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Application of Cone Beam Computed Tomography for Maxillofacial Diseases

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (15 August 2023) | Viewed by 27825

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Dr. Yiu Yan Leung

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Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
Interests: orthognathic surgery; trigeminal nerve repair; maxillofacial imaging; temporomandibular disorder
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Special Issue Information

Dear Colleagues,

Diseases and pathologies in the maxillofacial region are functional and aesthetic challenges for patients. However, the anatomy in the maxillofacial region is complex, and dentists and maxillofacial surgeons rely on good imaging tools for accurate diagnosis and the management of these conditions. Cone-beam computed tomography (CBCT), as an alternative to traditional computed tomography, offers a cheaper option requiring a lower dose of radiation, while providing good image quality, and has been a workhorse for the oral and maxillofacial imaging of hard tissue. The versatility and small space occupancy of a CBCT allow a clinic-based setup that improve access and popularize its usage.

The scope of the use of CBCT in the maxillofacial region ranges from simple oral surgery to complex maxillofacial deformities, diseases and trauma. Considerations and applications of CBCT in various anatomical spaces and clinical applications are of huge interest to practicing clinicians. Computer virtual planning and 3D printing based on CBCT images have further extended the clinical applications. Artificial intelligence can also use the data acquired from CBCT for the automated detection and diagnosis of disease conditions through machine- and deep-learning algorithms.

This Special Issue aims to cover the advances of CBCT in the diagnosis and management of maxillofacial diseases as well as other conditions that are of high clinical relevance.

Dr. Yiu Yan Leung
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cone-beam computed tomography
imaging
radiology
oral and maxillofacial surgery
dentistry
diagnosis
risk management
3D printing
artificial intelligence

Published Papers (9 papers)

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Research

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15 pages, 2587 KiB

Open AccessArticle

Augmented Reality-Guided Apicoectomy Based on Maxillofacial CBCT Scans

by Bernhard Remschmidt, Marcus Rieder, Christina Gsaxner, Jan Gaessler, Michael Payer and Juergen Wallner

Diagnostics 2023, 13(19), 3037; https://doi.org/10.3390/diagnostics13193037 - 25 Sep 2023

Cited by 3 | Viewed by 1242

Abstract

Implementation of augmented reality (AR) image guidance systems using preoperative cone beam computed tomography (CBCT) scans in apicoectomies promises to help surgeons overcome iatrogenic complications associated with this procedure. This study aims to evaluate the intraoperative feasibility and usability of HoloLens 2, an established AR image guidance device, in the context of apicoectomies. Three experienced surgeons carried out four AR-guided apicoectomies each on human cadaver head specimens. Preparation and operating times of each procedure, as well as the subjective usability of HoloLens for AR image guidance in apicoectomies using the System Usability Scale (SUS), were measured. In total, twelve AR-guided apicoectomies on six human cadaver head specimens were performed (n = 12). The average preparation time amounted to 162 (±34) s. The surgical procedure itself took on average 9 (±2) min. There was no statistically significant difference between the three surgeons. Quantification of the usability of HoloLens revealed a mean SUS score of 80.4 (±6.8), indicating an “excellent” usability level. In conclusion, this study implies the suitability, practicality, and simplicity of AR image guidance systems such as the HoloLens in apicoectomies and advocates their routine implementation. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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12 pages, 5505 KiB

Open AccessArticle

Prevalence of Incidental Maxillary Sinus Anomalies on CBCT Scans: A Radiographic Study

by Junaid Ahmed, Aditya Gupta, Nandita Shenoy, Nanditha Sujir and Archana Muralidharan

Diagnostics 2023, 13(18), 2918; https://doi.org/10.3390/diagnostics13182918 - 12 Sep 2023

Cited by 1 | Viewed by 2567

Abstract

CBCT significantly impacts dental procedures and has brought significant reforms to our approach to diagnosis and treatment planning despite its limitations in differentiating soft tissues. It is an excellent imaging modality and quickly identifies sinus opacification and provides valuable insight into paranasal sinus pathologies, with considerably lower radiation exposure. The present study aimed to investigate the occurrence of maxillary sinus abnormalities in CBCT scans, identify the frequency, type, and location of these findings, and find the correlation between the distance of periapical lesions and radiographic changes in the maxillary sinus. Two examiners independently evaluated 117 patients to diagnose and classify the cases into different abnormality subtypes. The periapical lesions most closely related to the sinus were recorded. The diameters of the left and right maxillary sinus ostium and the distance of the ostium’s lower border to the sinus’s osseous floor were recorded. The findings were correlated with the age and gender of these patients. The present study reveals that sixty-one patients were diagnosed with mucosal thickening (52.1%). The sinus wall most affected by mucosal thickening was the maxillary sinus floor, followed by the medial and lateral walls. Of 19 patients with periapical lesions, 15 had maxillary sinus mucosal thickening, which is statistically significant (p = 0.004). The high occurrence of abnormalities in the maxillary sinus emphasizes the importance for the radiologist to comprehensively interpret the whole volume acquired in CBCT images, including the entire sinus. Incidental findings may be considered in the individual clinical context of signs and symptoms, reducing the risk of overestimating the real impact of radiographic findings. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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11 pages, 3478 KiB

Open AccessArticle

CBCT Images to an STL Model: Exploring the “Critical Factors” to Binarization Thresholds in STL Data Creation

by Takashi Kamio and Taisuke Kawai

Diagnostics 2023, 13(5), 921; https://doi.org/10.3390/diagnostics13050921 - 1 Mar 2023

Cited by 3 | Viewed by 2261

Abstract

In-house fabrication of three-dimensional (3D) models for medical use has become easier in recent years. Cone beam computed tomography (CBCT) images are increasingly used as source data for fabricating osseous 3D models. The creation of a 3D CAD model begins with the segmentation of hard and soft tissues of the DICOM images and the creation of an STL model; however, it can be difficult to determine the binarization threshold in CBCT images. In this study, how the different CBCT scanning and imaging conditions of two different CBCT scanners affect the determination of the binarization threshold was evaluated. The key to efficient STL creation through voxel intensity distribution analysis was then explored. It was found that determination of the binarization threshold is easy for image datasets with a large number of voxels, sharp peak shapes, and narrow intensity distributions. Although the intensity distribution of voxels varied greatly among the image datasets, it was difficult to find correlations between different X-ray tube currents or image reconstruction filters that explained the differences. The objective observation of voxel intensity distribution may contribute to the determination of the binarization threshold for 3D model creation. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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13 pages, 917 KiB

Open AccessArticle

Comparison between Conventional Modality Versus Cone-Beam Computer Tomography on the Assessment of Vertical Furcation in Molars

by Jack Lam, Andy Wai Kan Yeung, Aneesha Acharya, Chris Fok, Melissa Fok and Georgios Pelekos

Diagnostics 2023, 13(1), 106; https://doi.org/10.3390/diagnostics13010106 - 29 Dec 2022

Cited by 2 | Viewed by 1361

Abstract

This study aimed to assess the accuracy of diagnosis of vertical furcation subclass in molars using periapical radiographs (PAs) and clinical chartings compared against cone-beam computer tomography (CBCT) as the gold standard. The protocol involved examiners with different levels of experience. This retrospective radiographic study retrieved 40 molar teeth with full periodontal chartings, PAs, and CBCT records. Fifteen examiners with different levels of experience evaluated the PAs and periodontal chartings to assess the vertical depth of furcation and, thus, the vertical subclassification. CBCT was used as the gold standard for comparison. The accuracy of vertical furcal depth measured was assessed together with the accuracy of vertical subclassification assignment. The reliability of the conventional diagnostic modality among the examiners was also evaluated. A linear mixed model adjusted for the CBCT vertical furcal depth measurement was constructed to determine if tooth position, horizontal furcation distribution, and examiner experience level affect the bias in the vertical depth of furcation measurement. The reliability of the conventional periodontal diagnostic method in measuring vertical furcal depth was found to be fair, while vertical subclass assignment was moderate. Significantly better reliability during subclass assignment was found with mandibular molars (p < 0.001) and in maxillary molars with isolated buccal class II furcation. Within the study’s limitations, conventional periodontal diagnostics based on periapical radiographs and clinical periodontal chartings appear to be in poor to fair agreement with CBCT (gold standard) when measuring the vertical depth of furcation. Examiners with the least experience were more prone to bias when estimating the vertical furcal depth. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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14 pages, 1997 KiB

Open AccessArticle

Evaluation of Root Canal Configuration of Maxillary and Mandibular First Molar by CBCT: A Retrospective Cross-Sectional Study

by Rakan Rafdan Alhujhuj, Rizwan Jouhar, Muhammad Adeel Ahmed, Abdullatif Abdulrahman Almujhim, Mohammed Tariq Albutayh and Necdet Adanir

Diagnostics 2022, 12(9), 2121; https://doi.org/10.3390/diagnostics12092121 - 31 Aug 2022

Cited by 6 | Viewed by 4473

Abstract

Adequate knowledge of root canal morphology along with its probable variations is imperative to acquire successful endodontic treatment. This retrospective cross-sectional study aimed to investigate the root canal configuration of maxillary and mandibular first molar using Cone-Beam Computed Tomography (CBCT) among patients in Al-Ahsa region, Saudi Arabia. A total of 377 samples were included, out of which 123 CBCT (I-CAT Vision QTM) scans with intact all first permanent molars were selected in this study and scanned in sagittal, axial, and coronal views by using BlueSkyPlan software. The number of canals in each root and their configuration according to the Vertucci classification system was evaluated. Statistical analysis was analyzed using SPSS version 21 (IBM). Chi-square test was applied to evaluate the association of root canal morphology and mandibular and maxillary first molars with respect to gender. Out of 123 CBCT scans, 59 (48.0%) were males and 64 (52.0%) were females; the mean age was 26.95 ± 10.65 years. The mesiobuccal root of bilateral maxillary first molar had Type-I (87.0%) of Vertucci classification followed by Type-IV (9.8%). Additionally, all mesiobuccal roots (100%) of the left mandibular first molar had Type-I of Vertucci’s classification. A significant association has been observed between gender and a number of canals in bilateral maxillary first molars. Females showed a significantly higher prevalence of three-root canal configuration in maxillary first molars of both sides compared four canals found most commonly in males (p = 0.004). This study concluded that the majority of maxillary and mandibular permanent first molars had three roots and three canals with Type-I Vertucci’s classification in patients belonging to the Al-Ahsa region of the Saudi Arabia. It was also proved that gender is significantly associated with the number of canals in a bilateral maxillary molar. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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Review

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17 pages, 8070 KiB

Open AccessReview

The Application of Cone Beam Computed Tomography (CBCT) on the Diagnosis and Management of Maxillofacial Trauma

by Arif Rashid, Lee Feinberg and Kathleen Fan

Diagnostics 2024, 14(4), 373; https://doi.org/10.3390/diagnostics14040373 - 8 Feb 2024

Viewed by 1357

Abstract

The assessment and management of facial trauma in an acute setting is one of the core services provided by oral and maxillofacial units in the United Kingdom. Imaging is a pre-requisite for appropriate diagnosis and treatment planning, with a combination of plain radiographs and medical-grade CT being the mainstay. However, the emergence of cone beam CT in recent years has led to its wider applications, including facial trauma assessment. It can offer multi-planar reformats and three-dimensional reconstruction at a much lower radiation dose and financial cost than conventional CT. The purpose of this review is to appraise its potential indications in all anatomical areas of maxillofacial trauma and provide our experience at a level 1 trauma centre. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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13 pages, 740 KiB

Open AccessReview

CBCT for Diagnostics, Treatment Planning and Monitoring of Sinus Floor Elevation Procedures

by Nermin Morgan, Jan Meeus, Sohaib Shujaat, Simone Cortellini, Michael M. Bornstein and Reinhilde Jacobs

Diagnostics 2023, 13(10), 1684; https://doi.org/10.3390/diagnostics13101684 - 10 May 2023

Cited by 3 | Viewed by 2684

Abstract

Sinus floor elevation (SFE) is a standard surgical technique used to compensate for alveolar bone resorption in the posterior maxilla. Such a surgical procedure requires radiographic imaging pre- and postoperatively for diagnosis, treatment planning, and outcome assessment. Cone beam computed tomography (CBCT) has become a well-established imaging modality in the dentomaxillofacial region. The following narrative review is aimed to provide clinicians with an overview of the role of three-dimensional (3D) CBCT imaging for diagnostics, treatment planning, and postoperative monitoring of SFE procedures. CBCT imaging prior to SFE provides surgeons with a more detailed view of the surgical site, allows for the detection of potential pathologies three-dimensionally, and helps to virtually plan the procedure more precisely while reducing patient morbidity. In addition, it serves as a useful follow-up tool for assessing sinus and bone graft changes. Meanwhile, using CBCT imaging has to be standardized and justified based on the recognized diagnostic imaging guidelines, taking into account both the technical and clinical considerations. Future studies are recommended to incorporate artificial intelligence-based solutions for automating and standardizing the diagnostic and decision-making process in the context of SFE procedures to further improve the standards of patient care. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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23 pages, 1470 KiB

Open AccessReview

Current Applications of Deep Learning and Radiomics on CT and CBCT for Maxillofacial Diseases

by Kuo Feng Hung, Qi Yong H. Ai, Lun M. Wong, Andy Wai Kan Yeung, Dion Tik Shun Li and Yiu Yan Leung

Diagnostics 2023, 13(1), 110; https://doi.org/10.3390/diagnostics13010110 - 29 Dec 2022

Cited by 11 | Viewed by 3636

Abstract

The increasing use of computed tomography (CT) and cone beam computed tomography (CBCT) in oral and maxillofacial imaging has driven the development of deep learning and radiomics applications to assist clinicians in early diagnosis, accurate prognosis prediction, and efficient treatment planning of maxillofacial diseases. This narrative review aimed to provide an up-to-date overview of the current applications of deep learning and radiomics on CT and CBCT for the diagnosis and management of maxillofacial diseases. Based on current evidence, a wide range of deep learning models on CT/CBCT images have been developed for automatic diagnosis, segmentation, and classification of jaw cysts and tumors, cervical lymph node metastasis, salivary gland diseases, temporomandibular (TMJ) disorders, maxillary sinus pathologies, mandibular fractures, and dentomaxillofacial deformities, while CT-/CBCT-derived radiomics applications mainly focused on occult lymph node metastasis in patients with oral cancer, malignant salivary gland tumors, and TMJ osteoarthritis. Most of these models showed high performance, and some of them even outperformed human experts. The models with performance on par with human experts have the potential to serve as clinically practicable tools to achieve the earliest possible diagnosis and treatment, leading to a more precise and personalized approach for the management of maxillofacial diseases. Challenges and issues, including the lack of the generalizability and explainability of deep learning models and the uncertainty in the reproducibility and stability of radiomic features, should be overcome to gain the trust of patients, providers, and healthcare organizers for daily clinical use of these models. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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12 pages, 6715 KiB

Open AccessReview

The Use of CBCT in Evaluating the Health and Pathology of the Maxillary Sinus

by Andy Wai Kan Yeung, Kuo Feng Hung, Dion Tik Shun Li and Yiu Yan Leung

Diagnostics 2022, 12(11), 2819; https://doi.org/10.3390/diagnostics12112819 - 16 Nov 2022

Cited by 11 | Viewed by 7398

Abstract

The use of cone-beam computed tomography (CBCT) has been increasing in dental practice. This narrative review summarized the relevance and utilizations of CBCT to visualize anatomical structures of the maxillary sinus and common pathologies found in the maxillary sinus. The detection/visualization rate, the location and the morphometric characteristics were described. For sinus anatomy, the reviewed features included the posterior superior alveolar artery, sinus pneumatization, sinus hypoplasia, sinus septa, and primary and accessory sinus ostia. For pathology, the following items were reviewed: membrane thickening associated with periapical lesions/periodontal lesions, mucous retention cyst, and antrolith. The visualization and assessment of the maxillary sinus is very important prior to procedures that take place in close proximity with the sinus floor, such as tooth extraction, implant insertion, and sinus floor elevation. Some sinus pathologies may be associated with odontogenic lesions, such as periapical diseases and periodontal bone loss. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases)

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