Simulation of three intraoral radiographic techniques in pediatric dental patients: subjective comfort assessment using the VAS and Wong-Baker FACES Pain Raiting Scale.

BACKGROUND: Perception of pain associated with intraoral radiography in pediatric patients was evaluated through statistical comparisons of data obtained using the Wong-Baker FACES Pain Raiting Scale (WBFPRS) and visual analog scale (VAS) scoring. METHODS: A total of 75 pediatric patients aged 6-12 years were included in this study. Simulations of each of three radiological methods (analog films, CCD sensor and phosphorus plates) were performed on 25 pediatric patients. Following the simulations, the meaning of each facial expression on the WBFPRS and the numbers on the VAS were explained to each child. For the comparison between groups, the homogeneity of the variances was tested with Levene's test; because the variances were not homogeneous, Welch's test was used. Tamhane's T2 test was used because the homogeneity assumption was not provided to determine the source of the difference between the groups. RESULTS: When the conventional method was compared to the PSPL (photostimulable phosphor luminescence) method, no significant differences were noted in either the WBFPRS or VAS results (p >0.05). The results obtained from both of the scales were significantly different between the conventional method and the CCD sensor method (p < 0.05). When the PSPL and CCD sensors were compared, a significant difference was observed for the WBFPRS (p < 0.05). It was found the highest level of pain scores when used the CCD sensor method than the analog film and PSPL methods (p < 0.05). CONCLUSIONS: It is expected that digital radiographic techniques will be improved in the future and that their disadvantages will be eliminated, resulting in imaging devices that are more comfortable for pediatric patients.

Distortion and magnification of four digital cephalometric units.

OBJECTIVES: To assess the validity of using the calibration ruler for correcting magnification of linear measurements and to explore and compare the vertical and horizontal magnification of four digital cephalometric units. METHODS: An acrylic box was imaged at seven sagittal positions using four digital cephalometric units: Orthopantomograph OC100, Orthopantomograph OC200, Sirona Orthophos CD, and Sirona Orthophos DS. The true linear lengths of the phantom, corrected, and uncorrected linear lengths on the images were measured and compared. The validity of measurements using the calibration ruler was assessed. The magnification values and distortion indices were calculated and compared among the four cephalometric units. RESULTS: For linear measurements on the mid-sagittal plane and averaged linear measurements on bilateral symmetric sagittal planes, the bias 1.96 STD of the calibration ruler ranged from 1% to 2% for the four cephalometric testing units. For linear measurements on the single lateral sagittal plane, the bias 1.96 STD ranged from 3% to 6%. The vertical scanning charge-coupled device cephalometric unit produced the greatest distortion, ranging from 1.029 to 0.964. CONCLUSION: The metal millimeter calibration ruler is an accurate reference for linear measurement magnification correction. Because of unpredictability and machine specificity, the magnification and distortion of a cephalometric unit should be calibrated for the estimation of cephalometric measurement error.

Microbial contamination in intraoral phosphor storage plates: the dilemma.

OBJECTIVES: The aims of this study were to evaluate microbial contamination in phosphor storage plates in dental radiology services and discuss the possible origin of this contamination. MATERIALS AND METHODS: The sample comprised 50 phosphor plates: 14 plates from service A, 30 from service B, and 6 in the control group, consisting of plates never used. Damp sterile swabs were rubbed on the phosphor plates, and then transferred to tests tubes containing sterile saline solution. Serial dilutions were made, and then inoculated in triplicate on Mueller Hinton agar plates and incubated at 37 °C/48 h, before counting the colony-forming units (CFU). The samples were also seeded in brain-heart infusion medium to confirm contamination by turbidity of the culture medium. All solutions, turbid and clean, were seeded in selective and non-selective media. RESULTS: At service A and B, 50 and 73.3 % of the phosphor plates were contaminated, respectively. This contamination was mainly due to bacteria of the genus Staphylococcus. CFU counts ranged from 26.4 to 80.0 CFU/plate. CONCLUSIONS: Most of the phosphor plates evaluated shown to be contaminated, mainly by Staphylococcus ssp. Quantitatively, this contamination occurred at low levels, possibly arising from handling of the plates. The use of a second plastic barrier may have diminished contamination by microorganisms from the oral cavity. CLINICAL RELEVANCE: There is a risk of cross-contamination by phosphor storage plates used in dental radiology services.

RadioVisioGraphy: A Simplified Nasal Bone Radiographic Imaging Tool.

Nasal fractures account for approximately 50% of all facial fractures. Although nasal fractures are the most common facial fracture, they often go unnoticed by physicians and patients. A simple radiographic imaging of the isolated nasal bone can be done by RadioVisioGraphy dental imaging system with high resolution and less radiation.

Digital radiographs displayed on different devices: effect on the detection of vertical root fractures.

AIM: To evaluate whether the type of display device affects the detection of vertical root fractures (VRFs) on digital radiographs in unfilled canals and canals with fibreglass posts. METHODOLOGY: Forty single-rooted human teeth were decoronated, and the root canals were prepared. The teeth were divided into 2 groups: controls (20 teeth) and with VRF (20 teeth). The VRFs were induced using an universal testing machine. Periapical radiographs of all teeth, with canal unfilled or with a fibreglass post, were obtained using the parallel technique in 3 directions (ortho-, mesio- and distoradial) on storage phosphor plates (VistaScan®). All images were evaluated and re-evaluated after 30 days by 3 examiners on a 5-point scale using 4 different devices (notebook display with full high definition resolution, desktop display with a standard resolution, 8-inch Android(™) tablet with high definition resolution and a 9.7-inch iPad® tablet with Retina resolution). Areas under ROC curves, sensitivity, specificity and accuracy values were compared by anova. RESULTS: The weighted kappa values for intra- and interobserver reproducibility were 0.55-0.88 and 0.31-0.65, respectively. There was a significant difference (P < 0.05) in relation to the area under the ROC curve, specificity and sensitivity when unfilled canals were compared with canals with a fibreglass post; however, no difference was observed for the different devices studied. CONCLUSIONS: The type of display device did not affect the detection of VRFs. Thus, the detection of VRFs can be performed using different screen sizes and resolutions.

Are children's dental panoramic tomographs and lateral cephalometric radiographs sufficiently optimized?

OBJECTIVES: Children are especially vulnerable to harmful effects of ionizing radiation. Cutting down the dimensions of the X-ray beam is the most effective way to reduce the patient dose. We evaluated the appropriateness of field-size in the most frequent radiographs, dental panoramic tomographs (DPTs) and lateral cephalometric radiographs (LCRs) among 7- to 12-year-olds. MATERIALS AND METHODS: The image field-size of 241 DPTs and 118 LCRs was analysed. The image field was considered appropriate when it did not include anatomic structures beyond the area of clinical interest. The image field was compared with factors such as the age of the patient, the radiographic equipment used and the programme selected. Moreover, we assessed the use of thyroid shield in LCR. RESULTS: The field-size was too large in 70% of the DPTs horizontally and in 96% vertically. None of the DPTs were segmented. Every LCR showed appropriate limitation anteriorly, but the image field was too large in 54% posteriorly, in 86% superiorly, and in 76% inferiorly. A thyroid shield had been used in only 71% of cases. CONCLUSION: Most DPTs and LCRs had been performed sub-optimally. An abundancy of DPTs had been taken using an adult programme, and the field-size had not been sufficiently adjusted in LCRs, possibly for technical reasons. To facilitate adherence to radiological best practice the equipment used for DPTs and LCRs should facilitate the adjustment of field-size in both the vertical and horizontal planes. In addition, those involved in taking radiographs should maintain their skills through regular update courses.

Assessment of intraoral image artifacts related to photostimulable phosphor plates in a dentomaxillofacial radiology department.

OBJECTIVE: The aim of the present study was to evaluate the presence, frequency, and causes of artifacts in intraoral images obtained using photostimulable phosphor (PSP) plates. MATERIALS AND METHODS: A total of 11,443 intraoral images, including 4291 periapical and 7152 bitewing images, acquired over a 6-month period as well as over a month 1-year after the initial imaging were evaluated by a single observer and image artifacts only related to the PSP system were recorded. Before the study, an experienced dentomaxillofacial radiologist and a research assistant assessed a set of image artifacts and agreed on the causes of these artifacts. All unidentified artifacts were reassessed by both researchers before the final decision. The data were analyzed using the statistical software SPSS 11.5. RESULTS: The total number of images with one or more artifacts was 2344 (20.4%). Of these, 2008 were of adult patients and 336 were of pediatric patients. While movement of the phosphor plate in the disposable pocket was the most common cause of the observed image artifacts in the children, non-uniform image brightness was the most frequently observed artifact in the case of the adults. CONCLUSION: The percentage of images with artifacts in the 6th month was lower than that during the 1st month. More significantly, the lowest percentage was obtained 1-year after the initial imaging, owing to the increase in familiarity with the system. Understanding the reasons for the image artifacts and studying ways of preventing are of high clinical importance.

Effect of display monitor devices on intra-oral radiographic caries diagnosis.

OBJECTIVES: Recent developments in digital computer technology have enabled radiological diagnosis to be performed using a monitor screen. In medical radiography, the importance of monitors has been shown in many diseases. Digital imaging and communication in medicine (DICOM)-compatible monitors are widely used. However, the effect of monitors on the diagnosis of oral disease has not yet been clarified and remains controversial. The aims of this study are to compare the caries diagnostic ability between DICOM monitors and other monitors and to examine if monitor capability affects the diagnosis. MATERIALS AND METHODS: One hundred proximal surfaces of 50 extracted human upper premolar teeth were used as specimens. Intra-oral radiographs of all specimens were taken digitally. Three types of monitors were compared in terms of caries diagnostic ability: a DICOM standard-compatible monitor, a standardized personal computer (PC) monitor, and a tablet PC. Six oral radiologists diagnosed each radiograph independently. Areas under the receiver operating characteristic (ROC) curve were generated and compared. RESULTS: Area under the ROC curve (AUC) of the DICOM monitor, PC monitor, and tablet PC was 0.68147, 0.67002, and 0.60189, respectively. There was no significant difference between the DICOM monitor and the PC monitor, but the tablet PC showed significantly lower accuracy. There were no significant differences among the monitors for dentin caries (p > 0.05). CONCLUSIONS: DICOM-compatible monitors and PC monitors have similar capabilities, but tablet PCs showed lower diagnostic accuracy, especially for superficial caries. CLINICAL RELEVANCE: Appropriate monitors are needed for radiographic diagnosis on monitor screens.

Evaluation of simulated periodontal defects via various radiographic methods.

OBJECTIVES: The aim of this study was to compare the diagnostic accuracy of conventional films and direct digital radiographs (DDR), in the determination of the depth and type of simulated periodontal intrabony defects. MATERIALS AND METHODS: Three types of periodontal intrabony defects (one, two, and three walled) were artificially created in dry mandibles. Standard radiographic images were taken with Ultraspeed, Ektaspeed, Insight films, and DDR. The radiographic images were evaluated by three oral radiologists to identify the type and depth of these defects on the radiographs. RESULTS: The average measured depth of the defects on the dry mandibles was 7.85 mm. The average depth of the type 1 defect on the radiographs was 7.19 mm, type 2 was 7.18 mm, and type 3 was 7.15 mm. The average depth of the defects via the Ultraspeed film was 7.15 mm, Ektaspeed film was 7.17 mm, Insight film was 7.19 mm, and DDR was 7.20 mm. Type 1, type 2, and type 3 defect depth measurements showed 8.9, 9.7, and 16.3% understated, respectively (p < 0.01). The accurate estimation rates of type 1, type 2, and type 3 defects were 93.8, 53, and 25.4%, respectively. CONCLUSIONS: Both radiographic techniques have the same diagnostic value and display the minor destructive changes in the bone. As the number of osseous walls increases, it becomes difficult to determine the defect type and morphology. Further research is needed to monitor the intrabony defects, with less radiation exposure. CLINICAL RELEVANCE: The accurate identification of defect type and depth depends on the number of walls, not the imaging methods.

Diagnostic accuracy of conventional and digital radiography for detecting misfit between the tooth and restoration in metal-restored teeth.

STATEMENT OF PROBLEM: Although the postprocessing of digital images with enhancement filters could lead to the presence of artifacts and result in false-positive diagnoses, no study has analyzed whether the use of digital radiographs and/or postprocessing of digital images interferes with the diagnosis of marginal adaptation in metal-restored teeth. PURPOSE: The purpose of this study was to compare the diagnostic accuracy of conventional and digital radiographic images with and without filters for detecting a misfit between the tooth and restoration in metal-restored teeth. MATERIAL AND METHODS: Forty teeth with mesial-occlusal-distal inlays and 40 with complete crowns (each with a perfect fit, 20 with a 0.2-mm gap and 20 with a 0.4-mm gap) were imaged with conventional film and digital phosphor plate systems. Digital radiographs were exported as original images and with edge enhancement (high and low), inversion, and pseudo-3-dimensional filters. Four examiners assessed the presence of gaps by using a categorical scale (fit, misfit, cannot decide). Sensitivity, specificity, and overall accuracy were calculated for each variable. In addition, time spent scoring the images was recorded. A multivariate logistic regression was performed with accuracy as the dependent variable. RESULTS: Of the images, 6.2% received the score "cannot decide," most of them with a high edge enhancement filter and in the crown group. A tendency for higher sensitivity (range 0.67-0.83), specificity (range 0.81-0.92), and accuracy (range 0.73-0.86) values was found in conventional and digital original images. Results of a logistic regression found that restoration type, gap size, and high enhancement and inversion filters had a statistically significant impact on accuracy (P<.05). CONCLUSIONS: Original nonfiltered images should be used to assess teeth with metal restorations. High enhancement filters and image inversion should be avoided, especially when metal crowns are present.

Guide to Digital Radiographic Imaging.

This is a resource for clinicians who are considering purchasing a digital imaging system or those already using one who want to optimize its use. It covers selected topics in digital imaging fundamentals, detector technology, image processing and quality assurance. Through a critical appraisal of the strengths and limitations of digital imaging components, the goal of this guide is to contribute to the appropriate use of these systems to maximize the health benefit for patients.

Assessing fit at the implant-abutment junction with a radiographic device that does not require access to the implant body.

STATEMENT OF PROBLEM: Radiograph paralleling devices provide an excellent means of obtaining orthogonal radiographs for the evaluation of the fit of implant restorations. Unfortunately, the clinical applicability of such devices is a significant issue because access to the implant body must be obtained at each radiographic appointment. PURPOSE: The purpose of the study was to investigate whether the fit or microgap at the implant-abutment junction could be more accurately and confidently assessed with a novel radiograph paralleling device that did not require access to the implant body once a proper registration index was made. MATERIAL AND METHODS: Microgaps of 0, 50, and 100 µm were introduced at the implant-abutment junction of a provisional implant crown in a manikin-typodont assembly. Dental assistants made 54 radiographs (18 per microgap) of the crown with and without a radiograph paralleling device; 9 clinicians then evaluated the standardized radiographs for the presence of misfit. The Cochran-Mantel-Haenszel test and the corresponding odds ratios were used to evaluate the effectiveness of the paralleling device in helping clinicians better assess misfit from the radiographs made. RESULTS: The use of the device led to a higher percentage of accuracy under all conditions (79.0% vs 70.4% at the 0-µm gap, 77.8% vs 16.1% at the 50-µm gap, and 100% vs 92.6% at the 100-µm gap); the improvement was statistically significant at the 50-µm gap (P<.001) and 100-µm gap (P=.049) but not at the 0-µm gap (P=.364). The odds ratio (95% confidence interval) of obtaining correct versus wrong answers with the device compared with without the device was 18.64 (7.94-43.77) at the 50-µm gap and 5.40 (0.25-114.25) at the 100-µm gap. CONCLUSIONS: The study indicated that the paralleling device helped the clinician more accurately assess the implant-abutment junction with the 50- and 100-µm gaps.

Quality assurance tests for digital radiography in general dental practice.

UNLABELLED: Quality assurance (QA) is essential in dental radiography. Digital radiography is becoming more common in dentistry, so it is important that appropriate QA tests are carried out on the digital equipment, including the viewing monitor. The aim of this article is to outline the tests that can be carried out in dental practice. CLINICAL RELEVANCE: Quality assurance for digital equipment is important to ensure consistently high quality images are produced.

Shall I go digital?

UNLABELLED: Dental radiographic imaging is slowly transferring to digital format. The decision to invest in this new technology should be based on a good understanding of the different types of digital imaging available within the dental field. This article outlines its use in general dental practice, highlighting the pros and cons of the various systems both for intra-oral and extra-oral radiography. CLINICAL RELEVANCE: An understanding of the mechanisms of digital imaging and their associated potential problems are required by any clinician moving to film-less imaging.

In vitro comparison between the image obtained using PSP plates and Kodak E-speed films.

OBJECTIVES: The aim of this study was to compare the intra-oral radiographic images obtained by a PSP digital radiography system ("Orex", Israel) with that obtained using Kodak Ultra speed films in terms of image quality, radiation dosage and diagnostic value. METHODS: The physical measurement of image quality was conducted with an aluminum step-wedge. Radiation dosage was measured with a dosimeter. Fog and base levels were measured by developing unexposed films and scanning unexposed PSP plates. The in vitro model included preparation and radiographic evaluation of approximal artificial lesions in premolars and molars in depths ranging from 0.25 mm to 1.00 mm. Radiographs were evaluated for the existence of a lesion and its size by 8 experienced clinicians. RESULTS: Relative contrast was similar in both methods. The resolving power of the digital system was lower than that of the E-speed film. As for the subjective evaluation of artificial lesions, there was no significant difference between the two methods excluding those tooth images without lesions, where the analog method was found to be more accurate. CONCLUSIONS: The PSP system ("Orex") provides good image quality and diagnostic information with reduced exposure when compared with E-speed film.

[Pseudo-color filter in two-dimensional imaging in dentistry].

Most digital systems that are currently used in two-dimensional imaging in dentistry provide opportunities for different image processing filters. One possible means of enhancing digital radiographic image is pseudocoloring (i.e., color conversion of gray-scale images). Recently, this method has become widely used in digital radiology. The human eye is more sensitive to differences in color than to differences in shades of gray. Theoretically, converting a gray scale intensity level of a digital image into colors could enhance the radiographic information. There have been some studies that applied pseudocoloring of digital radiographic images for the detection of caries and periodontal defects. However, thus far, this method failed to show a significantly improved ability for the detection of these lesions. Further investigations are necessary in order to develop specific algorithms that will increase the validity of pseudocoloring in two-dimensional imaging in dentistry.

Assessment of Perception of Pain with E-Speed Film, CCD Sensor and Photostimulable Phosphor Plates for Intraoral Radiographs in Children using Three Pain Rating Scales.

BACKGROUND: Dental radiography is an integral part of intraoral evaluation. Children are often uncomfortable during the placement of film or sensor due to the impingement of the soft tissues. Thus, the perception of pain with three intraoral radiographic methods in children was evaluated using three subjective pain rating scales. AIM: To evaluate the discomfort with three different techniques, that is, intraoral periapical (IOPA) radiograph, charge-coupled device (CCD), and photostimulable phosphor (PSP) luminescence (PSPL), using the Wong-Baker Faces Pain Rating Scale (WBFPRS), numerical rating scale, and visual analog scale (VAS). MATERIALS AND METHODS: A sample of 35 children aged 6-12 years were divided into two groups: group 1 (6-8 years) and group 2 (9-12 years). For each child, simulations of the three radiological methods (IOPA, CCD, and PSPL) were performed. The meaning of each facial expression on the WBFPRS, VAS, and the numbers on the numerical rating scale was explained to each child before the procedure. STATISTICAL ANALYSIS USED: A one-way analysis of variance (ANOVA) test and paired-samples t-test are used. RESULTS: The results revealed that the CCD sensors elicited higher pain scores than those obtained with IOPA and PSPL, whereas the IOPA film showed the least pain score. Higher score values were obtained in group 1 than in group 2, indicating that children aged 6-8 years felt higher discomfort than the 9- to 12-year age group for the same procedure. This difference was statistically significant (P < 0.001). CONCLUSION: It was concluded that conventional IOPA films were tolerated better by children when compared to PSP plates and CCD sensors.

Accuracy of enhancement filters in measuring in vitro peri-implant bone level.

OBJECTIVES: To identify the accuracy of enhancement filters of an intraoral phosphor-plate system for measuring the simulated peri-implant bone level. MATERIALS AND METHODS: A total of 20 titanium implants (Titamax(®) ) were placed into six fragments of bovine ribs and defects simulating bone loss were created. Periapical radiographs were taken with a phosphor-plate system (Vista Scan(®) ) according to the paralleling standard technique, and nine enhancement filters were applied: fine, caries 1, caries 2, perio, endo, noise reduction, invert, emboss, and sculpture. The Friedman test compared the radiographic measurements of the defects to those obtained on the bovine ribs with a digital caliper. Intra- and interobserver agreement was calculated with the intra-class correlation coefficient (ICC). RESULTS: The ICC values showed excellent intra- and interobserver agreement. The caries1, caries2, endo, and perio filters resulted on measurements statistically different from both the original images and the measurements of the digital caliper (P < 0.05). The other filters did not show statistically significant differences from the original images nor from the measurements of the digital caliper. CONCLUSION: In addition to the original images, the fine and emboss filters resulted on the most precise measures. The caries1, caries2, endo, and perio filters were the less accurate for measuring the peri-implant bone level.

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.

Assessment of the accuracy and reliability of new 3-dimensional scanning devices.

INTRODUCTION: The primary objective of this study was to assess the accuracy and the reliability of the SureSmile OraScanner (Orametrix, Richardson, Tex) by comparing it with other desktop 3-dimensional scanners: VIVID910 (Konica Minolta, Tokyo, Japan) and R700 (3Shape, Copenhagen, Denmark). A laser-based scanner, the SLP250 Laser Probe (Laser Design, Detroit, Mich), served as the gold standard. METHODS: Five sets of dental casts were used. First, the accuracy of each scanner was studied by comparing the 3-dimensional models created by OraScanner, VIVID910, and R700 with the gold standard 3-dimensional models of the SLP250. To assess the reliability of the 3-dimensional models, the shell/shell deviation of each model was calculated based on the same surface-based registrations for all 5 sets of dental casts. RESULTS: OraScanner, VIVID910, and R700 were sufficiently accurate when compared with the gold standard. In the assessment of reliability, there were no significant differences between all comparisons. CONCLUSIONS: The results showed that the OraScanner system has a sophisticated algorithm for 3-dimensional surface registration and can be used to generate accurate and reliable 3-dimensional digital models for use by clinicians.