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PubMed1982

Variation in radiographic caries diagnosis and treatment decisions among university teachers.

Twelve duplicated bitewing radiographs of clinical quality were viewed under controlled conditions by 42 dentists in a teaching department. The dentists noted surfaces with initial caries or with caries in need of treatment. The radiographs were rediagnosed by 20% of the dentists to determine inter- and intra examiner reliability. A norm for the validity of lesion presence in enamel or dentin was applied. The variation in surfaces indicated for treatment is illustrated by: mean 40, s.d. 16, min. 13 and max. 89 for the 42. The mean proportion of true positive filling decisions in percentages was 67, s.d. 18, the mean proportion of false positive filling decisions was 22, s.d. 22. A large individual variation was found in this study. The dental teachers saw less caries present than the norm but some indicated more fillings needed than dentin caries present. It is suggested that care in the educational process should be given to developing appropriate caries treatment criteria. Factors conducive to preventively orientated treatment decisions in the clinical situation need further attention.

Adolescent↗

PubMed2006

The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14-18 months.

This paper aims to assess radiographic changes after incomplete carious dentine removal and tooth sealing. Thirty-two teeth with deep caries lesions were studied. The treatment consisted of incomplete excavation, application of a Ca(OH)2 layer, sealing temporarily for a 6- to 7-month period and then restoration. Standardised bitewing radiographs were taken immediately after the temporary sealing and at 6- to 7- and 14- to 18-month intervals. The digitised images were analysed blind by image subtraction. The quantitative analyses subtractions were performed in the radiolucent zone (RZ) beneath the restoration and in two adjacent control areas (CA). Two cases were lost during the 6- to 7-month period (one pulp necrosis and one pulp exposure during removal of the provisional sealing). No difference (p > 0.05) was observed in the radiographic density of the CA and the RZ in the two experimental periods. The mean and standard deviation (grey tonalities scale) were 129.42+/-5.83 and 127.65+/-4.67 (control areas) and 132.96+/-7.41 and 132.90+/-5.99 (RZ) for the first and second experimental periods, respectively. The radiographic density of the CA differed from the RZ (Tukey test, p < 0.001). Interference in environmental conditions by partial dentine caries removal and tooth sealing arrests lesion progression, suggesting that complete dentine caries removal is not essential to control caries progression.

Adolescent↗

PubMed1989

Prevalence and distribution of caries in a Jerusalem adolescent population by age, sex, and family income.

Four hundred and fourteen high school students aged 12-17 were examined clinically using the DMFS index and bitewing radiographs. Analyses by age, sex, economic status, and types of teeth and tooth surfaces were performed and results were compared with other international studies. Only 7.5 percent of the study population had a zero DMFS score. Females had a significantly higher DMFS score than males (13.21 vs 9.59). Caries experience increased with age and a general trend of increasing DMFS was observed with increasing levels of income. Socioeconomic status (SES) was related directly to DMFS in Israel, in contrast to an inverse relationship observed in most other western countries. First molars were most susceptible to caries attack and accounted for 41.2 percent of the total DMFS. Almost 50 percent of all affected surfaces were occlusal and 29.4 percent were proximal. Caries prevalence in general and proximal caries in particular were found to be much higher in the study population than corresponding figures in other industrialized countries. A significant decrease in caries prevalence could be expected in Israel in the next decade if primary preventive measures are implemented immediately.

Adolescent↗

PubMed1975

A study of intra-examiner error associated with recording of radiographic caries at different diagnostic levels.

Pairs of posterior bitewing radiographs of forty children 13-15 years of age at the third and fourth examinations of three-year clinical trials were assessed by one examiner for primary caries. Duplicate assessments were carried out in independent sessions, recording simultaneously absence/presence of caries and caries degree, and in the same way for three different diagnostic levels recording only absence/presence of caries. Caries diagnostic inconsistency rate (D.I.R.) in per cent was always lower than 34 and usually below 20; a finding which is in agreement with previously published results. No preference could be expressed for any particular diagnostic level on the basis of the primary caries scores, but recording only relatively advanced lesions tended to give most favourable results for DFS increment scores. The recording of both absence/presence of caries and caries degree simultaneously had a small, but not consistently adverse effect on the D.I.R. and reliability coefficient. As there was no marked difference in examiner error associated with two of the demarcation lines used for recording of caries degree, i.e. half way through enamel and the A.D.J., the scoring codes described here may be suitable for studies of radiographic caries progression.

Adolescent↗

PubMed1980

A bitewing radiographic study of a population of diabetic and nondiabetic rhesus monkeys.

A population of 7 diabetic and 13 nondiabetic rhesus monkeys (Macacca mulatta) were examined radiographically using bitewing imaging techniques. Each subject was scored radiographically for bone levels, periodontal ligament (PDL) widening, radiographic calculus, and carious lesions. Prior to examinations blood samples were obtained for fasting blood glucose levels. Results indicated that all clinical variables were generally greater for the diabetic group, with bone loss being the only statistically significant parameter. Calculus levels, however, were found to be greater radiographically in the nondiabetic group. In viewing the study population as a single group of 20 monkeys, decreased bone levels were found to be positively correlated with PDL widening and blood glucose levels suggesting an association of hyperglycemic states with possible decreased resistance to infection. It was concluded that carbohydrate intolerance with hyperglycemia in diabetes mellitus may be associated with the radiographic variable of increased bone resorption using an objective system of measurement for evaluation and scoring. Without a quantitative system of measurement such as devised in this study, other radiographic variables such as PDL widening, calculus deposits, and carious lesions may not be accurately tested against one another or correlated with other experimental clinical parameters.

Alveolar Process↗

PubMed2005

Brazilian dentists' restorative treatment decisions.

PURPOSE: To investigate the pattern of decision-making by southern Brazilian dentists regarding the use of restorations in the treatment of dental caries. MATERIALS AND METHODS: A cross-sectional survey involving 840 dentists, randomly selected in three southern Brazilian states, was performed. Telephone interviews were conducted by three previously trained dentists, in which clinical situations with different-depth radiolucencies, based upon bitewing radiographs, were described. Two other situations, including dark fissures and white spots, were also described. The main outcome measures were the tendency in clinical decision-making in comparison with the number of years elapsed since qualification and attendance on postgraduate courses. RESULTS: The overall response rate was 89.4%: 31.5% of dentists would restore cavities in the outer half of the enamel; 54.5% when the cavity reached the inner half of the enamel, but not the enamel-dentine junction (EDJ); 79.0% when cavities reached the EDJ; and 96.9% when cavities reached the outer half of the dentine. Furthermore, 21.8% of dentists would restore dark fissures without signs of demineralization. Dentists qualified for less than 10 years and those who had attended postgraduate courses were less interventionist. CONCLUSION: It was concluded that dentists have an interventionist attitude in the making of treatment decisions for dental caries and may be over-treating in several situations.

Adult↗

PubMed1982

A further look at the role of radiographs in trials of caries-prophylactic agents.

To determine the role of bitewing radiographs in clinical trials of caries prophylactic procedures, data from the Chatham flossing study 26 were reanalyzed. The final examination records after 20 months of 147 second grade children were used to assess and compare the separate and combined results from clinical and radiographic examinations. Analysis of paired approximal surfaces from contralateral test and control quadrants revealed that the addition of radiographic findings to clinical data changed the mean increment reduction from 22 to 26 percent. This slight increase was further supported by the results of similar studies which reported either separate or combined radiographic and clinical findings or both. Although the magnitude of the increase of the mean increment reduction remains uncertain, data from these studies indicate that the use of combined radiographic and clinical data might be justified when testing a particular prophylactic procedure which is expected to incur a significant caries reduction to approximal surfaces. Furthermore, findings suggest that clinical trials of certain prophylactic agents that are particularly beneficial to approximal surfaces, but which fail to include radiographic examinations, might actually underestimate the preventive effect of the agent.

Child↗

PubMed1983

Effect of variation in caries diagnosis and degree of caries on treatment decisions by dental teachers using bitewing radiographs.

Nine teachers of clinical dentistry were presented with 12 pairs of duplicated bitewings on four different occasions. At the first two examinations they indicated the presence of caries in need of treatment and at the second two the degree of caries. The diagnostic sessions were repeated to measure reproducibility. A norm for the validity of degree of enamel caries and for the estimation of specificity and sensitivity of the diagnostic categories was applied. The teachers saw on average less caries and less deep caries than the norm. Variability by the teachers was especially large between examinations for enamel lesion categories. There was a mean of 69% agreement by the teachers with their own treatment indication criteria. Over recording of treatment need (mean 19%, SD 20%) and under recording (mean 36%, SD 17%) occurred at the same viewing periods. Using Cohen's kappa, it was found that despite their variation and inaccuracy this group of teachers should select caries in dentin as the teaching criterion for treatment need. It is suggested that the sensitivity and specificity with which dental practitioners can use a criterion should be taken into account firstly when selecting it, and secondly when choosing the frequency of radiographic screening.

Adolescent↗

PubMed1990

Limitations of the digital image subtraction technique in assessing alveolar bone crest changes due to misalignment errors during image capture.

The digital image subtraction method depends critically on the very precise registration of sequential radiographs. A method of using a single radiograph to form two identical digital images was created, eliminating any potential effects from irradiation or processing variation, to investigate the effects of misregistration between images. These images were displaced by 0.1-0.42 mm in the X, Y and XY directions before subtraction. A total of 35 alveolar crest margins from five bitewing radiographs were investigated for the extent of false bone loss or gain produced in the subtracted images. The mean grey level gradient across the interdental space/crestal margin interface was 3.1 (SD 1.4) grey levels per 0.05 mm pixel. Small displacements between subtracted images of 0.1-0.14 mm in the Y or XY directions caused 20-25% of crestal pixels to vary by greater than or equal to +/- 2.5% of the grey range. Larger displacements of 0.3-0.42 mm caused 65% of crestal pixels to vary by greater than or equal to +/- 2.5% of the grey range. A higher threshold of greater than or equal to +/- 4.1% of the grey range still showed up to 48% of crestal pixels were in this higher deviation band. A high noise threshold of +/- 8% of the grey range should be used to discriminate against false grey values. A visual method for estimating the direction of displacement error between images is discussed together with a method for setting noise thresholds for individual alveolar crest grey level gradients. In any radiograph, a range of alveolar crest gradients will be found and those with the higher gradients will produce the largest subtraction errors for any given displacement between images.

Alveolar Bone Loss↗

PubMed2005

Digital imaging fiber-optic trans-illumination, F-speed radiographic film and depth of approximal lesions.

BACKGROUND: Detection of early carious lesions is a prerequisite to an optimal preventive and minimal surgical intervention strategy. The authors conducted this study to determine whether Digital Imaging Fiber-Optic Trans-Illumination (DIFOTI) (Electro-Optical Sciences, Irvington, N.Y.) could be useful in evaluating early approximal lesions and to compare radiographs produced with F-speed film with both histologic lesion depth and cavitation. METHODS: The authors created artificial approximal lesions in vitro in extracted teeth over 14 weeks and imaged them using a "bitewing-like" view every two weeks with DIFOTI and F-speed radiographic film. At the end of the 14 weeks, the authors examined the lesions for surface cavitation using visual and tactile methods. They then thin-sectioned the lesions and subjected them to histologic analysis using polarized light microscopy (PLM). RESULTS: DIFOTI was not able to measure the depth of a lesion in any of the samples. It was, however, able to show surface changes associated with early demineralization as early as two weeks. The depth of a lesion measured using F-speed radiographic film was not statistically different from the depth of a lesion measured with PLM histologic analysis (P > .05). None of the lesions showed any signs of surface cavitation after 14 weeks of demineralization. CONCLUSIONS AND CLINICAL IMPLICATIONS: DIFOTI technology should not be used to decide between surgical or chemical treatment strategies based on lesion depth. We found that F-speed radiographic film was accurate in the approximating the depth of the lesion histologically. Ideally, the clinical decision whether to cut the tooth should be made based on cavitation rather than histologic lesion depth.

Bicuspid↗

PubMed2005

Radiographic recognition and distribution of approximal carious lesions in New Zealand undergraduate dental students.

Bitewing radiographs are widely used to detect caries on the approximal surfaces of teeth. The aim of this study was to determine the prevalence of approximal caries in an educated young adult (New Zealand dental student) population, and to compare the diagnostic decisions of students and university teachers. A total of 123 students aged from 18 to 25 years (mean age 21 years) participated, having given their informed consent. Their bitewings were digitised and assessed for approximal carious lesions from the distal surface of the first premolars to the mesial surface of the second molars on the same computer screen. The following criteria were used: (0) no detectable radiolucency, (R1) lesion confined to the outer half of the enamel, (R2) lesion into the inner half of the enamel, (R3) lesion into the outer half of dentine along the amelodentinal junction, (R4) lesion beyond the outer part of the dentine. The views were assessed by two final-year dental students and two experienced university teachers, and results were compared. A total of 2710 surfaces were examined; restored and missing surfaces (tooth absent, off film or surface unreadable) were excluded. Carious lesions were found in 173 (6.38 percent) of the surfaces. Only 57 subjects presented with carious lesions radiographically, but 16 (13 percent) of subjects had 87 percent of all the lesions. Seventy-nine percent of the lesions were enamel lesions (R1 and R2), with 21 percent of the lesions having dentine involvement (R3 and R4). Inter-examiner agreement was high, Pearson's correlation coefficient r = 0.8237, and Cohen's kappa kappa = 0.76.

Adolescent↗

PubMed2001

Evaluation of dental radiographic identification: an experimental study.

The object of this study was to assess the value of dental radiographs for the purposes of personal identification in the absence of tooth restorations. 198 periapical and bitewing radio graphs were taken of teeth contained in 22 dry skulls obtained from the skull collection of the Royal College of Surgeons of Edinburgh. Each selected view was taken three times: by a scientist, a dentist and a dental radiographer. Each operator independently positioned the films, selected the exposure times and positioned the cone of the X-ray machine. Three groups comprising forensic odontologists, dental vocational trainees and dental trainee hygienists attempted to match the randomly mixed radiographs into sets of three. Success rates for matching radio graphs ranged from 63.6 to 100%. The average for forensic odontologists was 93.3%, vocational trainees 85.2% and hygienists 89.7%. Where forensic odontologists had both formal training and experience, or extensive experience without formal training, the success rate was 100%. Where there was formal training but little experience the success rate was lower. Participants believed that root morphology and alignment had been the greatest aid to matching and not crown morphology. The depth of knowledge of the viewer correlated poorly with the number of correct results, although the forensic odontologists achieved the highest success rate. Formal training, although highly desirable, is no substitute for practical experience. Root morphology and alignment were cited most frequently as facilitating matching.

Clinical Competence↗

PubMed1988

Changes in prevalence of approximal caries in 17-year-olds and related restorative treatment strategies over a 6-year period.

Two cohorts of 17-yr-olds treated in a municipal child dental service in 1978-79 and 1984-85 had bitewing radiographs taken at the examination before the last course of treatment in the service. All radiographs were read by one examiner, who did not know to which cohort the individual belonged. The subsequent treatment was recorded from the treatment records by another examiner, who was unaware of the results of the radiographic examination. According to radiographic scores, the proportion of decayed or filled (DFS) approximal surfaces had decreased from 23.2% to 17.4% during the period (difference: 25%). The proportion of unfilled surfaces which were decayed (DS) had remained almost constant, while 9.6% of the surfaces were filled (FS) in 1978-79 compared to 3.1% in 1984-85 (difference: 68%). Thus, in spite of a 25% decrease in total caries experience (DFS), a reduction of 68% would be claimed if fillings (FS) were interpreted as expression of disease prevalence. The risk of an approximal surface being filled decreased to about one fifth from 1978-79 to 1984-85, and the risk of being filled was nearly three times as high for approximal surfaces of children who already had approximal fillings at the time of examination. Thus, both the year of examination and the subject's previously received treatment seemed to influence the treatment strategy of the dentist.

Adolescent↗

PubMed2005

Grey-scale reversed radiographic display in the detection of approximal caries.

OBJECTIVES: Purpose of this study was to determine the influence of grey-scale reversal of digital radiographic images on the detection of proximal caries. METHODS: Five observers assessed digital bitewing radiographs (Sidexis((R)), Sirona) of 320 unrestored surfaces of extracted posterior teeth embedded in 20 models, simulating pairing of maxillary and mandibular arches, using a six-category caries rating scale. Images were displayed in normal [N] and inverse [IN] mode at different image sizes (display ratio: 1:1, 1:2, 1:7) on a cathode-ray tube monitor (Nokia 446 XS) and a TFT display (Panasonic LC 50 S). Validation standard was defined as histological lesion depth. Validity was expressed as areas under receiver operating characteristic curves (AUC) calculated for two levels of histological caries penetration: presence of caries and presence of a dentine lesion. The factors 'inverse display', 'image size on-screen' 'display type' and 'disease cut-off' were analysed by repeated measures ANOVA. RESULTS: Inverse image display significantly influenced the diagnostic validity (P=0.014), but a reduced accuracy was only seen at the lowest image size (AUC (SE): [N] 0.64 (0.02); [IN] 0.62 (0.02)). At the validation threshold 'dentine caries' approximal caries detection deteriorated when using grey-scale reversal (AUC (SE): [N] 0.71 (0.02); [IN] 0.69 (0.02)). CONCLUSIONS: In conclusion, grey-scale reversal of digital radiographs did not optimise approximal caries detection and aggravated the detectability of dentinal lesions.

Analysis of Variance↗

PubMed2006

Marginal bone level in an adult Danish Population.

PURPOSE: To investigate the prevalence and distribution of marginal bone loss in the Danish population. MATERIALS AND METHODS: Six hundred and sixteen randomly selected Danish adults (304 females and 312 males), mean age of 42 years (range 21-63 years) underwent a full-mouth radiographic survey consisting of 14 periapicals and two bitewings. The marginal bone level was measured with a digital caliper in mm, rounded off to the nearest 0.1 mm. The measurements were performed at the mesial and distal aspect of the tooth, from the cemento-enamel junction to the marginal bone. These measurements were used to calculate the marginal bone level (A) in mm for each tooth and each patient. Three thresholds were defined: normal marginal bone level (A < 3 mm), borderline marginal bone level (3 mm < or = A < 4 mm) and reduced marginal bone level (A > or = 4 mm). RESULTS: The prevalence of reduced marginal bone level in the individual and the frequency of teeth with reduced marginal bone level were almost similar. A reduced marginal bone level was evenly distributed among the tooth groups. Approximately 12% had reduced marginal bone level, 12% were in the borderline marginal bone level group, and the remaining 76% had a normal marginal bone level. The marginal bone level was ever more reduced with increasing age. No significant difference in bone level was observed between genders. CONCLUSIONS: The prevalence of reduced marginal bone level in a random Danish population is approximately 12% and is comparable to findings in other European countries.

Adult↗

PubMed1995

Initial caries attack and average progression rates in 12-year-old Isle of Wight children.

Initial caries attack and progression rates of posterior approximal carious lesions were assessed based on 12-year-old school children residing on the Isle of Wight. Bitewing radiographs of a sub-sample of 165 subjects were randomly selected from the control group of a dentifrice clinical trial which took place between 1984 and 1987. Of the approximal surfaces that were caries-free at the first examination 71 per cent of the same surfaces remained caries-free after three years, an overall initial caries attack rate averaging 10.7 per cent per annum. Of the mesial surfaces of first permanent molars, 455 were initially caries-free, 67 per cent of which remained so after a three year period. The attack rate of this specified surface was 12.4 per cent per annum. The majority of surfaces that were caries-free at the start of the investigation would therefore be expected to remain so at least three years later. Caries progression appeared to be a slow process with only 12 per cent of initially carious outer enamel surface lesions penetrating into dentine after one year. After two years this had increased to 46 per cent and after three years, to 62 per cent. For a similarly defined group of individuals it would appear likely that the majority of early enamel lesions would not reach dentine within two years. For a substantial number of subjects this would extend to at least three years.

Child↗

PubMed1998

Comparison of reliability of manual and computer-intensive methods for radiodensity measures of alveolar bone loss.

OBJECTIVE: To compare the reliability of radiodensity measurements made from dental radiographs with manual and a novel computer-intensive methods. METHODS: As part of a prospective study of postmenopausal women, a series of seven vertical bitewing radiographs were taken of 36 patients. One of each set of radiographs was repeated. The original and the corresponding duplicate radiographs were used in this study. Radiographs were digitized at 50 microns spatial resolution and 12-bit gray-scale resolution. For the Manual Method, original and duplicate radiographs were manually cropped to improve image homology, histogram matched and mean pixel gray-scale values determined for an alveolar bone ROI within each image. For the computer-intensive method, images were put into registration with ANALYZE software (Mayo Foundation, Rochester, MINN, USA), cropped automatically, histogram matched and color-coded on the basis of the per cent difference. Alveolar bone ROIs adjacent to clinical crowns and root surfaces whose color code indicated less than a 5% change were sampled. Method error (ME) and the coefficient of variation of method error (CVME) were calculated. RESULTS: With the Manual Method the SD between original and duplicate measures was 95.21 out of 4096 gray scale values; ME = 67.32; CVME = 3.78%. For the computer-intensive method, the corresponding values were 54.74, 38.71, and 2.29%. CONCLUSIONS: The new computer-intensive method resulted in a 40% improvement over the Manual Method in the precision of radiodensity measurements.

Absorptiometry, Photon↗

PubMed1996

Correlations between radiographic, clinical and mobility parameters after loading of oral implants with fixed partial dentures. A 2-year longitudinal study.

The aim of present study was to correlate the changes in the peri-implant tissues occurring after functional loading of non-submerged titanium implants and assessed by radiographic, clinical and mobility measurements. 11 patients with distal extension situations received 18 implants of the ITI Dental Implant System. After a healing period of 3 months, the suprastructures were fabricated and seated 5 months post-surgically. For the assessment of peri-implant bone changes, standardized vertical bitewing radiographs with reproducible exposure geometry were evaluated using computer assisted densitometric image analyses (CADIA) and bone height measurements. Since the radiographic evaluations were performed at mesial and distal sites only, the clinical parameters from these implant aspects were included in the analysis. Clinical periodontal parameters modified for the use around implants were obtained, damping characteristics were expressed as Periotest readings and standardized radiographs were obtained at 1, 3, 6, 12 and 24 months after loading. In addition, radiographs were also taken at the start of functional loading. The data obtained from this small sample of implants demonstrated a wide range of different tissue alterations when using radiographic, clinical and mobility assessments. The parameters of probing attachment level (PAL) in combination with radiographic parameters obtained at 1, 3, and 6 months after loading were good predictors for the peri-implant tissue status at 2 years. This was shown by means of multiple stepwise regression analyses. Mobility measurements did not reveal valuable predictive information with the statistical models applied. Assessments of probing attachment levels using periodontal probes rendered information on peri-implant tissue alterations, which were closely correlated to the radiographically measurable peri-implant bone changes.

Adolescent↗