OBJECTIVE: Cone beam computed tomography (CBCT) is routinely used in radiotherapy to localize target volume. The aim of our study was to determine the biological effects of CBCT dose compared to subsequent therapeutic dose by using in vitro chromosome dosimetry.
METHODS: Peripheral blood samples from five healthy volunteers were irradiated in two phantoms (water filled in-house made cylindrical, and Pure Image CTDI phantoms) with 6 MV FFF X-ray photons, the dose rate was 800 MU/min and the absorbed doses ranged from 0.5 to 8 Gy. Irradiation was performed with a 6 MV linear accelerator (LINAC) to generate a dose-response calibration curve. In the first part of the investigation, 1-5 CBCT imaging was used, in the second, only 2 Gy doses were delivered with a LINAC, and then, in the third part, a combination of CBCT and 2 Gy irradiation was performed mimicking online adapted radiotherapy treatment. Metaphases were prepared from lymphocyte cultures, using standard cytogenetic techniques, and chromosomal aberrations were evaluated. Estimate doses were calculated from chromosome aberrations using dose-response curves.
RESULTS: Samples exposed to X-ray from CBCT imaging prior to treatment exhibited higher chromosomal aberrations and Estimate dose than the 2 Gy therapeutic (real) dose, and the magnitude of the increase depended on the number of CBCTs: 1-5 CBCT corresponded to 0.04-0.92 Gy, 1 CBCT + 2 Gy to 2.32 Gy, and 5 CBCTs + 2 Gy to 3.5 Gy.
CONCLUSIONS: The estimated dose based on chromosomal aberrations is 24.8% higher than the physical dose, for the combination of 3 CBCTs and the therapeutic 2 Gy dose, which should be taken into account when calculating the total therapeutic dose that could increase the risk of a second cancer. The clinical implications of the combined radiation effect may require further investigation.

Objective: This systematic review aims to summarize the evidence on the use and applicability of AI in impacted mandibular third molars. Methods: Searches were performed in the following databases: PubMed, Scopus, and Google Scholar. The study protocol is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202460081). The retrieved articles were subjected to an exhaustive review based on the inclusion and exclusion criteria for the study. Articles on the use of AI for diagnosis, treatment, and treatment planning in patients with impacted mandibular third molars were included. Results: Twenty-one articles were selected and evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) evidence quality scale. Most of the analyzed studies dealt with using AI to determine the relationship between the mandibular canal and the impacted mandibular third molar. The average quality of the articles included in this review was 2+, which indicated that the level of evidence, according to the SIGN protocol, was B. Conclusions: Compared to human observers, AI models have demonstrated decent performance in determining the morphology, anatomy, and relationship of the impaction with the inferior alveolar nerve canal. However, the prediction of eruptions and future horizons of AI models are still in the early developmental stages. Additional studies estimating the eruption in mixed and permanent dentition are warranted to establish a comprehensive model for identifying, diagnosing, and predicting third molar eruptions and determining the treatment outcomes in the case of impacted teeth. This will help clinicians make better decisions and achieve better treatment outcomes.

BACKGROUND: Accurate assessment of the bone supporting the implant is crucial. Early detection of bone defects around the implant can prevent the loss of bone support that ultimately leads to the loss of the implant. Therefore, the purpose of this study is to check the accuracy of CBCT in detecting peri-implant fenestrations around the implant.
METHODS: In this laboratory study, healthy beef ribs were used. The ribs were divided into three groups of 12 (control group, 1-2 mm fenestration group, and 2-3 mm fenestration group). The blocks were cut to a length of 20 mm and 36 osteotomies with dimensions of 4 × 12 mm were made by the periodontist in order to place the implant in these bone blocks. Then the titanium implant was placed in the holes and the initial scan was performed with CBCT. In the second group, fenestration-like lesions were created on the same buccal side at a distance of 10 mm from the crest with a diameter of 1-2 mm and in the third group with a diameter of 2-3 mm, and the CBCT scan was performed again with the same parameters. Two radiologists evaluated the images twice for the presence and absence of fenestration.
RESULTS: There was no statistically significant difference between direct measurements and CBCT in the fenestration group of 1-2 mm (p < 0.05), but there was a significant difference between direct measurements and CBCT in the fenestration group of 2-3 mm and underestimation was observed in CBCT measurements.
CONCLUSIONS: The findings of this study showed that CBCT radiography has a higher accuracy in measuring the fenestration around the implant with a smaller diameter and has an acceptable diagnostic value in detecting bone loss around the implant.

UNASSIGNED: To investigate the incidence of accessory canals and the variation in root canal morphology of permanent mandibular incisors and canines in Pakistani population using Cone Beam Computed Tomography (CBCT).
UNASSIGNED: A cross-sectional study was conducted in University College of Dentistry, The University of Lahore, Pakistan after getting institutional ethical permission from January 2020 to September 2022. The data included records of 111 patients consisting of 444 permanent mandibular incisors and 222 permanent mandibular canines. Accessory root, root canals and Vertucci canal configuration for each tooth was recorded. Data analysis was done using SPSS v20. Descriptive statistics were calculated for each anatomical parameter. Chi-square test was applied to determine association of gender with the presence of accessory roots and root canals.
UNASSIGNED: Among the 111 records evaluated, 48.6% were males and 51.4% were females. No accessory root was found in the central and lateral incisors. However, an accessory root was found in 4.9% of the canines. The incidence of accessory canals in the central incisors, lateral incisors and canines was 18.9%, 25.2% and 10.4% respectively. The most common canal configuration in teeth with accessory canals was Type-III, followed by Type-II and Type-V.
UNASSIGNED: None of the central or lateral incisor showed accessory root while it was detected in 4.9% canines. The frequency of accessory root canal was found to be 18.9%, 25.2% and 10.4% in central incisors, lateral incisors and canines respectively. The most common canal configuration was Type-I, followed by Type-III and Type-II. Type-V, VI and VII were less common.

UNASSIGNED: One key factor in determining endodontic treatment outcome is the clinicians\' comprehension of tooth anatomy, as missed canals may harbor bacteria ultimately leading to apical periodontitis. The study aimed to investigate the prevalence of middle mesial canal (MMC) in Mandibular first molars (MFMs) of Saudi subpopulation.
UNASSIGNED: The cross-sectional retrospective study was conducted at Qassim University Dental College from June to August 2023. Overall, 302 CBCT images with 604 bilateral lower first molars were examined by two calibrated assessors. The existence of MMC was noted. The data were coded, and analysis was done in SPPS-24. The reliability of inter-evaluator and intra-evaluator agreement for detecting MMC were estimated using Cohen\'s kappa.
UNASSIGNED: The patients\' average age was 30.95±11.61years. The sample\'s female to male ratio was 1:1.75. The overall frequency of MMC was 14.2%. The differences in the frequency of MMC on the basis of gender, quadrants and age groups were found to be insignificant. Inter-evaluator and intra-evaluator reliability was noted to be 0.78 and 0.74, depicting acceptable reliability.
UNASSIGNED: The MMC is an uncommon occurrence with rare bilateral presentation in MFMs of Saudi population. Endodontists performing endodontic treatment in such subjects should mindfully investigate inter mesiobuccal- mesiolingual canals area for locating, negotiating, and managing any present MMC\'s.

UNASSIGNED: To assess the efficacy of the gelatin torpedoes embolization technique after lung neoplastic lesions percutaneous radiofrequency ablation (PRFA) to reduce chest tube placement rate and hospital length of stay, and the safety of this embolization technique.
UNASSIGNED: A total of 114 PRFA of lung neoplastic lesions performed in two centers between January 2017 and December 2022 were retrospectively reviewed. Two groups were compared, with 42 PRFA with gelatin torpedoes embolization technique (gelatin group) and 72 procedures without (control group). Procedures were performed by one of seven interventional radiologists using LeVeen CoAccess™ probe. Multivariate analyses were performed to identify risk factors for chest tube placement and hospital length of stay.
UNASSIGNED: There was a significantly lower chest tube placement rate in the gelatin group compared to the control group (3 [7.1 %] vs. 27 [37.5 %], p < 0,001). Multivariate analysis showed a significant association between chest tube placement and gelatin torpedoes embolization technique (OR: 0.09; 95 % CI: 0.02-0.32; p = 0.0006). No significant difference was found in hospital length of stay between the two groups. Multivariate analysis did not show a significant relationship between hospital length of stay and gelatin torpedoes embolization technique. No embolic complication occurred in the gelatin group.
UNASSIGNED: Gelatin torpedoes embolization technique after PRFA of lung neoplastic lesions resulted in significantly reduced chest tube placement rate in our patient population. No significant reduction in hospital length of stay was observed. No major complication occurred in the gelatin group.

UNASSIGNED: The objective of this study was to investigate the utility of Cone Beam Computed Tomography (CBCT)-based pulp tooth volume- ratio of maxillary anterior teeth for accurate age estimation. The project aimed to utilize the HOROS software for image analysis and develop prediction models using regression analysis.
UNASSIGNED: 1800 male patients in the age group of 20 to 40 years were selected, and maxillary anterior teeth were picked. High-resolution CBCT scans were collected, and image analysis in terms of pulp volume (PV), tooth volume (TV), and pulp-volume-to-tooth-volume ratio (PV/TV) was calculated using HOROS software. Simple linear regression analysis was used to develop prediction models correlating the PV/TV with chronological age.
UNASSIGNED: PV/TV of all teeth ranged between 0.073 and 0.214. Pearson correlation coefficient was used to evaluate the correlation between the chronological age and the PV/TV. It shows a statistically significant (positive) but low correlation between age and PV/TV 13 and 22 (combined), respectively, and the highest Pearson correlation (0.849) for maxillary canine (13). This study presents four models for age estimation with maximum standard error ranging between 3.5 and 4.3 and an accuracy of 96%.
UNASSIGNED: This study illustrates the effectiveness of CBCT-based PV/TV of maxillary anterior teeth for age assessment. Accurate prediction models were constructed by using regression analysis and the HOROS software. These findings enhance the study of forensic odontology and have potential applications in forensic investigations, archaeological research, and legal-age assessment. Further research is necessary to validate and refine the prediction models, expanding their applicability to larger and more diverse population samples.

BACKGROUND: Understanding the root canal morphology is essential for the success of root canal treatment. Therefore, this study aimed to evaluate and analyze the root canal configuration of maxillary premolars using Cone Beam Computed Tomography in the Pakistani subpopulation.
METHODS: This cross-sectional study utilized CBCT scans from two distinct centres: Aga Khan University in Karachi and Jinnah MRI and Body Scans in Lahore. The CBCT images were visualized using GALAXIS version 1.9 (SICAT GmbH and Co. KG, Bonn, Germany), integrated within the Sirona Dental System (D-64625 Bensheim, Germany). The scanning parameters were standardized at 85 kV, 7 mA, with a 15-s exposure time and a voxel size of 0.16 mm. A total of 707 CBCT scans were collected, encompassing 2180 maxillary premolars. Root canal configurations were classified based on (Ahmed et al. Int Endod J. 2017;50(8):761-70). Statistical analyses were performed using SPSS version 26, employing the Chi-square test with a significance level set at p < 0.05.
RESULTS: The distribution of root canal morphologies varied significantly with age and gender. Among maxillary premolars, 50% exhibited the typical configuration of 2MPMB1 L1 (two roots, single canal in each buccal and lingual root), while 26% of maxillary right second premolars displayed 1MPM1 (one root, one canal). Overall, 1MPM1 accounted for 27.4% of the total cases in the second premolars. There was no statistically significant relationship between age and root canal distribution in either first premolars (p = 0.338) or second premolars (p = 0.833). Regarding gender, a significant difference was observed in the distribution of right maxillary 1st premolars (p = 0.022*), with a higher prevalence among females.
CONCLUSIONS: This study offers significant insights into the anatomical variations of root canals in maxillary premolars across diverse regional subpopulations in Pakistan. While specific root canal configurations were prevalent, the findings indicate no statistically significant correlation between age and root canal morphology in maxillary premolars. However, a notable gender disparity was observed in the distribution of the right maxillary first premolars.

Objective: The aim of the present study is to identify a more reliable reference point in three-dimensional cephalometric analysis to replace the Porion point used in two-dimensional analysis, enhancing the accuracy of assessments. Methods: The methodology assessed potential alternative landmarks for three-dimensional cephalometric analysis. Utilizing a segmenting technique, anatomical landmarks were accurately pinpointed from the external acoustic meatus of 26 Cone Beam Computed Tomography (CBCT) scans. These landmarks were chosen for their clear and unambiguous detectability. To assess reproducibility, each landmark was replicated twice with a one-week interval by a master\'s student. Reproducibility was quantitatively evaluated by analyzing the absolute difference per axis. Results: Five possible candidate landmarks were identified: the most anterior, posterior, superior, and inferior points of the external acoustic meatus (EAM) and a notch delineating the epitympanic recess. The reproducibility of pinpointing these landmarks ranged from 0.56 mm to 2.2 mm. The absolute mean differences between measurements were 0.46 mm (SD 0.75) for the most anterior point, 0.36 mm (SD 0.44) for the most posterior point, 0.25 mm (SD 0.26) for the most superior point, 1.11 mm (SD 1.03) for the most inferior point, and 0.78 mm (SD 0.57) for the epitympanic notch. Conclusions: The most superior point of the EAM might successfully replace the Porion as an anatomical reference.

Background/Objectives: The aim of this study was to assess the diagnostic accuracy of the AI-driven platform Diagnocat for evaluating endodontic treatment outcomes using cone beam computed tomography (CBCT) images. Methods: A total of 55 consecutive patients (15 males and 40 females, aged 12-70 years) referred for CBCT imaging were included. CBCT images were analyzed using Diagnocat\'s AI platform, which assessed parameters such as the probability of filling, adequate obturation, adequate density, overfilling, voids in filling, short filling, and root canal number. The images were also evaluated by two experienced human readers. Diagnostic accuracy metrics (accuracy, precision, recall, and F1 score) were assessed and compared to the readers\' consensus, which served as the reference standard. Results: The AI platform demonstrated high diagnostic accuracy for most parameters, with perfect scores for the probability of filling (accuracy, precision, recall, F1 = 100%). Adequate obturation showed moderate performance (accuracy = 84.1%, precision = 66.7%, recall = 92.3%, and F1 = 77.4%). Adequate density (accuracy = 95.5%, precision, recall, and F1 = 97.2%), overfilling (accuracy = 95.5%, precision = 86.7%, recall = 100%, and F1 = 92.9%), and short fillings (accuracy = 95.5%, precision = 100%, recall = 86.7%, and F1 = 92.9%) also exhibited strong performance. The performance of AI for voids in filling detection (accuracy = 88.6%, precision = 88.9%, recall = 66.7%, and F1 = 76.2%) highlighted areas for improvement. Conclusions: The AI platform Diagnocat showed high diagnostic accuracy in evaluating endodontic treatment outcomes using CBCT images, indicating its potential as a valuable tool in dental radiology.