Using Standard Digital Extra-Oral Photography in Patient With Cleft Lip and Palate / Uso de Fotografía Digital Extra Oral Estandarizada en Pacientes con Fisura Labiopalatina

ABSTRACT: A standardized photographic documentation is reproducible, which facilitates the evaluation of new techniques, treatment planning, and comparison of results. Clinical photography is important to impart scientific education to health professionals, because techniques can be better understood by the listener or reader when they are well illustrated. Documentation of consistent imaging of clinical diagnosis and treatment is also essential in medical-legal cases. Highquality clinical photographs along with radiographs and other medical and dental images should become an integral part of patients' medical records. Variables such as lens selection, camera position, distance, and patient's position should be understood and controlled by healthcare personnel for acquiring accurate photographs. In the case of patients with craniofacial deformities, such as cleft lip and palate, it is important to establish the standardization of photographic records because the patients' aesthetic evaluation is a fundamental clinical indicator in the deformity analysis, besides assisting the planning of patients' multidisciplinary treatment. This article aims to assist health professionals in acquiring standardized facial photographs (front, right profile, left profile, and submental oblique view) of patients with cleft lip and palate.

RESUMEN: Una documentación fotográfica estandarizada es reproducible, lo que facilita la evaluación de nuevas técnicas, la planificación del tratamiento y la comparación de resultados. La fotografía clínica es importante para impartir educación científica a los profesionales de la salud, ya que el oyente o lector puede comprender mejor las técnicas cuando están bien ilustradas. La documentación de imágenes consistentes de diagnóstico clínico y tratamiento también es esencial en casos médico-legales. Las fotografías clínicas de alta calidad junto con las radiografías y otras imágenes médicas y dentales deben convertirse en una parte integral de los registros médicos de los pacientes. El personal de atención médica debe comprender y controlar las variables como la selección de la lente, la posición de la cámara, la distancia y la posición del paciente para obtener fotografías precisas. En el caso de pacientes con deformidades craneofaciales, como labio leporino y paladar hendido, es importante establecer la estandarización de los registros fotográficos porque la evaluación estética de los pacientes es un indicador clínico fundamental en el análisis de la deformidad, además de ayudar en la planificación del tratamiento multidisciplinario del paciente. Este artículo pretende ayudar a los profesionales de la salud a adquirir fotografías faciales estandarizadas (frente, perfil derecho, perfil izquierdo y vista oblicua submental) de pacientes con labio leporino y paladar hendido.

Comparisons between photographic equipment for dental use: DSLR cameras vs. smartphones / Comparações entre equipamento fotográfico para uso odontológico: câmeras DSLR vs. smartphones

Objective: to compare the image quality obtained by six cameras used for dental documentation, including four DSLR cameras and two smartphones with different sensor size. Methods: the equipment determined the groups: APSCcan18-55 ­ Sensor APS-C Canon (EOS T5i) + 18-55 mm lens; APSCcan100 ­ Sensor APS-C Canon (EOS T5i) + 100 mm macro lens; APSCnik18-55 ­ Sensor APS-C Nikon (D5100) + 18-55 mm lens; APSCnik100 ­ Sensor APS-C Nikon (D5100) + 100 mm macro lens; ip1/3" ­ iPhone with 1/3-inch sensor; ga1/2.6"- Galaxy with 1/2.6-inch sensor. Two set of images -"dental documentation" and "small objects"- were obtained. The photographs were evaluated by three groups: US, undergraduate students; DS, dentists; and DP, dentists with photography experience. Scores between 0 and 10 were assigned. The results were compared by RM Anova and Tukey (α = 0.05). Results: the highest overall scores were obtained with APSCnik100 (8.5). For "dental documentation", APSCcan18-55 and APSCnik18-55 showed the lowest values, even compared to ga1/2.6" (for US, DS and DP evaluators) and ip1/3" (for US evaluators). For "small objects", DSLRs resulted in higher mean values compared to smartphones for US and DS. Conclusions: DSLR cameras with 18-55 mm lens and no circular flash should not be used for documentation photographs. DSLR cameras, regardless of lens, are superior to smartphones for small objects photographs. (AU)

Objetivo: comparar a qualidade da imagem obtida por seis câmeras utilizadas para documentação odontológica, incluindo quatro câmeras DSLR e dois smartphones com diferentes tamanhos de sensor. Métodos: a divisão dos grupos foi realizada pelo tipo de equipamento: APSCcan18-55 - Sensor APS-C Canon (EOS T5i) + lente 18-55 mm; APSCcan100 - Sensor APS-C Canon (EOS T5i) + lente macro de 100 mm; APSCnik18-55 - Sensor APS-C Nikon (D5100) + lente 18-55 mm; APSCnik100 - Sensor APS-C Nikon (D5100) + lente macro de 100 mm; ip1 / 3 "- iPhone com sensor de 1/3 de polegada; ga1 / 2.6 "- Galaxy com sensor de 1 / 2,6 polegadas. Dois conjuntos de imagens ­ "documentação odontológica" e "pequenos objetos" ­ foram realizados. As fotografias foram avaliadas por três grupos de examinadores: estudantes de graduação (US); dentistas (DS); e dentistas com experiência em fotografia (DP). Foram atribuídas pontuações entre 0 e 10. Os resultados foram comparados por Anova e Tukey (α = 0,05). Resultados: os maiores escores foram obtidos com o APSCnik100 (8,5). Para "documentação odontológica", APSCcan18-55 e APSCnik18-55 apresentaram os menores valores. Para "objetos pequenos", as DSLRs resultaram em valores médios mais altos em comparação aos smartphones. Conclusões: as câmeras DSLR com lentes de 18 a 55 mm e sem flash circular não devem ser usadas para fotografias de documentação. As câmeras DSLR, independentemente da lente, são superiores aos smartphones para fotografias de objetos pequenos. (AU)

Variability of color matching with different digital photography techniques and a gray reference card.

STATEMENT OF PROBLEM: Color matching in restorative and prosthetic dentistry is important for the success of dental treatments, although communication with the dental laboratory remains subjective, and studies of the performance of objective communication methods are lacking. PURPOSE: The purpose of this study was to evaluate color differences (ΔE) and compare color luminosity (L*) values among different types of digital photography equipment used to document tooth color, with and without a gray reference card, and to determine whether the gray card could be used to standardize color assessment in dental photography. MATERIAL AND METHODS: Sixty photographs were made (n=10) using different equipment: a D7000 digital camera (Nikon Corp) with an 85-mm lens and wireless close-up flash (DC+WCF); close-up flash surrounded by 80 grams per square meter (gsm; specification of paper thickness) white printing paper (DC+WPP); ring flash (DC+RF); close-up flash attached to a dual-point rigid flash bracket (DC+DPRF); cross-polarizing filter attached to a close-up flash (DC+CPF); and iPhone 7 (I7). For all photographs, a gray reference card with known color values was positioned at the patients' mandibular teeth, acting as a parameter for the analysis of white-balanced digital photographs. Each photograph underwent white balance with the reference card and software. ΔE were obtained from each piece of equipment by comparing images with and without white balance (original photo) with software and the smallest ΔE achieved was used as the gold standard for comparisons of luminosity. Values of luminosity were subsequently obtained for the different equipment with and without white balancing the photographs; these values were compared using a general estimating equation with Huber-White standard error (α=.05). RESULTS: The use of a cross-polarizing filter was used as the gold standard for luminosity evaluation, as the smallest ΔE (3.4) among photographs were observed when those with and without white balance were compared. Luminosity results from the cross-polarizing filter method (DC+CPF) were not significantly different from those of the DC+DPRF (P=.73), DC+WPP (P=.106), and DC+WCF (P=.551) groups but were statistically different from DC+RF (P=.028) and I7 groups (P<.001). Use of a gray card was significant when a ring flash (P=.008) or the iPhone (P=.023) were used but not statistically significant for the other groups (P>.05). CONCLUSIONS: The use of a cross-polarizing filter results in more color-standardized photographs, while the ring flash system and the iPhone 7 result in less standardized photographs. The gray reference card had a significant effect when a ring flash system or iPhone 7 was used.

Comparing the outcomes of gold-standard dental examinations with photographic screening by mid-level dental providers.

OBJECTIVES: To determine the detectability of the intra-oral photographic method in comparison to the baseline, comprehensive dental examination (CDE), in children when performed by different levels of dental practitioners. MATERIALS AND METHODS: As part of a quality assurance program, intra-oral photographs were obtained from 77 patients (2-18 years) as part of a CDE before undertaking dental treatment under general anaesthesia. A DSLR camera was utilised to acquire images which were subsequently uploaded to a cloud-based server. The baseline for each participant was established during the CDE, utilising both visual and radiographic examination, which was then compared to the assessment made by a mid-level dental practitioners (MLDP). The evaluation was based on utilising an odontogram where the teeth were charted either as decayed or filled. RESULTS: Specificity (95%) was higher than sensitivity (61.5%) when comparing the photographic assessment with the benchmark CDE assessment. The inter-rater reliability between the two methods of assessment was substantial, with a kappa score of 0.62. The photographic assessment method underestimated the decayed and filled teeth, as observed by the caries experience (dft/DFT scores) (CDE = 7.01 vs. photographic assessment = 5.22). There were lower levels of diagnostic detection in the posterior teeth as compared to the anterior teeth assessments. CONCLUSIONS: Although the CDE is still considered to be the gold-standard, this study found that the photographic caries assessment by MLDP produced an acceptable diagnostic level of detection particularly for the anterior teeth. CLINICAL RELEVANCE: The photographic method could offer a potential cost-saving and user-friendly screening.

Reliability of a Virtual Prosthodontic Project Realized through a 2D and 3D Photographic Acquisition: An Experimental Study on the Accuracy of Different Digital Systems.

AIMS: The study aims to assess the accuracy of digital planning in dentistry, evaluating the characteristics of different intraoral 3D scanners and comparing it with traditional imaging 2D recording methods. Specifically, using computer aided design (CAD) software and measuring inside CAD software, authors want to verify the reliability of different models obtained with different techniques and machines. METHODS: 12 patients that needed aesthetic restorative treatment were enrolled in the study. All the patients underwent recording data of the height and width dental elements 1.1, 1.2, and 1.3 size using different technologies and comparing 2D with 3D methods. A T test was then applied in order to verify whether there was a statistically significant difference between the measurements obtained, comparing the different tools data (Emerald, TRIOS, Photogrammetry and DSS (Digital Smile System)) with the reference values. RESULTS: No significant differences emerged in the measurements made with the different scanners (Trios 3Shape ®, Planmeca Emerald ®) and photogrammetry. Therefore, what should be underlined regarding the 2D measurements is the speed and simplicity compared to all 3D techniques, so this work can help to better define the field of application and the limits connected to 2D techniques, giving a good window of the technique. CONCLUSIONS: The low number of patients is not sufficient to provide statistically significant results, but the digital planning future prospects seem to be promising. This study results highlighted how a photogrammetric scanner for dental arches would only have a much smaller shooting field size and greater accuracy. Despite these considerations, the photogrammetric facial scanner provided excellent results for the measurement of individual teeth, showing a great versatility of use.

Comparison of user satisfaction and image quality of fixed and mobile camera systems for 3-dimensional image capture of edentulous patients: A pilot clinical study.

STATEMENT OF PROBLEM: An evaluation of user satisfaction and image quality of a novel handheld purpose-built mobile camera system for 3-dimensional (3D) facial acquisition is lacking. PURPOSE: The purpose of this pilot clinical study was to assess and compare the effectiveness between a handheld mobile camera system designed for facial acquisition and a fixed static camera arrangement by comparing the time effectiveness and the operator and participant preference for the 2 techniques of image capture. MATERIAL AND METHODS: Completely edentulous participants (n=12: women=7, men=5; mean age: 74.6 years) were included in this pilot study. Images were captured with and without the prostheses in situ while maintaining "serious" and "full-smile" facial expressions. Images were captured using a mobile and a static system. The working times for the participant installation and image captures were recorded. Operator and participant perceptions of the entire experience were recorded by using visual analog scale questionnaires. Nonparametric tests were used for statistical analyses (α=.05). RESULTS: The installation time was significantly shorter for the mobile system (static=24 ±13 seconds; mobile=10 ±10 seconds), but the differences in the image capture times were not statistically significant (static: 29 ±5 seconds; mobile: 40 ±18 seconds). Operator preference was in favor of the mobile system with regard to working time (P=.002), difficulty in using (installation: P=.002; handling: P=.045), and camera weight (P=.002); however, they preferred the static arrangement for image quality (P=.003) and comfort (P=.013). The participants rated the entire photographic experience favorably, and 10 of 12 participants preferred the static camera over the mobile one. CONCLUSIONS: Despite the complexity of the installation, the static system was evaluated better for image quality; the mobile system was easier in installation and handling. The operators preferred the mobile system, and the participants preferred the static system.

The best choice of equipment to obtain high quality standardised results in intra-oral photography - a comparison between the common practice in the UK and the gold standard set by the literature.

Since digital technology made dental photography widely available, photographers have been trying to establish the 'gold standard' when obtaining intra-oral photographs. A basic knowledge of photographic principles, familiarity with particular dental techniques and a correct choice and use of equipment contribute significantly both to the standardisation and quality of photographs. A recent survey between members of the Institute of Medical Illustrators shed a light on the current practice in the UK. Medical photographers do not always have access to the full range of suitable equipment. A better selection of retractors and occlusal mirrors would undoubtedly contribute to higher quality images.

End-user acceptance of a cloud-based teledentistry system and Android phone app for remote screening for oral diseases.

Objective This study aimed to evaluate users' acceptance of a teledentistry model utilizing a smartphone camera used for dental caries screening and to identify a number of areas for improvement of the system. Methods A store-and-forward telemedicine platform "Remote-I" was developed to assist in the screening of oral diseases using an image acquisition Android app operated by 17 teledental assistants. A total of 485 images (five images per case) were directly transmitted from the Android app to the server. A panel of five dental practitioners (graders) assessed the images and reported their diagnosis. A user acceptance survey was sent to the graders and smartphone users following completion of the screening program. Results Of the 22 surveys sent out, 20 (91%) were completed. Generally, users showed optimism towards the use of the teledentistry system, and strongly positively assessed items on content and service quality. The majority of graders took less than 15 min to read the images while phone users took 5-10 min to complete the dental photography using the Android app. This study identified a number of factors that are essential for improving the current system, such as optimization of smartphone camera features, the format of the server, and the orientation of images and using oral retractors during photography. Conclusions Users appear to be generally satisfied with the proposed teledentistry model. However, they have specific concerns to address, many of which could be resolved through more effective training, coordination between sites and upgrading the current system.

The use of a standardized gray reference card in dental photography to correct the effects of five commonly used diffusers on the color of 40 extracted human teeth.

OBJECTIVE: The aim of this in vitro study was to investigate the color changes of human teeth caused by five different diffuser materials commonly used in dental photography, as well as software influence, and to confirm whether the use of a standardized gray reference card is effective in correcting these color changes during digital postproduction. MATERIALS AND METHOD: Forty extracted human teeth were obtained from a specialized oral surgery practice in Cham, Germany. Five commonly used diffuser materials were chosen to be investigated, which included: polyethylene (PET), White Frost photographic paper, LumiQuest polyamide (nylon) material, 80 gsm white printing paper, and 3M linear polarizing filter sheet used for cross polarization. A digital single-lens reflex camera (Canon EOS 5D MKII) was used, together with a twin flash suitable for macrophotography (Canon MT-24EX Macro Twin Lite). Images were tethered into Adobe Lightroom CC using the RAW format. A standardized gray reference card (WhiBal, Michael Tapes Design) was used for exposure calibration and white balancing. Classic Color Me- ter software (Ricci Adams, version 1.6 (122)) was used to obtain CIE L*a*b* values of the specimens before and after white balancing and exposure correction. RESULTS: All diffusers caused visually perceivable color changes on the extracted teeth: White Frost (ΔE* 1.24; sd 0.47), 80 gsm printing paper (ΔE* 2.94; sd 0.35), LumiQuest polyamide (ΔE* 3.68; sd 0.54), PET (ΔE* 6.55; sd 0.41), and 3M linear polarizing filter sheet (ΔE* 7.58; sd 1.00). The use of a standardized gray reference card (WhiBal) could correct these values below the visually perceivable threshold: White Frost (ΔE* 0.58; sd 0.36), 80 gsm printing paper (ΔE* 0.93; sd 0.54), LumiQuest polyamide (ΔE* 0.66; sd 0.58), PET (ΔE* 0.59; sd 0.33), and 3M linear polarizing filter sheet (ΔE* 0.53; sd 0.42). SIGNIFICANCE: The use of a standardized gray reference card with specified CIE L*a*b* values should be considered when diffusers are used in dental photography in order to reveal the color of preoperative situations (ie, shade documentation) and document postoperative results accurately.

Accuracy of dental images for the diagnosis of dental caries and enamel defects in children and adolescents: A systematic review.

AIM: The aim of this review was to determine if photographic examination and subsequent image analysis provides comparable accuracy to visual inspection for the diagnosis of common dental conditions in children and adolescents. METHODS: We searched the PubMed database for studies that compared diagnostic accuracy of the two inspection techniques. Studies were screened for inclusion and were assessed for quality and risk of bias using the quality assessment of diagnostic accuracy studies tools. Findings were reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). FINDINGS: Sixteen studies met the inclusion criteria. Nine of the included studies evaluated dental caries and eight evaluated enamel defects (one study evaluated both conditions). CONCLUSIONS: Three studies found image analysis to be superior. For the remaining six studies the diagnostic accuracy was comparable. For enamel defects, three studies found image analysis to be superior, two found visual inspection to be superior and three studies reported comparable diagnostic accuracy. Most studies have found at least comparable results between photographic and visual inspection techniques. However, the wide variation in equipment and personnel used for the collection and interpretation of photographic images made it impossible to generalise the results. It remains unclear exactly how effective store-and-forward teledentistry is for the diagnosis of common dental conditions in children.

Identification of a stable reference area for superimposing mandibular digital models.

PURPOSE: The purpose of this retrospective study was to assess the stability of buccal and lingual alveolar bone surfaces for superimposing three-dimensional (3D) digital models of dental casts. MATERIALS AND METHODS: The pre- and posttreatment dental casts and lateral cephalometric radiographs were obtained from 10 adult patients who had undergone orthodontic treatment entailing the extraction of four premolars. Five of them had bilateral mandibular tori and the other 5 patients had no torus. Dental casts were scanned with a three-dimensional (3D) surface scanning system and 3D digital models were reconstructed using 3D reverse modeling software. The pre- and posttreatment digital models were superimposed on the following reference areas by the best-fit method: Area 1, bilateral lingual surfaces of the alveolar process of the posterior teeth; Area 2, the lingual alveolar surface of the anterior and posterior teeth; Area 3, bilateral surfaces of the posterior teeth's buccal and lingual alveolar surfaces; Area 4, bilateral mandibular tori. The horizontal and vertical movements of the mandibular central incisors and first molars were measured on cephalometric radiographs and on the 3D digital models. RESULTS: In the 5 patients without a mandibular torus, the median differences between cephalograms and 3D digital models ranged from 0.8-1.9 mm and the maximum differences from 1.5-10.0 mm. The median and maximum differences between cephalograms and 3D digital models superimposed on Area 2 were greater than those superimposed on Areas 1 and 3. In the patients with mandibular tori, the median differences between cephalograms and 3D digital models were under 1.0 mm, the maximum difference being 0.7 mm. CONCLUSION: The buccal and lingual alveolar surface near the dentition seems to be inappropriate as a reference area for superimposing 3D mandibular digital models of patients without a mandibular torus. Mandibular tori in adult patients are stable structures which can be used as reference areas for the superimposition of 3D mandibular digital models.

Photo-editing in Orthodontics: How Much is Too Much?.

Digital photography and radiology are the mainstay of orthodontic records but current image editing software programs nave led to increase in instances of digital forgery and scientific misconduct. In the present study, digital image data of orthodontic study casts and photographs were altered using software such as [Microsoft Paint6 1, Picasa3.1, Adobe Photoshop3.6]. Based on ethical guidelines on digital image manipulations, cropping or intensity adjustments in moderation to entire image were considered permissible while cloning or color adjustments were deemed unethical.

A validade ética e legal das fotografias digitais na ortodontia / The ethical and legal validity of digital photographs in orthodontics

A utilização de imagens digitais constituiu-se em um dos grandes benefícios que a evolução tecnológica proporcionou à Ortodontia. A introdução da fotografia digital permitiu aos profissionais utilizar recursos que facilitam a elaboração do diagnóstico e do planejamento ortodôntico, auxiliando a comunicação entre eles e também com os pacientes, além de ser importante ferramenta para o ensino e a pesquisa. Apesar destas vantagens, a utilização de fotografias digitais é frequentemente questionada quanto ao seu valor ético e legal. Dessa forma, através de uma revisão sistemática da literatura, este trabalho buscou abordar todos estes aspectos envolvidos na utilização deste recurso. Concluiu-se que os profissionais dessa área ainda desconhecem o tema, tornando-se necessário discuti-lo a fim de criar consciência da obrigação clínica, ética e legal quando forem utilizados. Além disso, concluiu-se também que ainda são necessárias ferramentas que assegurem valor legal absoluto a esse tipo de fotografia, evitando os riscos de manipulações ilícitas.

The use of digital images constitutes one of the great benefits that technological change provides to Orthodontics. The introduction of digital photography allows professionals to use features that facilitate the development of diagnostic and orthodontic planning, aid communication between them and also with patients, in addition to being an important tool for teaching and research. Despite these advantages, the use of digital photographs is often questioned as to their legal and ethical value. Thus, through a literature review, this study aimed to show all these aspects involved in the use of digital photographs in orthodontics. It was concluded that professionals are still do not know of the issue, making it necessary to discuss it in order to create awareness of the obligation clinical, ethical and legal when used such resources. One can also conclude that tools are still needed to ensure absolute legal value to this type of photography avoiding the risks of illegal tampering.

Evaluation of the clinical photographs in the Journal of Oral and Maxillofacial Surgery: from readers' perspectives.

PURPOSE: This study was designed to evaluate clinical photographs published in the Journal of Oral and Maxillofacial Surgery (JOMS) and understand the current status of oral and maxillofacial surgery. MATERIALS AND METHODS: A total of 1,317 photographs from the JOMS Volume 69 were assessed. These photographs were scored from 1 to 10 for the following parameters: sharpness; depth of field; exposure; composition; color or grayscale; background; position; distortion; label consistency; and white balance. Then, the distributions of scores were analyzed. Each score was compared with the average score. The effects of different subjects; emergency or nonemergency situations; and intraoperative, preoperative, or postoperative conditions on the quality of photographs were analyzed by conducting a nonparametric Kruskal-Wallis test. RESULTS: The total score of each photograph showed a left-skewed distribution, varying from 3 to 10, with an average score of 6.82. Four parameters, including sharpness, depth of field, exposure, and white balance, scored less than the average score. Photographs with an intraoral subject yielded the lowest score, with a significant difference (P < .05). The score of photographs taken during a nonemergency situation was significantly higher than that during an emergency situation (6.84 vs 6.03; P < .001). Photographs of an intraoperative condition yielded a score significantly lower than those of pre- and postoperative conditions (6.53 vs 7.11 and 6.75, respectively; P < .001). Approximately 45.5% of photographs (148 of 325) displayed uncovered eyes and 57.1% of specimens (40 of 70) did not appear with a plotting scale. CONCLUSIONS: Sharpness, depth of field, exposure, and white balance should be considered to a greater extent than the other parameters when oral and maxillofacial photographs are taken, particularly for intraoral conditions, emergency situations, and intraoperative conditions. Enhanced parameters and protection of a patient's identity may significantly improve the average level of photographic quality.

Clinical photographs: the gold standard, an update.

OBJECTIVE: This survey is an update of a survey that was originally carried out in 1999 and published in 2001. Over the last 10 years the prevalence of digital photography in orthodontics has increased beyond measure and the study was to document any effects of this change. MATERIALS AND METHODS: The opinions of 69 orthodontists from many European countries, as to what would be considered good practice with regards to intra and extra-oral photography with modern digital camera equipment, were sought. A written survey was distributed to the participants and collected by hand a few minutes later, once completed. A comparison was then made between current practice and what was considered best practice at the turn of the millennium. RESULTS: The main change was the widespread move from conventional to digital photography throughout Europe. This has resulted in a reduction in the cost of photographing each and every case on multiple occasions throughout treatment. CONCLUSION: The move to digital photography offers many advantages to orthodontists. High quality photographic documentation is almost routinely taken throughout treatment with little direct cost to the clinician.

Comparison of photographic and visual assessment of occlusal caries with histology as the reference standard.

BACKGROUND: The purpose of this study was to compare diagnostic performance for the detection of caries using photographs with an established visual examination method and histological sections as the reference standard. METHODS: 50 extracted permanent teeth were assessed for the presence of occlusal caries by 9 examiners using two methods; traditional visual examination developed by BASCD and photographs produced by an intra-oral camera. For both methods, diagnoses were made at "caries into dentine" level. The teeth were histologically sectioned and the diagnostic decisions using visual and photographic assessment were compared to the histological reference standard. Inter- and intra- examiner reliability for the methods was assessed and weighted kappa values were calculated. RESULTS: The visual examination method had a median sensitivity value of 65.6% and a median specificity value of 82.4%. The photographic assessments method had a median sensitivity of 81.3% and a median specificity of 82.4%. CONCLUSIONS: The photographic assessments method had a higher sensitivity for caries detection than the visual examination. The two methods had comparable specificities and good intra- and inter- examiner reliability.

Photographs of dental casts or digital models: rating dental arch relationships in bilateral cleft lip and palate.

Yardsticks have been developed to measure dental arch relations in cleft lip and palate (CLP) patients as diagnostic proxies for the underlying skeletal relationship. Travelling with plaster casts to compare results between CLP centres is inefficient so the aim of this study was to investigate the reliability of using digital models or photographs of dental casts instead of plaster casts for rating dental arch relationships in children with complete bilateral cleft lip and palate (CBCLP). Dental casts of children with CBCLP (n=20) were included. Plaster casts, digital models and photographs of the plaster casts were available for all the children at 6, 9, and 12 years of age. All three record formats were scored using the bilateral cleft lip and palate (BCLP) yardstick by four observers in random order. No significant differences were found for the BCLP yardstick scores among the three formats. The interobserver weighted kappa scores were between 0.672 and 0.934. Comparison between the formats per observer resulted in weighted kappa scores between 0.692 and 0.885. It is concluded that digital models and photographs of dental casts can be used for rating dental arch relationships in patients with CBCLP. These formats are a reliable alternative for BCLP yardstick assessments on conventional plaster casts.

Single implants in the esthetic zone: analysis of recent peri-implant soft tissue alterations and patient satisfaction. A photographic study.

PURPOSE: The appearance of the peri-implant soft tissue is a crucial factor in the success of implant therapy. However, no effective objective method exists to observe and document this factor over the long term. The aim of this clinical trial was to determine whether oral photographs can be used for peri-implant soft tissue data collection by observing peri-implant soft tissue alterations after placement of a single-tooth implant in the esthetic zone and to determine whether the pink esthetic score (PES) reflects patient satisfaction with the peri-implant soft tissue esthetic result. MATERIALS AND METHODS: Twenty-eight consecutive patients received single implants in the esthetic zone. Clinical photographs were taken to collect data on the peri-implant soft tissue at baseline (crown placement) and again 3 months later. Two observers assigned PES values to the peri-implant soft tissue in the photographs. Changes in the PES value from baseline to the 3-month follow-up were calculated. Patient satisfaction was measured using a visual analog scale (VAS) at the 3-month follow-up appointment. The correlation between the VAS and PES scores was calculated. RESULTS: The mean PES value (± SD) was 8.68 ± 2.69 at baseline and 10.37 ± 2.13 at follow-up (P < .01). VAS values ranged from 72.5 to 100. A significant correlation was found between VAS and PES values. The linear regression of patient satisfaction and PES values was significant. CONCLUSIONS: Oral photographs can be used to collect PES data on peri-implant soft tissue. The esthetic result of peri-implant soft tissue is markedly improved 3 months after restoration of the implant with a porcelain-fused-to-metal crown. The PES value generally reflects the degree of patient satisfaction with the peri-implant soft tissue esthetic result.

Clinical performance of two fluorescence-based methods in detecting occlusal caries lesions in primary teeth.

This in vivo study aimed to evaluate the performance of 2 fluorescence-based methods in detecting occlusal caries lesions in primary teeth, compared with the performance of visual inspection and radiographic methods, and to propose a mathematic correction of the diagnostic parameters due to the imperfect reference standard method used in the study. Two examiners assessed the occlusal surfaces of 407 primary teeth (62 children) using visual inspection (ICDAS), radiographic, DIAGNOdent pen (pen type laser fluorescence; LFpen), and fluorescence camera (FC) methods. At the noncavitated threshold (NC) the reference standard method was the results of ICDAS, and at the dentine caries threshold (D3) teeth diagnosed with dentine caries by ICDAS or radiographic methods were subjected to operative treatment to confirm the presence of lesion. Reproducibility, sensitivity, specificity, accuracy, and the area under the ROC curve were calculated for the methods at both thresholds. At the NC threshold, LFpen had a slightly better performance compared to the FC and radiographic methods. However, at the D3 threshold, both fluorescence-based methods performed similarly. Visual inspection and radiographic methods presented higher specificities but lower sensitivities than fluorescence methods. After corrections, there was a significant decrease in some parameters. In conclusion, both fluorescence-based methods presented similar performance in detecting occlusal dentine caries lesions in primary teeth, but they usually gave more false-positive results than did the visual and radiographic methods. The correction proposed shows that the performance of the methods can be overestimated, and the correction should be validated and considered in further studies that use an imprecise reference standard method.