Detection of Non‐Displaced Dentoalveolar Fractures Using <scp>CBCT</scp> : Influence of Visualization Techniques on Diagnostic Accuracy and Observer Workflow

OBJECTIVE: To evaluate the diagnostic accuracy of cone-beam computed tomography (CBCT) visualization techniques in detecting clinically relevant non-displaced dentoalveolar fractures and to assess their impact on observer efficiency during trauma evaluation. METHODS: Non-displaced alveolar fractures were experimentally induced in 15 fresh sheep heads under standardized conditions to simulate clinically relevant dentoalveolar trauma. CBCT imaging was performed using a standardized acquisition protocol, and four visualization techniques were generated using fixed display parameters. Fracture presence was confirmed by an independent oral and maxillofacial radiologist and served as the reference standard. Five blinded dentists evaluated datasets in two sessions separated by a 3-week washout interval. Diagnostic performance was assessed using ROC analysis with pairwise comparisons using the DeLong method. RESULTS: Multiplanar reconstruction demonstrated the highest diagnostic accuracy (AUC = 0.87), followed by volume rendering (0.75), surface rendering (0.73), and maximum intensity projection (0.70). Inter- and intra-observer agreements were substantial to almost perfect (κ = 0.78 and κ = 0.85, respectively). Multiplanar reconstruction required significantly shorter evaluation time and lower user interaction compared with volume rendering and surface rendering (p < 0.05). CONCLUSION: The selection of CBCT visualization techniques significantly influences diagnostic confidence and observer workflow efficiency in dentoalveolar trauma assessment. Multiplanar reconstruction provided the most favorable balance between diagnostic accuracy and efficiency, supporting its use in time-sensitive clinical trauma evaluation.