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PubMed1994

A laboratory evaluation of four quality control devices for radiographic processing.

Quality assurance programmes for radiographic processing traditionally employ expensive sensitometric and densitometric techniques. However cheap and simple devices for monitoring radiographic processing are available. The aim of this study was to make a comparison of four such devices in terms of their ability to detect variations in radiographic density of clinical significance. Three of the devices are commercially available while the fourth is easily manufactured from waste materials. Ideal bitewing exposure times were selected for four different kilovoltage/film speed combinations. Phantom bitewing radiographs, exposed using these exposure times, were processed using a variety of times and developer temperatures to simulate variations in radiographic quality due to inadequate processing conditions. Test films, produced using the four monitoring devices, were exposed and processed under identical conditions. The phantom bitewings were judged to have 'acceptable' quality when the optical density of that part of the film not showing calcified structures was within +/- 0.5 of that of the film processed under optimal conditions. The efficacy of the monitoring devices in indicating the adequacy of processing was assessed by a comparison of their readings with those made from the phantom bitewings. None of the monitoring devices was ideal for all the kilovoltage/film speed combinations tested, but the homemade device proved to be the most generally effective. We conclude that guidelines to dentists on radiographic quality assurance should include reference to and details of this simple device.

Densitometry↗

PubMed1990

[The role of x-ray films in diagnosis in operative dentistry].

In operative dentistry x-ray films play an important part as a diagnostic procedure. Image quality depends on factors such as exposure and projection but also on optimum processing of the x-ray film. Of particular importance among the exposure-related factors are such features as variable voltage, short exposure time and narrow focussing. According to the new regulations in Germany x-rays may be used if this is indicated for medical reasons in dentistry. This condition is given far more frequently than x-rays are performed in the dental office. In the diagnosis of caries individual bitewing radiographs, if indicated, should always be preferred over panoramic radiographs. In pulp diseases radiographs may aid in detecting chronic pulpitis and in differential diagnosis with apical periodontitis. Both for diagnosis and documentation on intraoral films, tooth fractures are best imaged using two different projections. Radiovisiography facilitates radiographic diagnosis by employing a simple technique and operating with considerably lower doses.

Dental Caries↗

PubMed1986

The relationship between the dentist's year of graduation and ordering of bitewing radiographs.

This article reports the results of a survey of general practice dentists on the relationship of the dentist's year of graduation to the ordering of bitewing radiographs for patients. More recent graduates were more likely to indicate ordering the radiographs at 6-month intervals. There were no differences in ordering associated with the dentist's experience. Shorter intervals between ordering were indicated by all dentists for patient groups at high risk of caries.

Adolescent↗

PubMed1989

Approximal caries progression in 13- to 15-year-old Danish children.

A total of 278 children aged 13 years in 1980, who lived in an area where preventive programs and professional attitudes towards restorative treatment had changed over a 10-year period, were dentally examined in 1980, 1981, and 1982. Different preventive treatments were given to the children, to decrease the variation in dental caries. The development of new lesions and the rate of progression of existing lesions were studied by means of bitewing radiographs. Ninety-four per cent of the surfaces remained unchanged. Of the surfaces diagnosed as carious at 13 years of age no progression had occurred in 63%, and 86% of enamel lesions remained within the enamel. Although caries progression was slow in this population, the variation in dental caries was only slightly altered.

Adolescent↗

PubMed1993

Radiation dose as a factor in the choice of routine pre-operative dental radiographs.

Radiation doses received by patients during dental x-ray examinations were measured in 95 patients referred to the X-ray Department of the Teaching Dental Hospital, University of Nairobi. The mean skin dose for single periapical films was 5.96 milligray (596 millirads) with the bitewing view recording a mean dose of 5.57 milligray (mGy). During a 14-film full-mouth periapical survey, mean doses ranged from 10.3-16.2 mGy for the upper jaw and 10.1-13.5 mGy for the lower jaw, respectively, depending on the region of dentition. In these full-mouth examinations, the distribution of skin dose over different parts of the dentition showed a characteristic pattern which may be explained by the overlap of radiation fields in the aggregated series of exposure. Orthopantomography recorded lower mean skin doses of 3.26 mGy in the molar region and 2.67 mGy at the posterior midline at the level of the 2nd cervical vertebra. The relative merits of intra-oral radiography versus orthopantomography are discussed, with radiation dosage as one of the factors to be considered. Some observations are made on measures to reduce patient dose.

Decision Making↗

PubMed1987

The radiographic detection of initial carious lesions on the proximal surfaces of teeth. Part I. The influence of exposure conditions.

The relationship between a number of technical exposure conditions and the diagnostic value of bitewing radiographs in the interpretation of initial proximal carious lesions was evaluated. The most important exposure factors for radiographs are tube voltage, filtration, and exposure time. Tube voltage and filtration were found to have an insignificant influence on the diagnostic quality. Exposure time proved to be the most critical factor in influencing diagnostic quality. The greatest difference in diagnostic quality, however, was caused by differences between observers.

Dental Caries↗

PubMed1975

Errors in diagnosis of approximal caries on bitewing radiographs.

The number of overlapped and unreadable surfaces occurring on bitewing radiographs of 1,417 children participating in a clinical trial was recorded. Of erupted surfaces, only 73.3% were completely visible to both participating examiners. Interexaminer and intraexaminer reproducibility ratios were calculated according to the F.D.I. recommendations. The ratios obtained in the present study ranged from 0.06 to 0.36. Almost 57% of approximal cavities were diagnosed on radiographic examination only: 21% were diagnosed clinically, but were not apparent on the radiographs.

Child↗

PubMedDate not supplied

The clinical diagnosis of occlusal caries: a problem.

The problem of the diagnosis of occlusal caries is discussed on the basis of a pilot study. Out of twenty-six selected molars and premolars with a virtually intact enamel cover, twenty were found to be affected by occlusal caries extending into the dentine. In six cases in which the enamel was covered by a sealant, dentinal caries could not be excluded. Two teeth had a sound enamel surface in spite of the presence of much dentine caries. The bitewing radiographs of these cases showed a distinct radiolucency. Until it becomes possible to diagnose occlusal caries more effectively, the combination of bitewing radiograph and clinical examination with mirror, light, and probe is to be regarded as optimal. The dentist in general practice should keep in mind that even a tooth classified as clinically sound may contain extensive dentinal caries. The prevalence of this form of caries should be investigated further, and the search for better diagnostic aids should continue.

Adolescent↗

PubMed2005

Use of radiographs in the diagnosis of periodontal disease.

UNLABELLED: Radiographs are commonly used in the diagnosis of periodontal diseases. They can be used to assess bone loss and the pattern of loss as well as in the identification of other periodontally relevant features, such as overhanging restoration margins, calculus deposits and furcation lesions. Horizontal and vertical bitewings, panoramic radiographs and periapicals can be used for periodontal assessment. Referral (selection) criteria based on clinical signs can assist the decision of the radiographs to use. All exposures must be made in accordance with the Ionizing Radiation (Medical Examination) Regulations 2000 and each exposure justified. CLINICAL RELEVANCE: Following a clinical examination, optimum selection of radiographs can assist in the assessment of patients with periodontal diseases.

Alveolar Bone Loss↗

PubMed1989

The detection of cavitation in carious approximal surfaces in vivo by tooth separation, impression and scanning electron microscopy.

Bitewings are the most effective method of detecting approximal lesions but correlation with surface integrity is poor. In this study teeth were separated using orthodontic elastic separators allowing impressions, taken in a vinyl polysiloxane impression material, to be viewed by scanning electron microscopy. Case reports demonstrate the effectiveness of this technique in assessing in vivo, and in detail, the extent of cavitation of lesions usually assessed by their radiographic image alone.

Adolescent↗

PubMed1976

The construction and use of diagnostic standards for primary radiographic caries.

The aim was to establish diagnostic standards for primary approximal radiographic caries diagnosis. These were described with reference to ranking of subjects, mean "intermediate" score per subject, which was based on the majority diagnosis recorded by three examiners, and by category of a certainty scale for individual tooth surface scores. The results recorded by two fourth year dental students and two hygienists, when reading 40 pairs of posterior bitewing radiographs of children between 13 and 15 years of age, showed an acceptable level of agreement for ranking of subjects. Agreement was less satisfactory, when comparing the mean scores of these four examiners with the "intermediate" score per subject and with a standard for individual surfaces. The proposed standards do not represent true scores, but serve as guidelines, as they depend on the diagnostic level of the examiners on whose scores the standards are based, and on the diagnostic criteria employed.

Adolescent↗

PubMed1983

A method for the geometric and densitometric standardization of intraoral radiographs.

The interpretation of dental radiographs for the diagnosis of periodontal disease conditions poses several difficulties. These include the inability to adequately reproduce the projection geometry and optical density of the exposures. In order to improve the ability to extract accurate quantitative information from a radiographic survey of periodontal status, a method was developed which provided for consistent reproduction of both geometric and densitometric exposure parameters. This technique employed vertical bitewing projections in holders customized to individual segments of the dentition. A copper stepwedge was designed to provide densitometric standardization, and wire markers were included to permit measurement of angular variation. In a series of 53 paired radiographs, measurement of alveolar crest heights was found to be reproducible within approximately 0.1 mm. This method provided a full mouth radiographic survey using seven films, each complete with internal standards suitable for computer-based image processing.

Absorptiometry, Photon↗

PubMed1989

Spatial resolution requirements for digitizing dental radiographs.

A study was performed to determine the appropriate spatial resolution for digitizing and transmitting dental radiographs with the KODAK EKTASCAN, a computer-based digital enhancement and transmission system. Periapical, bitewing, and panoramic radiographs were digitized in three formats representing varying spatial resolution parameters. Eight viewers used a 5-point rating scale to evaluate the detectability of periapical pathosis on the periapical images, of proximal surface caries on the bitewing images, and of various bony abnormalities on the panoramic images. Receiver operating characteristic curves were generated, and the results of the periapical, bitewing and panoramic experiments were presented as trapezoidal and maximum likelihood receiver operating characteristic curve areas. The results of this study indicate that digital images of dental radiographs provide adequate diagnostic accuracy for evaluating the presence of periapical pathosis, proximal surface caries, and specified bony abnormalities. The digitization parameters established for the KODAK EKTASCAN provide a guide for digitizing dental radiographs on other commercially available digital image-processing systems.

Computers↗

PubMed1976

A comparative radiographic investigation of caries prevalence in Danish schoolchildren.

In order to assess the prevalence of untreated caries in two groups of Danish 7th grade (13- to 14-year-old) school children in a blind study, a radiographic investigation was carried out. Only half of the children (394) had received regular school dental care during their years of attendance of primary school; the other children (368) had not. A bitewing radiograph of the right side of the mouth of each child was taken, employing a standardized technique. The radiographs were read without the examiner knowing the group identity of the radiographs. The criteria for discarding poor radiographs, teeth, and tooth surfaces are described. Some of the radiographic results are compared with the clinical caries score of the same group. Most of the radiographs without untreated caries were found among those of the children who received school dental service. Uncertainty of method in connection with radiographic investigation is discussed.

Adolescent↗

PubMed1990

Quality of intraoral radiographs sent by private dental practitioners for therapy evaluation by the Social Insurance Office.

Nearly all Swedish private dentists are affiliated with the Dental Care Insurance. Proposed treatment plans, including radiographs, are submitted to the Social Insurance Office for prior approval. In this study the quality of a sample of intraoral radiographs submitted by 404 private dental practitioners was analysed. Forty-four per cent of 3,708 periapical radiographs, simultaneously evaluated by two examiners, were satisfactory. The most frequent errors were excessive vertical angulation (18 per cent), missing apex (12 per cent), film positioning error (11 per cent) and underexposure (10 per cent). Fifty-five per cent of 294 bitewing radiographs were satisfactory; the major error was missing bone margin (33 per cent). The radiographs of 15 per cent of the 2,844 teeth proposed for therapy had insufficient radiographic documentation, six per cent because of missing radiograph and nine per cent because of missing apex on the radiograph. These errors applied to every second dentist. Compared to a similar study ten years ago, the present results do not indicate that the quality of intraoral radiographs has improved.

Chi-Square Distribution↗

PubMed1981

Radiographic and clinical examination of periodontal status of first molars in 15-16-year-old Danish schoolchildren.

The prevalence of alveolar bone loss was investigated in 2813, 15- and 16-year-old Danish schoolchildren using bitewing radiographs. The interproximal spaces of the mesial and distal aspects of the first molar teeth were examined. Only defects with depths of more than 2 mm were considered periodontal bone loss. Radiographic evidence of bone resorption was found in 48 children. When evaluated clinically, 42 out of the 48 children with radiographic signs of bone loss demonstrated clinical loss of attachment. Only four children (0.1%) had the characteristic radiographic features of juvenile periodontitis. Loss of attachment of more than 2 mm was observed in these children.

Adolescent↗

PubMed1995

[100 years of x-rays: increase in image quality of intra-oral radiographs, decrease in patient exposure].

Comparing a present-day bitewing radiograph with one of the first dental radiographs made immediately after the discovery of the X-rays, we can see how enormously the image quality of dental radiographs has improved. Besides the improved image quality, patient exposure has decreased considerably during the past 100 years. Improvement of image quality and reduction of patient exposure have been brought about by changes of X-ray equipment and radiographic films. These changes, which have led to a better image quality and a decrease of patient exposure during the past 100 years, are discussed in this article.

History, 19th Century↗

PubMed1989

Assessment of the DMF-S index with the use of bitewing radiographs.

A study population of students (ages 14 to 18 years) was examined radiographically (bitewings) and by clinical DMF-S evaluations. Results revealed a clinically detected total DMF-S of 8.31 with a D-S of 4.86. Decay clinically detected on premolars and molars alone was 4.38, whereas an additional 4.88 surfaces were radiographically detected as being carious. It was determined that a multiplying factor of 1.59 should be used in the present study population to better assess the actual total DMF-S figure. Validity of the correction factor was tested and validated.

Adolescent↗