Exploring Dental Anatomy: An Ex Vivo Comparative Study Between Photon-Counting Detector CT and Cone-Beam CT

Objectives: The aim of this ex vivo study was to assess the performance of photon-counting detector computed tomography (PCD-CT) compared with cone-beam computed tomography (CBCT) at equivalent radiation doses for detecting and evaluating mandibular and dental anatomical structures in porcine cadavers. Material and Methods: This intermodal comparative study evaluated imaging protocols at three radiation dose levels (high: 360 mu Sv, standard: 145 mu Sv, low: 20 mu Sv) in six porcine cadaver heads, analyzing 12 CBCT and 18 PCD-CT volumes. Two blinded observers assessed image quality, artifact susceptibility, and diagnostic interpretability using a 5-point Likert scale (5 = highest, 1 = lowest). Statistical analysis included descriptive statistics and interobserver reliability, assessed by weighted kappa (kappa) analysis. Results: PCD-CT either matched or outperformed CBCT at standard- and low-dose protocols, demonstrating superior anatomy coverage, density, contrast, and less artifact susceptibility. High- and standard-dose protocols achieved perfect scores 5 (SD = 0). At low-dose levels, PCD-CT showed slightly lower scores but still outperformed CBCT. PCD-CT showed minimal artifacts, with no significant artifacts in high and standard doses. Inter- and intra-reader reliability was higher for PCD-CT (kappa: 0.694-1; p < 0.001) compared to CBCT (0.55-0.916; p < 0.001), with the difference being largest at low doses. Conclusion: PCD-CT outperforms CBCT in diagnostic interpretability and artifact reduction across various radiation dose levels, offering a promising alternative for dentomaxillofacial imaging that aligns with the ALADAIP principle.