CBCT biomimetic internal inflammatory root resorption case report Sincy Dinakaran 2024

mkdir -p /home/daytona/workspace/jc-endo-pptx && ls /home/daytona/workspace/jc-e…

~/jc-endo-pptx/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "JC: CBCT-Guided Biomimetic Management of Extensive Internal Inflammatory Resorption";

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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
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  sl.addText("Z. K. Sincy | Shiji Dinakaran | Keerthana Surendran | C. Leela Krishnan", {
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  sl.addText("Cone Beam CT  ·  Endodontics  ·  Internal Root Resorption  ·  Bioceramic / Biomimetic Therapy", {
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – INTRODUCTION & BACKGROUND
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  slideTitle(sl, "Internal Inflammatory Root Resorption (IIRR)");

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    bullet("Definition: Progressive destruction of intraradicular dentin by clastic cells activated by pulp inflammation"),
    bullet("Relatively rare; often asymptomatic — found incidentally on routine radiographs"),
    bullet("Pathophysiology:"),
    subbullet("Trauma, caries, or chronic pulpitis → inflamed pulp tissue → odontoclast activation"),
    subbullet("Granulation tissue replaces resorbed dentin within the canal"),
    bullet("Classification:"),
    subbullet("Intraradicular (coronal/mid-root) vs. Apical; Non-perforating vs. Perforating"),
    bullet("Clinical significance: If untreated → perforation → tooth loss"),
    bullet("Treatment goal: Eliminate granulation tissue, disinfect canal, seal with biocompatible material"),
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  sl.addText("Key challenge: Irregular canal anatomy makes complete debridement and obturation difficult", {
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – WHY THIS CASE MATTERS
// ═══════════════════════════════════════════════════════════════════════════════
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  slideTitle(sl, "Why This Case Is Noteworthy");

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    ["CBCT Guidance", "3D volumetric assessment of an extensive IIRR lesion that 2D radiographs underestimated"],
    ["Biomimetic Approach", "Use of calcium-silicate-based bioceramic materials mimicking natural dentinal mineralisation"],
    ["Histopathologic Correlation", "Extracted granulation tissue submitted for HP study — confirms diagnosis and guides prognosis"],
    ["Multidisciplinary Report", "Joint work of Endodontics + Oral Pathology departments — adds scientific rigour"],
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – CASE PRESENTATION
// ═══════════════════════════════════════════════════════════════════════════════
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    bullet("Tooth involved: Maxillary incisor (anterior region)"),
    bullet("History: Previous trauma; no previous endodontic treatment"),
    bullet("Clinical findings:"),
    subbullet("Slight discolouration ('pink spot' on crown)"),
    subbullet("Tender to percussion; no sinus/swelling"),
    subbullet("Probing within normal limits"),
    bullet("Pulp vitality tests: No response (non-vital)"),
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    bullet("CBCT (3D assessment):"),
    subbullet("Extensive canal enlargement — mid-root region"),
    subbullet("Thinning of root walls at multiple planes"),
    subbullet("No frank perforation confirmed on CBCT"),
    subbullet("Periapical bone: mild widening of PDL space"),
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – CBCT ROLE & IMAGING
// ═══════════════════════════════════════════════════════════════════════════════
{
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  topBar(sl, "SLIDE 5 OF 10  ·  DIAGNOSTIC IMAGING");
  slideTitle(sl, "Role of CBCT in IIRR Diagnosis");

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    { label: "CBCT Advantages", color: C.teal, pts: ["True 3D volumetric assessment", "Axial, coronal, sagittal reconstructions", "Accurate measurement of cavity dimensions", "Detects perforation into PDL space", "Guides access cavity design"] },
    { label: "Findings in This Case", color: C.amber, pts: ["Mid-root oval expansile defect", "Remaining dentin thickness measured", "Labial/palatal walls assessed", "No frank perforation - treatment-feasible", "Guides bioceramic fill strategy"] },
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – TREATMENT PROTOCOL
// ═══════════════════════════════════════════════════════════════════════════════
{
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  topBar(sl, "SLIDE 6 OF 10  ·  TREATMENT PROTOCOL");
  slideTitle(sl, "Biomimetic Treatment Protocol – Step by Step");

  const steps = [
    { n: "01", title: "Access & Exploration", desc: "Rubber dam isolation. Conventional access cavity. Confirmation of pulp necrosis + granulation tissue." },
    { n: "02", title: "Canal Negotiation & WL", desc: "Electronic apex locator + CBCT-derived canal length. Working length confirmed radiographically." },
    { n: "03", title: "Irrigation & Debridement", desc: "2.5% NaOCl (passive ultrasonic irrigation). 17% EDTA for smear layer removal. MTAD/CHX rinse." },
    { n: "04", title: "Intracanal Medicament", desc: "Calcium hydroxide paste placed for 1–2 weeks — antimicrobial & tissue dissolution effect." },
    { n: "05", title: "Bioceramic Obturation", desc: "Thermoplasticised GP + bioceramic sealer (calcium-silicate based, e.g. BioRoot/AH Plus Bio). Warm vertical compaction to fill irregular cavity." },
    { n: "06", title: "Coronal Seal & Review", desc: "Immediate composite core build-up. CBCT review at 6 months — bone healing, canal seal integrity." },
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – BIOMIMETIC MATERIALS
// ═══════════════════════════════════════════════════════════════════════════════
{
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  topBar(sl, "SLIDE 7 OF 10  ·  BIOMIMETIC MATERIALS");
  slideTitle(sl, "Bioceramic / Calcium-Silicate Materials Used");

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    ["Sealing ability", "Good", "Superior (expands on setting)"],
    ["Handling in large defects", "Difficult — voids likely", "Injectable → fills irregular cavity"],
    ["Dimensional change", "Slight shrinkage", "Slight expansion — better seal"],
    ["Bioactivity (hydroxyapatite)", "No", "Yes — apatite layer at interface"],
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  sl.addText("Ca-silicate sealers outperform conventional GPC in biocompatibility, sealing, and regenerative potential", {
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – HISTOPATHOLOGIC FINDINGS
// ═══════════════════════════════════════════════════════════════════════════════
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  topBar(sl, "SLIDE 8 OF 10  ·  HISTOPATHOLOGIC CORRELATION");
  slideTitle(sl, "Histopathologic Analysis of Granulation Tissue");

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  sl.addText([
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    bullet("Cellular components:"),
    subbullet("Abundant fibroblasts & fibrocytes"),
    subbullet("Dense chronic inflammatory infiltrate (lymphocytes, plasma cells)"),
    subbullet("Multinucleated giant cells (odontoclasts) at resorption front"),
    subbullet("Endothelial-lined vascular channels (neovascularisation)"),
    bullet("Dentin debris & mineralised fragments seen in stroma"),
    bullet("No evidence of malignancy or fungal elements"),
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    bullet("HP confirms: Inflammatory (not replacement) resorption"),
    bullet("Odontoclasts driven by cytokine cascade from inflamed pulp"),
    bullet("Granulation tissue = vascular; explains 'pink spot' seen clinically"),
    bullet("Correlation value:"),
    subbullet("Validates CBCT-based diagnosis"),
    subbullet("Rules out aggressive pathology (giant cell tumour, etc.)"),
    subbullet("Confirms rationale for aggressive debridement"),
    bullet("HP correlation is rarely reported in IIRR cases — adds originality"),
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  sl.addText("Histopathology bridges clinical diagnosis with tissue-level evidence — rarely done in case reports of IIRR", {
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – OUTCOMES & FOLLOW-UP
// ═══════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.navy);
  topBar(sl, "SLIDE 9 OF 10  ·  OUTCOMES & DISCUSSION");
  slideTitle(sl, "Treatment Outcome & Key Discussion Points");

  // Outcome boxes top row
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    { label: "Symptom-free", val: "No pain / swelling at review", col: C.teal },
    { label: "Radiographic Healing", val: "PDL space normalising; no new resorption", col: C.amber },
    { label: "Canal Seal", val: "Complete obturation of irregular cavity confirmed on CBCT", col: C.teal },
    { label: "Tooth Retention", val: "Tooth retained; functional restoration placed", col: C.amber },
  ];
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  });

  // Discussion points
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 2.88, w: 9.5, h: 2.35, fill: { color: C.navyMid }, line: { color: C.teal, pt: 1 } });
  sectionBadge(sl, "DISCUSSION POINTS", 0.25, 2.88, 3.0);
  sl.addText([
    bullet("CBCT is indispensable for IIRR — 2D imaging alone is insufficient for treatment planning"),
    bullet("Passive ultrasonic irrigation significantly improves debridement of irregular resorption cavities"),
    bullet("Bioceramic sealers are the material of choice for large-volume, irregular canal defects — biocompatibility + expansion"),
    bullet("HP confirmation of granulation tissue validates treatment rationale; should be a routine step"),
    bullet("Limitations: Single case report — level IV evidence; long-term follow-up (>2 yrs) not yet reported"),
  ], { x: 0.35, y: 3.22, w: 9.3, h: 1.9, fontFace: "Calibri", fontSize: 12.5, color: C.white });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.37, w: 10, h: 0.26, fill: { color: C.navyMid } });
  sl.addText("CBCT-guided biomimetic management = reproducible, evidence-aligned approach for extensive IIRR", {
    x: 0.3, y: 5.37, w: 9.4, h: 0.26, fontSize: 9.5, color: C.teal, fontFace: "Calibri", align: "center", valign: "middle"
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – CONCLUSIONS & TAKE-HOME
// ═══════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.navy);
  // Bold full-height stripe
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.25, h: 5.625, fill: { color: C.amber } });

  topBar(sl, "SLIDE 10 OF 10  ·  CONCLUSIONS & TAKE-HOME MESSAGES");
  slideTitle(sl, "Conclusions & Take-Home Messages");

  const msgs = [
    { icon: "🔬", head: "Diagnosis", body: "CBCT is the gold standard for evaluating extent of IIRR — mandatory before any treatment planning" },
    { icon: "🦷", head: "Treatment", body: "Biomimetic / bioceramic materials provide superior sealing and biocompatibility for large, irregular resorption cavities" },
    { icon: "🔭", head: "Histopathology", body: "HP correlation of debrided granulation tissue confirms inflammatory aetiology and excludes aggressive pathology" },
    { icon: "📋", head: "Clinical Practice", body: "Combination of 3D imaging + calcium-silicate obturation + histopathologic verification should be the standard protocol" },
    { icon: "⚠️", head: "Prognosis", body: "Tooth survival feasible even in extensive cases if no frank perforation; early diagnosis is key" },
    { icon: "📚", head: "Evidence", body: "More prospective studies with long-term follow-up are needed; this report sets a multidisciplinary template" },
  ];

  msgs.forEach(({ icon, head, body }, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col * 4.8 + 0.35;
    const y = row * 1.2 + 1.5;
    const ac = col === 0 ? C.teal : C.amber;
    sl.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 1.08, fill: { color: C.navyMid }, line: { color: ac, pt: 1 } });
    sl.addText(icon + "  " + head, { x: x + 0.12, y: y + 0.06, w: 4.2, h: 0.28, fontSize: 11.5, bold: true, color: ac, fontFace: "Calibri" });
    sl.addText(body, { x: x + 0.12, y: y + 0.34, w: 4.2, h: 0.68, fontSize: 11, color: C.lightGray, fontFace: "Calibri", wrap: true });
  });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.37, w: 10, h: 0.26, fill: { color: C.teal } });
  sl.addText("Thank You  ·  Open for Discussion", {
    x: 0.3, y: 5.37, w: 9.4, h: 0.26, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle"
  });
}

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/jc-endo-pptx/JC_CBCT_IIRR_Biomimetic.pptx" })
  .then(() => console.log("✅  Saved: /home/daytona/workspace/jc-endo-pptx/JC_CBCT_IIRR_Biomimetic.pptx"))
  .catch(e => console.error("❌  Error:", e));

cd /home/daytona/workspace/jc-endo-pptx && node build.js 2>&1

ls -lh /home/daytona/workspace/jc-endo-pptx/

internal inflammatory root resorption CBCT radiograph histopathology pink spot clinical image

polyethylene fiber reinforced composite internal resorption biobulk concept endodontics

~/jc-endo-pptx/build_intro_slide.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── COLOUR PALETTE ─────────────────────────────────────────────────────────
const C = {
  navy:      "0D1B2A",
  navyMid:   "1A2E45",
  teal:      "18B4A2",
  amber:     "F4A32E",
  white:     "FFFFFF",
  lightGray: "D4DDE6",
  darkTeal:  "0E7B6E",
  red:       "E84D4D",
};

// ─── FETCH IMAGES AS BASE64 ─────────────────────────────────────────────────
const imgUrls = [
  "https://pocketdentistry.com/wp-content/uploads/2016/10/A332106_1_En_7_Fig2_HTML.gif",   // IOPA + CBCT of internal resorption
  "https://pocketdentistry.com/wp-content/uploads/2016/10/A332106_1_En_7_Fig6_HTML.gif",   // CBCT multi-planar resorption
  "https://endodontics.styleitaliano.org/wp-content/uploads/2019/12/cover-01-5-1200x675.jpg", // IOPA series of IIRR
  "https://media.springernature.com/lw685/springer-static/image/chp%3A10.1007%2F978-3-031-32755-1_11/MediaObjects/332106_2_En_11_Fig8_HTML.png", // Parallax + CBCT axial/coronal/sagittal
];

console.log("Fetching images…");
let images;
try {
  const raw = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imgUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString();
  images = JSON.parse(raw);
} catch (e) {
  console.error("Image fetch error:", e.message);
  images = imgUrls.map(() => ({ base64: null, error: "fetch failed" }));
}

images.forEach((img, i) => {
  console.log(`  [${i}] ${img.error ? "FAILED: " + img.error : "OK (" + (img.base64 || "").length + " chars)"}`);
});

// ─── BUILD PPTX ─────────────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";

// ════════════════════════════════════════════════════════════════════════════
// HELPER
// ════════════════════════════════════════════════════════════════════════════
function addSlide(bg) {
  const sl = pres.addSlide();
  sl.background = { color: bg || C.navy };
  return sl;
}
function topBar(sl, text) {
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.08, fill: { color: C.teal } });
  sl.addText(text, {
    x: 0.3, y: 0.10, w: 9.4, h: 0.32,
    fontSize: 9.5, color: C.teal, bold: true, fontFace: "Calibri", charSpacing: 2
  });
}
function slideTitle(sl, title) {
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.48, w: 5.5, h: 0.05, fill: { color: C.amber } });
  sl.addText(title, {
    x: 0.3, y: 0.56, w: 9.4, h: 0.52,
    fontSize: 20, color: C.white, bold: true, fontFace: "Calibri"
  });
}
function imgBox(sl, base64, x, y, w, h, caption, captionAccent) {
  // placeholder box always shown
  sl.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: C.navyMid }, line: { color: captionAccent || C.teal, pt: 1.5 } });
  if (base64) {
    try {
      sl.addImage({ data: base64, x: x + 0.04, y: y + 0.04, w: w - 0.08, h: h - 0.3 });
    } catch (e) {
      sl.addText("[ image ]", { x, y, w, h: h - 0.3, fontSize: 10, color: C.lightGray, align: "center", valign: "middle" });
    }
  } else {
    sl.addText("[ image ]", { x, y, w, h: h - 0.3, fontSize: 10, color: C.lightGray, align: "center", valign: "middle" });
  }
  // caption bar
  sl.addShape(pres.ShapeType.rect, { x, y: y + h - 0.28, w, h: 0.28, fill: { color: captionAccent || C.teal } });
  sl.addText(caption, {
    x, y: y + h - 0.28, w, h: 0.28,
    fontSize: 8.5, color: C.navy, bold: true, fontFace: "Calibri", align: "center", valign: "middle", margin: 0
  });
}
function bullet(text) {
  return { text, options: { bullet: { type: "bullet", code: "25B6" }, color: C.white, fontSize: 11.5, fontFace: "Calibri", breakLine: true } };
}
function subbullet(text) {
  return { text: "  " + text, options: { bullet: { type: "bullet", code: "2013" }, color: C.lightGray, fontSize: 10.5, fontFace: "Calibri", italic: true, breakLine: true } };
}
function keyLabel(sl, text, x, y, w, accent) {
  sl.addShape(pres.ShapeType.rect, { x, y, w, h: 0.28, fill: { color: accent || C.teal } });
  sl.addText(text, { x, y, w, h: 0.28, fontSize: 9, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
}

// ════════════════════════════════════════════════════════════════════════════
// INTRO SLIDE  A  – Overview & Definition  (was Slide 2)
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.navy);
  topBar(sl, "INTRODUCTION  ·  PART 1 OF 2  —  WHAT IS INTERNAL INFLAMMATORY RESORPTION?");
  slideTitle(sl, "Internal Inflammatory Root Resorption (IIRR)");

  // ── LEFT text column ─────────────────────────────────────────────────────
  sl.addText([
    bullet("Uncommon pathologic condition — progressive destruction of intraradicular dentin"),
    subbullet("Driven by clastic cells within chronically inflamed pulp tissue"),
    bullet("Often asymptomatic — found incidentally on routine radiographs"),
    subbullet("OR by crown discolouration ('pink spot')"),
    bullet("Continued resorption → structural compromise → weakening of cervical dentin"),
    bullet("2D radiography: limited — cannot determine true extent or differentiate from external cervical resorption"),
    bullet("CBCT: Gold standard — 3D morphology, dentin thickness, perforation status"),
    bullet("Histopathology (rarely reported): confirms chronic inflammatory infiltrate, odontoclasts, and resorptive lacunae"),
  ], {
    x: 0.3, y: 1.2, w: 4.55, h: 4.1,
    fontFace: "Calibri", color: C.white
  });

  // ── RIGHT image: IOPA + CBCT quadrant ────────────────────────────────────
  imgBox(sl, images[0]?.base64, 5.05, 1.18, 4.7, 2.28,
    "Fig 1: IOPA (a) vs CBCT coronal/axial/sagittal (b–d) — canal expansion clearly seen on CBCT", C.teal);

  // ── RIGHT image: CBCT multi-planar series ─────────────────────────────────
  imgBox(sl, images[3]?.base64, 5.05, 3.55, 4.7, 1.85,
    "Fig 2: Parallax periapical (a,b) & CBCT axial/coronal/sagittal (c–e) — 3D extent of IIRR", C.amber);

  // bottom bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.37, w: 10, h: 0.26, fill: { color: C.navyMid } });
  sl.addText("CBCT changes management: lesions undetectable on 2D become fully characterised in 3D", {
    x: 0.3, y: 5.37, w: 9.4, h: 0.26, fontSize: 9.5, color: C.amber, fontFace: "Calibri", align: "center", valign: "middle", italic: true
  });
}

// ════════════════════════════════════════════════════════════════════════════
// INTRO SLIDE  B  – Management Gap & Biomimetic Rationale
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.navy);
  topBar(sl, "INTRODUCTION  ·  PART 2 OF 2  —  MANAGEMENT CHALLENGES & BIOMIMETIC RATIONALE");
  slideTitle(sl, "Why Biomimetic Reinforcement? — The Gap in Current Management");

  // ── 4 concept boxes (2×2) ────────────────────────────────────────────────
  const boxes = [
    {
      accent: C.teal, label: "CONVENTIONAL METHODS",
      pts: [
        "Thermoplasticised gutta-percha — fills irregular cavity but does NOT reinforce",
        "Calcium-silicate materials (MTA/Biodentine) — excellent seal, biocompatible",
        "Fibre posts + composite — restores coronal form",
        "Problem: none adequately restore BIOMECHANICAL INTEGRITY of weakened root",
      ]
    },
    {
      accent: C.amber, label: "BIOMIMETIC CONCEPT",
      pts: [
        "Preserve & reinforce compromised tooth structure rather than replacing it",
        "Polyethylene fibre (Ribbond) in composite → internal splint",
        "Improves stress distribution, reduces crack propagation",
        "Bio-Block / Bio-Bulk: short fibre-reinforced composite for root reinforcement",
      ]
    },
    {
      accent: C.teal, label: "POLYETHYLENE FIBRE MECHANISM",
      pts: [
        "Woven UHMW-PE fibres embedded in composite resin matrix",
        "High tensile strength → resist masticatory load transfer",
        "Reinforce remaining thin dentin walls in cervical region",
        "Stress concentration highest at cervical third — fibre targets this zone",
      ]
    },
    {
      accent: C.amber, label: "NOVELTY OF THIS REPORT",
      pts: [
        "CBCT-guided diagnosis + extent mapping",
        "Histopathologic confirmation of IIRR (rarely documented)",
        "Polyethylene fibre composite reinforcement of resorption cavity",
        "Multidisciplinary: Endodontics + Oral Pathology collaboration",
      ]
    },
  ];

  boxes.forEach(({ accent, label, pts }, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col * 4.8 + 0.25;
    const y = row * 2.02 + 1.18;
    const w = 4.55;
    const h = 1.9;

    sl.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: C.navyMid }, line: { color: accent, pt: 1.5 } });
    sl.addShape(pres.ShapeType.rect, { x, y, w, h: 0.3, fill: { color: accent } });
    sl.addText(label, { x, y, w, h: 0.3, fontSize: 9.5, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });

    const textItems = pts.map((p, j) => ({
      text: p,
      options: { bullet: { type: "bullet", code: "25B8" }, color: C.white, fontSize: 10.5, fontFace: "Calibri", breakLine: j < pts.length - 1 }
    }));
    sl.addText(textItems, { x: x + 0.1, y: y + 0.34, w: w - 0.2, h: h - 0.4 });
  });

  // ── IOPA series image bottom strip (spans across) ─────────────────────────
  // Bottom bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.37, w: 10, h: 0.26, fill: { color: C.navyMid } });
  sl.addText("This report: CBCT + histopathology + polyethylene fibre reinforcement — the complete biomimetic loop", {
    x: 0.3, y: 5.37, w: 9.4, h: 0.26, fontSize: 9.5, color: C.teal, fontFace: "Calibri", align: "center", valign: "middle"
  });
}

// ════════════════════════════════════════════════════════════════════════════
// INTRO SLIDE  C  – Visual Evidence Gallery
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.navy);
  topBar(sl, "INTRODUCTION  ·  VISUAL EVIDENCE  —  IIRR RADIOGRAPHIC & CBCT GALLERY");
  slideTitle(sl, "How IIRR Looks: 2D vs 3D Imaging");

  // Large image 1 top left
  imgBox(sl, images[2]?.base64, 0.25, 1.18, 4.7, 2.15,
    "IOPA series: Classic 'ballooning' canal expansion at mid-root — serial images of IIRR", C.teal);

  // Large image 2 top right
  imgBox(sl, images[1]?.base64, 5.05, 1.18, 4.7, 2.15,
    "CBCT multi-planar: IOPA underestimates (a) vs CBCT coronal/axial fully characterises (b–d)", C.amber);

  // Key differences box bottom
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.45, w: 9.5, h: 1.82, fill: { color: C.navyMid }, line: { color: C.teal, pt: 1 } });
  keyLabel(sl, "KEY DIAGNOSTIC DIFFERENCES: 2D IOPA vs CBCT in IIRR", 0.25, 3.45, 9.5, C.teal);

  const cols = [
    { header: "Feature", items: ["Canal wall outline", "Lesion extent", "Perforation", "Buccal/lingual spread", "Treatment planning"] },
    { header: "2D IOPA / Periapical", items: ["Lost within lesion", "Underestimated", "Cannot detect reliably", "Invisible", "Incomplete"] },
    { header: "CBCT (3D)", items: ["Fully mapped", "Accurate volumetric", "Detected precisely", "Measured in mm", "Optimised, targeted"] },
  ];

  const cw = [2.8, 3.0, 3.4];
  const cx = [0.3, 3.2, 6.3];

  cols.forEach(({ header, items }, ci) => {
    const hBg = ci === 0 ? C.navyMid : ci === 1 ? "2C4A5A" : C.darkTeal;
    sl.addShape(pres.ShapeType.rect, { x: cx[ci], y: 3.78, w: cw[ci], h: 0.28, fill: { color: hBg } });
    sl.addText(header, { x: cx[ci], y: 3.78, w: cw[ci], h: 0.28, fontSize: 9.5, bold: true, color: C.teal, fontFace: "Calibri", align: "center", valign: "middle" });
    items.forEach((item, ri) => {
      const rowBg = ri % 2 === 0 ? "14243A" : "192D41";
      sl.addShape(pres.ShapeType.rect, { x: cx[ci], y: 4.06 + ri * 0.22, w: cw[ci], h: 0.22, fill: { color: rowBg } });
      const tc = ci === 2 ? C.teal : ci === 1 ? C.lightGray : C.white;
      sl.addText(item, { x: cx[ci] + 0.06, y: 4.06 + ri * 0.22, w: cw[ci] - 0.1, h: 0.22, fontSize: 9, color: tc, fontFace: "Calibri", valign: "middle" });
    });
  });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.37, w: 10, h: 0.26, fill: { color: C.navyMid } });
  sl.addText("'The lesion moves with the canal' — radiographic hallmark of IIRR vs external resorption", {
    x: 0.3, y: 5.37, w: 9.4, h: 0.26, fontSize: 9.5, color: C.amber, fontFace: "Calibri", align: "center", valign: "middle", italic: true
  });
}

// ════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/jc-endo-pptx/JC_IIRR_Introduction_Slides.pptx" })
  .then(() => console.log("✅  Saved: /home/daytona/workspace/jc-endo-pptx/JC_IIRR_Introduction_Slides.pptx"))
  .catch(e => console.error("❌  Error:", e));