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Clarity and diagnostic quality of digitized conventional intraoral radiographs.

OBJECTIVES: To compare digital images of conventional radiographs with the original radiographs for perceived clarity of endodontic files, periapical lesions and carious lesions, and to establish the diagnostic value of the digital images. METHODS: Four groups of ten radiographs were used: standardized bitewings demonstrating carious lesions, periapical radiographs of apical lesions, periapical radiographs showing endodontic files of various sizes at working length, and standardized periapical radiographs with size 08 files at working length. Radiographs were photographed using an Olympus C 2500-L digital camera and a Nikon D1X digital camera and were scanned using a Nikon Supercoolscan 4000 ED film/slide scanner. The digital images were then transferred to a Toshiba Satellite 2210 laptop. Three general dental practitioners compared each conventional radiograph with the three matching digital images. Images were ranked for clarity and were assessed for diagnostic quality. Data were analysed using General Estimating Equations. RESULTS: The clarity and diagnostic quality of the conventional radiographs were superior to the digital images produced by the three techniques (P < 0.001). No significant difference was found between the Nikon D1X and Camedia 2500-L cameras for clarity or diagnostic quality. The scanner was equivalent to the Camedia 2500-L camera for diagnostic quality, but was otherwise inferior to both cameras. CONCLUSIONS: Digitizing conventional radiographs using current high-grade digital cameras or scanners does not produce images of diagnostic quality. Improved resolution of viewing monitors is necessary to fully harness the potential of digital technology.

Computer Terminals↗

Comparison of direct digital and conventional intraoral radiographs in detecting alveolar bone loss.

BACKGROUND: Intraoral radiographs are important diagnostic aids in periodontics. The authors conducted a study to compare estimates of bone levels from direct digital and conventional radiographic under normal clinical use. METHODS: A full-mouth series of conventional radiographs was taken for each of 25 subjects who had periodontitis. A long cone paralleling technique was used for periapical, or PA, images, and a paper sleeve with biting tab was employed for bitewing, or BW, images. A set of direct digital radiographs matching the conventional radiographs was taken for each subject under the same conditions. The distance from the cementoenamel junction to the interproximal alveolar crest on all readable surfaces was measured. RESULTS: Examiners measured 857 PA image sites and 315 BW image sites matched on both radiographic systems. Paired t test showed significant differences in bone levels between the two systems. Measurements from conventional PA images were higher in all maxillary sextants (P < or = .02), and measurements from digital PA images were higher in mandibular anterior sextants (P = .007). Measurements in digital BW images were higher in mandibular posterior sextants (P = .002). A chi2 analysis of categorical bone levels (normal, early-to-moderate loss or advanced loss) showed significant differences between the imaging systems in revealing bone levels in both PA (P < .04) and BW (P < .001) images. Digital radiographs showed a higher number of sites with bone loss than did conventional radiographs. CONCLUSIONS: Under normal clinical use, alveolar bone levels revealed on intraoral direct digital radiographs differ from those revealed on conventional radiographs. CLINICAL IMPLICATIONS: Intraoral direct digital radiographs are not an equivalent substitute for conventional radiographs in evaluating alveolar bone levels.

Adolescent↗

Interaction between noise and file compression and its effect on the recognition of caries in digital imaging.

OBJECTIVES: To determine the interaction between image noise and file compression, with special emphasis on the accuracy of caries diagnosis. METHODS: Fifty-nine bitewing radiographs of patients were taken simultaneously with Ektaspeed Plus (Eastman-Kodak, Rochester, NY, USA) film without lead foil and the Digora storage phosphor system (Soredex, Helsinki, Finland). Three different levels of Gaussian noise were added to the original digital images which were then compressed with JPEG 53. Seven observers evaluated the presence and depth of caries lesions on selected approximal surfaces on a 5-point scale. The results of JPEG 27 compression from a previous study were also included. ROC analysis was used together with multivariate analysis of variance (MANOVA). RESULTS: JPEG 27 and 53 reduced the file size down to 7% and 4.6% of the original respectively. ROC curve analysis showed no significant difference between image conditions (original, JPEG 27, and JPEG 53) at the same noise level. JPEG 27 and 53 had larger Az scores than their original counterparts at the same noise level. However, MANOVA showed that for depth estimation of enamel lesions JPEG 53 resulted in a higher observer error. CONCLUSIONS: Both JPEG 53 and 27 could reduce some of the adverse effect of noise from the image by removing high spatial frequencies. JPEG 53, resulting in a compression ratio of 1:21, does not compromise the diagnostic performance in general. JPEG 53 compression may however affect the ability to detect enamel lesions.

Artifacts↗

Caries development in a young population managed by a restrictive attitude to radiography and operative intervention: II. A study at the surface level.

OBJECTIVES: To longitudinally assess the distribution of fillings and carious lesions in permanent posterior tooth surfaces, caries states fillings were made, and survival time of proximal lesions in different states in a young population managed by minimal operative treatment and a restrictive attitude to radiography. METHODS: Bitewing radiographs from age 6-20 in 285 patients were analysed. Proximal and occlusal surfaces were coded for caries depth and fillings. Start and end dates for different caries states in proximal surfaces were assigned and survival times in these states calculated by means of survival statistics. RESULTS: The frequency of carious/filled occlusal surfaces in the population increased from 6 to 19% and that of proximal surfaces from 1 to 26%. At age 19, 86% of the occlusal and 7% of the proximal surfaces affected by caries were filled. An overwhelming majority of unfilled carious proximal surfaces had enamel lesions only. Of all fillings, 81% were placed in surfaces with dentine lesions. The occlusal and proximal surfaces of the first molar and the distal surface of the second premolar accounted for most lesions and fillings among the 19-year-olds. The average survival time of lesions in the enamel was 8.0 years and in the outer half of the dentine 3.4 years when right-censored data were taken into account. CONCLUSION: In a young population exposed to optimal levels of fluoride with a caries preventive programme, a restrictive attitude towards operative treatment can be combined with longer average intervals between radiographic examinations than those prescribed by current guidelines.

Adolescent↗

Observer differentiation of mechanical defects versus natural dental caries cavitations on monitor-displayed images with imaging plate readout.

OBJECTIVE: The purpose of this study was to compare the ability of dentists to detect mechanically created defects vs natural dental caries cavitations on the proximal surfaces of extracted teeth by means of storage phosphor imaging plate technology. STUDY DESIGN: Fifty-two extracted molar and premolar teeth were blocked into sets for bitewing radiographs through use of the DIGORA digital imaging system. Sixteen natural caries cavities and 28 artificial lesions were present in the 80 proximal surfaces included in the study. A group of 16 dentists assessed proximal lesions on unenhanced images on the monitor and 1 month later on contrast-enhanced images. A different group of 16 dentists assessed proximal lesions on contrast-enhanced images and 1 month later on unenhanced images. The Mann-Whitney U test was used to check for a reading-order effect. The Zelen test of odds ratio was used to test for homogeneity, and the Mantel-Haenszel analysis or stratified logistic regression was used for inference about the common odds ratio. Alpha was set at P < .05. RESULTS AND CONCLUSIONS: With the DIGORA system, there was little difference between the detection rates of mechanical defects and natural carious cavities with unenhanced images, but the mechanical defects were more readily detected when contrast-enhanced images were used. Cavity depth positively affected the odds of diagnosis of lesions, with deeper lesions being more readily detected than more superficial ones irrespective of whether they were natural or artificial. In comparison with findings of previous studies in which film and a charge-coupled device detector were used, the overall detection rate for natural dental caries was remarkably constant across the modalities.

Dental Caries↗

Diagnostic accuracy of intraoral film and direct digital images for detection of simulated recurrent decay.

UNLABELLED: This study compared the diagnostic accuracy of bitewing images for detection of simulated recurrent caries using the following imaging modalities: Ektaspeed Plus film and different digital imaging system technologies comprised of a charge-coupled device (CCD) based digital imaging unit, a photo-stimulable phosphor (PSP) based unit and contrast- and brightness-enhanced PSP images. STUDY DESIGN: Twenty-four extracted posterior teeth with MOD inlay preparations were secured in models simulating a natural arrangement of teeth. Lesions were created in proximal boxes using dental burs of varying sizes. Defects were filled with wax and plaster and preparations were restored with composite or amalgam. RESULTS: Averages of receiver operating curve areas (Az) revealed diagnostic performances of Az = 0.74 for film, Az = 0.80 for CCD, Az = 0.73 for unenhanced PSP and Az = 0.64 for enhanced PSP. The differences between these means were significant (MANOVA p < 0.0001). Unenhanced PSP produced significantly poorer performance than other modalities. CCD performance was not significantly better than enhanced PSP. Lesions under radiopaque composite restorations were easier to detect, followed by those under amalgam and radiolucent composites across imaging modalities and lesion locations. Based on lesion location, those located at the buccal point angle were easiest to detect, followed by those at mid-gingival floor and lingual-point angle sites. CONCLUSIONS: Contrast and brightness-enhanced digital images enabled better signal detection and a comparable performance with film for detection of artificially induced recurrent caries.

Analysis of Variance↗

A comparison of two compression algorithms and the detection of caries.

OBJECTIVES: To assess the effect of two compression algorithms (JPEG and wavelet) on the detection of approximal caries. METHODS: Fifteen bitewing radiographs were generated using 100 posterior teeth mounted in blocks. The images were produced on conventional films (Ektaspeed Plus) and scanned at 300 d.p.i. Digital images were then compressed 9:1 with JPEG and wavelet methods. Nine observers detected the presence and depth of approximal caries recorded on a 5-point confidence scale and a 4-point depth scale from images viewed in random order. Histological examination provided the true depth of the lesions. Data were analysed by means of ANOVA. The null hypothesis was that there is no significant difference between the two compression algorithms and the original uncompressed images. RESULTS: JPEG performed significantly worse than the original and the wavelet algorithm (P<0.001) for the detection of dentinal lesions. However, no significant differences were found for the detection of sound surfaces, enamel lesions, and lesions up to the DEJ between JPEG-compressed images and each of the other two modalities. There was also no significant difference between the wavelet-compressed images and the original for all lesion depths. CONCLUSIONS: At a compression ratio of 9:1, there were no significant differences among the original images, JPEG and wavelet compressed images for the detection of enamel caries. JPEG-compressed images performed inferiorly to the original and wavelet-compressed images for the detection of dentinal lesions. Wavelet compression is a better choice than JPEG at the compression ratio investigated in this study.

Algorithms↗

Influence of displayed image size on radiographic detection of approximal caries.

OBJECTIVES: To evaluate the validity of approximal caries detection on digital bitewing radiographs displayed at different image sizes on either a cathode ray tube (CRT) monitor or a thin film transistor (TFT) monitor. METHODS: Five observers assessed digital radiographs of a charge-coupled device (CCD)-based sensor system (Sidexis) of 160 unrestored premolars and molars for approximal caries using a six category caries rating scale. Images were displayed at ratios of 1:1, 1:2 and 1:7 on a CRT monitor (Nokia 446 XS) and a TFT display (Panasonic LC 50S). Histological assessments of serial sections were used as the validation standard. Diagnostic accuracy was expressed as area under the receiver operating characteristic (ROC) curve (AUC) and was calculated at two levels of caries penetration: presence of caries (I) and presence of a lesion in the dentine (II). The influence of the factors "monitor type", "image size" and "validation threshold" were analysed with repeated measures analysis of variance. RESULTS: The ROC curve areas for approximal caries detection at both histological penetration levels were not influenced by the type of monitor display, whereas image size had a significant impact (P<0.01). AUCs for image size 1:7 (I, 0.62; II, 0.65) were smaller compared with ratios of 1:1 and 1:2 (P<0.01). No differences were observed between image size ratios 1:1 (I, 0.69; II, 0.74) and 1:2 (I, 0.68; II, 0.73). CONCLUSIONS: In this study, the type of monitor did not influence approximal caries detection on digital radiographs. Image sizes with a display ratio of 1:1 and 1:2 resulted in better diagnostic validity than those with a ratio of 1:7.

Analysis of Variance↗

Comparing the accuracy of Dutch dentists and dental students in the radiographic diagnosis of dentinal caries.

OBJECTIVES: To compare the diagnostic accuracy of dental students using bitewing radiographs for the diagnosis of dentinal caries with that of general dental practitioners and to establish a bench mark for testing for improvement in diagnostic performance. METHODS: Fourth year dental students (n=259) viewed bitewing radiographs of 105 proximal tooth surfaces. According to a micro-radiography "gold standard" 45 surfaces had dentine caries. The students were asked to diagnose presence and absence of dentine caries from which, under supervision, they calculated their sensitivity (TPR) and false positive rate (FPR). The students binary diagnostic data was compared with the historical data from a random sample of Dutch dentists (n=273). The Summary Receiver Operating Characteristic (SROC) curve method was used to analyse the data. The two groups were tested for differences in (a) diagnostic odds ratio and (b) the area under the SROC curve. RESULTS: The students mean TPR for dentine caries diagnosis was 67.2% (s.d. 11.8%) and the FPR was 8.3% (s.d. 8.4%). The corresponding values for dentists were: TPR 54.0% (s.d. 14.1%) and FPR 3.1% (s.d. 4.5%). Significantly more dentists (85%) than students (72%, P<0.001) had a diagnostic odds ratio > or =21. The area under the SROC curve (Az) was 0.8194 for students and 0.8140 for dentists (P=0.70). CONCLUSIONS: In our study (i) the students had a higher TPR but also a higher FPR than the dental practitioners, (ii) their overall performance (Az) was similar but (iii) for a clinically relevant population the dental practitioners would out-perform the students in diagnostic performance.

Benchmarking↗

[The importance of the bitewing image in the early recognition of caries and periodontal diseases in children and adolescents].

In estimating of bite-wing radiographies of lateral teeth at diabetic children in different age groups and developmental dental periods carious diagnostic effect is represented in comparison with clinical observations. Calculating the caries indices for permanent teeth no statistical significant differences appear between clinical and clinical radiographical dates. A comparison of statements at the approximal surfaces shows in all age groups an equal frequency only in radiographic visible destructions of enamel. After the 14th age the number of destructions in the dentin is increasing. The essential modifications at the periodontal bone are in a direct connection with caries and restorations at the corresponding approximal surfaces. The bite-wing radiographic remains his value in recognizing the period of caries activity and should be used in diagnostic of early lesions at patients of risk.

Adolescent↗

Classification of cervical burnout and its distribution in the dentition.

A retrospective analysis of 25 full mouth intra oral radiographs, including bitewing films was carried out from the hospital records of King Saud University College of Dentistry in Riyadh, Saudi Arabia, A new classification of cervical burnout (CB) based on shape was attempted. Analysis of the data revealed greater frequency of CB in maxillary teeth (67.5%) than in the mandibular teeth (32.5%). The highest frequency among maxillary teeth was in incisors (75%), while the least was in the molars (30%). In mandible, the corresponding findings was in the canines (40%) and in the molars (15.3%). Seventy per cent of CB disappeared in bitewing view in maxillary and mandibular premolars while remaining teeth showed this phenomenon in less than 50% cases. It was concluded that the frequency of CB was greater in maxillary teeth than mandibular teeth. Maxillary incisors and mandibular canines are more likely to show CB. In molars and premolars, CB present in periapical radiographs may disappear in a bitewing view.

Adolescent↗

Oral radiographic screening in Danish children.

The aim of the present study was to ascertain frequency and type of radiographic screening in the Danish Dental Service for children. A 5-item questionnaire was sent to each department of public dentistry in the 275 communities of Denmark. A total of 269 questionnaires were returned, four unanswered. Radiographic screening examinations were done on 162 respondents. Of these, 25% had bitewing screening and 25% panoramic screening. Two types of routine radiographic examinations were performed on more than one third of the respondents. The most frequent combination for screening radiography was bitewing and panorama. Even though the risks included in the use of ionizing radiation for dental screening purposes may be considered negligible, it is still ethically correct to avoid unnecessary exposure by a careful selection of patients prior to radiography. As economic support for dental health care had been cut, the radiographic screening procedure must prove itself to be cost/effective to be kept unchanged.

Child↗

Detection of dentine caries using the oblique lateral radiograph.

OBJECTIVES: The aim of the study was to evaluate the level of agreement between bitewing radiographs and oblique lateral radiographs for the diagnosis of dental caries extending into dentine, and to draw conclusions from the results as to which view is more useful. SAMPLE: Radiographs were selected from patients attending an orthodontic assessment clinic: 53 patients, 52% male, 48% female, aged 6-18 years old. Total 105 bitewings and 105 oblique lateral radiographs. METHODS: Contemporaneous bitewing and oblique radiographs taken over the period 1987-97 were independently assessed by two dentists for the presence of caries extending into dentine. RESULTS: The agreement between the oblique lateral and the bitewing radiographs for the presence of approximal caries expressed in the form of Cohen's Kappa gave values of 0.64 for observer 1 and 0.53 for observer 2. For occlusal caries, values were 0.72 for observer 1 and 0.56 for observer 2. Kappa values for the level of agreement between observers and for the same observer on different occasions were within the range 0.5-0.95 for both types of film. CONCLUSION: The Kappa values for the agreement between the two views as well as the intra- and inter-observer agreement and reproducibility of the oblique lateral view all fall in the range K = 0.5-0.75. Results suggested a fair to good agreement in diagnoses made using the two types of film. However, levels were lower than estimates of reproducibility reported for bitewing films alone.

Adolescent↗