Imaging modalities to inform the detection and diagnosis of early caries.

BACKGROUND: The detection and diagnosis of caries at the earliest opportunity is fundamental to the preservation of tooth tissue and maintenance of oral health. Radiographs have traditionally been used to supplement the conventional visual-tactile clinical examination. Accurate, timely detection and diagnosis of early signs of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES: To determine the diagnostic accuracy of different dental imaging methods to inform the detection and diagnosis of non-cavitated enamel only coronal dental caries. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared a dental imaging method with a reference standard (histology, excavation, enhanced visual examination), studies that evaluated the diagnostic accuracy of single index tests, and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were eligible for inclusion. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. Comparative accuracy of different radiograph methods was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS: We included 104 datasets from 77 studies reporting a total of 15,518 tooth sites or surfaces. The most frequently reported imaging methods were analogue radiographs (55 datasets from 51 studies) and digital radiographs (42 datasets from 40 studies) followed by cone beam computed tomography (CBCT) (7 datasets from 7 studies). Only 17 studies were of an in vivo study design, carried out in a clinical setting. No studies were considered to be at low risk of bias across all four domains but 16 studies were judged to have low concern for applicability across all domains. The patient selection domain had the largest number of studies judged to be at high risk of bias (43 studies); the index test, reference standard, and flow and timing domains were judged to be at high risk of bias in 30, 12, and 7 studies respectively. Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies, with sensitivities that ranged from 0 to 0.96 and specificities from 0 to 1.00. For all imaging methods the estimated summary sensitivity and specificity point was 0.47 (95% confidence interval (CI) 0.40 to 0.53) and 0.88 (95% CI 0.84 to 0.92), respectively. In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 63%, this would result in 337 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 43 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). Meta-regression indicated that measures of accuracy differed according to the imaging method (Chi2(4) = 32.44, P < 0.001), with the highest sensitivity observed for CBCT, and the highest specificity observed for analogue radiographs. None of the specified potential sources of heterogeneity were able to explain the variability in results. No studies included restored teeth in their sample or reported the inclusion of sealants. We rated the certainty of the evidence as low for sensitivity and specificity and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and the observed inconsistency of the results. AUTHORS' CONCLUSIONS: The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Low-certainty evidence suggests that imaging for the detection or diagnosis of early caries may have poor sensitivity but acceptable specificity, resulting in a relatively high number of false-negative results with the potential for early disease to progress. If left untreated, the opportunity to provide professional or self-care practices to arrest or reverse early caries lesions will be missed. The specificity of lesion detection is however relatively high, and one could argue that initiation of non-invasive management (such as the use of topical fluoride), is probably of low risk. CBCT showed superior sensitivity to analogue or digital radiographs but has very limited applicability to the general dental practitioner. However, given the high-radiation dose, and potential for caries-like artefacts from existing restorations, its use cannot be justified in routine caries detection. Nonetheless, if early incidental carious lesions are detected in CBCT scans taken for other purposes, these should be reported. CBCT has the potential to be used as a reference standard in diagnostic studies of this type. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Future research should evaluate the comparative accuracy of different methods, be undertaken in a clinical setting, and focus on minimising bias arising from the use of imperfect reference standards in clinical studies.

Morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces.

PURPOSE: The prolonged change in the head posture alters the morphological characteristics of cervical vertebrae. The difference in the head posture among subjects with short, normal, and long anterior facial heights might have a significant influence on the morphological characteristics of cervical vertebrae. Thus, the present study was conducted to evaluate the morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces. METHODS: Based on Frankfort mandibular plane angle (FMA) on lateral cephalograms, 135 subjects were equally divided into three groups, i.e. Group I [Short face], II [Normal face], and III [Long face]. The angular variables like Atlas-dens angle (ADA), Pars interarticularis-dens angle (PDA), Pars interarticularis-vertebrae angle of C3 vertebrae (PVA3), Pars interarticularis-vertebrae angle of C4 vertebrae (PVA4), Lamina-Pars interarticularis angle of C2 vertebrae (LP2), Lamina-Pars interarticularis angle of C3 vertebrae (LP3), and Lamina-Pars interarticularis angle of C4 vertebrae (LP4) in the first four cervical vertebrae were measured, analyzed, and compared. Descriptive statistics, analysis of variance, Bonferroni, and Pearson's correlation coefficient tests were used. The P value of 0.05 was considered as the level of significance. RESULTS: All parameters except PDA and PVA3 were comparable among the groups. The PDA was 54.350 ± 1.870, 57.890 ± 1.550, and 60.290 ± 2.830 in Group I, II, and III, respectively; these differences were statistically significant [P < 0.001]. The PVA3 was 42.700 ± 5.640 in Group I, 45.850 ± 3.820 in Group II, and 45.590 ± 5.530 in Group III subjects that were also statistically significant [P < 0.01]. A fairly strong positive correlation was observed between FMA and PDA. CONCLUSION: A significant difference was found in the PDA among subjects with short, normal, and long faces. The vertical height of the face had a strong correlation with the morphology of axis vertebra.

[Frequency and doses of diagnostic and interventional X­ray applications : Trends between 2007 and 2014]. / Häufigkeit und Dosis diagnostischer und interventioneller Röntgenanwendungen : Trends zwischen 2007 und 2014.

BACKGROUND: In Germany, approximately 95% of man-made radiation exposure of the population results from diagnostic and interventional X­ray procedures. Thus, radiation protection of patients in this field of application is of great importance. OBJECTIVE: Quantification and evaluation of current data on the frequency and doses of X­ray procedures as well as temporal trends for the years 2007-2014. MATERIAL AND METHODS: For outpatients the frequency of X­ray procedures was estimated using reimbursement data from health insurances and for inpatients by means of hospital statistics. For the years under review, representative values for the effective dose per X­ray application were determined mainly from data reported by X­ray departments to the competent authorities. RESULTS: In 2014 approximately 140 million X­ray procedures were performed in Germany with some 40% from dental examinations. On average 1.7 procedures per inhabitant and year were almost constantly carried out between 2007 and 2014. Besides dental diagnostics, X­ray examinations of the skeleton and thorax were performed most frequently. The number of computed tomography (CT) examinations increased by approximately 40%. The increase in magnetic resonance imaging (MRI) was even more pronounced with approximately 55% but overall CT examinations were still performed more often than MRI. The doses per X­ray procedure were only slightly reduced, despite the various dose reduction approaches established in recent years; therefore, the mean effective dose per inhabitant increased from approximately 1.4 mSv in 2007 to 1.6 mSv in 2014, mainly due to the increasing frequency of CT examinations. CONCLUSION: The principles of justification and optimization of radiological procedures are to be consistently applied in each individual instance, especially in the case of CT examinations.

[Evaluation of dental X-ray apparatus in terms of patient exposure to ionizing radiation]. / Ocena rentgenowskich aparatów stomatologicznych pod katem narazenia pacjentów na promieniowanie jonizujace.

BACKGROUND: The use of X-ray in dental procedures causes exposure of the patient to ionizing radiation. This exposure depends primarily on the parameters used in tooth examination. The aim of the study was to determine the patients exposure and to assess the technical condition of X-ray tubes. MATERIAL AND METHODS: Seventeen hundred dental offices were covered by the questionnaire survey and 740 questionnaires were sent back. Direct measurements were performed in 100 units by using the thermoluminescent detectors and X-ray films. RESULTS: The results showed that the most commonly used exposure time is 0.22±0.16 s. The average entrance dose for the parameters used most commonly by dentists is 1.7±1.4 mGy. The average efficiency of X-ray tube estimated on the basis of exposures is 46.5±23.7 µGy/mAs. CONCLUSIONS: The study results indicate that the vast majority of X-ray tubes meet the requirements specified in the binding regulations. Med Pr 2017;67(4):491-496.

Oral Health Status of Patients Undergoing Treatment for Head and Neck Oncology in Northern Ireland.

This study aimed to collect data on the oral health status of patients undergoing treatment for head and neck oncology across Northern Ireland. Data were collected on all patients referred to the Northern Ireland Multidisciplinary Head and Neck Oncology Team for discussion and treatment planning. Each patient underwent pre-treatment dental assessment in the Centre for Dentistry, Queen's University Belfast, between June 2013 and November 2014. Data were collected from clinical oral examinations supplemented with intra-oral radiographs. During the course of the study 96 patients were assessed and the levels of dental disease observed in this cohort were high. On clinical examination 43% were diagnosed with caries and 46% with periodontal disease. Ten patients were completely edentate. The disease profile of this patient group presents significant challenges to dental services tasked with rendering patients dentally fit prior to undergoing oncology treatment.

Appropriate use of ionizing radiation in orthodontic practice and research.

Ionizing radiation revolutionized medicine and dentistry in the past century. It has well-documented benefits in orthodontics, and these benefits outweigh the risks. Three-dimensional cone-beam computed tomography produces images that contain significantly more information than do traditional radiographs but generally exposes patients to more radiation. A group of pediatric radiologists initiated the Image Gently Campaign to raise awareness of the need to adjust the radiation dose when imaging children. The key principles of this campaign are justification, optimization, and dose limits. Orthodontists should adhere to the directive to keep radiation "as low as reasonably achievable." Prescribing radiographic imaging is specific to each orthodontic patient and requires judicious clinical judgment to maximize the benefits and minimize the harm.

Detection of radiolucencies around endodontically treated teeth on routine CT scans.

PURPOSE: This retrospective study compared computed tomography (CT) imaging to routine dental periapical radiographs in diagnosing radiolucencies around endodontically treated teeth. MATERIALS AND METHODS: Of the 244 CT scans evaluated, 104 had no teeth on the scan. On the remaining 140 scans, 353 teeth fell into the following categories: 59 maxillary molars, 30 mandibular molars, 66 maxillary premolars, 56 mandibular premolars, and 141 anterior teeth. Positive and negative predictive values were calculated, as were sensitivity, specificity, and prevalence assuming the CT scan was the test standard. RESULTS: For the total tooth population periapical radiograph - CT slice sensitivity was 52, specificity was 90, the positive predictive value (PPV) was 97, the negative predictive value (NPV) was 25, and the prevalence 85. CONCLUSION: In the population studied, the CT scan had a greater ability to show radiolucencies that were not evident on periapical radiographs.

Lack of Correlation between Benign Brain Tumors and Markers of Oral Health.

UNLABELLED: Case control studies implicating dental X-rays in the genesis of intracranial meningiomas have yielded conflicting results. To further evaluate what risk, if any, that intracranial meningioma might be associated with dental X-rays, we examined the association of benign brain tumor incidence with the number of dentists and other correlates of oral health in U.S. states and the District of Columbia. We compared these correlations to the association of the same markers of oral health with Alzheimer's death rates. Poor oral health, especially periodontal disease, is a well-established risk factor for dementia. RESULTS: Pearson correlations, number of cases (49, no data from Kansas or Maryland) and significance (2 tailed p values) of benign brain tumor incidence and parameters of oral health are presented. None of the correlations approached statistical significance. In contrast, Alzheimer's deaths by state were negatively correlated with number of dentists and other markers of oral health. CONCLUSION: Our finding of a total lack of correlation between benign brain tumors and markers of oral health and, by implication, dental X-rays, suggests there may be no relationship between dental X-rays and meningioma or other benign brain tumors. This conclusion is strengthened by our demonstration of the known negative correlation between Alzheimer's and dental care.

[Indications for and frequency of intraoral radiographs]. / Indicatie voor en frequentie van intraorale röntgenopnamen.

Radiographs are essential in dental practice today. Due to the exposure of patients to X-rays every radiograph has to be justified. The advantages and disadvantages of risks and diagnostic rewards have to be weighed against one another whenever X-ray imaging is considered. An important factor in this respect is the usefulness (in terms of sensitivity and specificity) of a radiograph and along with that, the monitoring of the quality of the entire process, from positioning the photo up to and including the development or scanning of it. Both for children and adults the indication for taking radiographs must be made on an individual basis. The most important considerations are: caries experience, oral hygiene and nutritional habits and exposure to fluorides. Based on these factors an individual risk assessment can be made and the possible benefit of bitewing radiographs for the dental treatment can be determined. European guidelines give advice on the indications and frequency of radiographs in, among other fields, periodontology, endodontology and implantology.

Artifact-resistant superimposition of digital dental models and cone-beam computed tomography images.

PURPOSE: Combining the maxillofacial cone-beam computed tomography (CBCT) model with its corresponding digital dental model enables an integrated 3-dimensional (3D) representation of skeletal structures, teeth, and occlusions. Undesired artifacts, however, introduce difficulties in the superimposition of both models. We have proposed an artifact-resistant surface-based registration method that is robust and clinically applicable and that does not require markers. MATERIALS AND METHODS: A CBCT bone model and a laser-scanned dental model obtained from the same patient were used in developing the method and examining the accuracy of the superimposition. Our method included 4 phases. The first phase was to segment the maxilla from the mandible in the CBCT model. The second phase was to conduct an initial registration to bring the digital dental model and the maxilla and mandible sufficiently close to each other. Third, we manually selected at least 3 corresponding regions on both models by smearing patches on the 3D surfaces. The last phase was to superimpose the digital dental model into the maxillofacial model. Each superimposition process was performed twice by 2 operators with the same object to investigate the intra- and interoperator differences. All collected objects were divided into 3 groups with various degrees of artifacts: artifact-free, critical artifacts, and severe artifacts. The mean errors and root-mean-square (RMS) errors were used to evaluate the accuracy of the superimposition results. Repeated measures analysis of variance and the Wilcoxon rank sum test were used to calculate the intraoperator reproducibility and interoperator reliability. RESULTS: Twenty-four maxilla and mandible objects for evaluation were obtained from 14 patients. The experimental results showed that the mean errors between the 2 original models in the residing fused model ranged from 0.10 to 0.43 mm and that the RMS errors ranged from 0.13 to 0.53 mm. These data were consistent with previously used methods and were clinically acceptable. All measurements of the proposed study exhibited desirable intraoperator reproducibility and interoperator reliability. Regarding the intra- and interoperator mean errors and RMS errors in the nonartifact or critical artifact group, no significant difference between the repeated trials or between operators (P < .05) was observed. CONCLUSIONS: The results of the present study have shown that the proposed regional surface-based registration can robustly and accurately superimpose a digital dental model into its corresponding CBCT model.

The use of radiography and the apex locator in endodontic treatment within the UK: a comparison between endodontic specialists and general dental practitioners.

AIM: To investigate the attitudes of general dental practitioners (GDPs) and specialist endodontists working in the UK in the use of radiography and apex locators during root canal treatment and to see if use was related to respondent's age and the year of graduation. METHODOLOGY: A postal questionnaire was sent to 857 randomly selected GDPs and all endodontic specialists working in the UK (170). Non-responders were sent a further two mailings. Chi-squared tests were used to compare both groups at the P < 0.05 level of significance. For nonparametric data, the Mann-Whitney U test was employed. RESULTS: The overall response rate was 73%. There were significant differences between endodontic specialists and GDPs in the prescription of the preoperative, the cone-fit and the postoperative radiograph. A total of 114 (86.4%) endodontic specialists and 321 (53.2%) GDPs reported using an apex locator (P < 0.001). Eighty-eight (66.7%) endodontists and 217 (36%) GDPs used an apex locator and a radiograph to determine the working length for a single-rooted tooth (P < 0.001). For multi-rooted teeth, 91 (68.9%) endodontists and 229 (38%) GDPs used a combined approach of an electronic apex locator and a working-length radiograph (P < 0.001). One-millimetre short of the radiographic apex was employed by 56.2% of respondents as the apical limit. There were significant differences (P < 0.001) between the two groups with regard to routine radiographic follow-up. CONCLUSIONS: Both endodontists and GDPs were found to be observing national guidelines when performing root canal treatment. Greater use of apex locators was found amongst endodontists who tended to use a combined approach of an apex locator and periapical radiography.

Detection of experimentally induced root fractures on digital and conventional radiographs: an in vitro study.

This study compared the diagnostic accuracy of digital radiographic images with conventional radiographs for the detection of experimentally induced root fractures. Horizontal fractures were induced by a mechanical force to the root of 15 single rooted teeth. Vertical fractures were induced in 15 single rooted teeth and 15 molars, respectively, by disk cutting. The teeth were mounted in dried mandibles and were radiographed with the parallel technique using a CCD-based Planmeca imaging system and F-speed films. Seven observers recorded their findings and then 2 pairs of them examined the same images together. Az values expressed the diagnostic accuracy of the imaging systems and the degree of agreement was estimated using the Cohen's kappa statistic. The areas under the ROC curves (Az) in single rooted teeth were 0.61 for conventional radiography and 0.64 for digital radiography. Digital imaging system did not perform significantly better than conventional one (p > 0.01). Digital radiographs (Az: 0.72) provided higher detection accuracy in molars than conventional images (Az: 0.51) (p = 0.0102). The digital images scored higher kappa values with narrower range than conventional. Observers in pairs did not perform significantly better than individually. The results were not affected by the observers but were affected by the cases (p < 0.001). Digital images were equivalent to F-speed films for the detection of root fractures in single rooted teeth. The digital system performed significantly better than the conventional in detecting root fractures in molars.

Detection of vertical root fractures by conventional radiographic examination and cone beam computed tomography - an in vitro analysis.

OBJECTIVES: This study compared the ability of conventional radiographic and cone beam computed tomography (CBCT) examinations to detect vertical root fractures (VRF) in teeth with or without root canal treatment and metallic posts. Furthermore, the influence of using different voxel sizes from CBCT images was assessed. METHODOLOGY: Sixty single-rooted human teeth were randomly divided into two groups: experimental and control. Twenty teeth were endodontically prepared and obturated with gutta-percha, twenty had a metallic postcemented after the filling, and twenty had no preparation. The teeth from the experimental group were fractured. All teeth were radiographed with three different horizontal angles, and after, CBCT images were acquired following three protocols in which the variation was the voxel resolution (0.4, 0.3, and 0.2 mm). Three calibrated examiners assessed the images. RESULTS: Chi-squared test showed no statistical difference among the images in detecting VRFs. The results of the diagnostic performance tests presented similar ability to detect VRFs when conventional radiographic examination was compared with 0.2 and 0.3-voxel CBCTs scans, in roots without endodontic treatment and metallic post. Moreover, specificity, sensitivity, and accuracy findings were similar for both 0.2 and 0.3-voxel resolution scans for teeth that are not root filled. However, it was observed that in teeth with root canal treatment and a post, the accuracy was higher when 0.2-mm voxel resolution was used. CONCLUSION: The radiographic examination with horizontal angle variation should be encouraged as the first complementary approach to assess the presence of VRFs. If conventional imaging is not capable to provide adequate information, CBCT can be indicated if a root fracture is strongly suspected. The root condition should then guide the voxel resolution choice, selecting 0.3-voxel for not root filled teeth and 0.2-voxel for teeth with filling and/or a post.

Dental radiography in New Zealand: digital versus film.

UNLABELLED: Digital x-ray systems offer advantages over conventional film systems, yet many dentists have not adopted digital technology. OBJECTIVES: To assess New Zealand dental practitioners' use of--and preferences for--dental radiography systems. DESIGN: Cross-sectional survey. SETTING: General and specialist dental practice. PARTICIPANTS AND METHODS: Postal questionnaire survey of a sample of 770 dentists (520 randomly selected general dental practitioners and all 250 specialists) listed in the 2012 NZ Dental Council Register. MAIN OUTCOME MEASURES: Type of radiography systems used by dentists. Dentists' experiences and opinions of conventional film and digital radiography. RESULTS: The participation rate was 55.2%. Digital radiography systems were used by 58.0% of participating dentists, most commonly among those aged 31-40 years. Users of digital radiography tended to report greater satisfaction with their radiography systems than users conventional films. Two-thirds of film users were interested in switching to digital radiography in the near future. Reasons given by conventional film users for not using digital radiography included cost, difficulty in integrating with other software systems, concern about potential technical errors, and the size and nature of the intra-oral sensors. CONCLUSION: Many dental practitioners have still not adopted digital radiography, yet its users are more satisfied with their radiography systems than are conventional film users. The latter may find changing to a digital system to be satisfying and rewarding.

Responsible use of cone beam computed tomography: minimising medico-legal risks.

This communication highlights some of the ethical and possible legal responsibilities which pertain to the taking, reading, reporting, and communication of findings from cone-beam computed tomography (CBCT) scans. The importance of knowledge of head and neck anatomy and pathology to reduce the likelihood of incorrect interpretation is emphasised. Failure to detect critical findings in any diagnostic image can potentially result in medico-legal consequences. CBCT is no exception to this rule. Dental schools are advised to include CBCT imaging as a diagnostic tool in their under- and postgraduate curricula thereby equipping graduates to use 3D imaging in general and CBCT in particular. Existing dental practitioners are advised to seek continuing education on 3D imaging as part of their required lifelong learning.

A comparative study of three imaging modalities currently used in the assessment of patients for maxillofacial surgery.

UNLABELLED: Diagnostic imaging is pivotal in clinical maxillofacial evaluation. This study evaluated and compared the use of conventional radiographs (CR) with two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) in patients requiring maxillofacial surgery. Pre-surgical records of sixty five patients who had undergone routine CR, 2D CT and 3D CT were selected and classified into the categories of traumatic injury, pathology and deformities. The accuracy of image analysis, diagnosis and treatment planning were scored and the data statistically analysed. 2D CT scanning was more effective diagnostically and is preferred for cases of traumatic injury (44%, SD=0.54, p>0.05) and pathology (34%, SD=0.47, p>0.05) whilst 3D CT imaging was indicated for the deformity category (22%, SD=0.58, p>0.05). Linear comparisons between radiographic modalities within each clinical group revealed significant differences (p<0.05). Multiplanar reformatted (MPR) 2D cross sectional CT views offered additional imaging information. CONCLUSION: 2D CT scanning is an excellent imaging modality for the majority of craniomaxillofacial surgical cases. 3D CT scanning is also recommended for cases of trauma and pathology. Both 2D CT and 3D CT scanning are vital in craniomaxillofacial deformities and reconstructive surgery.

The dose received by patients during dental X-ray examination and the technical condition of radiological equipment.

BACKGROUND: Implementation of X-ray dental examination is associated with the patients exposure to ionizing radation. The size of the exposure depends on the type of medical procedure, the technical condition of the X-ray unit and selected exposure conditions. The aim of this study was to determine the dose received by patients during dental X-ray examination and the assessment of the technical condition of medical equipment, MATERIALS AND METHODS: The study included a total number of 79 dental X-ray units located in the region of Mazovia. The test methods for the assessment of the technical condition of dental X-ray units and measurement of radiation dose received by patients were based on the procedures elaborated in the Department of Radiation Hygiene and Radiobiology in the National Institute of Public Health - National Institute of Hygiene (Warszawa, Poland) accredited for the certification of compliance with PN-EN 17025. RESULTS: The research found that 69.6% fully meets the criteria set out in the Polish legislation regarding the safe use of ionizing radiation in medicine, while 30.4% did not meet some of them. A tenfold difference in the size of the dose received by patients during dental X-ray examinations was discovered. For example, during a radiography of the canine teeth of a child, the recorded entrance surface dose (ESD) ranged from 72.8 to 2430 microGy with the average value of 689.1 microGy. Cases where the dose reference level defined in Polish legislation of 5 mGy was exceeded were also found. CONCKUSIONS: It is essential to constantly monitor the situation regarding the technical condition of X-ray units which affects the size of the population's exposure to ionizing radiation as well as raising dentists' awareness about the effects of X-rays on the human body.

Comparative study of cone beam computed tomography and intraoral periapical radiographs in diagnosis of lingual-simulated external root resorptions.

BACKGROUND: Owing to a lack of symptoms and difficult visualization in routine intraoral radiographs, diagnosis of external root resorptions can be challenging. AIM: The goal of this study was to compare two image acquisition methods, intraoral radiographs and cone beam computed tomography (CBCT), in the diagnosis of external resorption. MATERIAL AND METHODS: Thirty-four maxillary and mandibular bicuspids were divided into three groups. Perforations measuring 0.3 and 0.6 mm in diameter and 0.15 and 0.3 mm in depth, respectively, were made on the lingual root surfaces in thirty teeth, and four were used as controls. Next, teeth were mounted on an apparatus and radiographed at mesial, distal, and orthoradial angulations. CBCT images were also taken. The analysis of the intraoral radiographic and tomographic images was carried out by two experts using standardized scores. Data were then compared statistically. RESULTS: A strong agreement between the examiners was observed in both diagnosis methods, the intraoral radiographic (r = 0.93) and the tomographic analysis (r = 1.0). Tomography had higher statistically significant detection values than intraoral radiography (P < 0.05). In intraoral radiographs, the detection was significantly greater (P < 0.05) in the mandibular bicuspids, compared with their maxillary counterparts. The ability to detect 0.6-mm perforations by intraoral radiography was significantly higher than that of 0.3-mm perforations (P < 0.05). CONCLUSION: Cone beam computed tomography showed better diagnostic ability compared with intraoral radiography, regardless of the tooth or the dimensions of the resorption evaluated.

Orthognathic surgery--postoperative clinical and radiographic follow-up routines at Swedish oral and maxillofacial surgery departments.

Orthognathic surgery is a frequent procedure at Swedish Oral and Maxillofacial Surgery Departments.The number of clinical and radiographic postoperative follow-up examinations and the choice of radiographic methods seem to vary.The intention with this study was to find out when postoperative clinical and radiographic follow-up was performed following orthognathic surgery and the type of radiographic examinations that were used. In 2009, all Swedish Oral and Maxillofacial Surgery Departments in the Public Health Service (25 centres) were given a form containing standardized questions on the time for clinical follow-up after orthognathic surgery and the radiographic examinations used. A pilot study on 49 consecutive patients at one of the centres was performed to determine if the postoperative radiographic examinations added additional information, leading to further procedures compared to the clinical observations only. A one-year follow-up was the most frequently used clinical control reported by 15 centres, and a six-month follow-up, the next most frequent. At 14 of the 15 centres, radiographic examinations were included at the one-year follow-up. A five-year clinical and radiographic follow-up was reported by two centres. One or, at the most, two postoperative radiographic follow-up sessions were reported by 68% of the centres. Profile and panoramic imaging were most often used. In the evaluation of the postoperative handling of the 49 consecutive patients in the pilot study, a radiolucency around a fixation screw noted radiographically was the only additional postoperative radiological finding that resulted in a surgical procedure. Postoperative clinical and radiographic follow-up routines following orthognathic surgery vary considerably between the Swedish Oral and Maxillofacial Surgery Departments.There appears to be a need for studies on the value of the information,which repeated postoperative clinical and radiographic follow-up controls add in routine medical attendance.

Correlation of dental maturity with skeletal maturity from radiographic assessment: a review.

There have been many attempts to correlate dental development with skeletal growth. The relationship is generally considered to be moderate at best. However, there is evidence that hand-wrist radiographic interpretation of remaining growth can be augmented by taking into account the developing dentition. In addition, the practicality of evaluating routine dental radiographs and avoiding additional radiation is advantageous. To this point, no system has been described to match apical development by Demirjian's stages and compare it to skeletal development and remaining growth. This study reviewed articles pertinent to the relationship between developing teeth and skeletal maturity and remaining growth, and a system is proposed to give practitioners an additional assessment for growth and development.