This ex vivo study aimed to compare photon-counting detector computed tomography (PCD-CT) and cone-beam computed tomography (CBCT) at matched standard- and low-dose radiation levels for evaluating perioperative imaging parameters relevant to mandibular fracture stabilization with osteosynthesis plates.

Thirty-three osteosynthesis fixations were performed on six porcine mandibles with simulated fractures in the angle, body, and parasymphysis regions. Three types of plate systems (titanium microplates, titanium reconstruction plates, and bioresorbable copolymers) were used, each with varying plate thicknesses. Three blinded observers independently evaluated overall image quality, artifact severity, fracture line visibility, and visualization of peri‑osteosynthesis structures using 5-point visual analog scales. Descriptive statistics and inter-reader agreement (Krippendorff’s alpha) were calculated.

PCD-CT consistently demonstrated superior overall image quality, reduced artifact severity, and better visualization of fracture lines and peri‑osteosynthetic structures compared to CBCT, particularly using low-dose settings. Bioresorbable plates caused no artifacts in either modality. Inter-observer agreement was good to excellent across all parameters (Krippendorff’s α = 0.72–1.0).

PCD-CT outperformed CBCT in visualizing mandibular fracture stabilization with various osteosynthesis materials, particularly under low-dose conditions, demonstrating high reliability among observers. These findings indicate that PCD-CT may offer diagnostic advantages in the perioperative setting; however, further clinical studies are needed to confirm its role in imaging oral and maxillofacial trauma.