{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:52:22Z","timestamp":1787496742782,"version":"build-2736575974"},"reference-count":60,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T00:00:00Z","timestamp":1713312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Oral Implants Res"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The present study was conducted to evaluate the reproducibility of Lekholm and Zarb classification system (L&amp;Z) for bone quality assessment of edentulous alveolar ridges and to investigate the potential of a data\u2010driven approach for bone quality classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Twenty\u2010six expert clinicians were asked to classify 110 CBCT cross\u2010sections according to L&amp;Z classification (T0). The same evaluation was repeated after one month with the images put in a different order (T1). Intra\u2010 and inter\u2010examiner agreement analyses were performed using Cohen's kappa coefficient (CK) and Fleiss' kappa coefficient (FK), respectively. Additionally, radiomic features extraction was performed from 3D edentulous ridge blocks derived from the same 110 CBCTs, and unsupervised clustering using 3 different clustering methods was used to identify patterns in the obtained data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Intra\u2010examiner agreement between T0 and T1 was weak (CK 0.515). Inter\u2010examiner agreement at both time points was minimal (FK at T0: 0.273; FK at T1: 0.243). The three different unsupervised clustering methods based on radiomic features aggregated the 110 CBCTs in three groups in the same way.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results showed low agreement among clinicians when using L&amp;Z classification, indicating that the system may not be as reliable as previously thought. The present study suggests the possible application of a reproducible data\u2010driven approach based on radiomics for the classification of edentulous alveolar ridges, with potential implications for improving clinical outcomes. Further research is needed to determine the clinical significance of these findings and to develop more standardized and accurate methods for assessing bone quality of edentulous alveolar ridges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/clr.14271","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T09:43:40Z","timestamp":1713347020000},"page":"729-738","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Inter and intra\u2010operator reliability of Lekholm and Zarb classification and proposal of a novel radiomic data\u2010driven clustering for qualitative assessment of edentulous alveolar ridges"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5647-4414","authenticated-orcid":false,"given":"Giuseppe","family":"Troiano","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine University of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9767-4401","authenticated-orcid":false,"given":"Antonio","family":"Rapani","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Health Sciences University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine University of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6359-9143","authenticated-orcid":false,"given":"Federico","family":"Berton","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Health Sciences University of Trieste  Trieste 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