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PubMed1991

Effects of diagnostic threshold and overlapped approximal surfaces on reported caries status.

The aims of this study were to examine the influence upon reported caries status of: 1) employing different diagnostic thresholds and 2) using differing conventions for treating approximal surfaces which appeared overlapped on posterior bitewing radiographs. Caries prevalence data from a group of 211 Scottish schoolchildren aged 5-15 yr studied during a trial of elective temporary tooth separation in general dental practice in Scotland were used. In this "moderate" caries group, values for dmft/DMFT rose significantly (P less than 0.001) when the D1 diagnostic threshold (all grades of lesion accepted) was applied in comparison with the D3 threshold (only caries into dentine recognised); dmft increasing from 3.9 to 5.4 and DMFT increasing from 1.7 to 4.7. This demonstrated that an over-optimistic impression of overall caries levels may be given when only the D3 threshold is used uncritically. In this study the status of approximal surfaces which were overlapped on bitewing radiographs was assessed by direct clinical examination using the temporary elective tooth separation technique. The investigation showed that, for this juvenile population, most (81.8% mesial, 93.1% distal) overlapped approximal surfaces were sound. Significantly more mesial than distal surfaces were found to be overlapped.

Adolescent↗

PubMed2001

[Prevalence of approximal enamel lesions on bitewing radiographs in cohorts, ages 14 to 23 years].

Bitewing radiographs are mainly used to detect carious lesions in the approximal tooth surfaces, and are an indispensable aid to clinical diagnosis. The aim of this study was to assess the prevalence of approximal enamel lesions from radiographs in groups of 14-, 17-, 20- and 23-years-old persons, and to determine the relation with dentine lesions and restorations present. Per age group the bitewings of 120 persons were randomly selected and assessed for enamel lesions from the distal surface of the first premolar to the mesial surface of the second molar. A second examiner assessed for enamel lesions 20% of the material to measure the interexaminer agreement (Cohen's kappa = 0.63). An enamel lesion was found in about 12 to 15% of the unfilled surfaces. The mean number of enamel lesions was almost three per person. For all age groups it was found that about 20% of the persons had at least 4 enamel lesions and the number of enamel lesions was significantly correlated with the number of dentine lesions. Of all enamel lesions 20% was found in persons without any dentinal lesions or restorations. The bitewing radiographs showed a considerable amount of enamel lesions for these age groups. This seems to justify its use on a routine base as a diagnostic tool at the age of 14-16 years.

Adolescent↗

PubMed2004

Correlation between visual and radiographic examinations of non-cavitated occlusal caries lesions -- an in vivo study.

The aim of this study was to conduct an in vivo investigation of the correlation between the visual and radiographic scoring systems by Ekstrand et al.7 (1997) for the diagnosis of occlusal caries lesions. The study sample comprised 147 occlusal sites from 23 patients. Two trained and experienced examiners performed the clinical visual examinations. A third examiner, which was also trained, experienced and blind to the results of the visual clinical examination, performed the analysis of the bitewing radiographs. The correlation between visual and radiographic scores was assessed by Goodman & Kruskal's gamma correlation coefficient. Results showed a strong correlation between the scores for occlusal caries found in the visual and radiographic diagnosis systems used in this study.

Adolescent↗

PubMed2002

A survey of amalgam restorations in a south-western Nigerian population.

The present survey assessed the proportion of replacement restorations in comparison with new restorations because of primary caries in a setting where the caries experience had been reported to be low but probably on the increase. Also the relative importance of the main reasons for the replacements among other things was established. A total of 488 amalgam restorations were surveyed. About 25% of all restorations were replacements of failed restorations. The main reason for the replacement was bulk amalgam fracture, which accounted for 47.1% of all restorations. These show a reversal of what had been reported in settings where the caries experience was high but now is on the decrease. The importance of bitewing radiograph of all failed restorations was emphasized in order to minimize under or over treatment. The median age of failed restorations was 5.0 years. More than half (60.3%) of replaced restorations had failed during the first 5 years of use.

Adolescent↗

PubMed1991

Automatic analysis of radiographic images: I. Theoretical considerations.

Making accurate measurements from radiographic images is time consuming and expensive. Simple and inexpensive diagnostic/monitoring systems will require a high degree of automation if they are to be used by radiographers or nurses in routine clinical practice without special training. Completely automatic image analysis systems are rare in radiology, although a number of experimental automated (initial human interaction) systems do exist. No fully automatic system exists for analysing dental bitewing radiographs. The role of multiple layer image models and multiple sources of information are discussed in relation to dental images. The potential role of interdental spaces is suggested as necessary key image regions to be identified for the model building process. A theoretical image model data structure is proposed which is experimentally tested in the following paper.

Humans↗

PubMed2001

Clinical performance of a laser fluorescence device for detection of occlusal caries lesions.

Children and adolescents must be examined often for occlusal caries. Diagnosis of fissure caries is difficult especially when the tooth surface appears seemingly intact. It has been shown that using traditional clinical methods, as little as 20% of teeth with fissure caries under intact surfaces were correctly recognised as such. Therefore, new methods for increasing the accuracy of diagnosis have been sought for years. Recently, a new device, based on fluorescence measurements, was introduced. The purpose of this study was to test the device under in vivo conditions in order to provide recommendations for its use in the dental office. Seven general dental practitioners examined a total of 332 occlusal surfaces in 240 patients. Caries extent was determined for each site after operative intervention (='gold standard'). Clinical inspection and analysis of bitewing radiographs exhibited statistically significant lower sensitivities (31-63%) than did the DIAGNOdent device (sensitivity > or = 92%). It is recommended that the laser device is used in the decision-making process in relation to the diagnosis of occlusal caries as a second opinion in cases of doubt after visual inspection.

Adolescent↗

PubMed1992

Comparison of intra-examiner reproducibility in scoring caries in primary teeth of two scoring systems used to monitor caries progression.

The investigation was designed to compare the reproducibility of scoring systems proposed by Pitts (1), and Murray & Majid (2), when used to monitor caries progression in primary teeth. A sub-sample of the posterior bitewing radiographs of 301, 5-yr-old children from a Duraphat clinical trial were re-examined. The difference in the reproducibility of the two methods was not significant (P greater than 0.05). The concern regarding the effect on reproducibility of using scoring systems with subdivisions of enamel when measuring caries progression in primary teeth appears to be unfounded.

Bias↗

PubMed2001

Scanning resolution and the detection of approximal caries.

OBJECTIVE: To determine a proper scanning resolution for digitizing bitewing radiographs in the detection of approximal caries. METHODS: Fifty-two premolars and 48 molars were mounted in blocks and imaged on conventional film (Ektaspeed Plus, Eastman-Kodak, Rochester, NY USA) simulating a bitewing projection. The 15 bitewing radiographs were then scanned with a flatbed scanner at three resolutions 150, 300 and 600 d.p.i. The digitized images were displayed in random order on a high-resolution cathode ray tube monitor. Ten observers assessed the caries status of 200 approximal surfaces. They scored lesion presence on a 5-point confidence scale and depth on a 3-point scale. The observer's scores were compared with the results from a histological examination. Data were analysed using analysis of variance, by calculating signed observer error, absolute observer error and observer confidence. RESULTS: Lesion depth had a significant effect on confidence of lesion recognition. The main effect of resolution and the interaction between resolution and lesion depth were significant. Pair-wise comparison showed a significant difference between resolutions in case of sound surfaces and surfaces with dentinal lesions for absolute error. The confidence increased as the resolution increased but no significant difference was found between 300 and 600 d.p.i. The best score for depth estimation was obtained at the 300 d.p.i. scanning resolution. CONCLUSIONS: When bitewing radiographs are scanned with a flatbed scanner, a resolution of 300 d.p.i. seems the best choice. At this resolution the digital file size is manageable without significant loss of the information necessary for caries diagnosis.

Absorptiometry, Photon↗

PubMed2002

[Clinical underestimation of the prevalence of approximal dentin lesions and inadequate restorations].

The aim of this study was to determine the additional diagnostic value of bitewing radiographs compared to clinical examination, with respect to the presence of dentine lesions and inadequate restorations for different age groups. Subjects were 14-, 17-, 20-, 23-years-old, or were in the age groups of 25-34 and 35-54 years, who participated in 2 clinical epidemiological surveys. After obtaining informed consent, bitewing radiographs were made of approximately 25% of the participants (n = 663). The extra diagnostic yield of the bitewing radiographs varied between a factor 1.6 and 7.2 for approximal dentine caries diagnosis of untreated surfaces, and between 2.3 and 5.9 for inadequate restorations. In conclusion, a considerable increase in the numbers of approximal dentinal lesions and inadequate restorations for all age groups was found.

Adolescent↗

PubMed1996

Clinical evaluation of a samarium compound filter and E-speed film.

Producing radiographs of good diagnostic quality while keeping the dose as low as possible is the goal of the dental radiographer. Rare earth compound filters reduce the dose, but few clinical studies have evaluated the diagnostic yield. The diagnostic quality of a samarium compound filter used with E-speed film was compared with that of a conventional aluminum filter used with E-speed film. Bitewing projections with the test and standard filters were exposed for 39 patients. Agreement was evaluated with kappa statistics. The results indicated a substantial level of agreement between the two filter types. The combination of samarium compound filter and E-speed film appears to be a good mechanism for achieving dose reduction without compromising the diagnostic yield of the film.

Aluminum↗

PubMed1996

Long-term validation study of bitewing dental radiographs for forensic identification.

The validity of dental bitewing radiographs for forensic identification, with time lapses between the antemortem and postmortem film of up to 30 years, was tested. The ability to match radiographs from the same subject was expressed using sensitivity and specificity statistics. Although the overall accuracy of the observers was extremely high, it was obvious that radiographs from the same individual, when separated by time intervals greater that 20 years, had significantly reduced accuracy.

Forensic Dentistry↗

PubMed1998

Number and frequency of bitewing radiographs and assessment of approximal caries in 14-to-19-year-old Swedish adolescents.

The hypothesis of the present study was that previous experience of caries may serve as an indicator for individualised bitewing examinations in 15-19-old adolescents. One hundred adolescents, all 19 years old, were randomly selected from the files of public dental clinics in the County of Orebro. For 93 adolescents the total number of radiographs were summed for every patient from the age of 3 to 19 by assessing the files of public dental clinics and by assessing the files of the dental radiology department. All sets of bitewing radiographs from 14 up to and including the age of 19 were assessed with respect to approximal caries. The average number of intraoral radiographs exposed in a patient from the age of 3 through 19 was 24.4. It was shown that 70 to 80% of 14-19-year-old-adolescents had had a bitewing examination every year. The decision to perform a bite-wing examination in a 15-year-old was significantly correlated to the number of surfaces with initial caries at the age of 14. In the other age groups, none of the investigated variables was found to be significantly correlated to the performance of radiographic examinations.

Adolescent↗

PubMed2000

Effects of additional teaching of final-year dental students on their radiographic diagnosis of caries.

The aim of this study was to evaluate whether the skills of final-year dental students in the diagnostic interpretation of bitewing radiographs could be improved by additional didactic instruction. 6 consecutive classes of students in the same stage of education (last semester in the Department of Operative Dentistry) took part in the investigation from 1995 to 1998. At the beginning of each semester, the same in vivo made bitewing radiograph was demonstrated in a separate radiology revision lecture and interpreted with the students. The intensification of the training in the diagnosis of bitewing radiographs was made when the 4th class of students started. At the end of each semester, each student of the 6 consecutive classes was asked to evaluate the same bitewing radiograph, which had been demonstrated at the start of the semester. The students were not told that they had already diagnosed from this radiograph before. The results of the radiographic diagnosis were then analyzed using an evaluation system paying special attention to the treatment decision. True positive and true negative diagnoses were scored as correct and false positives and false negatives as incorrect. There was no significant difference (ANOVA) in the ability to diagnose from bitewing radiographs between the groups of students who received, and those who did not receive, additional training. The benefits of this type of additional instruction in the last semester in the Department of Operative Dentistry seem only to be important in some individual cases.

Analysis of Variance↗

PubMedDate not supplied

Prevalence of hidden caries.

Clinical evaluations of the first and second permanent molars were compared with radiographic evaluations of the same teeth, for 359 patients (between six and eighteen years old) of the pediatric department of the Academic Centre for Dentistry Amsterdam (ACTA). The teeth were professionally cleaned and dried before the clinical evaluation. Despite the thorough examination, taking into account the fact that all discolorations and/or decalcifications were noted, 15 percent of the teeth that did not show signs of enamel caries clinically, showed a dentine lesion on the bitewing radiograph. These 15 percent of teeth with hidden caries were found in 7.5 percent of the population studied. The absence of clinical signs of occlusal enamel caries or dentine caries does not guarantee a sound dentition. Sealant treatment of teeth that are sound (both clinically and radiographically) is justified, therefore, soon after tooth eruption.

Adolescent↗

PubMed1995

Reproducibility of repeat bitewing radiographs determined by measurement of the distance between the amelocemental junction and the alveolar crest: an ex vivo study using human skulls.

OBJECTIVE: To assess the reproducibility of repeat bitewing radiographs. METHODS: Five right and left pairs of posterior bitewing radiographs were taken without the use of beam-aiming or film-holding devices in five dry skulls with complete dentitions. The amelocemental junction (ACJ) and alveolar crest (AC) of every interdental site was traced on projected radiographs and the linear distance between the ACF and AC determined. RESULTS: There was close concordance between the ability to read the ACJ on the approximal tooth surface and the AC. The overall readability of interdental sites was 71% although sites at the extremities of radiographs were often unreadable. Kappa analysis of the readability of alveolar bone height from repeat radiographs was 0.52. There were significant differences in the reproducibility of ACJ and AC measurements from repeated radiographs (p<0.001). Intra-examiner variability was significantly less (p<0.001) than that due to repeat radiography with no significant differences between sites. The standard deviation for all surfaces from repeat readings of the same radiographs was 0.12 mm compared with 0.51 mm from repeat radiography. CONCLUSIONS: In this study a freehand technique produced a degree of imprecision in readings of alveolar bone height from successive films of the same site. In clinical terms, a difference of more than 1.4 mm between pairs of serial measurements from the same site would have to occur in order to be certain that the difference was not measurement error but real bone loss.

Alveolar Bone Loss↗

PubMed1999

Underestimation of the prevalence of approximal caries and inadequate restorations in a clinical epidemiological study.

UNLABELLED: The prevalence of clinically diagnosed approximal caries and inadequate approximal restorations is usually underestimated, when compared with radiographic assessment as a 'gold standard'. OBJECTIVE: The aim of this study was to determine the degree of this underestimation in a clinical epidemiological project. METHODS: Clinical data (n = 951) of 17- and 23-year-olds were collected by calibrated examiners and bitewing radiographs were taken after obtaining the participant's consent. The radiographic examination of the approximal surfaces on the radiographs of 621 participants was based on criteria derived from the clinical protocol. A second examiner judged 20% of the radiographic material to determine the interobserver agreement, using Cohen's kappa. The agreement proved to be good (kappa = 0.66) for dentine caries diagnosis, and fair (kappa = 0.44) for restoration assessment. RESULTS: Of the total number of recorded decayed or inadequately restored surfaces only 10.8% and 13.8% respectively were found clinically. Of the total number of clinically sound surfaces, 10.1% had dentine caries on the bitewing radiograph. The percentage of clinically adequate restorations needing replacement was 25.7%. CONCLUSION: It was concluded that the prevalence of approximal caries and inadequate restorations in this clinical epidemiological study was highly underestimated. At least for these age groups the results contain a serious warning for epidemiologists and general dental practitioners with respect to the outcome of clinical caries diagnosis.

Adolescent↗

PubMed1994

The use of a computer-based image analysis program for the diagnosis of approximal caries from bitewing radiographs.

Approximal surfaces of 13 extracted molar and premolar teeth were classified directly and radiographically as sound or decayed. Eleven faculty dentists examined bitewing radiographs of the teeth and responded on a 5-point certainty scale, whether caries was present. Ten other faculty dentists used a computer-based program to examine the radiographs. For sensitivity, area under the receiver operating characteristic curve, and interexaminer agreement (Kappa), the computer-assisted faculty was significantly (p < 0.05) superior or equal to the unassisted faculty group.

Bicuspid↗

PubMed1991

The use of bitewing positioning devices in children's dentistry.

The use of film-holding, beam-aiming devices have been shown to have a number of potential advantages in achieving high quality bitweing radiographs, however, little information is available about their acceptability to children. The aims of this study were: (1) to determine the level of acceptance of a conventional type of film positioner to child patients in a general practice setting in Scotland and (2) to compare the acceptability to children of bitewing procedures using: the freehand technique, a 'Rinn' positioner and a new positioner, the 'HPL' device. In the general practice group, following modifications made during a pilot study, 211 children aged 3-15 years were offered a bitewing examination with a modified Rinn positioner at recall. The overall acceptance rate of the bitewing procedure was 82.5%. All 10 children aged 3-4 years offered bitewings refused, while 77 (69%) of subjects aged 5-9 years accepted, as did all the 89 children aged 10-15 years. In the comparison of acceptability investigation, three groups of 30 children aged 6-15 years requiring bitewing radiographs were selected at random. Each group had a different bitewing technique carried out by the same operator. The children's acceptance of all three techniques was high (87-97%) and no statistically significant difference was found between the acceptability of the freehand method and those involving film positioning devices. Although the unmodified Rinn design suffered from a number of problems, the modified version was found to be acceptable by many children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗