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PubMed2006

Methods of determining the relationship of the mandibular canal and third molars: a survey of Australian oral and maxillofacial surgeons.

BACKGROUND: Surgical extraction of third molars is one of the most common oral and maxillofacial surgical procedures performed and may have a number of associated complications. One of these complications is inferior alveolar nerve (IAN) dysaesthesia or impairment of sensory perception (including paraesthesia and/or anaesthesia). Previous studies assume that most clinicians use various combinations of nine radiologic criteria on panoramic radiographs as indicators of the relationship and, therefore, predictors of the risk of postoperative dysaesthesia. Our study assessed both the current radiologic modalities and assessment criteria used by Australian oral and maxillofacial surgeons when determining the proximity of mandibular canal to third molars. METHODS: A survey of all surgeon members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZOMS) practising in Australia was undertaken. RESULTS: Of the 105 questionnaires sent to surgeons, 72 responses (68 per cent) were returned. All surgeons reported using the panoramic radiograph but only 25 per cent considered it sufficiently accurate in determining the relationship between the mandibular canal (MC) and the third molar root, while 61 per cent of surgeons use CT for this purpose but the average frequency of use was very low (five per cent). This study also revealed that the nine radiologic criteria on a panoramic radiograph are used to varying extents by Australian surgeons. Nearly all surgeons use 'change in MC direction' and 'MC narrowing' to determine and close relationship. Thirty-one per cent used superimposition of the MC and the root of the third molar alone and 24 per cent used appearance of contact of the root with the MC alone in the absence of any other radiologic criteria to indicate close or intimate relationship. CONCLUSION: Further research is required to determine the accuracy and observer agreement or reliability of using the nine panoramic characteristics, to determine this relationship and whether the presurgical determination of proximity and position (buccal or lingual) of the canal utilizing CT has any usefulness in determining the surgical protocol or affect on postoperative morbidity.

Australia↗
PubMed1996

Relationships between clinician variability and radiographic guidelines.

This study evaluated the replicability of clinical measurements under careful calibration of multiple dentists and how the replicability can relate to their use as selection criteria in guidelines for prescribing dental radiographs. For 48 consenting patients, three dentists clinically examined each patient and recorded the presence of all clinical findings using standardized selection criteria. The examinations were performed independently of each other, but with periodic conferences of the dentists to clarify general measurement criteria. The degree of agreement among the dentists is described by the interrater agreement kappa for several standard clinical indications such as rating of caries, periodontal disease, and tooth mobility. Almost perfect agreement was obtained for tooth status, restoration size, and restoration material. Moderate agreement resulted for measures of caries, defective restoration presence, and gingival recession presence. Only fair agreement was obtained for other periodontal disease measures. The relationship between extent of agreement and guidelines' results was examined for the FDA Guidelines. The differences among the dentists' clinical measurements resulted in considerable differences among the radiographs that were selected by the FDA Guidelines' criteria. Even so, the missed disease rates for 490 patients in a larger study of the FDA Guidelines' efficacy were very low and did not vary greatly among the three dentists. We conclude that guidelines' criteria can be quite robust to variation from dentists' clinical measurement differences, as seen from the FDA Guidelines applied under the idealized setting where the dentists are periodically recalibrated through group discussions of the clinical measurements' definitions and interpretations.

Adolescent↗
PubMed1999

Radiographic determinants of implant performance.

This paper reviews and compares the strengths and weaknesses of radiographic techniques including periapical, occlusal, panoramic, direct digital, motion tomography, and computed tomography. Practical considerations for each method, including availability and accessibility, are discussed. To date, digital subtraction radiography is the most versatile and sensitive method for measuring boss loss. It can detect both bone height and bone mass changes on root-form or blade-form dental implants. Criteria for implant success have changed substantially over the past two decades. In clinical trials of dental implants, the outcomes require certain radiographic analyses to address the hypothesis or clinical question adequately. Radiographic methods best suited to the objective assessment of implant performance and hypothesis were reviewed.

Alveolar Bone Loss↗
PubMed1991

Agreement between panoramic and intra-oral radiography in the assessment of marginal bone height.

Panoramic and intra-oral radiographs from 400 consecutive patients were evaluated for the assessment of the marginal bone height. Two hundred panoramic radiographs were exposed with the rotational technique and 200 with the intra-oral X-ray tube technique. Measurements of the approximal marginal bone level were independently performed by two observers. Complete agreement between panoramic and intra-oral radiographs was, on average, obtained in 55% and 49% of the sites, respectively. When the criterion for agreement was widened to include recordings with a difference of +/- 1 mm, the agreement was on average 87% irrespective of the techniques compared. The agreement varied with tooth type and severity of the marginal bone loss. Angular bony defects and furcation involvements were recorded separately. For angular bony defects there was a variation in agreement from 33% to 46% for the rotational technique and from 35% to 51% for the intra-oral X-ray tube technique depending on localization. Furcation involvements of the molars were equally recorded in 60% and 59%, respectively, but in only 12% and 28% for the upper premolars. Interobserver agreement was 58% for the intra-oral radiographs, 60% and 59% for the two panoramic techniques. Mean intra-observer agreement was 68%, 66% and 68%. It is concluded that panoramic radiography can often be used for the assessment of marginal bone loss alone, supplemented when necessary by intra-oral radiographs.

Adolescent↗
PubMed1993

Comparison of panoramic and intraoral radiography for the diagnosis of caries and periapical pathology.

Panoramic and intraoral radiographs from 400 consecutive patients were compared for their ability to demonstrate periapical pathology and caries. Two hundred panoramic radiographs were exposed with the rotational technique and 200 with the intraoral X-ray tube technique. Periapical osteolytic and sclerotic lesions as well as approximal caries were recorded independently by two observes. Agreement with intraoral radiographs for periapical osteolytic lesions was, on average, 63% for the rotational and 55% for the intraoral X-ray tube technique and for sclerotic lesions 40% and 36%, respectively. The agreement varied with tooth type and lesion size. When teeth without periapical lesions were also included in the comparisons, the values for agreement were over 96%. Interobserver agreement for periapical osteolytic lesions was 61% for the rotational and 56% for the intraoral X-ray tube technique. The corresponding values for sclerotic lesions were 29% and 23%. Intraobserver agreement for periapical osteolytic lesions was 71% for the rotational and 67% for the intraoral X-ray tube technique. The corresponding values for sclerotic lesions were 46% and 56%. Agreement with intraoral radiographs for enamel caries was, on average, 21% for the rotational and 27% for the intraoral X-ray tube technique and for dentinal lesions 44% and 53%, respectively. When caries-free approximal surfaces were also included in the comparisons, the values for agreement were over 95%. It is concluded that panoramic and intraoral radiography perform equally well as diagnostic tools for the detection of periapical lesions, although the results are not identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Comparison of observer reliability in assessing alveolar bone height on direct digital and conventional radiographs.

OBJECTIVES: Radiographs are an important adjunct in the assessment of periodontal disease in clinical practice and research. The purpose of this study is to compare intraexaminer and interexaminer reproducibility in assessing alveolar bone height on direct digital and conventional radiographs. MATERIALS AND METHODS: Matched sets of conventional radiographs and digital radiographs were taken on 23 subjects. Bone levels were measured on radiographs as the distance from the cementoenamel junction to the alveolar crest in millimetres at the mesial and distal surfaces of all available teeth excluding third molars. Two examiners measured bone levels twice on each type of imaging system independent of one another. Correlations and paired t-test values were computed. RESULTS: Intraexaminer relative agreement (r-value) on both digital and conventional radiographs ranged from 0.73 to 0.98, P<0.05; however, differences between measurements (absolute agreement) for each examiner were non-significant, P>0.05. Interexaminer relative agreement on both digital and conventional radiographs ranged from 0.70 to 0.95, P<0.05, and measurement differences between the two examiners were also significant, P<0.05. One examiner tended to score higher measurements than the other, P<0.05. CONCLUSIONS: Alveolar bone measurements are reproducible on both digital and conventional radiographs. Intraexaminer reproducibility is superior to interexaminer reproducibility. Direct digital radiographs did not enhance examiner agreement over conventional radiographs.

Adolescent↗
PubMed2005

Survey of dental radiological practice in Turkey.

OBJECTIVES: The aim of this study was to determine the dentist's knowledge about dose reduction techniques, radiographic equipment and quality of dental radiographic service in general dental practice in Turkey. METHODS: The survey was performed on 636 dentists who attended the 11th International Congress organized by the Turkish Dental Association. Information on the demographic characteristics of the dentists, radiographic equipment, techniques and processing they used and radiation protection was obtained with a 32 point questionnaire. RESULTS: The respondents' knowledge concerning the technical details of their equipment was limited, with 512 (86.9%) not knowing the kilovoltage peak (kVp) of their machine. Only 34 (5.5%) respondents reported having rectangular collimators. The dentists had little knowledge about the speed of film they used. D-speed film was the most preferred one with 21.6%. Fifty-eight (10.2%) dentists used E-speed film and the F-speed film was used only by 13 (2.3%) dentists. The most preferred technique (62%) for periapical radiography was the bisecting angle technique. Four hundred and eighty five (82.5%) of the dentists reported that they took the radiographs by themselves. CONCLUSIONS: In the present study, the results indicate that for minimizing any unnecessary radiation, attempts should be made to improve dentists' knowledge about radiation dose reduction techniques.

Adult↗
PubMed2006

Comparison of simulated periodontal bone defect depth measured in digital radiographs in dedicated and non-dedicated software systems.

OBJECTIVES: To compare simulated periodontal bone defect depth measured in digital radiographs with dedicated and non-dedicated software systems and to compare the depth measurements from each program with the measurements in dry mandibles. METHODS: Forty periodontal bone defects were created at the proximal area of the first premolar in dry pig mandibles. Measurements of the defects were performed with a periodontal probe in the dry mandible. Periapical digital radiographs of the defects were recorded using the Schick sensor in a standardized exposure setting. All images were read using a Schick dedicated software system (CDR DICOM for Windows v.3.5), and three commonly available non-dedicated software systems (Vix Win 2000 v.1.2; Adobe Photoshop 7.0 and Image Tool 3.0). The defects were measured three times in each image and a consensus was reached among three examiners using the four software systems. The difference between the radiographic measurements was analysed using analysis of variance (ANOVA) and by comparing the measurements from each software system with the dry mandibles measurements using Student's t-test. RESULTS: The mean values of the bone defects measured in the radiographs were 5.07 mm, 5.06 mm, 5.01 mm and 5.11 mm for CDR Digital Image and Communication in Medicine (DICOM) for Windows, Vix Win, Adobe Photoshop, and Image Tool, respectively, and 6.67 mm for the dry mandible. The means of the measurements performed in the four software systems were not significantly different, ANOVA (P = 0.958). A significant underestimation of defect depth was obtained when we compared the mean depths from each software system with the dry mandible measurements (t-test; P approximately equal to 0.000). CONCLUSIONS: The periodontal bone defect measurements in dedicated and in three non-dedicated software systems were not significantly different, but they all underestimated the measurements when compared with the measurements obtained in the dry mandibles.

Alveolar Bone Loss↗
PubMed2003

Radiographic alveolar bone loss in untreated Taiwan Chinese subjects with adult periodontitis measured by the digital scanning radiographic image analysis method.

OBJECTIVES: To determine differences in radiographic alveolar bone loss (RABL) by age group, gender and tooth type in subjects with adult periodontitis using the digital scanning radiographic image analysis (DSRIA) method. METHODS: A total of 4262 teeth were examined for RABL in 178 individuals (96 males and 82 females). Mesial and distal sites were determined by the DSRIA method following scanning of periapical radiographs and using the Microstation 95 image software. RESULTS: Linear assessment of RABL using DSRIA revealed the following results. Mean bone loss of maxillary and mandibular anterior teeth was significantly higher (P<0.001 and P<0.01, respectively) in males compared with females using a two-sample t-test. The highest values of mean RABL occurred most commonly in the maxillary first molars (53.8% and 51.4% for females and males, respectively) and the mandibular central incisors (50.4% and 41.5% for males and females, respectively). Mean RABL was greater in males than in females for both the mandibular and maxillary arches, with the exception of molar sites. CONCLUSIONS: Maxillary first molars and mandibular incisors are the highest risk sites. Moreover, greater loss occurs at the molar site in females compared with males for untreated periodontitis in Taiwan Chinese people.

Adult↗
PubMed2003

Detection of caries with local CT.

OBJECTIVES: An in vitro observer study of the detection of interproximal caries by local CT. METHODS: Detection of caries by means of conventional two-dimensional (2D) digital radiography and by two CT modalities was compared. Ground truth was obtained from histological examination of the sectioned teeth. Twenty-three extracted teeth (46 surfaces) were placed in groups of six in two dry mandibles. The observers (n=10) scored the proximal surfaces for the presence of caries on a 1-5 confidence scale. Data analysis used analysis of variance (a General Linear Model). Observer and method were entered into the model as within-subject variables and lesion depth was entered as a between-subjects variable. RESULTS: The analysis showed observer, method and lesion depth effects as well as several interaction effects to be significant. Observers performed significantly better with the vertically reformatted CT slices than with conventional radiographs (P=0.025). Furthermore, there were significant differences between observers, and several interactions were found to be significant. This means that although the reformatted slices performed best overall, this performance differed significantly depending on observer and on lesion depth. CONCLUSIONS: Vertically reformatted CT slices obtained with local CT performed significantly better than conventional 2D digital radiographs in visually detecting caries. Axial slices did not perform better than conventional radiographs. When vertically reformatted slices are used, local CT is a promising tool for the detection of interproximal caries.

Analysis of Variance↗
PubMed2003

Radiographic assessment of the marginal bone level after implant treatment: a comparison of periapical and Scanora detailed narrow beam radiography.

OBJECTIVES: To compare assessments of the marginal bone level around dental implants in the mandible using periapical radiography and Scanora detailed narrow beam (DNB) radiography. METHODS: Forty patients treated with Brnemark dental implants in the lower jaw were examined with periapical and Scanora DNB radiography. Ten implants were selected from each of the four dental regions (molar, incisor, canine, premolar), and no more than one implant was selected from the same patient. Seven observers assessed the level of the marginal bone on the mesial and distal surfaces of the implants. Three of the observers made all the assessments twice. RESULTS: Agreement between the methods was 61%. The highest agreement was found in the molar region. In DNB radiography the marginal bone level was observed to be situated more "coronally" in 17% and more "apically" in 22% compared with periapical radiography. The kappa value for interobserver agreement for all observers was 0.33 for periapical radiography and 0.27 for DNB radiography. The weighted kappa value for intraobserver agreement ranged from 0.75 to 0.99 for DNB radiography and from 0.94 to 0.98 for periapical radiography. CONCLUSIONS: Scanora multimodal radiography simplifies examination of implants in the mandible, and observer variation is comparable with that in intraoral periapical radiography.

Aged↗
PubMed2005

An overview of radiographic film holders.

OBJECTIVES: To provide an overview of radiographic film holders, from their inception in the early 1900s to present day. METHODS: A Medline literature search was conducted for dental studies that used keywords that pertain to radiographic film holders. Hand searches of the bibliographies were also conducted. Sixty articles (dating from 1896 to 1998) that describe new or improved film holders are reviewed here. RESULTS: From the earliest days of dental radiography, dentists attempted to standardize radiographic images and techniques. The focus of researchers in the 1950s to the 1970s was to develop a film holder that would hold the film and allow easy and predictable alignment of the X-ray tube. As research projects became more dependent on dental radiographic measurements, the focus shifted to producing reproducible radiographic images, from which highly repeatable measurements could be made. CONCLUSION: Existing devices have strengths and weaknesses. Readily available devices are adequate for routine clinical use; however, user-friendly and patient-friendly film-holding devices that result in highly reliable and accurate measurements have yet to be introduced.

Copying Processes↗
PubMed2002

The use of computerized tomography for diagnosis and treatment planning in implant dentistry.

Preoperative radiographic imaging of recipient sites for implant placement is imperative to obtain a functional and aesthetic implant-supported prosthesis. Although conventional radiographic techniques have inherent problems that restrict accurate imaging, the main drawback of panoramic and periapical radiography is the two-dimensional image. Computerized tomography provides cross-sectional radiographic images that facilitate proper assessment of potential recipient sites for implant placement. This paper reviews the role of computerized tomography in implant dentistry.

Anatomy, Cross-Sectional↗
PubMed2006

Clinical, radiographic, biochemical and histological findings of florid cemento-osseous dysplasia and report of a case.

Florid cemento-osseous dysplasia has been described as a condition that characteristically affects the jaws of middle-aged black women. It usually manifests as multiple radiopaque cementum-like masses distributed throughout the jaws. This condition has also been classified as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerosing osteitis, multiple estenosis and sclerotic cemental masses. The authors present a case of an uncomplicated florid cemento-osseous dysplasia in a 48-year-old black woman. Multiple sclerotic masses with radiolucent border in the mandible were identified radiographically. Histopathologic findings revealed formation of calcified dense sclerotic masses similar to cementum. All clinical, radiographic, biochemical and histological features were suggestive of the diagnosis of florid cemento-osseous dysplasia.

Cementoma↗
PubMed2000

Avulsion of posterior primary teeth and space maintaining appliance: case report.

A four-year-old child was presented to the Pediatric Dentistry Clinic of the Federal University, 21 days after an incident in which canine first and second primary molar teeth were avulsed, due to a trauma to the face. This was confirmed on radiological examination. The clinical examinations showed that tissues were normal. A removable space-maintaining dental-mucosa supported appliance was made in acrylic resin to replace the three missing teeth. After a period of eight months, the tissues were preserved, the device is helping the child to eat, to speak, and preserving the appearance of the patient. Radiograph examinations have shown that the first molar tooth and canine, first pre molar and second pre molar teeth are erupting normally. Trauma in primary dentition can cause psychological, morphological and functional problems. In the presented case the treatment was planned to recuperate the function and to avoid problems from the premature loss of primary teeth.

Acrylic Resins↗
PubMed2001

Intraoral craniofacial manipulation by using MRI appliance.

This case illustrates the use of the Maxillary-Rotation-Impaction Appliance (MRI) to rotate and impact the maxilla. When this maneuver was completed the transverse expansion screw widened the maxillary arch. The case was completed using fixed orthodontic appliances. The result is that the facial bones appear in the correct position and the teeth are correctly positioned in the face with a class I occlusion.

Cephalometry↗
PubMed2000

Comparison of morphological measurements extracted from digitized dental radiographs with lumbar and femoral bone mineral density measurements in postmenopausal women.

BACKGROUND: We set out to determine whether morphologic measurements extracted from digitized images of bite-wing radiographs correlated with lumbar and femoral bone mineral density (BMD) measurements in 45 postmenopausal women who had no or only mild periodontal disease (no probing depths >5 mm). METHODS: Lumbar spine and femoral BMDs were determined by dual-energy x-ray absorptiometry. Vertical bite-wing radiographs were taken and digitized. Crestal and apical regions of interest (ROIs) were drawn on the digital images of the maxillary and mandibular alveolar bone on the patient's right and left sides. For each patient, a single morphologic measurement was made for each of 8 ROIs. Correlation analysis was performed to determine the strengths of the relationships between the morphologic measurements made at the 8 locations and between these morphologic measurements and BMD measurements. RESULTS: The correlations (r) between the morphologic operator (MO) measurements and lumbar spine and femoral BMDs were weak (mean r = 0.02, range = 0.32 to -0.26) and not statistically significant, with no clear trends discernible. Correlations between MO measurements made at the 8 alveolar sites were also weak (mean r = 0.05, range = 0.35 to -0.38) and not statistically significant. CONCLUSIONS: The MO measurements used in this study were weakly correlated with lumbar spine and femoral BMDs, with no clear trends discernible in this population of postmenopausal women with no or mild periodontal disease.

Absorptiometry, Photon↗