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PubMed1978

The bitewing roentgenogram and its diagnostic importance.

The role of the bitewing roentgenogram in dentistry is reviewed, including the roentgenographic techniques used, accessories for stabilisation of the film, and execution of the roentgenograph. Common errors in application of the technique are listed. The literature on the bitewing roentgenogram is surveyed and the conclusion stated that this roentgenographic technique is a diagnostic instrument that has no substitute for the purpose of detecting incipient interproximal carious lesions and periodontal diseases in the early stages of affecting the alveolar bone. No dental examination can provide complete diagnosis without bitewing roentgenograms.

Child↗
PubMed2004

Wireless networking for the dental office: current wireless standards and security protocols.

Digital radiography has gained immense popularity in dentistry today in spite of the early difficulty for the profession to embrace the technology. The transition from film to digital has been happening at a faster pace in the fields of Orthodontics, Oral Surgery, Endodontics, Periodontics, and other specialties where the radiographic images (periapical, bitewing, panoramic, cephalometric, and skull radiographs) are being acquired digitally, stored within a server locally, and eventually accessed for diagnostic purposes, along with the rest of the patient data via the patient management software (PMS). A review of the literature shows the diagnostic performance of digital radiography is at least comparable to or even better than that of conventional radiography. Similarly, other digital diagnostic tools like caries detectors, cephalometric analysis software, and digital scanners were used for many years for the diagnosis and treatment planning purposes. The introduction of wireless charged-coupled device (CCD) sensors in early 2004 (Schick Technologies, Long Island City, NY) has moved digital radiography a step further into the wireless era. As with any emerging technology, there are concerns that should be looked into before adapting to the wireless environment. Foremost is the network security involved in the installation and usage of these wireless networks. This article deals with the existing standards and choices in wireless technologies that are available for implementation within a contemporary dental office. The network security protocols that protect the patient data and boost the efficiency of modern day dental clinics are enumerated.

Computer Security↗
PubMed1986

Absorbed doses from intraoral radiography with special emphasis on collimator dimensions.

Thermoluminescence dosimeters were used in a phantom head and on patients to measure the absorbed dose to organs of special interest from full surveys with intraoral films (20 exposures) and single bitewing exposures. Two x-ray machines were used, operating at 65 kVp. The apertures of the circular tube collimators had diameters of 55 mm and 48 mm. Rectangular (35 mm X 44 mm) tube collimators were also used. The distance from the x-ray focus to the open end of the collimators (FSD) was 0.20 and 0.35 m. Exposure values for Kodak Ultra-Speed film (speed group D) were used. The maximum skin dose measured from the full surveys decreased by 25 per cent on changing from the circular to the rectangular apertures. Using 0.35 m FSD and rectangular collimator the maximum skin dose was 13 mGy. The absorbed doses to the salivary glands and the thyroid gland were significantly reduced on changing from circular to rectangular apertures. The doses in the central part of the parotid and the thyroid glands were then 0.5 and 0.12 mGy, respectively, from a full survey with 20 intraoral films. With a leaded shield the thyroid dose was reduced to 0.05 mGy. All dose values could be further reduced by 40 per cent by using Kodak Ektaspeed film (speed group E).

Equipment Design↗
PubMed1986

Dose contributions to the Swedish population from oral radiography.

The purpose of the present investigation was to elucidate some factors which may influence the absorbed doses to organs of special interest, to determine the energy imparted (epsilon) and the effective dose equivalent (HE) from intraoral radiography, to estimate the collective effective dose equivalent (SE) to the Swedish population from oral radiography and to discuss these results regarding the biological effect of oral radiography on the Swedish population. The absorbed doses were found to be small from intraoral radiography (IR), with a reduction by a factor of about 50 to many organs since the 1960s. The epsilon to the patient from IR (20 exposures, 65 kVp, D-film) was 10 mJ with a circular (55 mm in diameter) and 6 mJ with a rectangular collimator (35 mm X 44 mm). For one bitewing the corresponding values were 0.4 mJ and 0.3 mJ, respectively. The mean value of epsilon for an ordinary bitewing examination in Sweden was 0.48 mJ. Energy imparted from IR was totally 5,500 J to the Swedish population. This corresponds to some per cent of the mean value of the annual natural irradiation. The use of film in speed group E reduces the energy imparted by 40 per cent. From panoramic radiography (PR) and lateral cephalographic radiography (CR) the mean values in Sweden were 0.5 mJ per examination. PR and CR imparted 56 J to the population. HE was calculated for IR and was found to be 0.23 mSv (20 exposures, D-film, circular collimator) and 0.14 mSv for the rectangular collimator, which corresponds to 12 and 7 mu Sv per intraoral film, respectively. The risk from IR, PR and CR to the population can be assessed by risk factors from the literature and estimated both from the sum of epsilon and from the sum of HE. Proceeding from the sum of epsilon and transforming to HE by dividing the body weight the collective effective dose equivalent was 79 manSv (IR) and 1 manSv (PR and CR). Proceeding from the calculated value of HE for IR would give 190 manSv. The risk of fatal cancer thus theoretically calculated would be between 1-3 cases. The magnitude of epsilon as well as HE is so low that it seems to be a very favourable ratio between benefit and risk for IR, when such examinations are indicated.

Adult↗
PubMed1988

Individualised restricted intraoral radiography versus full-mouth radiography in the detection of periradicular lesions.

The aim was to study the diagnostic yield of periradicular lesions using different combinations of periapical radiographs. One hundred patients were first examined clinically and then periapical radiographs were taken of teeth with clinical signs and symptoms. As a second step of the radiological examination, periapical radiographs were taken of teeth that were endodontically treated or had extensive cavities demonstrated by bitewing radiographs. Finally, these radiographs were supplemented to make up a full-mouth examination. Out of 226 periradicular lesions. 34% were indicated by the clinical symptoms, another 43% by the fact that the tooth was endodontically treated and an additional 13% by having an extensive cavity. The remaining 10% of the periradicular lesions were found only with the aid of the full-mouth examination. It is suggested that information from clinical examination and from bitewing radiographs of the whole dentition might be employed to select radiographs in order to detect periapical lesions.

Adult↗
PubMed1993

Technological advances in the clinical diagnosis of periodontal diseases.

Traditional diagnostic procedures for periodontal disease, such as probing and radiographic assessment, supply information on previous disease experience but not of present site-specific activity nor of possible future attachment loss. Although the newer automatic probes which record data electronically give higher resolution and accuracy than their manual counterparts, their use in clinical practice is only of value in longitudinal clinical trials. In general clinical practice, manual probing is adequate provided probing technique and probe tine characteristics are within acceptable limits. It is suggested that the general practitioner could use the CPITN method for screening purposes because of its relative speed and ease. This must, however, be supplemented by comprehensive probing in each sextant with advanced disease. The humble bitewing radiograph is likewise adequate for the assessment of alveolar bone loss in normal clinical practice but if refined data of bone loss over time is required, subtraction radiography is recommended. Currently, other forms of imaging technology have limited value in clinical practice because of technical complexity, access and cost. A number of other electronic devices are available which make the accurate assessment of mobility and occlusal function possible but, because the relationship between these signs and periodontitis is still equivocal, the general use of such apparatus is not indicated. The advent of a battery of easily performed chairside tests shows considerable promise for the future, particularly those tests that are becoming commercially available for the assay of host and bacterial markers of site-specific disease in the crevicular fluid. The clinical value and the cost-benefit of these assays need further investigation before they can be recommended for general use. Clinical practice objectives differ from those required for research projects and therefore the required sensitivity, specificity and predictive value of diagnostic tests must be in keeping with the intended purpose to justify the cost involved.

Cost-Benefit Analysis↗
PubMed1989

Reproducibility and overlapping of bitewing radiographs: comparison of Eggen-bite with Kwik-bite.

In the present study the reproducibility of horizontal dimensions and of overlappings of two filmholder techniques with aiming devices (Eggen-bite and Kwik-bite) and additionally the number of overlappings on the resulting bitewing radiographs were compared. The overlapping reproducibility was significantly higher with Kwik-bite. The microdensitometric reproducibility demonstrated the same tendency, but the result was not significant. Bitewings carried out by an oral radiologist demonstrated fewer overlappings with Eggen-bite than with Kwik-bite, while bitewings carried out by inexperienced students revealed no difference between the methods. Both reproducibility and number of overlappings should be taken into consideration when bitewing filmholder techniques are used in epidemiological and longitudinal studies.

Densitometry↗
PubMed1996

Use of an internal standard in subtraction radiography to assess initial periodontal bone changes.

OBJECTIVE: To assess the use of an internal reference when performing histogram analyses in digital subtraction images and to determine the ability of the method to detect initial bone lesions. METHODS: Fifty-one Royal Air Force recruits had standardized vertical bitewing radiographs and clinical assessment of attachment level recorded annually over three years. Subtraction analyses of crestal bone changes at the mesial surface of the upper right first molar were compared with changes at the mesial surface of the same tooth. Changes over the periods from age 17 to 18 years and age 18 to 20 years were monitored using two subtraction procedures. RESULTS: Reproducibility studies revealed that Pearson correlations between duplicate measurements of the test site alone (16 crest; r = 0.74) were lower than those between duplicate measurements of changes where misalignment was controlled for, either as a difference (16 crest-16 tooth; r = 0.93) or ratio (16 crest/16 tooth; r = 0.93). We used the differences between the mean subtraction density for 16 crest and 16 tooth as our measure of change in bone density. For the duplicate measurements, the standard deviation of these differences was 3.9: a difference of +/- 7.8 was therefore taken as a threshold value for evidence of real change. Bone gain was noted between the ages of 17 and 18 years (16/21 subjects), but some early bone loss was seen between 18 and 20 years (12/21 subjects), with four subjects showing changes significantly greater than the method error. There were no associations between the clinical and radiographic observations. CONCLUSION: Use of a control site in subtraction radiography improves the reproducibility; such systems can detect small changes in alveolar bone which may assist in early diagnosis of the initial periodontal lesion which may precede observable clinical changes.

Adolescent↗
PubMed1986

Clinical efficacy of dental radiography in the detection of dental caries and periodontal diseases.

This article reports the ability of dental radiographs to correctly detect evidence of dental caries and periodontal disease (sensitivity) and to correctly establish the absence of these diseases (specificity). The analysis used a unique data set that was collected as part of the Veterans Administration Dental Longitudinal Study in Boston. Periapical, panoramic, and posterior bitewing radiographs were independently compared with a consensus radiographic standard of all three radiographs read simultaneously. Findings showed that the sensitivities of all three radiographs to detect dental caries were lower than expected, at approximately 60%, whereas the sensitivities to detect evidence of periodontal disease averaged approximately 85%. Panoramic radiographs were substantially less sensitive for detecting dental caries than periapical and posterior bitewing radiographs, but no difference between these modalities was observed in the analysis of sensitivity to periodontal disease. The proportion of false-negative and false-positive readings from dental radiographs was substantial and requires further investigation.

Adult↗
PubMed1986

Rotational panoramic radiography in epidemiological studies of dental health. Comparison between panoramic radiographs and intraoral full mouth surveys.

In conjunction with an epidemiological study of oral health in women the capacity of the panoramic radiograph to yield information on oral conditions was compared to that of the intraoral full mouth survey including posterior bitewing radiographs. Full mouth surveys and panoramic radiographs of 75 women were compared for gross characteristics such as distribution of teeth, missing teeth, restorations, and endodontic treatment as well as for osteolytic lesions at the root, marginal bone loss and carious lesions. A nearly 100% agreement was found for gross characteristics but also for osteolytic lesions associated with teeth and for marginal bone loss the agreement was good; osteolytic lesions at single rooted teeth 76%, multirooted teeth 90% and a coefficient of correlation of .96 for individual mean marginal bone scores. Poor agreement was found for carious lesions as only 36% of those extending well into the dentine were found both in the intraoral radiographs and in the panoramic radiographs. It may be included that, except for carious lesions, the panoramic radiographs can be considered a useful tool in epidemiological studies of oral health.

Adult↗
PubMed1986

Energy imparted from intraoral radiography.

During the recent decade the equipment for dental radiography in Sweden has been standardized by the Swedish National Institute for Radiation Protection. The aim of this study was to experimentally determine the energy imparted to a phantom from a full survey with 20 intraoral films as well as from a single bitewing projection, using this standardized technique. Thermoluminescence dosimeters in predetermined volume elements of an anatomically formed tissue equivalent Alderson-phantom were irradiated (65 k Vp) using both a rectangular and a circular collimator of 0.2 m FSD. Exposure times fitted to film in speed group D were used. The energy imparted was determined from the integrated absorbed doses in the volume elements as well as calculated using published depth dose data. The energy imparted was found to be 9.6 mJ (circular collimator) and 5.9 mJ (rectangular collimator) for the full survey. For the single bitewing exposure the energy imparted was 0.42 mJ (circular collimator) and 0.29 mJ (rectangular collimator). With the rectangular collimator and film in speed group D the energy imparted from a full survey will correspond approximately to two weeks of environmental irradiation. With more sensitive film in speed group E the energy imparted would further be reduced by 40 per cent with retained diagnostic information.

Head↗