Impact of dental imaging on pregnant women and recommendations for fetal radiation safety: A systematic review.

Purpose: This study was conducted to investigate the safety of dental imaging in pregnant women with respect to fetal health. Materials and Methods: Searches were conducted of the PubMed, Scopus, and Web of Science databases in May 2023. The inclusion criteria encompassed cross-sectional and longitudinal studies that focused on the analysis of diagnostic dental imaging in pregnant women, as well as studies utilizing phantoms to simulate imaging examinations. The exclusion criteria consisted of reviews, letters to the editor, book chapters, and abstracts from scientific conferences and seminars. Results: A total of 3,913 articles were identified. Based on a review of the titles and abstracts, 3,892 articles were excluded, leaving 21 articles remaining for full-text review. Of these, 18 were excluded, and 4 additional articles were included as cross-references. Ultimately, 7 articles underwent quantitative-qualitative analysis. Three retrospective studies were focused on pregnant women who underwent dental imaging procedures. The remaining 4 studies utilized female phantoms to simulate imaging examinations and represent the radiation doses absorbed by the uterus or thyroid. Conclusion: Few dental radiology studies have been conducted to determine the safe radiation threshold for pregnant women. Additionally, the reviewed articles did not provide numbers of dental examinations, by type, corresponding to this dose. Dental imaging examinations of pregnant women should not be restricted if clinically indicated. Ultimately, practitioners must be able to justify the examination and should adhere to the "as low as diagnostically acceptable, being indication-oriented and patient-specific" (ALADAIP) principle of radioprotection.

Influência do tipo de compósito e tempo de exposição aos raios-x na produção de artefatos radiográficos em modelo de restaurações classe II / Influence of the composite type and exposure time to x-rays on the production of radiographic artifacts in a class II restoration model

Aim: To evaluate the effect of the exposure time and the type of composite in the production of radiographic artifact at the tooth / restorative interface. Materials and Methods: In 20 healthy bovine incisors, cavity preparations and class II restorations were made using composite resins Filtek Bulk Fill One (group 1) and Filtek Z350 (group 2). Then, the teeth were exposed to obtain digital radiographs, varying the exposure time by 0.07, 0.10, 0.14, 0.20 and 0.25s. The images were evaluated for investigation of the presence of artifact through the analysis of the modified number of pixels (QPXD) and the average gray value in class II (MGVR) restorations, using the Image J software (National Health Institute). Results: The presence of artifact was observed in all evaluated samples, regardless of the type of restorative material and the exposure time employed. There was no statistically significant difference in QPXD and MGVR between the resins used (ANOVA 2 factors, p p> 0.05). The MGVR analysis indicated that there were no statistically significant differences between resins or between exposure times (p> 0.05). There was a correlation between QPXD and MGVR (r = 0.29) for Filtek Bulk Fill One resin. Discussion: This study reveals the importance of attention to the region of the tooth-restoration interface by the Surgeon-Dentist, who must combine the radiographic findings diagnosed using digital tools to clinical signs in order to compose a unique therapeutic project with a real need for intervention, if there is such need. Conclusion: The presence of altered pixels on dentin in the region of the tooth-restoration interface was identified in all specimens. The variation in the exposure time as well as the type of the restorative composite did not influence the increase or decrease of QPXD and neither in MGVR. However, there was a correlation between QPXD and MGVR for Filtek Bulk Fill One resin.

Objetivo: Avaliar o efeito do tempo de exposição e do tipo de compósito na produção de artefato radiográfico na interface dente/material restaurador. Materiais e Métodos: Em 20 incisivos bovinos hígidos foram feitos preparos cavitários e restaurações classe II utilizando resinas compostas Filtek Bulk Fill One (grupo 1) e a Filtek Z350 (grupo 2). Em seguida, os dentes foram expostos para obtenção das radiografias digitais, variando o tempo de exposição em 0,07, 0,10, 0,14, 0,20 e 0,25s. As imagens foram avaliadas para investigação da presença de artefato através da análise do número de pixels modificado (QPXD) e do valor médio de cinza nas restaurações de classe II (MGVR), utilizando o software Image J (Instituto Nacional de Saúde, Bethesda, MD, EUA). Resultados: Observou-se a presença de artefato em toda amostra avaliada, independente de tipo de material restaurador e tempo de exposição empregado. Não se observou diferença estatisticamente significativa na QPXD e nos MGVR entre as resinas utilizadas (ANOVA 2 fatores, p p>0,05). A análise do MGVR indicou que não houve diferenças estatisticamente significativas entre as resinas nem entre os tempos de exposição (p>0,05). Observou-se uma correlação entre a QPXD e o MGVR (r=0,29) para a resina Filtek Bulk Fill One. Discussão: Como significado clínico, o presente estudo revela a importância da atenção à região da interface dente-restauração por parte do Cirurgião-Dentista, o qual deve aliar os achados radiográficos diagnosticados com o auxílio de ferramentas digitais aos sinais clínicos, para compor um projeto terapêutico singular com uma real necessidade de intervenção, caso haja. Conclusão: Foi identificado a presença de pixels alterados sobre a dentina na região da interface dente-restauração em todos os corpos de prova. A variação do tempo de exposição como também o tipo do compósito restaurador não influenciou no aumento ou diminuição do QPXD e nem tão pouco no MGVR. Contudo houve correlação entre o QPXD e o MGVR para a resina Filtek Bulk Fill One.

Niveles de referencia diagnósticos en equipos de radiografía dental en Bogotá, Colombia

Introducción: Las radiografías dentales son una de las exposiciones médicas más frecuentes a la radiación ionizante. El uso de radiación ionizante está asociado a un riesgo probable de desencadenar efectos biológicos adversos y posibles daños a la salud del paciente. Para evitar que los pacientes reciban dosis innecesariamente altas durante estas exposiciones, la Comisión Internacional de Protección Radiológica recomienda la utilización de los niveles de referencia para diagnóstico, como una herramienta efectiva de ayuda a la optimización de la protección radiológica de los pacientes. Objetivo: Estimar los niveles de referencia para diagnóstico en radiografía dental intraoral y panorámica en la ciudad de Bogotá, D. C. Metodología: Se evaluaron los parámetros de exposición radiográficos de los equipos y la calidad de imagen en 68 equipos de radiografía dental periapical y 23 equipos de radiografía panorámica. Se estimaron las magnitudes dosimétricas de kerma incidente en aire (Kai) en equipos intraorales para la radiografía de un maxilar molar de un adulto y el producto kerma aire-área (PKA) en equipos de radiografía panorámica en un examen de un adulto estándar. Resultados: El tercer cuartil de la distribución de kerma incidente en aire para radiografía intraoral fue de 3,3 mGy y del producto kerma aire-área para radiografía panorámica fue de 103,9 mGycm2. En la distribución de frecuencias de kerma incidente en aire para radiografía intraoral, el porcentaje más alto de equipos estuvo en el rango de 2,0-3,0 mGy. En la distribución de frecuencias del producto kerma aire-área para los equipos de radiografía panorámica, el porcentaje más alto de equipos estuvo en el rango de 60 a 80 mGycm2. Discusión: Las instituciones consideradas para establecer los Niveles de Referencia para Diagnóstico en este estudio contaron con una adecuada calidad de la imagen evaluada con un maniquí dental, pero las variaciones en las dosis de radiación entre instituciones señalan la necesidad de implementar herramientas que contribuyan a la optimización de las prácticas. Conclusiones: Se recomienda usar los valores de los niveles de referencia para diagnóstico encontrados en esta investigación para optimizar la protección radiológica en las exposiciones radiológicas dentales, y se espera que este estudio sirva de base para nuevas investigaciones en las demás ciudades del país.

Introduction: Dental X-rays are one of the most frequent medical exposures to ionizing radiation. The use of ionizing radiation is associated with a probable risk of triggering adverse biological effects and possible damage to the patient's health. To prevent patients from receiving unnecessarily high doses during these exposures, the International Commission on Radiological Protection recommends the use of diagnostic reference levels as an effective tool to help optimize radiological protection for patients. Objective: To estimate diagnostic reference levels in intraoral and panoramic dental radiography in the city of Bogotá, D.C. Methodology: In 68 periapical dental radiography equipment and 23 panoramic radiography equipment, the radiographic exposure parameters of the equipment and image quality were evaluated. The dosimetric magnitudes of incident air kerma (Ka,i) in intraoral equipment for the radiography of a maxillary molar of an adult and the air kerma-area product (PKA) in panoramic radiography equipment in a standard adult examination were estimated. Results: The third quartile of the incident air kerma distribution for intraoral radiography was 3,3 mGy and the air kerma-area product for panoramic radiography was 103,9 mGycm2. In the frequency distribution of incident air kerma for intraoral radiography, the highest percentage of equipment was in the range of 2,0-3,0 mGy, and in the frequency distribution of the air kerma-area product for equipment of panoramic radiography, the highest percentage of the equipment was in the range of 60 to 80 mGy cm2. Discussion: The institutions considered to establish the diagnostic reference levels in this study had an adequate quality of the image evaluated with a dental phantom, but the variations in radiation doses between institutions indicate the need to implement tools that contribute to the optimization of the practices. Conclusions: It is recommended to use the values of the diagnostic reference levels found in this research to optimize radiological protection in dental radiological exposures, and it is expected that this study will serve as a basis for further research in other cities of the country.

Dental age estimation in Indonesian adults: An investigation of the maxillary canine pulp-to-tooth volume ratio using cone-beam computed tomography.

Purpose: This study was performed to develop a linear regression model using the pulp-to-tooth volume ratio (PTVR) ratio of the maxillary canine, assessed through cone-beam computed tomography (CBCT) images, to predict chronological age (CA) in Indonesian adults. Materials and Methods: A sample of 99 maxillary canines was collected from patients between 20 and 49.99 years old. These samples were obtained from CBCT scans taken at the Universitas Padjadjaran Dental Hospital in Indonesia between 2018 and 2022. Pulp volume (PV) and tooth volume (TV) were measured using ITK-SNAP, while PTVR was calculated from the PV/TV ratio. Using RStudio, a linear regression was performed to predict CA using PTVR. Additionally, correlation and observer agreement were assessed. Results: The PTVR method demonstrated excellent reproducibility, and a significant correlation was found between the PTVR of the maxillary canine and CA (r=-0.74, P<0.01). The linear regression analysis showed an R2 of 0.58, a root mean square error of 5.85, and a mean absolute error of 4.31. Conclusion: Linear regression using the PTVR can be effectively applied to predict CA in Indonesian adults between 20 and 49.99 years of age. As models of this type can be population-specific, recalibration for each population is encouraged. Additionally, future research should explore the use of other teeth, such as molars.

A pilot study of half-value layer measurements using a semiconductor dosimeter for intraoral radiography.

Purpose: This pilot study was conducted to evaluate half-value layer (HVL) measurements obtained using a semiconductor dosimeter for intraoral radiography. Materials and Methods: This study included 8 aluminum plates, 4 of which were low-purity (less than 99.9%) and 4 high-purity (greater than 99.9%). Intraoral radiography was performed using an intraoral X-ray unit in accordance with the dental protocol at the authors' affiliated hospital: tube voltage, 60 kVp and 70 kVp; tube current, 7 mA; and exposure time, 0.10 s. The accuracy of HVL measurements for intraoral radiography was assessed using a semiconductor dosimeter. A simple regression analysis was performed to compare the aluminum plate thickness and HVL in relation to the tube voltage (60 kVp and 70 kVp) and aluminum purity (low and high). Results: For the low-purity aluminum plates, the HVL at 60 kVp (Y) and 70 kVp (Y) was significantly correlated with the thickness of the aluminum plate (X), with Y = 1.708 + 0.415X (r=0.999, P<0.05) and Y = 1.980 + 0.484X (r=0.999, P<0.05), respectively. Similarly, for the high-purity aluminum plates, the HVL at 60 kVp (Y) and 70 kVp (Y) was significantly correlated with the plate thickness (X), with Y = 1.696 + 0.454X (r=0.999, P<0.05) and Y = 1.968 + 0.515X (r=0.998, P<0.05), respectively. Conclusion: This pilot study examined the relationship between aluminum plate thickness and HVL measurements using a semiconductor dosimeter for intraoral radiography. Semiconductor dosimeters may prove useful in HVL measurement for purposes such as quality assurance in dental X-ray imaging.

Efficiency and accuracy of artificial intelligence in the radiographic detection of periodontal bone loss: A systematic review.

Purpose: Artificial intelligence (AI) is poised to play a major role in medical diagnostics. Periodontal disease is one of the most common oral diseases. The early diagnosis of periodontal disease is essential for effective treatment and a favorable prognosis. This study aimed to assess the effectiveness of AI in diagnosing periodontal bone loss through radiographic analysis. Materials and Methods: A literature search involving 5 databases (PubMed, ScienceDirect, Scopus, Health and Medical Collection, Dentistry and Oral Sciences) was carried out. A specific combination of keywords was used to obtain the articles. The PRISMA guidelines were used to filter eligible articles. The study design, sample size, type of AI software, and the results of each eligible study were analyzed. The CASP diagnostic study checklist was used to evaluate the evidence strength score. Results: Seven articles were eligible for review according to the PRISMA guidelines. Out of the 7 eligible studies, 4 had strong CASP evidence strength scores (7-8/9). The remaining studies had intermediate CASP evidence strength scores (3.5-6.5/9). The highest area under the curve among the reported studies was 94%, the highest F1 score was 91%, and the highest specificity and sensitivity were 98.1% and 94%, respectively. Conclusion: AI-based detection of periodontal bone loss using radiographs is an efficient method. However, more clinical studies need to be conducted before this method is introduced into routine dental practice.

A Importância dos Métodos de Determinação das Idades Esquelética e Dentária na Ortodontia e Odontopediatria ­ uma Revisão de Literatura / The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry ­ a Literature Review

O estágio de desenvolvimento humano é intimamente relacionado à sua maturidade óssea ou dentária, sendo essencial para a escolha do tratamento de alterações dentofaciais em crianças e adolescentes por ortodontistas e odontopediatras. Existem diversos indicadores biológicos para determinar a maturação do indivíduo, como a idade cronológica e as alterações hormonais, porém esses indicadores podem sofrer interferências. Visando uma determinação de desenvolvimento e dos picos de crescimento mais precisa, para um melhor diagnóstico e plano de tratamento, foram desenvolvidos diversos métodos para determinar a idade esquelética e a idade dentária, sendo estes a avaliação da maturação carpal, da morfologia das vértebras cervicais, da fusão óssea da sincondrose esfeno-occipital e da sutura palatina mediana, bem como dos estágios da calcificação dentária. A avaliação das radiografias de mão e punho é o padrão ouro da predição da idade esquelética, e sua correlação com outros métodos já é evidente. Sendo assim, é possível utilizar a avaliação das vértebras cervicais e das idades dentárias de Nolla e Demirjian.

The stage of human development is closely related to bone or dental maturity, being essential for the choice of treatment for dentofacial changes in children and adolescents by orthodontists and pediatric dentists. There are several biological indicators to determine an individual's maturation, such as chronological age and hormonal changes, but these indicators can suffer interference. Aiming at a more accurate determination of development and growth peaks, for a better diagnosis and treatment plan, several methods have been developed to determine skeletal age and dental age, these being the assessment of carpal maturation, the morphology of the cervical vertebrae, bone fusion of the spheno-occipital synchondrosis and the median palatal suture, as well as the stages of dental calcification. The evaluation of hand and wrist radiographs is the gold standard for predicting skeletal age, and its correlation with other methods is already evident. Therefore, it is possible to use the assessment of cervical vertebrae and dental ages by Nolla and Demirjian.

Avaliação da profundidade da cárie proximal nos exames radiográfico convencional e digitalizado / Evaluation of the size of proximal caries in radiography and digitized

Introdução: A cárie dentária é uma doença multifatorial que compreende vários fatores biológicos e sociais. A superfície proximal dos dentes é uma região de difícil visualização que pode esconder pequenas lesões cariosas no esmalte dentário, impossibilitando o diagnóstico através de inspeções visuais e táteis. Objetivo: O objetivo deste trabalho foi avaliar a profundidade da cárie proximal nos exames radiográficos convencionais e digitais, comparando as profundidades das lesões consideradas nestes exames às do exame histológico. Método: Foram utilizados exames radiográficos interproximais de 40 dentes humanos, 20 pré-molares e 20 molares, com alterações clínicas em uma das superfícies proximais, como lesões de mancha branca ou acastanhada e pequenas cavitações. Três profissionais especializados em radiologia odontológica com mais de cinco anos de experiência clínica mediram a profundidade das lesões pelos exames radiográfico e digital das amostras. Para obter os resultados, utilizou-se a técnica de análise de variância (ANOVA). Resultados: Constatou-se um nível de significância de 5% nas mensurações dos exames radiográficos convencionais e digitalizados, mostrando a fidelidade das imagens radiográficas em relação a real profundidade da lesão. Conclusão: Conclui-se que os exames de imagem avaliados foram eficientes na determinação da profundidade das lesões de cárie proximal.

Introduction: Dental caries is a multifactorial disease that comprises several biological and social factors. The proximal surface of the teeth is a region of difficult visualization that can hide small carious lesions in the dental enamel, making diagnosis through visual and tactile inspection infeasible. Objective: The objective of this study was to evaluate the depth of proximal caries in the conventional and digitized radiographic examinations, comparing the depths of the lesions considered in these examinations to those of the histological examination. Method: Interproximal radiographic examinations of 40 human teeth, 20 premolars and 20 molars, with clinical alterations on one of the proximal surfaces, such as white or brown spot lesions and small cavitations, were used. Three professionals specialized in dental radiology with more than five years of clinical experience measured the depth of the lesions by radiographic examination of the samples. To obtain the results, we used the technique of analysis of variance (ANOVA). Results: A level of significance of 5% was found in conventional and digitized radiographic measurements, showing the fidelity of the radiographic images in relation to the actual depth of the lesion. Conclusion: It was concluded that the imaging tests evaluated were efficient in determining the depth of proximal caries lesions.

Assessment of infection control in oral radiology during the COVID-19 outbreak: An international collaborative study.

Purpose: In the context of COVID-19, studies evaluating the adherence of dentists and dental students to infection control are relevant due to their high occupational exposure and risk, as well as their responsibility for disseminating information and good practices. This study evaluated the adherence of dentists and dental students to infection control in the oral radiology field in the setting of the COVID-19 pandemic on different continents. Materials and Methods: This cross-sectional observational study involved individuals who performed intraoral radiographic examinations during the COVID-19 pandemic. The Questionnaire on Infection Control in Oral Radiology was administered virtually using a Google Form. Participants from different continents (the Americas, Africa, Europe, Asia, and Oceania) were recruited. Data were subjected to descriptive analysis and simple and multiple binary regression (5%). Results: There were 582 valid answers, and 68.73% of the participants were from the Americas, 18.90% from Europe, and 12.37% from Asia. The median score for infection control protocols was 94 points for dental students and 104 points for dentists, and participants below the median were considered to have low adherence to infection control in oral radiology. Low access to infection control was found for 53.0% of dentists in the Americas, 34.0% from Europe, and 26.9% from Asia. Conclusion: The adherence to infection control protocols in oral radiology was low even in the face of the COVID-19 pandemic. The results may help improve the awareness of students and professionals, since oral radiology routines have the potential for transmitting COVID-19.

Radiolucent image in lower third molar: hidden caries or pre-eruptive resorption?: a case report / Imagem radiolucente em terceiro molar inferior: cárie oculta ou reabsorção pré-eruptiva?: um relato de caso

ABSTRACT Caries is a multifactorial disease due to the imbalance of the de/re-mineralization process. Complementary radiographic examinations are able to detect hidden caries. The purpose of this short communication was to investigate the radiolucent image suggestive of hidden caries in lower third molar. The extraction of the tooth, decalcification, inclusion and preparation were performed for histological analysis of the lesion. Histological findings revealed a pre-eruptive resorption, and the etiological factors of this coronary resorption were undefined. The professional should be aware of the occurrences of these lesions to early diagnose and propose appropriate treatment to avoid future complications to the patient.

RESUMO A cárie é conceituada como uma doença multifatorial condicionada ao desequilíbrio no processo de desmineralização e remineralização das estruturas dentárias. O propósito desse trabalho foi investigar a imagem radiolúcida sugestiva de cárie oculta em terceiro molar. Foi realizado a exodontia do elemento dentário, descalcificação e confecção de lâminas para posterior estudo histológico da lesão. O achado histológico conclui-se tratar de uma reabsorção pré-eruptiva. O profissional deve estar atento às ocorrências dessas lesões para diagnosticar precocemente e propor o tratamento adequado, evitando complicações futuras ao paciente.

Development and validation of a clinical phantom reproducing various lesions for oral and maxillofacial radiology research.

Purpose: The objective of this study was to propose a method for developing a clinical phantom to reproduce various diseases that are clinically prevalent in the field of dentistry. This could facilitate diverse clinical research without unnecessarily exposing patients to radiation. Material and Methods: This study utilized a single dry skull, which was visually and radiographically examined to evaluate its condition. Existing lesions on the dry skull were preserved, and other relevant lesions were artificially created as necessary. These lesions were then documented using intraoral radiography and cone-beam computed tomography. Once all pre-existing and reproduced lesions were confirmed by the consensus of 2 oral and maxillofacial radiologists, the skull was embedded in a soft tissue substitute. To validate the process, cone-beam computed tomography scans and panoramic radiographs were obtained of the fabricated phantom. All acquired images were subsequently evaluated. Results: Most lesions could be identified on panoramic radiographs, although some sialoliths and cracked teeth were confirmed only through cone-beam computed tomographic images. A small gap was observed between the epoxy resin and the bone structures. However, 2 oral and maxillofacial radiologists agreed that this space did not meaningfully impact the interpretation process. Conclusion: The newly developed phantom has potential for use as a standardized phantom within the dental field. It may be utilized for a variety of imaging studies, not only for optimization purposes, but also for addressing other experimental issues related to both 2- and 3-dimensional diagnostic radiography.

Factors Influencing Anxiety Levels During Dental Radiographic Examination Among Dental Students

@#Introduction: : Dental anxiety was found to be related to the radiographic procedure and can be influenced by sociodemographic characteristics of patients such as age, gender, level of education, and provoking factors such as past dental examination experience. Evaluating the anxiety regarding dental radiographic examination could be beneficial in ensuring the procedure’s continuance. This study aimed to measure the radiology knowledge among dental students and its association with anxiety due to dental radiographic examination. Methods: A cross-sectional study was conducted to collect the data using a questionnaire packet that included a knowledge and anxiety questionnaire, demographic data, and information about the experience of dental radiographic examination. A total sampling of 1st and 2nd year undergraduate and clerkship dental students at the Faculty of Dentistry, Universitas Gadjah Mada, Indonesia was selected based on inclusion and exclusion criteria. Anxiety-related factors were assessed using descriptive statistics and multiple linear regression conducted with STATA 15.1. Results: Results showed that knowledge and anxiety were negatively correlated but the correlation was not statistically significant. Gender, radiographic technique, and presence/absence of a companion during the examination were not correlated with anxiety. Meanwhile, the anxiety level was negatively and significantly correlated with age and examination frequency (p < 0.05). Multiple linear regression results showed strong evidence that age and examination frequency were the main factors for predicting anxiety. Conclusion: Although age, radiographic examination frequency, and educational level are significant bivariate predictors of anxiety, subsequent regression analysis indicated that only age and radiographic examination frequency influence anxiety.

Calidad radiográfica obtenida por estudiantes de Odontología mediante la técnica de bisectriz

Objetivo: Evaluar la calidad radiográfica mediante técnica de la bisectriz ejecutada por estudiantes de Odontología de tercer año. Material y Método: Estudio observacional descriptivo. Se evaluaron 220 radiografías ejecutadas por 55 estudiantes de Odontología de tercer año. La calidad radiográfica fue evaluada por dos investigadores, mediante una pauta creada con cuatro parámetros: posición de la película, angulación horizontal, angulación vertical y rayos X centrado. Fue comparada la calidad según sector radiográfico, anterior y posterior. Se realizó estadística descriptiva y prueba de chi-2 para establecer diferencias entre calidad y sector radiográfico, con un valor de significancia estadística de p0.05. Conclusión: Las radiografías periapicales tomadas mediante técnica de la bisectriz por estudiantes de Odontología de tercer año, son mayoritariamente de calidad inaceptable, sin diferencias significativas entre sectores.

Objective: To evaluate radiographic quality using the bisecting angle technique performed by third-year dental students. Material and Method: Descriptive observational study. 220 radiographs were evaluated, performed by 55 third-year dental students. Radiographic quality was evaluated by two researchers, using a guideline created with four parameters: film position, horizontal angulation, vertical angulation and centered X-ray (conecut). The quality was compared according to the radiographic sector, anterior and posterior. Descriptive statistics and chi-2 test were applied to establish differences between radiographic sector and radiographic quality, setting a value of statistical significance of p 0.005. Conclusions: The periapical radiographs taken by third-year dental students using the bisecting angle technique is mostly of unacceptable quality, with no significant differences between sectors.

Clinical comparison of intraoral CMOS and PSP detectors in terms of time efficiency, patient comfort, and subjective image quality.

Purpose: This study compared the effectiveness of complementary metal-oxide semiconductors (CMOS) and photostimulable phosphor (PSP) plates as intraoral imaging systems in terms of time efficacy, patient comfort, and subjective image quality assessment in real clinical settings. Materials and Methods: Fifty-eight patients (25 women and 33 men) were included. Patients were referred for a full-mouth radiological examination including 1 bitewing radiograph (left and right) and 8 periapical radiographs for each side (left maxilla/mandible and right maxilla/mandible). For each patient, 1 side of the dental arch was radiographed using a CMOS detector, whereas the other side was radiographed using a PSP detector, ensuring an equal number of left and right arches imaged by each detector. Clinical application time, comfort/pain, and subjective image quality were assessed for each detector. Continuous variables were summarized as mean±standard deviation. Differences between detectors were evaluated using repeated-measures analysis of variance. P<0.05 was accepted as significant. Results: The mean total time required for all imaging procedures with the CMOS detector was significantly lower than the mean total time required for imaging procedures with PSP (P<0.05). The overall mean patient comfort scores for the CMOS and PSP detectors were 4.57 and 4.48, respectively, without a statistically significant difference (P>0.05). The performance of both observers in subjectively assessing structures was significantly higher when using CMOS images than when using PSP images for all regions (P<0.05). Conclusion: The CMOS detector was found to be superior to the PSP detector in terms of clinical time efficacy and subjective image quality.

Materiales de restauración dental / Dental restorative materials

Objetivo: Identificar los efectos que producen la utilización de materiales restauradores en los tejidos dentarios luego de utilizarlos como una solución funcional y estética ante los problemas provocados por cualquier tipo de microorganismo es necesario. Método: de tipo bibliográfica mediante una búsqueda de artículos en base PubMed y Scielo. Resultados: Se encontraron 30 artículos, de los cuales solo se pudieron utilizar 15 de ellos, ya que contribuyeron a cumplir con el objetivo de esta investigación y el resto no. Conclusiones: Los materiales dentales son la base fundamental de la odontología restauradora, protésica y de varias especialidades y procedimientos realizados por parte del odontólogo. Por lo tanto, es necesario tener conocimientos de cómo actúa cada uno de estos materiales restaurativos, con base en su estructura interna, para poder ver cuál va a ser su comportamiento físico, mecánico y fisicoquímico en su uso odontológico.

Objective: To identify the effects produced by the use of restorative materials on dental tissues after using them as a functional and esthetic solution to the problems caused by any type of microorganism. Method: bibliographic type by means of a search of articles in PubMed and Scielo databases. Results: 30 articles were found, of which only 15 of them could be used, since they contributed to fulfill the objective of this research and the rest could not. Conclusions: Dental materials are the fundamental basis of restorative dentistry, prosthetic dentistry and various specialties and procedures performed by the dentist. Therefore, it is necessary to have knowledge of how each of these restorative materials acts, based on their internal structure, in order to be able to see what their physical, mechanical and physicochemical behavior will be in their dental use.

Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions.

BACKGROUND: During interventions for deep caries lesions without severe symptoms, preserving pulpal vitality is important to ensure treatment success, improve organ prognosis, and decrease cost-effectiveness. Current pre-operative radiographs allow visual estimation but not accurate measurement of lesion depth. PURPOSE: Investigate the ability of ratio 'remaining/total dentin thickness' (RDT/TDT, as determined on pre-operative radiographs) to predict pulp exposure during excavation. METHODS: This retrospective study (January 2018-June 2020) analyzed data on 360 patients. Four independent raters examined standard pre-operative radiographs and their contrasted versions. Lines put at the dentino-enamel junction, the floor of the carious lesion, and the pulp chamber wall allowed deriving RDT/TDT. Inter-rater agreements and concordance were assessed. A logistic regression accounting for measurement errors provided odds ratios that estimated the ability of the RDT/TDT to predict pulp exposure. RESULTS: The median RDT/TDT ratio ranges were 16.8-26.5% on standard and 16.2-24.6% on contrasted radiographs. Inter-rater agreements on RDT/TDT were rather poor and inter-rater reliability was low and similar in standard and contrasted radiographs: the concordance correlation coefficients (95% CIs) were estimated at 0.46 (0.40; 0.51) and 0.46 (0.40; 0.52), respectively. The risk of pulp exposure increased by 2.5 times [odds ratio (95% CI) 2.57 (2.06; 3.20)] per 10-point decrease of the ratio on standard radiographs vs. 4.15 (3.15; 5.46) on contrasted radiographs. CONCLUSION: RDT/TDT ratio is potentially helpful in predicting pulp exposure. However, the measurement errors on RDT and TDT being non-negligible and the interrater agreements poor, there is still place for advances through development of an automated process that will improve reliability and reproducibility of pulp exposure risk assessment. CLINICAL TRIAL: Trial registration number. ClinicalTrials.gov NCT04607395, October 29, 2020.

Evaluation of the microstructure, chemical composition, and image quality of different PSP receptors

Abstract This study aimed to assess the microstructure, chemical composition, and image quality of different photostimulable phosphor plates (PSP). Four PSP systems, Express®, Digora®, VistaScan®, and Apixia,® were assessed. Five radiographs of a homogeneous acrylic phantom were obtained with the PSP of each system, to acquire a total of 20 images. The images were objectively evaluated for uniformity using mean grey and standard deviation (SD) of their grey values. PSP receptors were analyzed using scanning electron microscopy (SEM) to determine the thickness of the granule layer and the size of the granules. The chemical composition of the PSP receptors was analyzed using total reflection X-ray fluorescence (TXRF). VistaScan showed more uniform and higher density images than the other tested systems (p < 0.05), as well as the lowest SD of grey values (p < 0.05). Regarding the microstructure of the receptors, Digora and VistaScan had thicker granule layers than Express and Apixia, and VistaScan had smaller granules than Digora and Express (p < 0.05). Fourteen chemical elements were detected in the receptors, with barium being the element with the highest concentration in all PSP systems. The microstructure, chemical composition, and image quality varied among all four PSP receptors studied. VistaScan receptors showed the smallest variation in granule size, one of the thickest granule layers, and the most uniform and least noisy images.

Imaginologic resources used in diagnosis of root resorptions: comparative study / Recursos imaginológicos utilizados no diagnóstico de reabsorções radiculares: estudo comparativo

ABSTRACT Objective: Compare the accuracy of early diagnosis of simulated internal root resorptions and external root resorption, using digital periapical radiography and cone beam computed tomography. Methods: Root resorption were simulated in extracted human teeth by demineralization with 5% nitric acid solution and 8% Sodium Hypochlorite in different periods (1 and 5 days). For the group external root resorption (n=12) composite resin cylinders were positioned on middle third of buccal surface of roots, to delimit application of demineralization substances. In group internal root resorptions (n=12) the teeth were sectioned longitudinally, and the composite resin cylinders were positioned in the middle third of root canals. The teeth were mounted in a dry mandible and evaluated by digital radiography and tomography. The images were evaluated by two examiners. Results: Analyzing the tomographic images in period of 1 day, the examiner 2 identified internal root resorptions that were not identified in radiographic images (p<0.05). No examiner was capable of diagnosing external root resorption irrespective of exam, in the group of 1 day (p>0.05). In 5 day period of induction, both exams identified internal root resorptions (p>0.05), however, the tomographic images were more effective in identifying external root resorption (p <0.05) for both examiners. Conclusion: Cone beam computed tomography was shown to be more effective than digital periapical radiography for detecting internal root resorptions with 1 day of induction. The imaginological resources used in this study were not able to early detect external root resorption.

RESUMO Objetivo: Comparar a acurácia do diagnóstico precoce de reabsorções radiculares interna (RRI) e reabsorções radiculares externa (RRE) simuladas, por meio de radiografia periapical digital e tomografia computadorizada de feixe cônico. Métodos: Reabsorções radiculares foram simuladas em dentes humanos extraídos utilizando a desmineralização com ácido nítrico 5% e hipoclorito de sódio 8% em diferentes períodos (1 e 5 dias). Para o grupo reabsorções radiculares externa (n=12) cilindros de resina composta foram posicionados no terço médio das faces vestibulares das raízes, delimitando a aplicação das substâncias de desmineralização. No grupo reabsorções radiculares interna (n=12) os dentes foram seccionados longitudinalmente, e os cilindros de resina posicionados no terço médio dos canais radiculares. Os dentes foram montados em mandíbula seca e avaliados por meio de radiografia digital e tomografia por dois examinadores. Resultados: Nas imagens tomográficas no período de 1 dia, o examinador 2 identificou reabsorções radiculares interna as quais não foram identificadas nas radiografias (p<0,05). Nenhum examinador foi capaz de diagnosticar as reabsorções radiculares externa independente do exame no grupo de 1 dia (p>0.05). No período de indução de 5 dias ambos os exames identificaram as reabsorções radiculares interna (p>0,05), entretanto, as tomografias foram mais eficazes na identificação das reabsorções radiculares externa (p<0,05) para ambos os examinadores. Conclusão: A tomografia computadorizada de feixe cônico mostrou-se mais eficaz do que a radiografia periapical digital na detecção de reabsorções radiculares interna com 1 dia de indução. Os recursos imaginológicos utilizados neste estudo não foram capazes de detectar precocemente a reabsorção radicular externa.

In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography

Abstract Objective: To compare the accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for the detection of external apical root resorption (EARR) due to root canal contamination. Material and Methods: Dog's teeth with experimentally induced root resorption due to root canal contamination underwent or not root canal treatment (n=62). True positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data were compared using chi-squared test (α=0.05). Results: EARR was detected in 35% of roots by PR, in 47% by CBCT, and in 50% of the roots by microscopy (p=0.03 PR versus microscopy; p=0.67 CBCT versus microscopy). Overall, CBCT produced more accurate diagnoses than PR (p=0.008). PR and CBCT allowed the identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p=0.003). Conclusion: Cone-beam computed tomography showed higher accuracy in detecting external apical root resorption of endodontic origin.

Deep learning convolutional neural network algorithms for the early detection and diagnosis of dental caries on periapical radiographs: A systematic review.

PURPOSE: The aim of this study was to analyse and review deep learning convolutional neural networks for detecting and diagnosing early-stage dental caries on periapical radiographs. MATERIALS AND METHODS: In order to conduct this review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies published from 2015 to 2021 under the keywords (deep convolutional neural network) AND (caries), (deep learning caries) AND (convolutional neural network) AND (caries) were systematically reviewed. RESULTS: When dental caries is improperly diagnosed, the lesion may eventually invade the enamel, dentin, and pulp tissue, leading to loss of tooth function. Rapid and precise detection and diagnosis are vital for implementing appropriate prevention and treatment of dental caries. Radiography and intraoral images are considered to play a vital role in detecting dental caries; nevertheless, studies have shown that 20% of suspicious areas are mistakenly diagnosed as dental caries using this technique; hence, diagnosis via radiography alone without an objective assessment is inaccurate. Identifying caries with a deep convolutional neural network-based detector enables the operator to distinguish changes in the location and morphological features of dental caries lesions. Deep learning algorithms have broader and more profound layers and are continually being developed, remarkably enhancing their precision in detecting and segmenting objects. CONCLUSION: Clinical applications of deep learning convolutional neural networks in the dental field have shown significant accuracy in detecting and diagnosing dental caries, and these models hold promise in supporting dental practitioners to improve patient outcomes.