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PubMed1983

Errors on dental bitewing radiographs.

The prevalence of common errors on posterior bitewing radiographs was assessed on 2409 pairs of films collected from different public dental clinics in the county of Buskerud, Norway. Only 4.6% fulfilled the criteria for correct bitewing radiographs. Incorrect position of the film was found in 42.7%. Exposures with wrong horizontal angulation of the central beam constituted 10.6%, and under/overaxial exposures 2.2%, of the sample. Cone cutting occurred in 4.3%. Disturbing spots were found on most of the films (88.1%); 7.7% of the films had been insufficiently washed. Other errors due to wrong darkroom procedures or equipment failures were more rarely observed. The present study has shown that unnecessary errors, reducing the readability of bitewing radiographs, are frequently found. Steps should be taken to improve the standard of the radiographs used for diagnosis.

Adolescent↗
PubMed1985

A comparison of combinations of clinical and radiographic examinations in evaluation of a dental clinic population.

Panoramic periapical anterior and posterior bitewing radiographic, mirror-explorer, and transillumination clinical examinations were performed on 300 patients. Various combinations of the radiographic and clinical examination techniques were compared in terms of their ability to diagnose caries, alveolar bone loss, calculus, periapical bone lesions, impacted teeth, root tips, and miscellaneous conditions. A mirror-explorer clinical examination with panoramic and posterior bitewing radiographs and either anterior bitewing radiographs or transillumination proved to be as efficient in the initial examination of patients as the mirror-explorer clinical examination with periapical and posterior bitewing radiographs.

Alveolar Process↗
PubMed2000

Progression rate of approximal carious lesions in Swedish teenagers and the correlation between caries experience and radiographic behavior. An analysis of the survival rate of approximal caries lesions.

The objectives were to study the progression rate of approximal caries in 14 to 19-year-old adolescents and to assess the influence of experience of previous caries as a predictor of caries progression during the following years. The study population comprised 100 adolescents, all 19 years old, randomly selected. In all, there were 93 adolescents included in the study, for whom all sets of bitewing radiographs from 14 up to and including the age of 19 were assessed with respect to approximal caries. It could be noted that 32% of the adolescents had had at least one bitewing examination every year from 14 to 19 years of age. At the age of 14, 38% of the males and 24% of the females were radiographically without any sign of caries lesions (caries-free). The median survival time of initial caries in the present study was >5 years, while for manifest caries it was 3.2 years. It was found that 37% of the surfaces with manifest caries in males and 18% of the corresponding surfaces in females were restored within a year. The results show that experience of previous caries does not seem to be a significant indicator and does not influence when the next radiographic examination should be performed. It is thus concluded that individualized bitewing examination is the exception rather than the rule.

Adolescent↗
PubMed2006

Sliding window adaptive histogram equalization of intraoral radiographs: effect on image quality.

OBJECTIVES: To investigate whether contrast enhancement by non-interactive, sliding window adaptive histogram equalization (SWAHE) can enhance the image quality of intraoral radiographs in the dental clinic. METHODS: Three dentists read 22 periapical and 12 bitewing storage phosphor (SP) radiographs. For the periapical readings they graded the quality of the examination with regard to visually locating the root apex. For the bitewing readings they registered all occurrences of approximal caries on a confidence scale. Each reading was first done on an unprocessed radiograph ("single-view"), and then re-done with the image processed with SWAHE displayed beside the unprocessed version ("twin-view"). The processing parameters for SWAHE were the same for all the images. RESULTS: For the periapical examinations, twin-view was judged to raise the image quality for 52% of those cases where the single-view quality was below the maximum. For the bitewing radiographs, there was a change of caries classification (both positive and negative) with twin-view in 19% of the cases, but with only a 3% net increase in the total number of caries registrations. For both examinations interobserver variance was unaffected. CONCLUSIONS: Non-interactive SWAHE applied to dental SP radiographs produces a supplemental contrast enhanced image which in twin-view reading improves the image quality of periapical examinations. SWAHE also affects caries diagnosis of bitewing images, and further study using a gold standard is warranted.

Algorithms↗
PubMed1979

Value of bitewing radiographs in detection of occlusal caries.

A system of diagnosing occlusal caries from bitewing radiographs was developed in an attempt to overcome the problems of clinical diagnosis found in other studies. Standardised bitewing radiographs for 1172 Berkshire schoolchildren aged 11-13 years who were participating in a toothpaste trial, were assessed for occlusal caries under uniform magnification and illumination. The radiographic scores were then compared with the clinical records for these subjects. The radiographic technique proved to be acceptably reproducible at 82.6%. However, only 33.2% of the lesions present were detected on the radiographs. It is concluded that bitewing radiographs for the detection of occlusal caries are of little value in epidemiological studies.

Adolescent↗
PubMed1980

Fibromyxoma of the mandible: case report and radiographic considerations.

A case of a 27-year-old black woman with typical findings of a large, asymptomatic myxoma involving the entire left half of the mandible is presented. The lesion was treated by a partial mandibulectomy and secondary bone graft with a titanium tray and condyle prosthesis. A comparison of the patient's bitewing, periapical, and panoramic radiographs was made. The lesion was not visible on the bitewings and was overlooked on the periapical films, but was clearly visible on the panoramic radiograph. The screening value of this radiograph was stressed.

Adult↗
PubMedDate not supplied

Evaluation of bitewing intervals in children.

With 1,153 pairs of bitewing radiographs representing data collected from 145 patients, we determined that the average positive bitewing interval was 17.7 months, which is consistent with published recommendations of 12- to 24-month intervals.

Adolescent↗
PubMed1992

Reducing transmitted radiation in dental radiography.

A significant amount of radiation escapes the rear of an image receptor in conventional dental radiographic procedures despite the placement of a lead-containing backing at the rear of the film pack. The purpose of this investigation was to place additional layers of lead on the film pack in an attempt to reduce transmitted radiation to tissues behind the film. Reduction of dose to tissues behind the film causes a reduction in scatter radiation to critical organs such as the thyroid gland and salivary glands. A thermoluminescent lithium fluoride dosimetry system (TLD) was used and calibrated in both the beam of interest and tissue of interest. A tissue-equivalent anthropomorphic phantom was used for dose determination. Successive layers of lead foils were added to the image receptor, and dose was determined for each additional lead foil in the tissues behind the image receptor. Two sets of exposure conditions were used, namely: 70 kVp, 10 mA, and 0.6 s, and 90 kVp, 10 mA, and 0.6 s. The beam-film-patient orientation used was for a first molar bitewing radiographic projection. Four lead layers (three additional foils equalling 3.92 x 10(-3) mm of lead) on the conventional film package resulted in a significant dose reduction. Four layers of lead resulted in a dose less than one-third that of the conventionally shielded package.

Models, Structural↗
PubMed1987

Use and quality of bitewing films in private dental offices.

Patient records (387) were obtained from twenty-five dentists in private practice in Rochester, New York. The number and types of radiographs taken at each recall examination in the most recent 10-year period were recorded. Bitewing radiographs were taken at 50.5% of the recalls with size 2 film used most frequently (83.7%). The average recall interval was 8.4 months overall and 18.0 months for bitewing recalls. Of all proximal surfaces available on the bitewing films, 68.2% were judged adequately separated for diagnostic purposes. For individual surfaces, the highest percentages were recorded for the mesial surface of the maxillary second premolar (89.9%) in the permanent dentition and for the distal surface of the mandibular second molar (83.7%) in the deciduous dentition. Taking four bitewing films instead of two improved the percentage of adequately separated proximal surfaces at a given recall by 2% to 25%. The percentage of unreadable proximal surfaces caused by overlapping or distortion on the bitewing radiographs, when excluding the canines, ranged from 6.3% to 39.5% in the permanent dentition and from 12.5% to 24.9% in the deciduous dentition.

Private Practice↗
PubMed2003

Vertical root fractures: clinical and radiographic diagnosis.

BACKGROUND: Early detection and management of vertical root fractures, or VRFs, remain a vexing issue that has caused needless suffering for patients as well as for dentists. The authors present techniques to aid the dentist in recognizing VRFs. METHODS: During a five-year period, the authors examined 36 patients who had VRFs. Absent control subjects and a larger number of patients, the authors did not design this investigation for statistical analysis. They diagnosed VRFs through dental histories and clinical and radiographic examinations. RESULTS: The study revealed VRFs in 36 teeth, two of which were vital and 34 of which were nonvital (that is, endodontically treated). The 34 VRFs resulted from excessive operative procedures performed in the root canal after endodontic therapy. Thirty-one of these 34 VRFs were caused by poorly designed dowels (too long, too wide or both) or inappropriate selection of the tooth as a bridge abutment; two VRFs were caused by a restoration that exerted lateral pressure on the axial walls of the preparation; and one VRF was caused by overzealous endodontic forces. The VRFs in the two vital teeth were in men who had a history of bruxism or clenching. CONCLUSIONS AND CLINICAL IMPLICATIONS: VRFs can be detected early by listening to the patient's chief complaints, carefully examining periapical and bitewing radiographs and performing a thorough clinical examination.

Adult↗
PubMed1987

Interpretation of bitewing radiographs: application of the kappa statistic to determine rater agreements.

The interrater agreement of 34 dentists in determining the presence or absence of caries and the depth of caries in bitewing radiographs was studied. The kappa statistic was used to determine rater agreement, and results indicate that there was substantial agreement on the presence or absence of caries and only fair agreement on the specific depth of caries. Because of the degree of disagreement in determination of the extent of caries among examiners, it is recommended that this fact be taken into account in relation to the findings on bitewing radiographs, particularly when there may be differences of opinion between parties.

Dental Caries↗
PubMedDate not supplied

Radiographic spatial frequencies essential to the diagnosis of incipient interproximal lesions.

The effects of fixed pattern noise on the interpretation of dental radiographs containing known lesions suggest that reliable detection of incipient interproximal caries is influenced by the spatial frequency of information visibly displayed. Frequencies less than the limiting resolution of existinta also permit demonstration that significantly less resolution is required horizontally than vertically to achieve a criterion level of diagnostic accuracy. These findings are consistent with the notion that accurate diagnosis may be possible with less resolution than is currently produced by conventional bitewing radiographic techniques. If this is trut means for radiographically detecting caries can be developed that require less exposure of the patient to ionizing radiation.

Dental Caries↗
PubMed1985

Investigation of the relationship between clinically detected loss of attachment and radiographic changes in early periodontal disease.

A total of 383 students, ages 12-16, were examined clinically to determine periodontal attachment loss by a trained examiner, utilizing standard techniques. 70 of these were selected, for whom bitewing radiographs were available for assessment of early alveolar bone loss by 2 radiologists and a general dentist, utilizing 4 criteria. The results indicate poor agreement between clinical and radiographic diagnoses by the 3 examiners. Variations were also found in the diagnosis of pathologic sites utilizing radiographs. The data indicate that bitewing dental radiographs were a poor screening or diagnostic procedure for the assessment of early periodontal disease in adolescents.

Adolescent↗
PubMed2005

[Detection of early fissure caries with clinical, radiologic, and laser fluorescence methods].

PURPOSE: The aim of study was to compare the diagnostic efficacy of the newly introduced DIAGNOdent laser fluorescence with traditional methods for detection of molar caries, namely visual inspection and bitewing radiographs. MATERIAL AND METHODS: Discolored fissures of 134 permanent molars were studied in 103 patients aged 12-18 years. RESULTS: The results indicate that visual examination and bitewing radiographs showed very high or high sensitivity and specificity for the detection of early fissure caries. Combination of these two methods decreased the number of false positive and negative results. Diagnostic accuracy of DIAGNOdent was significantly inferior to that of clinical examination or bitewing radiographs. CONCLUSION: However, the diagnostic accuracy of DIAGNOdent was increased by combining it with one of the two traditional methods studied.

Adolescent↗
PubMed1998

Digital radiography and caries diagnosis.

Direct digital acquisition of intra-oral radiographs has been possible only in the last decade. Several studies have shown that, theoretically, there are a number of advantages of direct digital radiography compared with conventional film. Laboratory as well as controlled clinical studies are needed to determine whether new digital imaging systems alter diagnosis, treatment and prognosis compared with conventional methods. Most studies so far have evaluated their diagnostic performance only in laboratory settings. This review concentrates on what evidence we have for the diagnostic efficacy of digital systems for caries detection. Digital systems are compared with film and those studies which have evaluated the effects on diagnostic accuracy of contrast and edge enhancement, image size, variations in radiation dose and image compression are reviewed together with the use of automated image analysis for caries diagnosis. Digital intra-oral radiographic systems seem to be as accurate as the currently available dental films for the detection of caries. Sensitivities are relatively high (0.6-0.8) for detection of occlusal lesions into dentine with false positive fractions of 5-10%. A radiolucency in dentine is recognised as a good predictor for demineralisation. Radiography is of no value for the detection of initial (enamel) occlusal lesions. For detection of approximal dentinal lesions, sensitivities, specificities as well as the predictive values are fair, but are very poor for lesions known to be confined to enamel. Very little documented information exists, however, on the utilization of digital systems in the clinic. It is not known whether dose is actually reduced with the storage phosphor system, or whether collimator size is adjusted to fit sensor size in the CCD-based systems. There is no evidence that the number of retakes have been reduced. It is not known how many images are needed with the various CCD systems when compared with a conventional bitewing, nor how stable these systems are in the daily clinical use or whether proper cross-infection control can be maintained in relation to scanning the storage phosphor plates and the sensors and the cable. There is only sparse evidence that the enhancement facilities are used when interpreting images, and none that this has changed working practices or treatment decisions. The economic consequences for the patient, dentist and society require examination.

Contrast Media↗
PubMed1995

Efficacy of the FDA selection criteria for radiographic assessment of the periodontium.

The diagnosis of periodontitis is generally made on the basis of a clinical examination supported by radiographic evidence of bone loss. Recent guidelines promulgated by the US Food and Drug Administration recommend that periapical radiographs be ordered on the basis of clinical signs and symptoms indicating the probable presence of disease. This study evaluated the effectiveness of the FDA Guidelines for ordering radiographs for new adult dental patients as related to assessment of the periodontal condition of the patient. We examined 490 patients and determined the periapicals needed to supplement the posterior bitewings based upon the patient's clinical findings. We measured the reduction in the number of radiographs ordered as well as the extent of missed alveolar and furcation bone loss resulting from the use of the selected set of radiographs compared with a complete set. Four hundred thirty-three subjects had at least one clinical sign of periodontitis present in their mouths, and 264 demonstrated radiographic evidence of alveolar bone loss. Of the 460 subjects on whom periodontal probing was conducted, two-thirds demonstrated periodontal probing depths in excess of 3 mm; almost half showed evidence of bleeding upon probing. Individuals with clinical signs of periodontitis had, on average, 10 periapicals ordered--more than twice the number as those with no sign of periodontitis. Of the 2,415 teeth with radiographic findings of proximal or furcal bone loss, 152 sites of bone loss (6%) were missed when the selected set of films plus the posterior bitewings was used.

Adolescent↗