## 4 Discussion  
The increasing use of CBCT in dentistry underscores the need to minimize the patients' exposure to radiation in accordance with the ALADA principle [12]. While low-dose CBCT protocols allow for minimal exposure, their diagnostic reliability relative to that of standard protocols must be determined in order to define the indication areas [13]. To investigate the diagnostic reliability of a pre-programmed, low-dose protocol with respect to typical osseous lesions, as well as fractures and sequestra, we employed an in vitro model widespread in dental medicine; the porcine jaw is well-suited to the investigation of dento-maximilofacial questions due to its resemblance to the macroscopic anatomy and composition of the human jaw [18; 19]. A total of 1920 lesions were evaluated in this study. On average, almost 71% of all four lesions were correctly detected with a negligible difference between the low-dose and standard-dose modes (LD = 70.8% (1359); SD = 70.9% (1361)). Great importance was given to a cautious preparation \begin{table}
\begin{tabular}{c c c} \hline \hline
**Lesions** & **Odds Ratio** & \(p\)**-Values** \\ \hline PL/BL * & 0.4026341 & 0.04344587 & \textless{}0.0001 \\ PL/EP & 1.1017147 & 0.10824976 & 0.7575 \\ PL/SF * & 0.3153958 & 0.03543323 & \textless{}0.0001 \\ BL/EP * & 2.7362678 & 0.29447974 & \textless{}0.0001 \\ BL/SF & 0.7833310 & 0.09380023 & 0.1736 \\ EP/SF * & 0.2862772 & 0.03208903 & \textless{}0.0001 \\ \hline \hline \end{tabular} PL and EP were detected significantly less than BL and SF (* statistically significant). Abbreviations: PL, periapical lesion; BL, recession of the buccal layer; EP, extended periodontal gap; and SF, sequester/fracture.  
\end{table} 
Table 2: Comparison of the detection rates of the different lesions. Figure 3: Assessment of the visibility of the four lesion types according to dose-mode (1 = very poor, 10 = perfect). Abbreviations: PL, periapical lesion; BL, recession of the buccal layer; EP, extended periodontal gap; SF, sequestrum/fracture; LD, low dose; and SD, standard dose. technique when generating the lesions--e.g., although only 20 jaws were used to generate the PL simulations, all first premolars were extracted. By doing so, it became possible to exclude extraction signs as a possible confounder influencing the evaluation. Missing buccal lamellae were prepared on multi-rooted teeth, and fractures/sequestra were prepared in the jaw angle in the absence of alveolar foramina, which could influence the evaluation. The aim was to create a discreet finding to detect a possible difference between the applied radiation doses in small lesions. This may be an explanation for the overall detection rate of only 71%. However, these results compare favorably to those of [PERSON] et al., who observed detection rates of 67.5-74.5% when examining prepared osseous lesions in pig mandibles using three different CBCT devices at a standard dose range [25]. The main objective of the present study was to ascertain possible differences in detection rates between low-dose and standard-dose protocols. This investigation failed to observe any statistically significant differences between low-dose and standard-dose CBCT protocols in the detectability of four different osseous lesions. We further found PL and EP to be correctly detected significantly less often than SF and BL; the former pair may have been rendered less visible also on account of the cautious preparation method and macroscopic anatomical differences between the pig and human jaws. Consistent with this finding, the evaluation for the visibility of the lesion types demonstrated that PL and EP were less visible than the BL and SF in both the low-dose and standard-dose modes, with little difference between the two. The low-dose method employed in our investigation achieved an effective radiation dose reduction of 85% (LD = 20 mSv; SD = 145 mSv [20,26]) by halving the radiation time (LD = 2.2 s; SD = 4.4 s) and using a larger copper diaphragm (LD = 1 mm copper diaphragm; SD = 0.3 mm copper diaphragm).