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PubMed2003

EAPD guidelines for use of radiographs in children.

Guidelines in dental radiology are designed to avoid unnecessary exposure to X-radiation and to identify individuals who may benefit from a radiographic examination. Every prescription of radiographs should be based on an evaluation of the individual patient benefit. Due to the relatively high frequency of caries among 5 year old children it is recommended to consider dental radiography for each child even without any visible caries or restorations. Furthermore, radiography should be considered at 8-9 years of age and then at 12-14, that is 1-2 years after eruption of premolars and second molars. Additional bitewing controls should be based on an overall assessment of the caries activity/risk. The high-risk patient should be examined radiographically annually, while a 2-3 years interval should be considered when caries activity/risk is low. Routine survey by radiographs, except for caries, has not been shown to provide sufficient information to be justified considering the balance between cost (radiation and resources) and benefit.

Adolescent↗
PubMed1981

Image resolution in dental and maxillofacial radiography with the conventional and "free focus" imaging concepts.

An investigation of the resolution capability of conventional and "free focus" dental radiography on non screen film was completed. The over-all imaging performance of conventional and "free focus" radiography exposed with three types of dental x-ray machines was comparable. Conventional "long-cone" radiography produced better resolution than "short-cone" radiography. "Short-cone" radiography exposed with conventional compact dental x-ray machines provided similar or better image resolution than those exposed with larger, high-energy machines. The miniaturized dental x-ray machines used in "free focus" radiography for periapical type exposures gave a resolution which was similar to or up to 100 percent higher than in conventional "long-cone" periapical radiographs. Differences in path length of the x-ray beam during clinical applications of conventional and "free focus" radiography indicated a higher potential for image noise and degradation in conventional films. A potential for segmental variation in image resolution in surveys of the dentition was seen only in the conventional techniques. These characteristics must be balanced against a tendency to variable segmental magnification in free focus radiography. Indications, however, are that applications of "free focus" radiography may be able to improve the early diagnosis of dental disease. Periapical type surveys of the dentition produced by "free focus" radiography may require only two exposures instead of the 14 to 20 required in conventional periapical surveys and may contain characteristics of periapical as well as bitewing films. "Free focus" radiography represents an attractive alternative that may be able to accomplish substantial time savings in the practice of dental radiography.

Face↗
PubMed2006

Comparing the accuracy of panoramic and intraoral radiography in the diagnosis of proximal caries.

OBJECTIVES: The purpose of this study was to compare the diagnostic accuracy of panoramic and intraoral radiographic surveys in the diagnosis of proximal caries according to the different dental regions (maxillary and mandibular incisor, canine, premolar and molar). METHODS: In this study, full mouth series and panoramic radiographs of 79 patients were used. The radiographs were evaluated for proximal caries by three observers. The diagnostic accuracy of radiographic surveys for each dental region was assessed by means of receiver operating characteristic (ROC) curve analysis. RESULTS: Full mouth series was the most efficient method in the diagnosis of caries for incisor and canine teeth. However, full mouth series and combination of panoramic plus bitewings had similar diagnostic accuracy for premolar and molar teeth. CONCLUSIONS: Panoramic survey alone was not sufficient for the diagnosis of proximal caries for the entire dentition. The combination of panoramic plus bitewing plus anterior periapical survey exhibited a diagnostic accuracy for proximal caries that was comparable with full mouth series.

Dental Caries↗
PubMed2002

Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria.

OBJECTIVES: We sought to measure the diagnostic yield of relevance to treatment on routine panoramic radiographs taken of new adult (ie, 18 years and over) patients in general dental practice. STUDY DESIGN: Routine panoramic radiographs (n = 1817) obtained from general dental practice were assessed and radiologic yield recorded using consensus viewing by 2 dental radiologists. A modified diagnostic yield of relevance to treatment for each radiograph was calculated by omission of findings that would have been identified on bilateral posterior bitewing radiographs and of radiologic findings of no relevance to treatment. Stepwise logistic regression analysis was used in attempt to identify clinical indicators of a high diagnostic yield of relevance to treatment. RESULTS: The diagnostic yield of relevance to treatment was zero for the majority (56%) of patients. This figure rose to 71% when the symptom-free patients were considered. Five clinical indicators for panoramic radiography were identified, as follows: clinical suspicion of teeth with periapical pathologic conditions, presence of partially erupted teeth, clinically evident caries lesions, swelling, and clinically suspected unerupted teeth. CONCLUSION: Routine panoramic radiography of adult dental patients is not supported by the results of this study. The use of clinical indicators to select patients may help to improve diagnostic yield.

Adult↗
PubMed1998

A quantitative analysis of dental radiography quality assurance practices among North Carolina dentists.

OBJECTIVE: The purpose of this study was to assess the level of compliance with dental radiography quality assurance recommendations on the part of dental practitioners in the state of North Carolina and to determine whether the age of the practice was an influential factor affecting compliance. STUDY DESIGN: On-site survey inspections by state officials using measurement devices and questionnaires were used to assess x-ray machine parameters and gather information about quality assurance practices in private offices in the state of North Carolina. RESULTS: There were approximately three intraoral units per facility, with an average entrance skin exposure of 267 mR per bitewing radiograph. There were no significant differences associated with the age of the practice in quality assurance practices except with respect to the type of processor used: dentists who had been in practice for more than 20 years used manual processing more frequently than those who had been in practice for less than 20 years (p = 0.001). CONCLUSIONS: Most practices showed a high level of compliance with equipment function requirements. North Carolina dentists are making an effort to comply with the American Academy of Oral and Maxillofacial Radiology recommendations. However, the use of faster film and rectangular collimation was much less than expected. Only 9% of the participants reported using E-speed film exclusively, and only 7.33% reported using rectangular collimation.

Dentists↗
PubMed2001

Experience of Norwegian general dental practitioners with solid state and storage phosphor detectors.

OBJECTIVES: To evaluate the opinions of Norwegian dental practitioners regarding the use of solid state sensor and storage phosphor (SP) detectors for intra-oral radiography. METHODS: A questionnaire received from 2199 dentists 309 (219 male, 86 female, four unknown) confirmed the use of digital radiography in their practices. RESULTS: Sixty-one per cent of dentists used a SP and 35% a sensor system; four (1.3%) used both. Approximately 50% of dentists had experienced technical problems and 33% had needed repairs. Almost all dentists stored their images on the hard disk (>97%) and 81% made a daily back-up. More sensor than SP users found difficulty with the positioning holder. Two-thirds of dentists reported digital image quality was the same or better than film. More Digora (Soredex, Helsinki, Finland) users reported better image quality than Denoptix (Gendex, Milan, Italy) or Digident (Digident, Nesher, Israel) users. Mean reduction in exposure time was 55% (range 2-90%), although 17 dentists stated that no reduction was achieved. Approximately half of the sensor users also used film and 38% of the SP users. Film was used more often for bitewing examination by the sensor users (27%) than by the SP users (4%). Mean time saved by the sensor users was 36 min/day (range 10-120) and by the SP users 25 min/day (range 5-120). CONCLUSIONS: The majority of dentists felt that digital image quality was the same or better than film and exposure and examination times were reduced. However, technical problems and repairs were common.

Compact Disks↗
PubMed1992

A comparison of conventional intra-oral radiography and computer imaging techniques for the detection of proximal surface dental caries.

The detection of proximal surface caries by the visual interpretation of bitewing radiographs is known to be relatively inaccurate. The present study was designed to examine whether computer image processing could improve the diagnostic accuracy. A computer-aided, software-driven, TV-based system was used to digitize conventional radiographs and digitally process the images using histogram equalization and grey-scale inversion to enhance the images. The computer-enhanced images were compared with conventional intra-oral radiographs for the detection of proximal surface caries using receiver operating characteristic analysis. The results indicate that the digital image processing techniques used did not improve the diagnostic accuracy of dental radiographs. No significant difference in diagnostic accuracy could be detected between the non-enhanced digital images and conventional film-based images for the detection of proximal surface caries.

Dental Caries↗
PubMed1994

Clinically undetected dental caries assessed by bitewing screening in children with little caries experience.

Following the decline in caries prevalence, it has been questioned whether it is still justifiable to continue the practice of radiographic bitewing screening. This study was undertaken to compare the value of a clinical examination with screening bitewing radiograph in children who had little previous caries experience. One hundred and sixty-eight 14-year-old children participated in the investigation. The children were examined clinically by one of three pedodontists for the presence of 'sound', 'suspect caries', and 'carious' occlusal and approximal tooth surfaces. Bitewing screening radiographs were obtained of all the children prior to the clinical examination. The radiographs were assessed for the presence and extent of occlusal and approximal caries. Radiography detected more than 94% of the total number of reported (clinically and radiographically) caries lesions. 1.2% of the occlusal and 10.2% of the approximal surfaces clinically designated sound were scored as carious by radiography. Of these clinically undetected lesions, 15% were assessed to have penetrated into dentine on the radiographs. Although the number of false-positive radiographic scores could not be ascertained in this study, it is likely that, as the caries prevalence was low, the probability of a false-positive diagnosis would be high. It was therefore concluded that there was no convincing evidence that 14-year-old children with little previous caries experience benefit from a screening bitewing examination.

Adolescent↗
PubMed2001

Screening panoramic radiology of adults in general dental practice: radiological findings.

AIM: To identify the radiological findings from routine screening panoramic radiographs taken of adult (> or = 18 years) patients in general dental practice. METHOD: Forty-one general dental practitioners (GDPs) who routinely took panoramic radiographs of all new adult patients were recruited. In total, they submitted 1,818 panoramic radiographs of consecutive patients along with basic patient information, radiological reports and treatment plans. The radiographs were also reported by 'experts' (consensus of two dental radiologists). Radiological findings were recorded from the GDP assessments (dentist RY), the experts (expert RY), after exclusion of findings that would have been seen on posterior bitewing radiographs (MRY) and after exclusion of findings of no relevance to treatment (MRYT). RESULTS: There was no significant difference in age profile between the study sample and Dental Practice Board population figures (P = 0.26). No radiographs other than the panoramic radiograph had been taken for 57.1% of patients. For the GDP assessments, only 4.6% of patients had radiographs with no radiological findings, while for the experts this proportion was 3.1%. With the exception of the assessment of periodontal bone loss, the experts diagnosed significantly greater proportions of cases as having positive radiological findings. Agreement between dentist and expert assessments varied greatly. When findings from bitewing radiographs were excluded, no radiological findings were recorded on the radiographs of 17.2% of patients. When proposed treatment plans were taken into account, the majority of patients' radiographs (56.3%) had no radiological findings of relevance to treatment. CONCLUSIONS: The choice of radiographic examination for the majority of patients in the study did not follow current guidelines. Dentists diagnosed fewer abnormalities than did experts. While many radiological findings are revealed by panoramic radiography, these may either duplicate information from bitewing radiographs or are often of no significance to treatment planning. This study did not provide evidence to support the practice of routine panoramic radiography of all new adult patients.

Adult↗
PubMed2006

The use of dental radiographs for identification of children with unrestored dentitions.

The success of dental identification is often dependent on the extent of previous dental care and the location of detailed dental records. However, several factors limit available comparable data among children. There are often no clinical indications for dental radiography before the age of five and many children and adolescents have no restorative care. This reduces the amount of individualizing information suitable for comparative identification. The aim of this study was to investigate matching of dental x-rays from children without fillings at different ages, and to see if radiographic expertise facilitated radiographic comparison. Five general dental practitioners (GDP) and five oral and maxillofacial radiologists (OMR) attempted to match bitewing examinations from 30 children. The results showed that dentists are likely to match bitewing radiographs in these conditions. This likelihood is further enhanced when oral and maxillofacial radiologists compare images. This suggests that manual comparison of bitewings from children allow sufficient concordant visible points for identification to occur.

Adolescent↗
PubMed2002

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

OBJECTIVES: To assess, in a young population (age 6-19) managed by a restrictive attitude to radiography and operative intervention, prevalence of patients with posterior caries and/or fillings, probabilities of new proximal dentine lesions given different caries experience, correlation between radiographic intervals and caries experience, and prevalence of endodontic treatment. METHODS: Bitewing radiographs, taken between age 6 through 19 in 285 patients, were analysed in succession. Occlusal and proximal surfaces were coded for caries depth (0-4) and presence of fillings (5). Simple regression analysis was used to determine relations between radiographic intervals and caries experience. Significance testings of probability estimates were made with chi(2)- and t-tests, when applicable adjusted by the Bonferroni-Holm correction for mass-significance. RESULTS: The prevalence of patients with >/ or =1 fillings/dentine lesions in occlusal surfaces increased from 6-78% and in proximal ones from 1-38%. The probability of developing new proximal dentine lesions/fillings over different time periods was significantly lower among caries-free patients than among those with enamel or dentine lesions. There was a poor correlation between radiographic intervals (mean=16 months, range=6-33) and accumulated caries experience. Endodontic treatment had been made in a total of six teeth in six patients. CONCLUSIONS: A restrictive attitude both to the frequency with which radiographs are taken and to operative treatment of proximal caries seems to be possible in young populations with low caries prevalence.

Adolescent↗
PubMed2006

A randomized double blinded study to assess the efficacy of a laser-guided collimator on dental radiography training.

OBJECTIVES: To assess the effect of a laser-guided collimator in intraoral radiography training. METHODS: A custom-made collimator with four red laser diodes on each corner on the rim of an aluminium alloy cubic housing was fabricated. The laser used low power diodes, which are classified as laser-safe by the United States Food and Drug Administration (FDA). When activated, the effective dimensions of the laser beams were 4 cm x 4.5 cm. Eighteen dental hygiene students were randomized into test and control groups. The Laser group used a rectangular collimator with the laser device, while the Non-laser group used a conventional rectangular collimator. Each group attended nine intraoral radiography training sessions. All radiographs were assessed and were classified into three categories: Excellent, Acceptable and Repeat, by a masked academic staff member. Reasons for repeats were marked. Statistical comparisons between the two groups were made. RESULTS: A total of 2334 radiographs were made. Conecut was more common on bitewings than periapicals. The Laser group produced fewer conecuts than the Non-laser group. The Laser group produced more excellent radiographs with fewer repeats than the Non-laser group, but there was not a significant difference. CONCLUSIONS: The laser-guided collimator helped the students to produce fewer repeats in a shorter period of time. It was an effective training aid.

Dental Hygienists↗
PubMed2002

Comparison of conventional and TACT (Tuned Aperture Computed Tomography) digital subtraction radiography in detection of pericrestal bone-gain.

Tuned Aperture Computed Tomography or TACT is a relatively new technique that transforms correlated two-dimensional images into a three-dimensional display. Associating TACT with digital subtraction radiography (TACT-DSR) may enhance its use in the detection of diseases. This study aims to assess observer performance in the task of detecting simulated bone-gain in periodontal defects, comparing conventional and TACT DSR. Buccal, lingual and proximal pericrestal bony defects in a human dry skull were imaged with and without increments of crushed-bone and wax mixtures using standardized vertical bitewing projections, acquired with an intraoral digital receptor in a tomographic X-ray machine. One hundred and twenty pairs of baseline and follow-up images were obtained for each imaging modality. Post-acquisition processing including image-registration, density-correction and subtraction operation were applied to both transmission images and TACT-slices. Eight calibrated observers evaluated the presence or absence of pericrestal bone-gain using a 5-point confidence scale. Details about the location of periodontal defects and the amount of bone-gain for each subtracted image were recorded and used in the statistical analysis. Observer performance and study design factors were analyzed by means of receiver operating characteristic (ROC) curve analysis and ANOVA. Mean values of areas under ROC curves for bone-gain detection performance were 0.82 for conventional DSR and 0.90 for TACT-DSR. TACT-DSR provided statistically superior detection performance of simulated periodontal bone-gain over conventional DSR for tooth-obscured defects (p = 0.001) and for the smallest bone mass (p = 0.024). The findings support TACT-DSR's potential to provide greater sensitivity and technique flexibility in detecting periodontal bone-gain than standard DSR.

Alveolar Bone Loss↗
PubMed2004

Evaluation of the diagnostic advantage of intraoral D and E film for detecting interproximal caries.

Clinicians strive to reduce the exposure of patients to X-ray radiation in an effort to decrease its harmful effects on the body. A potential strategy for achieving this goal is the use of high-speed films that require less exposure to radiation to generate a diagnostic image. There are two film types commonly used in intraoral radiography: high speed or "Ekta-speed" film (Type E) and normal speed or Ultra-speed film (Type D). Type E film requires nearly half of the exposure time that is required by Type D films to produce an acceptable diagnostic image; however, the diagnosis quality and usability of these film types are under question. The purpose of this research is to compare the diagnostic quality of Type E with Type D film when used to diagnose proximal caries. In this study 40 pairs of extracted maxillary premolar teeth were chosen and divided into four groups of 10 pairs. Cavities were made on proximal surfaces at different depths (0.5, 1, 1.5, and 2 mm) for each group. Bitewing radiographs were then taken on each pair of teeth using Type E film and then again using Type D film. Radiographs were evaluated by two oral radiologists and two operative dentistry specialists who recorded the perceived diagnostic depth of the prepared cavities. Our data showed both Type D and E films are suitable for use in diagnosing proximal caries, and despite a minor discrepancy between them no significant difference was found with regard to their value in diagnosing proximal caries.

Dental Caries↗
PubMed1989

Marginal bone in periodontal disease: an evaluation of image quality in panoramic and intra-oral radiography.

Five observers assessed the panoramic and full-mouth (14 periapical and four posterior bitewing) radiographs of 20 patients each for the ability to interpret and measure the marginal bone level. The image quality of each site was classified as excellent, acceptable or unacceptable. Depiction errors affecting interpretability and measurability were also noted. In the upper arch, the frequency of uninterpretable and non-measurable sites was almost equal for panoramic and periapical radiography. Image quality was better with periapical radiography in the lower arch. In the posterior regions of both arches, more sites could not be measured from panoramic compared with bitewing radiographs. Due to overlapping the distal surface of the maxillary canine and the mesial surface of the first maxillary premolar could often not be interpreted in either panoramic or periapical radiographs, but infrequently in the bitewings. In the lower arch, the most frequent depiction error was inadequate density in the incisor region of panoramic radiographs. On the basis of these results, we proposed that in clinical practice the panoramic radiograph can be supplemented with individually selected periapicals. In epidemiological studies, the panoramic radiograph should be combined with a premolar bitewing radiograph.

Adult↗
PubMed1990

Effective dose equivalent to the operator in intra-oral dental radiography.

The effective dose equivalent to the operator in intra-oral dental radiography has been determined. The exposure from a bitewing radiograph and periapical views of the left maxillary incisors and first molar was measured at nine heights and 16 positions, all 1 m from the patient. The effective dose equivalent was determined using data from ICRP 51 (International Commission on Radiological Protection: Data for Use in Protection Against External Radiation). The values presented are related to an exposure of 1 C kg-1 (3876 R) measured free in air at the tube-end. They thus constitute ratios which are not influenced by the sensitivity of the film or other detector used and form standard tables which permit the calculation of the effective dose equivalent in clinical situations.

Dental Staff↗
PubMed1982

Radiation safety for children.

In recent years there has been much public and professional concern about reducing patient exposure to radiation. This concern is especially appropriate for children because of their greater sensitivity to it. Exposure risks to children may be reduced by using radiography only when there is a specific clinical indication. Bitewing radiographs are indicated for detection of approximal caries in the child when the molar contacts are closed. The frequency of this examination should be determined on an individual basis. Other radiographs should be obtained only when there are clinical signs or symptoms suggesting disease. When a decision has been made to expose a patient to X-rays beam-restricting film holders, leaded aprons and thyroid collars should be employed. To minimize repeat radiographic examinations because of processing faults, the operator should use proper procedures coupled with an understanding of the film developing process. Further dose reduction may be anticipated with the advent of E-speed film, dental xeroradiography or rod-anode source radiography. Most importantly, dose reduction requires an awareness by the dentist and operator of its importance and the means available to accomplish it.

Child↗