Ruetters Maurice, Gehrig Holger, Mertens Christian, Sen Sinan, Kim Ti-Sun, Schlemmer Heinz-Peter, Ziener Christian H, Schoenberg Stefan, Froelich Matthias, Kachelrieß Marc, Sawall Stefan
Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Department of Oral- and Maxillofacial Surgery, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
J Imaging. 2025 Jun 30;11(7):215. doi: 10.3390/jimaging11070215.
Two-dimensional imaging is still commonly used in dentistry, but does not provide the three-dimensional information often required for the accurate assessment of dental structures. Photon-counting computed tomography (PCCT), a new three-dimensional modality mainly used in general medicine, has shown promising potential for dental applications. With growing digitalization and cross-disciplinary integration, using PCCT data from other medical fields is becoming increasingly relevant. Conventional CT scans, such as those of the cervical spine, have so far lacked the resolution to reliably evaluate dental structures or implants. This study evaluates the diagnostic utility of PCCT for visualizing peri-implant structures in routine clinical photon-counting CT acquisitions and assesses the influence of metal artifact reduction (MAR) algorithms on image quality. Ten dental implants were retrospectively included in this IRB-approved study. Standard PCCT scans were reconstructed at multiple keV levels with and without MAR. Quantitative image analysis was performed with respect to contrast and image noise. Qualitative evaluation of peri-implant tissues, implant shoulder, and apex was performed independently by two experienced dental professionals using a five-point Likert scale. Inter-reader agreement was measured using intraclass correlation coefficients (ICCs). PCCT enabled high-resolution imaging of all peri-implant regions with excellent inter-reader agreement (ICC > 0.75 for all structures). Non-MAR reconstructions consistently outperformed MAR reconstructions across all evaluated regions. MAR led to reduced clarity, particularly in immediate peri-implant areas, without significant benefit from energy level adjustments. All imaging protocols were deemed diagnostically acceptable. This is the first in vivo study demonstrating the feasibility of opportunistic dental diagnostics using PCCT in a clinical setting. While MAR reduces peripheral artifacts, it adversely affects image clarity near implants. PCCT offers excellent image quality for peri-implant assessments and enables incidental detection of dental pathologies without additional radiation exposure. PCCT opens new possibilities for opportunistic, three-dimensional dental diagnostics during non-dental CT scans, potentially enabling earlier detection of clinically significant pathologies.
二维成像在牙科中仍被广泛使用，但无法提供准确评估牙齿结构所需的三维信息。光子计数计算机断层扫描（PCCT）是一种主要用于普通医学的新型三维成像方式，在牙科应用中显示出了广阔的潜力。随着数字化和跨学科整合的不断发展，利用来自其他医学领域的PCCT数据变得越来越重要。传统的CT扫描，如颈椎扫描，迄今为止缺乏可靠评估牙齿结构或植入物的分辨率。本研究评估了PCCT在常规临床光子计数CT采集中可视化种植体周围结构的诊断效用，并评估了金属伪影减少（MAR）算法对图像质量的影响。本项经机构审查委员会批准的研究回顾性纳入了十颗牙种植体。在有和没有MAR的情况下，在多个keV水平重建标准PCCT扫描。对对比度和图像噪声进行了定量图像分析。由两名经验丰富的牙科专业人员使用五点李克特量表对种植体周围组织、种植体肩部和根尖进行定性评估。使用组内相关系数（ICC）测量阅片者间的一致性。PCCT能够对所有种植体周围区域进行高分辨率成像，阅片者间一致性良好（所有结构的ICC>0.75）。在所有评估区域，非MAR重建始终优于MAR重建。MAR导致清晰度降低，尤其是在种植体周围直接区域，能量水平调整没有显著益处。所有成像方案均被认为在诊断上是可接受的。这是第一项在临床环境中证明使用PCCT进行机会性牙科诊断可行性的体内研究。虽然MAR减少了周边伪影，但它对种植体附近的图像清晰度有不利影响。PCCT为种植体周围评估提供了出色的图像质量，并能够在不增加辐射暴露的情况下偶然检测到牙齿病变。PCCT为在非牙科CT扫描期间进行机会性三维牙科诊断开辟了新的可能性，有可能更早地检测出具有临床意义的病变。
