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1.
Br Dent J ; 231(8): 481-485, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34686815

RESUMO

Introduction Reversal of enamel-only proximal caries by non-invasive treatments is important in preventive dentistry. However, detecting such caries using bitewing radiography is difficult and the subtle patterns are often missed by dental practitioners.Aims To investigate whether the ability of dentists to detect enamel-only proximal caries is enhanced by the use of AssistDent artificial intelligence (AI) software.Materials and methods In the ADEPT (AssistDent Enamel-only Proximal caries assessmenT) study, 23 dentists were randomly divided into a control arm, without AI assistance, and an experimental arm, in which AI assistance provided on-screen prompts indicating potential enamel-only proximal caries. All participants analysed a set of 24 bitewings in which an expert panel had previously identified 65 enamel-only carious lesions and 241 healthy proximal surfaces.Results The control group found 44.3% of the caries, whereas the experimental group found 75.8%. The experimental group incorrectly identified caries in 14.6% of the healthy surfaces compared to 3.7% in the control group. The increase in sensitivity of 71% and decrease in specificity of 11% are statistically significant (p <0.01).Conclusions AssistDent AI software significantly improves dentists' ability to detect enamel-only proximal caries and could be considered as a tool to support preventive dentistry in general practice.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Inteligência Artificial , Cárie Dentária/diagnóstico por imagem , Esmalte Dentário/diagnóstico por imagem , Dentina , Odontólogos , Humanos , Papel Profissional , Radiografia Interproximal , Distribuição Aleatória , Software
2.
Sensors (Basel) ; 21(15)2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34372429

RESUMO

Dental caries is an extremely common problem in dentistry that affects a significant part of the population. Approximal caries are especially difficult to identify because their position makes clinical analysis difficult. Radiographic evaluation-more specifically, bitewing images-are mostly used in such cases. However, incorrect interpretations may interfere with the diagnostic process. To aid dentists in caries evaluation, computational methods and tools can be used. In this work, we propose a new method that combines image processing techniques and convolutional neural networks to identify approximal dental caries in bitewing radiographic images and classify them according to lesion severity. For this study, we acquired 112 bitewing radiographs. From these exams, we extracted individual tooth images from each exam, applied a data augmentation process, and used the resulting images to train CNN classification models. The tooth images were previously labeled by experts to denote the defined classes. We evaluated classification models based on the Inception and ResNet architectures using three different learning rates: 0.1, 0.01, and 0.001. The training process included 2000 iterations, and the best results were achieved by the Inception model with a 0.001 learning rate, whose accuracy on the test set was 73.3%. The results can be considered promising and suggest that the proposed method could be used to assist dentists in the evaluation of bitewing images, and the definition of lesion severity and appropriate treatments.


Assuntos
Cárie Dentária , Dente , Cárie Dentária/diagnóstico por imagem , Suscetibilidade à Cárie Dentária , Humanos , Redes Neurais de Computação , Radiografia Interproximal
3.
Sci Rep ; 11(1): 16807, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413414

RESUMO

The early detection of initial dental caries enables preventive treatment, and bitewing radiography is a good diagnostic tool for posterior initial caries. In medical imaging, the utilization of deep learning with convolutional neural networks (CNNs) to process various types of images has been actively researched, with promising performance. In this study, we developed a CNN model using a U-shaped deep CNN (U-Net) for caries detection on bitewing radiographs and investigated whether this model can improve clinicians' performance. The research complied with relevant ethical regulations. In total, 304 bitewing radiographs were used to train the CNN model and 50 radiographs for performance evaluation. The diagnostic performance of the CNN model on the total test dataset was as follows: precision, 63.29%; recall, 65.02%; and F1-score, 64.14%, showing quite accurate performance. When three dentists detected caries using the results of the CNN model as reference data, the overall diagnostic performance of all three clinicians significantly improved, as shown by an increased sensitivity ratio (D1, 85.34%; D1', 92.15%; D2, 85.86%; D2', 93.72%; D3, 69.11%; D3', 79.06%; p < 0.05). These increases were especially significant (p < 0.05) in the initial and moderate caries subgroups. The deep learning model may help clinicians to diagnose dental caries more accurately.


Assuntos
Aprendizado Profundo , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/diagnóstico , Radiografia Interproximal , Humanos , Redes Neurais de Computação
4.
Gen Dent ; 69(4): 28-34, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34185665

RESUMO

The objective of this study was to compare the accuracy of smartphone and tablet displays for the detection of incipient caries on bitewing radiographs. Forty-six digital bitewing radiographs with a total of 1656 unrestored, readable surfaces were evaluated. The included surfaces extended from the distal surface of each canine to the last posterior contact in each arch. The evaluation excluded nonreadable proximal surfaces. The gold standard for the presence or absence of incipient caries was the consensus of 2 expert oral and maxillofacial radiologists with 15 and 30 years of experience. The radiographs were then independently reevaluated by 2 other professionals with a master's degree in dentistry with an emphasis on oral radiology with more than 5 years of experience (observers 1 and 2). Observers 1 and 2 performed the reevaluations using a notebook computer (Pavilion dm1) with a calibrated LCD monitor as well as 2 smartphones (iPhone 6s and Galaxy Gran2 Duos) and 2 tablet computers (iPad and Galaxy Tab). The presence or absence of incipient dental caries was classified according to the following scale: 1, definitely present; 2, probably present; 3, uncertain; 4, probably absent; and 5, definitely absent. Receiver operating characteristic (ROC) curves were used to determine the accuracy of the diagnoses established by operators 1 and 2. The areas under the ROC curves (Az) were compared with the binomial exact test at a significance level of 5%. The mean Az values for the Pavilion dm1 (0.948), iPhone 6s (0.944), Galaxy Gran2 Duos (0.916), iPad (0.949), and Galaxy Tab (0.950) did not present statistically significant differences (P > 0.05). The results suggest that all of the displays used in this study have statistically similar accuracy and can be used to detect incipient caries on bitewing radiographs.


Assuntos
Cárie Dentária , Cárie Dentária/diagnóstico por imagem , Suscetibilidade à Cárie Dentária , Humanos , Variações Dependentes do Observador , Curva ROC , Radiografia Interproximal , Smartphone
5.
J Clin Pediatr Dent ; 45(3): 152-157, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34192750

RESUMO

OBJECTIVES: To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6-14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. STUDY DESIGN: Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. RESULTS: All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). CONCLUSION: Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Criança , Cárie Dentária/diagnóstico por imagem , Fluorescência , Humanos , Lasers , Dente Molar/diagnóstico por imagem , Radiografia , Radiografia Interproximal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tecnologia , Raios X
6.
Clin Oral Investig ; 25(8): 4801-4815, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34128130

RESUMO

AIM: This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions. MATERIALS AND METHODS: A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed. RESULTS: SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo. CONCLUSION: The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds. CLINICAL RELEVANCE: VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Cárie Dentária/diagnóstico por imagem , Fluorescência , Humanos , Radiografia Interproximal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Transiluminação
7.
Caries Res ; 55(4): 247-259, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34130279

RESUMO

The aim was to appraise the evidence on the performance of various means for the detection of incipient caries in vivo. Five databases of published and unpublished research were searched for studies from January 2000 to October 2019. Search terms included "early caries" and "caries detection." Inclusion criteria involved diagnostic test accuracy studies for early caries detection in permanent and primary teeth. A risk-of-bias assessment was performed using the QUADAS-2 tool. We performed the study selection, data extraction, and risk-of-bias assessment in duplicate. The review protocol was a priori registered in the Open Science Framework. Of the initially 22,964 search results, 51 articles were included. For permanent teeth, when histologic examination was considered as the reference for occlusal surfaces, the sensitivity (Se) range appeared high for the DIAGNOdent Pen (DD Pen) at 0.81-0.89, followed by ICDAS-II at 0.62-1, DIAGNOdent (DD) at 0.48-1, and bitewing radiography (BW) at 0-0.29. The corresponding specificity (Sp) range was: DD Pen 0.71-0.8, ICDAS-II 0.5-0.84, DD 0.54-1, and BW 0.96-1. When operative intervention served as the reference for occlusal surfaces, again, the DD means valued the most promising results on Se: DD 0.7-0.96 and DD Pen 0.55-0.90, followed by ICDAS-II 0.25-0.93, and BW 0-0.83. The Sp range was: DD 0.54-1, DD Pen 0.71-1, ICDAS-II 0.44-1, and BW 0.6-1. For approximal surfaces, the Se was: BW 0.75-0.83, DD Pen 0.6, and ICDAS-II 0.54; the Sp was: BW 0.6-0.9, DD Pen 0.2, and ICDAS-II 1. For primary teeth, under the reference of histologic assessment, the Se range for occlusal surfaces was: DD 0.55-1, DD Pen 0.63-1, ICDAS-II 0.42-1, and BW 0.31-0.96; the respective Sp was: DD 0.5-1, DD Pen 0.44-1, ICDAS-II 0.61-1, and BW 0.79-0.98. For approximal surfaces, the Se range was: DD Pen 0.58-0.63, ICDAS-II 0.42-0.55, and BW 0.14-0.71. The corresponding Sp range was: DD Pen 0.85-0.87, ICDAS-II 0.73-0.93, and BW 0.79-0.98. Se and Sp values varied, due to the heterogeneity regarding the setting of individual studies. Evidently, robust conclusions cannot be drawn, and different diagnostic means should be used as adjuncts to clinical examination. In permanent teeth, visual examination may be enhanced by DD on occlusal surfaces and BW on approximal surfaces. In primary teeth, DD Pen may serve as a supplementary tool across all surfaces.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Cárie Dentária/diagnóstico , Dentição Permanente , Humanos , Radiografia Interproximal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Dente Decíduo
8.
J Clin Pediatr Dent ; 45(2): 98-103, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33951172

RESUMO

OBJECTIVES: To determine different combinations of marginal ridge shape (MRS) and contact extents in nature of the contact between primary molars and its correlation with the presence of carious lesions on radiographic examination of approximal surfaces. STUDY DESIGN: Retrospective study of 347 clinical records, including photographs and bitewing radiographs, were assessed for intact MRS and caries extent. The carious lesions were scored (0-5, Mejàre scoring system) radiographically and correlated to the intact MRS on clinical photographs, and strength of associations quantified using logistic regression analysis and chi-square tests. RESULTS: Primary molars, 848(contact extent), and 757(MRS) were analyzed. Combination of straight-convex(35.4%) MRS was more common (p<0.001). None of the approximal surfaces were caries-free for straight and straight MRS with 36.4% of both approximal surfaces exhibiting caries in enamel, and 38.2% of one approximal surface exhibiting caries in dentin. Approximately 90% of the primary molars with substantial contacts exhibited carious lesions in the enamel and 80% with light contacts exhibited carious lesions in the dentin (p<0.001). CONCLUSION: Six different combinations of intact MRS were identified. Combination of concave-convex shapes exhibited caries extending into dentin. Substantial and/or light contacts between primary molars showed higher caries experience in the approximal surfaces.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Cárie Dentária/diagnóstico por imagem , Dentina , Humanos , Dente Molar/diagnóstico por imagem , Radiografia Interproximal , Estudos Retrospectivos
9.
J Am Dent Assoc ; 152(6): 444-447, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34044975

RESUMO

BACKGROUND: The development of specialized panoramic radiograph machine software has spawned the introduction of an innovative and promising dental radiographic examination type: extraoral bite-wings. But does this unconventional type of imaging belong in the bite-wing family? Is there any relationship at all to the conventional bite-wing radiograph? OBJECTIVES: The purpose of this article is not to make a case for the diagnostic effectiveness of one system over the other; this is best left to further clinical evaluation. Instead, the authors intend to provide an outline of a few key and distinguishing elements of the intraoral bite-wing radiographic examination followed by those of the extraoral panoramic substitute and draw attention to the importance of reimagining the increasingly universal naming convention of this novel radiographic examination, the paradoxical "extraoral bite-wing radiograph", based on the fundamental principles of each of these imaging systems. PRACTICAL IMPLICATIONS: The accuracy of clinical and technical terminology in oral radiography is of paramount importance to both the profession and patients, especially when considering emerging technologies.


Assuntos
Radiografia Interproximal , Humanos , Radiografia Panorâmica
10.
Dentomaxillofac Radiol ; 50(6): 20210005, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33956491

RESUMO

OBJECTIVES: The aim of this in vitro study was to evaluate the diagnostic potential of near-infrared reflection at 780 nm (NIRR780nm) for early proximal caries detection on the occlusal, buccal and oral surfaces of molars and premolars under simulated, clinically relevant conditions. The findings were validated by micro-computed tomography (µCT). METHODS: Bitewing radiography (BWR) was used as a comparative diagnostic method. 250 sound or decayed permanent teeth were examined using NIRR780nm and BWR. The NIRR780nm findings were evaluated using yes/no decisions depending on the presence of caries lesions, as the enamel-dentin junction was not detectable in the majority of samples. All NIRR780nm, BWR and µCT findings were obtained twice by two trained examiners. NIRR780nm images were evaluated both occlusally alone and combined occlusally, lingually and buccally. All findings were presented in a cross-table. Sensitivity, specificity and area under the curve (AUC) values were calculated. Reliability assessment was performed using κ statistics. RESULTS: Underestimation of caries was observed for NIRR780nm in 26.0% of all surfaces and for BWR in 32.8% of all surfaces. Overestimation was 10.0% for NIRR780nm and 0.4% for BWR. Trilateral NIRR780nm assessment exhibited an overall accuracy of 67.2 %, an underestimation of 13.6% and an overestimation of 19.2%. Trilateral NIRR780nm exhibited 63.0% sensitivity and 69.6% specificity, while BWR exhibited 26.7% sensitivity but 100% specificity for proximal caries detection. CONCLUSION: NIRR780nm is not suitable for reliable detection of early proximal caries, even with the application of an ideal setup and optimized in vitro conditions.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Cárie Dentária/diagnóstico por imagem , Humanos , Radiografia Interproximal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Transiluminação , Microtomografia por Raio-X
11.
Pediatr Dent ; 43(1): 28-33, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33662247

RESUMO

Purpose: The purposes of this study were to determine the presence of interproximal carious lesions in the primary molars and assess the risk to adjacent and contralateral surfaces when caries is detected in one quadrant. Methods: Clinical records of high caries-risk children, including bitewing radiographs, were assessed for interproximal caries and the extent of marginal ridge breakdown. The carious lesions were scored radiographically by two calibrated examiners with excellent inter- and intraexaminer reliability. Correlations for the presence of adjacent surface caries and caries in another quadrant were determined by employing the strength of the associations, as quantified using chi-square analysis. Results: A total of 1,290 pairs of primary molars (A and B, I and J, K and L, S and T) were included. Only eight percent of interproximal surfaces were caries-free. Approximately 70 percent of the adjacent surfaces (A and B, I and J, K and L, and S and T) exhibited carious lesions in the enamel when there was enamel caries in one quadrant. Furthermore, 90 percent of the adjacent surfaces exhibited caries in the dentin if one adjacent interproximal surface exhibited dentinal caries. Conclusions: In high caries-risk children, only a small proportion of surfaces remain caries-free, and the adjacent surface caries prevalence remains high at 70 percent to 80 percent. The presence of interproximal caries in one quadrant is a good indicator of caries in the other quadrants, as is the marginal ridge breakdown which indicates the proximity to the pulp.


Assuntos
Cárie Dentária , Dente Decíduo , Criança , Cárie Dentária/diagnóstico por imagem , Esmalte Dentário/diagnóstico por imagem , Humanos , Dente Molar/diagnóstico por imagem , Radiografia Interproximal , Reprodutibilidade dos Testes
12.
BMC Oral Health ; 21(1): 97, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33663454

RESUMO

BACKGROUND: The purpose of this prospective clinical diagnostic study with validation was to compare the diagnostic accuracy of near-infrared transillumination (NIRT), laser fluorescence measurement (LF), alternating current impedance spectroscopy (ACIS) and their combinations as adjunct methods to visual examination (VE) for occlusal caries detection using a hybrid reference standard. METHODS: Ninety-six first and second non-cavitated permanent molars from 76 individuals (mean age 24.2) were investigated using (VE) (ICDAS) and bitewing radiography (BWR), as well as NIRT, LF and ACIS. The findings of BWR and NIRT were evaluated by two examiners while the other examinations were conducted by one calibrated dentist. The hybrid reference standard consisted of non-operative validation based on the results of VE and BWR and operative validation. Statistical analysis included cross-tabulations, calculation of sensitivity, specificity and area under the receiver operating characteristic curve at three diagnostic thresholds: caries in general, enamel caries and dentin caries. RESULTS: NIRT, LF and ACIS exhibited high sensitivity for caries in general [1.00 (1.00-1.00), 0.77 (0.65-0.88), 0.75 (0.63-0.87)) and for dentin caries (0.97 (0.91-1.03), 0.76 (0.76-0.90), 0.64 (0.47-0.80)]. Sensitivity values for enamel caries were weak (0.21, 0.11, 0.37). Specificity values did not fall below 0.65 (NIRT) for all categories and methods, except for NIRT at the caries detection threshold (0.27). A combination of LF and ACIS with VE improved the diagnostic performance at the overall and the enamel caries threshold. The other methods showed fair to excellent discrimination at the overall caries threshold (NIRT 0.64, LF 0.89 and ACIS 0.86) and acceptable discrimination at the dentin caries threshold (NIRT 0.82, LF 0.81 and ACIS 0.79). AUROC for enamel caries exhibited the weakest discrimination. Accuracy was 65.6% for VE, 69.8% for BWR, 50.0% for NIRT, 53.1% for LF and 74.0% for ACIS. Reliability assessment for BWR and NIRT showed at least substantial agreements for all analyses. CONCLUSIONS: The methods, NIRT, LF and ACIS, revealed different potential but no impeccable performance for occlusal caries detection. All are suitable instruments to detect hidden carious lesion in dentin. As auxiliaries to VE, LF and ACIS showed an increase in diagnostic performance.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Adulto , Cárie Dentária/diagnóstico por imagem , Dentina , Fluorescência , Humanos , Estudos Prospectivos , Radiografia Interproximal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
13.
Clin Oral Investig ; 25(8): 4817-4824, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33751220

RESUMO

OBJECTIVES: Diagnosing cavitated proximal lesions is important for therapeutic decisions. This clinical study aimed to determine the validity of laser fluorescence (LF) and near-infrared reflection (NIRR) techniques for detecting early proximal cavities. MATERIALS AND METHODS: The study included 43 proximal surfaces in 15 females who had limited radiolucent lesions in their bitewing radiographs. The approximal areas of interest were assessed by DIAGNOdent Pen (LF) and the Proxi interchangeable head of VistaCam iX intraoral camera (NIRR). Finally, orthodontic separators were placed in the contact points to provide enough space between the teeth. The sensitivity, specificity, and accuracy of diagnosing cavitated proximal surfaces were calculated for LF and NIRR against direct visual and tactile examination as the reference standard. RESULTS: On the basis of the reference standard, 34 surfaces (79.1%) were not cavitated, whereas 9 surfaces (20.9%) were cavitated and in need of restoration. The sensitivity, specificity, and accuracy of LF were 44.4%, 61.8%, and 58%, and those of NIRR were 88.9%, 14.7%, and 30%, respectively. CONCLUSIONS: The VistaCam iX Proxi was more sensitive and DIAGNOdent Pen was more specific in detection of proximal cavities. However, none of the techniques was accurate enough to be recommended as a sole approach for proximal caries detection. CLINICAL RELEVANCE: LF showed an overall superior diagnostic performance to NIRR for diagnosing proximal cavitation in permanent posterior teeth. Within the limitations of this study, neither VistaCam iX Proxi nor DIAGNOdent Pen could be considered a suitable device for diagnosing proximal cavities.


Assuntos
Cárie Dentária , Cárie Dentária/diagnóstico por imagem , Feminino , Fluorescência , Humanos , Lasers , Radiografia Interproximal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
14.
J. oral res. (Impresa) ; 10(1): 1-8, feb. 24, 2021. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1282719

RESUMO

Purpose: This study was designed to evaluate the diagnostic value of digital Bitewing (BW) radiographs with and without horizontal tube shift in detecting Residual excess cement (REC) on the proximal and non-proximal surfaces of implant restorations. Material and Methods: Eight mandibular models were fabricated with two implants placed on each side in the premolar and first molar positions. Excess cement was applied to either proximal or non-proximal surfaces of the restorations intentionally during the process of crown cementation. BW radiographs with and without applying horizontal tube shift were acquired. Three maxillofacial radiologists were asked to determine the presence and location of REC in the radiographs. Sensitivity and specificity of the radiographic technique were assessed according to the restoration surface that contained REC. Results: Sensitivity of BW radiographs was 100% for the detection of REC on the proximal surfaces and 41-18, 80% on the non-proximal surfaces. Specificity of the technique was 85.71%-100% for the proximal surfaces and 75-94. 12% for the non-proximal areas. Specificity of the radiographic method was generally greater than its sensitivity for the non-proximal surfaces while in the proximal areas, the two variables had quite similar values. Conclusion: Digital BW radiography is generally more useful for detection of REC on the proximal surfaces. Higher specificity of this technique for the bucco-lingual surfaces suggests more reliability of the negative diagnoses in the non-proximal areas.


Objetivo: Evaluar el valor diagnóstico de las radiografías digitales bitewing (BW), con y sin desplazamiento horizontal del tubo, para detectar el exceso de cemento residual (ECR) en las superficies proximales y no proximales de las restauraciones con implantes. Material y Métodos: Se fabricaron ocho modelos mandibulares con dos implantes colocados a cada lado en las posiciones premolar y primer molar. El exceso de cemento se aplicó intencionalmente en las superficies proximales o no proximales de las restauraciones durante el proceso de cementación de la corona. Se adquirieron radiografías BW con y sin aplicación de desplazamiento horizontal del tubo. Se pidió a tres radiólogos maxilofaciales que determinaran la presencia y ubicación de ECR en las radiografías. La sensibilidad y la especificidad de la técnica radiográfica se evaluaron según la superficie de restauración que contenía ECR. Resultados: La sensibilidad de las radiografías de BW fue del 100% para la detección de ECR en las superficies proximales y del 41,18-80% en las superficies no proximales. La especificidad de la técnica fue 85-71, 100% para las superficies proximales y 75-94, 12% para las áreas no proximales. La especificidad del método radiográfico fue generalmente mayor que su sensibilidad para las superficies no proximales, mientras que en las áreas proximales, las dos variables tuvieron valores bastante similares. Conclusión: La radiografía digital BW es generalmente más útil para la detección de ECR en las superficies proximales. La mayor especificidad de esta técnica para las superficies buco-linguales sugiere una mayor confiabilidad de los diagnósticos negativos en las áreas no proximales.


Assuntos
Humanos , Intensificação de Imagem Radiográfica/métodos , Radiografia Interproximal/métodos , Cimentos Dentários , Técnicas In Vitro , Implantes Dentários , Coroas
15.
Dentomaxillofac Radiol ; 50(5): 20200471, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417507

RESUMO

OBJECTIVES: The present clinical trial was intended to clarify whether subjective assessments of diagnostic X-ray image quality achieved via hand-held (HH) Nomad Pro 2 (KaVo Kerr, Brea, CA, USA) X-ray device is non-inferior that of the wall-mounted (WM) KaVo Focus (KaVo Dental, Bieberich, Germany). METHODS: A prospective, cross-over, and in vivo non-inferiority clinical trial was conducted to compare these two diagnostic modalities. Based on sampling calculations, 205 patients were selected for study, generating 410 paired bitewing radiographs in randomized sequence. The films were assessed independently, engaging three observers blinded to modality for random, side-by-side-comparisons. Diagnostic image quality was rated as follows: no preference, HH preference, or WM preference. Observer judgements were combined accordingly to reach a majority. RESULTS: Collective observer ratings indicated no preference for diagnostic image quality in 63.9% of cases, with WM preference at 16.6% and HH preference at 19.5%. The difference in HH and WM preferences (19.5%-16.6% = 2.9%) was within the expected 95% confidence interval. Majority agreement was reached in 82.7%. CONCLUSIONS: Subjectively assessed diagnostic image quality in bitewing radiographs acquired by HH and WM devices did not differ significantly. The hand-held device is thus non-inferior to the WM in this regard. Our data set of paired bitewing radiographs may subsequently aid in future research.


Assuntos
Cárie Dentária , Intensificação de Imagem Radiográfica , Cárie Dentária/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Estudos Prospectivos , Radiografia , Radiografia Interproximal , Raios X
16.
Dentomaxillofac Radiol ; 50(2): 20200153, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32795199

RESUMO

OBJECTIVES: The aim of this study is to assess the accuracy of bitewing radiograph interpretation of predoctoral students, residents and general dentists who work under different core curriculum of dental education and healthcare policy. METHODS: A total of 118 examiners including predoctoral dental students, residents and general dentists from USA and Japan were tasked with evaluating a series of bitewing radiographs and diagnosing interproximal carious lesions. This study was approved by the Harvard Medical School Institutional Review Board (IRB). Participants graded interproximal aspects of those images and categorized the following criteria; "intact", "enamel caries <1/2 width", "enamel caries >1/2 width" or "caries into dentin". The gold-standard was determined by the consensus of two HSDM full-time faculty. RESULTS: There was significant difference in the sensitivity for all three caries levels between the two groups but there was no significant difference on specificity. The positive-predictive and negative-predictive values of the USA group for the enamel caries (<1/2 of enamel) were significantly higher than the Japanese group. The average of AUC (ROC) was significantly higher in the USA group (0.885 ± 0.04) than the Japanese group (0.785 ± 0.08, p<0.01). CONCLUSION: Teaching and adopting BW radiographs for diagnosis of interproximal caries is integral for dental providers to accurately and efficiently use them in their practices. It is critical that all dental educators approach policymakers to explain the importance of BW radiographs and promote their efficacy for prevention and early diagnosis of interproximal caries.


Assuntos
Cárie Dentária , Leitura , Cárie Dentária/diagnóstico por imagem , Dentina , Política de Saúde , Humanos , Japão , Radiografia Interproximal , Sensibilidade e Especificidade
17.
Dentomaxillofac Radiol ; 50(4): 20200449, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33353388

RESUMO

OBJECTIVE: To create and validate two new Image Receptor-Holding devices (IRHDs) to reduce proximal surfaces overlapping in bitewing radiography in comparison to a regular well-established and commercially available IRHD. METHODS: Two IRHDs for bitewing radiographs with a wedge on the biting surface were designed and 3D-printed. These IRHDs, with a large wedge (Pr-Lw) and small wedge (Pr-Sw), were compared with a regular commercially available IRHD (Rinn XCP®) during image acquisition of bitewing radiographs of four posterior regions (one upper region and three lower regions) in two dry skulls and mandibles. A total of 156 interproximal regions on bitewing radiographs were radiographed by 13 oral radiology graduate students and independently assessed by two oral radiologists (10 years of experience). IRHDs were compared by Cochran's Q test regarding the number of overlapped proximal surfaces in the acquired radiographs with a significance level of 5%. RESULTS: The observers were in perfect agreement (κ = 1.0) to classify the proximal surfaces overlapping. The Pr-Lw IRHD presented the lowest number of surfaces overlapping (19.2%) followed by the Pr-Sw IRHD (48.1%) and the XCP®IRHD with the highest surfaces overlapping (71.2%). The Pr-Lw IRHD surfaces overlapping was statistically different from the XCP IRHD (p < 0.001), and the Pr-Sw IRHD (p = 0.014). CONCLUSIONS: The Pr-Lw IRHD demonstrated the most efficient performance in overlapping surfaces reduction, compared with the Pr-Sw IRHD and the XCP® IRHD in adult dry skulls and mandibles.


Assuntos
Cárie Dentária , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Humanos , Mandíbula/diagnóstico por imagem , Radiografia Interproximal
19.
Folia Med (Plovdiv) ; 62(2): 358-364, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32666744

RESUMO

INTRODUCTION: Initial proximal caries is both diagnostic and therapeutic challenge. The disadvantages of the conventional methods for caries detection and the development of technologies led to the creation of contemporary optical devices for early caries detection. AIM: In vitro comparison of the diagnostic accuracy of several methods for early proximal caries detection - visual-tactile, bitewing radiography and laser fluorescence device (DIAGNOdent pen). MATERIALS AND METHODS: Fifty-eight proximal surfaces of extracted human permanent premolars and molars were examined by two examiners using visual inspection, bitewing radiography, DIAGNOdent with proximal contact, and DIAGNOdent directly in the lesion. Results were compared with the histological gold standard. Statistical analysis with ROC curve, sensitivity, specificity and diagnostic accuracy of each detection method was performed. Analysis was conducted in 3 diagnostic thresholds - initial, developed and advanced demineralization. RESULTS: Sensitivity of visual inspection was 16%-33%, specificity 93.3%-100%, sensitivity of bitewing radiography 54%-67%, speci-ficity 93%-94%, sensitivity of DIAGNOdent with proximal surfaces in contact 88%-91%, specificity 79%-89%, sensitivity of DIAG-NOdent directly 89%-92.5%, specificity 81.29%-93%. The highest diagnostic accuracy, increasing with the rise of the level of demin-eralization, was shown by DIAGNOdent directly, followed by DIAGNOdent with proximal contact, bitewing radiography, and visual inspection with the lowest accuracy. CONCLUSION: The use of contemporary diagnostic devices significantly increases the possibility for early detection of proximal lesions. DIAGNOdent can be used as an adjunct to and increasing the diagnostic accuracy of the conventional caries detection methods.


Assuntos
Cárie Dentária/diagnóstico , Imagem Óptica , Exame Físico , Radiografia Interproximal , Cárie Dentária/diagnóstico por imagem , Humanos , Técnicas In Vitro , Imagem Óptica/instrumentação , Sensibilidade e Especificidade
20.
Artigo em Inglês | MEDLINE | ID: mdl-32665203

RESUMO

OBJECTIVES: This study assessed effective doses (E) from conventional and stationary intraoral tomosynthesis (s-IOT) radiography for posterior bitewing (PBW) examinations and evaluated the effect of sensor attenuation. STUDY DESIGN: An adult human tissue-equivalent phantom and optically stimulated luminescent dosimeters were used. Series of 4 PBW radiographs were acquired with circular and rectangular collimation. s-IOT PBW radiographs were acquired with built-in rectangular collimation. Radiographs were acquired without and with a sensor in the beam path. RESULTS: E (in µSv) was 15.7 and 8.2 for conventional-circular, 4.6 and 1.1 for conventional-rectangular, and 11.9 and 5.9 for s-IOT in sensor-absent and sensor-present scenarios, respectively. For sensor-absent exposures, E for conventional-rectangular was 29.3% and E for s-IOT was 75.8% of the conventional-circular dose. With the sensor present, these values were 13.4% and 72.0%, respectively (P < .001). Sensor-present E was lower than sensor-absent E for all modalities (P < .001). Reductions in equivalent doses were similar to effective dose reductions. CONCLUSIONS: For PBW examinations, E for s-IOT was smaller than for conventional radiography with circular collimation, but larger than for conventional radiography with rectangular collimation. The presence of a sensor maintained these differences but reduced E for all modalities.


Assuntos
Radiografia Dentária , Radiometria , Adulto , Humanos , Imagens de Fantasmas , Doses de Radiação , Radiografia , Radiografia Interproximal
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