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Objective: The aim of this study was to evaluate the influence of the extensive use of a photostimulable phosphor (PSP) receptor on the diagnosis of proximal carious lesions., Study Design: Forty posterior teeth were paired and mounted in 20 phantoms. Using a PSP receptor of the Express intraoral system, 1 radiograph of each phantom was acquired, totaling 20 radiographs (group 1). After 400 acquisitions, another radiograph of each phantom was obtained, totaling 20 new radiographs (group 2). This procedure was also done after 800 (group 3), 1,200 (group 4), and 1,600 (group 5) acquisitions, resulting in 100 radiographs. Another 40 radiographs (20 phantoms × 2 groups) were obtained with a second PSP sensor to evaluate the diagnostic replicability of the receptors. All 140 radiographs were assessed independently by 5 examiners for the presence of proximal caries. Area under the receiver operating characteristic curve, sensitivity, and specificity were calculated and compared among the groups by analysis of variance. The Student t test evaluated the diagnostic replicability of the receptors. The significance level was set at 5% (P < .05)., Results: The diagnostic outcomes for proximal caries did not differ among the groups (P ≥ .37). The diagnostic values did not differ among the radiographs acquired with the 2 PSP receptors (P ≥ .75)., Conclusions: The diagnosis of proximal carious lesions was not affected by extensive use of the PSP receptor., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: This in vitro study aimed to evaluate the influence of the radiographic image file format and the transmission application (app) on the diagnosis of proximal caries lesions., Study Design: Twenty bitewing radiographs of 40 posterior human teeth placed in phantoms were acquired using the Digora Toto digital sensor. All images were exported as TIFF (Tagged Image File Format), BMP (Windows Bitmap), PNG (Portable Network Graphics), and JPEG (Joint Photographic Experts Group) and transmitted online via WhatsApp and Messenger. Five examiners evaluated the radiographs with no online transmission and as transmitted through the 2 apps for the presence of proximal caries lesions using a 5-point scale. The reference standard for caries lesions was established using micro-computed tomography. Two-way analysis of variance compared values of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (α = .05). The kappa test was used to assess intra- and interexaminer agreement., Results: Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve values showed no significant differences in the diagnosis of proximal caries lesions between the different image file formats (P ≥ .773) and transmission apps (P ≥ .608). Intraexaminer agreement was substantial (κ = 0.742) and interexaminer agreement was moderate (κ = 0.475)., Conclusion: The digital file format and transmission app did not influence the radiographic diagnosis of proximal caries lesions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

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.

Objectives: To access the influence of the addition of a lead foil to intraoral digital radiographic receptors on image contrast and approximal caries lesions diagnosis., Methods: 40 posterior teeth were distributed in silicone phantoms composed of two premolars, two molars and a non-test canine. Radiographic images of the phantoms were obtained with and without the incorporation of a lead foil, using the Digora Optime and Digora Toto systems. Four observers scored the images for the presence of caries lesions, using a 5-point scale. Images of an aluminum step wedge were acquired with and without the incorporation of a lead foil. Gray values and standard deviation of gray values were calculated in different thickness of the step wedge and, then, contrast variation was calculated., Results: Presence of a lead foil did not influence caries lesions diagnostic values, regardless of the type of digital system ( p > 0.05). In general, the objective analysis was not influenced by the presence of a lead foil in any of the tested systems ( p > 0.05). However, Digora Toto images showed greater gray values, lower standard deviation of gray values and lower contrast variation, regardless of the presence of the lead foil ( p < 0.05)., Conclusions: The addition of a lead foil to intraoral digital receptors did not influence image contrast nor caries lesions diagnosis.

Objectives: The aim of this study was to assess the influence of different viewing conditions (combinations of computer display, horizontal viewing angle, and ambient lighting) on the detection of approximal caries lesions on digital radiographic images., Study Design: Forty posterior teeth were mounted in a plaster block and radiographed by using a CMOS sensor-based system. Three oral radiologists assessed the radiographic images under different conditions of computer display (iMac 5K 27", Barco MDRC-2124, and Dell P2314H), horizontal viewing angles (90 degrees, 67.5 degrees, and 45 degrees), and ambient lighting (low, medium, and high) and were asked to detect the presence of approximal caries lesions, which were confirmed by means of micro-computed tomography (micro-CT), using a 5-point scale. The area under the receiver operating characteristic curve, sensitivity, and specificity were calculated and compared by analysis of variance testing (α = 0.05). Intra- and interobserver agreements were assessed with the Kappa test., Results: Computer display, horizontal viewing angle, and ambient lighting did not significantly influence the diagnosis of approximal caries lesions. In general, moderate values of accuracy, low sensitivity, and high specificity were found for all viewing conditions., Conclusions: The viewing conditions assessed in this study did not influence the detection of approximal caries lesions on digital radiographic images. Dental practitioners are encouraged to find their most comfortable viewing condition for this diagnostic task., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This study aims to assess the influence of high-density material on the radiographic diagnosis of proximal caries in digital systems with automatic exposure compensation, and to evaluate the effect of subjective adjustment of brightness and contrast to undertake this diagnostic task. Twenty bitewing radiographs of forty posterior human teeth with non-cavitated carious lesions, confirmed by micro-CT, were obtained with two digital systems. A porcelain-fused-to-metal crown attached to a titanium implant was inserted into the exposed area, and all the radiographs were repeated. Five radiologists assessed the radiographs and diagnosed proximal carious lesions. Afterwards, the observers were asked to adjust image brightness and contrast, based on their subjective perception, and to reassess the images. Thirty percent of each experimental group was reassessed to test intraobserver reproducibility, totaling 208 images per observer. Intraobserver and interobserver agreements ranged from fair to substantial. Sensitivity, specificity, predictive values, and area under the ROC curve were calculated and compared for each radiographic system, using ANOVA (α = 0.05). Overall, presence of high-density material and adjustment of brightness and contrast did not significantly influence the radiographic diagnosis of proximal caries (p ≥ 0.05). Regarding Digora Optime, adjustment of brightness and contrast significantly increased (p < 0.05) the diagnostic accuracy of proximal carious lesions in the presence of high-density material. In conclusion, the presence of high-density material in the X-rayed region does not influence radiographic diagnosis of proximal caries. However, when it is present in the X-rayed area, subjective adjustment of brightness and contrast is recommended for use with the Digora Optime digital system.

Objectives: To evaluate the performance of periapical radiography assessed under different radiographic brightness and contrast variations in the detection of simulated internal (IRR) and external (ERR) root resorption lesions. Additionally, observers' preferences related to image quality for these diagnostic tasks were evaluated., Methods: Thirty single-root teeth were divided into two groups (n = 15): IRR, in which lesions were simulated using mechanical and biochemical processes; and ERR, in which cavities standardized with drills of different sizes were performed on the root surfaces. Digital radiographs were obtained and subsequently adjusted in 4 additional combinations, resulting in 5 brightness/contrast variations (V1-V5). Five radiologists evaluated the radiographs. The observers' preference on the image quality was also recorded., Results: For both conditions, there were no differences in the accuracy and specificity between the five brightness/contrast variations (p > 0.05), but the sensitivity for ERR was significantly lower in V4 (+ 15% brightness/-15% contrast) in the large size (p < 0.05). The observers classified V2 (- 15% brightness/+15% contrast) as the "best" image quality for IRR and ERR evaluation., Conclusions: For IRR and ERR lesions, brightness and contrast variation does not affect the diagnostic performance of digital intraoral radiography within the tested range. The observers prefer images with a reasonable decrease in brightness and increase in contrast., Clinical Relevance: Brightness and contrast enhancement tools are commonly applied in digital radiographic assessment. The use of these tools for detection of root resorptions can be applied according to the observer preference without influence on diagnostic accuracy.

Objectives: To assess the influence of brightness and contrast adjustments of digital radiographs on the diagnosis of proximal caries lesions, and to compare with observers' preferences for subjective image quality., Methods: 80 proximal surfaces of posterior teeth were radiographed using an intraoral digital system (Digora Toto, Soredex, Finland). Initial images and four different combinations of brightness and contrast for each radiography were analysed. Five observers scored the images for the presence and extension of caries lesions. Micro-CT images were used as gold standard. In a second stage, the observers were asked which of the radiographs they preferred for the assessment of caries lesions., Results: No differences were found between the original and adjusted radiographic images regarding the area under the receiver operating characteristic curve, sensitivity, and specificity (p > 0.05). There was a significant difference between the micro-CT and the intraoral radiographs (p < 0.0001). Images with high brightness and low contrast presented higher number of true negative cases, but also a decrease in caries detection. On the other hand, there were more cases of overestimation of the presence and extension of caries lesions in images with low brightness and high contrast. The subjective evaluation of image quality showed that radiographs with lower brightness and higher contrast tended to be preferred by observers., Conclusions: Brightness and contrast adjustments in digital intraoral radiographs within the range tested in this study do not significantly influence the diagnosis of proximal caries lesions, although observers tend to prefer lower brightness and higher contrast images.