{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T05:19:29Z","timestamp":1763097569077,"version":"3.45.0"},"reference-count":30,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016964","name":"the Werner Siemens Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016964","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Innovation Focus Regenerative Surgery, University Hospital Basel"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Imaging"],"abstract":"<jats:p>The accurate reconstruction of craniofacial defects requires the precise segmentation and mirroring of healthy anatomy. Conventional workflows rely on manual interaction, making them time-consuming and subject to operator variability. This study developed and validated a fully automated digital pipeline that integrates deep learning\u2013based segmentation with algorithmic mirroring for craniofacial reconstruction. A total of 388 cranial CT scans were used to train a three-dimensional nnU-Net model for skull and mandible segmentation. A Principal Component Analysis\u2013Iterative Closest Point (PCA\u2013ICP) algorithm was then applied to compute the sagittal symmetry plane and perform mirroring. Automated results were compared with expert-generated segmentations and manually defined symmetry planes using Dice Similarity Coefficient (DSC), Mean Surface Distance (MSD), Hausdorff Distance (HD), and angular deviation. The nnU-Net achieved high segmentation accuracy for both the mandible (mean DSC 0.956) and the skull (mean DSC 0.965). Mirroring results showed minimal angular deviation from expert reference planes (mandible: 1.32\u00b0 \u00b1 0.71\u00b0 in defect cases, 1.58\u00b0 \u00b1 1.12\u00b0 in intact cases; skull: 1.75\u00b0 \u00b1 0.84\u00b0 in defect cases, 1.15\u00b0 \u00b1 0.81\u00b0 in intact cases). The presence of defects did not significantly affect accuracy. This automated workflow demonstrated robust performance and clinical applicability, offering standardized, reproducible, and time-efficient planning for craniofacial reconstruction.<\/jats:p>","DOI":"10.3390\/jimaging11110407","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T07:58:32Z","timestamp":1762934312000},"page":"407","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fully Automated AI-Based Digital Workflow for Mirroring of Healthy and Defective Craniofacial Models"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5377-1530","authenticated-orcid":false,"given":"Michel","family":"Beyer","sequence":"first","affiliation":[{"name":"Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Grossi","sequence":"additional","affiliation":[{"name":"Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2995-9878","authenticated-orcid":false,"given":"Alexandru","family":"Burde","sequence":"additional","affiliation":[{"name":"Department of Prosthetic Dentistry and Dental Materials, Iuliu Hatieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sead","family":"Abazi","sequence":"additional","affiliation":[{"name":"Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Seifert","sequence":"additional","affiliation":[{"name":"Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Polligkeit","sequence":"additional","affiliation":[{"name":"Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1624-5611","authenticated-orcid":false,"given":"Neha Umakant","family":"Chodankar","sequence":"additional","affiliation":[{"name":"Department of Dentistry, Healthway Hospitals, Ella Old Goa 403110, Goa, India"},{"name":"Miramar Dental Centre, Caranzalem, Panaji 403001, Goa, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3035-9308","authenticated-orcid":false,"given":"Florian M.","family":"Thieringer","sequence":"additional","affiliation":[{"name":"Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s12663-023-01881-z","article-title":"Patient Specific Alloplastic Implant Reconstruction of Mandibular Defects-Safe Practice Recommendations and Guidelines","volume":"22","author":"Subash","year":"2023","journal-title":"J. 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