Impact of different evaluation methods for diagnostic tasks in panoramic radiography / Impacto de diferentes métodos de evaluación durante el diagnóstico en la radiografía panorámica

Abstract The aim of this study was to evaluate the observers diagnostic performance in panoramic radiography using monitor, tablet, X-ray image view box, and against window daylight as a visualization method in different diagnostic tasks. Thirty panoramic radiography were assessed by three calibrated observers for each visualization method, in standardized light conditions, concerning dental caries, widened periodontal ligament space, and periapical bone defects from the four first molars; mucosal thickening and retention cysts in maxillary sinus; and stylo-hyoid ligament calcification and atheroma. A five-point confidence scale was used. The standard-reference was performed by two experienced observers. Diagnostic values using window light were significantly lower for caries and periapical bone defect and retention cyst, stylo-hyoid ligament calcification detection (p<0.05). For atheroma detection, X-ray image view box, tablet, and widow light had lower accuracy than the evaluation on the monitor (p<0.05). Observers diagnostic performances are worsened using window light as an evaluation method for panoramic radiography for dental, sinus, and calcification disorders, while the monitor was the most reliable method.

Resumen El objetivo de este estudio fue evaluar el desempeño diagnóstico de los observadores en la radiografía panorámica utilizando monitor, tablet, caja de visualización de imágenes de rayos X y contra la luz del día de la ventana como método de visualización en diferentes tareas de diagnóstico. Treinta radiografías panorámicas fueron evaluadas por tres observadores calibrados para cada método de visualización, en condiciones de luz estandarizadas, con respecto a caries dental, espacio del ligamento periodontal ensanchado y defectos óseos periapicales de los cuatro primeros molares; engrosamiento de la mucosa y quistes de retención en el seno maxilar; y calcificación y ateroma del ligamento estilohioideo. Se utilizó una escala de confianza de cinco puntos. La referencia estándar fue realizada por dos observadores experimentados. Los valores diagnósticos con luz de ventana fueron significativamente menores para caries y defecto óseo periapical y quiste de retención, detección de calcificación del ligamento estilohioideo (p <0.05). Para la detección de ateroma, la caja de visualización de imágenes de rayos X, el tablet y la luz de viuda tuvieron una precisión menor que la evaluación en el monitor (p <0.05). El rendimiento diagnóstico del observador empeora al utilizar la luz de la ventana como método de evaluación de la radiografía panorámica para los trastornos dentales, de los senos nasales y de la calcificación, mientras que el monitor fue el método más fiable.

Evaluation of Radiopacity of Luting Cements Submitted to Different Aging Procedures.

PURPOSE: To evaluate the radiopacity of luting cements submitted to different aging procedures. MATERIALS AND METHODS: Twenty discs (1 × 4 mm) of each of the following cements were prepared: zinc phosphate, RelyX Luting 2, Variolink 2, AllCem, RelyX U200, Multilink, Panavia F2.0, and RelyX ARC. Then, they were randomly divided into two groups (n = 10/group), according to the aging procedure: thermal cycling group and water storage group. Before and after aging procedures, specimens were x-rayed with an aluminum step-wedge (11 steps, 1 mm thick each) and three dental slices (1 mm thick). The radiopacity was evaluated by means of optical density, which was measured using ImageJ software. The values were converted into millimeters of aluminum with a logistic regression calibration curve. The data were analyzed by one-way ANOVA and Tukey post-hoc test (α = 0.05). RESULTS: In the thermal cycling group, RelyX Luting 2, RelyX U200, and Panavia F2.0 showed a statistically significant reduction in radiopacity (p < 0.05). In the water storage group, all cements showed a significant reduction in radiopacity (p < 0.05), and RelyX Luting 2 and Panavia F2.0 performed below the desired ISO 4049 standard. CONCLUSIONS: The radiopacity of luting cements can decrease after aging, especially after 1-year water storage.

Influence of cone-beam computed tomography image artifacts on the determination of dental arch measurements.

OBJECTIVE: To compare dental plaster model (DPM) and cone-beam computed tomography (CBCT) in the measurement of the dental arches, and investigate whether CBCT image artifacts compromise the reliability of such measurements. MATERIALS AND METHODS: Twenty patients were divided into two groups based on the presence or absence of metallic restorations in the posterior teeth. Both dental arches of the patients were scanned with the CBCT unit i-CAT, and DPMs were obtained. Two examiners obtained eight arch measurements on the CBCT images and DPMs and repeated this procedure 15 days later. The arch measurements of each patient group were compared separately by the Wilcoxon rank sum (Mann-Whitney U) test, with a significance level of 5% (α  =  .05). Intraclass correlation measured the level of intraobserver agreement. RESULTS: Patients with healthy teeth showed no significant difference between all DPM and CBCT arch measurements (P > .05). Patients with metallic restoration showed significant difference between DPM and CBCT for the majority of the arch measurements (P > .05). The two examiners showed excellent intraobserver agreement for both measuring methods with intraclass correlation coefficient higher than 0.95. CONCLUSION: CBCT provided the same accuracy as DPM in the measurement of the dental arches, and was negatively influenced by the presence of image artifacts.

In vitro comparison of cone beam computed tomography with different voxel sizes for detection of simulated external root resorption.

The present study compared the efficacy of cone beam computed tomography using different voxel sizes in the diagnosis of simulated external root resorption. The presence or absence of simulated defects on buccal, mesial and distal root surfaces of 20 premolars was evaluated. The defects were small (0.26 mm in diameter and 0.08 mm deep), medium (0.62 mm in diameter and 0.19 mm deep) and large (1.05 mm in diameter and 0.24 mm deep), equally distributed on each root surface. Images were obtained using Classic i-CAT cone beam computed tomography with different voxel sizes: 0.12, 0.20, 0.25 and 0.30 mm. Five oral radiologists evaluated the images. Accuracy, sensitivity, specificity, positive and negative predictive values were determined. The sensitivity decreased and specificity increased as voxel size increased. Accuracy values were the highest for the smallest voxel size (0.12 mm). The results for voxel sizes 0.20 mm and 0.25 mm were similar. Positive and negative predictive values were similar in all protocols, except with 0.30 mm, in which they were the lowest. In conclusion, external root resorption was more easily diagnosed when a smaller voxel size was used.

Oral streptococci growth on aging and non-aging esthetic restorations after radiotherapy.

The aim of this study was to examine Streptococcus mutans biofilm growth on both aged and non-aged restorative dental resins, which were submitted to therapeutic irradiation. Sixty-four disks of an esthetic restorative material (Filtek Supreme) were divided into 2 groups: aged group (AG) and a non-aged group (NAG). Each group was subdivided into 4 subgroups: non-irradiated and irradiated with 10Gy, 35Gy, and 70Gy. The biofilms were produced by Streptococcus mutans UA159 growing on both AG and NAG surfaces. The colony-forming units per mL (CFU/mL) were evaluated by the ANOVA and the Tukey LSD tests (α=0.05). AG presented smaller amounts of CFU/mL than the NAG before irradiation and after 10Gy of irradiation (p<0.05). AG irradiated with 35 and 70Gy showed increased amount of bacterial biofilm when compared to non-irradiated and 10Gy-irradiated disks (p<0.05). The exposure to ionizing radiation at therapeutic doses promoted changes in bacterial adherence of aged dental restorative material.

Ultrastructural assessment of the radioprotective effects of sodium selenite on parotid glands in rats.

The aim of this study was to assess the radioprotective effects of sodium selenite on parotid glands in rats by ultrastructural analysis of acinar cells. Four experimental groups were assessed; control, irradiated, selenium, and selenium/irradiated. The sodium selenite dose was 0.5 mg/kg, administered intraperitoneally 24 h before irradiation in the head and neck region with a single 15-Gy dose of gamma radiation. At 4, 8, 12, 48 and 72 h after irradiation, all animals were sacrificed and the parotid glands were removed. Radiation caused cellular changes from 4 h, and the organelles that presented the greatest alterations were the mitochondria and the secretion glands; nuclear alterations were also observed. Sodium selenite was found to have a radioprotective action, as the selenium/irradiated group presented with less damage when compared to the irradiated group. However, sodium selenite caused cellular alterations that were evident after 8 h, but with less damage when compared to those caused by radiation, which demonstrates a favorable risk-benefit for its use as a radioprotector. Thus, this research shows that sodium selenite has an effective radioprotective action in the parotid gland, which may contribute to the reduction of the adverse effects brought by the radiotherapy.

Oral streptococci growth on aging and non-aging esthetic restorations after radiotherapy

The aim of this study was to examine Streptococcus mutans biofilm growth on both aged and non-aged restorative dental resins, which were submitted to therapeutic irradiation. Sixty-four disks of an esthetic restorative material (Filtek Supreme) were divided into 2 groups: aged group (AG) and a non-aged group (NAG). Each group was subdivided into 4 subgroups: non-irradiated and irradiated with 10Gy, 35Gy, and 70Gy. The biofilms were produced by Streptococcus mutans UA159 growing on both AG and NAG surfaces. The colony-forming units per mL (CFU/mL) were evaluated by the ANOVA and the Tukey LSD tests (α=0.05). AG presented smaller amounts of CFU/mL than the NAG before irradiation and after 10Gy of irradiation (p<0.05). AG irradiated with 35 and 70Gy showed increased amount of bacterial biofilm when compared to non-irradiated and 10Gy-irradiated disks (p<0.05). The exposure to ionizing radiation at therapeutic doses promoted changes in bacterial adherence of aged dental restorative material.

O objetivo deste estudo foi avaliar a formação do biofilme de Streptococcus mutans crescido em resina restauradora envelhecida e não-envelhecida, submetidas à radiação terapêutica. Sessenta e quatro discos do material restaurador Filtek Supreme foram divididos em 2 grupos: grupo envelhecido (AG) e grupo não-envelhecido (NAG) e cada grupo foi dividido em 4 sub-grupos: não-irradiado e irradiado com 10Gy, 35Gy e 70Gy. O biofilme de S. mutans UA159 foi produzido na superfície de ambos os discos AG e NAG. As unidades formadoras de colônia/mL (UFC/mL) foram avaliadas por ANOVA e teste de Tukey (α=0,05). O grupo AG demonstrou menores quantidades de UFC/mL que o grupo NAG antes da radiação e após a radiação de 10Gy (p<0,05). Os sub-grupos AG irradiados com 35 e 70Gy demonstraram aumento na quantidade de biofilme quando comparado aos não irradiados e irradiados com 10Gy (p<0,05). A exposição à radiação ionizante nas doses terapêuticas promoveu mudanças na aderência bacteriana no material restaurador.

Effect of X-ray radiation dose on the bond strength of different adhesive systems to dentin.

PURPOSE: To investigate the influence of different x-ray radiation doses on the bond strength of adhesive restorations to dentin using different bonding strategies. MATERIALS AND METHODS: Flat dentin surfaces on human molars were obtained and cylinder-shaped specimens for the microshear bond test were built up with a composite (Z250, 3M ESPE), using three adhesive systems: a two-step etch-and-rinse (Single Bond 2--SB2, 3M ESPE), a two-step self-etching (Clearfil SE Bond--CSE, Kuraray), or a single-step self-etching (Adper Prompt--ADP, 3M ESPE). The specimens were assigned to 4 groups (n = 10), according to the x-ray dose: 0 (control), 5, 35, or 70 Gy. Radiation was directed to the surface of the resin cylinders. Microshear testing was conducted after 24 h, and the failure modes classified under magnification (200X). Data were submitted to two-way ANOVA and Holm-Sidak's test (p < or = 0.05). A nonlinear regression analysis was carried out with bond strength as dependent variable. RESULTS: Bond strength results were dose and material dependent. SB2: control > 5 = 35 > 70; CSE: control = 5 > 35 = 70; ADP: control = 5 = 35 = 70. Generally, SB2 > CSE > ADP. The nonlinear regression plots showed that in general, an increase in radiation dose may predict a decrease in bond strength (R2 > or = 0.905). Failure modes were dependent on the bonding system, generally with no significant influence of radiation. CONCLUSION: X-ray radiation might present a dose-dependent detrimental effect on the bond strength of resin composite restorations to dentin.

Alternative erasing times of the DenOptix system plate: performance on the detection of proximal caries.

OBJECTIVE: Our aim was to investigate the DenOptix system for detection of proximal caries using alternative erasing times for the photostimulable phosphor plates. STUDY DESIGN: Human teeth were X-rayed with phosphor plates using different erasing times. Five observers evaluated the images for the presence of caries by scoring the proximal surfaces of each tooth. Mean pixel intensity analyses were also carried out. The erasing times were evaluated using receiver operating characteristic (ROC) curve analysis. Analysis of variance for differences among erasing times and pixel intensity values was performed, followed by linear regression analysis for correlation between these variables. RESULTS: The mean ROC curve for each erasing time varied from 0.61 to 0.66 (not significant). Analysis of variance did not show any significant effect of the erasing times on the pixel intensity values of the images (P > .05). CONCLUSION: Erasing times for DenOptix phosphor plates from 20 to 130 s were satisfactory for diagnosis of proximal caries, and their use is therefore feasible in clinical practice.

Imaging findings of Ewing's sarcoma in the mandible.

First described by James Ewing in 1921, Ewing's sarcoma (ES) or Ewing's tumor is one of the most aggressive bone tumors known. ES is an uncommon intra-osseous malignant tumor of questionable pathogenesis that occurs in children and young adults. Reports indicate that only 2 to 7% of cases involve the maxillofacial region, usually the mandible ramus, and few reported cases have involved the maxilla. In the present report of a case of ES of the mandible, we describe the results of imaging and evaluation after therapeutic treatment. This report provides a rare opportunity to observe radiologic features of ES in the mandible.

Avaliação do efeito radioprotetor do selenito de sódio no processo de reparação tecidual em ratos / Evaluation of the radioprotective effect of sodium selenite in the tissue repair process in rats

OBJETIVO: Avaliar a ação radioprotetora do selenito de sódio no processo de reparação tecidual. MATERIAIS E MÉTODOS: Ratos Wistar foram submetidos a procedimento cirúrgico para a realização de ferida na região dorsal. Os animais foram divididos em quatro grupos experimentais: controle, selênio, irradiado e selênio-irradiado. Os grupos selênio e selênio-irradiado receberam 2,0 mg/kg de selenito de sódio, 48 horas após a cirurgia. Os grupos irradiado e selênio-irradiado foram submetidos à irradiação em dose única de 6 Gy, administrada somente nas bordas das feridas. Após 4, 7, 13 e 21 dias do procedimento cirúrgico, os animais foram sacrificados e avaliados por meio de análise morfológica, histoquímica e birrefringência do tecido. RESULTADOS: O aspecto estrutural e morfológico, assim como a qualidade do tecido e sua maturação através da quantidade e disposição dos feixes de fibras colágenas, juntamente com o seu grau de orientação macromolecular, permitiu observar a presença de intenso retardo provocado pela irradiação, bem como o efeito radioprotetor do selenito de sódio no processo de reparação. CONCLUSÃO: Dentro das condições experimentais utilizadas, o selenito de sódio apresentou-se como radioprotetor eficaz, visto que o processo de reparação no grupo selênio-irradiado comportou-se, histologicamente, semelhante ao grupo controle.

OBJECTIVE: To evaluate the radioprotective effect of sodium selenite in the tissue repair process. MATERIALS AND METHODS: Male Wistar rats submitted to a surgical procedure to produce a wound in the dorsal region. These animals were then divided in four experimental groups: control, selenium, irradiated and selenium-irradiated. The selenium and selenium-irradiated groups received sodium selenite (2.0 mg/kg), 48 hours after surgery. The irradiated and selenium-irradiated groups received a single dose of 6 Gy, administered only in the borders of the wound. The animals were sacrificed after 4, 7, 13 and 21 days after surgery and morphological, histochemical and tissue birefringence analyses were performed. RESULTS: The structural and morphologic aspects, as well as the quality and maturation of the tissue assessed by the amount, arrangement and molecular orientation of the collagen fibers, showed a marked delay in wound healing caused by radiation and that sodium selenite has a radioprotective effect on the tissue repair process. CONCLUSION: The present study showed that sodium selenite is an efficient radioprotector given the fact that tissue repair process in the selenium-irradiated group was histologically similar to the control group.

As alterações radiográficas digitais efetuadas em programas gráficos são identificáveis? / Can manipulations on the digital radiographs using image processing softwares be recognizable?

As radiografias digitais, assim como as radiografias convencionais digitalizadas, podem facilmente ser modificadas por técnicas de processamento de imagens, tais como ajuste de contraste e brilho, realce de bordas, e outras, que contribuem para o aumento do seu potencial diagnóstico. Por outro lado, estas radiografias também podem ser manipuladas pela alteração, adição ou remoção de objetos na imagem. Para testar o potencial para uso fraudulento destas alterações, os autores alteratam uma série de radiografias digitais, utilizando programas de processamento de imagens, e submeteram estas à avaliação de 142 cirurgiões dentistas, que tentaram indentificá-las por meio do preenchimento de um questionário.