Guidelines on the timing and frequency of bitewing radiography: a systematic review.

Objectives To identify guidelines on when and how frequently bitewing radiographs should be used in dentistry for the diagnosis of caries, and to provide an objective appraisal of their quality.Data sources MEDLINE (OVID), US National Guideline Clearinghouse (www.guideline.gov) and the Royal College of Surgeons of England (https://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines) websites were searched using a variety of relevant search terms (2 August 2016).Data selection Publications were included if they made recommendations on the issue of when and how frequently radiographs should be used in any dentally-related specialty pertaining to the diagnosis of caries; and/or if they were aimed at the individual practitioner (any health professional working within dentistry) and/or patients.Data analysis Thirteen published guidelines were included and assessed using the AGREE II instrument.Conclusions There was a significant variation amongst the guidelines in the recommendations at what age radiography should be undertaken. There was also disagreement on the frequency of repeat radiographs and how this is influenced by the age of the patient and their caries risk.

Radiographic methods used before removal of mandibular third molars among randomly selected general dental clinics.

OBJECTIVES: To assess radiographic methods and diagnostically sufficient images used before removal of mandibular third molars among randomly selected general dental clinics. Furthermore, to assess factors predisposing for an additional radiographic examination. METHODS: 2 observers visited 18 randomly selected clinics in Denmark and studied patient files, including radiographs of patients who had their mandibular third molar(s) removed. The radiographic unit and type of receptor were registered. A diagnostically sufficient image was defined as the whole tooth and mandibular canal were displayed in the radiograph (yes/no). Overprojection between the tooth and mandibular canal (yes/no) and patient-reported inferior alveolar nerve sensory disturbances (yes/no) were recorded. Regression analyses tested if overprojection between the third molar and the mandibular canal and an insufficient intraoral image predisposed for additional radiographic examination(s). RESULTS: 1500 mandibular third molars had been removed; 1090 had intraoral, 468 had panoramic and 67 had CBCT examination. 1000 teeth were removed after an intraoral examination alone, 433 after panoramic examination and 67 after CBCT examination. 90 teeth had an additional examination after intraoral. Overprojection between the tooth and mandibular canal was a significant factor (p < 0.001, odds ratio = 3.56) for an additional examination. 63.7% of the intraoral images were sufficient and 36.3% were insufficient, with no significant difference between images performed with phosphor plates and solid-state sensors (p = 0.6). An insufficient image predisposed for an additional examination (p = 0.008, odds ratio = 1.8) but was only performed in 11% of the cases. CONCLUSIONS: Most mandibular third molars were removed based on an intraoral examination although 36.3% were insufficient.

Age Related Prevalence of Pre-Eruptive Intracoronal Radiolucent Defects in the Permanent Dentition.

OBJECTIVE: The present study aimed to determine if the prevalence of pre-eruptive intracoronal radiolucent defects is higher for young age groups, in which there are more unerupted teeth. STUDY DESIGN: A retrospective study of panoramic and bitewing radiographs was conducted. An inclusion criterion was the presence of un-erupted permanent teeth with a formed and clearly visible crown. Age groups were: young (6-8 years), intermediate (9-12 years) and adults (13-53 years). Significance level was set at p≤0.05. RESULTS: Thirteen (3.9%) pre-eruptive lesions were detected in 335 records. No lesions were found in the young group (7.4%), in the intermediate and adult age groups six and seven lesions were found, respectively. In most cases the pre-eruptive lesion was found in a third molar. CONCLUSION: The prevalence of pre-eruptive intracoronal lesions was not higher for young age groups. The prevalence of pre-eruptive intra coronal radiolucent lesions is 3.9%, irrespective of age.

A clinical comparison of extraoral panoramic and intraoral radiographic modalities for detecting proximal caries and visualizing open posterior interproximal contacts.

OBJECTIVES: The purpose of this study was to compare extraoral panoramic bitewings (BWs) to intraoral photostimulable phosphor (PSP) plate BWs for the detection of proximal surface caries and to establish if there was any difference between extraoral BWs, intraoral BWs and panoramic radiographs in visualizing open posterior interproximal contacts. METHODS: Extraoral panoramic and intraoral BW images were acquired on each of 20 patients, resulting in 489 total non-restored, readable surfaces that were evaluated by 4 observers. The ANOVA analysis to determine diagnostic variability between and within each subject was utilized. The surfaces included in the study extended from the distal of each canine to the last posterior contact in each arch with non-readable proximal surfaces excluded (i.e.surfaces where over half the enamel layer was overlapped or where those surfaces were not visible in one or both modalities). RESULTS: The statistical analysis indicated that the overall mean area under the receiver operating characteristic curves across all observers for the intraoral BWs and extraoral panoramic BWs were 0.832 and 0.827, respectively, and the difference of 0.005 was not significant at p = 0.7781. The percentage of non-readable proximal surfaces across the three modalities was 4.1% for intraoral BWs, 18.3% for extraoral panoramic BWs and 51.5% for the standard panoramic images. CONCLUSIONS: The investigators concluded there was no significant difference in posterior proximal surface caries detection between the modalities. Extraoral panoramic BWs were much better than panoramic radiographs in visualizing open posterior interproximal contacts, 81.7% vs 48.5%, but below the 95.9% value for intraoral BWs.

Intraoral versus extraoral bitewing radiography in detection of enamel proximal caries: an ex vivo study.

OBJECTIVE: To compare the diagnostic accuracy of digital intraoral and extraoral bitewing (EO BW) radiography in the detection of enamel proximal caries regardless of their ability to separate contacts. METHODS: Artificial caries with different degrees of decalcification was induced in 80 human sound premolars and molars using formic acid. Intraoral radiographs were taken with photostimulable phosphor plate (PSP) and complementary metal oxide semiconductor (CMOS), using the paralleling bitewing technique. Extraoral bitewing radiographs were obtained using Sirona digital panoramic X-ray unit (Sirona Siemens, Bensheim, Germany). In total, 160 proximal surfaces were assessed by 2 observers twice. Area under the receiver operating characteristic curve (Az) values for each image type, observer and reading were compared using z-tests, with a significance level of p ≤ 0.05. Sensitivity, specificity, positive-predictive value and negative-predictive value for each observer and reading were calculated. RESULTS: Spearman's test showed a strong positive correlation between the duration of demineralization and histological grading of carious teeth surfaces. For the three radiographic techniques, intraobserver reliability was strong to excellent. Moreover, interobserver agreement was strong. The differences between all detection methods were not statistically significant (p > 0.05). Intraoral bitewing using CMOS sensor had the highest sensitivity while EO BW had the highest specificity in the detection of incipient proximal caries. CONCLUSIONS: Within the limits of the ex vivo design, the difference in diagnostic accuracy between the three radiographic techniques was not significant. EO BW could be used in the detection of enamel proximal caries with results comparable with intraoral bitewing with PSP plate and CMOS sensor.

Ex vivo evaluation of new 2D and 3D dental radiographic technology for detecting caries.

OBJECTIVES: Proximal dental caries remains a prevalent disease with only modest detection rates by current diagnostic systems. Many new systems are available without controlled validation of diagnostic efficacy. The objective of this study was to evaluate the diagnostic efficacy of three potentially promising new imaging systems. METHODS: This study evaluated the caries detection efficacy of Schick 33 (Sirona Dental, Salzburg, Austria) intraoral digital detector images employing an advanced sharpening filter, Planmeca ProMax(®) (Planmeca Inc., Helsinki, Finland) extraoral "panoramic bitewing" images and Sirona Orthophos XG3D (Sirona Dental) CBCT images with advanced artefact reduction. Conventional photostimulable phosphor images served as the control modality. An ex vivo study design using extracted human teeth, ten expert observers and micro-CT ground truth was employed. RESULTS: Receiver operating characteristic analysis indicated similar diagnostic efficacy of all systems (ANOVA p > 0.05). The sensitivity of the Schick 33 images (0.48) was significantly lower than the other modalities (0.53-0.62). The specificity of the Planmeca images (0.86) was significantly lower than Schick 33 (0.96) and XG3D (0.97). The XG3D showed significantly better cavitation detection sensitivity (0.62) than the other modalities (0.48-0.57). CONCLUSIONS: The Schick 33 images demonstrated reduced caries sensitivity, whereas the Planmeca panoramic bitewing images demonstrated reduced specificity. XG3D with artefact reduction demonstrated elevated sensitivity and specificity for caries detection, improved depth accuracy and substantially improved cavitation detection. Care must be taken to recognize potential false-positive caries lesions with Planmeca panoramic bitewing images. Use of CBCT for caries detection must be carefully balanced with the presence of metal artefacts, time commitment, financial cost and radiation dose.

Detecting Secondary Caries Lesions: A Systematic Review and Meta-analysis.

Secondary caries lesions are the main late complication of dental restorations, limiting their life span and generating costs by repeated reinterventions. Accurate detection of secondary lesions is crucial for estimating the true burden of the disease and allocating appropriate treatments. We aimed to assess the accuracy of detection methods for secondary caries lesions. Clinical or in vitro studies were included that investigated the accuracy of 5 detection methods--visual, tactile, radiography, laser fluorescence, quantitative light-induced fluorescence--of natural or artificially induced secondary lesions, as verified against an established reference test. Sensitivity, specificity, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated and publication bias assessed. From 1,179 screened studies, 23 were included. Most studies were performed in vitro, on permanent posterior teeth, and had high risk of bias or applicability concerns. Lesions were on proximal (14 studies) or other surfaces and adjacent to amalgam (16 studies) or tooth-colored materials. Visual (n = 11), radiographic (n = 13), and laser fluorescence detection (n = 8) had similar sensitivities (0.50 to 0.59) and specificities (0.78 to 0.83), with visual and laser fluorescence assessment being more accurate on nonproximal surfaces and adjacent to composites, respectively. Tactile assessment (n = 7) had low accuracy. Light-induced fluorescence (n = 3) was sensitive on nonproximal surfaces but had low specificities. Most analyses seemed to suffer from publication bias. Despite being a significant clinical and dental public health problem, detection of secondary caries lesions has been assessed by only a few studies with limited validity and applicability. Visual, radiographic and laser-fluorescence detection might be useful to detect secondary lesions. The validity of tactile assessment and quantitative light-induced fluorescence remains unclear at present.

Severe root resorption resulting from orthodontic treatment: prevalence and risk factors.

OBJECTIVE: To assess the prevalence of severe external root resorption and its potential risk factors resulting from orthodontic treatment. METHODS: A randomly selected sample was used. It comprised conventional periapical radiographs taken in the same radiology center for maxillary and mandibular incisors before and after active orthodontic treatment of 129 patients, males and females, treated by means of the Standard Edgewise technique. Two examiners measured and defined root resorption according to the index proposed by Levander et al. The degree of external apical root resorption was registered defining resorption in four degrees of severity. To assess intra and inter-rater reproducibility, kappa coefficient was used. Chi-square test was used to assess the relationship between the amount of root resorption and patient's sex, dental arch (maxillary or mandibular), treatment with or without extractions, treatment duration, root apex stage (open or closed), root shape, as well as overjet and overbite at treatment onset. RESULTS: Maxillary central incisors had the highest percentage of severe root resorption, followed by maxillary lateral incisors and mandibular lateral incisors. Out of 959 teeth, 28 (2.9%) presented severe root resorption. The following risk factors were observed: anterior maxillary teeth, overjet greater than or equal to 5 mm at treatment onset, treatment with extractions, prolonged therapy, and degree of apex formation at treatment onset. CONCLUSION: This study showed that care must be taken in orthodontic treatment involving extractions, great retraction of maxillary incisors, prolonged therapy, and/or completely formed apex at orthodontic treatment onset.

Hypodontia and supernumerary and impacted teeth in children with various types of clefts.

INTRODUCTION: The purpose of this study was to determine the prevalence of hypodontia, hyperdontia, and impacted teeth in children with various types of clefts. METHODS: This study sample consisted of 201 cleft patients including 131 male subjects with a mean age of 12.3 ± 4 years and 70 female subjects with a mean age of 12.6 ± 3.9 years. Charts, models, radiographs, and intraoral photographs were used for the study. t tests, chi-square tests, and binomial tests were used for assessment of the data. RESULTS AND CONCLUSIONS: Hypodontia was found in 129 subjects (64.1%). The chi-square test showed no statistically significant difference between the type of cleft and hypodontia (P <0.319). The binomial test showed that the frequencies of subjects with hypodontia were significantly higher in both unilateral and bilateral cleft lip and palate patients (P <0.015 and P <0.001, respectively). Hyperdontia and impacted teeth were also found to occur mostly in the maxillary arch, and maxillary canines were the most commonly impacted teeth in both unilateral and bilateral cleft lip and palate patients.

Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial.

The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is needed to establish their effect on the healing dynamics of PA tissues (ClinicalTrials.gov NCT02201641).

Influence of contact points on the performance of caries detection methods in approximal surfaces of primary molars: an in vivo study.

This in vivo study aimed to evaluate the influence of contact points on the approximal caries detection in primary molars, by comparing the performance of the DIAGNOdent pen and visual-tactile examination after tooth separation to bitewing radiography (BW). A total of 112 children were examined and 33 children were selected. In three periods (a, b, and c), 209 approximal surfaces were examined: (a) examiner 1 performed visual-tactile examination using the Nyvad criteria (EX1); examiner 2 used DIAGNOdent pen (LF1) and took BW; (b) 1 week later, after tooth separation, examiner 1 performed the second visual-tactile examination (EX2) and examiner 2 used DIAGNOdent again (LF2); (c) after tooth exfoliation, surfaces were directly examined using DIAGNOdent (LF3). Teeth were examined by computed microtomography as a reference standard. Analyses were based on diagnostic thresholds: D1: D 0 = health, D 1 ­D 4 = disease; D2: D 0 , D 1 = health, D 2 ­D 4 = disease; D3: D 0 ­D 2 = health, D 3 , D 4 = disease. At D1, the highest sensitivity/specificity were observed for EX1 (1.00)/LF3 (0.68), respectively. At D2, the highest sensitivity/ specificity were observed for LF3 (0.69)/BW (1.00), respectively. At D3, the highest sensitivity/specificity were observed for LF3 (0.78)/EX1, EX2 and BW (1.00). EX1 showed higher accuracy values than LF1, and EX2 showed similar values to LF2. We concluded that the visual-tactile examination showed better results in detecting sound surfaces and approximal caries lesions without tooth separation. However, the effectiveness of approximal caries lesion detection of both methods was increased by the absence of contact points. Therefore, regardless of the method of detection, orthodontic separating elastics should be used as a complementary tool for the diagnosis of approximal noncavitated lesions in primary molars.

Root canal treatment and prevalence of apical periodontitis in a nigerian adult subpopulation: a radiographic study.

PURPOSE: To evaluate the frequency, distribution and quality of root canal treatment in an adult Nigerian subpopulation and to determine the prevalence of apical periodontitis. MATERIALS AND METHODS: The periapical status and length of root fillings of 756 patients attending Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria for the first time were evaluated using full mouth periapical radiographs. The length of the root canal filling was considered 'adequate' if it was ≤ 2 mm from the radiographic apex, 'under-filled' if it was > 2 mm short of the apex, and 'overfilled' if filling material extended beyond the radiographic apex. Periapical status was assessed using the periapical index (PAI) with teeth classified as having apical periodontitis if the score was over 2. RESULTS: Overall, 61.2% of the patients had root-filled teeth and 67.2% featured apical periodontitis. Of the 21,468 teeth examined, 12.2% had been root filled, and of these 41% exhibited apical periodontitis. The prevalence of root-filled teeth was higher in the younger patients, while the prevalence of apical periodontitis in root-filled teeth was similar between age groups. Root-treated teeth that were overfilled or were mandibular incisors had the highest prevalence of apical disease. Overfilled teeth were more prone to developing an apical radiolucency than were under-filled teeth (P < 0.001 and P < 0.05, respectively). CONCLUSIONS: The prevalences of endodontically treated teeth and apical periodontitis were within the range reported for other countries; however, a very large number of patients required treatment or retreatment.

Deep carious lesions and other consequences of caries among 18-year-olds at Public Dental Health Service in Northern Norway: A cross-sectional age cohort study.

OBJECTIVES: To document deep carious lesions and other consequences of caries (DCL-CC) in molars of 18-year olds leaving the free-of-charge Public Dental Health Service (PDHS). To explore the association between background factors and DCL-CC. MATERIALS AND METHODS: The final study sample (n=1876) comprised 95% of individuals born in 1993 and registered in the PDHS in Troms County, Northern Norway. The most recent digital bitewing radiographs of each subject were examined for DCL-CC (deep untreated carious lesions, deep restorations, root canal obturations or extractions due to caries). Inter- and intra-observer kappa scores were 0.62 and 0.87, respectively. Information on background factors (gender, clinic location, history of medical problems, bitewing examination interval, DMFT score and planned recalls) were retrieved from dental records. RESULTS: About one-quarter of subjects (488) had at least one molar with DCL-CC. There were 848 molars in total with DCL-CC; the majority were deep restorations (70%), but 4% were deep untreated carious lesions. More than a quarter of DCL-CC were either root canal obturations (14%) or extractions (12%). Multivariable logistic regression analyses showed that a 1-unit increase in DMFT score was associated with deep untreated carious lesions and extractions due to caries. There was no association between urban/rural clinic location, which indicated socio-economic status, and either DMFT score or DCL-CC. CONCLUSIONS: Despite the existence of a free-of-charge dental service, more than one-quarter of the subjects in the present study had at least one molar with DCL-CC.

An in vivo comparison of radiographic and clinical examination with separation for assessment of approximal caries in primary teeth.

AIM: To compare in vivo, clinical examination (CE) and bitewing radiographs (BW) for the detection of cavitations and initial approximal lesions in deciduous molars with validation after temporary separation (TS) and direct visual examination (DE) of the approximal surfaces. MATERIALS AND METHODS: Thirty children aged 4 to 8 years without visual cavitations or restorations and with at least one approximal contact. Two calibrated examiners evaluated 355 surfaces of primary molars, which were then validated through TS and DE. RESULTS: Of the 280 surfaces considered sound by CE, 24.6% were cavitated after separation. Comparing BW and DE, it was observed that, when the radiolucency involved the inner half of dentin, 68.4% of lesions were cavitated. The sensitivity and specificity of CE and BW were 0.14 and 0.43, and 0.80 and 0.75, respectively. CONCLUSION: DE identified a greater number of pre-cavitated lesions and cavities. BW were useful for detection of decayed surfaces, but with low specificity for diagnosis of sound surfaces, while detection of sound or decayed approximal areas by means of CE alone was not possible. The combination of methods was effective in obtaining an accurate diagnosis of caries in the primary dentition.

Evaluation of orthodontic mini-implant placement: a CBCT study.

BACKGROUND: Optimal positioning of orthodontic mini-implants is essential for a successful treatment with skeletal anchorage. This study aims to compare the accuracy of two-dimensional radiographs with a cone beam computed tomography (CBCT) for mini-implant placement. METHODS: An ideal site for mini-implant placement at the buccal interradicular space between the second premolar and the first molar was determined for 40 sites (in 13 patients aged 14 to 28 years) by using CBCT data. The mini-implant placement procedure was then divided into two groups. In CBCT group, mini-implants were placed at the sites determined from CBCT data. In RVG group, mini-implants were placed with the help of two-dimensional digital radiographs and a custom made guide. Postplacement CBCT scans were obtained to determine the accuracy of the mini-implant placement. The results were statistically analyzed with a Mann-Whitney test. RESULTS: A statistically significant difference (p value=0.02) was observed between the two groups for deviation from an ideal height of placement of the mini-implants. Deviations in mesiodistal positioning and angular deviation showed a statistically non-significant difference. Three out of twenty mini-implants in the RVG group showed root contact in the mandibular arch that may be attributed to the narrower interradicular space and reduced accessibility in the mandibular posterior region. CONCLUSIONS: Although CBCT provides an accurate three-dimensional visualization of the interradicular space, the two-dimensional intraoral radiograph of the interradicular area provides sufficient information for mini-implant placement. Considering the amount of radiation exposure and cost with the two techniques, it is recommended to use two-dimensional radiographs with a surgical guide for a routine mini-implant placement.

Accuracy of cone-beam computed tomography and periapical radiography in apical periodontitis diagnosis.

INTRODUCTION: This study aimed to investigate the correlation and the agreement between periapical radiography (PR) and cone-beam computed tomography (CBCT) correlating to histologic findings in the diagnosis of apical periodontitis (AP). METHODS: One hundred thirty-four premolar root canals from 10 dogs were treated after AP induction. Four months later, the animals were killed, and standard digital PRs were obtained. The area of AP was measured by using ImageJ software. CBCT (i-CAT) images from each arch were obtained, and AP area and volume were measured by using Osiri-X software. The apical inflammatory infiltrate was evaluated under light microscopy. The correlation between imaging methods was evaluated by using the Pearson coefficient. The Bland-Altman method was used to assess the agreement between PR and CBCT data. The Spearman coefficient was used to correlate the imaging data and histologic findings. RESULTS: Despite a strong correlation between PR and CBCT areas, the agreement limits were very broad (95% limits of agreement, 0.19-1.08). PR only measured, on average, 63% of CBCT values. Although there was a strong correlation between PR area and CBCT volume, the Bland-Altman method suggests that the larger the CBCT volume, the more underestimated the PR value. When APs had a volume smaller than 6 mm(3), the PR estimation of CBCT data was unpredictable. A positive correlation was found for PR area, CBCT area, CBCT volume, and histology data. CONCLUSIONS: The diagnosis of AP based on PR data is clinically limited, and it should not be used for scientific investigations.

Prevalence of peri-implantitis in patients with implant-supported fixed prostheses.

OBJECTIVE: The purpose of this study was to evaluate periimplantitis prevalence in patients using implant-supported fixed prostheses that did not have any routine maintenance care. METHOD AND MATERIALS: A total of 161 implants (27 patients) were evaluated in patients using implant-supported fixed prostheses. Collected data included information related to patient general health and local factors such as characteristics of implants, time in function, type of loading, positioning, Modified Bleeding Index, bacterial plaque, bleeding on probing (BOP), marginal recession, probing depth (PD), keratinized mucosa, and radiographic bone loss (BL). Factors related to the prostheses were also evaluated. The exclusion criteria were patients that have had any follow-up visit for plaque control of the prosthesis and/or the implants. RESULTS: From a total of 161 implants, 116 (72%) presented without peri-implantitis (PD > 4 mm + BOP + BL > 2 mm) while 45 (28%) had some sign of the disease. Implants placed in the maxilla were 2.98 times more likely to develop the disease (P < .05). Moreover, patients aged ≤ 60 years old were 3.24 times more likely to develop peri-implantitis (P < .05). Another analysis with statistical relevance (P < .05) was that implants with less than 3 mm interimplant distance were three times more likely to have peri-implantitis. There was no statistical relevance considering other analyses. CONCLUSION: It can be concluded that patients aged ≤ 60 years have a greater chance of presenting periimplantitis, as well as for implants positioned in the maxilla and those placed with an interimplant distance < 3 mm.

Comparing the in vivo diagnostic accuracy of digital periapical radiography with cone-beam computed tomography for the detection of vertical root fracture.

INTRODUCTION: The purpose of this study was to determine whether there is a difference in the in vivo diagnostic accuracy of digital radiography (DR) and cone-beam computed tomography (CBCT) imaging in the detection of vertical root fracture (VRF). The presence/absence of VRF was confirmed by visual inspection of the extracted root surface and was the reference standard against which both imaging modalities were compared. METHODS: Twenty-one unsalvageable teeth from 20 patients that had been radiographed and scanned with CBCT imaging were included in the study. The teeth were atraumatically extracted and visually inspected under a microscope to confirm the presence/absence of fracture. The widest point of each fracture was recorded using an optical coherence tomography scanner in order to quantify the size of fractures. Images were viewed under standardized conditions by 13 examiners and repeated 2 weeks later to assess their consistency. RESULTS: DR and CBCT imaging showed similarly poor sensitivity of 0.16 and 0.27, respectively. Both imaging modalities had similarly high specificity of 0.92 and 0.83, respectively. There was no statistical difference between the diagnostic accuracy of either imaging modality. Fracture width did not affect the detection rate of either imaging modality. Receiver operating characteristic analysis revealed mean Az values of 0.535 and 0.552 for DR and CBCT imaging, respectively. CONCLUSIONS: Both DR and CBCT imaging have significant limitations when detecting vertical root fractures.

Cone-beam computed tomographic scans in comparison with periapical radiographs for root canal length measurement: an in situ study.

INTRODUCTION: The primary aim of this study was to compare the precision of root canal length determination on cone-beam computed tomographic (CBCT) scans and periapical radiographs (PAs) with the actual root canal length. The secondary aim was to examine the influence of tooth type on root canal length measurements as assessed on CBCT scans and PAs. METHODS: In total, 40 root canals of 33 teeth (molars, premolars, canines, and incisors) out of 5 dentate maxillas of human cadavers were included. Root canal length measurement was performed by a consensus panel (2 examiners) on CBCT scans (3D Accuitomo 170; J Morita, Kyoto, Japan) and digital PAs. After straight-line access opening, a #15 file was fixated in every root canal at the length measured on CBCT scans. All teeth were extracted, and the root canal containing the file was uncovered. Measurements made on images taken with a digital camera (AxioCam; Carl Zeiss, Sliedrecht, The Netherlands) linked to a stereozoom microscope (Stemi SV6, Carl Zeiss) were used as the actual root canal length. RESULTS: When all roots were examined together, it was not clear which method is better for all types of teeth. For root canals of anterior teeth, there was no significant difference between the 2 methods. For root canals of posterior teeth, CBCT images gave results significantly closer to the actual root canal length in comparison with PAs (t value = -1.96; critical value is 1.74 with a significance level of 0.05). CONCLUSIONS: Root canal length measurements of posterior maxillary teeth were more accurate when assessed by CBCT images than PAs.

Oblique lateral radiographs and bitewings; estimation of organ doses in head and neck region with Monte Carlo calculations.

OBJECTIVES: When bitewing radiographs are not possible (e.g. patients with special needs), oblique lateral radiographs may offer an alternative. The aims of this study were to assess the impact of horizontal projection angulation, focus-to-skin distance, exposure time and age of the patient on the equivalent radiation dose of several organs in the head and neck region by means of personal computer X-ray Monte Carlo (PCXMC) calculations and to assess the dose obtained from conventional bitewing radiographs. METHODS: PCXMC v. 2.0 software (STUK(®), Helsinki, Finland) was used to estimate the equivalent radiation doses and the total effective dose. Three exposure times, five age categories, two focus-to-skin distances and eight horizontal geometric angulations were assumed. The organs involved were the thyroid gland, oesophagus, salivary glands, bone marrow, oral mucosa, skull, cervical spine and skin. A similar calculation was also performed for bitewings taken with a rectangular collimator. Results and conclusion Bitewings taken with rectangular collimation decrease the radiation burden of the patient to 50%, compared with circular collimation. In the oblique lateral radiographs, focus-to-skin distance, patient's age and beam collimation had a significant impact on the equivalent doses measured in this study. Exposure time had a significant impact on the equivalent doses of the salivary glands, oral mucosa, skull and skin. Horizontal angulations had a significant impact on the equivalent doses of the thyroid gland, bone marrow, oral mucosa, skull and cervical spine. The total effective radiation dose was significantly influenced by all parameters investigated in this study.