Photon-counting-detector CT outperforms state-of-the-art cone-beam and energy-integrated-detector CT in delineation...

This experimental phantom study investigates current standard of care protocols in cone beam computed tomography (CBCT), energy-integrating-detector (EID) CT, and photon-counting-detector (PCD) CT regarding their potential in delineation of dental root canals. Artificial accessory canals (diameters: 1000, 600, 400, 300 and 200 μm) were drilled into three bovine teeth mounted on a bovine rib as a jaw substitute. The phantom was scanned in two dental CBCTs, two EID-CTs and a PCD-CT using standard clinical protocols. Scans from a micro-CT served as reference standard. Spatial resolution was evaluated via line profiles through the canals, whereby visibility compared to surrounding noise and compared to the ground truth were assessed. PCD-CT was able to delineate all artificial canals down to 200 μm diameter. In CBCT and EID-CT canals could only be reliably detected down to 300 μm. Also, PCD-CT showed a considerably smaller width-divergence from the ground trough with 4.4% at 1000 μm and 35.1% at 300 μm compared to CBCT (13.5 and 72.9%) and EID-CT (10.1 and 115.7%). PCD-CT provided superior resolution, accurate size measurement, and enhanced detection of small dental root canals, thereby offering improvements in diagnostic capabilities compared to CBCT and EID-CT systems.