In vitro assessment of CBCT metal artifact reduction algorithms in TMJ prosthetic components

Metal artifacts from temporomandibular joint prosthetic components significantly compromise cone-beam computed tomography (CBCT) image quality and limit postoperative assessment. Therefore, it is of interest to evaluate the effectiveness of metal artifact reduction (MAR) algorithms in improving CBCT image quality using standardized anthropomorphic skull phantoms with five commercially available TMJ prosthetic systems. CBCT scans were acquired with three imaging systems with and without MAR activation, followed by quantitative analysis of artifact index, signal-to-noise ratio and contrast-to-noise ratio, along with qualitative assessment by four calibrated oral radiologists. MAR algorithms significantly reduced artifact indices by 34.7-58.2% and improved diagnostic acceptability scores (3.6 ± 0.8 vs 2.1 ± 0.7; p < 0.001), with titanium components generating fewer artifacts than cobalt-chromium-molybdenum alloys. Despite substantial improvement, residual artifacts persisted near cobalt-chromium-molybdenum components, indicating the need for further optimization of MAR algorithms and CBCT acquisition protocols.