{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:20:20Z","timestamp":1787498420226,"version":"build-2736575974"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to determine the maxillary sinus volume and surface area values and their relationship in individuals with and without temporomandibular disorders (TMDs) using Cone-Beam Computed Tomography and Machine Learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study was performed on 127 subjects, 66 in the control group (41 females, 25 males; mean age 28.35\u2009\u00b1\u20099.9years) and 61 in the TMD group (54 females, 7 males; mean age 35\u2009\u00b1\u200912.6years) using dento-maxillo-facial CBCT images. Images were acquired as DICOM files and imported into 3D Slicer (version 5.6.2). The volume and surface area of the maxillary sinus were automatically calculated by the 3D Slicer programme. In addition, automatic prediction was performed using classical machine learning techniques on the dataset obtained in the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Maxillary sinus volume was 30.85\u2009\u00b1\u200910.14\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      in the control group and 26.97\u2009\u00b1\u200910.33\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      in the TMD group. Maxillary sinus volume and surface area were significantly smaller in the TMD group compared to controls. No significant differences were observed between age decades in either group. Furthermore, the results obtained in machine learning showed that gender selection generally improved the results, and the most successful classifier was the Logistic Regression algorithm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates that TMDs were associated with smaller sinus volume. Furthermore, a machine learning-based model can be used to discriminate temporomandibular dysfunction even when the size of the dataset is small.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0343691","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T17:32:07Z","timestamp":1773855127000},"page":"e0343691","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["CBCT-based volumetric assessment of the maxillary sinus in temporomandibular disorder: Integration of morphometric analysis and classical machine learning classification"],"prefix":"10.1371","volume":"21","author":[{"given":"\u00c7a\u011fatay","family":"B\u00f6lgen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sema","family":"Polat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1373-4700","authenticated-orcid":true,"given":"Mahmut","family":"Tun\u00e7","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2765-0631","authenticated-orcid":true,"given":"Hazal Duyan","family":"Y\u00fcksel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut","family":"\u00d6ks\u00fczler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6nder","family":"\u00c7oban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6nder","family":"Yentar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esin","family":"\u00d6z\u015fahin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u0131nar","family":"G\u00f6ker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"1","key":"pone.0343691.ref001","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1186\/s12903-024-05341-z","article-title":"Maxillary sinus volume changes in individuals with different craniofacial skeletal patterns: CBCT study","volume":"24","author":"K Din\u00e7","year":"2024","journal-title":"BMC Oral Health"},{"issue":"1","key":"pone.0343691.ref002","doi-asserted-by":"crossref","first-page":"200","DOI":"10.5603\/fm.100054","article-title":"Relation between orthodontic malocclusion and maxillary sinus volume","volume":"84","author":"K Oru\u00e7","year":"2025","journal-title":"Folia Morphol (Warsz)"},{"issue":"1","key":"pone.0343691.ref003","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jobcr.2012.11.005","article-title":"Dimensional changes in maxillary sinus of mouth breathers","volume":"3","author":"T Tikku","year":"2013","journal-title":"J Oral Biol Craniofac Res"},{"issue":"12","key":"pone.0343691.ref004","doi-asserted-by":"crossref","first-page":"3425","DOI":"10.3390\/jcm13123425","article-title":"Changes in Maxillary Sinus Volume and Mucosal Thickness Post Bimaxillary Advancement Procedures: A Retrospective Study","volume":"13","author":"PP Grab","year":"2024","journal-title":"J Clin Med"},{"issue":"9","key":"pone.0343691.ref005","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.ijporl.2015.05.032","article-title":"Development of the maxillary sinus from birth to age 18. Postnatal growth pattern","volume":"79","author":"D Lorkiewicz-Muszy\u0144ska","year":"2015","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"pone.0343691.ref006","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1186\/s12903-022-02633-0","article-title":"A comparison of maxillary sinus diameters in Chinese and Yemeni patients with skeletal malocclusion","volume":"22","author":"AY Albarakani","year":"2022","journal-title":"BMC Oral Health"},{"issue":"5","key":"pone.0343691.ref007","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1080\/00016357.2017.1310294","article-title":"Evaluation of maxillary sinus volume and dimensions in different vertical face growth patterns: a study of cone-beam computed tomography","volume":"75","author":"R Ok\u015fayan","year":"2017","journal-title":"Acta Odontol Scand"},{"issue":"5","key":"pone.0343691.ref008","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1177\/00220345830620051201","article-title":"Occlusal forces in normal- and long-face adults","volume":"62","author":"WR Proffit","year":"1983","journal-title":"J Dent Res"},{"issue":"2","key":"pone.0343691.ref009","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4103\/ejd.ejd_345_17","article-title":"Cephalometric association of mandibular size\/length to the surface area and dimensions of the frontal and maxillary sinuses","volume":"12","author":"S Yassaei","year":"2018","journal-title":"Eur J Dent"},{"issue":"3","key":"pone.0343691.ref010","doi-asserted-by":"crossref","first-page":"208","DOI":"10.4274\/TurkJOrthod.2022.2022.4","article-title":"The Evaluation of Maxillary Sinus Dimensions in Different Craniofacial Patterns: A Systematic Review and Meta-Analysis","volume":"36","author":"R Chunduru","year":"2023","journal-title":"Turk J Orthod"},{"key":"pone.0343691.ref011","first-page":"20","article-title":"Correlation between malocclusion and temporomandibular joint disorders (TMD): a comprehensive review","volume":"1","author":"M Tanaka","year":"2025","journal-title":"Int J Orthopedic and Orthodontic Res"},{"issue":"9","key":"pone.0343691.ref012","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/joor.13471","article-title":"Longitudinal trends in temporomandibular joint disorder symptoms, the impact of malocclusion and orthodontic treatment: A 20-year prospective study","volume":"50","author":"E Myllym\u00e4ki","year":"2023","journal-title":"J Oral Rehabil"},{"issue":"7","key":"pone.0343691.ref013","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1111\/j.1365-2842.2012.02304.x","article-title":"The dental occlusion as a suspected cause for TMDs: epidemiological and etiological considerations","volume":"39","author":"JC T\u00fcrp","year":"2012","journal-title":"J Oral Rehabil"},{"issue":"1","key":"pone.0343691.ref014","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s00276-022-03055-x","article-title":"Anatomical study of the maxillary sinus: which characteristics can influence its volume?","volume":"45","author":"AMG Lessa","year":"2023","journal-title":"Surg Radiol Anat"},{"issue":"2","key":"pone.0343691.ref015","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.ejrad.2009.03.042","article-title":"A comparative evaluation of Cone Beam Computed Tomography (CBCT) and Multi-Slice CT (MSCT) Part I. On subjective image quality","volume":"75","author":"X Liang","year":"2010","journal-title":"Eur J Radiol"},{"issue":"2","key":"pone.0343691.ref016","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s11282-018-0340-1","article-title":"Reproducibility of CBCT image analysis: a clinical study on intrapersonal and interpersonal errors in bone structure determination","volume":"35","author":"S Schnutenhaus","year":"2019","journal-title":"Oral Radiol"},{"issue":"2","key":"pone.0343691.ref017","doi-asserted-by":"crossref","first-page":"100639","DOI":"10.1016\/j.ortho.2022.100639","article-title":"Evaluation of the diagnostic accuracy of CBCT-based interpretations of maxillary impacted canines compared to those of conventional radiography: An in vitro study","volume":"20","author":"MY Hajeer","year":"2022","journal-title":"Int Orthod"},{"issue":"1","key":"pone.0343691.ref018","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1179\/146531204225011346","article-title":"Applications of 3D imaging in orthodontics: part I","volume":"31","author":"MY Hajeer","year":"2004","journal-title":"J Orthod"},{"issue":"6","key":"pone.0343691.ref019","article-title":"Association between the temporomandibular joint disc position on magnetic resonance imaging and the mandibular deviation on posteroanterior cephalogram: a cross-sectional study in adolescents","volume":"171","author":"E Guercio-Monaco","year":"2020","journal-title":"Clin Ter"},{"issue":"1","key":"pone.0343691.ref020","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jcms.2014.10.013","article-title":"Is mandibular asymmetry more frequent and severe with unilateral disc displacement?","volume":"43","author":"Q Xie","year":"2015","journal-title":"J Craniomaxillofac Surg"},{"issue":"6","key":"pone.0343691.ref021","article-title":"The relationship between partial disc displacement and mandibular dysplasia in female adolescents","volume":"16","author":"J-J Shi","year":"2010","journal-title":"Med Sci Monit"},{"issue":"1","key":"pone.0343691.ref022","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1590\/S2176-94512012000100011","article-title":"Cephalometric deviations present in children and adolescents with temporomandibular joint disorders","volume":"17","author":"LVW Bastos","year":"2012","journal-title":"Dental Press J Orthod"},{"issue":"9","key":"pone.0343691.ref023","first-page":"1297","article-title":"Disc displacement of the temporomandibular joint and facial asymmetry in children and adolescents: a systematic review and meta-analysis","volume":"9","author":"O Alm\u0103\u0219an","year":"2022","journal-title":"Children (Basel)"},{"issue":"1","key":"pone.0343691.ref024","doi-asserted-by":"crossref","first-page":"14009","DOI":"10.1038\/s41598-022-18436-w","article-title":"Deep learning-based fully automatic segmentation of the maxillary sinus on cone-beam computed tomographic images","volume":"12","author":"H Choi","year":"2022","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0343691.ref025","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1016\/j.identj.2025.02.025","article-title":"Machine learning models in the detection of MB2 Canal Orifice in CBCT Images","volume":"75","author":"S Shetty","year":"2025","journal-title":"Int Dent J"},{"key":"pone.0343691.ref026","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/978-981-97-7498-2_24","article-title":"Computer-aided diagnosis model for temporomandibular joint disorder based on CBCT","author":"N Zheng","year":"2025","journal-title":"Smart Innovation, Systems and Technologies"},{"issue":"1","key":"pone.0343691.ref027","first-page":"112","article-title":"Craniofacial parameters and their interrelationships: a comprehensive CBCT analysis of cranial, nasal, mandibular, and maxillary dimensions with sinus measurements","volume":"41","author":"DN \u00dcr","year":"2025","journal-title":"Aust Orthod"},{"issue":"1","key":"pone.0343691.ref028","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11607\/jop.1151","article-title":"Diagnostic criteria for temporomandibular disorders (DC\/TMD) for clinical and research applications: recommendations of the international RDC\/TMD Consortium Network* and orofacial pain special interest group\u2020","volume":"28","author":"E Schiffman","year":"2014","journal-title":"J Oral Facial Pain Headache"},{"issue":"4","key":"pone.0343691.ref029","doi-asserted-by":"crossref","first-page":"294","DOI":"10.5005\/jp-journals-10024-1844","article-title":"The accuracy and reproducibility of linear measurements made on CBCT-derived digital models","volume":"17","author":"AL Maroua","year":"2016","journal-title":"J Contemp Dent Pract"},{"issue":"8","key":"pone.0343691.ref030","doi-asserted-by":"crossref","first-page":"648","DOI":"10.5005\/jp-journals-10024-1736","article-title":"An evaluation of inter- and intraobserver reliability of cone-beam computed tomography- and two dimensional-based interpretations of maxillary canine impactions using a panel of orthodontically trained observers","volume":"16","author":"HK Al-Homsi","year":"2015","journal-title":"J Contemp Dent Pract"},{"key":"pone.0343691.ref031","first-page":"1","article-title":"Addressing gender disparities in automatic disease detection: A broad-spectrum analysis of machine learning across diverse disease types","author":"\u00d6 \u00c7oban","year":"2025","journal-title":"Arab J Sci Eng"},{"issue":"1","key":"pone.0343691.ref032","doi-asserted-by":"crossref","first-page":"1","DOI":"10.69882\/adba.cem.2026011","article-title":"Evaluating the Performance Disparity and the Role of Gender-Aware Approaches in Machine Learning Based Disease Detection","volume":"3","author":"O Coban","year":"2026","journal-title":"CEM"},{"issue":"3","key":"pone.0343691.ref033","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/s42979-021-00592-x","article-title":"Machine Learning: Algorithms, Real-World Applications and Research Directions","volume":"2","author":"IH Sarker","year":"2021","journal-title":"SN Comput Sci"},{"issue":"01","key":"pone.0343691.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4236\/jilsa.2017.91001","article-title":"Survey of machine learning algorithms for disease diagnostic","volume":"09","author":"M Fatima","year":"2017","journal-title":"JILSA"},{"key":"pone.0343691.ref035","first-page":"2825","article-title":"Scikit-learn: Machine learning in Python","volume":"12","author":"F Pedregosa","year":"2011","journal-title":"The Journal of Machine Learning Research"},{"issue":"26","key":"pone.0343691.ref036","doi-asserted-by":"crossref","DOI":"10.1002\/cpe.7282","article-title":"A new modification and application of item response theory\u2010based feature selection for different machine learning tasks","volume":"34","author":"O Coban","year":"2022","journal-title":"Concurrency and Computation"},{"issue":"3","key":"pone.0343691.ref037","doi-asserted-by":"crossref","first-page":"541","DOI":"10.3390\/healthcare10030541","article-title":"Machine-Learning-Based Disease Diagnosis: A Comprehensive Review","volume":"10","author":"MM Ahsan","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"pone.0343691.ref038","unstructured":"Kohavi R. A study of cross-validation and bootstrap for accuracy estimation and model selection. In: IJCAI. 1995;1137\u201345."},{"issue":"1","key":"pone.0343691.ref039","article-title":"Association between temporomandibular disorders, chronic diseases, and ophthalmologic and otolaryngologic disorders in Korean adults: A cross-sectional study","volume":"13","author":"H-S Song","year":"2018","journal-title":"PLoS One"},{"issue":"8","key":"pone.0343691.ref040","article-title":"The impact of temporomandibular disorders on orthodontic management: a systematic review and meta-analysis","volume":"15","author":"MK Alam","year":"2023","journal-title":"Cureus"},{"issue":"6","key":"pone.0343691.ref041","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.tripleo.2004.10.007","article-title":"Statistical correlation between pharyngitis and temporomandibular joint disease","volume":"99","author":"Y-D Jeon","year":"2005","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"1","key":"pone.0343691.ref042","first-page":"24","article-title":"Assessment of maxillary sinus volume in patients of temporomandibular joint bony ankylosis","volume":"2","author":"M Dehis","year":"2015","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"4","key":"pone.0343691.ref043","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s11282-020-00506-2","article-title":"Evaluation of maxillary sinus volume in different craniofacial patterns: a CBCT study","volume":"37","author":"B Shrestha","year":"2021","journal-title":"Oral Radiol"},{"issue":"2","key":"pone.0343691.ref044","first-page":"185","article-title":"Gender assessment through three-dimensional analysis of maxillary sinuses by means of cone beam computed tomography","volume":"19","author":"M Saccucci","year":"2015","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"1","key":"pone.0343691.ref045","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ajodo.2012.07.020","article-title":"Space closure in the maxillary posterior area through the maxillary sinus","volume":"145","author":"JH Park","year":"2014","journal-title":"Am J Orthod Dentofacial Orthop"},{"issue":"4","key":"pone.0343691.ref046","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.ajodo.2014.03.025","article-title":"Orthodontic tooth movement through the maxillary sinus in an adult with multiple missing teeth","volume":"146","author":"H Oh","year":"2014","journal-title":"Am J Orthod Dentofacial Orthop"},{"issue":"1","key":"pone.0343691.ref047","first-page":"66","article-title":"Anatomical evaluation of the relationship between the maxillary posterior teeth and maxillary sinus","volume":"68","author":"RB Junqueira","year":"2020","journal-title":"Gen Dent"},{"issue":"1","key":"pone.0343691.ref048","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.joms.2015.07.006","article-title":"Temporomandibular Joint Disorders in Patients With Different Facial Morphology. A Systematic Review of the Literature","volume":"74","author":"D Manfredini","year":"2016","journal-title":"J Oral Maxillofac Surg"},{"issue":"1","key":"pone.0343691.ref049","doi-asserted-by":"crossref","first-page":"118","DOI":"10.5114\/aoms.2013.33072","article-title":"Skeletal pattern in subjects with temporomandibular joint disorders","volume":"9","author":"OC Alm\u0103\u015fan","year":"2013","journal-title":"Arch Med Sci"},{"issue":"4","key":"pone.0343691.ref050","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.ajodo.2004.12.019","article-title":"Lateral cephalometric characteristics of malocclusion patients with temporomandibular joint disorder symptoms","volume":"129","author":"C-J Hwang","year":"2006","journal-title":"Am J Orthod Dentofacial Orthop"},{"issue":"3","key":"pone.0343691.ref051","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.ajodo.2005.01.024","article-title":"Longitudinal study of temporomandibular joint disc status and craniofacial growth","volume":"130","author":"C Flores-Mir","year":"2006","journal-title":"Am J Orthod Dentofacial Orthop"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343691","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T17:32:21Z","timestamp":1773855141000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343691"}},"subtitle":[],"editor":[{"given":"Essam","family":"Al-Moraissi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":51,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0343691","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]}}}