis. This study describes the preliminary results of a surgical technique for secondary orbital reconstruction using a combined scalp flap and temporalis muscle flap (TMF), referred to as the “Pacman flap with tongue,” performed prior to prosthetic rehabilitation. Materials and Methods: Five elderly patients with multiple comorbidities and osteoradionecrosis following orbital exenteration and radiotherapy underwent secondary orbital reconstruction using the “Pacman flap with tongue” technique. The clinical outcomes, flap viability, complications, and feasibility of subsequent prosthetic rehabilitation were assessed. After stabilization of healing, digitally planned ocular epitheses were fabricated using cone-beam computed tomography (CBCT), computer-aided design, and three-dimensional printing. Results: Healing was uneventful in all patients. No flap necrosis, wound dehiscence, or recurrent bone exposure was observed. The reconstructed orbital sockets provided a stable, well-vascularized prosthetic bed, enabling satisfactory prosthetic rehabilitation. Conclusions: The “Pacman flap with tongue” may be considered a feasible option for secondary orbital reconstruction in selected high-risk patients, particularly in the setting of osteoradionecrosis. Full article

This study develops a multi-scale fiber-reinforced cementitious composite (MFRC) by hybridizing calcium carbonate whisker (CW), polyvinyl alcohol (PVA) fiber, and steel fiber. The interfacial micromechanical properties between steel fiber/matrix and PVA fiber/matrix under the influence of CW were systematically examined through single-fiber pull-out tests. The two-dimensional and three-dimensional distribution characteristics of fibers in the MFRC were analyzed using backscattered electron imaging (BSE) and X-ray computed tomography (X-CT), respectively. Based on the fiber distribution characteristics, flexural strength prediction models were developed with R² values of 0.79 (2D) and 0.82 (3D). Experimental validation via splitting tensile tests and three-point bending tests confirmed the model’s effectiveness in simultaneously predicting splitting tensile strength (R² = 0.89) and flexural strength (R² = 0.93). These findings demonstrate the reliability and universality of the proposed model for predicting flexural–tensile strength in an MFRC. Full article

Recent anatomical and morphometric studies indicate that the sella turcica is a structurally informative region and a distinctive anatomical formation that can exhibit shape variation among individuals. The aim of this study was to evaluate, in three dimensions, the extent to which sella turcica morphology differs among three sheep breeds (Akkaraman, Morkaraman, Zom) and between sexes. A total of 102 specimens were examined. All skulls were CT-scanned specifically for this study; the sella turcica region was reconstructed as a three-dimensional model, and 12 anatomical landmarks were manually digitized for each specimen. The findings showed that sella turcica size differed among breeds, with the Zom group exhibiting the largest sella turcica size. In contrast, no clear size difference was observed between females and males. Shape assessment also revealed differences among breeds, largely driven by the separation of Zom from Akkaraman and Morkaraman, whereas no distinct sex-related shape pattern was detected. Importantly, the breed-related shape differences persisted after accounting for size effects. Overall, these results suggest that the sella turcica carries a breed-associated morphological signal in sheep, while showing no pronounced sexual differentiation in the present sample. Full article

This study investigates the application of computational hemodynamic modeling, involving both FSI and CFD models, using SimVascular to simulate blood flow in the right pulmonary artery for patient-specific cardiovascular assessment. The artery’s three-dimensional geometry was reconstructed from a computed tomography (CT) image, and pressure measurements from a CardioMEMS™ device were used as clinical ground truth for validation. To represent the arterial hemodynamics, we initially formulated a fluid–structure interaction (FSI) approach to capture wall mechanics. However, given the high computational cost of fully patient-specific FSI simulations for routine clinical decision-making, we evaluated the validity of key simplifications by assuming rigid vessel walls coupled with a three-element Windkessel (3WK) model and applying a half-sine inflow waveform derived from the patient’s cardiac output. These simplifications yielded results with minimal error: the rigid-wall assumption introduced a 1.1% deviation, while the idealized waveform resulted in a 0.56 mmHg offset. Crucially, while wall rigidity was acceptable, we found that arterial compliance in the boundary conditions is non-negotiable; reducing the model to a pure resistance approach resulted in non-physiological pressures (130 mmHg). A subsequent parametric analysis examined how varying resistance (R) and compliance (C) distinctively alter the pressure waveform morphology. The results underscore the potential of combining remote monitoring data with validated computational simulations to deepen the understanding of cardiovascular dynamics and enhance diagnostic and therapeutic approaches for cardiovascular diseases. Full article

Background/Objectives: Current evidence regarding the association between the temporal bone and paranasal sinus pneumatization remains limited. This study aims to investigate the potential morphological association between zygomatic process pneumatization and sphenoid sinus pneumatization using three-dimensional cone-beam computed tomography. Methods: Cone-beam computed tomography images from 573 individuals aged 16 to 87 years (170 males, 403 females) were evaluated in this study. Zygomatic process pneumatization was assessed in two forms: pneumatized glenoid fossa (a radiolucent defect on the glenoid fossa roof) and pneumatized articular eminence (a radiolucent defect within the articular eminence). The sphenoid sinus was classified into four major pneumatization types: conchal, presellar, sellar, and postsellar. The postsellar configuration was additionally divided into four subtypes—subdorsal, dorsal, occipital, and combined—according to its posteroanterior orientation. Lateral sphenoid sinus pneumatization was categorized into pterygoid, greater wing, full lateral (combining pterygoid and greater wing), lesser wing, and anterior types. Results: The analysis revealed a significant relationship between zygomatic process pneumatization and sphenoid sinus pneumatization (p < 0.001), where the former was detected in 64.0% of participants. The postsellar type represented the most frequent form of sphenoid sinus pneumatization (55.5%), whereas the conchal type was the rarest (1.2%). Conclusions: A significant correlation was observed between the zygomatic process and sphenoid sinus pneumatization, with individuals exhibiting the former tending to display more extensive sphenoid sinus pneumatization Full article