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Background: The detection and diagnosis of caries at the earliest opportunity is fundamental to the preservation of tooth tissue and maintenance of oral health. Radiographs have traditionally been used to supplement the conventional visual-tactile clinical examination. Accurate, timely detection and diagnosis of early signs of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services., Objectives: To determine the diagnostic accuracy of different dental imaging methods to inform the detection and diagnosis of non-cavitated enamel only coronal dental caries., Search Methods: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles., Selection Criteria: We included diagnostic accuracy study designs that compared a dental imaging method with a reference standard (histology, excavation, enhanced visual examination), studies that evaluated the diagnostic accuracy of single index tests, and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were eligible for inclusion. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation., Data Collection and Analysis: Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. Comparative accuracy of different radiograph methods was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression., Main Results: We included 104 datasets from 77 studies reporting a total of 15,518 tooth sites or surfaces. The most frequently reported imaging methods were analogue radiographs (55 datasets from 51 studies) and digital radiographs (42 datasets from 40 studies) followed by cone beam computed tomography (CBCT) (7 datasets from 7 studies). Only 17 studies were of an in vivo study design, carried out in a clinical setting. No studies were considered to be at low risk of bias across all four domains but 16 studies were judged to have low concern for applicability across all domains. The patient selection domain had the largest number of studies judged to be at high risk of bias (43 studies); the index test, reference standard, and flow and timing domains were judged to be at high risk of bias in 30, 12, and 7 studies respectively. Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies, with sensitivities that ranged from 0 to 0.96 and specificities from 0 to 1.00. For all imaging methods the estimated summary sensitivity and specificity point was 0.47 (95% confidence interval (CI) 0.40 to 0.53) and 0.88 (95% CI 0.84 to 0.92), respectively. In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 63%, this would result in 337 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 43 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). Meta-regression indicated that measures of accuracy differed according to the imaging method (Chi 2 (4) = 32.44, P < 0.001), with the highest sensitivity observed for CBCT, and the highest specificity observed for analogue radiographs. None of the specified potential sources of heterogeneity were able to explain the variability in results. No studies included restored teeth in their sample or reported the inclusion of sealants. We rated the certainty of the evidence as low for sensitivity and specificity and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and the observed inconsistency of the results., Authors' Conclusions: The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Low-certainty evidence suggests that imaging for the detection or diagnosis of early caries may have poor sensitivity but acceptable specificity, resulting in a relatively high number of false-negative results with the potential for early disease to progress. If left untreated, the opportunity to provide professional or self-care practices to arrest or reverse early caries lesions will be missed. The specificity of lesion detection is however relatively high, and one could argue that initiation of non-invasive management (such as the use of topical fluoride), is probably of low risk. CBCT showed superior sensitivity to analogue or digital radiographs but has very limited applicability to the general dental practitioner. However, given the high-radiation dose, and potential for caries-like artefacts from existing restorations, its use cannot be justified in routine caries detection. Nonetheless, if early incidental carious lesions are detected in CBCT scans taken for other purposes, these should be reported. CBCT has the potential to be used as a reference standard in diagnostic studies of this type. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Future research should evaluate the comparative accuracy of different methods, be undertaken in a clinical setting, and focus on minimising bias arising from the use of imperfect reference standards in clinical studies., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Data from dental intraoral radiography quality controls was gathered from 1201 units (22% of the licensed X-ray units existing in Portugal), using film and digital image systems, between 2016 and 2018. The median incident air KERMA for standard superior molar tooth was evaluated in 0.9 mGy with the value of 1.3 mGy as the upper quartile. Comparisons with a 1990 published survey from dental exposures in Portugal were made. A 85% reduction for incident air KERMA per exposure was observed (6.0 mGy for the 1990 survey), which can be attributed to technical advances in the X-ray image receptors, as well as the implementation of legal requirements for technical acceptability of radiological units. It was also observed an increase of X-ray exams, which is related to an increase of dental practitioners, available radiological equipment and the level of dental healthcare., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: To determine the frequency and reasons of digital radiography and cone-beam computed tomography usage among paediatric dental practitioners, and to assess their knowledge and need for specific education.., Methods: The cross-sectional study was conducted from January to July 2017 and comprised paediatric dentists present at the European Academy of Paediatric Dentistry Interim Seminar in Turin, Italy, and members of the Turkish Society of Paediatric Dentistry who did not attend the event. Data about sociodemographics and their attitude towards, use of, and knowledge of digital radiography and cone beam computed tomography was collected by means of a 20-item questionnaire that was mailed to all the subjects. SPSS 22 was used to evaluate data., Results: Of the 435 questionnaires distributed, 245(56%) were returned, while 194 (45%) were deemed usable. The mean age of the responding paediatric dentists was 35.84±9.10 (range: 24-67 years) and 126(64.9%) were female. Users of digital radiography identified its advantages, such as lower radiation dose 166(85.7%), ease of image storage 150(77.3%), and the possibility to change image settings and to carry out measurements 106(54.5%). Overall, 70(36%) paediatric dentists had no knowledge of cone beam computed tomography. Dental trauma was cited as the reason for using cone beam computed tomography by 70(61.3%) subjects, dental development issues by 138(71%) and pathology in the jaws by 147(75.8%)., Conclusions: Digital radiography and cone beam computed tomography users are increasing in the world.

Introduction: The purpose of this study was to compare root and root canal width measurements between digital intraoral radiography (IOR) and micro-computed tomography (μCT). The accuracy of IOR measurements of canine mandibular molars was scrutinized to assess feasibility of developing a model to estimate animal age based on dentinal thickness., Materials and Methods: Thirty-nine canine mandibular first molars were imaged using μCT and IOR. For each tooth, the root and root canal width of the mesial and distal roots were measured by a single observer at 3 marked sites on μCT and IOR. Two different software programs were used to measure the radiographs. The radiograph measurements were compared to each other and to the μCT measurements. The μCT images were considered the anatomic reference standard for structural representation., Results: The data collected demonstrated IOR bias and variability throughout all measurement sites, with some sites being more affected than others. Neither IOR system produced unbiased measurements that closely reflected the μCT measurements consistently. The overall lack of agreement between measurements demonstrated the difficulties in developing a standardized protocol for measuring root and root canal width for the first molar teeth in dogs., Conclusion: Developing a protocol to accurately measure and compare μCT and IOR measurements is challenging. Designing a measurement system that would allow for universal application to age dogs would require continued research utilizing a standardized approach to overcome the limitations identified in this article.

Objective: The aim of this study was to identify the factors derived from the 405nm laser-induced autofluorescence (AF) spectra that could be used to diagnose and stage caries., Materials and Methods: Teeth (20 teeth per stage) were classified as sound, stage II, III, and IV based on a visual and tactile inspection. The specimens were re-examined and reclassified based on micro-CT analysis. From the teeth, the AF was obtained using a 405nm laser. Three spectral factors (spectral slope at 550-600nm, area under the curve at 500-590nm, and two-peak ratio between 625 and 667nm) were derived from the AF spectra. Using these factors, the diagnosis and staging of caries were tested, and the results were compared with those of DIAGNOdent., Results: After micro-CT analysis, only 13, 11, and 13 teeth were reclassified as stages II, III, and IV, respectively. The reclassified groups showed less data overlap between the stages, and the spectral slope was 40.1-74.6, 27.5-39.6, 11.1-27.4, and 1.0-9.7 for sound, stage II, III, and IV, respectively. The differentiation of stages III and IV using DIAGNOdent appeared to be difficult due to the considerable data overlap., Conclusion: Among the factors tested, the spectral slope at 550-600nm showed the best match with the caries specimens, in which their stage had been identified precisely., Clinical Significance: The 405nm laser-induced AF spectra can be applied to the diagnosis and staging of caries alone or in conjunction with conventional methods, such as visual, tactile, and X-ray inspection., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Cephalometric inclination change of the lower incisors during orthodontics is used to assess treatment outcome. The lower border of the mandible is commonly used for measuring inclination change, despite it being subject to remodelling in growing patients. Superimposition of radiographs using Björk's 'stable structures' is intended to exclude these growth changes. We tested whether there is a significant difference for three commonly used methods to assess inclination change induced by orthodontic treatment (Me-Go, Go-Gn, the tangent to the lower border of the mandible) when comparing it to Björk's 'stable structures'., Methods: Björk's superimposition does not allow measuring incisor inclination changes directly; hence, one pre- and mid-treatment cephalogram of 39 growing orthodontic patients were superimposed in this retrospective study. The radiographs were taken at least 1 year apart (120 weeks; SD = 34.4). Patients undergoing growth modification treatment were excluded. Standardized cephalograms were hand traced and changes in lower incisor inclination, using the three mandibular planes, were compared to the changes obtained by anatomical superimposition of Björk's 'stable structures'., Results: Linear regression showed good intra-class correlation (ICC) between all methods. ICC was 0.96 for Me-Go, 0.94 for Go-Gn, and 0.92 for the lower border tangent. ICC for operator reliability was 0.99., Limitations: Measurement errors affect all investigations of both analogue and digital radiographs, but movement artefacts particularly apply to the latter. Cephalometry uses two-dimensional measurements of a three-dimensional subject, which can lead to further inaccuracies. These limitations have to be taken into account when interpreting the results of our investigation., Conclusion: Data obtained from Björk's superimposition did not vary significantly from the other more commonly used techniques (Me-Go, Go-Gn, and the tangent to the lower border of the mandible). Remodelling of the lower border of the mandible was insignificant for the time period investigated., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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.

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.

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.

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.

Objective: The Radiation and Nuclear Safety Authority in Finland has paid attention to the large numbers of dental panoramic tomographs (DPTs), particularly in 7-12-year-old children. The majority of these radiographs are taken for orthodontic reasons. Because of the high radiosensitivity of children, the size of the irradiated field should be carefully chosen to yield the necessary diagnostic information at the lowest possible dose. The purpose of the present study was, therefore, to assess the outcome of DPTs within this age group in terms of type and location of pathological findings. It was also hypothesized that DPTs of orthodontic patients rarely display unrestored caries., Materials and Methods: Four hundred and forty-one DPTs, taken of 7-12-year-old children in 2010-2014, were randomly sampled. The 413 of them (94%) that had been taken for orthodontic reasons were analysed., Results: All pathologic findings were restricted to the tooth-bearing area and there was no pathology in the bone structure or any incidental findings in the region of temporomandibular joint. Unlike hypothesized, 27% of the orthodontic DPTs showed caries in deciduous teeth and 16% in permanent teeth. A sub-sample of 229 DPTs, analysed for developmental dental and occlusal problems, most commonly displayed crowding (50%), positional anomalies and local problems with tooth eruption (32%), as well as hyperodontia (15%)., Conclusion: Inclusion of only the actual area of interest in the image field should be considered case-specifically as a means to reduce the radiation dose.

Objectives: Given the limitations of panoramic radiography for assessing topographic relationship of maxillary teeth with sinus floor, the purpose of this study was to assess signs on panoramic radiography that could predict root protrusion into the sinus., Methods: A total of 46 individuals (330 maxillary posterior teeth) who underwent panoramic radiography and CBCT were enrolled. The relationship between the posterior teeth and the maxillary sinus and panoramic radiography signs (projection of the root apices, interruption of the maxillary sinus floor, lamina dura, darkening in the root apices, and superiorly curving sinus floor enveloping the associated tooth root) associated with protrusion of root apices into the sinus were evaluated., Results: There were differences between the imaging modalities about the positioning of the root apices regarding the sinus (p < 0.05). Only the projecting of the root apices and the interruption of the sinus floor on panoramic radiography were predictors for the root protrusion (p < 0.05). No significant association was observed for the other panoramic radiography signs (p > 0.05)., Conclusions: The root projection into the sinus and the interruption of the sinus floor are indicative signs of root protrusion into the sinus on CBCT.

Purpose: Technological advances in intra-oral receptors have resulted in film-holding devices that may or may not be interchangeable with photostimulable phosphor receptors. This study evaluated the number and types of technique errors that occurred when using PSP receptors with a standard film-holding device and a dual PSP/film-designed device., Methods: The Rinn XCP-ORA® (Standard) and the Rinn Flip-Ray® PA device (Test) were compared using rectangular collimation. DenOptix® imaging plates (sizes 1 and 2) were used as receptors. Fourteen periapical (10-size 2 and 4-size 1) projections were exposed per full mouth series on each Dental X-ray Teaching and Training Replica with both devices. Five Dental X-ray Teaching and Training Replicas were exposed by 3 experienced radiographers. Data were analyzed using a paired t-test to determine differences in the performance scores between the 2 devices. Technique errors (receptor placement, vertical angulation, horizontal angulation and cone centering) were reported using frequencies. An experienced evaluator critiqued each projection., Results: A total of 15 full mouth series (210 projections) were taken per device. The mean performance scores per device were 88.4 (standard device) and 88.1 (test device) and were not statistically different (p=0.88). Cone centering errors were the most common error observed in both the standard (36%) and test (43%) devices. Receptor placement errors occurred when using the standard (12%) and test (9%) devices. Vertical and horizontal errors were <2% for both devices., Conclusion: Devices designed for use with film may be used interchangeably with photostimulable phosphor receptors. Some difference was noticed between devices regarding error type and occurrence., (Copyright © 2015 The American Dental Hygienists’ Association.)

Background: The reproducibility of measurements on radiographs is influenced by the techniques by which the images as well as the measurements are obtained. Thus, bias resulting from errors in the image and/or image examinations at two points in time may result in wrongful registrations of true biological or pathological changes. The aim of the present study was to propose and evaluate an indirect radiological examination technique, by which bias, when measuring radiographic bone level, could be substantially reduced as compared to the technique using direct mm measurements., Methods: A plugin to ImageJ was designed to reduce bias when measuring bone loss on radiographic images. In human dry mandibles, radiographic images of 20 teeth were obtained parallel with the tooth axis (alpha = 0) and at an angle of 30° deviation. The direct technique of measuring radiographic bone level (RBL) and the indirect, length-adjusted RBL were registered by four researchers in a double blinded fashion., Results: When mean RBL measured at 0° angle was 7.0 mm, the corresponding mean RBL measured at 30° angle was 7.8 mm, signifying an 11.4% increase (p = 0.032), whereas the mean length-adjusted RBL increased by 0.6% (p = 0.9)., Conclusions: This study showed that the use of the original, direct technique (ImageJ) resulted in markedly biased radiographic bone level at 30° angle, while the proposed indirect length-adjusted technique (ImageJ plugin) did not.

Purpose: The purpose of this study was to evaluate and compare the clinical and laboratory performances of an electronic caries monitor (ECM-IV) and the DIAGNOdent device with that of conventional methods, including visual (VE) and radiographic examinations (RE), for the detection of occlusal caries in primary teeth., Methods: Three different observers examined 200 primary molars before extraction (in vivo), immediately after extraction (in vitro 1), and 14 days after extraction (in vitro 2). Examinations were performed visually, radiographically using the DIAGNOdent and ECM-IV devices., Results: Among all the methods, the ECM-IV yielded the highest sensitivity and Az (Area under the ROC curve) values at the enamel (D1) threshold and visual examination for dentin (D3) threshold. For reproducibility, the ECM-IV presented the highest Kappa values at the D1 threshold, and the DIAGNOdent presented the highest Kappa values at the D3 threshold. Both devices presented high intraclass correlation coefficient values, although DIAGNOdent showed higher values than ECM-IV in all stages of the study and for all observers., Conclusion: Considering the importance of early identification of caries in primary teeth, the use of the ECM and DIAGNOdent devices, together with conventional examination methods, will increase the rate of identification of occlusal caries during routine clinic visits.

Background: This study aimed to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) unit with digital intraoral radiography technique for detecting periodontal defects., Methods: The study material comprised 12 dry skulls with maxilla and mandible. Artificial defects (dehiscence, tunnel, and fenestration) were created on anterior, premolar and molar teeth separately using burs. In total 14 dehiscences, 13 fenestrations, eight tunnel and 16 without periodontal defect were used in the study. These were randomly created on dry skulls. Each teeth with and without defects were images at various vertical angles using each of the following modalities: a Planmeca Promax Cone Beam CT and a Digora photostimulable phosphor plates. Specificity and sensitivity for assessing periodontal defects by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05., Results: The kappa values for inter-observer agreement between observers ranged between 0.78 and 0.96 for the CBCT, and 0.43 and 0.72 of intraoral images. The Kappa values for detecting defects on anterior teeth was the least, following premolar and molar teeth both CBCT and intraoral imaging., Conclusions: CBCT has the highest sensitivity and diagnostic accuracy for detecting various periodontal defects among the radiographic modalities examined.

Background: Subjective radiographic classifications of alveolar bone have been proposed and correlated with implant insertion torque (IT). The present diagnostic study aims to identify quantitative bone features influencing IT and to use these findings to develop an objective radiographic classification for predicting IT., Methods: Demographics, panoramic radiographs (taken at the beginning of dental treatment), and cone-beam computed tomographic scans (taken for implant surgical planning) of 25 patients receiving 31 implants were analyzed. Bone samples retrieved from implant sites were assessed with dual x-ray absorptiometry, microcomputed tomography, and histology. Odds ratio, sensitivity, and specificity of all variables to predict high peak IT were assessed., Results: A ridge cortical thickness >0.75 mm and a normal appearance of the inferior mandibular cortex were the most sensitive variables for predicting high peak IT (87.5% and 75%, respectively). A classification based on the combination of both variables presented high sensitivity (90.9%) and specificity (100%) for predicting IT., Conclusions: Within the limitations of this study, the results suggest that it is possible to predict IT accurately based on radiographic findings of the patient. This could be useful in the treatment plan of immediate loading cases.

Objectives: Cone beam computed tomography (CBCT) was introduced to Norwegian dental clinics in 2007. The aim of the study was to investigate how dental clinics use this imaging modality, including factors related to workflow and image quality, and to evaluate dentists' opinions on and experiences of using it., Materials and Methods: A web-based 59-item questionnaire regarding the clinical use of CBCT was sent to all 39 CBCT clinics in Norway., Results: Twenty-nine clinics (74%) responded. Most respondents (93%) were from clinics with more than one dentist and 83% had at least one specialist. All clinics had digital intraoral x-ray receptors and all but one had panoramic imaging. The most common indications for CBCT were implant treatment planning (34% of all clinics) and localization of impacted teeth (43% of specialist clinics). Seventy-two per cent of clinics reported an average of four or fewer CBCT examinations each week and 83% of respondents were subjectively satisfied with the image quality. The most commonly used enhancement functions were contrast (97%), brightness (90%) and zoom (86%)., Conclusions: The Norwegian CBCT clinics surveyed were fully digitized and had multiple dentists. Periodontists and oral and maxillofacial surgeons were the most frequent specialties represented in the clinics. Clinics with only dental specialists performed more CBCT examinations/week than clinics with general practitioners or both general practitioners and specialists. The most common indications for CBCT examinations were related to treatment planning. This study found some challenges related to image quality and communication within the radiological team.

Introduction: In this study, we aimed to evaluate the adenoidal nasopharyngeal ratio (ANR) on lateral cephalograms by assessing upper airway volumes using cone-beam computed tomography (CBCT) images as the validation method., Methods: Fifty-five patients were included in the study, and it was essential that the lateral cephalograms and CBCT images taken at their examinations were not more than 1 week apart. There were 32 subjects in group A (age ≤15 years) and 23 subjects in group B (age >15 years). The ANR was measured on the lateral cephalograms. The area and volumetric measurements of the nasopharynx and the total upper airway were obtained from CBCT images. Repeated measurements of the ANR and airway volume were performed on 10 subjects by 2 observers., Results: Group A had a higher correlation (r = -0.78) between the ANR and the nasopharynx volume than did group B (r = -0.57). The ANR had a weak correlation with the total upper airway volume (group A, r = -0.48; group B, r = -0.32). Both measurements made on lateral cephalograms and CBCT were highly reproducible in terms of intraobserver and interobserver agreement., Conclusions: Based on our results, the measurement of the ANR on lateral cephalograms can be used as an initial screening method to estimate the nasopharynx volumes of younger patients (age ≤15 years)., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Although the postprocessing of digital images with enhancement filters could lead to the presence of artifacts and result in false-positive diagnoses, no study has analyzed whether the use of digital radiographs and/or postprocessing of digital images interferes with the diagnosis of marginal adaptation in metal-restored teeth., Purpose: The purpose of this study was to compare the diagnostic accuracy of conventional and digital radiographic images with and without filters for detecting a misfit between the tooth and restoration in metal-restored teeth., Material and Methods: Forty teeth with mesial-occlusal-distal inlays and 40 with complete crowns (each with a perfect fit, 20 with a 0.2-mm gap and 20 with a 0.4-mm gap) were imaged with conventional film and digital phosphor plate systems. Digital radiographs were exported as original images and with edge enhancement (high and low), inversion, and pseudo-3-dimensional filters. Four examiners assessed the presence of gaps by using a categorical scale (fit, misfit, cannot decide). Sensitivity, specificity, and overall accuracy were calculated for each variable. In addition, time spent scoring the images was recorded. A multivariate logistic regression was performed with accuracy as the dependent variable., Results: Of the images, 6.2% received the score "cannot decide," most of them with a high edge enhancement filter and in the crown group. A tendency for higher sensitivity (range 0.67-0.83), specificity (range 0.81-0.92), and accuracy (range 0.73-0.86) values was found in conventional and digital original images. Results of a logistic regression found that restoration type, gap size, and high enhancement and inversion filters had a statistically significant impact on accuracy (P<.05)., Conclusions: Original nonfiltered images should be used to assess teeth with metal restorations. High enhancement filters and image inversion should be avoided, especially when metal crowns are present., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

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.

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.

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., (Copyright © 2014. Published by Elsevier Inc.)

Introduction: The aim of the study was to compare the diagnostic ability to radiographically detect separated stainless steel (SS) versus nickel-titanium (NiTi) instruments located at the apical third of filled root canals with either AH 26 (Dentsply DeTrey GmbH, Konstanz, Germany) or Roth sealer (Roth International Ltd, Chicago, IL)., Methods: Sixty single-rooted extracted human teeth with 1 straight root canal were instrumented to a size 25 apical diameter. In 40 teeth, apical 2-mm segments of SS (n = 20) or NiTi (n = 20) files were intentionally fractured in the apical part of the root canal. The remaining 20 teeth without fractured files served as a control group. Subsequently, the root canals were filled using laterally condensed gutta-percha and either AH 26 sealer (AH) or Roth sealer (Roth). All teeth were radiographed using conventional Kodak film (Eastman Kodak Co, Rochester, NY) and a charge-coupled device digital sensor. The evaluation of the images for the presence of a fractured instrument was performed independently by 2 blinded observers. The data were statistically analyzed using McNemar and Fisher exact tests., Results: The kappa values were 0.76 and 0.615 for the first and second observers, respectively, and 0.584 between the observers. There were no significant differences in the diagnostic ability between digital and conventional radiography or the different root canal sealers (AH vs Roth, P > .05). The sensitivity to detect fractured SS was significantly higher than NiTi (P < .05)., Conclusions: It may be difficult to radiographically detect a retained separated instrument. It is easier to radiographically detect fractured SS than NiTi instruments retained at the apical third of the root canal., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purposes of this study were to examine the following in young adults residing in the United States: (1) the prevalence of teeth with root canal therapy (RCT) and teeth in need of RCT, (2) how frequently treatment practices associated with success as cited in the literature are found in posterior teeth with RCT, and (3) which treatment practices are associated with periradicular pathology., Methods: Panoramic radiographs taken of all basic trainees entering the US Air Force in 2011 were evaluated in a 2-part review. A general survey of all radiographs was performed to determine the prevalence of teeth with and teeth in need of RCT. All panoramic radiographs that showed a posterior tooth with RCT were evaluated in detail to consider the presence and quality of cuspal coverage restorations, the quality of RCT, and the presence of periradicular pathology., Results: A total of 35,811 panoramic images were evaluated. Ten percent of basic trainees had existing RCT, whereas 5% showed a need for RCT. The total number of posterior teeth with RCT was 3,455. Nearly half of these teeth had either no cuspal coverage or an unacceptable cuspal coverage restoration. Almost one third of the existing RCT was considered inadequate based on best treatment practices. Approximately 25% of teeth with RCT had periradicular pathology present. A strong correlation was found between the quality of RCT and the absence of periradicular pathology. Of RCT teeth deemed hopeless, 97.5% had no cuspal coverage restoration present., Conclusions: Factors cited in the literature as being associated with success are lacking in the dental treatment of young adults residing in the United States., (Published by Elsevier Inc.)

Objectives: A cephalometric analysis especially designed for the patient who requires maxillofacial surgery was developed to use landmarks and measurements that can be altered by common surgical procedures. Identification of landmarks in cephalometry is very important and useful for orthognathic surgery. The aim of this study was to evaluate the accuracy of linear measurement based on digital lateral cephalograms (DLC) and on lateral cephalograms obtained from cone-beam computed tomography (CBCT) scans., Materials and Methods: The linear distances between anatomic landmarks on 6 dry human skulls were measured by 2 observers using digital calipers for sella-nasion (S-N), menton-nasion (M-N), anterior nasal spine-nasion (ANS-N), anterior nasal spine-posterior nasal spine (ANS-PNS), and pogonion-gonion (Pog-Go). Then, images were obtained by using DLCs and in lateral cephalograms obtained from CBCT scans. The measurement errors were calculated for each modality, compared with each other, and analyzed via SPSS software version 18., Results: For all lines (S-N, M-N, ANS-N, Pog-Go, and ANS-PNS), CBCT-derived values did not differ from actual dry skull dimensions (gold standard) (P > 0.05). In DLC, for S-N, M-N, ANS-N, and Pog-Go lines, measurements were significantly higher than actual measurements (P ≤ 0.05), but ANS-PNS values did not differ from actual measurements (P > 0.05)., Conclusions: The results showed that the values obtained in CBCT imaging compared with calculated values of the digital lateral cephalometry much closer to the actual distance are more accurate indicators of this type of imaging and that CBCT permits oral surgeons to visualize the position and surgical anatomy of the tooth as it will be seen in the operating theater and allows orthodontists to plan directional traction.

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., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Several studies have published measurements of the height of the ramus on orthopantomographic (OPT) images of patients with unilateral fractures of the mandibular condyle as a possible quantitative measure for making decisions about treatment. However, we know of no studies that have described the accuracy and validity of such measurements. The aim of the present study was to assess the shortening of the ramus in patients with such fractures, and compare them with differences found in a control group. Seventy-four patients and 74 controls were studied. The height of the ramus on the fractured was less than that on the uninjured side, although this was not statistically significant (p=0.25). In the control group, 50 subjects (68%) had a difference in the ramal height of more than 2mm. Of 74 patients, 25 (34%) had a shorter, uninjured ramus on the opposite side. A Bland and Altman scatterplot showed 23 outliers (31%) among the patients, which exceeded the mean (SD 1.96) of the control group. The interobserver and intraobserver reliability both showed excellent agreement for all measurements made. Shortening of the ramus can be measured on OPT images. However, in a control group there was a large mean difference in height. Among the patients, 25/74 (34%) also had an uninjured ramus on the opposite side that was shorter than that on the fractured side. Measurement of the difference in height on an OPT image cannot be relied on as an absolute indication for intervention., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: The objective of the study was to determine the diagnostic accuracy of panoramic radiographs in the evaluation of pneumatization of the temporal bone, with confirmation of the diagnosis by cone-beam-computed tomography (CBCT) images., Methods: Images of 200 patients' digital panoramic radiographies and CBCT were examined by three evaluators regarding the presence or absence of pneumatization on temporomandibular joint (TMJ) fossa and/or articular eminence. When present, the defect was classified as uni- or multilocular, and as unilateral or bilateral. Areas under the ROC curve were compared to assess the accuracy of panoramic radiograph., Results: The values obtained in the comparisons ranged from Az = 0.67 to 0.55 (Az = area under the ROC curve)., Conclusions: The panoramic radiograph, is not the exam of choice for detecting the presence of these air cells based on its medium to low accuracy for diagnosis of pneumatized articular eminence and TMJ fossa when compared to CBCT., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: In the United States almost 70% of root canal treatment (RCT) is performed by general dentists (GPs), yet little is known about their treatment protocols., Methods: A paper survey was mailed to 2000 United States GPs with questions about the types of endodontic cases treated, routine treatment protocols, use of newer technologies, and endodontic continuing education (CE)., Results: Completed surveys were returned by 479 respondents (24%). GPs who perform RCT (84%) reported providing anterior (99%), bicuspid (95%), and molar (62%) RCT and retreatment (18%). Rubber dam was used always (60%), usually (16%), sometimes (13%), and never (11%). Newer technologies used by GPs included digital radiography (72%), magnification (80%), electronic apex locator (70%), and nickel-titanium rotary instrumentation (74%). Compared with GPs with >20 years of experience, those in practice for ≤10 years were more likely to use rubber dam (P < .05), nickel-titanium rotary instrumentation (P < .001), apex locators (P < .001), and magnification (P < .01); in contradistinction, GPs in practice >20 years were more likely to perform retreatments (P < .05). Women were less likely to perform retreatment or molar RCT (both P < .05). GPs with >5 hours of CE were more likely to use rotary instrumentation (P < .001), irrigant activation devices (P < .01), and apex locators (P < .001) and perform molar RCT (P < .001) and retreatment (P < .05), but no more likely to use rubber dam., Conclusions: Recent GP graduates (≤10 years) were more likely to adopt new technologies and use rubber dam than those who practiced for >20 years. More experienced GPs were more likely to take on complicated cases than those with fewer years of practice. There was no association between hours of CE and compliance with rubber dam usage., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to compare the accuracy of digital periapical (PA) radiography and 3 cone-beam computed tomographic (CBCT) scanners in the identification of various internal anatomic patterns in mandibular incisors., Methods: Forty mandibular incisors were scanned using micro-computed tomographic imaging as the gold standard to establish the internal anatomic pattern. The number of root canals and internal patterns were classified into type I (single canal, n = 12), type Ia (single oval canal, n = 12), and type III (2 canals, n = 16). The teeth were placed in a human mandible, and digital PA radiography and 3 CBCT scans (Kodak 9000 3D [Carestream Health, Rochester, NY], Veraviewepocs 3De [J Morita MFG Corp, Kyoto, Japan], NewTom 5G [QR Srl, Verona, Italy]) were performed. Two blinded examiners classified each tooth's anatomic pattern, which were then compared with the micro-computed tomographic determinations., Results: Considering type I and type Ia, which both presented with 1 root canal, there was a high degree of accuracy for all methods used (P > .05). The same result was found for type III. When identifying the shape of single canals (type I), CBCT imaging was more accurate compared with PA radiography. Concerning oval canals (type Ia), there was a significant difference between PA radiography and NewTom CBCT (PA radiography = 44%, NewTom = 88%). However, there were no significant differences between the 3 CBCT units., Conclusions: Double-exposure digital PA radiography for mandibular incisors is sufficient for the identification of the number of root canals. All CBCT devices showed improved accuracy in the identification of single root canal anatomy when a narrow canal was present. However, the identification of oval canals was improved only with the NewTom CBCT device., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this in vitro study was to compare the diagnostic accuracy of different radiographic imaging modalities in detecting occlusal caries lesions., Materials and Methods: Under standardized conditions, 125 extracted human permanent molar teeth with sound or occlusal caries lesions were radiographed using a conventional film system (F-speed), a direct digital imaging system (complementary metal oxide semiconductor sensor), an indirect digital imaging system (photostimulable phosphor plate) and a cone beam computed tomography system (CBCT). Two observers scored the resultant images for the presence or absence of caries. Then, the teeth were histologically prepared and a definite diagnosis was determined by stereomicroscopic assessment. The area under the receiver operating characteristic curve (Az), sensitivity, specificity and accuracy of each imaging modality were calculated, as well as the intra- and interexaminer reproducibility., Results: For both thresholds, interexaminer agreement were higher for CBCT. For intraexaminer agreement, observers had different scores for both thresholds, but the scores were generally higher for CBCT. Similar Az values were achieved with all imaging methods at a diagnostic D1 threshold. The Az values of the CBCT system were found to be statistically higher than those of the other imaging modalities at a diagnostic D3 threshold (p > 0.05); no significant differences were found among the other imaging modalities. All radiographic methods showed similar sensitivities, specificities and accuracy in detecting D1 threshold. The CBCT system showed higher sensitivity and accuracy in detecting dentine lesions., Conclusions: Within the limitations of this study, CBCT exhibited better performance in detecting deep occlusal caries lesions than the other radiographic systems.

Objectives: To assess the influence of metallic posts in the detection of simulated vertical root fractures (VRFs) using the following imaging examinations: 2 cone beam CT (CBCT) systems [CBCT1: NewTom(®) 3G (QR Srl, Verona, Italy) and CBCT2: i-CAT Next Generation(®) (Imaging Sciences International, Hatfield, PA)] and film and digital radiographs. Additionally, the influence of the orientation of the fracture line in the detection of VRFs was evaluated., Methods: 100, human, single-rooted endodontically treated premolars were divided into 5 groups (Group 1: with posts and buccolingual VRFs, Group 2: with posts and mesiodistal VRFs, Group 3: without posts and with buccolingual VRFs, Group 4: without posts and with mesiodistal VRFs, and Group 5: with posts and without VRFs). The premolars were placed in human mandibles and imaged using the four examination modalities. The sensitivity and the specificity of each examination in the experimental groups were calculated. The data were analysed using Student's t-test., Results: The presence of metallic posts reduced the sensitivity of the CBCT1 system (p = 0.0244). Digital radiographs and the CBCT1 and CBCT2 systems had a higher sensitivity in detecting buccolingual fractures in teeth with posts, whereas film and digital radiographs had a higher sensitivity in detecting buccolingual fractures in teeth without posts (p < 0.05). The CBCT1 examination demonstrated the lowest specificity (p < 0.05)., Conclusions: The presence of metallic posts did not influence the sensitivity of most of the examinations, excluding the CBCT1 system. The fracture line orientation may influence VRF detection.

Objectives: The present study assesses the accuracy of three-dimensional (3D) cone beam CT (CBCT) and intra-oral radiography (CR) in visualizing peri-implant bone compared with histology., Methods: 26 titanium dental implants were placed in dog jaws with chronic type vestibular defects. After a healing period of 2 and 8 weeks (n = 12 dogs) the animals were sacrificed. CBCT scans and CR of the specimen were recorded. Dissected blocks were prepared, and histomorphometric analysis was performed. Both modalities were measured twice by two observers and compared with histomorphometry regarding bone levels and thickness around implants as well as length and diameter of implants., Results: Measurements of CBCT correlated well with histomorphometry of the vestibular bone level, oral bone thickness and implant length (all p-values <0.05). Compared with histomorphometry, the mean differences between CBCT and histomorphometry were between 0.06 and 2.61 mm. Mesial bone level (MBL) and distal bone level (DBL) were underestimated by both CR and CBCT. CR and histology measurements were only significantly correlated for implant length measurements. All intraclass correlations were highly significant., Conclusions: 3D CBCT provides usable information about bone in all dimensions around implants with varying accuracy. CR and CBCT perform similar in assessing MBL and DBL, but, within its limits, the CBCT can assess oral and buccal bone. Metallic artefacts limit the visualization quality of bone around implants and further research could elucidate the value of post-processing algorithms. When information about osseous perforation of implants is needed, CBCT may still provide clinically valuable information.

Introduction: This in vitro study compared cone-beam computed tomography (CBCT) exam with different voxel sizes with digital periapical radiography in the detection of vertical root fractures in teeth with and without intracanal metallic posts., Methods: Eighteen single-rooted human teeth were endodontically treated, prepared for cast metal posts, and artificially fractured. After positioning the teeth in dry mandibular sockets, the samples were subjected twice (with and without posts) to digital periapical radiography at 3 different angles and to CBCT examinations with 2 voxel sizes, 0.125 and 0.25 mm. The images were evaluated by 3 oral radiologists. Indices of sensitivity, specificity, and positive and negative predictive values, in addition to the areas under the receiver operating characteristic curves (accuracy), were calculated. Comparison of the accuracy of the imaging methods was assessed by using the χ(2) test. Comparison of the accuracy between teeth with and without posts was determined by using the Fisher exact test., Results: The accuracy of the imaging methods showed no significant differences (P = .08). The comparison between teeth with and without posts in each examination revealed significant differences for CBCT with a voxel of 0.125 mm (P = .04) and for periapical radiography (P = .04)., Conclusions: No significant differences were observed between CBCT and periapical radiography in the detection of vertical root fractures, except for teeth with metallic posts in images from CBCT with a voxel of 0.125 mm and in digital periapical radiography. Furthermore, voxel size did not significantly influence the diagnosis of vertical root fractures., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Digital intraoral radiographic systems have been rapidly replacing conventional dental X-ray films for diagnosis of dental diseases. Current scientific literature supports the use of these digital systems for the detection of dental caries, periodontal bone loss, and periapical pathologies. However, relatively few studies have been published addressing the detection of dental root fractures. The purpose of this study was to compare the intraoral F-speed film (Insight) with two photostimulable phosphor (PSP) indirect digital systems (ScanX and Digora Optime) for the detection of simulated dental root fractures. Ten raters evaluated images acquired from 10 dry human cadaver mandibles under optimal viewing conditions. These data were analyzed by a 5-point receiver operating characteristic curve analysis for statistical differences. Sensitivity and specificity of these systems were also assessed. Since statistically significant difference between the systems was not observed, the results of this study agreeably support indirect digital PSP plates as an alternative to the evaluated conventional film for the detection of dental root fractures., (© 2013 John Wiley & Sons A/S.)

Unlabelled: Digital x-ray systems offer advantages over conventional film systems, yet many dentists have not adopted digital technology., Objectives: To assess New Zealand dental practitioners' use of--and preferences for--dental radiography systems., Design: Cross-sectional survey., Setting: General and specialist dental practice., Participants and Methods: Postal questionnaire survey of a sample of 770 dentists (520 randomly selected general dental practitioners and all 250 specialists) listed in the 2012 NZ Dental Council Register., Main Outcome Measures: Type of radiography systems used by dentists. Dentists' experiences and opinions of conventional film and digital radiography., Results: The participation rate was 55.2%. Digital radiography systems were used by 58.0% of participating dentists, most commonly among those aged 31-40 years. Users of digital radiography tended to report greater satisfaction with their radiography systems than users conventional films. Two-thirds of film users were interested in switching to digital radiography in the near future. Reasons given by conventional film users for not using digital radiography included cost, difficulty in integrating with other software systems, concern about potential technical errors, and the size and nature of the intra-oral sensors., Conclusion: Many dental practitioners have still not adopted digital radiography, yet its users are more satisfied with their radiography systems than are conventional film users. The latter may find changing to a digital system to be satisfying and rewarding.

Objectives: To measure the reliability of tooth length measurements taken using dental pantomograms (DPT), long cone periapical radiographs (PR), and cone beam computed tomography (CBCT) and to compare their effective radiation dose., Subjects and Methods: A model containing sixteen anterior teeth was used to simulate a patient undergoing fixed appliance treatment. PRs were taken at standardized vertical angulations to the occlusal plane (0, 5, 10, 15, and 20°) using conventional and digital techniques. DPT and CBCT images were also taken. Measurements of radiation dosages were used to estimate a risk benefit analysis for each of the techniques., Results: DPT consistently overestimated tooth lengths by 2 mm or more [mean: 2·34 mm; 95% confidence interval (CI): 1·4-3·3 mm]. CBCT consistently underestimated tooth length (mean: -0·89 mm; 95% CI: -0·44 to -1·33 mm). PRs taken at 90° angulation closely resembled the actual tooth length (mean: -0·14 mm; 95% CI: -0·64 to 0·37 mm), but overestimation occurred with increasing PR film angulation. The radiation dosages ranged widely: DPT plus eight PRs that would be necessary to assess all teeth and root length of the upper and lower labial segments amounted to 23 μSv. Radiation dose from CBCT ranged from 17·8 to 60 μSv, depending on equipment and settings.

Objective: The purpose of this in vivo study was to compare the ability of digital tactile, digital radiographic and electronic methods to determine reliability in locating the apical constriction., Materials and Methods: Informed consent was obtained from patients scheduled for orthodontic extraction. The teeth were anesthetized, isolated and accessed. The canals were negotiated, pulp chamber and canals were irrigated and pulp was extirpated. The working length was then evaluated for each canal by digital tactile sensation, an electronic apex locator (The Root ZX) and digital radiography. The readings were then compared with post-extraction working length measurements., Results: The percentage accuracy indicated that EAL method (Root ZX) shows maximum accuracy, i.e. 99.85% and digital tactile and digital radiographic method (DDR) showed 98.20 and 97.90% accuracy respectively., Clinical Significance: Hence, it can be concluded that the EAL method (Root ZX) produced most reliable results for determining the accurate working length.

Introduction: This cross-sectional study determined the prevalence of apical periodontitis in 1086 root canal-treated teeth from an urban Colombian population and evaluated the association of several factors with the periradicular status., Methods: Periapical radiographs were used for analyses, and teeth were classified as healthy or diseased according to the periradicular status. Other factors were also evaluated for their association with the periradicular conditions, including gender, quality of both endodontic treatment and coronal restoration, apical level of filling, and presence of post restoration., Results: Fifty-one percent of the treated teeth were classified as healthy. Only 33% of the teeth had endodontic treatment rated as adequate. The quality of both endodontic treatment and coronal restoration significantly influenced the periradicular conditions (P < .001). Combined data revealed that teeth with both adequate endodontic treatment and adequate restorations showed significantly better periradicular status than the other combinations (P < .01), except for teeth with adequate treatment and inadequate restoration (P = .08). Canals filled up to 0-2 mm short of the apex had a significantly higher number of teeth rated as healthy than overfilled or underfilled cases (P = .02). Regression analysis showed that the quality of endodontic treatment was the most significant factor influencing the periradicular status (P < .001). Gender and presence of post restoration had no association with the periradicular conditions., Conclusions: Data from this Colombian population showed a relatively high prevalence of apical periodontitis in root canal-treated teeth. This was largely due to an equally high prevalence of treatments performed under substandard technical quality. The quality of the endodontic treatment was the most determinant factor for healthy periradicular status., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this article is to demonstrate how the contrast properties of an imaging system can be ideally fitted with the use of stripe patterns and the logistic function., Study Design: Stripe patterns with defined amounts of line pairs (lp/mm) per mm (10-20 lp/mm) were recorded with the use of digital photostimulable storage phosphor. Scan data and normalized image data were analyzed with the use of ImageJ and MatLab to calculate different contrast curves., Results: For original scan data, the goodness of fit was 0.0000019 (sum of squared error [SSE]). The R-square was 0.9998. For normalized data the goodness of fit was 0.0007 (SSE) and the R-square 0.998. An amount of 50% contrast could be calculated to be found on 11.67 lp/mm in normalized images., Conclusions: This article addresses a potentially new approach to compare digital x-ray modalities using a direct assessment of a known technical target., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To evaluate and compare the accuracy of root canal lengths (RCLs) in primary teeth using different clinical methods., Methods: RCLs of 70 extracted human primary single-rooted teeth were estimated in vivo by a calibrated investigator using the electronic apex locator (EAL) method, radiovisiography (RVG), conventional radiography (X-ray), and tactile sensation method (TSM). The teeth were categorized into Group 1 (G1; teeth without physiological root resorption [PRR]); Group 2 (G2; teeth with one-fourth apical PRR); and Group 3 (G3; teeth with one-fourth to three-fourths lingual PRR). RCLs determined by various in vivo methods were compared with the ex vivo actual root canal length method (ARCL), as determined by stereo-microscope. Data obtained were compared using analysis of variance, Newman-Keuls test, and Student's test., Results: In Groups 1 and 2, the mean RCL determined by EAL was closest to that of the gold standard ARCL, followed by RVG, X-ray, and TSM. In G3, the mean RCL determined by EAL was closest to ARCL, followed by TSM, RVG, and X-ray., Conclusion: A fifth-generation electronic apex locator was found to be useful in accurately determining root canal lengths of primary teeth with or without physiological root resorption.

Aim: The aim is to radiographically quantify the bone density and relate the same with observer strategy in the bone healing., Objectives: To assess pattern of bone regeneration following grafting of defects with hydroxyapatite after apicoectomy/cystic enucleation., Materials and Methods: An observer strategy involving trained and experienced examiners used in large series of cases, evaluated radiographically over a period of 1 year with intervals. The cases were grouped into different categories depending on (1) surgical site outline merging with material margin, (2) internal portion of surgical site (i.e. bone formation characteristics) and (3) density of surgical site. The radiographs examined by blind process and the findings were tabulated. Operating surgeon (oral surgeon) has done the interpretation of data to create observer strategy of grafting cases., Observations and Results: The outline of the defect was changed, partly reduced and completely absent along with remodeling, which showed ground glass, specular or trabecular pattern of bone over a time with increasing density correlating bone regeneration within a short duration. The applied strategy and classification are recommended for follow-up studies. In this study the characteristics of the new bone formation were also delineated. This strategy is helpful for follow-up studies; implant procedures and so; to know quality and condition of bone after treatment.

Objectives: To evaluate the morphological condylar changes following orthognathic surgery by using a rapid and reliable computational method on panoramic radiographs., Methods: Digital panoramic radiographs of 45 patients who underwent bilateral sagittal split osteotomy (alone or associated with a Le Fort I osteotomy) between 2007 and 2010 were analysed. Calculation of the area, perimeter and height of 90 condyles was performed by using a specific computational method. Measurements were taken before surgery (m1), 1 day after surgery (m2) and 1 year after surgery (m3). The evolution of each index was analysed using paired t-tests between measures before and 1 day after surgery (m1 - m2) and measures before and 1 year after surgery (m1 - m3). The changes in the condylar area, perimeter and height were examined using the Bland and Altman plotting method., Results: There were no statistically significant changes in the mean condylar area, perimeter or height between m1 and m2 or between m1 and m3. The Bland and Altman plots for each index showed that a very limited number of condyles increased or decreased in area, perimeter and/or height outside the boundaries of the measurement error. Given the impossibility for a condyle to increase in size, these results are considered to represent the limits of the computational method used., Conclusions: This study demonstrated that there were no significant morphological condylar changes at the 1-year follow-up following surgery and that the range of normality in condylar changes could be influenced by the methodology used.

Unlabelled: The objective was to investigate diagnostic performance on approximal caries detection among Swedish and Chinese dental students using analogue and digital radiographs in vitro. Additionally, to compare the diagnostic accuracy of two image modalities for approximal caries detection. 46 extracted premolars and molars were mounted in blocks and exposed with two intra-oral systems, one CCD based digital radiographs and one with conventional films. 10 Swedish and 10 Chinese senior dental students diagnosed the approximal sites of the teeth exposed with the digital and analogue images. A 5 point diagnosis confidence scale was applied for caries registration for all the observers. Subsequently, the teeth were sectioned and histo-pathologically analyzed in order to obtain a gold standard. The data were analyzed in terms of receiver operating characteristic (ROC) curves for evaluation of diagnostic accuracy of the two radiographic methods and for the two groups of students for enamel and dentinal caries detection, respectively. The area under the ROC curve was significantly higher for dentinal caries detection compared with enamel caries detection for both Chinese and Swedish students and for both imaging modalities (p<0.001). The present results indicated that the students' ability for enamel caries detection on approximal surfaces was poor. Neither between the two student groups (p=0.15-0.64) nor between the two image modalities (p=0.34-0.91) a statistically significant difference in detecting approximal caries was found., Conclusions: The two different intra-oral x-ray systems were equally accurate. Chinese and Swedish students showed similar outcomes in their performance for approximal caries detection.

Objectives: Conventional panoramic radiography, a widely used radiographic examination tool in implant treatment planning, allows evaluation of the available bone height before inserting posterior mandibular implants. Image distortion and vertical magnification due to projection geometry is well described for rotational panoramic radiographs. To assess the accuracy of vertical height measurements on direct digital panoramic radiographs, implants and metal balls positioned in the posterior mandible were used as radio-opaque reference objects. The reproducibility of the measuring method was assessed by the inter- and intraobserver agreements., Methods: Direct digital panoramic radiographs, performed using a Kodak 8000C (Eastman Kodak Company, Rochester, NY), of 17 partially edentulous patients (10 females, 7 males, mean age 65 years) were selected from an X-ray database gathered during routine clinical evaluation of implant sites. Proprietary software and a mouse-driven calliper were used to measure the radiological length of 25 implants and 18 metal reference balls, positioned in mandibular posterior segments. The distortion ratio (DR) was calculated by dividing the radiological implant length by the implant's real length and the radiological ball height by the ball's real height., Results: Mean vertical DR was 0.99 for implants and 0.97 for balls, and was unrelated to mandibular sites, side, age, gender or observer. Inter- and intraobserver agreements were acceptable for both reference objects., Conclusions: Vertical measurements had acceptable accuracy and reproducibility when a software-based calibrated measurement tool was used, confirming that digital panoramic radiography can be reliably utilized to determine the pre-operative implant length in premolar and molar mandibular segments.

This study compared the diagnostic accuracy of digital radiographic images with conventional radiographs for the detection of experimentally induced root fractures. Horizontal fractures were induced by a mechanical force to the root of 15 single rooted teeth. Vertical fractures were induced in 15 single rooted teeth and 15 molars, respectively, by disk cutting. The teeth were mounted in dried mandibles and were radiographed with the parallel technique using a CCD-based Planmeca imaging system and F-speed films. Seven observers recorded their findings and then 2 pairs of them examined the same images together. Az values expressed the diagnostic accuracy of the imaging systems and the degree of agreement was estimated using the Cohen's kappa statistic. The areas under the ROC curves (Az) in single rooted teeth were 0.61 for conventional radiography and 0.64 for digital radiography. Digital imaging system did not perform significantly better than conventional one (p > 0.01). Digital radiographs (Az: 0.72) provided higher detection accuracy in molars than conventional images (Az: 0.51) (p = 0.0102). The digital images scored higher kappa values with narrower range than conventional. Observers in pairs did not perform significantly better than individually. The results were not affected by the observers but were affected by the cases (p < 0.001). Digital images were equivalent to F-speed films for the detection of root fractures in single rooted teeth. The digital system performed significantly better than the conventional in detecting root fractures in molars.

Unlabelled: The aim of this study was to investigate the prevalence and extent of periodontal disease registered as marginal bone loss and subject characteristics in the adult population in the county of Skåne in Sweden. One thousand individuals, 20-89 years old, were randomly selected and 451 subjects agreed to participate in the study. They answered a questionnaire and in conjunction with the clinical and radiological examination the subjects answered questions about their medical history. The examiners were co-ordinated regarding the diagnostic criteria through comprehensive written instructions, practice and discussions of clinical cases. One observer estimated marginal bone loss around the teeth on digital panoramic radiographs and bitewings. The individuals were classified regarding periodontal disease experience according to the following criteria: PD- = loss of supporting bone tissue < 1/3 of the root length, PD = loss of supporting bone tissue > or = 1/3 of the root length in < 30% of the teeth and PD+ = loss of supporting bone tissue > or = 1/3 the root length in > or = 30% of the teeth. Subjects with no or minor bone loss, i.e. PD- constituted 69% of the population. Twenty percent of the study population had marginal bone loss corresponding to localised periodontal disease (PD) and 11% exhibited generalised periodontal bone loss (PD+). The periodontal treatment need, defined as probing pocket depth > or = 6 mm and bleeding on probing > or = 20%, was 53% in the PD+ group. An interesting result was that there were no differences in periodontal disease experience between the genders., Conclusions: The prevalence and extent of periodontal disease in this study correlates well with recent other studies. Eleven percent of the population has experienced generalised periodontal disease, and 53% of them have a periodontal treatment need defined as 1 or more site with PPD > or = 6 mm and BoP > or = 20%.