الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cystic lesions represent a prevalent kind of pathology within the oral and
maxillofacial region. A true cyst refers to a pathological cavity within the bone,
characterized by a fibrous connective tissue outer wall that encloses the lumen
of the cyst. Based on the size of the cyst, jaw cysts can be categorized into
small, medium, and large cysts, which have the potential to infiltrate teeth and
significantly impact an individual’s overall quality of life. The selection of the
treatment regimen for cysts is determined by various factors, including the cyst’s
location and size, the degree of tissue damage, the feasibility of surgical access,
the patient’s age, the proximity of the cyst to important anatomical structures,
and the impact of the impacted teeth on eruption.
CBCT provides a more exact assessment of the size and internal
composition of jaw cysts, as well as a more effective analysis of their closeness
to critical anatomical structures. Therefore, CBCT scans can function as a
valuable tool for surgeons in facilitating suitable surgical treatments. The
utilization of automatic, semi-automatic, or manual object segmentation
techniques is of significant importance in computer-assisted preoperative
planning, follow-up, and image-guided surgical procedures for the purpose of
volume calculations. There are multiple software options available for the threedimensional
rendering of images acquired using CBCT.
This study aimed to evaluate the precision and reliability of volume
analysis for cystic jaw lesions by employing three software packages that are
widely utilized by maxillofacial surgeons or commonly employed in the fields
of medicine or biomedical engineering (namely, OnDemand and MIMICS) or
that are open-source (Invesalius). The assessment of the software packages’
reliability involved the utilization of 49 randomly and retrospectively selected
CBCT data sets obtained from (SCANORA® 3Dx. Soredex. Tuusula, Finland).
The software packages OnDemand3D® (CyberMed, Seoul, Republic of Korea),Mimics (Materialise‘s interactive medical image control system), and InVesalius
(version 3.1.1; Renato Archer Information Technology Center, Brazil) were
utilized to determine the volume of the cystic jaw lesions. Three observers
conducted measurements on a sample of five randomly selected cysts in order to
evaluate the inter-observer reliability of the measures of cystic lesions. This was
assessed using the Cronbach’s alpha reliability coefficient and the Intra-Class
Correlation Coefficient (ICC).
In order to evaluate the accuracy of the software applications, two
desiccated human mandibles were utilized. Specifically, bone defects were
created at the base of the extraction sockets and were afterwards spread across
various tooth locations using dental burs. A duplicate was fabricated with rapid
soft silicone imprint material in order to accurately depict the actual dimensions
of the defects, which serve as the gold standard. The aforementioned defects
were subsequently subjected to scanning using the same scanner. The volume
measurements obtained using OnDemand3D®, InVesalius, and MIMICS
software were assessed by one observer and afterwards compared to the
established gold standard. The findings of this study indicate that the interobserver
reliability of the measures of the cystic lesions utilizing the various
software packages was very good.
The software that demonstrated the highest level of agreement amongst
examiners was Invesalius, as shown by a Cronbach’s alpha coefficient of 0.992.
The results of the pair-wise comparisons indicated that there were no
statistically significant differences observed among the Mimics, OnDemand, and
Invesalius software. However, it is worth noting that all three software options
demonstrated volumetric measures that were statistically considerably greater
compared to measurements obtained using the Ellipsoid equation. A statistically
significant disparity was observed between the volumetric measurements of dry
mandibles and the Gold Standard. The volumetric measurements of the dry mandible were found to be considerably lower in all software compared to the
Gold Standard, as indicated by statistical analysis.
In conclusion, Open-source software, exemplified as InVesalius, presents
substantial and significant possibilities for virtual analysis and unhindered
accessibility, while also offering the distinct advantage of minimum financial
burden. Consequently, it assumes a crucial role in diagnostics and serves as a
beneficial intra-operative guide preceding surgical procedures. In the context of
3D volume analysis utilizing software, it is important to acknowledge that while
rational numbers can be derived from 3D volume analysis, they cannot fully
substitute the expertise and practical knowledge possessed by surgeons in the
surgical domain. The user is presented with the process of segmenting the jaw
cyst and is also inevitably faced with the precise morphology in order to identify
any issues prior to surgery.