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@ARTICLE{Ruetters:303195,
      author       = {M. Ruetters and H. Gehrig and C. Mertens and S. Sen and
                      T.-S. Kim and H.-P. Schlemmer$^*$ and C. Ziener$^*$ and S.
                      Schoenberg and M. Froelich and M. Kachelrieß$^*$ and S.
                      Sawall$^*$},
      title        = {{O}pportunistic {D}iagnostics of {D}ental {I}mplants in
                      {R}outine {C}linical {P}hoton-{C}ounting {CT}
                      {A}cquisitions.},
      journal      = {Journal of imaging},
      volume       = {11},
      number       = {7},
      issn         = {2313-433X},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2025-01546},
      pages        = {215},
      year         = {2025},
      note         = {#LA:E025#},
      abstract     = {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.},
      keywords     = {X-ray computed (Other) / dental (Other) / dental implants
                      (Other) / incidental findings (Other) / radiography (Other)
                      / tomography (Other)},
      cin          = {E010 / E025},
      ddc          = {004},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)E025-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40710602},
      doi          = {10.3390/jimaging11070215},
      url          = {https://inrepo02.dkfz.de/record/303195},
}