Avaliação tomográfica das dimensões verticais dos tecidos periodontais supracrestais em dentes anteriores da maxila / Tomographic evaluation of the vertical dimensions of periodontal supracrestal tissues in maxillary anterior teeth

O objetivo do presente estudo foi avaliar em tomografias computadorizadas as dimensões dos tecidos periodontais supracrestais (TPSC). Cem pacientes, 600 dentes anteriores da maxila (200 incisivos centrais, 200 incisivos laterais e 200 caninos), foram avaliados. A distância média da margem gengival até a crista óssea alveolar (COA) foi de 3.25mm (95% IC: 3.20-3.30), enquanto que da junção cemento-esmalte até a COA foi de 1.77mm (95% IC: 1.72-182mm). As medidas foram significativamente diferentes entre os grupos de dentes (ANOVA, p < 0.001). A tomografia, pode representar uma importante ferramenta para a avaliação das dimensões dos TPSC.

The aim of this study was to evaluate the dimensions of the supracrestal periodontal tissues (SPT) on tomographic scans. One hundred patients, 600 maxillary anterior teeth (200 central incisors, 200 lateral incisors and 200 canines), were evaluated. The average distance from the gingival margin to the alveolar bone crest (ABC) was 3.25mm (95% CI: 3.20-3.30), while the distance from the cemento-enamel junction to ABC was 1.77mm (95% CI: 1.72-182mm). The measurements were significantly different between the tooth groups (ANOVA, p < 0.001). When properly indicated, tomography can be an important tool for assessing the dimensions of TPSCs on a case-by-case basis.

Can ultrasonography be used to detect root perforation? An in vitro study.

This study assessed the usability of ultrasonography in detecting root canal perforations. The buccal side of incisor root were perforated. The actual lengths up to the perforation site were measured by visualisation of the tip of a file. Specimens were embedded in gypsum, and it was scraped to simulate bone resorption. Resorption cavities were filled with ultrasound gel. Measurements were taken by advancing a file through the canal until the tip became visible in the ultrasound image. 3D scans were obtained using cone-beam computed tomography (CBCT) and the distance between the coronal point of the resorption cavity and the reference point was measured. The actual distance of the resorption cavity from the reference point varied 6-10.6 mm. The same distances were measured via ultrasound as 5.7-10.9 mm, while measured using CBCT 6-10.5 mm. No significant differences were found. Ultrasonography shows promise for detecting root perforations, however further research is needed.

Immediate implant placement in the premolar maxillary area: a cone-beam computed tomography study.

PURPOSE: This research aimed to investigate potential factors associated with the risk of perforation of the labial bone plate, nasal floor, or maxillary sinus floor during immediate implant placement (IIP) in the maxillary premolar area, utilizing a cone-beam computed tomography (CBCT) virtual study. METHODS: CBCT exams from 179 eligible participants, encompassing 716 teeth, were included. Implants were virtually positioned in 2 orientations: along the long axis of the tooth (the prosthetically-driven position) and in an optimal position relative to adjacent anatomical structures (the bone-driven position). Binary logistic regression analysis was employed to assess potential associations between perforation or invasion and various covariates, including sex, age, tooth region, the distance from the tooth apex to the nasal floor or maxillary sinus floor, the angle between the prosthetically- and bone-driven positions (implant-line A angle [ILAA]), and the labial concavity angle (LCA). RESULTS: The mean ILAA was 18.3°±8.0°, and the angle was significantly larger for the second premolar compared to the first premolar. The mean minimum implant length was 13.0±2.1 mm, with a bone anchorage of 4 mm. The incidence of perforation was 84.1% for the prosthetically-driven position and 40.5% for the bone-driven position. Factors associated with a higher risk of cortical bone wall perforation or invasion of the 2-mm safety margin from surrounding anatomical structures (in the bone-driven position) included female sex, older age, shorter distance from the tooth apex to the nasal cavity/maxillary sinus, and smaller LCA. CONCLUSIONS: A high prevalence of cortical bone wall perforation or invasion of the 2-mm safety margin is anticipated when performing IIP in the maxillary premolar region.

Three-dimensional assessment of the skeletal characteristics accompanying unilateral maxillary canine impaction: a retrospective cone-beam computed tomography study.

BACKGROUND: Environmental and genetic factors associated with canine impaction have been extensively researched, whereas the bone characteristics in the impaction area have not been thoroughly studied. Accordingly, the objective of this investigation was to provide a skeletal assessment in terms of bone density, bone microstructure, bone volume, and palatal volume in subjects with unilaterally impacted maxillary canines. METHODS: A retrospective design has been employed to address the aim of this study, where the initial pre-treatment cone-beam computed tomography (CBCT) scans of 30 patients with unilateral maxillary canine impaction were assessed. The obtained patients' data were equally divided according to the location of the impaction into 2 groups, one with buccally impacted canines, and another with palatal impactions, with the contra-lateral sides in both groups serving as the controls. Skeletal measurements such as bone density (BD), bone microstructure in terms of fractal dimension (FD), maxillary bone volume (MBV), and palatal volume (PV) were evaluated from the acquired CBCTs in both groups and compared to the controls. RESULTS: With buccal impactions, significantly greater BD and FD have been reported (p < 0.001), whereas non-significant differences were found regarding the PV when compared with controls (p = 0.56). MBV was significantly greater on the non-impaction side in comparison with buccal impaction sides (p < 0.001). For palatal impactions: BD, FD, and MBV were significantly greater on the impaction sides (p < 0.001), and conversely with PV which has been reported to be significantly greater on the non-impaction sides (p < 0.001). CONCLUSIONS: As per the obtained results, buccally impacted canines are associated with greater BD and FD, and less MBV, whereas palatally impacted canines are accompanied with greater BD, FD, and MBV, in addition to less PV, when both conditions are compared with the non-impaction sides.

Morphometric Assessment of Temporomandibular Joint Space in Dentate and Edentulous Patients by Using Cone Beam Computed Tomography.

AIM: This study aimed to determine the changes in the temporomandibular joint due to ethnicity and to reveal gender differences. METHODS: This retrospective study included the evaluation of cone beam computed tomography (CBCT) images of 110 patients (220 temporomandibular joint {TMJs}), 64 dentulous (32 females, 32 males) and 46 edentulous (18 females, 28 males). Anterior, superior, and posterior joint spaces and the roof of the glenoid fossa (GF) were measured in sagittal views. Shapiro-Wilk test, independent sample t-test, and Mann-Whitney U tests were used to determine significant differences between dentulous and edentulous patients. RESULTS: The difference in terms of anterior and posterior joint space was statistically significant (p=0.005, p˂0.001). However, no statistically significant difference was found in the upper joint space (p=0.227). A statistically significant difference was not found in GF roof thickness (p=0.229). CONCLUSIONS: Upper joint space and GF roof thickness were not associated with edentulism. However, this situation is directly related to both posterior and anterior joint spaces, and this relationship manifests itself as a decrease in the posterior joint space and an increase in the anterior joint space with edentulism.

Healing of a Large Periapical Lesion Using Non-Surgical Root Canal Retreatment: A Case Report.

This case report highlights the successful healing of a large periapical lesion through non-surgical root canal retreatment. A 29-year-old male patient presented with a significant radiolucency associated with teeth #21 and #22, initially treated non-surgically. Despite the lesion's size, the treatment, which included thorough canal disinfection and obturation, led to substantial healing. A follow-up cone-beam computed tomography (CBCT) scan after one year confirmed the buccal cortical bone reformation and improvement in the incisive canal area except for the apical region of #21. Subsequently, root canal retreatment was performed for #21. Complete healing was achieved after two years, demonstrating that even extensive periapical lesions can be effectively treated with non-surgical endodontic retreatment, avoiding invasive surgical intervention.

Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study.

AIMS: This cross-sectional retrospective study was conducted to assess the differences in the microarchitecture of the trabecular bone of the posterior mandibular region at dentulous and edentulous sites with the help of fractal dimension (FD) and lacunarity using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Ninety CBCT scans were analyzed for the purpose of the present study. Inclusion criteria included subjects with unilaterally missing mandibular molars or premolars and an with intact contralateral opposing tooth. The coronal view of the dentulous and edentulous sites was used, and the region of interest (ROI) was selected 2.6 mm below the apex of the tooth present. These images were then transferred to ImageJ Software, and fractal analysis was done using the box-counting method of the FracLac plug-in. A paired samples t-test was performed to compare the means of FD and lacunarity, and a Kendall correlation was performed to check correlations. A p-value less than 0.05 was considered to indicate statistical significance. RESULTS: Statistical analysis revealed that the mean FD of the edentulous side was significantly greater than that of the dentulous side (p-value = 0.011). Additionally, the mean lacunarity of the edentulous side was marginally significantly greater than that of the dentulous side (p-value = 0.089). A significant negative correlation was detected between the FD and lacunarity of the edentulous region (p-value = 0.017), and a marginally significant negative correlation was detected between edentulous lacunarity and dentulous lacunarity (p-value = 0.081). CONCLUSION: The differences in occlusal forces exerted in dentulous and edentulous regions can lead to a change in the trabecular pattern of the bone in these regions. This change in the microarchitecture of bones can be detected by FD and lacunarity, which can further help us assess changes pre- and post-implant. CLINICAL SIGNIFICANCE: The advanced technology, the assessment of microarchitecture of the bone has been made easy, using FD and lacunarity, as done in the present study. This analysis can further aid us in both pre- and post-implant analysis to prevent failure of the implant. How to cite this article: Bhoraskar M, Denny C, Srikant N, et al. Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study. J Contemp Dent Pract 2024;25(6):581-587.

Efficacy of Mastoid Morphometry in Sex Determination Using Cone-beam Computed Tomography: A Retrospective Analysis in Dakshina Kannada Population.

AIM: To evaluate the morphology of the mastoid process and its role in sex determination with the help of cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A retrospective study was conducted on 200 adults who were subjected to full FOV CBCT scans (100 males and 100 females). Eight parameters of the mastoid process were assessed for sex determination. The study measured eight parameters of the mastoid process, including mastoid length (ML), mastoid width, mastoid height (MH), intermastoidale distance (IMD), intermastoidale lateral surface distance (IMLSD), mastoid medial convergence angle, mastoid size (MS), and mastoid surface area (MSA). Data were recorded and statistically analyzed. RESULTS: Statistics revealed a significant value for MH (p < 0.001), IMD (p < 0.001), IMLSD (p < 0.001), MSA (p < 0.001), MS (p < 0.001), and ML (p = 0.032). A highly significant value was noted for MH (p < 0.001), IMD (p < 0.001), IMLSD (p < 0.001), MSA (p < 0.001), MS (p < 0.001), followed by ML, all of which were found to be greater in males. Out of the eight parameters, IMD was found to be the best sex determinant among all the eight parameters, with an accuracy of 70%. The study showed a significant difference between the mastoid process morphometric measurements for males and females. CONCLUSION: It can be concluded from the present study that IMD can be used as a good index for sex determination. The combined parameters that were found to be the most accurate were right MH, left ML, and IMLSD, with an accuracy of 75%. CLINICAL SIGNIFICANCE: The three-dimensional imaging techniques can contribute significantly towards disaster victim identification and sex determination in the fields of forensic odontology and anthropology. For the recognition of victims, sex determination becomes one of the most difficult parameters to assess. In such events, the mastoid process can become an important anatomical landmark for the estimation of sex. This is due to the condensed nature of the petrous bone and its protected position in the skull. How to cite this article: Ahmed J, Saha A, Muralidharan A, et al. Efficacy of Mastoid Morphometry in Sex Determination Using Cone-beam Computed Tomography: A Retrospective Analysis in Dakshina Kannada Population. J Contemp Dent Pract 2024;25(5):453-458.

Morphology of Roots and Canals of Maxillary First Premolars: A CBCT Study in a Peruvian Sample.

Introduction: It is important to take into account variations in structures related to dental pulp for planning the most adequate endodontic treatment management. The objective of this study was to determine the morphology of roots and canals of maxillary first premolars (MFPs) using cone-beam computed tomography (CBCT). Materials and Methods: This retrospective study included a sample of 392 CBCTs of Peruvian adults proportionally selected by sex, age, and quadrant. One MFP per individual was selected for evaluation by a calibrated evaluator based on the number of roots and canal configuration according to the Vertucci classification (VC; Cohen's κ ≥ 0.834). Pearson's χ 2 and Kruskal-Wallis tests were used with a significance level of P < 0.05. Results: Most MFP presented double roots (59.9%) and were VC type IV (52%). Morphology showed a nonsignificant difference by quadrants (P=0.994). A significant positive association was found between the presence of double roots and type IV in men and with older age, while single roots and type I and II were associated with women and younger age (P < 0.05). Double roots were associated with VC type IV (86%) and single roots with types III (34%), II (32%), and I (26%; P < 0.001). Conclusions: MFPs in a Peruvian sample presented a higher frequency of double roots with two separate canals. The morphology of root and canals was associated with age and sex.

Repeatability and Reproducibility of a Modified Lekholm and Zarb Bone Quality Classification Based on Cone Beam Computed Tomography: An Observatsion Study.

Aim: We propose a modified Lekholm and Zarb classification that considers all possible combinations of cortical and cancellous bone to provide parameters that favor greater repeatability and reproducibility. Materials and Methods: This observational and analytical study consisted of a sample of 50 cone beam computed tomography (CBCT) scans. Two new types (V and VI), three subtypes to type II (II-A, II-B, and II-C), and two subtypes to type III (III-A and III-B) were added to the original bone quality classification. The new types refer to regenerated bone (type V) and bone with some pathology (type VI). The subtypes are described as type II-A: thick cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type II-B: thick cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae in the basal bone and predominant presence of wide and visible medullary spaces; type II-C: thick cortical surrounding the abundant cancellous bone with predominance of very thick and sharp trabeculae in the basal third as well as presence of small and visible medullary spaces; type III-A: thin cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type III-B: thin cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae and presence of diffuse medullary spaces. Five dental specialists were trained in the use of the modified classification and were provided with CBCT-sectioned images of edentulous jaws for classification. Each specialist classified the images twice at a 7-day interval. The strength of intra-examiner and inter-examiner agreement was measured with Cohen's and Fleiss' kappa index, respectively. In addition, the agreement between both classifications was analyzed. All data were analyzed at a 95% confidence level, considering a P-value <0.05. Results: According to the modified Lekholm and Zarb classification, an almost perfect intra-examiner agreement was significant (P < 0.05) in all five specialists, with the kappa index [k] ranging from 0.91 [95% confidence interval (CI): 0.82-0.99) to 0.95 (95% CI: 0.89-1.00). Furthermore, substantial inter-examiner concordance (k=0.76; 95% CI: 0.73-0.79) was significant (P < 0.05). Conclusion: The high repeatability and reproducibility of the modified Lekholm and Zarb classification on CBCT suggest its applicability to distinguish between the various combinations of cortical and cancellous bone and help to define treatment appropriately to optimize results.

Impact of Guided Endodontics on the Success of Endodontic Treatment: An Umbrella Review of Systematic Reviews and Meta-Analyses.

Endodontic treatment, essential for preserving teeth affected by pulp or periapical diseases, often encounters challenges such as complex root canal anatomies and calcifications that can hinder success. Traditional techniques, although effective, are limited in addressing these complexities. Guided endodontics, which utilizes advanced imaging and navigation technologies, promises enhanced accuracy and precision, potentially improving treatment outcomes. Thus, this umbrella review aims to assess whether guided endodontics influences the outcome of endodontic treatment by synthesizing evidence from multiple systematic reviews and meta-analyses. Comprehensive searches were conducted in PubMed, Scopus, EBSCOhost, and Cochrane databases to identify relevant studies. Additionally, grey literature was searched. The umbrella review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024564150). Inclusion criteria comprised randomized controlled trials (RCTs), randomized clinical trials, case series, and case reports. Exclusion criteria included reviews, non-English language articles, in vitro studies, ex vivo studies, randomized experimental (in vitro) studies, narrative reviews, and expert opinions. Studies involving patients undergoing guided endodontic treatment with dynamic and static navigation systems were included. The interventions aimed at improving the accuracy and precision of endodontic procedures, particularly in challenging cases such as locating calcified canals and performing microsurgery. The study involved three reviewers who independently appraised the systematic reviews for eligibility, data extraction, and review quality. The quality of the systematic reviews was evaluated using the "A Measurement Tool to Assess Systematic Reviews 2" (AMSTAR2) assessment tool. The methodological quality of the systematic reviews was assessed. A pooled review of the studies showed that guided endodontics demonstrated more precise and better results than conventional endodontic procedures.

Single-Isocenter, Multiple-Target Abdominal Cone-Beam Computed Tomography (CBCT)-Guided Online Adaptive Stereotactic Body Radiotherapy (SBRT).

Stereotactic body radiotherapy (SBRT) is increasingly being prescribed for treating patients with multiple metastases, especially in the setting of oligometastatic disease. Treating multiple targets presents unique challenges in radiotherapy planning and delivery, including practical considerations relating to treatment time, resource allocation, and treatment planning complexity. Treating targets in a common isocenter reduces the time required for treatment and simplifies planning, but historically, it has often not been feasible due to inter- and intra-fractional variation in relative target positions. With online adaptation, individual targets can be re-contoured on each treatment fraction to obviate inter-fractional variation, and with appropriate margin selection intra-fractional motion can be managed. In this case report, we describe single-isocenter, multiple-target treatment via online adaptation of a 93-year-old man with a history of metastatic hepatocellular carcinoma. He initially presented with a 9.1 cm liver mass, suspicious lung lesions, and an enlarged porta hepatis lymph node, which were biopsy proven to be hepatocellular carcinoma. Following 18 months of systemic immunotherapy, he demonstrated a favorable response, including a reduction in primary liver mass to 5.1 cm and resolution of pulmonary lesions; however, recent serial imaging demonstrated oligoprogression of two peripancreatic lymph node conglomerates that were biopsy proven to be poorly differentiated carcinoma. The patient was offered adaptive SBRT to a dose of 35-40 Gy in five fractions as a consolidative approach for treating both the primary liver mass and oligoprogressive lymph nodes. He tolerated treatment without any grade 2 or higher acute toxicity and had stable disease on three-month post-treatment imaging. By leveraging online adaptation, especially for the daily re-definition of target volumes, we were able to treat three targets in the abdomen accurately in a common isocenter. Treating in this manner vastly shortened and simplified the patient's radiation course. Quantitative evaluation of re-contoured targets and post-treatment imaging highlighted the value of online adaption with careful margin specification and alignment instructions.

Monte Carlo-based simulation of virtual 3 and 4-dimensional cone-beam computed tomography from computed tomography images: An end-to-end framework and a deep learning-based speedup strategy.

Background and purpose: In radiotherapy, precise comparison of fan-beam computed tomography (CT) and cone-beam CT (CBCT) arises as a commonplace, yet intricate task. This paper proposes a publicly available end-to-end pipeline featuring an intrinsic deep-learning-based speedup technique for generating virtual 3D and 4D CBCT from CT images. Materials and methods: Physical properties, derived from CT intensity information, are obtained through automated whole-body segmentation of organs and tissues. Subsequently, Monte Carlo (MC) simulations generate CBCT X-ray projections for a full circular arc around the patient employing acquisition settings matched with a clinical CBCT scanner (modeled according to Varian TrueBeam specifications). In addition to 3D CBCT reconstruction, a 4D CBCT can be simulated with a fully time-resolved MC simulation by incorporating respiratory correspondence modeling. To address the computational complexity of MC simulations, a deep-learning-based speedup technique is developed and integrated that uses projection data simulated with a reduced number of photon histories to predict a projection that matches the image characteristics and signal-to-noise ratio of the reference simulation. Results: MC simulations with default parameter setting yield CBCT images with high agreement to ground truth data acquired by a clinical CBCT scanner. Furthermore, the proposed speedup technique achieves up to 20-fold speedup while preserving image features and resolution compared to the reference simulation. Conclusion: The presented MC pipeline and speedup approach provide an openly accessible end-to-end framework for researchers and clinicians to investigate limitations of image-guided radiation therapy workflows built on both (4D) CT and CBCT images.

Positions of the Mandibular Foramen and Canal in Different Skeletal Classes and Implications for Bilateral Sagittal Split Osteotomy.

Objectives: To evaluate the positions of the mandibular foramen (MF) and mandibular canal (MC) between different skeletal classes to highlight the implications for bilateral sagittal split osteotomy (BSSO). Methods: A cross-sectional study was performed using cone-beam computed tomography on 90 patients classified into classes I, II and III. Linear measurements were performed on multiplanar reconstructions as follows: from the MF to the edge of the mandibular ramus (1), to the mandibular notch (2), to the ramus width (3) and to the occlusal plane (4); and from the MC to the alveolar crest (A), to the lower border of the mandible (B) and to the mandibular buccal cortical bone (C). Mandibular thickness (D), width (E) and height (F) of the MC were measured. Intra-class correlation coefficient (ICC) checked the reliability. Two-way ANOVA and Tukey's test were used to compare measurements and classes. Results: Linear measurements 2 presented a statistically significant difference between classes I and II. There was no statistically significant difference between the classes and measurements B, C, D, E and F. Linear measurements A were shorter in class III than in class II. Conclusions: Although most measurements suggest that the BSSO technique does not need to be modified for each skeletal class, measurements from the MF to the mandibular notch in class II and from the MC to the alveolar crest on distal of the second molars in class III could help surgeons to recognize critical regions.

Analysis of palatal marginal alveolar exostosis and palatal torus using cone-beam computed tomography.

The aim of the present study was to analyze palatal marginal alveolar exostosis (PMAE) and palatal torus (PT). Cone-beam computed tomography (CBCT) of the maxilla in multiplanar sections and volumetric renderings were used to assess this. PT and PMAE were classified according to location and morphology. Height, width, length, and thickness of the overlying mucosa were determined. The prevalence of PT and PMAE was assessed according to sex and age group. The correlation between the occurrence of PMAE and PT was also evaluated. A total of 385 CBCT scans were examined. PT was found in 38.70% of the sample and located more frequently in the middle third of the maxilla (52.35%) with a flat shape (42.95%). PMAE was found in 54.80% of the sample, bilaterally in 56.40% of the cases, and located more frequently in the molar region (62.42%) in the form of small nodules (36.97%). The mucosa covering PMAE was generally thicker than that over PT. The use of CBCT for the identification of PT and PMAE in vivo showed high frequencies of both conditions. The occurrence of PMAE was independent of the presence of PT.

Three-dimensional assessment of root canal morphology of primary dentition using cone beam computed tomography.

BACKGROUND: Root canal therapy in primary teeth is exceedingly complex due to the unique internal geometry of the pulp cavity. AIM: The purpose of this study was to evaluate variations in primary teeth root canal morphology and applicability of the Ahmed et al. (Int Endod J, 50, 2017, 761) alphanumeric system for classifying them. DESIGN: A retrospective analysis of 2024 primary teeth from an existing CBCT database was performed for assessing variations in root canal morphology. Descriptive statistics and the chi-squared test were used for data analysis. RESULTS: The maxillary canines exhibited splitting levels of 5.9% (right) and 6.6% (left), and merging levels of 1% (both sides); maxillary lateral incisors showed splitting levels of 2.6% (right) and 0.8% (left), with no merging observed; mandibular second molars had splitting levels of 1.5% (right) and 0.8% (left), with no merging observed; and mandibular lateral incisors exhibited a merging level of 0.9% (right), with no splitting observed. CONCLUSION: This study provides new insights into the variations in root canal morphology of primary teeth, particularly highlighting the variations found in primary canines. The Ahmed et al. (Int Endod J, 50, 2017, 761) classification system was found to be a useful tool for categorizing these variations.

Prevalence of Incidental Findings and Assessment of Maxillary Sinus Pathologies and Dental Diseases Using Cone-Beam Computed Tomography (CBCT) in the Tamil Nadu Population: A Retrospective Study.

Background Cone-beam computed tomography (CBCT), a cross-sectional imaging technique, is valuable for clinical diagnosis and creating effective treatment plans. CBCT can precisely examine the connection between the maxillary sinuses and the maxillary root apices. Oral radiologists must be aware of all potential incidental findings and should be diligent in thoroughly identifying and assessing possible underlying diseases. Aim To determine the prevalence of incidental maxillary sinus pathologies and their relationship to dental diseases. Materials and methods In the present retrospective study, CBCT scans from 300 subjects (encompassing 600 right and left maxillary sinuses), aged 18 to 70, were gathered from various CBCT centers to represent the Tamil Nadu population. The CBCT images were analyzed using proprietary software, which provided both a panoramic reconstruction view and multiplanar reformation modules, including axial, sagittal, and coronal slices. The entire sample size was classified as follows: Group 1, age groups of 18 to 25 years; Group 2, age groups of 26 to 35 years; Group 3, age groups of 36 to 45 years; Group 4, age groups of 46 to 55 years; Group 5, age groups of 56 to 65 years; Group 6, age groups of 66 to 70 years. The prevalence of incidental maxillary sinus findings was analyzed, and their relationship with periapical abscess, periapical granuloma, periapical cyst, and breach was assessed. Results There was a prevalence of 52.05% of cases that had incidental maxillary sinus findings. Among them, 53.43% were males and 50.65% were females. Maxillary sinus pathologies were more common in individuals between 46 and 55 years, i.e., Group 4. In 300 datasets, the frequency of incidental maxillary sinus findings on the right is 21.33%, on the left is 24%, in both is 6.67%, and absent in 48% of the cases. Mucosal thickening was observed in 30% of cases with a periapical abscess, 19.52% with a periapical granuloma, 25% with a periapical cyst, and 51.79% with a breach. Polypoidal mucosal thickening was present in 32.50% of cases with a periapical abscess, 13.79% with a periapical granuloma, 50% with a periapical cyst, and 23.21% with a breach. Opacification occurred in 37.50% of cases with a periapical abscess, 20.69% with a periapical granuloma, 25% with a periapical cyst, and 25% with a breach. Conclusion Dental professionals should have a bird's-eye view in treating chronic odontogenic infections close to the maxillary sinus. Early diagnosis and prompt treatment of odontogenic infections help prevent maxillary sinus pathologies.

Cone-Beam Computed Tomography (CBCT)-Based Online Adaptive Radiation Therapy (oART) for a Prostate Cancer Patient With Inflammatory Bowel Disease and Bilateral Total Hip Arthroplasty: A Case Report.

This case report addresses the complex management of a patient with concurrent prostate cancer, inflammatory bowel disease (IBD), and bilateral total hip arthroplasty, and demonstrates the efficacy of cone-beam computed tomography (CBCT)-guided daily online adaptive radiation therapy (oART) and advanced imaging techniques in overcoming significant treatment challenges. A 68-year-old male with a history of ulcerative colitis and bilateral hip prostheses was diagnosed with high-risk prostate cancer. Conventional radiation therapy modalities, including external beam radiation therapy (EBRT), proton therapy, and magnetic resonance imaging (MRI)-based oART, faced limitations because of the patient's comorbidities and metallic implants. Daily oART, using the Ethos platform (Varian Medical Systems, Palo Alto, CA, USA) with HyperSight™ metal artifact reduction (MAR) imaging, was employed to enhance treatment efficacy. The daily oART treatment on the Ethos platform facilitated the successful delivery of a therapeutic dose while sparing healthy tissues, and the treatment was successful without an IBD flare-up. Daily oART also optimized the target dose while best sparing the critical organs based on the patient's daily anatomy. The HyperSight MAR algorithm significantly reduced imaging artifacts caused by the hip prostheses, enabling accurate identification of the prostate, bladder, and surrounding organs. The oART workflow was delivered without technical challenges, with a total session time of 20 to 30 minutes, similar to our typical prostate patients without hip implants. Despite the complex anatomy and comorbid conditions, the treatment plan met all organ-at-risk constraints and delivered the prescribed dose to the target volumes. Ethos oART with HyperSight provided an effective solution for treating a patient with concurrent prostate cancer, IBD, and bilateral hip arthroplasty. The patient's case was successfully treated without complications, despite such challenging clinical and technical scenarios.

Supervised deep learning-based synthetic computed tomography from kilovoltage cone-beam computed tomography images for adaptive radiation therapy in head and neck cancer.

PURPOSE: To generate and investigate a supervised deep learning algorithm for creating synthetic computed tomography (sCT) images from kilovoltage cone-beam computed tomography (kV-CBCT) images for adaptive radiation therapy (ART) in head and neck cancer (HNC). MATERIALS AND METHODS: This study generated the supervised U-Net deep learning model using 3,491 image pairs from planning computed tomography (pCT) and kV-CBCT datasets obtained from 40 HNC patients. The dataset was split into 80% for training and 20% for testing. The evaluation of the sCT images compared to pCT images focused on three aspects: Hounsfield units accuracy, assessed using mean absolute error (MAE) and root mean square error (RMSE); image quality, evaluated using the peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM) between sCT and pCT images; and dosimetric accuracy, encompassing 3D gamma passing rates for dose distribution and percentage dose difference. RESULTS: MAE, RMSE, PSNR, and SSIM showed improvements from their initial values of 53.15 ± 40.09, 153.99 ± 79.78, 47.91 ± 4.98 dB, and 0.97 ± 0.02 to 41.47 ± 30.59, 130.39 ± 78.06, 49.93 ± 6.00 dB, and 0.98 ± 0.02, respectively. Regarding dose evaluation, 3D gamma passing rates for dose distribution within sCT images under 2%/2 mm, 3%/2 mm, and 3%/3 mm criteria, yielded passing rates of 92.1% ± 3.8%, 93.8% ± 3.0%, and 96.9% ± 2.0%, respectively. The sCT images exhibited minor variations in the percentage dose distribution of the investigated target and structure volumes. However, it is worth noting that the sCT images exhibited anatomical variations when compared to the pCT images. CONCLUSION: These findings highlight the potential of the supervised U-Net deep learningmodel in generating kV-CBCT-based sCT images for ART in patients with HNC.

Automatic maxillary sinus segmentation and pathology classification on cone-beam computed tomographic images using deep learning.

BACKGROUND: Maxillofacial complex automated segmentation could alternative traditional segmentation methods to increase the effectiveness of virtual workloads. The use of DL systems in the detection of maxillary sinus and pathologies will both facilitate the work of physicians and be a support mechanism before the planned surgeries. OBJECTIVE: The aim was to use a modified You Only Look Oncev5x (YOLOv5x) architecture with transfer learning capabilities to segment both maxillary sinuses and maxillary sinus diseases on Cone-Beam Computed Tomographic (CBCT) images. METHODS: Data set consists of 307 anonymised CBCT images of patients (173 women and 134 males) obtained from the radiology archive of the Department of Oral and Maxillofacial Radiology. Bilateral maxillary sinuses CBCT scans were used to identify mucous retention cysts (MRC), mucosal thickenings (MT), total and partial opacifications, and healthy maxillary sinuses without any radiological features. RESULTS: Recall, precision and F1 score values for total maxillary sinus segmentation were 1, 0.985 and 0.992, respectively; 1, 0.931 and 0.964 for healthy maxillary sinus segmentation; 0.858, 0.923 and 0.889 for MT segmentation; 0.977, 0.877 and 0.924 for MRC segmentation; 1, 0.942 and 0.970 for sinusitis segmentation. CONCLUSION: This study demonstrates that maxillary sinuses can be segmented, and maxillary sinus diseases can be accurately detected using the AI model.