A bitewing radiographic study of some problems related to space management in the posterior segments of the primary and mixed dentitions.
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Dentition, Mixed↗
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A study to determine and assess the diagnostic quality of bitewing radiographs taken by two methods: using paper bite tags and using a proprietary film holder.
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Adult↗
The effect of alignment errors on bitewing-based bone loss measurements.
Alveolar bone loss measurements made using digitized dental radiographs have been shown to be precise and accurate. We determined the influence of alignment errors introduced when exposing the radiographs on the precision and accuracy of bone loss measurements. Bitewing radiographs of 15 day skulls were obtained using a positioning device (modified after the methods of Duckworth and associates). The sequence of radiographs was taken while the alignment of the main Roentgen beam was systematically varied within a 10 degree cone. Angular displacements were calculated from the digitized radiographs. Space variant digital image enhancement was performed to improve visualization of the cementoenamel junctions and alveolar crests. Corresponding bone loss measurements were made on dry skulls and radiographs. The criterion for truth in these measurements was established by 2 expert observers who measured the skulls with periodontal probes. Radiographic measurements were statistically compared with the criterion using validity coefficients. We found beam positioning errors of up to 10 degrees do not substantively affect alveolar bone loss measurements of mandibular molars taken from enhanced digital images of bitewing radiographs.
Adult↗
Temporary elective tooth separation as a diagnostic aid in general dental practice.
This study examined the feasibility, acceptability and potential diagnostic value of using a 'blanket' technique for placing elastomeric separators as a diagnostic aid in a general practice situation. Five practices were visited and 211 children between 5 and 15 years were examined. All 211 children accepted the 'clinical without separators' examination, 37 children were unwilling to have the radiographic examination and 12 of the 146 children who required separators refused or removed them. The use of the technique as a routine aid was acceptable to the host practitioners, the parents, most of the patients and to the clinician conducting the study. The method was shown to be valuable in revealing additional approximal lesions. A total of 703 lesions were disclosed by the 'clinical with separators' method, compared with 479 diagnosed by routine clinical examination alone. As many of the additional lesions were at the precavitation stage, this information could be used to target those patients with special needs for preventive care. While the larger dentinal lesions revealed by temporary elective tooth separation were confirmed by bitewing radiographs, many of the small precavitation lesions were not. The results showed, however, that bitewing radiographs were still an important diagnostic aid, especially in the deciduous dentition. Elastomeric separators may have a role as a diagnostic aid in conjunction with bitewings, rather than as a replacement for them.
Adolescent↗
[Bitewing examinations as a part of preventive dentistry--a review].
For an optimal treatment of approximal caries lesions it is important to rely on a safe diagnosis. Bitewing examinations are an aid for detecting hidden lesions in the approximal surfaces. Other techniques for this purpose are fibre-optic transillumination (FOTI), digital imaging fibre-optic transillumination (DIFOTI), electric resistance measurement, laser fluorescence measurement and tooth separating. Since no direct view on approximal surfaces is feasible the detection of approximal lesions in the clinical examination is mostly insufficient. For a systematical controlling of the different grades of caries lesions, a time schedule for examinations is useful. For such a schedule, a couple of factors, such as caries risk of the patient or fluoridations, seem to be important. This article gives a survey of recommendations found in the literature to optimise the arrangement of bitewing examination in the therapeutical concept of caries monitoring and treatment planning.
Dental Caries↗
Bitewing examination to detect caries in children and adolescents--when and how often?
UNLABELLED: It is generally agreed that the decision to take bitewing radiographs for detecting caries should be based on the benefit to the individual patient in relation to the risks associated with low dose radiation exposure and the costs. There is incomplete knowledge about the effectiveness of various methods for selecting individuals who will benefit from bitewing examination. Available knowledge suggests, however, that our ability to identify correctly those who will benefit is limited. It may, therefore, be more effective to combine population- and individual-based selection criteria. For this purpose, four key ages and individual-based criteria between the key ages are suggested. CLINICAL RELEVANCE: The purpose of the presented selection criteria are to improve the dental practioner's effectiveness in selecting patients who will benefit from bitewing examination, thereby reducing the number of arbitrary and 'just in case' radiographs and the radiation dose.
Adolescent↗
Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population.
OBJECTIVES: The aims of the study were: (1) to determine if bitewing radiographs provided additional diagnostic yield for occlusal and approximal dental caries in adults aged between 17 and 30 years of age when compared with a clinical examination only, (2) how this translated into the measurement of dental caries experience, and (3) to determine the influence of water fluoridation on the diagnosis of dental caries in occlusal and approximal surfaces by clinical examination alone and by radiographic examination. METHODS: Between November 2002 and March 2003 a total of 879 subjects aged 17-30 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately and blind. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs. RESULTS: Between 22.9-32.9% of approximal caries and 75.9-82.9% of occlusal caries was detected by clinical examination, while 93.1-97.1% of approximal caries and 33.1-42.6% of occlusal caries was detected by radiographic examination. In addition, while only 0.97% of clinically sound approximal surfaces and 0.83% of clinically sound occlusal surfaces were diagnosed with dentine caries on the radiographs, 67.1-77.1% of approximal caries was detected by radiographs alone, an additional diagnostic yield of 204-336%. The DS score increased 45-46% and the DMFS score increased 6-11% from the clinical examination with the addition of the radiographic information (P<0.001). CONCLUSIONS: The prevalence of approximal and occlusal caries was underestimated when clinical means only were employed. There was a significant increase in DS and DMFS scores from the clinical examination only when radiographic information was added across all age groups (P<0.001). This study confirms the value of bitewing radiographs in caries diagnosis.
Adolescent↗
Effect of X-ray beam vertical angulation on radiographic assessment of alveolar crest level.
Periodontal diseases are diagnosed and monitored by various methods. Probing pocket depth measurements and dental radiographs are two of the most commonly used methods. The aim of this study was to assess the effect of x-ray beam vertical angulation on radiographic assessment of alveolar crest level in five human mandibles. A standardized technique was used to take bitewing radiographs with -10 degrees, 0 degree and +10 degrees angulation of X-Ray beam. The range of the mean differences at individual sites was from 1.84 mm (0.58 +/- SD) to 3.70 mm (1.01 +/- SD). It was found that there was a wide range of over or underestimation of the alveolar crest level due to a change in beam angulation. It was concluded that, to monitor patients with periodontal disease or treatment outcomes, it is important to have reproducible images and bitewing film holders should be used to minimize the X-Ray beam angulation error in general dental practice.
Alveolar Bone Loss↗
Effect of illumination on the accuracy of identifying interproximal carious lesions on bitewing radiographs.
BACKGROUND: Dentists generally use a viewbox as the primary source of illumination when examining radiographs. Secondary sources of illumination (i.e., light other than that originating from the viewbox) can reduce radiographic contrast and may therefore affect diagnostic accuracy. OBJECTIVE: To determine if the accuracy of identifying interproximal carious lesions on bitewing radiographs depends on the level of secondary illumination. METHODS: Fourteen dentists examined bitewing radiographs of simulated interproximal lesions on dentition phantoms in conditions of maximal secondary illumination (the light condition) and minimal secondary illumination (the dark condition). RESULTS: There was no significant difference (p = 0.07) in the accuracy of identifying simulated interproximal carious lesions on bitewing radiographs in the light mean accuracy (72%+/-12%) and dark (75% +/- 12%) conditions. CLINICAL SIGNIFICANCE: Examining bitewing radiographs on a viewbox located in the operatory is adequate for accurately identifying interproximal carious lesions.
Dental Caries↗
How often should we take bitewing radiographs?
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Adolescent↗
Intervals between bitewing examinations in young patients when applying a radiologic algorithm.
Every prescription of a radiograph should be based on an evaluation of the individual patient benefit. An algorithm developed to make it possible to individualize the frequency of bitewing radiographs was applied on a group of young patients in order to evaluate if its application could increase the time intervals between bitewing examinations. The time intervals between bitewing examinations actually performed on 221 patients from exfoliation of all primary teeth up to and including 18 yr of age were determined. The number of surfaces with carious lesions as well as restorations in the posterior approximal surfaces were diagnosed from the radiographs. The intervals between bitewing examinations according to the algorithm were estimated and compared to the actual ones. For most patients the time intervals between examinations increased when the algorithm was applied, without a concomitant risk of missing lesions developing into the deeper parts of the dentin. The results render support to an individualized scheduling of bitewing radiographs based on number of and extent of approximal lesions in baseline radiographs.
Adolescent↗
Optimum bitewing examination recall intervals assessed by computer simulation.
OBJECTIVE: To assess the effect of altering bitewing examination recall intervals on health gain from dental restorative treatment and to determine optimum recall intervals under varying clinical conditions. DESIGN: A computer simulation of the caries process in posterior approximal tooth surfaces. The effect of superimposing restorative treatment, based on diagnoses from bitewing radiological examinations carried out at differing time intervals, was incorporated. Input data included caries attack rates, median survival times of restorations, and sensitivity (Sn) and specificity (Sp) of treatment decision making by a high (A) and a low (B) performing dentist. PARTICIPANTS: A hypothetical population, initially 14-15 years old. INTERVENTIONS: Class II amalgam restorations. OUTCOME: Health gain in utility based units (UBUs) was assessed relative to interim end point UBUs pertaining under 'do nothing scenarios'. RESULTS: One thousand approximal surfaces, designated initially as 920 sound, 51 carious and 29 filled were followed in the model over 10 years. The greatest health gain (39.33 UBUs) was from dentist A (Sn = 0.23, Sp = 0.99, restoration median survival time = 20 years, caries rate = 4.4% per annum, optimal recall interval between bitewing radiological examinations = 7 months). The least was from dentist B (Sn = 0.52, Sp = 0.88, median survival time = 5 years. caries rate = 0.0% per annum, optimal recall interval between bitewing radiological examinations > 120 months) representing a loss of 16.79 UBUs compared with 'do nothing'. CONCLUSIONS: In the best interests of their patients, it would seem that dentists need to exercise considerable caution in making positive decisions to restore approximal tooth surfaces on the basis of bitewing radiographic evidence and that for some dentists current guidelines for bitewing examination intervals would appear to be too permissive.
Computer Simulation↗
Bitewing film quality: a clinical comparison of the loop vs. holder techniques.
OBJECTIVE: To compare in vivo bitewing film quality using the holder versus the paper loop technique. METHOD AND MATERIALS: Four bitewing films were taken from the right and left premolar and molar regions of 45 dental students using both the bitewing holder and paper loop techniques. A total of 360 films were taken and assessed by an experienced practitioner not apprised of the bitewing technique used. Of interest were: (1) the number of overlaps and the percentage of teeth showing the alveolar crest; (2) proper film positioning; and (3) the percentage of cone cutting. A Poisson regression using generalized estimating equations (GEEs) was used to estimate the difference in overlap between the two techniques. For proper positioning and cone cutting, logistic regressions using GEEs were used. RESULTS: The average number of horizontal overlaps for the loop and holder techniques at the right premolar, right molar, left premolar, and left molar were 1.64, 2.11, 2.16, 2.78, and 1.64, 2.00, 2.00, 2.18, respectively. The loop technique was 1.11 times more likely to cause overlapping than the holder technique. The highest percentage of teeth showing the alveolar crest by the loop technique was 97.8% in the mandibular second premolar and first molar. With respect to film positioning, the loop technique was 1.12 times more likely to cause improper positioning than the holder technique. Both techniques demonstrated minimal cone cutting (1 in the loop versus 0 in the holder). CONCLUSION: The quality of bitewing films taken by the loop and holder techniques was not significantly different.
Alveolar Process↗
Ontario dentists: 2. Bitewing utilization and restorative treatment decisions.
Guidelines for the selection of patients requiring radiological examination have recently been published in Canada and the United States. The purpose of this paper, the second in a three-part series on the results of a questionnaire to Ontario general practitioners, is to compare bitewing use in Ontario against the U.S. guidelines. This questionnaire determined the frequency of recall bitewing examination for low and high caries risk patients, as well as the factors that influence the diagnostic and treatment decisions of the responding dentists. For example, 49 to 78 per cent of dentists order recall bitewings--in accordance with U.S. guidelines--for their patients in individual low caries risk categories. Similarly, 49 to 88 per cent of dentists order recall bitewings for individual patients in high caries risk categories, which is also consistent with the U.S. guidelines. However, across all low and high caries risk groups of patients, the percentages of dentists who followed the recommended guidelines were 34 and 15 per cent, respectively. The responding dentists' estimates of the length of time required for caries to progress through enamel are indirectly associated with the interval prescribed for recall bitewing examination.
Adolescent↗
The effect of experience and training on the diagnosis of approximal coronal caries from bitewing radiographs. A Swiss-American comparison.
The purpose of the present study was to compare the development of skills in the radiographic diagnosis of approximal coronal caries. Swiss (Bern) and American (Alabama) dental students with and without clinical experience, Swiss general practitioners, and Swiss and American dental school faculty viewed bitewing radiographic films of 13 teeth. The observers examined the 26 approximal surfaces on the radiographic films and responded, on a five point certainty scale, whether approximal caries was present. Mean sensitivity ranged from a low of 0.59 for American faculty to a high of 0.80 for Swiss students with clinical experience, mean specificity ranged from 0.84 for Swiss pre-clinical students to 0.95 for American faculty. For a summary measure of accuracy, i.e., area under the receiver operating characteristic (ROC) curve, the scores for student observers tended to increase with experience. The scores for Swiss and American students with clinical experience and faculty did not differ significantly. Inter-examiner agreement (Kappa) could only be characterized as moderate at best. Formal didactic instruction and clinical experience produced dental students with skills in the diagnosis of approximal caries from bitewing radiographs similar to that of faculty dentists.
Alabama↗
[Bitewing radiographs in dentistry: how frequently are they indicated?].
Bitewing radiographs should be taken on an individual indication. The individual's caries risk is an important factor in determining the frequency of bitewing radiographs and, therefore, a dentist should estimate the individual's caries risk. Given two serial bitewing radiographs, the dentist should be able to distinguish freshly developed caries lesions, which require preventive or restorative treatment, from old remineralized lesions, which do not require any treatment at all. Assessment of caries progression from serial bitewing radiographs should also provide the dentist with information to determine the moment of subsequent bitewing radiographs. Because in many western countries the caries prevalence is quite low, this is a complicated task, since the dentist is expected to carry out the diagnostic and decision making process without errors. The true probability of caries progression was derived and plotted as a function of the time span between two bitewing radiographs. The results indicated that the interval between standardized serial bitewing radiographs should be approximately three years for individuals which run a high risk of developing caries, and four years for individuals with a low caries risk.
Dental Caries↗
[Dental care for young people insured by health insurance fund 1. Prevalence and treatment of dental caries between 1987 and 1999].
In 1987, 1993 and 1999 an epidemiological study was performed on oral health in youngsters, aged 5, 11, 17 or 23 years, in whom oral health care was covered by a health insurance fund. The prevalence of caries in the deciduous teeth of the 5-year-olds (examined without radiographs) did not change significantly between 1987 and 1999. Only a small proportion of dmfs was filled. Caries prevalence in permanent teeth of the 11-, 17- and 23-year olds decreased significantly. The number of filled surfaces decreased also. Between 1993 and 1999 the number of clinically found DS increased. However, this rise in dentinal caries lesions was not confirmed by similar findings in a simultaneous performed study with bitewing radiographs.
Adolescent↗
Caries-detector dyes--how accurate and useful are they?
Commercially available caries-detector dyes are purported to aid the dentist in differentiation of infected dentin, yet research has established that these dyes are not specific for infected dentin. They are non-specific protein dyes that stain the organic matrix of less mineralized dentin, including normal circumpulpal dentin and sound dentin in the area of the amelo-dentinal junction. A considerable body of evidence indicates that conventional tactile and optical criteria provide satisfactory assessment of caries status during cavity preparation. There is reason for concern that subsequent use of a caries-detector dye would result in unnecessary removal of sound tooth structure. The use of caries-detector dyes has also been suggested as a diagnostic aid for occlusal caries. Although diagnosis of carious dentin beneath apparently sound enamel can be challenging, there is a lack of substantive evidence supporting the use of dyes for this purpose and false positives are a significant concern. Careful visual inspection combined with bitewing radiographic diagnosis has been shown to be the most reliable diagnostic method for the presence of infected dentin requiring operative treatment.
Coloring Agents↗