Dental radiographs and dental caries: a challenge.
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Dental Caries↗
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Results for “Radiography, Bitewing”
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The efficacy of caries detection using three intraoral films under different processing conditions.
This study compares the diagnostic accuracy of caries detection using Ultra-speed (Eastman Kodak), Ektaspeed (Eastman Kodak) and Ektaspeed Plus (Eastman Kodak) films after they were developed in both new and used processing solutions. Ektaspeed Plus film provided significantly better diagnostic accuracy for small proximal-surface caries limited to the outer third of the dentin than did Ektaspeed film. Ektaspeed Plus film did not differ significantly from Ultra-speed film in aiding in the diagnosis of small carious lesions, and it maintained diagnostic accuracy in used processing solutions. Dentists can offer the X-ray dose-reducing technology of Ektaspeed Plus film to their patients and maintain consistently high diagnostic quality.
Analysis of Variance↗
Human mineralized bone in extraction sites before implant placement: preliminary results.
BACKGROUND: Bone loss after tooth extraction may prevent dental implant placement. Human mineralized bone grafts can be used to restore bone volume and allow for tooth replacement with dental implants. METHODS: The authors grafted 22 sites in 18 patients with human mineralized bone after tooth extraction. They allowed molar sites 16 weeks for graft healing, placed the implants and restored them with a final crown after a four-month integration period. Single-rooted maxillary sites received implants and immediate placement of provisional crowns or underwent a delayed two-stage restoration approach. The authors used radiographs and clinical examinations to evaluate the results. RESULTS: All of the sites were restored successfully with a single-tooth implant restoration. Periapical radiographs indicated that the crestal bone levels were limited to the first thread of the implants or slightly coronal to the first thread of the implant. Clinical evaluation indicated excellent gingival health around the provisional and final restorations, without obvious gingival migration. CONCLUSIONS: The use of human mineralized bone may have significant potential to reconstruct missing bone resulting from tooth extraction and to preserve bone after tooth extraction. In addition, healed bone graft sites seem to be able to support immediate placement of a provisional crown and implant restorations. CLINICAL IMPLICATIONS: Patients who are having teeth extracted may become candidates for implant restorations when the sites are appropriately grafted to preserve and reconstruct bone volume, thus allowing for more options for reconstructing the missing tooth site.
Alveolar Ridge Augmentation↗
A two-year clinical evaluation of pit and fissure sealants placed with and without air abrasion pretreatment in teenagers.
BACKGROUND: Long-term retention of pit and fissure sealants is essential for their success. The aim of this study was to compare the retention rates of sealants placed with acid-etching and air abrasion followed by acid etching. METHODS: Sixteen subjects aged 16 and 17 years were included in the study. Using a half-mouth design, the authors performed fissure preparation with phosphoric acid gel on randomly assigned maxillary and mandibular permanent premolars and molars from one side of the mouth (Group I) and performed air abrasion followed by acid etching on the contralateral side of the mouth (Group II). The authors applied sealant material on 162 teeth, and they evaluated the sealants as complete retention, partial loss or total loss at six, 12 and 24 months. RESULTS: While fissure sealant retention rates were not significantly different for the two techniques at six months (P = .97), the retention rates for the teeth in Group II were significantly higher at 12 (P = .025) and 24 months (P = .002). Molar retention rates were significantly less than those for premolars at each evaluation period (P < .05). CONCLUSION: The sealant retention rates at 12 and 24 months were higher in Group II (air abrasion followed by acid etching). CLINICAL IMPLICATIONS: As air abrasion followed by acid etching resulted in significantly higher sealant retention rates, this method could be a good choice for fissure preparation before sealant placement for long-term success.
Acid Etching, Dental↗
Comparison of three methods for detection of carious lesions in proximal surfaces versus direct visual examination after tooth separation.
The present study aimed to compare clinical, fiber-optic transillumination and bite-wing radiographic assessment of carious lesion depth in contacting proximal surfaces with the results obtained by direct visual inspection after tooth separation of the respective surfaces. It is suggested that when a carious lesion is diagnosed as non-cavitated by clinical examination or restricted to enamel by FOTI or radiographic examinations in a population of children with low caries prevalence, dentists should adopt a preventive approach.
Adolescent↗
Periodontal disease morbidity quantification. I. Optimal selection of teeth for periodontal bone loss surveys.
The assessment of alveolar bone loss with bite-wing radiographs is attractive because bite wings are relatively convenient, inexpensive, and available. The choice of teeth used influences the validity of global bone loss assessments based on partial mouth measurements. The objective of this study was to validate periodontal bone loss indices based on a few teeth. The mandibular posterior teeth were considered as a basis for abbreviated indices. The optimum number of teeth included was evaluated, and the utility of abbreviated indices was determined experimentally. The teeth from 75 skulls were measured from the cemento-enamel junction (CEJ) to the alveolar bone at six locations per tooth. The subsets of teeth which best represent the average whole mouth bone loss were found with all-possible-subsets regression analysis. Bone loss data from 179 prehistoric skulls were used to test the validity of selected teeth indices. Bone loss measurements from the mandibular posterior areas were representative of full-mouth bone loss measurements. Mandibular second premolars plus any other mandibular posterior teeth were the optimal combination of tooth for an abbreviated index. This subset is suitable for use with bite-wing radiographs.
Adult↗
Periodontal disease morbidity quantification. II. Validation of alveolar bone loss measurements and vertical defect diagnosis from digital bite-wing images.
Quantitative alveolar bone loss evaluation by digital processing of dental radiographs was performed. More than 20 contrast and edge enhancement techniques were applied to bite-wing radiographs of adult molar teeth and the results subjectively evaluated. Wallis space variant image enhancement was selected as the most promising candidate for improved visualization of the cemento-enamel junctions and alveolar crests. Seventy-three skulls were radiographed, the films digitized, and enhancement performed on the digital images. Alveolar bone loss measurements from skulls (truth) were compared with those from the original radiographs, unprocessed digital images, and enhanced digital images. The average intraclass correlation coefficient for two observers was 0.83 for radiographs, 0.86 for digital images, and 0.91 for enhanced images. The intraclass correlation coefficient between the 2 sets of dry skull measurements made by two additional observers was 0.88. Means and 95% confidence limits were determined for differences between measurements from dry skulls and radiograph-based images. In the worst case for measurements from enhanced images, the mean difference from truth was -0.40 mm with a 95% confidence interval from -0.54 to -0.25 mm. Receiver operating characteristic (ROC) analysis was used to determine the utility of radiograph-based images for the diagnosis of vertical defects. The ability of two observers to diagnose vertical defects on dry skulls was also tested. All methods of vertical defect diagnosis, including the identification of vertical defects on dry skulls, had relatively low diagnostic performance. Image processing technology has considerable potential in periodontal disease studies for quantitative evaluations of alveolar bone height. The diagnosis of vertical defects using current definitions and techniques is problematic, with considerable room for improvement.
Alveolar Bone Loss↗
The relationship between probing attachment loss and computerized radiographic analysis in monitoring progression of periodontitis.
This study attempted to evaluate quantitative changes in radiographic density as an indicator of progression of periodontitis. Twenty-one subjects with a history of periodontitis were monitored at baseline, 3, 6, and 9 months using duplicate probing attachment level (PAL) measurements from stents and computer assisted densitometric image analysis (CADIA) of standardized radiographs. Results indicate that the majority of sites exhibited no PAL change during the 9-month period; however, the percentage of sites with loss increased with time. A mean of 6.1% of the sites/patient exhibited probing attachment loss during the study, as compared to a mean of 38.3% of the sites/patient that exhibited a loss of radiographic density. Due to the two dimensional nature of radiographs, density analysis was calculated in terms of radiographic "complexes" of multiple probing sites. There was significantly more density loss at complexes with greater than or equal to 2 mm of attachment loss than at sites with no change in PAL at 9 months; there was no such difference noted at 3 and 6 months. Also, density loss tended to increase as more sites within each complex experienced PAL. Although there was a significant correlation between mean density and PAL changes during the same time interval, there were wide variations at individual sites. This study suggests that there is a complex relationship between density change on radiographs and PAL change. The difficulties inherent in comparing highly sensitive new technologies to relatively imprecise clinical measurements of the attachment level are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)
Absorptiometry, Photon↗
Progression of probing attachment loss in adult periodontitis.
Thirty patients with adult periodontitis were monitored using an automated periodontal probe for 6 months in order to determine the prevalence of active sites and the overall pattern of disease progression in active sites. The automated probe is capable of measuring probing attachment levels relative to the cemento-enamel junction with better than 0.2 mm of accuracy. The prevalence of disease activity was dependent on the threshold for probing attachment loss used. When the smallest threshold (0.4 mm) was used the prevalence of active disease was 29%, whereas a large threshold (2.4 mm) detected only 2% active sites. Regression analysis of the active sites revealed that 76% of the sites lost probing attachment consistent with a continuous model for disease progression. A small subset of sites demonstrated either bursts of activity or exacerbations and remissions of disease activity.
Aged↗
Cigarette smoking and periodontal bone loss.
The association between smoking and loss of periodontal bone height was investigated in Swedish dental hygienists. The study group included 210 subjects: 24 to 60 years of age, 30% smokers, 32% former smokers, and 38% non-smokers. The study was based on bite-wing radiographs, where loss of the interproximal bone height was measured as the distance from the cemento-enamel junction (CEJ) to the interdental septum (IS). The magnitude of the CEJ-IS distance was read at 12 sites, representing 3 maxillary and 3 mandibular bone septa in each subject. The CEJ-IS distance was significantly greater for smokers when compared to non-smokers, mean +/- SEM 1.71 +/- 0.08 mm and 1.45 +/- 0.04 mm, respectively. The mean +/- SEM for former smokers was 1.55 +/- 0.05 mm. In smokers, the CEJ-IS distance increased with increased smoking exposure. The results, based on adults with good oral hygiene, suggest that loss of periodontal bone is related to smoking. The smoking related bone loss is not correlated with plaque infection.
Adult↗
Destructive forms of periodontal disease in adolescents. A 3-year longitudinal study.
We studied the periodontal disease progression and the relationship between some forms of destructive periodontitis in a group of Brazilian adolescents with high prevalence of periodontal destruction, and evaluated the adequacy of reducing data by limiting the measurement of disease to first molars and by aggregating and pooling site-scores into subject-level scores. Over a period of 3 years 222 adolescents were examined annually by bite-wing radiographs. Individuals displaying arc-shaped bone lesions adjacent to greater than or equal to 2 first molars were diagnosed as juvenile periodontitis (JP) patients, while those with greater than or equal to 1 first molars showing vertical lesions were regarded as periodontal risk subjects. Teenagers with greater than or equal to 2 first molars exhibiting longitudinal bone loss were defined as high-risk patients. At the ages of 13 and 16 years, 3 (1.3%) and 4 (1.8%) subjects had JP, while 12 (5.4%) and 28 (12.6%) were regarded as periodontal risks; 8 (3.6%) subjects were assigned to the high-risk group; 4 (1.8%) 13-year olds had greater than or equal to 1 first molars missing; hence, no loss of posterior teeth occurred over a period of 3 years. Analyzing the data at the site-level revealed progressive loss and little fluctuation in the alveolar bone height in the high-risk group, and a more pronounced bone loss at the mesial than at the distal surfaces. Simpler data sets were constructed by aggregating some of the site-scores or by pooling these into subject-level scores.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
What alveolar crest level on a bite-wing radiograph represents bone loss?
In advanced periodontal disease alveolar bone crestal loss is readily apparent on radiographs. However, in incipient disease there is a lack of consensus regarding what constitutes crestal bone loss on a radiograph. To properly assess crestal bone loss radiographically requires an appropriate base of reference indicative of the absence of destructive periodontal disease. In this study the radiographic CEJ-crest distance as a measure of crest height was determined for sites at which clinical attachment measurements indicate no attachment loss. From these measurements it is concluded that no crestal bone loss is consistent with a range of radiographic CEJ-crest distance between 0.4 and 1.9 mm (95% confidence limits) as evidenced on bite-wings.
Adolescent↗
Elastase as an indicator of periodontal disease progression.
THIS STUDY SOUGHT TO EVALUATE the ability of gingival crevicular fluid (GCF) elastase to predict attachment and bone loss in human periodontitis. Thirty subjects who were medically healthy and had a history of progressive periodontitis were studied with an automated probe. Five sites in each patient were monitored bi-monthly for a 6-month period for attachment loss. Subtraction radiography was utilized at the beginning and end of the study to monitor bone loss. GCF elastase was measured at 0 month and then bi-monthly by collecting GCF on paper strips impregnated with PMN leukocyte elastase substrate inserted into the gingival crevice for 15 seconds. After 8 minutes of reaction time, the strips were scored relative to fluorescent standards in an ultraviolet view box. Strips were then eluted in methanol and total elastase measured by spectrofluorometry. Total elastase was significantly higher in sites demonstrating progressive attachment loss than in inactive sites (2.81 +/- .29 versus 2.03 +/- .07, P less than 0.0005) and sites demonstrating bone loss (2.32 +/- .17 versus 2.01 +/- .08 P less than 0.05). When considering the joint presence of bone loss and attachment loss of 1.0 mm or greater in the 6-month period following a visual elastase kit score of 2 or greater, the test kit shows a sensitivity and specificity of 82% and 66%, respectively. This study demonstrated that GCF elastase levels are significantly higher in sites demonstrating progressive periodontal attachment and bone loss assessed 6 months later and may serve as a predictor of future bone and attachment loss.
Adult↗
Radiographic methods for the detection of progressive alveolar bone loss.
Intraoral transmission radiographs have been the primary diagnostic method for the assessment of bone support as well as for the detection and measurement of osseous changes due to periodontitis. The purpose of the present paper is three-fold. The first is to review radiographic techniques for the assessment of periodontal disease progression, presenting the strengths and weaknesses of each method while placing special emphasis on digital subtraction radiography. The second purpose is to present data from a recent study that compared the ability of digital subtraction radiography and automated attachment level probing to detect the same active sites. Thirty periodontitis patients and eight control patients were studied over a 6-month period. The results indicate that when these two sensitive methods for the assessment of progressive periodontitis were used there was concordance between the presence or absence of probing attachment loss and bone loss in 82.1% of the sites. The final goal of this paper is to present future directions for the quantitative analysis of digital radiographic images.
Alveolar Bone Loss↗
Computerized methodology for detection of alveolar crestal bone loss from serial intraoral radiographs.
The aim of this study was to develop a computerized measurement system for analysis of unstandardized serial radiographic images. A new approach for estimating the error associated with the determination of alveolar crest loss is described. The study shows that a difference of 0.87 mm in cemento-enamel junction-crest measurement between unstandardized serial radiographs taken within accepted clinic routine is required for a significant loss in crestal bone height. The ability to detect with significance a difference of less than 1 mm in crestal bone height makes the appropriate use of traditional bite-wing radiographs a useful diagnostic tool for the assessment of periodontal maintenance.
Adolescent↗
Association between detection of oral Actinobacillus actinomycetemcomitans and radiographic bone loss in teenagers. A 4-year longitudinal study.
The aim of the present study was to assess a possible association between radiographic bone loss and presence of Actinobacillus actinomycetemcomitans on the site and subject level over time. Forty-six teenagers with registered radiographic bone loss and 8 controls participated in the study, which began in 1984. In 1986 and 1988 new sets of bite-wing radiographs were obtained and examined for bone loss. Subgingival plaque was sampled from both diseased and contralateral healthy sites in the same individual. Only 15 of the 46 originally diseased sites persisted with bone loss in 1986, and 60% of these sites harbored A. actinomycetemcomitans. Of the 31 "healed" sites, 29% contained A. actinomycetemcomitans. The difference was statistically significant at P less than 0.05. Six of the contralateral healthy sites had developed bone loss during these 2 years and 50% of them contained A. actinomycetemcomitans, while 35% of the remaining contralateral sites harbored A. actinomycetemcomitans. The difference was not statistically significant (P greater than 0.05). The difference between patients with and without persistent bone loss regarding presence of A. actinomycetemcomitans was statistically significant in 1986; however, none of the observed differences were statistically significant in 1988. A. actinomycetemcomitans was found 2 to 3 times more frequently in patients with radiographic bone loss at all examinations than in "healthy" subjects. Detection of A. actinomycetemcomitans on the site level appeared to be a poor predictor of future radiographic bone loss.
Adolescent↗
Evaluation of a simple modified radiographic alignment system for routine use.
Radiographic frames used for longitudinal studies may be in part unreadable for measuring crestal bone change. Sites may not be present on the film, or the measurement reliability may be compromised because of dissimilar geometry. Several techniques used to address this problem are expensive, time-consuming, and required great skill. For the present study a commercially-available alignment system was simply modified by addition of a reference pin in the bite block, facilitating the repositioning of the film holder for a second exposure. This study determined the ability of the modified instrument to: 1) improve the geometrical correspondence between serial radiographs; and 2) reduce the frequency of missed sites in the film. Two pairs of x-rays were taken for each of 40 subjects, 1 pair with the standard alignment instrument of an assigned site and 1 pair with the modified instrument of the contralateral site. Measurements of alveolar bone height were performed using the "side by side" technique. The modified instrument yielded significantly smaller measurement differences and a significantly better geometrical correspondence than the conventional system (P < 0.05). Also, the modified instrument yielded significantly greater (P < 0.01) readable sites (86%) as compared to the conventional instrument (62%). The simply-modified instrument facilitates the correct interpretation of serial radiographs.
Acrylic Resins↗