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Biomedical subjects

M K Shrout

Publications and source records attributed to M K Shrout.

At least 19 recordsLinked to original sources
PubMed1999

A retrospective study of Angle Class I malocclusions treated orthodontically without extractions using two palatal expansion methods.

The correction and relapse of mandibular anterior crowding was evaluated in a population of 58 patients with Angle Class I malocclusion who were treated orthodontically without extraction of permanent teeth. The subjects were retrospectively evaluated from records taken before treatment, posttreatment, and postretention. The postretention period averaged 8 years (minimum of 4 and maximum of 20 years). All cases in Groups A and B were given orthopedic treatment to develop the maxillary apical base in the transverse and anteroposterior planes. Group A was treated with expansion of the inner bow of the face bow appliance (Kloehn), and Group B was treated with the Haas palatal expansion appliance. Both groups were then treated orthodontically with tandem mechanics. The response variables measured were: overbite, overjet, intercanine distance, intermolar distance, and irregularity index. Study groups A and B were not significantly different for subject age, retention, or postretention time. Moreover, the groups did not show significant difference for any of the response variables before treatment. However, there was a statistically significant difference in the treatment times (P =.0133). A statistically significant treatment effect was observed for most response variables in the groups. Overbite, overjet, and irregularity index were significantly reduced, intermolar distance was significantly increased, and intercanine distance showed no significant change in Groups A and B. In the postretention period, there was a tendency for variables to change slightly toward their before treatment values but no compromise of orthodontic correction was noted. The irregularity index in Group A was corrected from 4.8 to 1.1 mm and remained at 1.1 mm in the postretention period. The irregularity index in Group B was corrected from 5.1 to 1.2 mm (P =.0001) and changed slightly from 1. 2 to 1.7 mm (P =.0540) in the postretention period. We concluded that mandibular incisors tended to become more crowded postretention. However, in contrast to previous reports, we calculate this relapse to be small. Neither before treatment nor posttreatment variables were predictive of relapse.

Adolescent↗
PubMed1998

Morphologic operations used to distinguish between two patient populations differing in periodontal health.

OBJECTIVES: This study was conducted to determine whether morphologic operation procedures applied to digitized, non-standardized, clinical radiographs of mandibular alveolar bone could be used to distinguish between a population of patients diagnosed with periodontitis and a population of patients either diagnosed with gingivitis or having healthy gingivae. STUDY DESIGN: Two groups, one consisting of 29 patients who either had healthy gingivae or had been diagnosed with gingivitis and the other consisting of 32 patients who had been diagnosed with periodontitis, were compared. Pre-existing clinical radiographs were digitized, and for each patient three to six regions of interest were placed on an image of the mandibular posterior region of the interdental bone. The regions of interest were processed under two morphologic-operations protocols, and a mean density (referred to as an MO number) was calculated for each patient. With paired t-tests, the resulting MO numbers for the two groups were compared. RESULTS: The two populations were statistically different (p < 0.05). CONCLUSION: The results of this study indicate that morphologic operations have the potential to differentiate between patient groups differing in periodontal health.

Adult↗
PubMed1998

Comparison of reliability of manual and computer-intensive methods for radiodensity measures of alveolar bone loss.

OBJECTIVE: To compare the reliability of radiodensity measurements made from dental radiographs with manual and a novel computer-intensive methods. METHODS: As part of a prospective study of postmenopausal women, a series of seven vertical bitewing radiographs were taken of 36 patients. One of each set of radiographs was repeated. The original and the corresponding duplicate radiographs were used in this study. Radiographs were digitized at 50 microns spatial resolution and 12-bit gray-scale resolution. For the Manual Method, original and duplicate radiographs were manually cropped to improve image homology, histogram matched and mean pixel gray-scale values determined for an alveolar bone ROI within each image. For the computer-intensive method, images were put into registration with ANALYZE software (Mayo Foundation, Rochester, MINN, USA), cropped automatically, histogram matched and color-coded on the basis of the per cent difference. Alveolar bone ROIs adjacent to clinical crowns and root surfaces whose color code indicated less than a 5% change were sampled. Method error (ME) and the coefficient of variation of method error (CVME) were calculated. RESULTS: With the Manual Method the SD between original and duplicate measures was 95.21 out of 4096 gray scale values; ME = 67.32; CVME = 3.78%. For the computer-intensive method, the corresponding values were 54.74, 38.71, and 2.29%. CONCLUSIONS: The new computer-intensive method resulted in a 40% improvement over the Manual Method in the precision of radiodensity measurements.

Absorptiometry, Photon↗
PubMed1998

Reliability of linear alveolar bone loss measurements of mandibular posterior teeth from digitized bitewing radiographs.

Observer reliability in performing linear measurements between the cementoenamel junction and alveolar crest was determined for mandibular posterior teeth from digitized clinical bitewing radiographs acquired during recall examinations. 6 measurements (corresponding to traditional probing measurements) were made per tooth by 3 observers. Mesial and distal measurements made to the most coronal aspects of the alveolar crest were the most reliable and least biased. As was anticipated, intra-observer reliability was better than inter-observer reliability although the 3 observers of our study were able to detect a significant mean change (0.1 mm, p<0.0001) in alveolar bone height over a 1-year period for 10 patients. For our most reliable and unbiased measurements (mesial measurements to the alveolar crest), a change of 0.54 mm (90th percentile) would be required to indicate change at a site from one time to the next. Based on the reliability of our digital radiographic measurements, with the alpha error rate set at 0.05 and beta at 0.20, a difference in alveolar bone height of 0.3 mm could be detected with a patient sample size of between 13 (best case) and 54 (worst case).

Alveolar Bone Loss↗
PubMed1998

A comparison of 2 patient populations using fractal analysis.

This study was undertaken to demonstrate that the fractal dimensions calculated using digitized non-standardized, clinical radiographs of mandibular alveolar bone from a population of patients diagnosed with periodontitis are statistically different from fractal dimensions calculated from another population diagnosed as having gingivitis or healthy gingiva. The fractal dimension was calculated using a public domain fractal analysis program distributed by the National Institutes of Health (NIH). Fractal dimensions were calculated from digitized clinical radiographs for 29 patients diagnosed with healthy gingiva and/or gingivitis and 32 patients diagnosed with periodontitis and compared. To estimate the reproducibility of the technique, we recalculated the fractal dimension from images of the gingivitis patients 3 months after the original calculations and compared them to the originals. A 2 sample, 2-tailed Student t test showed the gingivitis data group to be different from the periodontitis data group (P = 0.0012). The original gingivitis and repeat gingivitis groups fractal dimension calculation were the same and analysis showed the two data sets were not significantly different (P = 0.99). We found that: 1) fractal dimensions could be used to distinguish between gingivitis and periodontitis patient groups; 2) fractal dimensions could be calculated from non-standardized clinical radiographs; and 3) fractal dimensions for gingivitis patients were reproducible over a 3-month period.

Adult↗
PubMed1997

Implant site assessment using panoramic cross-sectional tomographic imaging.

OBJECTIVES: The purpose of this study was to evaluate the ability of two different panoramic imaging systems to produce cross-sectional images with accurate vertical dimensions of the posterior mandible. STUDY DESIGN: Three partially edentulous human cadaver mandibles were used for this study. On each mandible, three potential implant sites were arbitrarily identified in an area between the mental foramen and the ascending ramus. Each site was imaged using two different panoramic machines. Using each image, the mandible's outline, cortical thickness, and position of the mandibular canal were traced on clear acetate film. The mandibles were then sectioned at each site to serve as a gold standard. The cadaver sections and tracings (corrected for magnification) were measured, recording the overall mandibular height, distance from the crest of the ridge to the superior aspect of the mandibular canal, and the thickness of the cortical bone at the most inferior aspect of the mandible. RESULTS: There were no significant differences between either of the system's image measures and the gold standard when considering the distance between the crest and the mandibular canal. Differences were noted between the systems measures and the gold standard in the assessment of the cortical bone thickness and the overall mandibular height. CONCLUSIONS: Both imaging systems can be useful for vertical measurements of a potential implant site in the posterior mandible.

Alveolar Process↗
PubMed1997

The effect of image variations on fractal dimension calculations.

OBJECTIVES: We used digitized dental radiographs of alveolar bone to test the hypothesis that the fractal dimension, as calculated with the program "ImageFractal" was independent of variations in X-ray exposure, beam alignment, and region of interest placement. STUDY DESIGN: The radiographic data set consisted of 72 radiographs digitized with 200 microns pixels. Radiographs were obtained with the use of three time settings and two alignments. Rectangular regions of interest were placed on each digital image over the interdental bone between the mandibular first and second molars on six hemimandibles. Each of six hemimandibles had identical copies of a unique region of interest placed on every image in its series. New regions were made 3 months later. A fractal dimension was computed from each region of interest with the caliper method included in ImageFractal, a public domain program available through National Institutes of Health. The resulting fractal dimensions were evaluated with two repeated measures analysis of variance. RESULTS: No significant differences were found between the fractal dimensions calculated for baseline images and those from overexposed and underexposed images, from images with 4 to 6 degrees of alignment variations, or from repeat regions of interest. CONCLUSION: The results support the hypothesis that fractal dimensions derived from digitized dental radiographs are not affected by variations in exposure or small variations in alignment and imply an absolute region of interest placement may not be necessary. However, caution should be used with the use of the fractal dimension to discriminate among alveolar bone variations until further research is performed.

Absorptiometry, Photon↗
PubMed1997

The effect of varying the region of interest on calculations of fractal index.

OBJECTIVES: To compare the effect of using regions of interest (ROIs) of different size and shape on the fractal index of alveolar bone. STUDY DESIGN: Two sets of clinical posterior bitewing radiographs were used to calculate the fractal index (S). Two comparisons were made. First, S was calculated from large interdental ROIs that included small amounts of root structure and compared with S from small ROIs that included no root structures. Then S was calculated from large interdental ROIs (similar to those used for the first set) and compared with S calculated from ROIs that included nearly all of the mandibular alveolar bone (and adjacent root) present on the bitewing. RESULTS: For the first comparison, paired t-tests showed that fractal indices calculated with the large ROIs were significantly different from the respective indices calculated from the small ROIs (P < 0.001). For the second comparison, the fractal indices calculated from the large quadrant ROIs were not significantly different from those calculated from the large ROIs (P = 0.120). CONCLUSION: ROI size and shape may affect the results of fractal analysis of alveolar bone.

Alveolar Process↗
PubMed1997

Attachment loss with postmenopausal age and smoking.

To determine whether postmenopausal bone loss and factors associated with osteoporosis affect tooth retention, we examined vertebral and proximal femoral (postcranial) bone mineral density in relation to tooth loss and attachment loss in a cross-sectional study of 135 postmenopausal women (age range 41-70 yr). Women had at least 10 teeth and no evidence of moderate or severe periodontal disease. Full-mouth attachment loss measurements were made using a pressure-sensitive probe, and bone density was determined by dual-energy X-ray absorptiometry. Attachment loss was correlated with tooth loss (number of remaining teeth, radiologically determined), but not with vertebral or proximal femur bone density. Multivariate analysis showed current smoking (p = 0.01), years since menopause (p = 0.02) and the interaction of age and current smoking (p < 0.01), to be statistically significant predictors of attachment loss in our study population.

Absorptiometry, Photon↗
PubMed1996

Spatial resolution in radiometric analysis of enamel loss. A pilot study.

This pilot study was undertaken to determine whether spatial resolution affects radiometric analyses aimed at detecting progressive enamel loss. Four teeth were weighed, attached to a positioning device, and evaluated with radiography. A 1 mm strip of enamel was removed from each tooth, and the teeth were weighted again and reexamined by radiography. This process was repeated five times until 1/2 mm of dentin was removed. The radiographs were digitized twice with 59 and 200 microns pixels at 8 bits, providing two series of images with the optical densities converted into 256 gray levels. Each series of images was adjusted for contrast variation. Regions of interest were drawn on the crowns, and cumulative percent histograms (CPHs) were calculated. Within a series of CPHs enamel reduction resulted in shifts in the CPHs that were directly proportional to the amount of enamel removed. CPH shifts associated with the smaller 59 microns pixels accounted for 68% of the variation in weights caused by enamel reduction, whereas the shifts associated with the larger 200 microns pixels accounted for 50%. The results indicate that pixel size does affect radiometric determinations of enamel reduction.

Dental Caries↗
PubMed1996

Histogram-matching and histogram-flattening contrast correction methods: a comparison.

OBJECTIVES: To compare the results or two methods of histogram matching and two methods of histogram flattening for their ability to correct for contrast variations in digital dental images. METHODS: A custom-built, aluminium stepwedge with 0.1, 0.5 and 1.0 mm steps was placed over Ektaspeed films and exposed for 0.06, 0.12 and 0.25 s, respectively. Radiographs were digitized at 50 microns spatial resolution and 12-bit contrast resolution. Contrast corrections were performed using Rüttimann et al.'s algorithm (1986) for one method of matching (RM) and flattening (RF) and Castleman's algorithm (1979) for the other method of matching (CM) and flattening (CF). Mean pixel grey-scale values were determined for each step. The 0.12 s exposure was considered to be the target image exposure. Absolute differences in pixel grey-scale values between the target images and the modified images were determined. RESULTS: The median values of the absolute differences in pixel grey-scale values between the target images and the contrast corrected images were: CM = 4.3; RM = 4.1; CF = 70.2 and RF = 70.2. CONCLUSION: Castleman's and Rüttimann's matching algorithms perform equally well in correcting digital image contrast. Histogram flattening was less effective.

Algorithms↗
PubMed1996

Digital enhancement of radiographs: can it improve caries diagnosis?

Unlike traditional radiographs, digital images are electronically alterable and offer the potential for enhancing diagnostic information. The authors conducted a small-scale study to examine differences in clinicians' diagnoses of caries using traditional radiographs and digitized images vs. microscopic diagnosis. Two general dentists and one oral-maxillofacial radiologist scored the images for caries. This study suggests that digital enhancements may aid some clinicians in caries diagnosis.

Dental Caries↗
PubMed1996

Spatial resolution and angular alignment tolerance in radiometric analysis of alveolar bone change.

This pilot study was undertaken to determine the effect of x-ray beam alignment and spatial resolution on quantification of alveolar bone using radiometric techniques. Six (6) dry mandibles were radiographed at 70 kVp, 10 mA, 0.6 seconds using D-speed film, with a bone chip (2.64, 4.10, or 6.07 mg) present or absent at 7 x-ray beam alignments (0 degree, 2 degrees horizontal, 2 degrees vertical, 4 degrees horizontal, 4 degrees vertical, 6 degrees horizontal, 6 degrees vertical). This resulted in 28 radiographs per mandible. Radiographs were digitized using 50- and 200-microns pixel spatial resolution. Image gray levels were standardized using a simple look-up table shift. Regions of interest (ROIs) were positioned on the alveolar bone where the bone chips had been placed. Cumulative percent histograms (CPH) were calculated for those ROIs. Regression analysis was used to evaluate the relationships between CPH changes and bone chip size as x-ray beam angulation and spatial resolution was varied. The resulting R2 values for angulation ranges of 0 degree to 1.4 degrees, 1.5 degrees, to 2.4 degrees, and 2.5 degrees to 5.5 degrees were: 0.983, 0.941, 0.891 for 50-microns pixel images and 0.869, 0.909, and 0.774 for 200-microns pixel images. We conclude that 50-microns pixel spatial resolution is apparently superior to 200-microns pixel images if radiometric data is to be evaluated. With 50-microns pixel spatial resolution, alignment variations up to 5 degrees may be acceptable in clinical studies, depending on the magnitude of bone change that is to be detected.

Alveolar Process↗
PubMed1995

Reproducibility of beam alignment using different bite-wing radiographic techniques.

Longitudinal radiographic assessment of crestal alveolar bone plays an important role in the diagnosis and long-term evaluation of periodontal disease in patients. Because practitioners use several radiographic techniques to obtain bite-wing radiographs, horizontal and vertical alignment errors could adversely affect the diagnostic impression gained from this type of radiographic examination. The objective of this study was to determine the alignment reproducibility of three different clinical techniques used to acquire bite-wing radiographs. Patients who require bite-wing radiographs as part of a dental school screening process were radiographed with modified standard bite-wing tabs and two different intraoral positioning devices. Horizontal and vertical angular deviations were measured and alignment errors were calculated for each radiograph. The mean total angular alignment error for the standard bite-wing tab technique was 6.2 degrees, whereas the mean alignment error for both positioning devices was less than 1.8 degrees. The results of this study suggest that an intraoral positioning device for acquiring bite-wing radiographs should be used.

Alveolar Bone Loss↗
PubMed1995

Intrafilm controls to standardize grey level variations in digitized radiographs.

OBJECTIVES: Radiometric analysis can be used to identify small changes in grey levels taken from investigator-defined regions of interest (ROIs). To do this, standardization of the radiographic optical densities and image grey scales is considered essential. Rigid standardization is one of the impediments to applying existing radiometric techniques to clinical practice. The purpose of this study was to evaluate the use of grey-level variations from a series of intrafilm control regions of interest (ROIs) to adjust radiometric grey-level data taken from test ROIs. METHODS: After digitization, ROIs were drawn on three locations: the background, anatomical crown, and tooth root. Mean grey levels, histograms and cumulative percent histograms (CPHs) were determined for each group. With the goal of decreasing the distribution of these curves from their unadjusted grey-level positions to zero (superimposing all curves), shifts required to align the control CPHs were applied to test CPHs. Changes between the pre- and post-adjusted CPH distributions were measured. RESULTS: Intrafilm controls provided a combined decrease of 45.3% in the grey-level distribution error. CONCLUSION: While CPHs can be adjusted using intrafilm controls, these adjustments may have limited benefit.

Humans↗
PubMed1994

Bitewing-based alveolar bone densitometry: digital imaging resolution requirements.

The resolution requirements were determined for detection of incremental alveolar bone loss from digitized Ektaspeed radiographs. Ten clinical radiographs were examined with a calibrated optical microscope to measure the smallest feature of interest discernible for alveolar bone. Images of trabeculae > 100 microns in diameter could be identified, but smaller ones could not be resolved. The Nyquist Criterion requires sampling with 50 microns (or smaller) pixels to measure such features. Numerous 25 microns Ag aggregates were present. Fifty microns resolution is a practical compromise between noise level and feature resolution. In another example of 10 bitewings digitized at 8 bit grey scale, about half the available range was used for alveolar bone, resulting in uncertainty, over a range of 2 optical density (OD) units, of about 1.42% at the average OD for alveolar bone (1.1). With the same radiographs digitized at 12 bit resolution, over 2000 of 4096 grey scales were used with a corresponding uncertainty of about 0.09%. Twelve-bit precision was also able to resolve smaller increments in an aluminium stepwedge than was 8 bit precision. Twelve-bit grey scale and 50 microns spatial resolution are recommended for alveolar bone densitometry performed with Ektaspeed radiographs.

Absorptiometry, Photon↗
PubMed1993

35-mm film scanner as an intraoral dental radiograph digitizer. I: A quantitative evaluation.

A 35-mm slide scanner digital imaging system was tested for its suitability in digitizing intraoral dental radiographic film for quantitative studies. The system (Nikon model LS-3510AF Nikon Electronic Imaging, Nikon, Inc., Melville, N.Y.) uses a charge-coupled device linear photodiode array. The data content in the original film images was evaluated, and the system performance assessed objectively with the use of specially designed test films. Radiometric and geometric performances for the digitizing system were extracted from measurements and observations, and these were compared with published data for two other film digitizing systems (video camera DAGE MTI, Michigan City, Ind. and Barneyscan 35-mm film digitizer Barneyscan, Berkeley, Calif.). The techniques used to evaluate this system are easy and suitable for evaluation of any digitizing system. This scanner system (Nikon) was superior to previously evaluated systems in transforming and recording radiographic film densities across the range (0.3 to 2.0 optical density units) of clinically relevant optical densities. The scanner offers substantial advantage over the other digitizing systems for gray scale information from clinically important optical densities.

Evaluation Studies as Topic↗