The Sivan three-dimensional cone-beam computed tomography volumetric imaging protocol: a novel dual-mode rendering technique for integrated visualization of temporomandibular joint disc and osseous structures to evaluate temporomandibular joint disorders.

OBJECTIVES

Temporomandibular joint disorders (TMDs) require precise imaging of both osseous and soft-tissue components for accurate diagnosis. Current diagnostic protocols often necessitate separate cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) scans, increasing cost, complexity, and patient burden. This study aimed to develop and validate the Sivan 3D CBCT Volumetric Imaging Protocol, a novel post-processing technique designed to enable simultaneous high-resolution visualization of the temporomandibular joint (TMJ) disc, retrodiscal tissue, and adjacent osseous structures using a single CBCT data set.

METHODS

This retrospective study analyzed anonymized CBCT volumes from 42 patients diagnosed with TMD. The data sets were processed using NNT software, incorporating dual-mode volumetric rendering, voxel intensity modulation, and anisotropic filtering. Fifteen expert raters assessed conventional CBCT, enhanced CBCT, and MR images across eight diagnostic parameters using a 5-point Likert scale. Inter- and intra-rater reliability was assessed using intraclass correlation coefficients (ICC), and statistical comparisons were performed using one-way ANOVA, Tukey's post-hoc test, and Cohen's d effect size analysis.

RESULTS

Enhanced CBCT images showed excellent inter- and intra-rater reliability (ICC > 0.95) and significantly outperformed conventional CBCT and MRI in visualizing both soft and hard TMJ structures (p < 0.001), with large effect sizes (Cohen's d > 2.3), especially for disc and retrodiscal tissue delineation.

CONCLUSIONS

The Sivan 3D CBCT Volumetric Imaging Protocol provides a robust, single-modality alternative to MRI for comprehensive TMJ evaluation, improving diagnostic accuracy, efficiency, and accessibility in clinical settings with limited MRI availability.