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Little details, little errors mar and blemish X-rays.
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Multiple pre-eruptive intracoronal radiolucent lesions in the permanent dentition: case report.
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[Technique for bitewing and occlusal radiography. Lecture 4].
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Individual identification by means of conventional bitewing film and subtraction radiography.
An analysis of simulated post- and antemortem (p.m. and a.m.) victim radiographs was performed. Existing pairs of bitewing radiographs randomly sampled from a large population of adolescents were used. Two categories of individuals were included based on dental therapy conditions (none or few simple fillings). Subtraction images were performed of pairs of bitewings originating from the same individual (identical images) and different individuals (non-identical images) within each group. Four observers were asked to match the bitewings and to assess the subtraction images with respect to identity based on the score system: 1 = 'eliminated', 2 = 'possible', 3 = 'likely', or 4 = 'certain'. Three observers each mismatched the film radiographs among two out of 12 individuals without fillings. True positive identification (identified by scores 2 + 3 + 4) of subtraction images were made in 10-12 individuals out of a possible 12. The range of false positive (FP) and false negative (FN) scorings was 3-15 and 0-2, respectively. All observers were capable of correctly matching bitewings originating in the 12 individuals with amalgam fillings. By use of subtraction radiography, 12-14 identical images out of a possible 15 were assessed correctly. The range of FP and FN scorings of subtraction images in this group was 1-4 and 1, respectively. Defining only score 4 as positive identification, the sensitivity of the subtraction technique decreased from approximately 0.90 to 0.70 in both categories of individuals, while specificity increased to almost 1.00 from 0.82 vs. 0.96 in the categories with and without dental restorations. Bitewing radiographs from single individuals within a group of individuals were sufficiently identical to allow for valid identification by a strict criterion. The subtraction technique may add to the subjective matching of radiographs as a screening test in victim identification.
Comparison of panoramic and intraoral radiography and pocket probing for the measurement of the marginal bone level.
Panoramic, bitewing and periapical radiography and probing for measurement of the marginal bone level were compared. Altogether 237 sites of 23 patients were examined. Radiographs were taken with a splint containing steel balls to allow calculation of the enlargement of the radiographs. Probing was done before and during flap surgery using the same splint. The open bone measurement represented the true value. All radiographs were assessed by 5 observers. The mean enlargement of panoramic radiography was 27% in the upper and 26% in the lower arch. For bitewing and periapical radiography, it was 8% in the upper and 4-5% in the lower arch. All methods underestimated the bone loss. Probing bone level before surgery was most accurate, deviating at most 5% from the true value. Periapical radiography was more accurate than panoramic and bitewing radiography (p less than 0.001). Panoramic radiography presented a slightly lower mean accuracy than bitewing radiography (p less than 0.05). The underestimation of the bone loss ranged from 13 to 32% in orthopantomograms, 11-23% in bitewing and 9-20% in periapical radiographs. The interobserver variation of the radiographic methods was substantial.
Patient discomfort and cross-infection control in bitewing examination with a storage phosphor plate and a CCD-based sensor.
OBJECTIVES: The aim was to compare a CCD-based sensor and a storage phosphor plate with respect to patient discomfort and the efficacy of a simple cross-infection control procedure in connection with a posterior bitewing examination. METHODS: 130 patients accepted to have one posterior bitewing of the left and right side taken with two digital radiography systems, the Digora phosphor plate and the Trophy RVG XL, CCD-based sensor system. The patients assessed their feeling of discomfort after the examination on a 100-mm. Visual Analogue Scale (VAS). Microbiological samples were taken from the RVG sensor and cord and from the Digora envelope, plate and scanner during examination of 14 patients. The samples were plated and incubated anaerobically, and the colony-forming units counted. RESULTS: Median VAS score for discomfort was 20 min for Digora and 32 min for the RVG sensor (P < 0.001). Median total counts of cultivable bacteria were low (< 20), the majority being catalase-positive, Gram-positive cocci and Gram-positive rods, presumably skin bacteria. Only the samples taken from the enveloped Digora plate and the rubber tube coated RVG sensor immediately after exposure yielded large numbers of oral bacteria. CONCLUSION: The phosphor plate was less unpleasant than the CCD sensor. Cross-contamination posed a minor problem for both systems when a simple, standard hygiene procedure was followed.
Preventing radiographic irregularities. Proper technique for periapical, bitewing, panoramics.
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Evidence for healing of class II and III furcations after GTR therapy: digital subtraction and clinical measurements.
In 21 patients with advanced periodontitis, 39 teeth exhibiting class II (n = 21) and class III (n = 18) furcations were treated by the guided tissue regeneration technique using expanded polytetrafluoroethylene (ePTFE) membranes (n = 20) or bioabsorbable barriers (n = 19), respectively. Clinical parameters were assessed before and 6 months after surgery. Presurgically and 6 months postsurgically, 35 pairs of standardized bitewing radiographs were taken. Using subtraction radiography, gain of bone density within furcation areas was assessed. Eighteen radiographs showed sufficiently accurate geometry to be analyzed by subtraction. Within the defects suitable for subtraction, the average gain of vertical attachment assessed was 1.35 +/- 1.27 mm in the class II furcation group and 1.58 +/- 1.37 mm in the class III furcation group. The average horizontal attachment gain in the class II furcation group was 1.96 +/- 0.59 mm. No statistically significant differences were observed between results after GTR therapy using non-resorbable and bioabsorbable barriers. Radiographic bone gain as assessed by subtraction analysis correlated with vertical (r = 0.458, P < 0.025) and horizontal (r = 0.734, P < 0.005) attachment gain. A statistically significant number of more radiographs for maxillary molars were not suitable for subtraction analysis than mandibular molars (P < 0.05). Further, statistically more radiographs that were taken with potentially unstable support of the filmholder were not suitable for subtraction analysis than those with stable support (P < 0.05). There is a statistically significant correlation between clinical improvements and bony fill within furcation defects. Only 18 of 35 pairs of radiographs were suitable for subtraction analysis. Subtraction analysis of maxillary molars seems to be more difficult than assessment of radiographic bone changes in mandibular molars. Potentially stable support of the filmholder seems to be a condition to provide radiographs suitable for subtraction analysis.
Occlusal caries diagnosis in molar teeth from bitewing and panoramic radiographs.
INTRODUCTION: Previous studies have implied that the panoramic radiograph was inferior to the bitewing radiograph for caries diagnosis. However, these clinical studies lacked a method of validation. The aim of this study was to use an electronic caries meter (ECM II, LODE, Groningen, The Netherlands) to validate occlusal caries diagnosis made from bitewing and panoramic radiographs. MATERIALS AND METHOD: Forty-nine Army recruits were examined with the ECM, and had bitewing and panoramic radiographs taken. In total 299 molar occlusal surfaces were available for examination. Seven examiners viewed the bitewing and panoramic radiographs on two separate occasions and assessed each occlusal surface for dentine caries as 1: almost definitely no caries, 2: probably no caries, 3: unsure, 4: caries probably present, and 5: caries almost definitely present. This was repeated on 20% of the radiographs at two further separate sittings. ECM conductance readings greater than 9 were taken to indicate dentine caries. Examiner decisions that caries was probably and definitely considered to be present were taken as positive diagnoses. RESULTS: Bitewing and panoramic radiographs provided sensitivity values of 0.25 and 0.19 and specificity values of 0.93 and 0.97 respectively. ROC analysis indicated no statistically significant difference in diagnostic quality between the bitewing and panoramic radiographs. Intra-examiner reproducibility was found to be poor to moderate (Kappa values for bitewing = 0.31-0.44, panoramic = 0.07-0.54). CONCLUSION: No difference in overall diagnostic performance was found between bitewing and panoramic radiographs for the diagnosis of occlusal dentine caries.
A diagnostic comparison of panoramic and intraoral radiographs.
OBJECTIVE: This study compared panoramic and intraoral radiographic surveys in the evaluation of specific dental pathoses in Air Force personnel. STUDY DESIGN: The radiographs of 30 subjects were read singly and in various combinations: panoramic survey only; periapicals plus bitewings; panoramic survey plus bitewings; and panoramic survey plus periapicals plus bitewings. Three independent, blinded examiners using standardized viewing conditions assessed the radiographs in random order for the presence of caries, periapical pathoses, bone loss, furcation involvement, impacted/unerupted teeth, internal/external root resorption, and retained roots. The consensus radiographic standard of true pathosis was the simultaneous interpretation by the three examiners of all radiographs for each subject. RESULTS AND CONCLUSIONS: The panoramic survey by itself was shown to have the lowest correlation with the consensus radiographic standard when basic military trainees with generalized dental pathoses were evaluated. The combination of panoramic survey plus bitewing radiographs exhibited a diagnostic yield for specific pathoses that was comparable to that of panoramic survey plus bitewings plus periapicals.
Bitewing examination with four digital receptors.
OBJECTIVES: To evaluate recording errors and patient discomfort during bitewing examinations using four digital receptors. METHODS: Seventy-eight patients had two bitewings taken on each side of the mouth with the intention of displaying the tooth surfaces from the distal surface of the canine to the distal surface of the most posterior molar, using four digital receptors, two charge-coupled device (CCD) and two photostimulable phosphor (PSP) systems. The patients scored their feelings of discomfort during the examination on a visual analogue scale. Receptor positioning errors in the sagittal plane were determined from the tooth surfaces present on each image and in the vertical plane from the presence of the alveolar bone crest. Cone positioning errors were determined from cone cuts. RESULTS: Canine and premolar surfaces were more often not depicted on the CCD images than on the PSP images (P<0.05). Cone cuts occurred in 19% of DenOptix images, in 9% of Digora images and in one Planmeca image. The bone crest was more often missing in the upper jaw on Planmeca images than on PSP images (P<0.01). In the lower jaw, Trophy images more often missed the bone crest than the other systems (P<0.05). Patients ranked the receptors as follows (with increasing discomfort): DenOptix, Planmeca, Digora and Trophy, with all being significantly different (P<0.05). CONCLUSIONS: It was more difficult to correctly position CCD sensors than PSP plates in the vertical plane, resulting in more images with missing alveolar bone crest. CCD sensors most often did not display the most anterior surfaces in a bitewing examination.
A prospective comparison between findings from a clinical examination and results of bitewing and panoramic radiographs for dental caries diagnosis in children.
AIM: To compare the findings of a clinical examination with those from bitewing (BW), panoramic (Pan) and panoramic plus bitewing (PanBW) radiographs for dental caries in children. METHOD: A population of 39 children, aged 3.8 to 11.9 years, who required radiographs as part of their initial assessment for care in the Department of Paediatric Dentistry (Leeds), was selected. Each subject was examined clinically for dental caries. Subsequently, a paediatric dentist and a specialist in dental radiography read the radiographs. ANALYSIS: A database in Microsoft Access was used to compare the examiners readings for each radiographic view; agreements were taken to be a consensus. Disagreements were re-viewed by both examiners to arrive at a consensus. Radiographic results were compared with those of the clinical examination. RESULTS: The clinical examination identified 6.0% (95% CI 4.1 to 7.8, p<0.001) more carious surfaces than Pan. Clinical examinations also identified more carious surfaces than BW 1.2% (95% CI -0.7 to 3.2, p<0.247) and PanBW 0.6% (95% CI -1.1 to 2.3, p<0.533) but these differences were not statistically significant. When occlusal surfaces only were compared, the clinical examination identified significantly more carious occlusal surfaces then BW (15.2%, p<0.001), Pan (17.1%, p<0.001) and PanBW (13.5%, p<0.001). Comparing the approximal surfaces only, the BW and PanBW identified significantly more carious surfaces than the clinical examination, 5.1% (p<0.001) and 4.3% (p<0.001) respectively. CONCLUSION: The use of a clinical examination with PanBW provided the maximum information on dental caries in the primary and mixed dentitions, particularly for approximal surfaces. This is important in planning comprehensive dental care for children.
Comparison of clinician agreement during visualization of conventional and digitized bitewing radiographs.
Digital technology is becoming more common in dental practices. Indirect digitization of radiographs can be an alternative to direct digital systems. This study was designed to evaluate intra-observer, inter-observer, and inter-technique agreement of proximal caries diagnosis on bitewing radiographs before and after indirect digitization. Four bitewing radiographs were obtained from 50 dental students. Conventional films were digitized with a flatbed scanner at 150 and 300 dpi. Three observers recorded the presence and depth of caries on 1,642 proximal surfaces for the conventional and digitized radiographs. Radiographs were evaluated twice (one week apart), using each viewing technique. Intra-observer, inter-observer, and inter-technique agreement (Kw) were determined. The intra-observer, inter-observer, and inter-technique agreements of proximal caries diagnosis on bitewing radiographs before and after indirect digitization were moderate to good.
Clinical and historical predictors of dental caries on radiographs.
This report evaluates the efficacy of the clinical predictors of caries proposed in the USA FDA guidelines for prescribing dental radiographs. The clinical findings that best associate with the presence of any caries where a history of pain, a defective restoration, unusual calcification, and an abutment tooth for a fixed or removable prosthesis. There is a group of measures of periodontal disease that were also weakly associated with the presence of caries. The best predictors of caries extending into the dentin were the presence of clinically defective restorations, a history of pain, and signs of periodontal disease. Proximal lesions are likely to appear on teeth with defective restorations, unusual calcification or large or deep restorations. The best predictors of radiographic root caries are periodontal findings such as furcation involvement, increased mobility, a history of periodontal therapy and gingival recession. While the specificities for these findings were generally high, the sensitivities and positive predictive values were usually under 50%, and often much lower. Thus these clinical findings cannot successfully be used as exclusive criteria for ordering radiographs for caries detection. Because caries is found fairly frequently, and because we are unable to identify tooth-specific criteria with clinically useful sensitivity and specificity values, these data support the FDA panel recommendation of bitewing examinations for all new patients and at periodic intervals for recall patients.
Assessing the accuracy of caries diagnosis via radiograph. Film versus print.
BACKGROUND: The authors conducted this study to determine if proximal caries diagnoses made using bitewing radiographic images printed on photographic paper were comparable with diagnoses made using traditional radiographic film images. METHODS: The authors digitized 15 posterior bitewing radiographs that contained 74 carious and 127 sound unrestored proximal surfaces and printed them on photographic paper. Fourteen dentists evaluated the radiographs and two printed image formats (4 x 3 centimeters and 8 x 6 cm) for evidence of caries. The diagnostic accuracy and interobserver agreement for caries diagnoses obtained in the two printed image formats were compared with those for radiographic film images. RESULTS: Overall, the diagnostic accuracy of printed images did not differ significantly from radiographic film images for dentinal caries. However, for caries limited to the enamel surface, a decrease in sensitivity was noted in six of the 14 observers for the smaller print images, while no significant differences in the diagnoses of enamel caries were observed among any of the observers in the enlarged print format. CONCLUSION: This study provides evidence that printed images can be used to diagnose dental caries reliably. CLINICAL IMPLICATIONS: The results of this study indicate that the diagnostic information obtained by viewing printed images is equivalent to that obtained by viewing standard radiographs. Size of the printed image also may be important in caries diagnosis and care must be taken to print bitewing radiographic images at a size that optimizes interpretation. Other factors that must be considered are the type of printer, printer resolution, paper quality and type of ink used. With careful consideration of printing parameters, clinicians can be assured of diagnostic quality in printed images.
Interobserver variability in pediatric radiographic quality assessment.
Programs to monitor radiographic quality have been established in several Canadian provinces. These quality assurance programs depend in part on the evaluation of technical radiographic errors. Interobserver variability in the assessment of these errors reduces the reliability of such information. This study examined the interobserver variability of three dental specialists involved in documenting radiographic technical errors, and the need for retakes following the initial radiographic surveys of 200 children. Observers were trained and calibrated to standardize the evaluation of errors. The overall frequency at which errors were found in bitewing radiographs was consistent with the results of previous studies, but the number of periapical and panoramic technical errors was low. Interobserver variability occurred in the recording of radiographic technical errors, primarily in the recording of bitewing errors. There was also interobserver variability in the ordering of retakes. The interobserver variability in the assessment of radiographic quality could not be eliminated, despite prior observer training. This could indicate that the decision to retake a radiograph may be based on subjective criteria, especially in the absence of clinical information.
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.