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PubMed2001

Evaluation of computer aided learning in developing clinical decision-making skills.

AIM: The aim of this study was to determine whether an educational intervention delivered by a computer aided learning package improved the sensitivity and specificity of dentists' restorative treatment decisions. METHOD: The study was a randomised controlled study using a Solomon three-group design. Ninety-five dentists were randomly allocated to the three study groups. One group of dentists read the radiographs pre and post an educational intervention, a second group read the radiographs once, after the intervention, and a third group read the radiographs twice, but received no intervention. On each occasion the dentists read 24 surfaces on each of 15 radiographs and made 360 decisions on how certain they were about restoring the tooth surface. Comparisons of mean sensitivity, specificity and areas under ROC curves were made within and between the study groups. Kappa values were used to assess changes in the level of agreement between dentists. RESULTS: There were no significant changes in sensitivity, specificity or area under ROC curves caused by the intervention. There was no evidence that the level of agreement between the dentists improved after the intervention. CONCLUSION: A computer aided learning package had no effect on dentists' treatment decision-making behaviour.

Computer-Assisted Instruction↗
PubMed1994

Diagnosis of secondary caries: a laboratory study.

Secondary caries is difficult to diagnose accurately. The purpose of this laboratory study was to investigate various non-invasive clinical and radiographic criteria which might predict the presence of carious dentine beneath the margin of the filling. A total of 331 sites, each 3 mm in length on the tooth restoration margin, were selected on 112 extracted and filled teeth. Thirty of these sites showed obvious carious cavities. Ditching was apparent in a further 70 sites, while 231 sites were clinically intact. Staining of the margin of the filling was recorded and radiographs were taken of posterior teeth. Restorations were then removed and the enamel-dentine junction (EDJ) immediately below the sites was examined for its consistency (hard/soft) and colour (stained/stain-free). Results showed that staining around a filling is not a reliable predictor of softening or discolouration of the dentine beneath. A clinical carious cavity and radiographic evidence of demineralisation indicate soft and discoloured dentine and should trigger operative intervention, while ditching alone should not.

Dental Caries↗
PubMed1995

Periodontology: a clinical approach. 1. Periodontal examination and screening.

Periodontology has witnessed some of the most intensive and extensive research in dentistry over the last 30 years. This has led to a much clearer understanding of the aetiology of periodontal diseases and clinical studies have done much to compare and improve treatment modalities. The wealth of literature can certainly lead to confusion but for the most part should ultimately result in a more rational application of diagnostic and treatment methods. This new series is based upon the authors' wide experience in clinical practice and interpretation of the scientific literature.

Dental Records↗
PubMed1998

Advances in periodontal diagnosis. 1. Traditional clinical methods of diagnosis.

This series will consider the limitations of traditional periodontal diagnostic techniques and the recent advances which have sought to overcome them. It will cover improvements in probing and radiographic techniques and also discusses the attempts to find bacterial or tissue-derived markers which will diagnose or predict periodontal disease activity. The first paper describes the traditional methods of periodontal diagnosis.

Adolescent↗
PubMed2002

Radiographic evaluation of the relationship between the projection of genial tubercles and the lingual foramen.

OBJECTIVE: Reports in specialized literature present divergent opinions about what corresponds to the radiopaque areas surrounding the lingual foramen. The purpose of this study is to radiographically evaluate whether these areas correspond to the genial tubercles. METHODS: We selected 15 dry mandibles and obtained images of the lower incisors region by computed tomography (CT) and periapical radiography at vertical angles of -10 degrees, -20 degrees and -30 degrees. For periapical radiography, the genial tubercles and the lingual foramen were marked with stainless steel wire to demonstrate the relationship between them. RESULTS: The images on periapical radiographs, as well as on CT scans of the region, showed that there is no relationship between radiopaque areas around the lingual foramen and the genial tubercles. CONCLUSION: The radiopaque area surrounding the lingual foramen corresponds to the walls of a nutrient canal and not to the genial tubercles. Therefore, we recommend that the information about this anatomical landmark be reviewed in specialized literature.

Chin↗
PubMed2002

A comparison of the effective dose from scanography with periapical radiography.

OBJECTIVES: To compare organ and effective doses from analogue scanographic and periapical radiography. METHODS: Thermoluminescent dosimeters (TLD-700) were inserted in the parotid glands (bilateral), submandibular glands (bilateral) and bone marrow (left ascending ramus) of three human cadavers. Dosimeters were also attached to the skin, thyroid gland and lens of both eyes. Central, left lateral and left posterior scanograms were obtained with a Cranex Tome (Soredex, Helsinki, Finland) multimodal imaging system. A similar procedure was applied for periapical radiographs of the midline, left lateral and left molar regions using E-speed film both with and without rectangular collimation. Organ and effective doses were calculated for scanograms and periapical radiographs. RESULTS: The effective doses for the scanograms were 0.001 mSv (central), 0.011 mSv (lateral) and 0.015 mSv (posterior). The effective doses for periapical radiographs were 0.001 mSv (anterior), 0.001 mSv (lateral) and 0.003 mSv (posterior) for rectangular collimation and 0.001 mSv (anterior), 0.002 mSv (lateral) and 0.005 mSv (posterior) for round collimation. CONCLUSIONS: When a larger area of the upper or lower jaw needs to be visualised, scanograms might be considered as an alternative to periapical radiography since the effective dose is lower.

Bone Marrow↗
PubMed1996

RVG-S, VIXA, and Ektaspeed film in detection of proximal enamel defects under orthodontic bands.

An in vitro investigation was carried out to compare CCD-based intraoral radiographic systems with E-speed film for the detection of proximal enamel defects beneath orthodontic bands, with and without added niobium filtration to attenuate the x-ray beam. Twenty caries-free extracted teeth were randomly divided into five groups. Fifteen of 30 contacting proximal surfaces remained lesion free; the other 15 received a small, medium large mechanically induced enamel defect. Images were made with and without the addition of 30 microns niobium filtration, and with and without orthodontic bands. Six dentists were viewers. Receiver operating characteristic (ROC) curves were developed for each modality under each test situation. The area under the curve (Az) was used as an index of diagnostic accuracy, and the critical ratio was used for statistical comparisons. In the absence of orthodontic bands, the Az values for E-speed film and for nonenhanced RVG-S were greater than for all other modalities tested, indicating that they have the greatest diagnostic accuracy. With orthodontic bands, the RVG-S with steep gradient enhancement (X-function) had a higher Az value than all other modalities. Addition of niobium had no significant effect on defect detection. CCD-based devices hold no diagnostic advantage over conventional film for detecting changes in the density of enamel not covered by orthodontic bands. Contrast enhancement of digital images (RVG-S X-function) holds promise for the detection of such changes beneath orthodontic bands.

Bicuspid↗
PubMed1998

Eruption and function of maxillary third molars after extraction of second molars.

After extraction of maxillary second molars, will the third molars erupt into a functional position in a timely manner? To answer this question, 56 consecutively treated cases of maxillary second molar extraction were reviewed. The unerupted positions of the maxillary third molars were measured on cephalometric radiographs, ages of eruption were evaluated, positions of erupted third molars analyzed, and interproximal periodontal health of adjacent first molars compared. The results showed that, generally, the eruption of third molars was accelerated. Most of the third molars had acceptable interarch and intra-arch occlusal relationships. The interproximal periodontal health of the third molars was similar to that of adjacent first molars. Most maxillary third molars will successfully erupt into an acceptable position by the late teens.

Adolescent↗
PubMed2002

The effects of nitanium maxillary expander appliances on dentofacial structures.

The aim of this study was to determine the sagittal, transverse, and vertical effects of a Nitanium maxillary expansion appliance on dentofacial structures in patients with bilateral posterior cross bites in the permanent dentition. For this purpose, and without distinguishing the skeletal classification, a total of 16 patients (4 boys and 12 girls) with a mean age of 13.8 years and a bilateral posterior crossbite in the permanent dentition were chosen. Lateral and frontal cephalometric radiographs, maxillary and mandibular plaster models and periapical radiographs were obtained from each patient at pretreatment (T1), post-treatment (T2), and at the end of the retention period (T3) time points. The measurements that were obtained from the lateral and frontal cephalometric radiographs and maxillary and mandibular plaster models were evaluated by a Wilcoxon paired 2-sample test. This test compares 3 pairs of time points, the pretreatment (T1) and posttreatment (T2), the pretreatment (T1) and post retention (T3), and the post-treatment (T2) and post retention (T3). Periapical radiographs were used to demonstrate changes in the midpalatal suture. Skeletal expansion occurred simultaneously with dentoalveolar expansion in the transverse plane with the Nitanium maxillary expansion appliance. The upper incisors were extruded and retroclined. Also, the extrusion of the upper first molars caused the mandible to rotate backward and downward. This resulted in an increased vertical dimension of the lower face. It was clinically observed that the posterior cross-bite and mesiopalatal rotation of the upper first molars were improved and that the crowns of these teeth were moved slightly to the distal side.

Adolescent↗
PubMed2005

Apical root resorption six and 12 months after initiation of fixed orthodontic appliance therapy.

The low explained variance of identified risk factors for apical root resorption in orthodontic patients suggests effects of parameters related to individual predisposition. Our purpose was to explore this hypothesis. We evaluated standardized periapical radiographs of the maxillary incisors made before treatment (T1) as well as at about six and 12 months after bracket placement (T2 and T3) of 247 patients aged 10.1 to 57.1 years at T1. The radiographs were converted to digital images, and commercially available software was used to correct for differences in projection. The results showed that 20.2%, 7.7%, and 5.3% of the patients had > or =1 tooth with >2.0, 3.0, and 4.0 mm resorption at T3, respectively. Pearson's correlation revealed an association between resorption from T1 to T2 and from T2 to T3 (P < .01). The risk of > or =1 tooth with >1.0 mm resorption from T2 to T3 was 3.8 times higher (95% CI 2.4-6.0) in patients with > or =1 tooth with >1.0 mm from T1 to T2 than in those without. Also, resorption was more pronounced (P < .001) from T2 to T3 in patients with > or =1 tooth with >1.0 mm and >2.0 resorption from T1 to T2 than in those without. The explained variance of identified risk factors was <10%. Orthodontic patients with detectable root resorption during the first six months of active treatment are more likely to experience resorption in the following six-month period than those without.

Adolescent↗
PubMed2000

Periapical status and quality of root fillings and coronal restorations in a Danish population.

AIM: The aim of this study was to investigate the quality of endodontic and coronal restorations and the association with periapical status in a Danish population. METHODOLOGY: A total of 614 randomly selected individuals (20-60+ years of age) from Aarhus County had a full-mouth radiographic examination. The quality of endodontic and coronal restorations and the periapical status of endodontically treated teeth were assessed by radiographic criteria. Root fillings were categorized as 'adequate' or 'inadequate' with regard to root filling length and lateral seal. Coronal restorations were categorized into 'adequate' and 'inadequate', defined by the absence or presence of radiographic signs of overhangs or open margins. Results were analysed statistically using the chi-squared test. RESULTS: The total number of endodontically treated teeth was 773, and 52.3% had apical periodontitis (AP). Root-filled teeth with an adequate lateral seal had a lower incidence of AP than teeth with an inadequate seal (44.3% vs. 57.8%), and teeth with an adequate root filling length were associated with a better periapical status than teeth with inadequate length of the root filling (42.0% vs. 67.6%). Similarly, adequate coronal restorations were associated with better periapical status than inadequate restorations (48.0% vs. 63.9%). When both root filling and coronal restoration quality were assessed, the incidence of AP ranged from 31.2% (optimal quality) to 78.3% (all parameters scored as inadequate). CONCLUSIONS: Inadequate root canal and coronal restorations were associated with an increased incidence of AP.

Adult↗
PubMed1999

The effect of alterations in horizontal X-ray beam angulation and bucco-lingual cavity width on the radiographic depth of approximal cavities.

The effects of changes in horizontal X-ray beam angulation and different cavity shape on images of approximal cavities on bite-wing radiographs were examined using a laboratory model. Cylindrical-, rectangular- and cone-shaped bur cut cavities were prepared in the approximal surfaces of 108 teeth and their depth determined using silicone putty impressions. Spatial relationships were controlled by fixing specimens into perspex blocks. Standardized radiographs were taken at baseline (0 degree) and then using pre-angled wedges to imitate horizontal X-ray beam movements of 5, 10 and 15 degrees in both mesial and distal directions. Radiographic cavity depth to the nearest 0.1 mm was measured. Over the range of X-ray beam movements, more than 72% of cavities deepened compared to baseline. As bucco-lingual cavity width increased the magnitude of the depth change increased. For some cylindrical cavities increases equating to 200% over baseline were seen; in some rectangular cavities increases of up to 400% over baseline occurred. The present study suggests that changes in irradiation geometry from baseline are likely to result in a cavity appearing to deepen. In a clinical context over-treatment is therefore the most likely outcome.

Dental Caries↗
PubMed2001

Estimation of skeletal bone mineral density by means of the trabecular pattern of the alveolar bone, its interdental thickness, and the bone mass of the mandible.

OBJECTIVE: We sought to evaluate the use of the alveolar trabecular pattern, the mandibular alveolar bone mass (MABM) measured by photodensitometry, and the interdental alveolar thickness for prediction of the skeletal bone mineral density (BMD). STUDY DESIGN: MABM and the coarseness of trabeculation were assessed by using periapical radiographs in 80 dentate women. The interdental alveolar thickness was measured on casts, and BMD of the forearm with dual X-ray absorptiometry. RESULTS: Significant correlations were found between skeletal BMD and MABM (r = 0.46, P <.001) as well as the coarseness of the trabeculation (r = 0.62, P <.001). The interdental alveolar thickness improved the correlation between skeletal BMD and MABM (R2 = 0.44, P <.001). Age, but not interdental thickness, improved the correlation between the coarseness of trabeculation and skeletal BMD (R2 = 0.52, P <.001). CONCLUSION: Evaluation of the coarseness of trabeculation of the alveolar bone as seen on intraoral radiographs is a helpful clinical indicator of skeletal BMD and better than densitometric measurements of the alveolar bone. Dense trabeculation is a strong indicator of high BMD, whereas sparse trabeculation may be used to predict low BMD.

Absorptiometry, Photon↗
PubMed2002

Response of autotransplanted teeth to electric pulp testing.

OBJECTIVE: The purpose of this retrospective study was to assess the results of third molar autotransplantation by using electric pulp testing (EPT) and to determine the correlation of EPT response and bone formation. STUDY DESIGN: Fourteen patients with 22 transplanted teeth were studied. The patients had received autotransplantation of third molars and regularly came for follow-up on the third, sixth, ninth, and twelfth months. Postoperative clinical assessment included pain, inflammation of surrounding soft tissues, tooth mobility, and the EPT response. Periapical radiographs were subsequently evaluated during follow-up. The correlation between pulpal response to EPT and bone healing was analyzed. RESULTS: Most of the teeth had normal mobility within 3 months, which corresponded to bone formation. Bone healing at the recipient sites completely occurred within 6 months, and more than 50% had lamina dura. The teeth with EPT response increased to 95% within 12 months. There was no significant association between the EPT response and bone formation. CONCLUSIONS: The EPT response subsequently increased with time, and it seemed to be unchanged after 1 year.

Adolescent↗
PubMed2003

Diagnosis of approximal caries: bite-wing radiology versus the Ultrasound Caries Detector. An in vitro study.

OBJECTIVE: We sought to examine the validity, sensitivity, and specificity of bite-wing radiographs and a high-frequency sound wave device (the Ultrasound Caries Detector) used to detect caries on contacting approximal surfaces. METHODS: A total of 36 extracted premolars and molars were first visually examined for the presence of caries; then a probe was used. Twelve models were prepared, each containing 3 teeth with 2 approximal surfaces and 2 contacted surfaces (of adjacent teeth). Bite-wing radiographs were taken and evaluated for proximal caries lesions. A high-frequency sound wave (ultrasound) device called the Ultrasound Caries Detector was also used to detect caries. Examinations were repeated after 1 week. Teeth were then sectioned and viewed under a stereomicroscope at 20x magnification, with which the true interproximal caries diagnosis was validated. The receiver operating characteristic curves were computed to establish the accuracy of the observer data. RESULTS: The efficacy of the ultrasound diagnostic device for cavitated carious lesion detection was assessed by determining its specificity and sensitivity, 1.0 for each, in comparison with those of bite-wing radiography, 0.92 and 0.90, respectively (P <.001). The mean receiver operating characteristic value for the area under the curve was 0.934 with bite-wing radiography and 1 with the ultrasound diagnostic device. CONCLUSIONS: Under in vitro conditions, the ultrasound diagnostic device had a higher sensitivity and specificity, in terms of the detection of approximal carious lesions, than bite-wing radiographs.

Area Under Curve↗
PubMed2004

Root length in transplanted premolars.

The objectives of the present prospective longitudinal study were to establish the survival and success rates for premolars with partly developed roots transplanted according to a set protocol, and to analyze the effect of varying pre-surgery root development on final root length. Standardized periapical radiographs of 132 consecutively transplanted premolars were obtained at predetermined intervals over a 4-year follow-up period. Survival and success rates were calculated on the basis of presence of teeth and recording of defined radiological variables, respectively. Final root length was compared to normative metric data for root morphology. From the total sample, 54 patients with 68 transplanted premolars suitable for analysis of root growth relative to initial root length were identified, and divided into subsamples according to root length pre-transplantation. Survival rates were 100% after 1, 2, and 3 years, and 98.6% 4 years post-transplantation. The success rates were 92.9%, 92.8%, 89%, and 90.5% in subsamples collected 1, 2, 3, and 4 years after transplantation, respectively. The transplants obtained on average 78% of normative root length, and by dichotomizing the transplanted teeth in subsamples with 'short' and 'long' roots pre-surgery, similar final root lengths were observed even if 'short' roots had the greatest increase. Very early transplantation (roots < 7 mm), however, tended to result in short final root length. It is concluded that the success and survival rates were comparable to results obtained in similar studies. Initial root length was a significant predictor of root length increase. Transplanting teeth with short roots is to risk short final root length.

Bicuspid↗