Cone-beam computed tomography (CBCT) has become a vital tool in implantology, playing a key role in both pre- and post-surgical phases. Preoperatively, CBCT provides detailed three-dimensional evaluation of anatomical structures, offering precise information on bone quality and quantity, as well as the location of critical structure. This accuracy enhances surgical planning, reducing intra- and postoperative risks and ensuring more precise implant placement. Post-surgically, CBCT is equally important for monitoring osseointegration and detecting potential complications, such as failed integration, infections, or implant misalignment. Its high-resolution imaging capabilities enable clinicians to make accurate therapeutic adjustments, improving treatment outcomes. Overall, CBCT improves decision-making in implantology, offering greater predictability and safety compared to traditional two-dimensional radiography, significantly enhancing the success rates of implant-based oral rehabilitation procedures.

Lately, radiomic studies featuring the development of a signature to use in prediction models in diagnosis or prognosis outcomes are being published increasingly. While the results are shown to be promising, these studies still have many pitfalls and limitations. One of the main issues of this methodology is that radiomic features depend on how the images are preprocessed before their computation. Since, in widely known and used software for radiomic features calculation, it is possible to set these preprocessing parameters before the calculation of the radiomic feature, there are ongoing studies assessing the stability and repeatability of radiomic features to find the most suitable preprocessing parameters for every used imaging modality. This review examines the impact of preprocessing parameters on the reproducibility and reliability of radiomic features extracted from multimodality imaging (CT, MRI, CBCT, PET/CT). Standardized preprocessing is crucial for consistent radiomic feature extraction. Key preprocessing steps include voxel resampling, normalization, and discretization, which influence feature robustness and reproducibility. From our work, we highlighted the need to harmonize the use of preprocessing parameters and their values, especially in light of future studies of prospective studies, which are still lacking in the current literature.

MAD is the gold standard therapy for mild/moderate OSA and is a second-choice treatment in patients with severe OSA not responding to CPAP. The aim of this study was to analyze the upper airway characteristics of OSA patients and the morphological changes in the upper airway, inducted by four different types of mandibular advancement devices, using CBCT 3D imaging. Twenty-two patients were recruited after OSA diagnosis with polysomnography. Four different customized and titratable MAD were used and an initial CBCT scan was obtained for each patient. After 6 months to the end of the MAD titration phase, all the subjects showed an AHI of < 5 or a decrease of 50% in AHI with MAD when compared with initial AHI and a second CBCT scan with MAD in situ was performed. An important improvement of the airway was observed (+33.76%) and a significant difference in the enlargement ratio between the posterior soft palate (+32.41%) and the posterior tongue (+36.96%) region was also found. The greatest increase in airway volume was achieved in patients treated with the MAD Forward and TAP (respectively +42.77% and + 41.63%). MAD therapy is effective to treat mild/severe OSA with increased upper airway volume. The design of the MAD can influence the effectiveness of the treatment.

This retrospective study evaluated changes in the pharyngeal portion of the upper airway in pa-tients with constricted and normal airway treated with clear aligners (Invisalign, Align). Additionally, the paper has assessed the change of tongue position in the oral cavity from lateral view. Evaluation was performed with specialized software (Invivo 6.0, Anatomage) on pre-treatment and posttreatment pairs of cone beam computed tomography imaging (CBCT) data. The level of airway constriction, volume, cross-section minimal area, and tongue profile were evaluated. Patients with malocclusion, with pair or initial and finishing CBCT and without sig-nificant weight change between the scans, treated with Invisalign clear aligners were distributed in two groups. Group A consisted of fifty-five patients with orthodontic malocclusion and con-stricted upper airway. Control group B consisted of thirty-one patients with orthodontic malocclusions without any airway constriction. In the group with airway constriction, there was a statistically significant increase in volume during therapy (p<0.001). The surface of the most con-stricted cross-section of airway did not change significantly after treatment in any of the groups. The airway constriction was most frequently localized at the level of 2nd cervical vertebra. The final tongue position was different from initial in 62.2% of all clear aligner treatments.

Since the development of CBCT had been utilized in dentistry, the images of the CBCT can assist the surgeon to evaluate the anatomy carefully. Despite the value of the radiology evaluation, the implant procedures may require additional consideration rather than only evaluating the anatomical factors. The purpose of this study is to evaluate the predictability of using CBCT alone to plan for implant placement on the edentulous patient digitally CBCT images were analyzed by clinicians, measuring the ridge heights and widths of 4 selected implant sites in the maxillary and 2 selected implant sites in the mandibular arches for 91 patients planning for the implant-supported overdenture. (A total of 47 patients out of the 91 had completed the implant placement on the edentulous ridge, contributing to 55 upper and/or lower arches (136 dental implants). . Both predictabilities are low, implying the CBCT planning for implant placement on the edentulous ridge is not a good index and is insufficient to predict the surgical procedures as a solo method. The finding of this study indicates that digital planning by CBCT is insufficient to serve as an individual tool to predict implant procedures. Further information and evaluation must be considered for implant placement on the edentulous ridge.

Atlas Posterior Arch Deficiency (APAD) is a rare anatomical variation of the atlas vertebra that can be detected using cone-beam computed tomography (CBCT). This study aims to evaluate the prevalence, classification, and clinical implications of APAD in an Italian cohort.

The advent of AI in medicine has transformed various medical specialties, including orthodontics. AI has shown promising results in enhancing the accuracy of diagnoses, treatment planning, and predicting treatment outcomes. With the growing number of AI applications and commercially available tools, there is an increase in their usage in orthodontic practices worldwide. This review aims to explore the principles of artificial intelligence (AI), its applications in the diagnostic process of modern orthodontic practices, and concerns associated with the implementation of AI algorithms in clinical practice. A comprehensive review of the literature was conducted, focusing on five categories where AI has been applied in orthodontics: dental diagnostics, cephalometric evaluation, skeletal age determination, temporomandibular joint (TMJ) evaluation, and extraction decision making. AI has demonstrated high efficacy in all those fields. However, variations in performance and the necessity of manual supervision indicate that AI should be used cautiously in clinical settings. Nevertheless, the high complexity and potential unpredictability of AI algorithms call for cautious implementation and regular manual validation of results. Continuous AI learning, proper governance, and addressing privacy and ethical concerns are crucial for the successful integration of AI into orthodontic practice.

The aim of this study was to examine the relationship of the distance between the apex tip of the upper central tooth (U1A) and the anterior nasal spine (ANS) and the nasal floor (NF) with the vertical cephalometric values using cone-beam computerized tomography (CBCT). A total of 122 patients who applied to Department of Orthodontics between January 2011-June 2019 were included. On the CBCT’s, distances between the U1A and the NF and ANS were measured. Statistical significance was considered as p&lt;0.05. Of 122 individuals 73.8% (n=90) were female and 26.2% (n=32) were male with an mean age of 22,8±3,3 years. A statistically significant moderate positive correlation was found between the NF-U1A mean values and the measurements of N-Me, ANS-Me and ANS-Gn, S-Go, and N-ANS measurements (p &lt;0.01). A statistically significant positive correlation was found between the ANS-U1A mean values and Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me and ANS-Gn (p &lt;0.01). In this study, we found that the distance of U1A from ANS and NF points was related to orthodontic vertical direction parameters. It was demonstrated that the ANS-U1A and NF-U1A points can serve as reference points for identifying the orthodontic vertical growth pattern on CBCT scans.

Abstract: The widespread and popular use of TADs for orthodontic anchoring has become a daily routine in clinical orthodontic treatment. However, as there have been many accidents over the past decade, safety action is needed to help reduce these accidents. We have advocated using the surgical guide and developed a procedure that can benefit patients and orthodontists. The first part of this paper is about the rationale for making the surgical guide for various implant placements that were observed. Due to their anatomical structure, some placements may require particular attention, which is focused on and discussed in length. The second part deals with fabricating the surgical guide in the laboratory procedure. The data from the intraoral SLT acquisition was extracted, and with the DICOM data from CBCT and in a 3-Shapes software, the guidance was designed. The detailed and step-by-step laboratory procedure, CAD/CAM, and 3D printers to make the surgical guide for TADs are explained. The procedure is performed in an easy-to-understand manner to make using the surgical guide possible for the daily practice of orthodontics (Pubmed).

The current paradigm shift in orthodontic treatment planning is based on facially driven diagnostics. This requires an affordable, convenient, and non-invasive solution for face scanning. Therefore, utilization of smartphones` TrueDepth sensors is very tempting. TrueDepth refers to front-facing cameras with a dot projector in Apple devices that provide real-time depth data in addition to visual information. There are several applications that tout themselves as accurate solutions for 3D scanning of the face in dentistry. Their clinical accuracy has been uncertain. This study focuses on evaluating the accuracy of the Bellus3D Dental Pro app, which uses Apple's TrueDepth sensor. The app reconstructs a virtual, high-resolution version of the face, which is available for download as a 3D object. In this paper, sixty TrueDepth scans of the face were compared to sixty corresponding facial surfaces segmented from CBCT. Difference maps were created for each pair and evaluated in specific facial regions. The results confirmed statistically significant differences in some facial regions in amplitudes greater than 3 mm, suggesting that current technology has limited applicability for clinical use. The clinical utilization of facial scanning for orthodontic evaluation, which does not require accuracy in the lip region below 3 mm, can be considered.

Objectives (Purpose) This study aims to evaluate the outcomes of the Subcrestally Placed Implant (SPI) technique in single molar cases, focusing on biological stability and aesthetics. It proposes a schematic model to elucidate the interplay between the biological stability of soft tissues and bone around the SPI and the morphological requisites that Implant Abutment Prostheses (IAP) must fulfill to effectively replace natural teeth. Materials and methods I examined 20 cases using the SPI technique with Internal Platform Switching (IPS) design implants for single molar replacements to assess their stability. Routine check-ups utilized plain panoramic X-rays to measure changes in crestal bone on the mesial and distal sides. Additionally, 10 cases with CBCT X-rays taken more than one year after the initial surgery underwent a novel 3-dimensional soft tissue analysis (3DSTA). Measurements included placement depths (PD), soft tissue thickness (STT) at central (cPD, cSTT) and peripheral areas (pPD, pSTT), the length of the Transitional Zone (TZ) on mesial, distal, facial, and lingual aspects, and crestal bone thickness (CBT) at buccal and lingual sites. Results Panoramic analyses showed minimal changes in crestal bone (mean changes of pPD were less than 0.1 mm) over an average period of 3.3 years. Average measurements were as follows: cPD was 1.7 mm, pPD was 2.7 mm, cSTT was 0.2 mm, pSTT was 0.6 mm, TZ length was 3.8 mm, buccal CBT was 3.0 mm, and lingual CBT was 3.7 mm. Conclusions CBCT analyses of the topographical relationships between soft tissue and crestal bone with IAP for SPIs demonstrated stable results over an average 3-year period. The consistency in the relationship between crestal bone and surrounding soft tissue can be ascribed to biological structural integrity. The study classified peri-implant soft tissues into subcrestal and supracrestal (transitional zone – TZ) segments, exploring their characteristics through dimensional measurements and assessing mechanical resistance. Further histological study is needed to identify specific features of each segment.

Radiotherapy commonly utilizes CBCT for patient positioning and treatment monitoring. CBCT is deemed to be secure for patients, making it suitable for the delivery of fractional doses. However, limitations such as a narrow field of view, beam hardening, scattered radiation artifacts, and variability in pixel intensity hinder the direct use of raw CBCT for dose recalculation during treatment. To address this issue, reliable correction techniques are necessary to remove artifacts and remap pixel intensity into HU values. This study proposes a deep-learning framework for calibrating CBCT images acquired with narrow FOV systems and demonstrates its potential use in proton treatment planning updates. Cycle-consistent GAN processes raw CBCT to reduce scatter and remap HU. Monte Carlo simulation is used to generate CBCT scans, enabling the possibility to focus solely on the algorithm’s ability to reduce artifacts and cupping effects without considering intra-patient longitudinal variability and producing a fair comparison between planning CT and calibrated CBCT dosimetry. To showcase the viability of the approach using real-world data, experiments were also conducted using real CBCT. Tests were performed on a publicly available dataset of 40 patients who received ablative radiation therapy for pancreatic cancer. The simulated CBCT calibration led to a difference in proton dosimetry of less than 2%, compared to the planning CT. The potential toxicity effect on the organs at risk decreased from about 50% (uncalibrated) up the 2% (calibrated). The gamma pass rate at 3%/2mm produced an improvement of about 37% in replicating the prescribed dose before and after calibration (53.78% vs 90.26%). Real data also confirmed this with slightly inferior performances for the same criteria (65.36% vs 87.20%). These results may confirm that generative artificial intelligence brings the use of narrow FOV CBCT scans incrementally closer to clinical translation in proton therapy planning updates.

Spinal metastatic tumors are common and often cause debilitating symptoms. Image-guided percutaneous thermal ablation (IPTA) has gained significant recognition in managing spinal column tumors due to its exceptional precision and effectiveness. Conventional guidance modalities, including computed tomography, fluoroscopy, and ultrasound, have been important in targeting spinal column tumors while minimizing harm to adjacent critical structures. This study presents a novel approach utilizing a fusion of Cone Beam Computed Tomography with Magnetic Resonance Imaging to guide percutaneous thermal ablation for four patients with secondary spinal column tumors. The visual analog scale (VAS) evaluated procedure effectiveness during an 18-month follow-up. Percutaneous vertebroplasty was performed in two cases, and a thermostat was used during all procedures. Imaging was performed using the Stealth Station navigation system Spine 8 (SSS8) and a 1.5T MRI machine. The fusion of CBCT with MRI allowed precise tumor localization and guidance for thermal ablation. Initial results indicate successful tumor ablation and symptom reduction, emphasizing the potential of CBCT-MRI fusion in spinal column tumor management. This innovative approach is promising in optimizing therapy for secondary spinal column tumors. Further studies are necessary to validate its efficacy and applicability.

A method for generating fluoroscopic (time-varying) volumetric images using patient-specific motion models derived from 4-dimensional cone-beam CT (4D-CBCT) images is developed. 4D-CBCT images acquired immediately prior to treatment have the potential to accurately represent patient anatomy and respiration during treatment. Fluoroscopic 3D image estimation is done in two steps: 1) deriving motion models and 2) optimization. To derive motion models, every phase in a 4D-CBCT set is registered to a reference phase chosen from the same set using deformable image registration (DIR). Principal components analysis (PCA) is used to reduce the dimensionality of the displacement vector fields (DVFs) resulting from DIR into a few vectors representing organ motion found in the DVFs. The PCA motion models are optimized iteratively by comparing a cone-beam CT (CBCT) projection to a simulated projection computed from both the motion model and a reference 4D-CBCT phase, resulting in a sequence of fluoroscopic 3D images. Patient datasets were used to evaluate the method by estimating the tumor location in the generated images compared to manually defined ground truth positions. Experimental results showed that the average tumor mean absolute error (MAE) along the superior-inferior (SI) direction and the 95th percentile in two patient datasets were (2.29 mm and 5.79 mm) for patient 1 and (1.89 mm and 4.82 mm) for patient 2. This study has demonstrated the feasibility of deriving 4D-CBCT-based PCA motion models that have the potential to account for the 3D non-rigid patient motion and localize tumors and other patient anatomical structures on the day of treatment.