TY  - JOUR
AU  - Ruetters, Maurice
AU  - Gehrig, Holger
AU  - Mertens, Christian
AU  - Sen, Sinan
AU  - Kim, Ti-Sun
AU  - Schlemmer, Heinz-Peter
AU  - Ziener, Christian
AU  - Schoenberg, Stefan
AU  - Froelich, Matthias
AU  - Kachelrieß, Marc
AU  - Sawall, Stefan
TI  - Opportunistic Diagnostics of Dental Implants in Routine Clinical Photon-Counting CT Acquisitions.
JO  - Journal of imaging
VL  - 11
IS  - 7
SN  - 2313-433X
CY  - Basel
PB  - MDPI
M1  - DKFZ-2025-01546
SP  - 215
PY  - 2025
N1  - #LA:E025#
AB  - 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.
KW  - X-ray computed (Other)
KW  - dental (Other)
KW  - dental implants (Other)
KW  - incidental findings (Other)
KW  - radiography (Other)
KW  - tomography (Other)
LB  - PUB:(DE-HGF)16
C6  - pmid:40710602
DO  - DOI:10.3390/jimaging11070215
UR  - https://inrepo02.dkfz.de/record/303195
ER  -