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PubMed1993

Radiographic screening examination: frequency, equipment, and film in general dental practice in Denmark.

The aim of the present study was to evaluate types and frequencies of radiographic screening examinations, and radiographic equipment and film used in general dental practice in Denmark. A questionnaire was mailed to 400 randomly selected dental practitioners. A total of 258 questionnaires were returned, out of which 249 were analyzed. Two-thirds of the respondents performed radiographic screening examinations, of which bitewing-screening was the one most frequently used for first-visit and regular patients. The more recent their graduation year, the more apt were dentists to perform radiographic screening examinations. More than 40% of the dentists had radiographic units operating at a voltage capacity of 60-70 kV, and more than 50% had facilities for automatic or semiautomatic processing. Only one-quarter of the respondents used the Kodak Ektaspeed film (E-speed film). The results show that radiographic procedures and film used in general dental practice are not always in accordance with guidelines and recommendations.

Denmark↗

PubMed2003

Incidence of dental radiographic procedures during a 48-month population-based study of dentate adults.

OBJECTIVES: The purpose of this population-based study was to quantify the incidence of radiographic procedures and the intervals between radiographic exposures. STUDY DESIGN: The Florida Dental Care Study was a prospective cohort study of a representative sample of dentate adults. In-person interviews and dental examinations were conducted at baseline, with subsequent interviews every 6 months during 48 months of follow-up. Dental record information was abstracted afterward. RESULTS: Thirteen percent of all dental procedures, and 42% of all diagnostic procedures, were radiographic. Annual person-level incidence of receipt of any radiograph was 48%. Incidence of specific types of radiographic procedures ranged from 5% to 30%. Among the 45% of the sample population who had had more than 1 bitewing procedure, 70% of the intervals between bitewing exposures were 1 year or longer. Receiving more than 1 full-mouth series or panoramic radiographic in any 24-month period was very rare. CONCLUSIONS: Annual incidence of radiographic procedures was substantially higher than the incidence reported in previous studies based on responses by dentists to hypothetical situations, but was stable during the 4 years of follow-up. On the basis only of intervals between exposures, and not of clinical status on the day of service, there was no substantial evidence of inappropriately frequent radiographic examinations.

Adult↗

PubMed1997

Occlusal 'hidden caries'.

The term 'hidden caries' is used to describe a carious lesion seen in dentine on a bitewing radiograph where clinically the occlusal enamel appears sound or only minimally demineralized. The relative rise in the number of clinically sound occlusal surfaces over the past two decades could be a reason why hidden caries has come into sharper focus for practitioners and researchers. Dentists, routinely examining children who are clinically caries-free, may be shocked to discover a large lesion on a radiograph that they have apparently missed clinically. This underlines the importance of careful examination of the radiograph. It is important that the practitioner appreciates the possibility of hidden caries, and the value of the radiograph in its diagnosis.

Child↗

PubMed1992

Effects of digital grey-scale modification on the diagnosis of small approximal carious lesions.

The aim of this study was to evaluate the accuracy of approximal caries diagnosis from digitized radiographs and digitally modified radiographic images, compared with conventional radiography. Twenty bitewing radiographs were digitized and from the digitized radiographs mirror-images were produced, resulting in 40 digital images. The caries progress at three approximal surfaces was graded by 12 dentists from conventional radiographs, digital unmodified images and digitally modified images. The image modifications were derived from the cumulative probability of grey values in the original digital image using one of five probability distributions: uniform, exponential, Rayleigh, hyperbolic cube root and hyperbolic logarithmic. Interobserver agreement was substantial. The unmodified digital images produced sensitivities comparable to radiographs but their specificities were lower. When the diagnostic task was to discriminate between 'caries' and 'no caries', the exponential, hyperbolic cube root and hyperbolic logarithmic modifications and radiographs performed equally well. With the decision cut off between 'dentinal caries' and 'no dentinal caries', the sensitivity of the hyperbolic logarithmic type of modification was statistically significantly superior to that of radiographs, but this modification was also associated with a statistically significant reduction of specificity. It is concluded that in particular the hyperbolic logarithmic modification can be an alternative to conventional radiography in incipient approximal caries diagnosis and restorative decision making.

Color↗

PubMed1997

Digital radiographic measurement of approximal caries progression in fluoridated and non-fluoridated areas of Rio de Janeiro, Brazil.

The effect of fluoridation on approximal caries progression was investigated using serial digitized bitewing images and conventional film images of 290 12-16-year-old schoolchildren who were lifetime residents of either Rio de Janeiro (a fluoridated area) or Mangaratiba and Angra dos Reis (non-fluoridated areas) in the state of Rio de Janeiro, Brazil. One examiner scored a maximum of 28 approximal surfaces of posterior teeth per subject using both methods. The intraexaminer reliability for rating lesion depth with digital images was comparable with that of the conventional bitewing films (namely, intraclass correlation of 0.99 and weighted Kappa scores of 0.82, respectively). Approximal surface D1S was 3.17 +/- 0.25 (sx) in fluoridated areas and 6.64 +/- 0.44 in non-fluoridated areas. After 1 year, the rate of caries progression in approximal surfaces was significantly lower in the fluoridated areas (0.54 +/- 0.14) as compared with the non-fluoridated areas (1.41 +/- 0.20) using Pitts' scoring system for conventional bitewing radiographs (P < 0.001). Similarly, the digital radiographic method was able to detect subtle differences in approximal caries progression in the enamel and the dentin (overall mean: 0.34 mm/year in fluoridated areas vs 0.49 mm/year in non-fluoridated areas, P < 0.05). The two radiographic methods were strongly correlated (rs = 0.7). Assuming a constant rate over time, these results indicate that lesion progression from the outer half of the enamel into the outer half of the dentin takes approximately 3-4 years in schoolchildren from the fluoridated areas compared to 2 1/2 years in the non-fluoridated areas.

Adolescent↗

PubMed2003

Dental caries experience in a young adult military population.

BACKGROUND: The purpose of this study was to investigate a group of young Australian adults to determine their caries experience and compare these current levels with similar aged cohorts over the past 30 years. Caries experience was also related to lifetime exposure of fluoridated water consumption. METHODS: This was achieved through a cross-sectional study involving Australian Army recruits seen for their initial dental examination at 1st Recruit Training Battalion, Kapooka. A total of 499 recruits had a clinical examination with the aid of bitewing radiographs and an orthopantogram. Sociodemographic and fluoride history data were elicited via a questionnaire. RESULTS: Mean DMFT scores for age cohorts were: 17-20 years of age--DMFT 3.59; 21-25 years of age--DMFT 4.63; 26-30 years of age--DMFT 7.07; 31-35 years of age--DMFT 9.04. Subjects with a lifetime exposure to fluoridated water had significantly lower dental caries experience (DMFT 3.80) than subjects with no exposure to fluoridated water (DMFT 5.15). CONCLUSIONS: It was found that there has been a decline in the level of caries experience in young Australian adults when the data from this study were compared to other ad hoc studies.

Adult↗

PubMed1999

Performance of film, desktop monitor and laptop displays in caries detection.

OBJECTIVES: To compare film, desktop monitor and laptop displays of digitized film images for accuracy of caries detection. METHODS: Sixty-four extracted teeth were mounted in eight models and radiographed with E-speed bitewing film. Films were digitized and displayed on a desktop monitor and a laptop display. Six observers scored the presence or absence of enamel and dentinal caries for each proximal surface for film, desktop and laptop displays. Results were compared with the histology of ground sections. ROC curve areas for each display mode and observer were assessed for significant differences with ANOVA. RESULTS: Diagnostic accuracy for proximal surface caries detection was not significantly different for conventional film or desktop monitor and laptop displays for detection of enamel caries (P = 0.9112) or dentin caries (P = 0.2796). CONCLUSIONS: Current laptop active matrix liquid crystal displays provide diagnostic quality for caries detection comparable with conventional film and desktop monitor displays.

Analysis of Variance↗

PubMedDate not supplied

Enhancing accurate assessment of periodontal disease by improving radiographic interpretation.

One of the most difficult areas of radiographic interpretation is periodontal assessment--an area critical to the success of the role of today's dental hygienists charged with the responsibility of evaluation and treatment of periodontal disease. The accurate evaluation and interpretation of radiographs, used by dental hygienists in conjunction with a clinical periodontal examination, is essential for effective planning and provision of nonsurgical periodontal therapy and appropriate referral as necessary. Definitive assessments require high quality radiographs with the minimum of distortion. Currently, bitewing radiographs are the technique of choice for evaluation of periodontal structures, with the use of vertical bitewings (which allow the clinician to view osseous tissue in both arches simultaneously) recommended as disease progresses. Clinicians have complete control over the various technical factors which may affect the processed radiograph and consequently the periodontal interpretation. The procedures highlighted in this article will result in good diagnostic quality with the minimum of exposure to the patient. Accurate radiographic assessment also depends upon the ability of the hygienist to recognize the appearance of normal periodontal tissues as well as the periodontium in a diseased state. Because in the early stages of disease radiographic changes are difficult to observe, a keen, well-trained eye is required to see the slight alterations occurring in the periodontium. This article reviews the radiographic appearance of normal tissues and the generally accepted sequence of radiographic changes associated with periodontitis according to the American Academy of Periodontology (AAP).

Alveolar Bone Loss↗

PubMed2004

Patient characteristics associated with receipt of dental radiographic procedures during a 48-month population-based study of dentate adults.

OBJECTIVE: The objective was to test hypotheses that patient characteristics are associated with receipt of specific types of radiographic procedures. STUDY DESIGN: The Florida Dental Care Study was a prospective cohort study of dentate adults. RESULTS: From 19% to 59% of participants received a full-mouth series, panoramic, bitewing, or periapical radiograph(s), depending on procedure type. Receipt varied with reason(s) for dental visit(s), baseline clinical condition, race, approach to care (problem-oriented or regular dental attender), and socioeconomic status. CONCLUSION: These findings underscore the distinction between what dentists hypothetically would prescribe, compared to what is actually received, receipt that results from the interaction between dentist recommendations and what patients will accept and pay for. Blacks and lower-income persons received dental radiograph types that were consistent with less comprehensive dental treatment, even with entry into the dental care system, reason(s) for incident dental visit(s), baseline clinical status, and regular versus problem-oriented attendance taken into account.

Adult↗

PubMedDate not supplied

Conventional, digital and contrast-enhanced bitewing radiographs in the decision to restore approximal carious lesions.

The purpose of the present investigation was to compare the accuracy of treatment decisions in proximal sites using three intra-oral radiographic systems. Additionally, the impact of an automated non-linear grey-level display was evaluated. Ten observers assessed 84 surfaces on bitewing radiographs for their requirement of restorative treatment using a 6-rank confidence scale. Radiographs were taken with conventional film images (Ultraspeed), a storage phosphor plate (Digora) and a CCD system (Dexis). Additionally, the Dexis software was expanded by a contrast enhancement routine (Dexis+). The restorative treatment threshold was defined as presence of macroscopic cavitation. Regarding the areas below mean ROC curves no significant differences were detected between the groups (p>0.05). Likelihood ratios for positive test results were: 5.29 (Ultraspeed), 8.14 (Digora), 9.67 (Dexis) and 11.37 (Dexis+). The accuracy of restorative treatment decisions based on digital and conventional radiographs is comparable. If a dichotomous treatment decision was requested, the digital systems demonstrated a notable tendency towards higher likelihood of true-positive decisions.

Confidence Intervals↗

PubMed2004

Radiation exposure in dental radiology: a 1998 nationwide survey in Switzerland.

OBJECTIVES: To measure the frequencies of dental radiological examinations in Switzerland and to determine the associated collective radiation doses. METHODS: To evaluate the frequencies, a sample of 376 dental practitioners and other institutions performing dental radiology were requested to fill in questionnaires designed to measure, amongst others, frequencies of dental radiodiagnoses according to type of examination, patient age and gender, dental specialty and type of surgery. The associated collective radiation doses were determined by multiplying the relevant frequencies with dose estimates obtained from recent measurements and calculations. RESULTS: The total number of dental examinations performed in Switzerland in 1998 was 4.1 million (581 per 1000 population). Periapical, bitewing and panoramic radiographs were the most frequent types of dental examinations. The collective dose associated with dental radiology was 71 person.Sv. This amounts to an annual average effective dose to the population of 10 muSv per caput, which is in agreement with the figures reported for countries of similar healthcare level. Various features such as the age distribution of the radiographed patients, the forms of collimators used, film consumption and the use of digital imaging systems are presented. CONCLUSIONS: Several recommendations for dose reduction are made. These include the re-evaluation of the patterns and justification for prescribing some particular types of dental examinations as well as the avoidance of unnecessary irradiation by the use of rectangular collimation and high sensitivity F-speed films.

Adolescent↗

PubMed1997

Selective periapical radiology compared to panoramic screening.

PURPOSE OF STUDY: To assess whether selected periapical radiographs, taken according to High Yield Criteria, can reveal as much intra-osseous pathology as universal panoramic screening. POPULATION STUDIED: The records of 1101 RAF recruits enlisted in 1988-89, average age 19 years (range 16-26). METHODS: The clinical records and bitewing radiographs of the recruits were examined and the requirement for periapical radiographs determined according to high yield criteria. A template, cut out to simulate the area covered by a periapical bitewing radiograph, was placed over the suspect region on the panoramic film and any findings found within the template recorded. The entire dental panoramic tomograph was then examined on a masked screen under 2X magnification and any further findings recorded. FINDINGS: There was a considerable number of findings reported, including three large isolated radiolucent areas, 75 periradicular radiolucent areas, four probable cysts and 1187 unerupted mandibular third molars. However, when the clinical significance of these 'lesions' was assessed only those related to dental causes appeared to have significant clinical implications and the results indicated that these could have been detected by selective radiology. CONCLUSION: This study showed that the only pathology which occurs frequently enough to justify radiographic screening of the jaws in young adults is related to teeth. It seems probable that this type of pathology can be at least as well detected by selective periapical screening, using high yield criteria, as is possible by universal panoramic screening.

Adolescent↗

PubMed1999

Effect of noise on the compressibility and diagnostic accuracy for caries detection of digital bitewing radiographs.

OBJECTIVES: To determine the effect of noise on the compressibility and the diagnostic accuracy for caries detection of digital bitewing radiographs. METHODS: Bitewing radiographs of patients were obtained with a storage phosphor (Digora, Soredex, Helsinki, Finland) and compressed at different JPEG compression levels (2, 27, 53 and 128). A just noticeable difference study was performed to select a compression level to study the added noise effect. Gaussian noise was added at low, medium, and high levels to both the original and compressed images. Seven observers examined the selected approximal surfaces to identify the caries depth. ROC analysis was performed together with ANOVA at P = 0.05. RESULTS: The compressibility of the images decreased as the noise level increased. ROC analysis revealed no significant difference between the original and compressed images within the same noise level (P > 0.06). With added noise compressed/decompressed images had a higher Az than the corresponding original images. CONCLUSIONS: JPEG compression at level 27 can be used without a significant deterioration in diagnostic accuracy. Compression at this level seemed to reduce the effect of noise to some extent.

Analysis of Variance↗

PubMed2005

Noise in subtraction images made from pairs of bitewing radiographs: a comparison between two subtraction programs.

OBJECTIVES: To compare noise in subtraction images produced by two subtraction programs. METHODS: Twenty-five pairs of bitewing radiographs exposed under clinical conditions were subtracted using two digital subtraction programs: X-PoseIt (XP) software and EMAGO/Advanced 3.43 (EM) software. Four reference points were located between the mesial surface of the upper first premolar and the distal surface of the upper first molar (the region of interest) on the same anatomical structures using XP and EM. The standard deviation (SD) of the histogram defining the distribution of the shades of grey in the region of interest was used as the statistical parameter for comparing noise in the subtraction images created by the two subtraction programs. RESULTS: The mean and median grey shade value was lower with EM software (126.9, 126) than with XP software (128.3, 128) (P < 0.05). For the SD, the mean value was significantly lower with XP (6.2) than with EM (7.8) (P < 0.05). The range of the SD values was larger for EM (3.6-12.8) than XP (3.3-9.9). CONCLUSIONS: The standard deviation of the grey shade histogram showed that subtraction images produced with X-PoseIt software were statistically less noisy than images produced with EMAGO/Advanced 3.43 software.

Humans↗

PubMed1998

Effect of different background lighting conditions on diagnostic performance of digital and film images.

OBJECTIVE: To compare the performance of a photostimulable phosphor (PSP) imaging system with radiographic film for the detection of approximal lesions under two background lighting conditions. METHODS: Bitewing exposures were made of the extracted human teeth with artificial approximal lesions using D-speed and E-speed radiographic film and a PSP imaging plate. Eight dentists rated 12 approximal surfaces in each image on a 5-point scale. Images were viewed with overhead fluorescent room lighting on and off. ROC curves were generated for each image receptor and lighting condition. Repeated measures analysis of variance ANOVA tested differences between observers, lesion size, image receptor, lighting condition. RESULTS: Mean ROC curve areas for D-speed film viewed in full ambient light scored highest (0.8030) followed by E-speed film using dark conditions (0.7386). The lowest mean curve area was found when PSP (enhanced mode) images were viewed in a dark room (0.6726). Significant differences were found between observers, lesion size, image receptor and image receptor-lesion size interaction. No significant difference was found with background lighting. CONCLUSIONS: Background lighting does not appear to effect the ability to detect artificial approximal lesions.

Analysis of Variance↗

PubMed1998

Tuned aperture computed tomography and detection of recurrent caries.

This study compared the diagnostic efficacy of four imaging modalities for the detection of artificially induced recurrent caries: intraoral film, direct digital bitewing images, tuned apertuce computed tomography (TACT) slices and iteratively restored TACT images using an in vitro model. Twenty-four posterior teeth were prepared for MOD inlay restorations. These were then restored with different restorative materials (amalgam, Herculite and Durafill). Lesions were simulated in half the number of surfaces studied. These lesions were created either at the intersection of the facial or lingual walls and the gingival floor or on the gingival floor midway between the facial and lingual walls in the proximal boxes of the MOD restorations. Analysis of observations from 8 observers using ROC curve reveal the superior diagnostic efficacy with TACT iteratively restored images (Az for TACT iteratively restored images = 0.9171, TACT slices = 0.7052, Film = 0.6608, direct digital images = 0.5979). ANOVA revealed significance with respect to the imaging modality used (p < 0.0001). The results suggest that TACT images hold promise as a more effective imaging modality than film or direct digital systems for detection of recurrent caries.

Analysis of Variance↗

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↗

PubMed2004

Extraoral imaging for proximal caries detection: Bitewings vs scanogram.

OBJECTIVE: The objective of this study was to compare the diagnostic accuracy of 3 extraoral imaging modalities with an intraoral bitewing radiograph for proximal caries detection. STUDY DESIGN: Three modalities of Cranex TOME scanograms, x-ray film and DenOptix photostimulable phosphor plates with and without digital enhancement, were compared with Insight intraoral radiographs for proximal caries detection. Nine observers evaluated images of the proximal surfaces of 45 extracted posterior teeth. The presence or absence of caries was scored using a 5-point confidence scale. The ground truth was determined from histological sections. Responses were evaluated by repeated measures analysis of variance (ANOVA) for areas under receiver operating characteristic (ROC) curves (A z ). RESULTS: Repeated measures ANOVA (at alpha = 0.05) demonstrated significant differences among modalities ( P = .041). Paired t tests with Bonferroni correction demonstrated that Insight was superior to only unenhanced digital scanograms ( P = .003). Mean A z scores (+/-SD) were 0.73 (+/-0.08) for Insight, 0.65 (+/-0.06) for screen/film scanogram, 0.64 (+/-0.04) for unenhanced digital scanogram, and 0.66 (+/-0.07) for enhanced digital scanogram. CONCLUSIONS: The performances of film-based and enhanced digital scanograms were not statistically different from Insight film for proximal caries detection. Unenhanced digital scanograms exhibited a statistically significant lower diagnostic accuracy than Insight film.

Analysis of Variance↗