Validity and reliability of eye healthcare professionals in the assessment of glaucoma - a systematic review.

OBJECTIVE(S): To explore the validity and reliability of eye healthcare professionals with different levels of training in diagnosing and/or identifying glaucomatous progression. CLINICAL RELEVANCE: Substantial pressure is being placed on our current eye healthcare workforce by chronic diseases such as glaucoma. Shared care schemes and role expansion of professionals other than ophthalmologists are being proposed to alleviate this pressure. A sound evidence base is imperative to determine whether other allied health professionals are skilled and clinically competent, when it comes to taking on these new roles in glaucoma management. METHODS: A systematic review of research articles identified in MEDLINE, CINAHL, Embase, Scopus and Cochrane Library was performed. Studies which investigated rater reliability of various health professionals in diagnosing and/or identifying glaucoma progression against a reference standard were included. RESULTS: Of the 4088 publications identified by the initial database search, 32 met the inclusion criteria. The majority of studies demonstrated positive results, with most finding moderate to substantial agreement for inter- and intra-rater reliability across all testing modalities. The eye health professionals with ophthalmology training consistently attained the greatest agreement. When allied health professionals with different levels of training were compared, those who had completed residency training were significantly better than those who had not. CONCLUSION: The studies included in this review show promising results, including those raters without ophthalmology training. A lack of power calculations, unequal sample sizes in some studies and the diversity of the testing procedures used make it difficult to make sound inferences.

Ex vivo detection of mesiobuccal canals in maxillary molars using CBCT at four different isotropic voxel dimensions.

AIM: To study observers' ability to detect mesiobuccal (MB) canals in maxillary molars using iCAT cone-beam computed tomography (CBCT) at different voxel dimensions and to assess the impact of clinical experience on accuracy of detection. METHODOLOGY: Using 12 experimental models with two molars each, CBCT scans were acquired at four different voxel dimensions. From the cross-section view of these scans, 96 videos were generated. Five endodontic postgraduate students and two endodontic staff watched the videos and counted the MB canals in each root. Horizontal sections of the roots were evaluated under magnification to determine the true canal numbers. The detection of MB canals within the four resolutions was compared by odds ratio, and the weighted χ(2) test compared detection accuracy to raters' clinical experience. Rater agreement was measured by kappa statistics. RESULTS: Overall, 92% of the maxillary molars had two MB canals upon analysis of horizontal cross-sections. The CBCT detection increased from 60.1% at 0.4 mm voxel size to 93.3% at 0.125 mm voxel size. Significant differences (P < 0.01) were observed between the different resolutions except for the 0.2 and the 0.125 voxel scans. Second-year trainees were significantly (CI = 0.2929-0.712) more accurate than first-year trainees and endodontic staff at MB canal detection (87.9% against 77.1% and 76.8%). Intra-rater reliability increased with higher-resolution scans (41.1% to 96.4%). CONCLUSIONS: The reliability of detection of maxillary molar MB2 canals in CBCT scans increased as the resolution improved. Accuracy of MB2 canal detection among observer groups could not be correlated with the observers' level of clinical experience.

Functional performance status of hematopoietic SCT recipients in the sub-acute phase of recovery.

This study assessed the functional capacity of sub-acute SCT recipients using validated physical performance tests, including 6-min walk distance, repeated sit-to-stand time and 50-ft walk time, and compared these outcomes with those reported for a heterogeneous oncology population. The medical records of 80 consecutive sub-acute SCT recipients not receiving corticosteroids were retrospectively reviewed for demographic, medical and anthropometric information, and outcomes for these physical performance tests administered at the time of initial physiotherapy evaluation. Measures of central tendency, 95% confidence intervals, unpaired t-tests and correlation coefficients were calculated using a SPSS statistical package. SCT recipients completed the 50-ft walk in 10.66+/-4.43 s, repeated sit-to-stand trial in 4.16+/-1.82 s and walked 400.2 m in 6 min. For the timed tests, SCT recipients were approximately twice as fast as a heterogeneous group of oncology patients and walked approximately 50% further in 6 min. No overlap in the 95% confidence intervals for the two groups was observed for any of the tests. These results (1) suggest that reference values describing the functional capacity of a heterogeneous oncology population underestimate the functional capacity of SCT recipients and (2) provide clinically useful reference values for assessing functional capacity of sub-acute SCT recipients referred for physiotherapy.

Variables affecting endodontic recall.

AIM: To determine the recall rate in an endodontic practice and to evaluate specified variables as to their effect on the rate of patients returning for recall. METHODOLOGY: The records of 7105 patients treated by one endodontist between 1975 and 1998 were reviewed. Recorded variables included chart number, patient gender and age, treated tooth number, pulp status, presence of spontaneous pain at initial visit, history of trauma to treated tooth, previous root canal treatment in the treated tooth, and presence of endodontic recall. RESULTS: The recall rate was 49% for the 5641 patients who completed endodontic treatment. Odds ratio analysis showed that females returned for recall at a rate that was significantly higher than males (52% vs. 44%). Odds ratio and chi square analysis revealed that a diagnosis of pulp necrosis or previous root filling resulted in a higher than expected recall rate while a diagnosis of irreversible pulpitis resulted in a lower than expected recall rate (p < 0.001). Patients aged 6-40 years of age returned at a lower rate than expected and those aged 41-80 returned at a higher rate than expected (p < 0.001). There was no significant difference in recall rate for patients reporting spontaneous pain or history of trauma with the treated tooth. The type of treated tooth had no effect on patient recall rate. CONCLUSIONS: Forty-nine per cent of patients returned for recall after a minimum of 6 months with patient age, patient gender and pulp status affecting the rate of recall significantly.

Time and motion study: a comparison of two photostimulable phosphor imaging systems used in dentistry.

OBJECTIVES: To compare two photostimulable phosphor (PSP) dental radiographic systems in terms of time efficiency in making full mouth intraoral X-ray surveys (FMS). METHODS: PSP systems compared were (1) DenOptix) (Kavo/Gendex, Des Plaines, IL) and (2) ScanX) (Air Techniques, Hicksville, NY). Twenty one FMS of a DXTRR) Manikin (Dentsply, Des Plaines, IL) were made with each of the systems. Time for each procedural step was determined using a stopwatch. Steps studied were: (1) plate erasure; (2) packaging; (3) positioning/exposure; (4) unpacking, loading processor, scanning; and (5) image transfer to virtual FMS mount. The first six test runs for each system were excluded to eliminate the learning curve period influencing results. An independent groups t-test was employed for statistical analysis. The a priori was set at P< or =0.05. RESULTS: The total time involved in producing a FMS was not proven to be statistically significant comparing DenOptix) and ScanX). The mean procedure time for DenOptix) was 31.2 min; for ScanX) it was 27.1 min. While the processing time with ScanX) (mean time: 3.9 min) was shorter than for DenOptix) (mean time =7.8 min), the opposite was true for the image transfer to FMS format with the time much shorter with DenOptix) using VixWin) software (mean time =2.0 min) compared with ScanX) using Vipersoft) (mean time =3.9 min). The differences between the systems for these two steps did prove to be statistically significant (P< or =0.05). CONCLUSIONS: Although the mean time to make a FMS was slightly shorter on average with ScanX) than DenOptix), this difference was not proven to be statistically significant (P>0.05) in terms of time efficiency in producing a FMS.

Pilot study of correlation of pulp stones with cardiovascular disease.

We propose that calcification of dental pulp may have a similar pathogenesis as calcified atheromas and could lead to use of routine dental radiographs as a rapid screening method for early identification of potential cardiovascular disease (CVD). Fifty-five dental patients ages 20 to 55 were chosen because pulp stones in pulpally noninflamed teeth were not expected in this age group. They completed a questionnaire regarding their CVD status and that of their parents and siblings. Entry criteria included at least one asymptomatic, minimally restored, noncarious molar and no history of gout, renal disease, or renal lithiasis. Patients' periapical radiographs of record were viewed to determine the presence of pulp stones. There was a significant relationship between pre-existing CVD and pulp stones (odds ratio of 4.4 with a 95% confidence interval of 1.1, 18.7), but no relationship was found for family history of CVD and pulp stones (odds ratio of 1.7 with a 95% confidence interval of 0.5, 5.5). Seventy-four percent (14/19) of patients with reported CVD had detectable pulp stones while only 39% (14/36) of patients without a history of CVD had pulp stones. This pilot study demonstrates that patients with CVD have an increased incidence of pulp stones in teeth with noninflamed pulps compared to patients with no history of CVD. No relationship was found between presence of pulp stones and family history of CVD. The findings suggest that dental radiographic determination of the presence or absence of pulp stones may have possibilities for use in CVD screening.

Impact of ambient lighting intensity and duration on the signal-to-noise ratio of images from photostimulable phosphor plates processed using DenOptix and ScanX systems.

OBJECTIVES: To evaluate the impact on photostimulable phosphor (PSP) image signal-to-noise ratio (SNR) of pre-scanning ambient lighting exposures. METHOD: PSP imaging plates (IPs) were exposed to different radiation exposures to achieve flat field images. The exposed IPs were subjected variously to visible light of different intensities (300, 150 or 20 lux) for durations ranging from < 10 s to 120 s. They were processed using laser scanners from two systems for further comparison (DenOptix versus ScanX). Histogram analysis was performed in each case and mean pixel value and its standard deviation were used as surrogates to assess SNR. Statistical methods applied included analysis of variance with Tukey honestly significant difference test for pair wise comparisons. The a priori alpha was set at P < or = 0.05. RESULTS: SNR decreased with increased duration and intensity of pre-scanning light exposure. Lower X-ray exposures resulted in decreased signal resulting in reduced SNR, and increased the need to reduce ambient lighting. No statistically significant differences were found comparing ScanX and DenOptix digital imaging systems in terms of SNR. CONCLUSION: Reduced ambient lighting is preferred for handling IPs prior to processing in the laser scanner.

Array geometry for assessment of mandibular implant position using tuned aperture computed tomography (TACT).

OBJECTIVE: To evaluate observer faciolingual depth and vertical depth reading errors when using various X-ray beam array geometries to make basis images for tomosynthetic reconstruction using tuned aperture computed tomography (TACT). MATERIALS AND METHODS: Tissue-equivalent models were constructed to replicate the position of dental implants in relation to simulated mandibular canals. X-ray beam geometries used to acquire the basis images for TACT(TM) integration included horizontal linear, vertical linear, and symmetric and asymmetric conical arrays. Twenty-one dentists trained in the use of TACT acted independently as observers. Tasks included: (1) determination of the relative position of the implant in relation to the simulated canal; and (2) measurement of the vertical depth and faciolingual (lateral) depth dimensions between these two structures. As the study did not involve repeated measures (only one measure was obtained from each observer on each of the two dependent variables), data for faciolingual depth and vertical depth reading errors were analysed using a one-way analysis of variance (ANOVA) with Tukey's honestly significant different (HSD) procedure. RESULTS: Errors in determining the relative position of the implant to the simulated canal were most frequent when the linear horizontal projection geometry was employed for producing basis images (57% error for model #2 where the implant was lingually placed). The mean measurement errors for TACT images constructed using the various different projection arrays depended both on the structural relationship of anatomic features and the employed beam array geometry. CONCLUSION: Conical beam arrays are preferred over linear beam arrays for constructing basis images used with TACT for the purpose of correlating the position of a mandibular dental implant in relation to the mandibular canal. They more consistently allowed the observers to establish a measurement of the faciolingual relationship of the implant to the canal. For vertical depth measurement of the relationship of a mandibular dental implant to the mandibular canal, TACT does not appear to have any advantage over individual simple transmission radiographic images.

Comparison of complementary metal oxide semiconductor and charge-coupled device intraoral X-ray detectors using subjective image quality.

OBJECTIVE: To compare the subjective image quality of the newer generation Schick CDR detector employing complementary metal oxide semiconductor (CMOS) technology with images using the earlier generation charge-coupled device (CCD) Schick CDR detector. METHODS: All radiographic images were made using the same formalin-fixed adult cadaver maxilla with surrounding natural soft tissues in place. The X-ray generator used was a Villa Sistemi Medicali Diamatic srl AP/Explor X operated at 70 kVp and 8 mA. The source-to-detector distance was set at 38 cm and an optical bench was used to ensure reproducible beam geometry. A range of exposures was applied for both detectors. A panel of nine dentists independently observed and evaluated images made at each exposure. For both detectors, the three images ranked highest were randomized for re-evaluation in panels of six images. Each image was repeated randomly a total of 10 times. Features chosen as observation points were: (1) proximal dental caries; (2) gingival soft tissues; (3) cortical bone; (4) root canal space; (5) root apices; (6) periodontal ligament space; and (7) endodontic instrument tip clarity. Comparisons were made by use of odds ratio analysis applying a 95% confidence level. Interrater and intrarater reliabilities were computed to assess consistency in observer ratings. RESULTS: The CMOS sensor was rated as outperforming its CCD predecessor for depiction of cortical bone and root apices; the CCD detector was only rated superior for depiction of root canal space. No significant difference was found between the two detectors in perceived depiction of proximal dental caries, gingival soft tissues, periodontal ligament space or endodontic instruments. Combining rating scores from each of the tasks, CMOS and CCD detectors had a similar proportion of image ratings of excellent, acceptable and poor. CONCLUSIONS: Regarding subjective image quality, the Schick CMOS and CCD detectors were perceived to produce radiographic images of similar overall quality.

Apical pressures developed by needles for canal irrigation.

Drying instrumented canals with pressurized air may result in patient morbidity or even fatality. Low pressure and side vent needles have been suggested to lessen the danger. This study observed apical pressures from different needles inserted deeply into small round and ovoid canals as instrumentation progressed. Low-pressure (5 psi) air was injected through the needles, and apical pressures were recorded after each instrument. Pressures varied greatly within each test group. Generalities that can be drawn are that binding the needle within the canal gives higher pressures than with the needle slightly short of binding and that pressures were higher with apexes instrumented to size 30 and higher. With the needle tightly bound, neither needle size, needle design, nor canal shape resulted in statistically significant mean pressure differences. With the needle slightly withdrawn, larger bore needles gave higher pressures than small diameter needles. Caution is advised with the clinical use of pressurized air in the drying of root canals.

Measurement of intraosseous pressures generated by the Wand, high-pressure periodontal ligament syringe, and the Stabident system.

Intraosseous pressure generated by the use of three anesthetic systems-the Wand; a hand-operated high-pressure periodontal ligament (PDL) syringe; and the Stabident system-were studied in fresh mandibles of 14 large swine. The mandibles were drilled and tapped in one area of both the right and left posterior molar regions. Pressure gauges were attached via threaded fittings. Pressures during injection were recorded for the Wand first, then the PDL syringe, and finally Stabident. Results showed averages of 8.3 mm Hg generated by the Wand, 16.3 mm Hg with the high-pressure PDL syringe, and 43.7 mm Hg from the Stabident system. Results were corroborated with data from three human cadaver mandibles.

Effectiveness of three endodontic irrigants at various tubular depths in human dentin.

Bacteria from infected root canals can invade dentinal tubules, thus dentin disinfection is an important aspect of endodontic therapy. This study compares three endodontic irrigants for efficiency in killing bacteria established within human dentinal tubules. Root canals in extracted teeth were prepared and sterilized. Broth cultures of Enterococcus faecalis were allowed to grow within the canals to penetrate dentinal tubules. The infected canals were exposed individually to each of the irrigants for 1 min. Irrigants were 0.525% sodium hypochlorite, Tubulicid (0.2% EDTA), and 0.12% chlorhexidine (Peridex). Sterile water was the control. Viable bacteria were analyzed by drilling incrementally into dentin from the cementum toward the canal. Smaller diameter drills were used for each depth. Shavings were cultured at three depths, for each of three root levels: coronal, midroot, and apical. Although considerable variation occurred between roots, sodium hypochlorite seemed to be superior. Tubulicid and Peridex were better than water. More bacteria remained viable at greater distances from the pulp. These observations apparently apply to all levels in the canal.

Wet and dry deep cavity preparations compared by a novel odontoblast culture technique.

The human odontoblast's unique cellular extension within dentin does not easily allow culturing by traditional methods. This study leaves these cells in their natural position in the dentin. Deep preparations were made through the occlusal surfaces of extracted human third molars. The crowns were separated from the roots and the pulps gently teased from the chambers, leaving the odontoblast layer intact. These inverted pulp chambers were then incubated in cell culture medium for 2 to 4 days. Trypan blue staining was used to detect non-vital odontoblasts, and the differentiation between vital and nonvital cells was verified by SEM and toluidine vital staining. Control teeth and areas not adjacent to the preparation showed no blue staining, indicating intact cells. Areas of nonvital cells were greatest with wider preparation. Irrigation decreased odontoblast death with wide preparations. No difference due to irrigation was detected in narrow preps. A comparison of wet preparations to which heat was applied versus dry preparations showed statistically similar results. This study provides a simple in vitro method for the study of odontoblasts with their processes intact within dentin.

Beneficial effects of a hospital bereavement intervention program after traumatic childhood death.

PURPOSE: An investigation of the experiences of parents grieving the traumatic death of their child, the initiatives that helped, and common parental concerns that would benefit from improved education. METHODS: From January 1, 1995, to December 31, 1998, 81 of 3,501 children admitted to our pediatric trauma center died. An attempt was made to enroll all parents. Interactions included family contact at hospital, home/funeral home visit within 1 month of death, educational meeting with parents and 15 supporters at a restaurant within 2 months of death, follow-up survey to parents/supporters, and final interview/survey with parents in 1999-2000. RESULTS: Seventy-seven families were enrolled; 59 families completed the educational meeting with supporters, and 245 parental supporters returned surveys. Supporters were likely to use proposed interventions (82%), were more accepting of the duration of grief (94%), and interacted with parents more often after the death (78%). Parents (n = 44) felt the hospital staff was appropriately sensitive to their child (90%), themselves (93%) and prepared them for their child's death (81%). Parents (n = 54) on behalf of 37 children have completed the final interview. Poor conceptualization of aspects of the medical care and brain death, and delayed regret for missing the opportunity to donate organs, were recurring themes. CONCLUSION: We conclude that parents' unanswered questions or misconceptions regarding brain death, organ donation, and their child's medical care adversely affect their grief; that "normal life" for parents is challenged as they struggle to establish a new sense of normal; and that hospital and trauma service personnel can positively impact the grieving process with appropriate training.

Array-projection geometry and depth discrimination with Tuned-Aperture Computed Tomography for assessing the relationship between tooth roots and the inferior alveolar canal.

OBJECTIVES: The purpose of this study is to compare Tuned-Aperture Computed Tomography (TACT) image sets made with linear vertical, linear horizontal, conical, and x-shaped x-ray projection arrays with regard to observer accuracy in (1) measuring the distance from the apex of a tooth root to the middle of the inferior alveolar canal (IAC), (2) measuring the shortest distance from the surface of a tooth root to the surface of the IAC, and (3) determining whether the root is buccal or lingual to the IAC. The same relationships were also examined by means of pairs of images and the buccal object rule. STUDY DESIGN: Two artificial mandible sections with simulated IACs were fabricated. The same human mandibular premolar root was used in both models to prevent development of learning cues to differentiate between models. The models were imaged from both sides, resulting in 4 orientations. An optical bench was designed to precisely orient different beam projection arrays for production of TACT image sets and pairs of images for use with the buccal object rule. Twelve dentists participated as observers to independently assess the relationships between the tooth root and the IAC with regard to the 4 orientations. RESULTS: For measuring the distance from the tooth apex to the middle of the IAC, TACT image sets made from conical and x-shaped arrays proved significantly more accurate than TACT image sets made from linear vertical or linear horizontal projections or pairs of digital images used with the buccal object rule (P <.05). For measuring the shortest distance between the tooth surface and the IAC surface, TACT image sets made from linear vertical, conical, and x-shaped projection arrays were significantly more accurate than measurements made through use of the buccal object rule or TACT image sets made through use of a linear horizontal projection array (P <.05). The following percentages of mistakes were made in determining whether the tooth root was buccal or lingual to the IAC: buccal object rule (58%), linear horizontal array (31%), linear vertical array (2%), conical array (0%), and x-shaped array (0%). CONCLUSIONS: For TACT, images acquired with conical and x-shaped beam projection arrays are preferred to those acquired with linear arrays for assessing the relationship between tooth roots and the IAC. TACT was found to be significantly more accurate than standard application of the buccal object rule for the relationships investigated.

Disinfection/sterilization of extracted teeth for dental student use.

Extracted human teeth are used in many preclinical courses. While there has been no report of disease transmission with extracted teeth, sterilization of teeth used in the teaching laboratory should be a concern. The purpose of this study was to determine the effectiveness of different sterilization/disinfection methods of extracted human teeth using Bacillus stearothermophilus, a bacteria resistant to heat and frequently used to test sterilizers. In this study, 110 extracted molars with no carious lesions were collected and stored in buffered saline. An endodontic occlusal access preparation was cut into the pulp chamber of each tooth. Pulp tissue in the chamber was removed with a broach. Approximately 1 x 10(5) B. stearothermophilus endospores in culture medium were injected into the pulp chamber, sealed with Cavit G, and then placed in sterile saline for twelve hours. Ten teeth were placed into each of eleven groups. Seven groups were immersed for one week in one of the following solutions: a) sterile saline (control group), b) 5.25% NaOCl, c) 2.6% NaOCl, d) 1% NaOCl, e) 10% buffered formalin, f) 2% gluteraldehyde, g) 0.28% quaternary ammonium. Four additional groups were treated by h) 10% formalin for two days, i) 10% formalin for four days, j) autoclaving at 240 degrees F and 20 psi for twenty minutes, and k) autoclaving at 240 degrees F and twenty psi for forty minutes. Each tooth was then aseptically split and placed in an individual test tube with growth medium. Samples were examined for evidence of growth (turbidity) at forty-eight hours. Only autoclaving for forty minutes at 240 degrees F and 20 psi or soaking in 10 percent formalin for one week were 100 percent effective in preventing growth. A chi-square analysis of the data indicates these two methods were significantly better than all other methods (p<0.001).

A comparison of porous and non-porous teflon membranes plus demineralized freeze-dried bone allograft in the treatment of class II buccal/lingual furcation defects: a clinical reentry study.

BACKGROUND: The aim of this 9-month reentry study was to compare the regenerative healing using porous (P) and non-porous (NP) teflon barrier membranes plus demineralized freeze dried bone allografts (DFDBA) in Class II buccal/lingual furcation defects. METHODS: Twenty-four patients, 13 males and 11 females, ages 38 to 75 (mean 54 +/- 10), were included in this study. Each patient had adult periodontitis and one Class II furcation defect measuring > or = 3 mm open horizontal probing depth. Twelve patients were randomly selected to receive the NP treatment and 12 received the P membrane. All defects received a DFDBA graft. Measurements were performed by a masked examiner. RESULTS: No statistically significant differences (P>0.05) were found between NP and P groups at any time with respect to any open or closed measure. Improvement in mean open horizontal probing depth was significant for both the NP (2.33 +/- 0.78 mm) and P (2.75 +/- 0.75 mm) groups. Mean clinical attachment level gains at 9 months were significant for both NP (1.50 +/- 1.62 mm) and P (2.50 +/- 2.11 mm) groups. Seventeen of 24 defects had an intrabony component and > or = 50% fill was obtained in 100% of these defects. CONCLUSIONS: The results of this 9-month reentry study comparing the use of porous and non-porous barrier membranes with a DFDBA graft indicate that there were no statistically significant differences between groups. Both groups showed a statistically significant improvement following the treatment of Class II furcation defects in humans.

The management of mature cystic teratomas in children and adolescents: a retrospective analysis.

Mature cystic teratomas (MCT) are the most common ovarian tumours seen in children and adolescents. Fifty-two patients <21 years of age had surgical removal of an MCT, 14 of whom were approached laparoscopically. Compared with laparotomy, those patients managed laparoscopically had a significantly shorter hospital stay. Intra-operative tumour spillage occurred in 27 (52%) patients; there were no cases of chemical peritonitis. Available follow-up data on 34 (65%) patients revealed seven pregnancies occurring at a median of 70 months (46-123) postoperatively, including four in patients with intraoperative MCT spill. There were no cases of tumour recurrence during the follow-up period among the 27 (52%) patients managed with ovarian cystectomy. These results demonstrate that some of the conclusions regarding the contemporary management of MCT in adults are applicable to children and adolescents.

Comparison of three intra-oral storage phosphor systems using subjective image quality.

OBJECTIVE: To compare the subjective image quality of three intra-oral storage phosphor systems. METHODS: DenOptix (Dentsply/Gendex, Chicago, IL, USA), Digora (Soredex, Helsinki, Finland), and CD-Dent (DigiDent Digital Imaging Technologies, Nesher, Israel) were compared. Two different imaging plates (IPs), BAS300 and HR300 (Fuji Photo Film Co., Tokyo, Japan) were used with the DenOptix system. The specimen was the maxilla and surrounding soft tissues of an adult cadaver. Imaging was at 70 kVp and 8 mA with a focus-detector distance of 38 cm using an optical bench. The exposure times were varied and a panel of five dentists independently evaluated the images produced with each system/IP receptor for seven features; proximal caries, gingival soft tissues, cortical bone, root canal space, root apices, periodontal ligament space and endodontic instrument clarity on a three-interval confidence scale. The best three exposures were chosen according to the highest scores for each system. These images were re-read in random order a total of 10 times. Pair-wise comparisons were made by use of odd's ratio analysis. A 95% confidence interval was applied. RESULTS: Images made with the DenOptix system/BAS IP combination were perceived to have the best overall image quality. The DenOptix/HR IP combination and Digora were rated almost equally in second place. The DigiDent system was ranked inferior. The Digora was considered to be the best for demonstrating gingival soft tissues (P < 0.05) and the DenOptix/HR300 combination the best for clarity of endodontic instruments (P < 0.05). CONCLUSIONS: While the DenOptix/BAS 300 combination was rated highest overall, the ranking of image quality by modality was found to be task-dependent. Digora was rated best for demonstrating gingival soft tissues.

Dental endosseous implant assessments in a type 2 diabetic population: a prospective study.

Diabetes mellitus, a prevalent disorder worldwide, is associated with systemic adverse sequelae, such as wound healing alterations, which may affect osseointegration of dental implants. This prospective multicenter study assessed the success of 2-stage endosseous root-form implants (3 different implant systems) placed in the mandibular symphysis of 89 male type 2 diabetic subjects. The implants were uncovered approximately 4 months after placement, restored with an implant-supported, Hader bar clip-retained overdenture, and maintained at scheduled follow-up data collection examinations for 60 months after loading. Sixteen (9.0%) of the 178 implants failed. Life table methods calculated implant survival at approximately 88%, from prosthesis placement through the 60-month follow-up, and at approximately 90% from implant placement through the observation period. No implants failed between surgical placement and uncovering, 5 failed at uncovering, 7 failed after uncovering before prosthesis placement, and 4 failed after prosthesis placement. Fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) values were determined before implant placement (baseline) and approximately 4 months later at surgical uncovering (follow-up). The 5-year implant outcomes (successes versus failures) were analyzed against the following predictor variables: (1) baseline and follow-up FPG values, (2) baseline and follow-up HbA1c values, (3) subject age, (4) duration of diabetes (years), (5) baseline diabetic therapy, (6) smoking history, and (7) implant length. Regression analysis found only duration of diabetes (P < .025) and implant length (P < .001) to be statistically significant predictors of implant failure. There was no statistically significant difference in failure rates between the 3 different implant systems used. This study supports the use of dental implants in type 2 diabetic patients.